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

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

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...

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

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

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

[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?

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

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.

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 - 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

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

Wow. So part of the conflict was that she was specifically warning about GenderGP and Webberly? And even reporting them?

YG - suggests that there is no meeting between SA and PC in September 2017 (para 20 witness statement). PC can’t find reference to it
SA - we did have a meeting. A follow up meeting. And at that meeting Dr C wld confirm that GR would be the lead.

It was a much easier,cordial meeting. Not that previous one was unmanageable.

YG - according to PC there is a written service protocol. She’s unclear as to what else you were looking for to satisfy yourself as to how things operated in GIDS

SA - issue in 2017 was that I was not directed towards that model. Dr C talked very helpfully about the service attracting critics and admirers. But when I talked about the model, Dr C became tearful and helpfully Dr Senior wound the meeting up. September meeting much better

SA - it was a difficult meeting and it was a difficult meeting when I raised the subject again in 2018

YG - in October and Nov 2017 you receive info from concerned GIDS clinicians, you’ve established a s/g lead and had constructive meetings with Dr C, and yet you don’t go and talk to Dr C about that. Isn’t that blind siding her?

SA. Not it’s not at all. If I have a concern about anything to do with safeguarding I raise that with my manager. My manage assists me…

… I don’t make the decision myself to talk to anyone about v sig safeguarding matter without discussing with my line manager, which is exactly what I did.

YG - you send an email to Dr senior, who doesn’t respond in October or November. Presumably you’re in close proximity to each other?
SA - yes, same floor
YG - so you could have said let’s discuss with Dr C

SA - I did discuss this with Dr S and his advice was that he would speak to Dr Carmichael’s manager. He did not ask me to speak to Dr Carmichael

YG - it feels very process driven rather than outcome driven…
SA - I’m damned if i do and damned if I don’t. I don’t know what add S wld have said if I’d had a conversation with Dr C without talking to him. I wld do the same again - I spoke to my line manager and he said…

…he wld talk to Dr C’s line manager. When I came back from sick leave there was still not a response from Dr S so wrote again on 19th Jan and still no response.

YG - let’s go back a stage (402). In your first email to dr Senior you list a series of issues - Team members ‘coerced into not supporting s/g issues’; most concern that some team members ‘reported the tensions around political conformity within and beyond the trust’

This looks like ‘some kind of back room approach.’ You propose to have a meeting with the team without their managers being involved

SA - I don’t think it’s as conspiratorial as you’re suggesting. I’ll be absolutely clear agin: I consider it was right and proper that I speak to my line manager about matters brought to my attention. I wasn’t being underhanded. I wanted to ensure he would advise me on next steps

YG - your contemporaneous email undermines that and your approach was to undermine the management of the team

It displays a stark lack of safeguarding knowledge that she doesn’t know that if you have a safeguarding concern you talk to the person above you and if you’re the safeguarding lead you have to talk with your manager.

YG - you yourself we’re not doing anything. That wld systemically ameliorate these problems. That’s correct isn’t it?

SA - it is not correct. it was unfortunate that I was unable to meet with Garry during the autumn break, but I do know that Dr Senior was present in the team. It’s unfortunate that I could not have been as visible as I wld have liked.

YG - despite what you say, and I know you had health concerns in Nov 2017, but in June you’re holding a number of concerns from clinicians which have developed, and yet there is nothing more to be done from your end at all …

SA - if I were the only member of the s/g team I’d accept that. But I wasn’t. Dr Senior was working with the team. The only month I wasn’t away at all was October. It’s not ordinarily what I would subscribe to, but the service was not left …

…this was a service which had access to a psychiatrist who’d previously had a lot of involvement with the service. Of course I accept I wasn’t able to see GR in a timely way but what I cannot accept the proposition that is being put today that I basically did nothing

…the fact that Dr C was perturbed by the fact I spoke to my line manager before her is unfortunate. But as a safeguarding lead my duty is to speak to my own line manager first

YG - presumably you didn’t think a child was at risk? SA - no child was mentioned in my contact with 4 members of staff. They were telling me about their own experiences and how that effected their work. Some felt coerced. And that is a safeguarding concern…

…”staff whose job it is to make children safe do not feel safe themselves.”

YG - but that is an immediate safeguarding concern? If that’s genuine it doesn’t make any sense at all not to tell the director managing the service

SA - I think we’re going to have to agree to differ… I could not have gone and had that conversation with a senior manager without telling my own line manager. And his response was that he would speak to Polly’s manager

I don't know if I'm reading this right, but it seems to me that they are simultaneously saying there was no safeguarding issue, and that SA should have been doing more to sort out the safeguarding issue.

It's very odd, the implication that she didn't do enough to sort out a problem that wasn't there

As for Dr C "becoming tearful" - wtaf?

YG discussing follow up email SA sent to dr senior - “it seems the most limited response you could possibly make” - do you agree?

SA - it was ltd and it was my way of chasing Dr S. I admit i didn’t put a strong text but I wanted him to know that I wasn’t going to let go and I wanted a response. But before he responded someone else contacted me and I did go to sally hodges (Polly Carmichael’s manager)

@TurquoiseBaubles

I don't know if I'm reading this right, but it seems to me that they are simultaneously saying there was no safeguarding issue, and that SA should have been doing more to sort out the safeguarding issue.

It's very odd, the implication that she didn't do enough to sort out a problem that wasn't there

Yes that's my impression.

@TurquoiseBaubles

As for Dr C "becoming tearful" - wtaf?

That jumped out at me too. Sounds like she took the discussions about safeguarding personally

Forgot to say, thx for the updates Melrose, and everyone else who has taken a turn.

Blame shifting - it can't have been that bad or you would have done something else, if it was that bad why didn't you do more, it's all your fault.

I am also wtf about PC crying in the meeting, what the hell? Totally inappropriate response from a professional in her position, ridiculous

Discussion of another email sent by professional in the trust.

SA - I just wondered about it so I rang him and he said ‘actually, everyone’s really really anxious” and that prompted me to speak to sally Hodges who was PC’s line manager. She suggested that I should go and speak to Dr Carmichael, which is exactly what I did.

(Discussion about lots of emails)

SA disagrees with YG suggestion on who knew what, when (HB - sorry not to be clearer)

YG suggests that PC had not been informed about really serious matters
SA - not trying to be difficult but I cannot confirm that at the moment. But the critical thing is that I did go and speak with Dr C’s manager who advised me to speak to Dr C, which I did about a week later

SA confirms she spoke to Sally Hodges after speaking to another colleague - Mr Lowe - and more importantly I copied my line manager in and he did not respond. I was alert with no other choice but to raise with sally Hodges which I did.