Annex A > Chapter 16 - Support and Counselling > Guidance and expert evidence on support and counselling > Expert evidence
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Expert evidence
343 In addition to the oral evidence of Mrs Vegoda, Miss Stratton, the Reverend Cermakova and Mrs Pratten, the Inquiry heard evidence from Mrs Mandelson, Manager and Senior Counsellor at the Alder Centre, a centre based at Alder Hey Children's Hospital, Liverpool to offer support and counselling to anyone affected by the death of a child.
344 Mrs Mandelson told the Inquiry that the Centre had been open for ten years and provided a range of services to parents who had suffered bereavement, from parents who have lost a child through miscarriage, to those who had experienced the death of an adult child. The Centre also offers training and consultation to other professionals and carers who may be supporting bereaved families. [426]
345 In her evidence to the Inquiry, Mrs Mandelson commented:
`I do feel however that when we are talking about loss and grief work we need to recognise that it does not only apply to families who have lost a child but families who, when their child is diagnosed as having a life threatening condition, can find themselves dealing with potential loss and certainly the loss of a future they might otherwise have expected.' [427]
346 Mrs Mandelson commented on the structures and systems in place at Bristol and the nature of the services provided, and compared them with those in place at other centres during the relevant period.
347 She expressed the view that the necessary `joined up services' within the hospital seemed to be lacking. In terms of structure, she said:
`... I think it is very important when we think of the need for line management, and line management not only so that there is accountability, but there is also support and supervision of people carrying out a very difficult job. In a sense, that reflects on the service that they are able to deliver to the users of that service, because anyone who is under a great deal of pressure and stress emotionally, obviously then it is very difficult for them to question the service that they are able to deliver ...' [428]
348 Asked about the degree of isolation which came across in the evidence she said:
`I think the question of isolation is one that would be quite common in a sense, because I think in the late 1980s this was a fairly new area of work. I think bereavement services, bereavement support, counselling, was something that people certainly in the mid-1980s, they were doing as part of their work rather than being specifically employed in that position. It was an add-on; it was an extra. I think there were a lot of people working very hard to raise awareness around the issues and needs of bereaved families and bereaved parents, and I think with that push, we have seen the development of some of these dedicated posts, but very often, in a hospital you might just get one person doing that.' [429]
349 She stressed the need for peer support and peer co-operation and for the person in that role to fit into part of a team so that the support given to bereaved families is part of a continuum of care. [430]
350 As to how the services at Bristol compared with those in the rest of the country at the time she said:
`... I think certainly in the late 1980s, people were becoming very much more aware of the needs of families ...
`The centre of which I am a part opened in 1988 and at the time was the first centre of its kind in the country ... We have already heard Helen Vegoda say she paid a visit to the Alder Hey Centre. It seems a centre of excellence.' [431]
351 By the time Miss Stratton left in early 1994, Mrs Mandelson said that it was fairly common to find structures for support and counselling, of one kind or another, in most critical units:
`You may well find in some hospitals still it would be specialist social workers; in Leeds, certainly, there are structures that I am aware of through their Accident and Emergency Department doing a lot of work on bereavement support.' [432]
`One of the things that I feel is very important ... is the need for protocols. I think it is so easy for people and families to fall through the gap, certainly when there are lots of families, lots of demands on services and resources are scarce. We need to ensure that there are protocols in place for referral, for management of referral systems, etc to try and make sure that happens as little as possible.' [433]
353 Mrs Mandelson noted the distinction drawn between the terms `support' and `counselling', but told the Inquiry that what was important was that there were proper protocols or other measures in place to ensure that those most in need were identified and offered care. They would not necessarily identify themselves.
`What needs to be in place is a continuum of care that offers readily accessible and appropriate intervention at the time when it is needed by patients and families. Research has shown that often when people need help most that is the time they have the least personal resources to access such help. It falls to the professionals employed within an organisation such as the NHS to ensure that a system is in place that enables potential users of a support service to know what is available and how to access it. Whilst, for a number of reasons, not everyone would wish to use such a service, protocols and procedures should be in place which ensure equity of access to information and appropriate interventions.' [434]
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Footnotes
[427] INQ 0026 0007; Mrs Mandelson
[429] T47 p.178-9 Mrs Mandelson
[434] INQ 0026 0008; Mrs Mandelson