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

Does anyone remember the 'inquiry' ordered by then Minister Penny Mordaunt into the boom in the number of referrals of girls to GIDS/Tavistock? That was announced in September 2018.

As far as I'm aware, such an inquiry has never happened nor findings been published. Or has it been dressed up as something else?

I'm really curious about this.

@SpindleWhorl

Does anyone remember the 'inquiry' ordered by then Minister Penny Mordaunt into the boom in the number of referrals of girls to GIDS/Tavistock? That was announced in September 2018.

As far as I'm aware, such an inquiry has never happened nor findings been published. Or has it been dressed up as something else?

I'm really curious about this.

This is presumably still ongoing. It's not clear whether Case will be specifically looking at female referrals though. www.mumsnet.com/Talk/womens_rights/4030690-NHS-independent-review-into-childrens-gender-ID-services

The last update was a letter to NHS England in May in which Dr Cass said she aims to produce an interim report this summer and a full report next year.
cass.independent-review.uk/letter-to-nhs-england-may2021/

Reading the letter I'm not totally confident the right questions are being asked. We shall have to see what the interim report looks like.

*Cass not Case!

Thank you, @OvaHere. I'll read those links now.

(I've got some thoughts coalescing around this. SA's case, and the nature and manner of the Tavistock's defence, are very, very significant I think given the ministerial / government involvement since 2018 in a blaze of publicity.)

Hannah Barnes
@hannahsbee
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59m
THREAD: DAY 4 – Sonia Appleby v Tavistock and Portman Trust employment Tribunal

SA - Sonia Appleby
YG - Yvette Genn, Tavi counsel
AP - Anya Palmer, SA counsel
EJG - employment judge Goodman

Questioning of SA by YG set to continue…

(HB: need to leave proceedings for a while…)

Is anyone else in the court giving updates do we know?

Hannah Barnes @hannahsbee

(HB: Apologies for any lack of clarity - I had to leave for personal reasons. Proceedings began at about 10:25 and I am now back and listening)

YG - referring to events of May 2018 - suggests SA has been 'anything but transparent'
SA - i was seeking to help and to be transparent. 'i copied in everyone i was asked to copy in... i wasn't collecting data and not being clear about it' (par 45)

YG - SA is surprised by results of the audit... what you don't do is set out what steps are going to be taken to look at the data or remedy any problems it has thrown up. It is - i suggest - just thrown out as criticism , without any positive analysis

SA - i don't accept that it was a critical report. after the audit I asked for an appointment to be made with GIDS admin team and Garry Richardson to establish how many referrals were being made to social services

Audit had shown that in the last financial year GIDS had made 10 referrals and my baseline was that that seemed low in comparison to other service.
YG - You should have known that GIDS was not comparable to the other services

(my note: WHY should safeguarding not be 'comparable' in all services?!!! FFS)

SA - I did qualify my analysis by saying that there may be reasons why there may be differences between the services
YG - you are comparing to other CAMHS services, it's quite a dif model. It is receiving from CAMHS services rather than referring to. were you aware of that?

SA - yes I was aware of that... "but the point of my exercise was are we recognising s/g concerns ie when children are at risk and i heavily qualified that data analysis with a number of cautions."

SA - I asked the patient safety officer to establish with gids what their own processes were to record children with involvement with social care

The Tavistock's barrister YG is really pissing me off now. These are outrageously unfair accusations she's putting to SA.

I just read Ova's links and the recent letter from Dr Hilary Cass, chair of the independent inquiry into the Tavistock's GIDS, makes it clear that data is STILL not being properly collected let alone analysed for any remedy. Cass is making interim recommendations but she won't be fully reporting till next year. Says it's a massive job ahead.

(Thanks, Ova, for helping with my brain fog.)

To criticise SA for not doing this job on her own, back then, is bloody ludicrous.

I think Dr Hilary Cass ought to be VERY concerned about the nature and manner of the Tavistock's defence here.

@SpindleWhorl

The Tavistock's barrister YG is really pissing me off now. These are outrageously unfair accusations she's putting to SA.

I just read Ova's links and the recent letter from Dr Hilary Cass, chair of the independent inquiry into the Tavistock's GIDS, makes it clear that data is STILL not being properly collected let alone analysed for any remedy. Cass is making interim recommendations but she won't be fully reporting till next year. Says it's a massive job ahead.

(Thanks, Ova, for helping with my brain fog.)

To criticise SA for not doing this job on her own, back then, is bloody ludicrous.

You're welcome

WHY should safeguarding not be 'comparable' in all services?!!!

I don't think YA is suggesting that you can't make a comparison between GIDS and other services here. Just that you might not expect the rate of SG referrals to be the same as other services.

You might expect a GP service too have a lower rate (corrected for caseload volume) than a specialist CAMHS service for example.

Audit had shown that in the last financial year GIDS had made 10 referrals and my baseline was that that seemed low in comparison to other service.

Previous evidence given,

AS: no problem at all with day to day supervision/line management from GR. just when it came to complex cases

AS: recurring theme in his supervision with Garry Richardson was don’t go to social care because they won’t know what to do with cases involving gender identity

I don't know whether or not Sonia will win - I expect she has to prove she received detrimental treatment because of her raising of these issues - but the evidence is getting important stuff out into the public domain. I hope it all gets written up in the judgement,and informs the Cass review.

One thing that struck me yesterday - polly carmichael was said to have become tearful when the model was raised. What would that mean - what do they mean by model and why would she be upset at someone raising it (presumably it was being criticised)?

YG - i don't see that there is any action that you're proposing to take to work with gids or dr hodges to work on s/g issues - if that was your concern

SA - i basically say that i'm currently conducting a further audit ... so trying to take fwd both the number of children being referred to social care and the assurance in terms of s/g that's taking place

YG - do you see why a further audit might appear to be critical, rather than seeking to help the service?

SA - i see what you're saying but don't agree. I don't see audit as frightening or intrusive. when dr hodges asks are we referring children to social care where there are known risks, how would we know that unless we are scrutinising our own records?. One can't do it anecdotally

Found that GIDS wasn't correctly using the trust's care notes system (electronic record) and instead using their own form, and this posed a problem.

YG - i'm not suggesting it wasn't a problem, but was a trust wide problem. What did you do positively to work with GIDs to remedy that?

SA - yes there were trust-wide problems, but completely different issue: GIDS were not even trying to use care notes, but instead were using their own forms.

YG - what did you do to work with gids to help them and make sure they were using the recommended system?

SA - i had a meeting with sally hodges and garry richardson in august 2018 and discussed that the system they were using was unlikely to be able to evidence the work they were doing...

dr hodges said that she believed that taking the s/g fwd woudl be best to occur in late October because there were a number of 'manifest issues' that needed to be addressed in the interim. And it was obvious she was right about that

YG - I've asked you a number of times why mr richardson is left out of emails and suggested that you thought little of him, which you didn't agree with...

YG - (P509 - looking at emails from May 2019) - you receive a referral (from gids staff), you copy in GR, you set up a meeting with them on 31st May

SA - i think that was a date already in the diary for the two workers. wider context was that one of these workers was leaving the service and that was their meeting with Mr R to wind down their work and discuss...

YG - so why are you asking GR for his availability?
SA - i need to read the trail completely... i did not arrange a meeting, i'm just qualifying that there was a meeting already set up...

i didn't know whether it was a good idea for me to attend because, i believe, the meeting was already in hand and was discussing other issues as well as the case in hand
YG - if you'll forgive me i think that is a reconstruction... i think you must be wrong about the 31st...

YG says email trail betw GR and SA suggests that the tone and content is really quite disrespectful to another colleague who is trying to work out a potential child protection matter.

SA - my concern was yes i could help them with the s/g matter, but it wasn't my clinical responsibility to sort other aspects, which needed urgent attention before the clinician left and i wanted to make that clear;

i had assisted in terms of the s/g concern and it was a chronic concern that the local authority was aware of so no need for a referral - i was trying to help a colleague who says she is having difficulty in tying this down

SA - you say i was discourteous to mr richardson. i dispute that. What i saw there were clinicians who were really worried, said they were running out of time, we need to speak to our line manager. can you help? I'm suggesting that leaving it until the last minute was unhelpful;

that's why the workers came to me. But there were issues that were rightly better addressed by Mr Richardson. I was not trying to be discourteous but felt there needed to be line drawn between his managerial responsibilities and mine.

Hannah Barnes @hannahsbee

• - Back to 2017 - -

(1080 bundle - this is actually 2018 - v hard to follow)
YG cites safeguarding report for 2017/18 which indicates that things have improved i terms of s/g reporting...

SA establishes that exec summary is written by Dr Senior, plus the report refers to April 2017 to March 2018, 'my point being that it was not until june 2018 that i became aware that there was a sig problem'...

... in terms of ordinary practice not happening in the gids service - that they were not recording s/g referrals using the system we would use to collect data

YG - then you didn't look...
SA - i didn't look specifically at GIDS - was looking at the child and adolescent dept as a whole...

SA - "unless i have concerns, as i said yesterday, i would be giving the board an overview. if a had specific concerns about a service i would bring that to the attention of the medical director and the medical director sits on the board

YG - this is actually quite a worrying revelation:you didn't know what the state of play was in gids. You produce a report that to the reasonable observer is read as the use of care notes has improved.

SA - i don't agree. it would be different if i was segmenting every service in the trust

Right - I'm really beginning to understand this now!

GIDS don't use 'Care Notes' that can be shared between depts, social services and the patients local CAMHS. So there's no record of concerns being linked - presumably because it's 'transphobic' to link anything social or mental health to gender dysphoria??

When it was pointed out they should be doing care notes GIDS got all 'That's so transphobic'. Now retrospectively, SA should've fixed it all for them, and told them in a more friendly way, not a grumpy way, because that's not nice.

@NonHypotheticalLurkingParent

Right - I'm really beginning to understand this now!

GIDS don't use 'Care Notes' that can be shared between depts, social services and the patients local CAMHS. So there's no record of concerns being linked - presumably because it's 'transphobic' to link anything social or mental health to gender dysphoria??

When it was pointed out they should be doing care notes GIDS got all 'That's so transphobic'. Now retrospectively, SA should've fixed it all for them, and told them in a more friendly way, not a grumpy way, because that's not nice.

Thank you for summarising.

A woman's place is in the wrong.