GOSH – the Lancet's view

Following my letter to Baroness Blackstone, Chair of GOSH Board in which I call for an investigation – in a signed editorial, Richard Horton (editor of the Lancet) arrives (pretty much) at the same conclusions that I did over the with-holding of information by Great Ormond Street from the Serious Case Review into the death of Baby Peter. I paste his editorial at the bottom

Interestingly he links the ‘cover up’ with GOSH’s application for Foundation Status and the dilemma that the Sibert report posed with its damning conclusions about the dangerous conditions at St Ann’s – where Baby Peter was seen.

Long ago on this blog – Friday November 21st, 2008 to be precise – I said:

I did go personally to see the Chair of Haringey PCT with all these concerns. I was told – this is no longer the concern or business of the PCT. They had ‘outsourced’ their health team to Great Ormond Street Hospital. So – in my limited research as to why such an important local service would be outsourced – this is what I have been told thus far. Great Ormond Street want to become a Foundation Trust Hospital. In order to do so it has to demonstrate ‘community outreach’. Great Ormond Street had none and no experience in that area. Hence it negotiated with Haringey to take on that department. Well – if that’s all the case, is that what should have happened?

So in the Lancet article (pasted below) Richard Horton sitesthe role of GOSH’s quest for Foundation Status as a potential reason why the information was with-held from the Serious Case Review.

CommentI mentioned a few weeks ago that a scandal might soon erupt at a leading London teaching hospital. It has now done so. The Home Office Equalities Minister, Lynne Featherstone, has called on the Chief Executive of Great Ormond Street Hospital for Children (GOSH), Dr Jane Collins, to resign. In a letter sent to the Secretary of State for Health, Andrew Lansley, as well as to the Chairs of the Care Quality Commission and the GOSH Board, Ms Featherstone writes that Dr Collins “appears [to have]…withheld vital information” from a serious case review into the death of Peter Connelly (also known as Baby P). On BBC television news, Featherstone said that Dr Collins “has to resign. I can think of no more serious charge”.

*

Peter Connelly was born on March 1, 2006. He died on Aug 3, 2007. According to a January, 2008, report by Prof Jonathan Sibert and Dr Deborah Hodes, commissioned by Dr Collins, doctors who saw Baby P at North Middlesex Hospital found injuries, bruises, skin breakdown, and deep tissue damage on his body at the time of death. Prof Sibert and Dr Hodes agreed with the view of one witness they consulted that St Ann’s Hospital, where Baby P was seen just prior to his death and whose clinical staff were employed and managed by GOSH, was a “clinically risky situation”. The arrangements for child protection at St Ann’s “cause grave concern”, they wrote. When a serious case review of the events surrounding the care of Baby P took place, it might have been expected that Dr Collins would submit the full Sibert/Hodes report as evidence. But only “a partial and selective version” (Ms Featherstone’s words) was passed on: “important information was deliberately withheld.” In particular, because GOSH was responsible for “the dangerous conditions” under which Baby P was seen and eventually died, and since “it appears that Dr Collins has attempted to cover-up the fact that the situation was ‘clinically risky’”, Featherstone concluded in her letter to Lansley that “the depth of the deception that has been perpetrated is unbelievable”. “Dr Collins bears a share of responsibility”, the Member of Parliament writes, for what looks like “a deliberate attempt to hide the management failings highlighted in the Sibert Report.” BBC news says that GOSH denies a cover up. The hospital’s Board, chaired by Baroness Tessa Blackstone, has complete confidence in Dr Collins. But there are unanswered questions. Have the events that led to the death of Peter Connelly been fully and transparently investigated? Have the right lessons been learned? And have those who managed (and continue to manage) children’s services at GOSH and its associated facilities been held properly responsible for the quality of care they delivered? The answers to these three questions are the same—we don’t know. These uncertainties now rest with the Secretary of State for Health to resolve as a matter of urgency.

*

There remains one additional and very puzzling question. Why did an alleged “cover-up” take place at all? The reasons given are, first, that GOSH submitted a partial report based on legal advice and, second, that the hospital had employment obligations to staff mentioned in the report. There is a third reason that ought to be considered. GOSH is seeking Foundation Trust status, an objective it hopes to achieve by autumn, 2011. The hospital’s perfectly legitimate quest for greater independence, which brings more freedom to manage its affairs, has been ongoing over several years and has not always been a happy journey. But this prestigious repositioning is now within reach. What GOSH did not need at this late stage was a public debate about the integrity of its leadership or the quality of its management of services that failed Baby P. When the highly critical Sibert/Hodes report landed on the desks of GOSH’s managers, they clearly faced a difficult dilemma. If they made the findings public, the inevitable media scrutiny might have damaged their reputation and slowed the progress of their Foundation Trust application. If they edited out GOSH’s failings, they might leave themselves open to the claim of “cover up”. An unkind observer might conclude that GOSH’s board is still trying to reduce its exposure to public criticism. I have no evidence to prove that this was (or is) the calculus of GOSH’s managers. But as one person close to these events put it to me, if GOSH’s management team had been in Wigan they would almost certainly have departed by now. Perhaps GOSH is just too important to be seen to fail. Even when a child dies.

Richard Horton

http://www.thelancet.com Vol 377 June 18, 2011

Offline: “The depth of the deception”?