Following recent media coverage of concerns about some of the island’s health services, I feel compelled to share publicly my experiences as a previous employee of Health & Social Care.
I believe the issues being discussed today are not new, and reflect similar cultural and systemic problems which I encountered nearly two decades ago.
Some of these have been highlighted by the challenge and scrutiny of services provided by Deputy Gavin St Pier and the defensiveness he has reportedly encountered.
I have decided to speak out partly to support the many families represented by Deputy St Pier who have campaigned for change, having been let down by health services when they needed them most.
Their experiences and mine are different and I am not for one moment trying to make them seem equivalent. There are, however, some common themes, chiefly the reaction of a dysfunctional system when it is challenged.
The families have spoken of the terror they feel in pursuing complaints. I have felt that, too, and it is only now, having left Guernsey five years ago and, with my children and I having no remaining connections to the island, that I feel safe enough to share my experiences.
This is my account of what happened to me. I do not name individuals because my purpose is not to pursue personal grievances, but to highlight systemic weaknesses which, in my view, caused harm – to staff, to patients, and to public confidence.
I was born and grew up in Guernsey. I returned to the island to work in 2004, as a clinical psychologist in the adult mental health department. I came back out of a sense of commitment to the island that had educated me and supported my professional development.
In 2007, I recommended referring a patient for an off-island assessment with a specialist service. I believed this was fully in line with National Institute for Health and Care Excellence treatment guidelines at the time. I met with the psychiatrist who was also involved in the case, but only once, after which all subsequent meetings I arranged, or attempted to arrange, were cancelled. I was surprised at this approach, as it was completely contrary to my previous experience working in the NHS, where team members worked collaboratively to ensure the best outcomes for patients.
Throughout the summer of 2007, I repeatedly tried to raise this issue with my line manager, who obfuscated and placated me.
The day before a short period of leave when I got married, in a meeting with my line manager, the exact words said to me were: ‘We will sort this all out when you get back, just go and enjoy your wedding’.
On my return to work three days later, I discovered that I had been locked out of my office.
Another manager met me at the door, demanded the keys to my office (and confidential patients’ files), told me that I was suspended and must leave the premises immediately. It took weeks to find out why I had been suspended. Eventually, I was told there had been a complaint about me, but not who had complained, or about what.
I was suspended pending an investigation which took five months to complete. During this time, I was actively contacted by another health professional who reported having experienced similar issues when they tried to initiate constructive clinical debate. Their housing qualifications, however, were tied to their job and they reported that the management had threatened not to renew their contract. It appeared that this was the preferred method of maintaining compliance with a culture best described as ‘command and control’.
Anyone unprepared to accept it was at risk of simply being removed from the health service. This practice was seemingly supported and certainly administered by levels of management who simply ‘looked the other way’. The problem management faced with me was that I was local and my housing qualification was not linked to my job. The normal method of disposing of staff who acted with too much independence of thought was unavailable. And I wasn’t going to give up.
I had benefitted from a States scholarship to The Ladies’ College and the States had paid my tuition fees to Cambridge University and part-funded my subsequent Masters degree. I had moved back to Guernsey to give back to my island. I also felt that what was going on was utterly wrong – not just for me professionally and personally, but also for patients referred to the service and ultimately Guernsey as a whole.
Even before my suspension, the team was carrying vacancies for psychologists, which led to a substantial backlog of referrals. There were applicants for jobs who were not recruited, despite being ideally qualified. This was clearly unhealthy and indicative of serious and systemic problems.
As the waiting list grew longer and longer, there was growing pressure on me to see more and more patients each day, to the point where they were being rushed through in a way that I felt and identified to management was unsustainable and resulted in an approach that afforded little thought or respect to the experience of the referred individuals.
I offered to research ways that we could provide services in fair, compassionate and respectful ways to maximise available resources, but that was rebuffed. The only way forward from management’s point of view was for me to see more and more patients, beyond what I believe were safe limits.
The investigation ultimately cleared me of professional misconduct. The report described difficulties in communication within the department which, clearly, I was already aware of and keen to see rectified, as I had been all along.
I wanted to return to work but HSC refused until there was a ‘return-to-work’ process in place. Despite insisting upon this, HSC was unable to say what such a process would involve, and this dragged on and on, resulting in an ironic, dystopian, ongoing nightmare. During this time, HSC tried to terminate my employment on a number of occasions, including when I was pregnant and during my maternity leave.
At one point, I received a letter from a senior member of staff at HSC informing me of a new condition necessary for me to return to work ‘safely’.
The condition, quite without any justification or explanation, was that I would need to sign a letter admitting that I had acted with gross misconduct and personally and professionally fallen short of expected standards. It did not seem to matter that the investigation, HSC’s own investigation, had unambiguously cleared me of any professional wrongdoing. I was astonished. Clearly, I was not going to sign any such thing.
At various times, my union representative said he felt as if his head was about to explode, so bizarre and unreasonable was HSC’s behaviour. He had a lot of experience of industrial relations and specifically involving public services, and he couldn’t believe what was going on. If it wasn’t for him, I don’t know where I would have been because I felt relentlessly hounded by this experience.
In 2009, my husband was diagnosed with terminal cancer when our newborn son was just five weeks old. During this time, three locum psychotherapists were flown to the island weekly to cover my work and put up in hotels with all expenses paid by HSC. All this happened whilst I was unnecessarily suspended on full pay. The costs to the taxpayer were enormous and obscene. In some cases, I believe the States was paying these locums £250 an hour, which was well above the market rate at the time as it was over 15 years ago, while also paying me to do nothing for two years despite being cleared by their own investigation.
On the second anniversary of my suspension, the story was documented in the Guernsey Press. The information contained in that article did not come from me. I suspected it had come from within HSC as the article included all the dates relevant to my case and none of this was in the public domain. The Guernsey Press reported the case accurately, focusing on the immense costs to the taxpayer.
I was eventually told I could return to work, but I was unable to as someone else had been recruited into my job. I considered going for constructive dismissal but I didn’t want to be forced into private practice as it wasn’t what I had been trained to do. I just wanted to do the job I was employed to do.
Instead, I was offered a project setting up a new primary care mental health and wellbeing service. By this time, I had been off work for over two years, and had developed concerns about how I would effectively return to a clinical role, and so I took the job I was offered.
I worked with colleagues to build the new service, which is still running and now known as Healthy Minds, and we made a success of it.
By this time, my husband was so poorly that he wasn’t working. Although I had great reservations about going back to work at HSC, frankly we needed the money. My husband died in November 2011. By this time, enough of the management at HSC had changed, and there was more support and professionalism.
I continued to work with HSC until the summer of 2020, when I moved to the UK. In my latter years at HSC, I worked with better managers, who had the confidence to challenge the status quo when they needed to, and excellent psychiatrists, who were not only open to but actively welcomed and invited professional debate for the good of the patient. It was a different world from my experience of earlier years – not perfect, but much, much better – and that contrast reinforced my belief that leadership and governance profoundly shape whether organisations respond defensively or reflectively when challenged.
I must say that I am still processing this experience almost 20 years later. What troubled me most was not simply the suspension itself, but what it revealed about the organisational culture at the time. From my perspective, the system appeared ill-equipped to manage professional disagreement in a mature and transparent way. Raising a clinical concern led not to dialogue, but to escalation and exclusion.
I do not compare my experiences to those who have had problems with their sick children and the medical profession, but the factors underlying my case seem to mirror many of the problems I have heard described by the families campaigning for change in recent years.
In my view, some consultants in the medical profession work in the context of a system which discourages challenge, even when it obviously and clearly contributes to good clinical care.
I felt at the time that a major factor which encourages poor practice is the presence of managers, many of them nurses, untrained and unsupported in management or leadership skills.
They had trained, and had often only worked within, a local, patriarchal system in which nurses must defer to doctors at all times. I saw this with my own manager on many occasions, who clearly saw what was wrong, and the impact it was having on me, and the service, but felt powerless to act.
I also believe it is unhealthy for HSC to be led politically by former medical professionals, as was the case at the time of my experiences and is again today. I believe that, sadly, this encourages silence and complicity at a political level.
Both the head of the civil service and the political committee of HSC knew about my case at the time.
I understand and concur with a point made many times by Deputy St Pier and other deputies supporting him – that this is not about individuals but about an incompetent and dysfunctional system which needed scapegoats, and clearly and sadly still needs them as a way of managing conflict and challenge.
I feel appalled, years after my unhappy and traumatic experience, that these dynamics are still prevailing in too many parts of the health service.
I remember my union representative saying to me many times that he was ‘shocked but not surprised’ and that still seems an apt description today of a system in need of significant further reform.
Healthcare organisations must be able to tolerate scrutiny, and indeed welcome it. Clinical disagreement is not misconduct. Raising concerns, or even clinical views contrary to those in the room who are more senior or who are ascribed more power by HSC, should not result in professional isolation. Where systems respond defensively, trust erodes – among staff and among the public. HSC must ensure that governance structures are robust enough to distinguish between legitimate professional challenge and genuine misconduct.
If Guernsey is serious about restoring and maintaining confidence in its health services, it must ensure that:
investigations are transparent, timely and proportionate;
professional disagreement is welcomed, supported and treated as part of good clinical practice;
leadership is equipped to manage complexity without defensiveness; and
staff can raise concerns without fear of exclusion.
Only then can the system move from reaction to reflection.
I share this account because I believe sunlight strengthens institutions. Accountability is not an attack on healthcare – it is essential to its integrity.