Great Ormond Street kept report into Baby Peter secret?

Tim Donovan of BBC London has done a brilliant piece of investigative journalism on the role that Great Ormond Street Hospital played in the Baby Peter tragedy. Read the full report here.

For months I banged on about the role of the health protection team and its management  – on this blog and on the floor of the House of Commons. Everyone leaped (quite rightly) to criticising the Doctor who failed to recognise broken ribs and abuse injuries – but she was a locum.

I, meanwhile, questioned why there was a locum there in the first place. And when I dug  – I found that there was a locum because four senior consultant paediatricians in the child protection health team which was now run by Great Ormond Street had either resigned, gone off sick or had been put on special leave. Dr Kim Holt – was the one put on ‘special leave’ because she was a whistle-blower on the dangerous practises going on in that department – more on Dr Holt’s dreadful treatment follows.

It emerged that the four senior consultant paediatricians (including Dr Holt) had jointly signed a letter to Great Ormond Street Hospital (GOSH) management saying that they were so worried about bad processes in the department that children were being put in danger. Sadly – a year later – they were proved right.

Now Tim Donovan of BBC London has discovered that Great Ormond Street Hospital commissioned an Independent Report on the role of the paediatric health team run by GOSH – and its finding were damning. Whilst we all heard about the Doctor who saw Baby Peter and failed to recognise the abuse and injuries – the report found that the conditions she was working under were unsafe. So whilst she may have been inadequately qualified – it was GOSH that had hired an underqualified doctor for such a senior post. Dr Al Zayat was under extreme pressure of work as the department was understaffed. Apart from the four consultants who for different reasons were not there -there was a lack of nurses. There was no information available about children coming to the department. No proper IT system. No Support. And, there was no ‘named’ doctor in the department – a vital role in child protection. Now – I (like everyone else) haven’t seen the report – so this is what I have been told.

But that over-used phrase ‘lessons must be learned’ is useless if facts are kept hidden.

This report never seems to have seen light of day. GOSH are now saying that it was made available to key agencies. But Tim Donovan has discovered that if anything at all was handed over to any investigating authority or agency – it was a summary only.

In the Joint Area Review – the report commissioned by Ed Balls that so damned and led to the sacking of Ms Shoesmith – there was barely a word about the role the health team played. I’ve read it – and we are literally talking about two lines about GOSH.

Given the importance of the role in Baby Peter’s death that the health team (or lack of one) played – you cannot help but come to the conclusion that the role of Great Ormond Street in all of this was suppressed.

I have raised the role of GOSH and the child health team in Haringey on the floor of the House. It is in Hansard. And yet – until now – there has been a deafening silence on this part of the Baby Peter tragedy.  I could not understand why such an important part of the jigsaw had no traction or even real interest from the powers that be. Was Great Ormond Street being protected?

I remember phoning Ed Ball’s office and threatening to raise hell if the treatment by GOSH of the whistle-blower Dr Kim Holt (the paediatric consultant who was and is still on special leave from the health team) was not put right. Ed Balls commissioned an investigation by NHS London (to his credit) but the findings of that investigation are also astonishing.

Whilst the report finds Dr Holt to have a spotless record and to be an excellent paediatrician and recommends that she is gotten back to work – the report also finds a whole series of faults with the management processes and some personnel in GOSH. Not a single recommendation pertains to that part of the findings.

GOSH has failed to re-instate Dr Holt now some five or six months since the findings of that report came out.

Haringey Council, of course,  rightly were first in the firing line as they were the lead agency and Ms Sharon Shoesmith the Executive Director of Children’s Services and the person under the 2004 Children’s Act in the accountable position.

However, the focus of the spotlight on Haringey Council does not mean that other agencies – GOSH, Haringey PCT (who commissioned GOSH) and OFSTED to name but three – should not come under the same scrutiny as Haringey.

The secrecy, the cover ups, the lack of transparency, the refusal to publish the Serious Case Review, the appalling treatment of whistle blowers Nevres Kamal (Haringey Social Worker) and Dr Kim Holt (Senior Paediatric Consultant) and now this vital Independent Report – all mean that we cannot be confident that lessons have been learned at all.

We need a public inquiry!

0 thoughts on “Great Ormond Street kept report into Baby Peter secret?

  1. As General Shukov said in the opening months of the Nazi invasion of the USSR ‘it gets worse by the hour.’

  2. Lynn has been unfalteringly in her support for uncovering the truth.

    I remain on temporary secondments in Great Ormond street with the job insecurity that that entails. I am saddened not only that we were unable to protect Peter, but that it was clear by the end of 2006 that we were headed for disaster.

    I have always tried to advocate for children. Vulnerable children have no voice and no vote?
    I owed it to Peter to speak out.

  3. A protracted establishment cover up, which continues..

    Hopefully with Lynne, Tim Donovan and Kim continuing to keep up the pressure something might happen.
    Kim should be reinstated.

    Dr Al- Zayyat was placed in a very dysfunctional environment and subsequently scapegoated. The national governmental and media knee jerk took her to the GMC and to a sick bed.
    I wonder whether the GMC saw the full Sibert report?

  4. Dear Lynn

    I would be very pleased to meet you at any time. I have been called a ‘public sacrifice’ by the appeal court judge. I have extensive material from my judicial review including 16 drafts of the Ofsted report and a record of what Christine Gilbert had to say to Ed Balls on 1 December 2008. Your comments about the Ofsted report are accurate but there is much more for you to consider. My judicial review did not examine or make judgements about the content of the report. You have come this far in understanding what happened to Peter Connolly, please don’t stop now.

    Yours sincerely
    Sharon Shoesmith

  5. There is a serious question here about patient safety, and quality of our services for the most vulnerable in our communities. As professionals we have a duty to speak up on behalf of our patients; in fact it is the first obligation under duties of a doctor according to the GMC, and we as paediatricians did but things got worse it now seems according to this report.

    Child protection is complex and difficult and requires all parts of the system to be functioning. If Professor Sibert had grave concerns in 2008, why was that not disclosed to the investigators and inquiries that followed?

    I myself have only seen this report in the past month.May 2011; it was written in may 2008; and I have been asking for it repeatedly over the past year.

    ( as one of the consultants employed to work in Haringey I should have been both interviewed and given the information in my view)

    There is a trust between employer and employee that seems to have been broken here. I agree with Lynn that there should be a thorough investigation of management practice within Great Ormond Street, and in particular examination of their adherence to whistleblowing policy, both then and now. It saddened and shocked me to observe Dr Al Zayyat made a scapegoat following Peter’s death, because she was left holding the fort. It is now widely known that she became seriously mentally ill to the point of suicide, and I question any society that thinks that she deserved that. She also was told by her employer that she had a permanent job after she had seen Peter; none of this makes any sense at all. It definitely warrants a proper investigation so that we can all really learn from this and move forward with confidence.