Earlier this week Barry Morris, Verita partner and Lucy Scott–Moncrieff, associate hosted a breakfast seminar on safeguarding following their experiences with the Verita review into governance arrangements at Cambridge University Hospitals NHS Foundation Trust.
20 people attended the event which was held at the Foundling Museum on Wednesday between 8.30-9.30am.
Lucy opened by emphasising that Verita’s investigation was into the Trust’s governance systems and processes, not into the clinician. She gave an overview of the purpose, methodology, conclusions and recommendations of the investigation.
In response to questions, Lucy said that the event that had revealed the years of abuse was a phone call from the grandmother of a patient who called the ward clerk seeking confirmation that her grandson’s description of a consultation was normal practice. The ward clerk, trained in safeguarding, had immediately escalated the query to the ward nurse and all safeguarding processes were followed meticulously.
The following themes and areas of discussion followed:
- Parallels were drawn with findings from other cases such as Savile; ‘hiding in plain sight’. Individuals with the ability to isolate themselves from peers and trainees, whilst maintaining power and control with the patient/family. Unlike the Savile case, patients did not know that they were being abused- ‘patients thought he (Savile) was God’.
- The chaperone policy was poorly designed and understood, as were transitional arrangements for older children. This was exploited by Myles Bradbury. Discussion followed about whether a competent child’s wish not to have a chaperone should be overridden; how financial constraints compromise the proper implementation of chaperone policies; the informal approach to chaperones in primary care; the importance of taking a considered and proportionate response to an extreme case.
- There was agreement that open conversations with and among clinicians about how others are approaching problems and putting in place barriers that will be effectiveand workable is important; ‘thoughtfulness in practice’ rather than a tick box approach which stops people from thinking.
- It was acknowledged that the recommendations from this review are not a blue print – they would not work in primary care or inpatient settings. However there are two points of general applicability:
- First, unusual patterns of behaviour; look for them, be curious, have systems and processes which will identify them.
- Second, give patients information about what is normal – what to expect in terms of physical examination and frequency of appointments, chaperones.
It was recognised that although abuse of trust is seen in many situations from porters and nurses to doctors, it is doctors that have greater opportunity to abuse. Abusers are clever, subtle and conceal their behaviour. The answer lies with empowering patients through education to ask, to challenge, to raise concerns.
Strong governance comes from a whole system approach regardless of setting – hospital, school – where everyone has been trained in safeguarding and follows the process.
Barry Morris shared the following reflections from a senior nurse involved in the investigation into the clinician:
- Being new in post, with no prior allegiances and an objective perspective was very helpful.
- Managing the different lines of communication is important and challenging; it involves Trust board, executive, frontline staff; police; families; regulators as well as local and national media.
- The case brought a huge emotional burden of telling ‘incomplete truths’ to staff and families at the request of the police during their investigation.
The discussion concluded at 9.30am.
Our next event will be in the first week of April and is likely to take place in both London and Leeds. The discussion topic will cover the role of social media in investigations and complaints.