By Rachel Cashman
The person who raises a safeguarding concern is inevitably the least popular person in the room.
I have learned that over more than two decades working in organisations where failures of leadership, governance and professional judgement can cause serious harm. It is rarely comfortable work. Nor should it be. Safeguarding means being prepared to examine things that others would prefer not to see.
But what happens when the people and institutions responsible for safeguarding appear more concerned with protecting their decisions, relationships and reputations than examining the possibility that something has gone badly wrong?
I attended the recent Redvers v NHS Sussex & Doyle employment tribunal hearing. I sat in court and listened to evidence about the treatment of a safeguarding GP who had raised concerns about clinical practice at Brighton’s WellBN primary care surgery, where under 18s were being prescribed medication as treatment for gender distress/dysphoria (GP says she was forced out of job after raising concerns about gender treatment – BBC News. I was investigated by the NHS, called a transphobe and thought of suicide. Hannah Barnes Times 25.10.26)
After several days of testimony, Adam Doyle, the former chief executive of NHS Sussex, was recalled to the witness stand when questions arose about the disclosure of evidence. Diary entries had come to light showing meetings titled “mentorship” between Doyle and Dr Sam Hall, the WellBN clinician at the centre of the safeguarding concerns. They raised questions about a mentoring relationship that Doyle had previously disputed in his written and oral evidence.
What happens when those exercising public power become so accustomed to defending their position that openness, challenge and scrutiny are treated as threats rather than obligations?
The tribunal must determine the claims before it. It is not a public inquiry. Yet the evidence raises questions far beyond a single employment dispute.
Bigger than the Tavistock
Baroness Hilary Cass has reportedly described the WellBN scandal as dwarfing what happened at the Tavistock. I understand the comparison. It is the breadth of the apparent systemic failure: clinical governance, commissioning, safeguarding, regulatory oversight and the treatment of those who raised concerns. These are not separate issues. They are interconnected.
What concerns me most is the possibility that the various actors within the system became mutually reinforcing. Clinicians relying on commissioners. Commissioners relying on clinical assurances. Senior executives relying on relationships and established positions. Regulators considering individual referrals without examining the wider picture.
Each part of the system capable of pointing towards another. I have come to think of this as a self-protection bubble.
Not necessarily a conspiracy, or even a consciously coordinated effort, albeit I appreciate that Dr Redvers may contest that her treatment was exactly that. Something potentially more ordinary and therefore more dangerous: a network of professional relationships, shared assumptions and institutional incentives in which challenge becomes increasingly difficult and uncomfortable evidence is too easily explained away.
That is precisely why public services need independent scrutiny. When people who know, trust or depend upon one another are also responsible for assuring one another’s decisions, relational power matters. And when the clinical subject is politically contentious, those risks become greater, not smaller.
The warnings were there
I have repeatedly raised concerns about safeguarding, clinical governance and patient safety of services for gender distressed children in Brighton. I approached NHS Sussex, NHS England, the local medical committee, the Care Quality Commission and the General Medical Council.
Five organisations with different responsibilities, powers and opportunities to examine those concerns. To my knowledge, none undertook a substantive investigation at that time.
More than two years later, the independent patient safety investigation into WellBN identified serious deficiencies in assessment, prescribing and clinical oversight. Its conclusion was unequivocal: care fell far short of what could be considered safe or appropriate. You can read it here: Patient Safety Investigation WellBN General Practice | ICB – Surrey and Sussex
That is not a matter of personal vindication. I would much rather those concerns had been properly examined at the time, and that the findings had been different. The important question is why it took so long for the system to establish what was happening.
A safeguarding concern is not proof of wrongdoing. But it is a reason to ask questions. An investigation that eventually identifies serious harms does not demonstrate that every organisation failed in its legal duties. But it makes the decisions taken before it matters of legitimate public interest. I want to know who examined the warnings, what assurances they sought, what evidence they relied upon and why further scrutiny did not happen sooner.
Those are not unreasonable demands. They are the ordinary questions of quality assurance.
Follow the entire pathway
A public inquiry cannot begin and end with the clinical decisions made inside WellBN. It must establish how children were referred or directed to the service in the first place. Accounts from families raise questions about informal routes into care involving people and organisations outside established clinical pathways.
Who was identifying children as potentially requiring specialist intervention? On what basis? Safeguarding does not begin when a patient enters a consulting room. It begins wherever a vulnerable person is being advised, influenced, referred or directed towards a course of care.
Take away the politics for a moment
Imagine these findings concerned another area of healthcare. Children receiving treatment without appropriate assessment. Weak clinical oversight. Repeated safeguarding concerns. We would never regard political sensitivity as a reason to examine it less thoroughly. Yet that is the danger when clinical questions become entangled with identity and ideology. Evidence is interpreted through loyalty. Professional challenge is mistaken for personal hostility.
Children experiencing gender distress deserve compassion, respect and access to competent healthcare. They also deserve careful assessment and protection from avoidable harm. Those responsibilities are not in competition. There will undoubtedly be patients who received treatment for gender distress by WellBN who are now living happy, fulfilled lives following social and medical transition. Their individual positive experiences do not strike out the whole system of regulation, safeguarding and ethics associated with prescribing of evidence-based medicine.
Safeguarding must never become a licence for hostility towards those who identify as transgender. Nor can legitimate concerns be dismissed because the person raising them is perceived to hold the wrong views.
Controversy is not an exemption from accountability. It is a reason to be more rigorous.
Punished through process
Dr Sarah Redvers raised concerns about prescribing and safeguarding. She subsequently became the subject of an investigation herself. An independent review later described that investigation as accusatory and biased rather than properly fact-finding. Her tribunal claims are for the judge to determine.
There is a form of institutional harm that tends not to announce itself as retaliation. It is delivered through process. An investigation. A delay. A referral. A meeting from which somebody is excluded. Sometimes those processes are necessary and entirely legitimate. But they can also be disproportionate or used in ways that leave the person raising concerns isolated and exposed.
The question is not whether a person who raises safeguarding concerns should be immune from scrutiny. They should not. It is whether organisations can demonstrate that their scrutiny is independent, proportionate, evidence-based and free from retaliatory purpose. A process can appear procedurally respectable while being experienced as deeply punitive. And when the process becomes the focus, the original safeguarding concern can disappear.
Nolan, Hillsborough and the duty of candour
The Nolan Principles are not aspirations to be displayed in a boardroom. Consider the diary evidence. The issue is not whether a senior NHS executive was entitled to mentor a clinician. Professional relationships are ordinary and can be valuable. The issue is whether they were appropriately disclosed and considered when concerns arose about that clinician’s practice. How do we ensure that personal loyalties, whether conscious or unconscious, do not influence professional judgement?
It is striking that these questions arise as Parliament considers the Public Office (Accountability) Bill, widely known as the Hillsborough Law, which seeks stronger duties of candour for public officials. Its principle should be uncontroversial: those exercising public power must not place institutional or personal protection ahead of the public interest. The rules do not become less important because a person is senior, experienced or convinced of the correctness of their decisions. Quite the opposite.
When something goes wrong, is your first instinct to establish the truth or to defend your position?
D uty of care does not stop with those we agree with
There is another uncomfortable conversation that must not be avoided. It concerns Dr Sam Hall. The findings about clinical practice at WellBN are serious and demand scrutiny. But I also believe Dr Hall is owed a duty of care. That may be difficult for some readers to hear. It should not be.
Fair process, dignity and proportionate treatment are obligations, not rewards. Nor should one clinician become the sole focus of accountability if a wider network of organisations supported, commissioned or failed to scrutinise the care being delivered. We cannot make martyrs of those whose practice requires scrutiny. Equally, we must not allow them to become convenient repositories for accountability that has multiple points of failure.
Why there must be a public inquiry
I believe the case for a public inquiry into WellBN and the wider failures of NHS oversight is compelling. Not simply because of the clinical findings. Not simply because of Dr Redvers’s experience. And not simply because concerns were raised repeatedly without, to my knowledge, receiving the substantive investigation they warranted. It is the combination of those matters, and the unresolved questions about relationships, assurance and accountability across the system.
An inquiry must have the powers and independence to examine the whole picture. It must establish what concerns were raised, who received them and what decisions followed. It must examine the relationships between clinicians, commissioners, senior NHS leaders and regulators, including how conflicts of interest were managed and whether the regulatory system was sufficiently responsive to evidence of risk. It must examine the rogue referral pathways through which children were directed into this service. And it should ask whether the approach developed in Brighton influenced provision elsewhere.
An inquiry must follow the children, the decisions, the money, the relationships and the warnings.
Public trust must be earned
The NHS and its regulators are entrusted with public money, public authority and, most importantly, the care of people who may be at their most vulnerable.
There is a familiar institutional response when serious failures are finally exposed. New policies. New procedures. New assurances. Lessons learned. But learning is not the same as accountability. Accountability requires us to examine the decisions made, the relationships that influenced them and the warnings received. And it requires us to act on the answers.
The person who raises a safeguarding concern may always be the least popular person in the room. But in a functioning safeguarding system, they should never have to be the only person willing to ask the difficult questions.
Say the thing. Own the thing. Stay human.
The children and young people at the centre of this case deserved better.
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