Tuesday, 2 December 2014

Addenbrookes Hospital

We heard yesterday of the 22-year sentence handed down to Myles Bradbury for a string of sexual offences against patients in his care at Addenbrookes Hospital.

He was obviously able to continue abusing for a several years while at Addenbrookes Hospital, and as a result one has to look into the safeguarding arrangements which are in place there and whether they are adequate. No doubt there will be a Serious Case Review which will conclude that lessons need to be learned. I've read a sufficient number of similar documents to have a decent idea of what it will say.

So here is something which the Serious Case Review needs to look at and which any member of the public can examine: the Child Protection Policy for Addenbrookes Hospital. The safeguarding statement for Cambridge University Hospitals NHS Trust (of which Addenbrookes is part) is here and the page includes a link to a PDF of the trust's safeguarding children policy. It is this PDF that I am reviewing.

Based on the experience of Little Heath Primary School, Bishop Bell Academy and various other places which have had abuse scandals, it has been a common element that the safeguarding policy for the setting was of poor quality. I would go so far as to say that if the written policy and procedures are of low quality, then it is highly unlikely that the practical arrangements are any better. While it's possible to have a good written policy which people aren't bothering to follow, it is extremely rare to find good arrangements that haven't been well documented.

The first thing I always look at on a policy is the date. These policies should be updated yearly in order to take account of any changes in law or statutory guidance,  any changes in the local arrangements for liaison with children's services, changes in key staff within the organisation, and most importantly any lessons learned from any recent incidents, whether or not they were successfully dealt with. The CUH policy is dated March 2012. In other words it has not been updated since Myles Bradbury was arrested. This is really not good enough. There have been changes in statutory guidance in the meantime, for instance a new version of Working Together to Safeguard Children.

Sections 1-3
Introductory text. Doesn't get to any procedures yet. The list of abbreviations includes "ACPC - area child protection committee". This is seriously outdated, they were replaced by Local Safeguarding Children Boards many years ago. Not a good start.

Section 4
The "Working Together" reference is outdated, it should be to the March 2013 version.
The section mentions the Laming and Bichard recommendations but doesn't say how it is implementing them or how it complies with Cambridgeshire LSCB procedures or has considered the CQC review, all of which are mentioned in this section. It's just said that it has to do all these things without saying whether it has done them, and if so how.

Section 5
Contains references to external documents that provide guidance, but includes no specific procedures.

Section 6
Contains references to external documents describing what people should be doing. This is very bad, it requires that people essentially built their own child protection policy out of component parts that are scattered across many documents. You can guarantee that in a busy place like a hospital nobody will bother doing this.

The references to external documents are mostly to outdated versions, unsurprisingly since the document itself is so old.

The DfES mentioned in  this section hasn't existed for many years, having been superseded by the DCFS and subsequently the DfE.

The external documents are actually guidance as to how a safeguarding procedure document should be written and implemented. To refer to them does not of itself actually give you a safeguarding procedure document.

Section 6.1.1.
Contains a long description of what Cambridgeshire Local Safeguarding Children Board (LSCB) (i.e somebody else outside the hospital) is supposed to be doing.

Section 6.2
A long description of what Cambridgeshire Local Safeguarding Children Board (LSCB): Business Committee is supposed to be doing.

Section 6.3
A long description of what Cambridgeshire Health Safeguarding Group (HSG) is supposed to be doing. All these three organisations are not unbder the control of CUH NHS trust and the descriptions in these three sections contain no guidance on what Trust employees should be doing.

Section 6.4 - 6.14
A short description of what each of various people within the Trust are supposed to be doing, but contains no procedures for how they are supposed to do it.

Section 7
A statement of general principles. No procedures

Section 8
A statement of general principles. No procedures. Contains an outdated reference to "Working Together to Safeguard Children".

Section 9
A statement of general principles. No procedures.

Section 10.
A statement of general principles. No procedures, unless these exist in Chapter 8 of the Cambridgeshire LSCB inter-agency procedures, which are mentioned buit not included in the document.

Section 11
It might possibly be that "the Trust‟s safeguarding children procedures and guidance notes provides specific, detailed actions that must be taken when there are concerns that a child is suffering or at risk of suffering significant harm" but this is not a published document, so we can't tell.

No procedures in this section of the document.

Section 12.
Claims that effective procedures are in place. No description of what the procedures are.

Section 13
Contains a promise, but no procedure to describe how the promise is fulfilled.

Section 14.
Promises and commitments. No procedures describing how they are implemented. The trusts's safeguarding children supervision policy might have something useful, but it has not been published.

Section 15
Promises and commitments on training and miscellaneous external references, but no  information on how the trust ensures that adequate training is actually delivered.

Section 16
By definition you cannot monitor compliance with a policy that has no procedures. In fact, this table describing what is supposed to be checked, is the nearest the document comes to describing what people are supposed to be doing! It's a page long.

Section 17
Information, no procedures

Equality and diversity statement
Just what is says it is - a statement.

Appendix 1
The flowchart is not all that bad, but this is the first procedure mentioned in the document (on page 15 of 17), and you can't fit sufficient detail of what people are supposed to do into flowchart boxes. This should be a summary of a more detailed procedure described in the body of the document. But that more detailed description is not included.

The reference to the DfES reference is way out of date.

Appendix 2
This is an orgchart. No procedure.

Appendix 3
This is an orgchart. No procedure.

My overall conclusion is that this policy is utterly useless. It provides no guidance at all for how staff should respond to evidence or suspicions of abuse, whether by staff or by others.

It may be that there is another unpublished document which contains these procedures. However no such document is referred to in the policy. If there were a more detailed set of procedures somewhere, I would expect to see references to it at various points in this document saying something like "For detailed procedures on how to do task X, look at sections P and Q of document R." But there is nothing like that, which makes me think that this document is basically all there is.

I wish to make it clear that I am aware of no evidence that Myles Bradbury's behaviour raised any suspicions within the hospital before he was arrested. This is something that the Serious Case Review will have to investigate. If there were no suspicions, then the shortcomings in the hospital's safeguarding procedures would have made no difference. But I have to say that I am very troubled by the extremely poor quality of the document, especially that it has not been updated in over two and a half years during which time the Trust has had a major safeguarding incident involving one of its employees. It also appears that the trust has also made no changes to its policy in order to implement lessons learned from the Lampard Review into abuses perpetrated by Jimmy Savile at a large number of NHS hospitals.

If it turns out that suspicions about Bradbury existed that were not acted upon, then the Cambridge University Hospitals NHS Trust will have some serious explaining to do.

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