Great Ormond Street tries to lie its way out of trouble

I have described in the past how Great Ormond Street Hospital has provably lied to try to counter stories about its failings in the Baby P case. The hospital employed the doctors at the Haringey child protection clinic which missed Baby Peter Connolly’s broken back.

In May 2009, I revealed that all four consultants at that clinic had warned Great Ormond Street management, in writing, a year before Baby P’s death that there was a “high risk” of a tragedy because the place was so understaffed. After my story, Great Ormond Street’s chief executive, Jane Collins, claimed that the consultants’ concerns had been “addressed at the time.

The truth, alas, is that after the consultants’ letter, GOSH reduced the number of consultant posts at the clinic still further, from four to three, and removed the consultant identified as the ringleader of the protest, Dr Kim Holt, from her job: a post to which she has still not been reinstated. By the time Baby P came to the clinic, all four of the experienced permanent consultants had been either removed, had left in disgust, or gone sick, and he was seen by an inexperienced locum. The hospital subsequently admitted that Ms Collins’ statement “could be seen as disingenuous” and removed it from its website.

In December 2009, Dr Holt told me that Great Ormond Street had offered her £120,000 to “buy her silence” – an offer she refused. In response, Great Ormond Street lied again, claiming the offer of money “took place before any specific concerns were raised by [Dr Holt] around child protection.” In fact, the offer was made eighteen months afterwards, and I’ve seen papers which prove it.

Last month, we learned that Great Ormond Street “covered up” the findings of an internal inquiry into the Baby P case, editing it to remove serious criticisms of itself before passing it on to the external “serious case review.” Great Ormond Street claims it did this on police advice. Last week, the police told the BBC that this was not true.

On Sunday, I published a report, based on leaked emails and documents, about broader failings in patient care and deep dissatisfaction by medical staff in the hospital. It included the statement that Great Ormond Street’s quality rating had been “steadily downgraded in recent years by the NHS inspectorate, the Care Quality Commission, from ‘excellent’ to ‘good’ to ‘fair.’”

In an email to staff yesterday, passed to me, Ms Collins said: “I want to correct the statement in the Telegraph that the hospital’s quality rating has been steadily downgraded. For last year, we would have been awarded ‘excellent’ had the ratings system not been abolished. Our previous rating of fair (not poor, as the Telegraph claimed) arose from long waiting times in only one specialty, where there were national capacity issues.

“Once again, I want to dispute claims that individuals are making (again, anonymously) about being “targeted” for raising patient safety issues.”

Well, if you’ve read the article you’re probably ahead of me. We never claimed that the hospital had ever rated poor. (In fact, as you might expect a hospital chief executive to know, there is no such rating – the bottom rating is “weak” – and we never claimed the hospital had rated that, either).

Two of the individuals who have been targeted were not anonymous – they were named in the piece. And as for Ms Collins’ claims that Great Ormond Street was not “steadily downgraded,” here is the evidence. “Excellent” in 2006/7 goes down to “Good” in 2007/8 and down again to “Fair” in 2008/9 (published last year, and the last available verdict before the ratings system was abolished.) Ms Collins may think she would have been back up to “excellent” by now – but the whole point of rating systems, alas, is that you can’t rate yourself.

Kim Holt is very lucky to have as her MP the superb Lynne Featherstone, who has been fighting her constituent’s corner for the last three years. The hospital has been sabre-rattling against her as well, publishing on its website a, shall we say, unsatisfactory account of its dealings over the issue. Ms Featherstone has now published her response – and she, too, accuses Great Ormond Street of “concealing” and “misleading.”

This kind of behaviour is always a deeply telling sign of an institution in real trouble. Ms Featherstone has called on Ms Collins to resign, and says that if what is known now had been known at the time, she would have gone three years ago, along with Haringey’s Sharon Shoesmith. I agree.


Great Ormond Street: a hospital in serious trouble

Among the general public, the Great Ormond Street Hospital for Sick Children still has a high reputation. Criticising it sometimes feels a bit like questioning the health of Prince Charles’s marriage in, say, 1985. But in the annual assessment exercise by the NHS regulator, the Care Quality Commission, its rating has declined from “excellent” first to “good” and then merely to “fair.” And in the medical profession, there are deep concerns about what has been happening at this celebrated institution.

After the hospital’s serious failings in the Baby P case, as documented at length by me and BBC London’s Tim Donovan, the respected medical journal, The Lancet, stated in a recent editorial (free but requires registration) that “if Great Ormond Street’s management team had been in Wigan they would almost certainly have departed by now. Perhaps Great Ormond Street is just too important to be seen to fail, even when a child dies.” A government minister has called on the chief executive to resign. This week’s Lancet includes a letter from a number of GOS consultants demanding an independent inquiry (as well as one from the hospital defending itself.)

Increasingly, however, it is clear that the hospital’s problems are wider than those exposed by Baby P. My story in today’s paper starts:

“The crisis at the world’s most famous children’s hospital has been laid bare by damning leaked documents.

“In emails, letters and secret internal reports, consultants at Great Ormond Street Hospital say that vital medical services have been “destroyed,” patient safety is “at risk” and they have been “harassed and targeted” by management for raising their concerns.

“In one of the leaked letters, Dr Cathy Owens, one of the world’s most eminent child radiologists and herself a Great Ormond Street consultant, says there is a “culture of fear” in the hospital with “malicious and vexatious targeting” of doctors who complain.

“She says her department is in a “dire situation” after steep job cuts and a number of experienced consultants being forced from their posts. Dr Owens is the current general secretary, and former president, of the European Society of Paediatric Radiology.”

You will also see Christine Hall, emeritus professor at Great Ormond Street and a former consultant at the hospital, quoted as saying that “management at the hospital has failed on all levels from the top down…I speak to other clinicians around the country, and they all ask: what is going on there?”

Read the whole thing here.

Baby P: Great Ormond Street 'deeply mired in denial'

One of the best signs of a serious scandal is when the body concerned flatly denies facts which are provably true. By that criterion, Great Ormond Street Hospital is in desperate trouble today over its role in the death of Baby Peter.

Yesterday, one of the consultant paediatricians at the clinic which failed Peter, Dr Kim Holt, told me that she – and all her three senior colleagues – alerted managers, more than a year before Peter’s death, that the clinic was inadequately staffed, “falling apart” and that a child could die if action was not taken.

Instead of acting, she says, Great Ormond Street – which employed the doctors at the clinic and was the “lead agency” on the health side for child protection in Haringey – “bullied” her, forced her out of her job on “wholly spurious grounds” (meaning she was not around when Peter came in) and later offered her £120,000 to keep quiet.

“They were in a panic [after Peter],” she said. “They said I had to withdraw my allegations or the money was off the table. They wanted me to sign a statement saying that all my concerns had been addressed. I refused because it would have been a lie. They were trying to buy my silence.”

Great Ormond Street has issued a statement saying that it does not accept Dr Holt’s version of events. But the hospital’s statement casts far greater doubt on its own credibility than on hers.

Extraordinarily, the hospital claims that the offer of money “took place before any specific concerns were raised by [Dr Holt] around child protection.”

That simply isn’t true. As documents I’ve seen prove, the offer of money (initially a year’s salary, later rising to £120,000) was first made in November 2007 – eighteen months after Dr Holt and her three colleagues raised concerns about child protection, in writing, to their senior managers, Jane Elias (from NHS Haringey) and David Elliman (from Great Ormond Street).  You can see their very strongly-worded letter – which Great Ormond Street concedes was written in spring 2006 – here.

Great Ormond Street also claims that a report by NHS London into Dr Holt’s case – due to be published tomorrow – “broadly supports [the hospital’s] view of events.” Well, I have a leaked copy of the report – and that’s another clear misrepresentation.

This report isn’t a total slam-dunk for Dr Holt. It doesn’t find that she was “targeted” for complaining, something she takes issue with, although it does say she was right to feel aggrieved at the way she was treated.

It’s written in classic weedy, circumlocuted bureaucratese and does its best to underplay the failings it finds. In another favourite trick of official reports, its rather bland findings (at the front) are not fully consistent with the serious failings it outlines in the detail section at the back.

But, particularly if you read into that detail, it is far more favourable to Dr Holt’s version of events than to Great Ormond Street’s.

The version I’ve got says that there was was inadequate staffing at the clinic, “the workload of the consultant team was excessive” and “the concerns raised by the consultant team were genuine and well-founded.” It says that the consultants’ concerns were “taken seriously” (Dr Holt disputes this) and some action was taken on some of the complaints but there was “no evidence” that the consultants’ main concern, their workload, was “adequately addressed.”

The number of consultant posts at the clinic was in fact further reduced after the consultants’ complaints, from four posts to three. Since Baby P, consultant staffing at the clinic has been increased to nine posts. As for “taking the concerns seriously,” this seems to have consisted of drawing up an “action plan” almost entirely on paper.

The NHS London report quotes another doctor, Michelle Zalkin, saying that Great Ormond Street managers created a “very hostile environment” which became “pervasive, insidious and quite unbearable.” Managers communicated, she said, largely by “shouty emails and post-it notes.”

A team leader, Nicola Bennett, said she was reprimanded after voicing her concerns and told “that she should have adopted the management line.”

Another consultant at the clinic, Dr Sethu Wariyar, accused a senior manager of being “confrontational and divisive.”

The NHS London report says that David Elliman, the senior Great Ormond Street manager responsible for the clinic, claimed that the problems in 2006-7 did not affect patient safety. “That is a conclusion with which we would not agree,” the investigators say.

The NHS London report describes Dr Holt as a “highly committed, efficient and effective” doctor. It says: “We do not consider Dr Holt has been directly targeted, but we do consider that she is entitled to feel aggrieved… Dr Holt feels strongly that she should be entitled to return to Haringey, and that she has done nothing wrong which would prevent her from doing so. We accept that… We can see how she feels she has been penalised for [whistleblowing.]”

Were I a harsher person, I would say that some of Great Ormond Street’s claims about Dr Holt and the NHS London report are simple, straightforward lies. Let us instead simply echo the view of Dr Holt’s MP, Lynne Featherstone, that this prestigious and respected institution is “mired in denial”.