Great Ormond Street Hospital – no confidence in CEO

I missed this on the news – but caught it on the BBC website this morning.

Over 40 consultants have apparently signed and handed over a letter of no confidence in the CEO and senior management of Great Ormond Street Hospital.

Ever since I got involved with the excellent child paediatrician, Kim Holt, who tried to raise concerns over the management and processes in Haringey’s child protection health team (which was managed by Great Ormond Street and included the doctor who failed to recognise Baby Peter’s condition) and who has been on ‘special leave’ ever since for her trouble – I have wondered whether the management would ever be brought to account.

I have been working on Kim Holt’s case now for three years.

Kim is supported by thousands of her colleagues who recently handed in a petition to the Secretary of State for Health.

I succeeded in getting an ‘independent’ investigation by NHS London into her case a while back – which reported about six months ago.

Ms Holt is a senior child paediatrician with an unblemished and exemplary record (as stated in the investigation by NHS London report) but she has been blocked from returning to her post for three years now – since she raised concerns about the management of child protection in the Haringey health team. The report recommended mediation as a route back to work.

However the Trust needs to be a party to the mediation in order for the dispute to be resolved.

Given that the Trust is the organisation against whom Ms Holt was a whistle blower, the Strategic Health Authority should ideally be commissioning the mediation process. Otherwise this is tantamount to handing back to the organisation that Ms Holt has made allegations about, the full responsibility for determining her future.

So – to find today – that over 40 consultants have taken such a serious step as signing a letter of no confidence in the CEO Jane Collins – would seem to back up everything that Kim Holt has experienced in trying to get her job back!

Baby Peter and beyond – Great Ormond Street in the dock

Kim Holt has finally broken cover over the health team’s part in the Baby Peter tragedy with an interview in the Sunday Telegraph with Andrew Gilligan.

Who is Kim? She is (or rather was) a senior paediatric consultant in Haringey’s child protection health team.

Kim first came to me (over a year ago), terrified to talk to me, as she had been gagged – forbidden to talk to anyone. However, because I was her MP, she and I believed that must give her cover as it couldn’t be the case that a citizen loses their right to talk to their MP.

Kim was desperately worried that children in Haringey were at risk because none of the senior managers at Great Ormond Street were taking proper notice of the concerns she and three other senior consultant paediatricians had raised about the dreadful way things were being handled by management in charge of the child protection health team. The four consultants were so worried that they took the unusual step of jointly signing a letter enumerating their concerns and stating that they believed management were ignoring them. This was exposed in the Evening Standard recently also by Gilligan – with a scanned version of the letter for all to see.

In fact, when Kim tried to raise these issues and became vocal about them – guess what – the establishment turned on her. She was bullied by management – and worse – the situation was ignored. She eventually found herself on ‘special leave’ where she has been for two years – kept away from work by management at taxpayers’ expense to try and stop her exposing what had been going on.

Worse than that – additional to keeping her from working (and she a senior consultant paediatrician with an impeccable track record of 25 years of dedicated service) they tried to buy her silence. They offered her £120,000 if she would sign a statement saying all her concerns had been addressed.

But Kim wouldn’t be bought off. Kim’s real and genuine concern is and always has been the well-being of the most vulnerable of children. That is why over the year or so since she first came to me – I have completely and totally supported Kim and believed that she is the victim of bad management, bullying and a desire by those in charge to not rock the eminent boat of Great Ormond Street.

So – when Kim first came to see me to tell me about the bullying – I went to see Richard Sumray, Chair of Haringey Primary Care Trust (PCT) to talk to him privately about this situation. The child protection task had been handed over from Haringey PCT to Great Ormond Street Hospital (GOSH). The existing senior manager in charge had been transferred across from Haringey PCT to GOSH. It was now a matter for GOSH. That is what he said – but he also said he would look into it.

Then the Baby Peter trial concluded and all hell let loose. Haringey Council was rightly first in line, as the lead agency and the most culpable, and got all the attention. But knowing a little at that time about the health team and wondering why there was a locum in place – the locum who failed to recognise Peter’s broken back and ribs – I started asking questions.

I raised it in Parliament and if you look back in Hansard you will see me raise the issue of why out of four senior paediatric consultants, two had resigned, one was on sick leave and one on special leave. (You will also read that our health spokesperson Norman Lamb raised it too). I was, at that point, still bound to keep Kim’s confidence but was desperately trying to get the health team management looked at.

Kim was still not working and in my view was being kept from working because of her whistle-blowing. At this point, I ‘phoned Ed Balls office and told them of the dreadful treatment of Kim Holt and said if they didn’t do something at some point this would all blow up and with the reputation of the world’s foremost children’s hospital at stake – they needed to act.

I was very pleased that I was called shortly after this by the Chief Nurse from London Strategic Health Authority who I met with and who undertook to carry out a private investigation of the issues around Kim’s bullying and exclusion.

That investigation reports this coming week. Kim gave an interview to the Sunday Telegraph – finally – because she believes the report leaves out the important issues. She is gagged from talking about what is in the report. I have not seen it – but have met with its author and the NHS chief nurse who briefed me on their view of the content.

Now we wait to see the report. But if it doesn’t get Kim back to work, it doesn’t dismiss any managers and it doesn’t tackle the bullying culture – then it will all have been for nought.

Two years since the Baby Peter tragedy

A spate of phone calls and texts from the media remind me that it is two years since Baby Peter was ‘allowed to die’. The anniversaries will come and go. The investigations, inspections and reports come and go. But what will really change?

The fear that haunts me is that the words are easy – ‘lessons must be learnt’ – but we heard that beating of the chest and wringing of hands post Victoria Climbie – but nothing much actually changed at Haringey Council. New processes were brought in post Lord Laming’s inquiry – but the culture of Haringey didn’t change one iota. It remained arrogant, unwilling to let in the light scrutiny – or even to be questioned. That defensiveness, secrecy and closing of ranks allowed a second tragedy of immense proportion to take place despite the promises that lessons would be learned.

What I think is that unless and until processes take place in a culture that is open, welcoming of questioning and where people do their own job to the highest standard possible (not relying on tick boxes but on conscience, good training and supervision) it could all happen again. I fear that some of the investigations and recommendations, followed by numerous action plans and inspections feel like lots is being done – but real change can only come from leadership at every level.

Sadly, secrecy prevails. The Government refuses to hold a public inquiry. The Government refuses to publish the (now two) Serious Case Reviews.

We still need that inquiry. Whilst Haringey, quite rightly, was held firmly in the spotlight of blame as the lead agency, the other agencies have had relatively scant focus. They have contributed their reports to the investigations – but the pressure is not so focused.

In terms of health – the managers at Great Ormond Street who refused to take the concerns of four paediatric consultants seriously (the four who signed a letter to the management flagging up the dangers for children because management were not listening) are still in place.

Ofsted, who inspected Haringey at the time of Baby Peter and gave them a three star rating which plummeted to one star post Baby Peter scandal, have got away virtually scot free.

The police, whose poor handovers and missing files led to the Crown Prosecution Service saying that had this been done properly they might have been able to bring an early conviction, are out of the limelight. And so on and so on.

Ed Balls says he doesn’t want to publish the Serious Case Review – even though this would allow professionals right across the country in all the agencies to witness the litany of failures, both personal and systemic – and so learn for their own services and their own work.

The shock of that document (which I am still forbidden to speak about – and I only saw the first one not the second one re-commissioned by Balls) is the casualness with which people did their jobs. To most people, if a child is on an at risk register – we would expect more rigour and absolute professionalism around such care. What we see is lots small failures: files lost, people not attending important meetings, missed appointments unchecked and unquestioned, inadequate or no handovers, etc etc etc.

How can lessons be learned when the details of what went wrong and how and why are kept secret?

So – I plough on trying to get things out in the open and done publicly. That is the first step only in my view. In Haringey, at least, the people have changed. The accountable people have actually lost their jobs – which at least sends the message that there is a point to the position – that there is responsibility and consequences. But as I say – in the end the two things I believe would offer better protection are a change in culture and the reinstatement of personal responsibility within any function – above and beyond putting a tick in a box.

Great Ormond Street Hospital – senior management must take responsibility over Baby Peter

So – Dr Al-Sayyat – the doctor who famously failed to diagnose Baby Peter’s broken back and broken ribs – is suing Great Ormond Street Hospital over her dismissal.

For all the criticism over her behaviour, that shouldn’t let Great Ormond Street off the hook. As far as I can tell Great Ormond Street’s management has a lot of responsibility for the hospital’s failings during the Baby P tragedy.

Yes, it was Dr Al-Sayyat who saw Baby Peter, failed to spot major injuries and was then dismissed following an investigation. But just as with Sharon Shoesmith – who wasn’t the actual front social worker visiting the house but paid the proper price for overseeing a system that failed so badly – so the senior people in charge at Great Ormond Street should have to take responsibility for a system that failed so badly.

Jane Collins (CEO), Dr Elliman (designated safeguarding doctor) and Jane Elias (senior management) are the key people at Great Ormond Street, who are commissioned by Haringey Primary Care Trust (PCT) to be responsible for running the children’s health service for Haringey.

The Evening Standard recently published a damning letter from four senior paediatricians to Elliman and Elias over desperately serious concerns about the safety of children at risk in the borough. Moreover, they say in their letter that their concerns are being ignored by management. And when the letter was published – Jane Collins went on TV and rather than facing up to the issue and taking action, she dodged around.

So – there is still a job to be done to ensure that the senior management at Great Ormond Street are properly held to account.

Between 2006 and 2008 out of four senior paediatricians, two resigned, one was off sick and one was on special leave. That left the staffing at Great Ormond Street’s services to Haringey’s children at danger level. And I only got those figures after digging and digging to find out why it was a locum doctor – Dr Al-Sayyat – who had looked at Baby Peter.

Those responsible for there being dangerously low staffing levels in such a vital service need to pay the same price as those in Haringey Council did for their part in Baby Peter’s tragic death.

Great Ormond Street failed Baby P too!

When I found out that the last doctor to see Baby Peter failed to recognise a broken back and ribs – like the rest of the nation I thought she must be a terrible doctor. And she clearly was. However, I also read that she was a locum – and ever since then I have been digging and digging to find out why there was a locum and what lay beneath.

I found out. And whilst I have no doubt that Haringey Labour Council and Sharon Shoesmith were first in line for retribution being the lead agency and lead individual – I have also had no doubt that there were other agencies who were just as bad.

There was a locum because the consultant pediatricians, four of them, in the children’s health department in Haringey (commissioned by Haringey PCT and run by Great Ormond Street – GOSH) had either left, been off permanently sick or on special leave! On digging I found that these doctors had raised their concerns with GOSH and been ignored. Yet again – management taking no notice of dangers being flagged up by professionals – just as the police and a senior social worker at Haringey raised concerns that Baby P should be taken away from the family.

I raised it on my blog. I got Norman Lamb (Lib Dem Health Spokesperson) to raise it in a health debate. I raised it myself in a speech in the chamber. But it is only now that investigative journalist for the Evening Standard, Andrew Gilligan, has found out the real detail of the story and broken it in the paper that the part that GOSH and Haringey PCT played in Baby P’s death is coming to light. He actually has a copy of the letter to the management at GOSH saying that they don’t believe the management has taken their concerns seriously and listing the reasons that children’s lives were at risk.

And yesterday – the Health Care Commission report into Baby P’s death also came out with findings that make it clear that there were systemic and individual failings in GOSH and the Health Trusts – all scandalous stuff.

What has been going on in children’s health in Haringey is practically a mirror image of what was going on in Haringey Council, Children’s Services and the Safeguarding Board.

I hope that this now all comes to light and that equally drastic and appropriate action is taken.

Needless to say – I will be writing to Ed Balls in this regard.