Thread by @hannahsbee

THREAD: DAY 3 - 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

Kirsty Entwistle is the next witness. YG chooses not to cross examine

Pause while emails sent about supplementary evidence etc

AP - no questions other than whether contents of witness statement are true?
KE - Yes. Para 13 - typo - the word 'before' is missing.
Other than that it is all true

End of witness involvement

KE statement at para 30: "Whilst working at Leeds GIDS I received support from Sonia for a complicated safeguarding issue that I had. Sonia was extremely professional, knowledgeable and
helpful. In hindsight I wish I had contacted Sonia about other complex safeguarding cases"

Claimant Sonia Appleby (SA) is next witness

SA says she wld like to make changes to P.57 - shd read as 4th June, not May. linked to P.53

changes being made...

SA explains DB sending Dr Anna Hutchinson transcript on 15th Dec 2019 - and sending the email to herself.
AP - did you read transcript at this time?
SA - no. didn't have time. sent at 8pm
AP - what d we see next?
SA - Dr Bell sending me other transcript.

AP - when did you first read them?
SA - Jan '20. Thought they had been lost when bought a new phone.

SA explains that she pointed out to DB and said wasn’t prepared to send the docs to solicitor without the two people concerned – Dr Spiliadis and Dr Hutchinson – knowing a) I had them and b) I wld forward them to my lawyer.

YG 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

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?

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)

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?

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?

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

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

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 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 - 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

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

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

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

SA - it was absolutely not my intention to do so. I cannot be more clear about it. There’s much more of a concern about me being a miscreant than the people presenting with major concerns about the service

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

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)

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.

SA says nothing she did was with the intention of causing harm to Polly Carmichael

YG cites an email from PC to rob senior in Jan 2018 - “you can see there, she is blind sided isn’t she?”
SA - I can see that she is not best pleased
YG - she’s blindsided because she’s not given any information

YG says Bernadette Wren (member of GIDS exec) also does not know about safeguarding concerns

SA - dr wren does actually suggest that she was aware that I had spoken to rob senior about the concerns. I am disappointed if dr Senior failed to avail dr Carmichael on some of the factual details of this matter - that I had gone to him and was awaiting a response

It’s challenging now because it was in the past

YG - para 30 of your witness statement. Why do you challenge the description of GIDS as a highly specialist service?

SA - I’m essentially saying that portraying as a highly specialised service without acknowledging that the service is riven with challenges from staff ...

If you have a staff group working with complex patients… but if that service is undermined by staff saying they’re too afraid to speak up, too afraid to use professional curiosity…and that some staff feel - and I’m not saying everyone experiences this…

…they have said you’re in danger of being called a transphobe if you’re perceived about being Curious about what the service is doing, even though I’m sure all staff members want to do their very best

I’m not disputing that this is a specialist service, and the work is complex. “But that work is made even more complicated by the complexities of the culture within the service”…

on the one hand we have children w complex needs and on the other we have some members of staff who have had serious problems in the service, and I don’t think these are deviant misfits. And they have struggled …in a service with serious splits.

…GIDS clinicians have some of the highest caseloads in the trust. They work incredibly hard.

SA - I think it’s unfortunate you are implying i don’t recognise the diversity in GIDS service, Dr Spiliadis indicated he was denigrated because of his diversity

YG - but at the same time as some are saying they’re being called transphobes, there are others who say they’ve experienced homophobia?
SA - I agree

SA - I myself Became known as a transphobe… anyone who accesses an NHS service needs a safe service.

SA I understand in one of the redacted transcripts in Dr Sinha’s review that I was referred to as a transphobe

YG - what you were doing was adding to splits already in the service. Your role in this was very partial - not impartial…

sa - I strongly reject that. “I know that I was bringing uncomfortable news to GIDS.” I respect their work but I do object to the name calling in this way and it’s something others have cited. And I do hope it’s something that can be put right.

SA - “I am not against the GIDS service. I never have been and I am very supportive of those who have the challenges that many of their clients have. I think anyone whether they be transgender or gender dysphoria… deserves a safe service.”

(HB - apologies. Couldn’t use hands. There has been a back and forth with YG suggesting SA being disingenuous and SA rejecting this. Very similar to earlier questioning)

YG questioning SA about first meeting between her and GR in March 2018

YG - Curiosity is we’ve got your evidence that there were concerns and yet there’s no action. There wasn’t any will on your part to help GIDS make the progress you want them to be making
SA - I’ve said this before. I had several restraints on my availability …

I was due to see Garry in May. I saw him in June, July, August where we had specific things to discuss.

END OF EVIDENCE TODAY