GIDS being sued by their safeguarding lead.

[ItsAllGoingToBeFine]

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My Details

My name is Sonia Appleby. I am a qualified social worker (1981); adult psychoanalytic psychotherapist (I992); MSc. in health psychology, (research) and MBA. I have a long career safeguarding and protecting children in social care, health and as a children’s guardian in public and private proceedings.

I am currently the Named Professional for Safeguarding Children and the Safeguarding Children Lead at the Tavistock and Portman NHS Foundation Trust. I am therefore still employed by the Trust against which I am bringing my claim.

What is Safeguarding?

In all NHS trusts and organisations there are professionals such as myself, who work with other internal departments and external agencies to ensure there are 'root and branch' systems to keep patients and service users safe. This means responding to patient/service users' personal experiences, also including their environmental, familial, community/peer circumstances and sometimes any of the aforementioned domains could require the intervention of other professionals in different agencies. Safeguarding children and young people also concerns ensuring there is a sufficiently, healthy culture that does not unwittingly contribute to potential harm regarding the people who use and deliver NHS services.

Safeguarding within the Trust

My primary task is to ensure that clinicians protect their patients/service users from avoidable harm and are also able to recognize and appropriately respond to situations where under 18s are in need of safeguarding. My secondary task is challenge practices which are either harmful or could lead to harm. The Trust is commissioned by NHS England to deliver a National Gender Identity Development Service (GIDS), which provides services for children and adolescents diagnosed with gender dysphoria. The treatments available also include "puberty blockers".

I have sought to ensure the principle of ''safeguarding children and young people'' is upheld whilst service users are being assessed and treated within the GIDS service.

My Claim

I lodged a whistle-blowing claim in November 2019 at the Central London Employment Tribunal. Since then I have made 2 applications to amend my claim as new information came to light.

In my claim, I allege that because I made "protected disclosures" to my line manager regarding concerns raised by GIDS staff ( that the health or safety of patients was being, had been or was likely to be endangered), I was subjected to detriments.

I allege these detriments are:

i) the Tavistock misused it's own procedures to besmirch me and therefore jeopardize the role of safeguarding within the Trust;

ii) there was an unwritten but mandated directive from the Tavistock management that safeguarding concerns should not be brought to my attention despite being the Trust Safeguarding Children Lead;

iii) and, clinicians were discouraged from reporting safeguarding concerns to me.

I also allege various other detriments.

Further to disclosures made to Newsnight by former staff, BBC Newsnight produced a programme focusing on the allegation that the Trust did not want to report any concerns to me. www.bbc.co.uk/news/health-51806962

and you can watch it here

G to question SA now. Asks SA to confirm she came by the interview transcripts via Dr Bell?
SA: Yes.
SA confirms these are transcripts of interviews with Dr Sinha as part of GIDS review. SA confirms she also contributed to the review

YG: Was there a tiem when either AS or AH said they wld send you their transcripts?
SA - They may have done, but I'm not sure whether to the best of my knowledge i received anything at that time. The first time I received them was on 15th Dec from DB.

YG - Did DB send you any other transcripts?
SA - No.
YG - There's a third one - Dr Bristow...?
SA - i don't think DB sent me Dr B's transcript. I think he (Dr Bristow) may have given me those directly. He certainly gave me other documents

YG - you yourself are a v experienced clinician?
SA - i have been a clinician for very many years
YG - adult psychoanalytic therapist for at least 24 yrs
SA - yes. Confirms she has been a professional witness and also a children's guardian
Been employed by Tavi since 2004

YG - wld it be fair to say during that time youve developed your role and a significant amount of autonomy?
SA - agree in so far as all safeguarding leads... obv need to work to degree with autonomy - get on w daily business - but working in isolation can be quite dangerous...
So wouldn't say i worked in a wholly autonomous way

SA - "i've always endeavoured to work as closely as i possibly can to mu line manager"
YG - but you wld agree i'm sure that you have only ever been subject to fairly light touch management?
SA - regard myself as being an accountable person...

'i have to be accountable and in an ideal world i wld like to have a very close relationship with my line manager' and keep them up to date with key decision making i have to make, and that's what i've been used to. Bear in mind by time cases reach me they are v serious

SA "if there are issues in terms of sig risk" or we take part in a serious case review these are things that require me to escalate in terms of information

YG - Your responsibility is across the whole of the Trust's work?
SA - yes.
YG points to job description in the bundle

YG - asks whether duties of the role are quite proactive?
SA - yes. Role is to be proactive, visible and provide trust w safeguarding assurance

YG - it mentions providing 'support and advice to other individuals'
SA - yes. there are some problems with this job description - it was actually drafted in 2011 with a review date in 2013. difference with the previous was that previous medical director was also Named Dr...

YG continues to go through the job description to set out SA's responsibilities.

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.

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

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

@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.

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

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

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

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.

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 - 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

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

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

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