GOSH – responds to my allegations

Great Ormond Street Hospital sent me their rebuttal of my allegations on the 21st June – which I post below. It is on their website too.

Needless to say – I disagree!  My response follows shortly.

21st June 2011

Dear Ms Featherstone,

I am replying on behalf of Great Ormond Street Trust Board to your letter of 8th June 2011 (which was received by the Trust on 10th June). In this letter, you called for an investigation into Dr Jane Collins’ actions, based on an allegation that the Trust withheld vital information from the original Serious Case Review into the death of Peter Connelly.

All members of the Trust Board have reviewed the documentary evidence in response to each of your individual claims. Our conclusions are that your allegations about the Trust’s failure to share information are incorrect and unsubstantiated by the evidence.

The Trust Board found that:

–  There was no intention by Great Ormond Street Hospital management to hide anything.
– Reasonable decisions were made about the information sent to the first Serious Case Review.
– The full Sibert report was shared with the second Serious Case Review.

We firmly reject any call for an investigation into Dr Collins’ actions and, as you will see from our specific responses to your allegations below, much of what you allege is factually incorrect. Attached to this letter are copies of specific documents which clearly show what you have got wrong. These documents have been scrutinised by an external legal advisor.

It is highly regrettable that you did not give the Trust the opportunity to provide you with this evidence to answer your allegations before you made them in public on BBC London on 9th June 2011. To clarify, you made your allegations public the day before I had received a copy of your letter.

The Trust has always accepted its failings in the care of Peter Connelly and said that it did not get everything right. However, to claim that the Trust deliberately sought to mislead any inquiry into his death is a very grave allegation which we refute.

I will deal with your particular allegations in turn:


1. Allegation 1 (withholding vital information)

I assume that you are referring here to the Sibert Report. The Sibert Report, as we assume you know since you have read it, was commissioned by Dr Collins. She commissioned the report specifically to examine the practice of the clinician involved in the case, once the nature of Peter Connelly’s injuries were revealed by the Police, (who had access to the coroner’s post mortem report). The Sibert Report was not commissioned as part of the SCR process and it was completed a matter of weeks before the original date of the criminal trial.

It is correct that the full Sibert Report was not shared with the first SCR, however this followed advice from lawyers and the police.

The following documents were shared with the Chair of the Local Safeguarding Children’s Board (who also chaired the Serious Case Review) and they contain the “vital information” about the service:
– An extract of the Sibert Report (see document 1 as sent)
– Draft updated recommendations arising from the Sibert Report (see
   document 1 in yellow highlight)
– Action plan as at 12th May 2008 (see document 2)
– A summarised version of the Sibert Report, (known as the Addendum), with
  an updated Action Plan as at 25th May 2008 (see document 3 – already in
   public domain)

The Trust Board carefully reviewed the information that was passed to the first SCR, and we do not agree that “vital information” was withheld. We believe that we provided all the information that was needed to the SCR from the Sibert Report.


2. Allegation 2 (deliberate attempt to hide failings)

The second part of this allegation concerns the motivation behind the decisions made as to what information should or should not be shared. i.e.

There is no evidence to support this allegation.

The whole Sibert Report was sent to the Metropolitan Police, the Crown Prosecution Service, the Joint Area Review (involving the Healthcare Commission), the Care Quality Commission, NHS London and the General Medical Council.

The Trust Board has reviewed the evidence, which includes documented discussions with lawyers and Police, and which provides the clear rationale for not sharing the whole document with the first SCR. The Trust took advice from lawyers at the time.

We are not able to discuss this because it is legally privileged. However, the advice we took from the Police concerned our duty not to prejudice the criminal trial. We told the Police we wished to co-operate fully with the SCR but did not want to prejudice the criminal process, and would therefore not send the full Sibert report to the SCR Chair unless they instructed us to do so, which they did not.

We reviewed Section 8.32 of Working Together to Safeguard Children 2006 (the guidance in place at the time) and noted its comment : “constraints on public information-sharing when criminal proceedings are outstanding, in that
providing access to information may not be within the control of the LSCB”.

This guidance was particularly pertinent given the imminent planned June date of the criminal trial in this case.

Failings within the service were clearly identified in several different documents (including the draft updated recommendations from the Sibert report) which were sent to the Chair of the LSCB as listed above, and thus could not and cannot be described as being ‘hidden’.

There is no evidence of any motivation to hide management failings. On the contrary, evidence reveals individuals at the Trust trying to do the right thing, and having to balance competing concerns in difficult circumstances.


3. Allegation 3 (removal of conclusions)

It is correct that the “Overall conclusions” section was not included in the Addendum. However, every critical point contained within this section had been previously communicated to the Chair of the LSCB in one or more other documents, including in the recommendations from the Sibert report (see document 4).

The words “clinically risky” which were contained within the “Overall Conclusions” section, were not themselves replicated in any other document. However, the fact that the Trust sent a list of 14 recommendations (including: increasing the numbers of doctors; appointing a named doctor; and developing a clinical pathway) does not
suggest an organisation seeking to hide failings, but rather to present a picture of a service needing significant improvement.

Turning to the specific issue of the arrangement at St Ann’s, GOSH management agreed with the view in the Sibert Report that the arrangements current at that time were unsatisfactory. The Trust took over the full running of the service in April 2008 and upon receiving the Sibert Report in May 2008, the child protection service was moved to the North Middlesex Hospital within weeks.
4. Allegation 4 (removal of two key recommendations)

It is correct that these recommendations were not in the list of recommendations included within the Addendum. We do not know the reason for this. However, given that the same individual had previously sent the full set of recommendations (including the recommendation to appoint a named doctor) to the Chair of the LSCB, it is not credible that there was any intention to deceive.

There is simply no evidence for your allegation of deception.


5. Allegation 5 (Dr Collins’ BBC interview)

The Trust Board reviewed the transcript of Dr Collins’s BBC interview last summer. Your summary of what she said is incorrect. The relevant passages are actually as follows:

 [What was shared by GOSH with the Chair of the LSCB]

“What we shared were the issues around the doctor. We shared information about what was happening at St Ann’s. We pointed out the issue about the named doctor”.

[Why the whole Report wasn’t shared]

“The Report included a review, which is what I had requested, about some other children. It wouldn’t be appropriate for their confidentiality to pass that information on……because they were children who were being seen for other reasons. Because I wanted a review of the whole practice, not just the child protection practice.”

Having reviewed the documents that were shared with the Chair of the LSCB the Trust Board supports Dr Collins’ statements.


6. Allegation 6 (issues found at St Ann’s clinic)

All of the above points have been discussed extensively in the media over the past three years. Points c) to g) formed the basis of the action plan which was included as part of the first SCR and over the last three years has been monitored as part of the multi-agency working.

With regards to points a) and b), the Trust continues to ensure – as it did in the substantive appointment of Dr Al-Zayyat – that all consultant appointment panels are properly convened. They must all include an external, independent Royal College representative (whose role is to ensure that candidates are not appointed unless they
are properly qualified) as well as local specialist clinicians.

In summary, these issues within the clinic at St Ann’s were sent to the Chair of the LSCB in May 2008 ( see documents 1,2 and 3). GOSH took over full running of this service in April 2008 and over the next three years these issues formed the basis of an action plan to improve the service, which the Trust succeeded in doing.


7. Allegation 7 (Consultant absences)

As the CQC Report acknowledged, Haringey is a challenging borough in which to provide healthcare, which makes it a challenging borough in which to try to retain staff.

The allegations made by one individual Haringey Consultant have already been extensively aired in public. As you know, an independent review commissioned by NHS London concluded that the concerns raised by this individual were genuine, and were taken seriously by GOSH. The Report also found that the Trust’s management made genuine attempts to address these concerns.

Turning to the two individuals who left, neither raised any issues with the Trust before they left, despite having the opportunity to do so.

In summary, this is not a new allegation, it has been fully investigated previously by the independent review commissioned by NHS London, the results of which were accepted by GOSH and NHS London.


8. Allegation 8 (Designated Doctor comments)

The Trust Board do not consider that it is appropriate to comment on any statement made by the Designated Doctor. This role was (and is) a PCT role, and this individual is no longer a GOSH employee.


9. Allegation 9 (not giving information to Graham Badman)

Firstly, it should be noted that the Addendum was an Addendum to the first IMR not to the SCR, therefore it was entirely appropriate that it was not published alongside the first SCR.

However, with reference to the substantive allegation, we have reviewed the documentation and it is clear that GOSH did share the full Sibert Report with the IMR writers for this second SCR. This is the normal and appropriate means by which agencies in an SCR process share information.

We do not know how the IMR team subsequently chose to share our Report. However we do have correspondence with Mr Badman which implies that he did have a copy of the report, and we are writing to Mr Badman to clarify this.

10. Allegation 10 (refusing information to Graham Badman)

Graham Badman did recently ask the Trust for a copy of the Sibert Report, which he mistakenly believed had been commissioned as part of the SCR process. On 22 December 2010 he spoke to the new Trust Solicitor who clarified that:

1. The Sibert Report was about the whole practice of Dr Al-Zayyat;
2. It was not only a report about Peter Connelly (Baby P);
3. The Report had been independently commissioned by the Trust;
4. It had not been commissioned for the IMR or SCR processes;
5. The sections of the Report about Baby P were shared with the SCR as an Addendum to the IMR.

The opportunity was missed to clarify our understanding that Mr Badman had already seen the whole report because the Trust Solicitor was not aware of that when she spoke to him.

We have been in communication with Mr Badman on this issue already, have apologised for any miscommunication between us and enquired whether there is any further information he requires from us.

Summary Allegations

You conclude your letter by highlighting the following:

Firstly, the Trust Board saw no justification for your decision to target Dr Collins so personally on this issue.

As I state at the beginning of my letter, each member of the Trust Board has reviewed the evidence, which has also been scrutinised by an QC. The conclusion of the Trust Board is that:

– There was no intention by Great Ormond Street Hospital management to hide anything.
– Reasonable decisions were made about the information sent to the first Serious Case Review.
– The full Sibert report was shared with the second Serious Case Review.

You suggest that managers did not face proper scrutiny. It is patently untrue that they were unscrutinised and that the facts about the situation in Haringey did not come to light.

Documents / reports that highlighted the situation in Haringey include:

– The 14 recommendations sent to Sharon Shoesmith in May 2008 (see document 1)
– The Action Plan sent to the SCR Panel in May 2008
– The Care Quality Commission report published in May 2009 (publicly available, see particularly pages 16, 19 and     20)
– All the monitoring documents of action plans as part of the Joint Area Review
– A variety of critical media coverage

As I said at the beginning of this letter, the Trust has never hidden our role in the tragic death of Peter Connelly. We have apologised for our failings on several occasions and alongside all the other agencies involved, tried to learn lessons. Since we took over the service in April 2008, we have implemented many changes that have been favourably reviewed by the CQC and others.

Your allegation that the Trust deliberately sought to mislead any inquiry into his death is serious and not supported by the evidence we have shared with you. On the basis of this, we ask you to withdraw it.

Yours sincerely,

Baroness Blackstone

Chair, Great Ormond Street Hospital for Children NHS Trust


Dame Jo Williams, Chair, Care Quality Commission

The Rt Hon Michael Gove MP, Secretary of State for Education

The Rt Hon Andrew Lansley, MP, Secretary of State for Health

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