Thread by @hannahsbee

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…)

(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

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

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.

- - 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

(446/7/8) YG brings up s/g audit from May 2018 and then meeting in June, which results in some action points. With the exception of Dr Senior having a conversation with Sally, it seems to me these are all external things, rather than involving the service

SA - i can see that and i think i've made clear this was a very complicated scenario that i could not solve by myself. It was likely it would result in something transformational happening to the service...

...but what i was doing was meeting with Garry, and these were by this point in the presence of Sally Hodges, and also included Dr C... there were some very basic s/g issues that we needed to attend to

YG - Dr R's recall is that there were meetings but they were about other things, than specifically about trying to come up with an action plan

SA - i believe that Dr C and Dr H wrote to the gids service seeking both of them to bring about a multi-pronged form of remedy... at that time i was doing my very best to make sure the right people were involved in this conversation...

I had learned from the previous autumn that this wasn't just a matter for safeguarding, but needed involvement from all key stakeholders in the organisation, and frankly it was like trying to herd cats. Solution to complicated, serious situations does not happen overnight...

SA - "I was trying to engage the organisation to understand the magnitude of difficulties."

YG now on July 2018 - proposed meeting with Dr Bell, Polly Carmichael and SA. YG suggests that PC felt blind-sided...

SA - the suggestion is that somehow i was acting as an intermediary for Dr Bell. If anyone wanted to find out from Dr Bell what he was doing then surely they'd be best to follow up with him?

YG cites email (just mentioned) from Sally Hodges and PC to gids staff. Do you respond to Dr Hodges given you'd been so involved in raising the concerns?

SA - I can't remember whether i did or didn't but what i was v pleased to see was that Dr Hodges... and Dr C, given they'd co-written the response, was that they'd copied in the CEO to the email correspondence which wld lend a great deal of authority, which i was v pleased about

YG - what i'm concerned about is that you don't appear to respond to dr hodges in a collegiate way and instead you respond to dr bell to critique the email communication... i wonder why you thought that the course to take rather than lending support to dr hodges?

SA - dr hodges was already very aware - and i want to make it v clear - that i was as supportive as i could be within my role... and i was v pleased that dr hodges and dr carmichael had the foresight to alert the CEO...

...the fact that Dr bell then wrote to me and i responded is no indication of disregard for dr hodges. she actually says pointedly to Dr bell that she is aware of my help and is grateful for it and makes the point that I am keeping her abreast of concerns...

...To read into that that i was disregarding of Dr hodges and dr Carmichael's involvement is frankly unhelpful.

SA clarifies she thought response from SH and PC was robust and told Dr Bell it was a v good response; that they understood it was their responsibility to deal with the challenges...

...He had asked whether she would join him in writing to gids staff to say they could speak to them at any time and she thought that 'provocative'.

YG again questions why, given her raising of concerns for a year, SA didn't write to Sally Hodges to say she was pleased with email to gids
SA: "i don't ordinarily send congratulatory emails to someone who does something that it required" ...

...but that is not to suggest i wasn't supportive.

YG again suggests that SA was not supportive of gids in helping to overcome the issue of the service not recording s/g issues in care notes. SA again disagrees and says she was supportive

Discussion of case where designated nurse from Cambridgeshire calls SA. She says gids view of this is that she should have referred to GR, but says NHS protocol dictates that they wld directly contact the named professional - and that is exactly what happened...

SA - i responded to that and we made a plan. and when i came off the call i alerted mr richardson. i also looked at care notes record to be informed.

In essence the concern was why did the trust make a safeguarding referral to CAMHS service rather than local authority who have statutory duty to address that. Without further info i couldn't address that, so i alerted GR and looked at case record

SA - it's not that anyone is disregarding the gids service, the protocol would always be that the named professional (i.e SA) wld be contacted first, irrespective if GIDS had its own s/g lead
YG - But GR was aware of the case so looks like you're undermining him.

SA - i'm not undermining him. (SA goes into some extra detail)

LUNCH

(P472 475, par 76 SA) YG is discussing Tavistock electronic notes system, Care Notes. What more did you do to facilitate changes to better document in GIDS staff?
SA - the patient safety officer was to help GIDS with this administrative task…

But as already pointed out earlier, Dr Hodges requested that I step away until October to allow these changes to be embedded… I think she says she expects Mr R to come back with a plan

YG - were you aware that for some time GIDS had been missed off an all-trust email circulation list re: updates to care notes?
SA - yes. I believe it was a matter that the patient safety officer uncovered

YG - the role you’ve got now, you say, is ltd, while GR and SH take other matters forward
SA - I basically put myself on hold, at the advice of SH, until October.

YG - in august 2018 there’s a change of leadership. Dr Dinesh Sinha is appointed and he becomes your line manager?
SA - yes, he does
YG - he has a different style toner Senior and from outside the trust?
SA - yes he was

YG says he hit the ground running. CQC inspection, Bell report submitted to governors and the review that followed afterwards. Were you familiar with the reason that the reason why Dr Sinha was given that job was that he was a new person and did not have a side whatsoever?

SA - I did not know that

YG - re: your relationship with him, would you accept it wasn’t surprising that you did not have the engagement you perhaps would have liked to have in a less busy time?
SA - I wld have preferred to have had more contact albeit from what you’re saying he had to hit ground running

YG - would you agree it was not an easy relationship? He will say that you were not used to rather closer management in his style?

SA - I don’t agree. I had monthly supervision with Dr Senior and wld see at least once or twice depending on number and complexity of issues in trust re: safeguarding.

YG - fact is when dr Sinha was your manager you operated without close consultation with him: in oct 2018 you’d asked GR for safeguarding data.

S- - every quarter I have to collect safeguarding data -every single service where child is primary patient has exactly the same request. So rather than ask patient safety officer to get the data I was encouraging GR to undertake these audits himself, following our talks in Aug…

… and these are the kind of requests I make to every single service.
YG - I can’t see you providing that level of detailed explanation other than in an email to sally Hodges

SA - GR would know that every quarter I look at this data. If he wasn’t aware, I’d be surprised but we could have moved on from that.

YG - it’s only when SH challenges it that you provide the data
SA - I wrote directly to Garry saying this is what we need, referencing our conversations in august

YG says SH advises that GIDS is under a sig burden at the time, gathering data for NHSE. You don’t take account of this
SA - I think this is a misunderstanding the emails. I acknowledge they were compromised in providing the data because they were providing data to another body

YG - I’m going to suggest that you’re suspicious about GIDS not providing information you think needs to be provided without accepting any difficulties at all. This is all part of your belief that.. (inaudible)

SA - if you read what i say I say I didn’t know this and I’ll ask the patient safety officer so I don’t think your portrayal of me is accurate
YG - we’ll see

YG references email from Dr Sinha asking to explain the data request you had made… you take that’s a some kind of extremely poor treatment of you. Why are you upset by Dr S asking you to be managed by him?

SA - I was less upset and more curious as to why he wasn’t aware that as a safeguarding lead I would collect quarterly data
YG - he makes a perfectly reasonable request - why do we need this information from GIDS and who has requested it?

SA - as far as I was concerned… I responded to my line manager - unfortunately he may not have seen my email, but I was really concerned that his response was cancel the meeting with GIDS. But this was 2018. My statement is written in 2021 & by then I had formulated a dif view

YG - it was nothing more sinister than seeking clarification over a data request
SA - I did the very best I could. My line manager asked me for context and i provided it… just to make sure I wasn’t wrong footing myself I sought to clarify with him….

SA - It seems to me the line of questioning is basically whatever I did, I was wrong… you’re suggesting suspicion, when in fact I was cautious…
I responded to dr Sinha in a timely way providing him with the context he sought.

YG - let's go to your meeting re: GIDS review... you produced a document...
SA - it's not simply as an aid memoir, but as a document to submit as part of the review...

YG - in the interview you had, i'm going to suggest he puts a similar line of questions that he puts to everyone else... you suggest that's he's interrogating you or ill-mannered...

SA: I want the court to know that I was never given the opportunity to review the transcript… he was ‘very cool’ in his treatment…But I very strongly felt he did not want to hear about the very serious concerns clinicians had brought to me

SA - it was not a review about me, it was a review about the service. And the service includes the people who work for the service
YG - the purpose of the review and it was designed to capture the views of people in the service.
SA -yes

YG - and he interviewed 31 people… and at the end he said is there anything else you want to tell me?
SA - yes
YG - and confidentiality was promised and that was to garner open views… the report is also accompanied by an action plan…

YG - I’m looking at C and one of the actions is to develop an SOP for GIDS and you worked on that with PC and GR didn’t you?
SA - yes

YG - had you seen that action plan prior to court bundle?
SA - yes
SA confirms there’s nothing controversial in it, needs to be redefined over time, but I took part in action 14

YG - surprised you didn’t mention action plan in your statement. You pick up one word in the whole report (p1507) and decide that’s about you. It’s a rather self important observation on your part.

SA - what I wanted to point out in a witness statement that has a v specific focus was that dr Sinha seems to make a point himself as to whether safeguarding team itself was being respectful

YG - you disrespect all the work that has gone into this report and interpret it as being about you
SA - No.

YG - there’s nothing in action plan that sidesteps or disregards your role. Do you agree?
SA - yes…
YG - you didn’t have any concerns that referrals were going to dr Senior and then dr McKenna…

SA - obv there are conversations that take place within services that s/g leads are not going to sighted about, but where s/g issues are brought to the safeguarding team we agreed it wld be recorded in the safeguarding inbox. And they were not.

(Explains this wasn’t Mr R’s responsibility, but rather the person he was having conversation with)

EJG - so people who were meant to record these conversations were you and Dr McKenna?
SA - correct

YG - you suffered ill health in 2019 and absent until May. Not your fault, but that contributed to you being unable to build a relationship with dr Sinha

YG - I think it was explained that you line manager needed to know details in order to manage any needs for your return to work
SA - I didn’t actually know that those documentations had to go to line manager and not HR. That had changed and when I realised i did send direct

SA - I’m not putting a ‘bleak perspective’ on it. I thought it would be helpful to agree a time to speak when I came back. Which is exactly what happened.

YG - he’s trying to be supportive and helpful
SA - yes I can absolutely see that and I did absolutely everything he requested of me.
YG - your witness statement makes out things to be much darker than they actually were

(Discussion of meeting between Dinesh Sinha and SA)

Yg - back to work meeting was not designed in any way to strip Gounod your functions?
SA - as far as I can ascertain, no it was not

YG - what is the evidence to show that you are perceived or being treated as a pariah? (Par 125)
SA - since the latter part of 2017 I was trying to raise concerns within the trust and I said as early as June 2018 I was cast as a person asking difficult questions

YG - where?
SA - it’s in the correspondence
EJG - bottom of page 418(???)

Break from SA testimony. Next witness is former GIDS clinician Anna Churcher Clarke

AP - p509 – refers to an email to SA asking for consultation on safeguarding query. Who would you usually go to?
ACC - At that time, Gr
AP - why not now
ACC - He was unavailable
AP - Any other reason?

ACC - Well I was leaving the service and had had last appointment with this case, but I was also keen to speak to Sonia
AP - Why?
ACC – I had previously approached Sonia on one or two cases and found her advice, support and authority v helpful

AP - you give an explanation to GR that he’s not available…
ACC - I think it was at that time there was ‘a sense that going to Sonja wld not be approved of’ - officially Garry could escalate but going directly to Sonja was difficult.

ACC – I can’t remember the exact timing of it - think late 2018 - following the Dave Bell report and leaking of that to the press - there was a lot more anxiety in the exec team.

I did have Polly say to me ‘oh you haven’t taken a case to Sonia have you’ as if that might have repercussions for the service. So I was aware in my mind there was an association between Sonia and david bell. And therefore an anxiety.

AP - how many times has that happened?
ACC - Only once and I can’t quite remember whether it was in relation to this particular case or another one

AP - p490 – You see four text msgs from Melissa Midgen - do you know anything about them?
ACC - I’ve seen these & I think that - I’m pretty sure the context was a whole team meeting following the DB report when Garry was appointed GIDS safeguarding lead, when it was made more...

official that safeguarding should go to him. I can’t remember exactly what was said but I thought there was a sense of the not going Sonia...
I was worried that the service was becoming increasingly isolated in relation to the rest of the trust.

ACC - I can’t remember details. I remember some kind of announcement around safeguarding and that we should go to Garry and some kind of suggestion to refer to him and not to Sonia. But can’t remember precise

AP - who said this?
ACC - It was Polly who announced this sort of change in approach to safeguarding. She was the person who made important announcements in relation to the team.

AP - what sort of level of clinician were you?
ACC - Between Oct 2018 and March 2019 I was acting up and was in the senior team

AP - what if anything did you take from the senior team meetings about SA?

ACC - I can’t recall specifics but the thing I most remembered was the presentation of and leaking of DB's report and the association - their names were linked together - and the sense ‘that they were out to get us - that kind of feeling.’ ...

That was definitely the sense, maybe in the wider team, but certainly in the senior team. And that GIDS issues weren’t understood.

(YG to now question ACC)

YG – I think there was an official announcement about GR in aug/sept 2018 – but do you recall that GR was taking on official safeguarding functions some time before that?
ACC – Can’t remember

YG – but reasonable to see that is right?
ACC – I think so and maybe it was made more official later on
YG – If you think that’s right, part of that was that the whole s/g process was trying to be more embedded in GIDS

ACC – well yes that was the explicit reason given but I think there was the sense that there are all sorts of other things that were also ‘known’

YG – Well he was the official s/g lead from 2017… do you remember that as part of that that you were all advised that to manage s/g it was to start with Garry first, and that it wasn’t a don't go to Sonia but go to Garry and then he would go to Sonia?

ACC – I suppose I didn’t have faith… my experience was – I was on good terms with Garry as a colleague, but in terms of safeguarding I suppose.. I was working on a joint case with Garry, complicated case, a YP with custodial (??) …sexual involvement (?)...

... I had real concerns about the way the young person was presenting. I wanted us to get external representation from the Portman – another service in the trust – and i remember there being resistance to that; the feeling that that wasn’t really approved of.

...Sort of don’t go outside the service. There was an anxiety I think in the exec team about exposing something gids…I mean I wrote to the exce team about my concerns about safeguarding in GIDS and I spoke about it in my interview with Dinesh

YG – but it’s right you were never stopped? You were never blocked from doing that were you?
ACC – well I did feel that i needed to explain exactly why I was going to Sonia. I think the fact I went to Sonia, whether it was this case or another...

...as there was another I mentioned in my interview with dinesh - that Polly had said ‘oh you haven’t taken it to Sonia’ ...

YG – you’ve done that three times – mimicking… this wasn’t a serious issue was it? You were free to take issues to anyone. There was a structure in place and that was to take to GR first, but that was it, wasn’t it?

ACC – I don’t completely agree with what you say. It’s true that I wasn’t punished for doing so but there was a sense that one had to walk with care...

...You’re in a team where you needed to have collegiate relationships, as well as do the right thing clinically. It was a sort of telling off.

YG – well it’s not a telling off, not at all. And if you look at the texts which are sort of gossiping betw yourselves
ACC – well they’re not my texts.
YG – one says ‘chatting to Anna CC’ – she says ‘telling people not to go to Sonia is not right’ - so you weren't told not to go

ACC – I can’t remember the exact words in that meeting. But it wasn’t gossip. I also went to see Gill Rusbirdger - the speak up champion – I did have concerns about how things were being managed in the service. So I wouldn’t say it was gossip.

YG – when we look at the reality, when you had a serious case you were dealing with – you’ve sent a message to Sonia, copied in GR… there’s a response from Sonia that she’s free...

there are a few exchanges between you and SA but by the time Garry gets involved I can’t see anything in this run of emails where he’s chastising you or telling you you’ve done the wrong thing...

On the contrary he’s working with you and SA to make sure this particular safeguarding issue is resolved.

ACC – yes but I suppose what I’m trying to say is that the official line was things went to garry and then they might go to Sonia. Sonia was already involved; I think it would be unlikely he would say that wasn’t the appropriate channel.

I guess what I’m saying is that it was subtler than that. I don’t think Polly had called me into a meeting when she said this, she might have come into my office, or I’d gone to see her.

I wouldn't have expected Garry to tell me off at that point but there was a sense that it wasn’t the done thing.

YG – there’s nothing in this chain of emails that supports what you’re saying… nothing to suggest he’s told you off or disapproved of what you’ve done.. literally nothing in there to signal you’ve done anything wrong
ACC – not in that email chain, no.

YG – and in fact it never happened that GR or PC were telling you off.
ACC – It did happen with Polly Carmichael that she was telling me off...

In my interview with Dinesh I mentioned a similar scenario, of GR being off and going to Sonia, and feeling like a traitor. It’s difficult because it’s not recorded in documents, but it was things that were said over a period of time about association between Sonia and David Bell

YG – that may be your pirvate view formed with colleagues your’e chatting to… But, if you’ll forgive me the proof of the pudding is in the eating… so whether or not you had a sense, but in fact on the ground if you needed help from SA, no consequences come from that

ACC – I can’t go further than what I remember – Polly saying that to me on one occasion. I can’t remember a concrete action that followed, but what I’m trying to convey is...

after the DB report I was approached by Polly to ask if I knew who had spoken to him. I didn’t and I didn’t myself. And there was a real focus on who’d taken part rather than the issues raised in that report...

...And in senior meetings there was a sense of Sonia being in cahoots with David bell. There was a sense it became ‘are you with us or against us?’

YG - Did it not cross your mind that Polly Carmichael was concerned with what the concerns were and not just the names?
ACC - that wasn’t my experience

- - Witness is released from her witness order - -

AP requests to see – unredacted – the relevant sections of ACC's interview with Dinesh Sinha as part of GIDS review.
EJG says it does not seem like an unreasonable request.
YG says her only issue is if ACC gives permission for that. If she does, then fine.

ADJOURNED UNTIL MONDAY MORNING 10:00

(HB - To try to clarify this - as was trying to type quickly. Dr Churcher Clarke describes a complicated case involving a GIDS patient where - i think - there was sex offending. Patient wanted to transition, in part so they wouldn't be recognised.)

(HB - To try to clarify earlier tweet - was typing fast - Dr Churcher Clarke describes a very complex case involving a GIDS patient who had had a custodial sentence in relation to sex offending. Patient wanted to transition, in part so they wouldn't be recognised. ACC concerned)