GIDS being sued by their safeguarding lead.

SA - i think that Mr Hodge has got his timeline wrong

YG - i'm putting to you that he's put in that role in June 2017, there may have been a more formal announcement in august 2018, but do you agree he was doing the work?
SA - yes he was in post
YG - Andrew Hodge who wrote report into your grievance says GR put in post in Jan 2019?

SA - that's not a date i relate to Garry Richardson

My issue that autumn - I was on sick leave from Nov until better part of new year, and I made an appointment with Mr R in March... then May and we had a series of meetings focused on helping the gids service.

it was v unfortunate that i wasn't able to help mr R in the way i wld have wanted, and if he felt stranded i am sorry about that, but Dr Senior was there
YG - i'm not suggesting he felt stranded, but that GR was operating as a lead

SA - no. i perceived Mr R as a good colleague who was going to help elevate the s/g protocols in gids. i wasn't conflicted about his post in 2017 and for a v good part of 2018...

...as i said, i welcomed the opportunity proffered by Dr Carmichael - Garry being a s/g link and later a lead in the service.

YG suggests that SA knew Garry Richardson being made the 'lead' is why SA had no more contact with him until the following March

SA - it wasn't a question of leaving Mr R but my circs were v challenging in the autumn, but he was supported by Dr Senior and Dr Senior was able to provide a training session to Mr R.

YG - Thinking back to period end of '16 to summer '17 - what happened to those early cases that clinicians brought to you. Did you refer to other agencies?
SA - cases on the waiting list, gids staff made aware of them; it's a network response...

I provided safeguarding advice in ensuring the networks were aware of these children, advising in terms of parents being guided not to avail themselves of Dr Webberley - but the challenges are for those children on waiting list it involves liaising with part agencies.

in some of those cases, children will leave the service and we write to GO sand advise them ... but one of the problems is lack of safeguarding with these things
YG - but if they're going to a private provider it's not in your control

SA - but what we can do is appropriately alert other agencies who have more immediate contact with that child and i do believe alerting the GMC about Dr Webberley if we have info that she is providing treatments off licence

YG - You'll know that there was a joint referral by GIDS and UCLH to GMC
SA - and i commend the clinicians for that

[quote Elegaic]@Caorthann thanks for sharing that piece by Di Ceglie, fascinating to see where the service came from and how integrated Mermaids was from the beginning. Extraordinary ending as well:

“But what about outcome? What has happened to children and teenagers, some of whom have attended our service for years? What kind of life do they have? What memories do they have of their contact with our service? We know little about this, except in an anecdotal way. It is now time that we start to find out.”

Written 13 years after the service was set up! Astonishingly casual.[/quote]
Di Ceglie
"On the other hand, a resilient child or teenager can disentangle him/ her-self from these projections and recognise them as not belonging to themselves. The following clinical vignette illustrates this point.

Case Vignette: A girl whom I shall call Mary was referred to the gender identity development service at the age of nine years after teachers had noticed uncertainty about her gender identity. During the interviews it emerged that at birth her mother was convinced that she was a boy but had been transformed into a girl through a black magic spell by her mother- in- law. The mother went on to treat Mary as a boy and gave her a name that in her culture could be given to both genders. When Mary was asked if she was a boy or a girl she said she did not know, possibly not to contradict her mother. The mother brought the girl to our service in the hope that we would transform her into the boy she believed she was. Apart from this particularly intense belief, the mother was warm and affectionate towards her child and other people. Mary’s father totally colluded with his wife’s beliefs and never seemed to challenge her. We offered Mary individual therapy in order to explore her gender identity and clarify who she believed she was. It became clear that Mary saw herself as an ordinary girl and eventually said that in her opinion her mother thought that she should be a boy because in her culture males had an advantage. In fact, from our interviews with the mother it was evident that her mother’s beliefs were much more deep- rooted and not linked to the social advantages of being male. She believed that Mary had male organs inside her, which she hoped one day would emerge. The onset of her menstruation was a confrmation for Mary that she was a girl and dispelled any doubts about her gender. This case shows that in spite of her mother’s beliefs and pow-erful projections, Mary had developed an autonomous self. In a less resilient child, however, one can hypothesise that the child’s sense of autonomy could be accected to some extent.

For a more detailed description of this case, see A Stranger in My Own Body (Di Ceglie, with Freedman, 1998).
The case has been anonymised and name and places changed for condentiality.Autonomy and Social ProcessesSocial processes have an impact on individual autonomy.

www.researchgate.net/publication/331746003_Autonomy_and_Decision_Making_in_Children_and_Adolescents_with_Gender_Dysphoria

I find this account truly shocking, not just the treatment of the girl but the subsequent use of it as anecdote as late as 2019 which is post Victoria Climbie Inquiry.
How many schools have made inappropriate referrals to GIDS?

SA is sooooo good. It is really interesting to get an insight into these type of proceedings. I had no idea they could be quite so combatative. No wonder people do anything to avoid one.

I think I might up my game in the note taking department

Thanks for posting melroses and thanks to @hannahsbee for tweeting.

SA - not quite - another meeting in sept 2017 between Polly, Rob and myself, and in Oct 2017 staff came forward with concerns, but in terms of conversations most took place in safeguarding supervision forum

YG - what i'm interested to know is that there doesn't appear to be any email communication betw you and GR along lines of 'how's it going?' 'anything i can do to help you?'
SA - that was partly hindered by my own health difficulties and when I came back things had changed

and Rob Senior was involved, but i take on board that I did not make further appointments with GR as far as I'm aware.
YG - two possibilities - 1) Mr R was s/g lead for gids and therefore he wld manage any s/g issues

2. he was just a link and if you'll forgive me there was a bit of a dereliction of duty in terms of making that link effective

SA - i would not call it a dereliction as there were discussions in the s/g forum, but ideally i would have followed up with him in October

I was sighted by Garry, albeit not as frequently as i may have liked. but he was not left to his won devices as Rob Senior was very visible in the service. I accept my part, but Mr Richardson was not left in a defenceless position

LUNCH

YG suggests that at this point one wld think SA wld want to keep an eye on GIDS, but there doesn't seem to be more conversations or work on the structure of the new arrangement...

Yes - the cross examination is getting tougher but she is doing well so far.

Sonia is a good witness isn’t she?Very articulate and clear.

YG - Polly was positive about establishing a safeguarding link or lead wasn't she?
SA- Yes. as we all were. it was a resolution to a problem. but that wasn't the only thing discussed in our meeting

YG - you wanted better grip on s/g, better understanding? i suggest that it was a neutral solution to have link or lead within the srvc?

SA - yes and i thought at time in 2017 that was a reasonable solution to speak much more expansively - not saying that they weren't think about s/g - but having someone with that responsibility wld make discussions much more focused

YG refers to an email in June 2017 where Polly C writes and says she's spoken to Garry Richardson to act as a s/g link - 'safeguarding is not straightforward...'
You (SA) thanks for invitation to contact Garry etc

Polly says: "I am getting very confused and unsure of the agenda here", following email from SA to GR. YG says PC is confused as to what's being asked of GR.
YG - do you know why you didn't respond to PC?
SA - I cld have had an appointment. i wouldn't hv deliberately not replied

SA - Rob Senior replies and i think what he's trying to do is assure Polly that there isn't any agenda. Rob says "Hello Polly - I don't think there is an agenda here"; it's about what we can expect him to reasonably do.
I thought that was a helpful, reassuring email

YG - what's curious though is that you seem to become quite exercised in your witness statement in PC picking up the wrong end of the stick, as busy professionals do, and making more out of it than need be (para 17 witness statement)

SA - at time i thought little of it. but writing my statement a few weeks ago, you'll see that the word 'agenda' has taken on the form of 'name-calling'
At the time i was concerned that Polly was confused, but now 'agenda' - 4 yrs on has taken on a different form of resonance

YG - I would suggest that you're putting together 2 and 2 and making 5 or even 7 and there there is nothing sinister
SA - i would say the word has become emblematic

SA - i have to say that i am not putting to you a situation where we didn't seek to deal with those situations at the time. what i'm putting to you and noting a particular pattern - that is when we decided it was appropriate to speak to Dr Carmichael.

what i wanted to do is help service come up with a procedure that would help staff when faced with this situation.
YG - you say in witness statement that this was "and immediate and alarming safeguarding risk" - well was it or not?

Yes. It wasn't that they were being left in risky situation. it was how could we deal with this in the future.
YG - these are your words. do you want to correct your statement?
SA - no - when you have an immediate risk you manage those risks

YG - I suggest that this para implies a level of risk that is not warranted and a criticism of the gids service
SA - i don't agree with you. to say there are risks and they need addressing is not to say the service is at fault.

YG - im suggesting if this is correct, you were obliged to have gone to work with the service at a much earlier stage?

SA - It was an accumulating problem. in 2016 i was less bothered about than I was in May 2017 because there were ltd numbers and the appropriate safeguarding actions were undertaken.

...so in fact what i was doing in 2017 with my line manager was to help the service develop a strategic approach to a problem that we saw needed to be remedied.

YG - the conclusion with your discussion with Dr Senior lands in emails with Dr Carmichael in June 2017 and those are about 'embedding safeguarding' in the gids service.
SA - well that was the solution proffered - service needed its own s/g link

sorry didn't get all the tweets in - try again

YG - so these are fairly low numbers, trust-wide, and you say you're going to improve training to improve reporting. fair enough?
SA - well the focus is on patient care. You prevent avoidable harm if you're able to recognise harm

YG - despite upturn in GIDS referrals in 2015/16 it doesn't cause concern because not mentioned in this report?
SA - No. I only started really thinking about gids late 2016, early 2017 "and that was guided by staff knocking on my door saying 'I'm worried."

SA - I don't agree that i wasn't paying attention to gids. i was supporting their cases etc, but when there was an increase of people knocking on my door - I spoke to my line manager Dr Senior. Staff were highlighting a specific problem re: Dr Webberley.

"yes there was a gestational period in late 2016 ..." but both Dr Senior and myself recognised that there was a need within the Gids service which we needed to think about

YG - what were you and central safeguarding doing to support this service from end of 2016 to autumn 2017?
SA - Other than supporting staff, I was observational, ...Dr Senior had more involvement, but when more staff came to see me, i said to Dr Senior what can we do?

He determined that we should have a meeting with Dr Carmichael.
It started as drizzle, then a trickle and then a stream of staff coming to me about Dr Webberley - a private GP who were prescribing puberty blockers and CSH to children on the waiting list

YG - But this was a private provider?
SA - Yes
YG - but talking to Dr Carmichael doesn't happen for a year?
SA - i think Dr C's witness statement says this is June 2017

SA - well the focus is on patient care. You prevent avoidable harm if you're able to recognise harm

If you are unable to recognise potential harms then you cannot safeguard against it.

SA - clinicians will say it takes an awful lot of time.
YG - You make record in this report of continuing challenge - and that is trust wide isn't it?
SA - yes. It's a much safer system than a manual record but with that comes the cost of time

SA confirms that recommendations in the 2016 report re: safeguarding children are Trust-wide

SA says these data would be considered to be very low today - you can't safeguard or protect a child if you can't recognise the kind of harm they may be facing.

YG - so these are fairly low numbers, trust-wide, and you say you're going to improve training to improve reporting. fair enough?
SA - well the focus is on patient care. You prevent avoidable harm if you're able to recognise harm

YG references Care Notes; SA says this is patient electronic record. SA says it's designed for record of care and it contains referral info, 'patient diary' which deals w appointments, and the more challenging parts of patient record relate to sig info on clinical assessment

Some clinicians external to trust can also share key pieces of information in safe way eg if CAMHS worker is working with child with sig medical history that will be recorded

SA - clinicians will say it takes an awful lot of time.
YG - You make record in this report of continuing challenge - and that is trust wide isn't it?
SA - yes. It's a much safer system than a manual record but with that comes the cost of time

YG - There's a reference to 2016 CQC inspection in which no specific recommendations are made in relation to child protection issues... They weren't highlighting and specific issue or making any recommendations?
SA - that was the position i recorded in 2016

YG - you seem to me to be a v assiduous recorder... I see that you are a careful writer, you choose words with care... is that fair?
SA - I try v hard to but sometimes the pressure of work... you do your best with the resources before you

SA says she endeavours to write with care

@Caorthann thanks for sharing that piece by Di Ceglie, fascinating to see where the service came from and how integrated Mermaids was from the beginning. Extraordinary ending as well:

“But what about outcome? What has happened to children and teenagers, some of whom have attended our service for years? What kind of life do they have? What memories do they have of their contact with our service? We know little about this, except in an anecdotal way. It is now time that we start to find out.”

Written 13 years after the service was set up! Astonishingly casual.

1057 in bundle - Board of Directors 2016 - Safeguarding Children's Report. YG - as far as i can tell there isn't specific ref to the gids servce?
SA - no and v good reason for that.

SA - It wasn't just gids staff affected by the work. but by 2016 i was receiving concerns from gids staff and other staff but i wouldn't specify a particular service in a report unless there was v good reason.

what i wanted to convey was that staff were working under 'considerable pressure' - not just workloads but because of the nature of the work too - 'distressing and even traumatic.'

YG - so it wasn't just gids, it was trust-wide?
SA - Yes. Absolutely

YG - we're not at odds about your involvement, but would you agree that Dr Senior and then Dr Mckenna afterwards had a greater role?
SA - Yes
YG - Growth in gids referrals quite extraordinary - from about 97 i 2009, to excess of 2000 in 2018. surge happened in 2015/16. agree?

·
3s
SA - yes. and narratives from gids staff support that - what felt like an exponential growth in cases, and acceptance of cases too
YG - You accept that was the major increase - 2015 or so?
SA - yes and i think talking to gids colleagues there were various causal reasons

17s
YG - Reason why i'm looking at this is you ref it in your witness statement ...you mention gids has contract with NHSE

YG suggests SA has a proactive role in ensuring Trust is managing system of data collection, production - having the information that either CCG may need or any other interested party. Is that fair?
SA - Yes. Though not only person in Trust where audit systems need to take place
Hannah Barnes
@hannahsbee
·
44s
YG - Will you accept that for a large amount of time - bef at least 2o17 - it was your line manager/colleague that was more involved w GIDS on day to day basis?
Hannah Barnes
@hannahsbee
·
44s
SA - yes and there were pragmatic reasons for this. Dr Senior had a role within gids in terms of providing psychiatric consultation, advice, support etc and had much more contact with gids than i did (Rob Senior was Medical Director and Named Dr)
Hannah Barnes
@hannahsbee
·
56s
YG - So clinicians in GIDS knew Dr Senior better than they knew you?
SA - Yes. in terms of knowing, he was a colleague to many of the snr staff in GIDS and was familiar presence in way i was not.
YG - fair to say that his successor - Caroline M - had a role within gids as well?
Hannah Barnes
@hannahsbee
·
42s
SA - i was still quite involved with the gids service as far as a i could be. I gave training to Leeds, and supported staff as best as I could.