Delays in appointment
GOSH has made it clear that failure to see the child promptly was unacceptable and procedures have been revised.
There are three broad areas of concern: the letter of June 2006, staffing levels, and whether staff were put under pressure for raising concerns.
Concerns acted on at the time
The letter of June 2006 concentrated on a long list of administrative and process issues. The management of the service at the time felt that they responded fully to these concerns at the time, meeting with the consultants and drawing up plans with the doctors to address the issues.
Reduction in staffing at unit
GOSH does not accept that temporary reductions in staffing at the unit were in any sense a response to or caused by the letter of June 2006.
Haringey TPCT is the commissioner and they ultimately decide on funding levels of the service, and hence the maximum possible level of staff. That we then have to recruit and retain those doctors is clearly our responsibility. That is why senior management at the hospital met regularly with the management of the service around recruitment issues and why some locum costs were met from Great Ormond Street Hospital central budgets rather than the service.
These are hard roles to recruit into and to retain staff. Trusts struggle to fill community paediatrics posts.
Allegations of failure to act independently investigated when GOSH took management control
It was only after Peter’s tragic death that Great Ormond Street Hospital (GOSH) took over the service and then senior management became aware of allegations that concerns raised in June 2006 ‘had not been acted on'. GOSH commissioned an independent investigation, which found that Haringey PCT and subsequently GOSH had taken steps to address those issues now raised. By this time a second independent investigation had been commissioned by NHS London, with which we are fully cooperating.
The Trust may be in a position to respond more fully when that investigation is concluded.
Were staff pressurised for raising concerns?
GOSH has no evidence that any of the consultant staff were in any way inappropriately pressurised for making comments about the service. NHS London is investigating such matters.
Two of these doctors are returning to duty. We understood that the other two consultants moved essentially for family or career reasons. The doctor who first spoke to the Standard had a 1-2-1 with the chief executive on his departure and at no point raised any issue about the service, other than a specific clinical development issue. (in essence, whether he could provide a certain clinical service on the Great Ormond Street Hospital site.)
What we need to make clear is that if we have evidence that staff were pressurised into either ignoring clinical incidents or as a result of raising professional concerns, we will take that seriously and we will investigate immediately. (independently of whether these matters have also been raised with NHS London or any other body.)
Division of management roles pre 1 April 2008 acknowledged not to be ideal
We have confirmed that division of responsibility within the service was far from ideal, with Great Ormond Street Hospital providing the doctors and some oversight of child protection, the Primary Care Trust providing all other staff including the service manager, and as commissioner, providing the funding. This is one reason by mutual agreement, Great Ormond Street Hospital took total responsibility for the whole service 1 April 2008.
Actions to address funding, staffing levels, administrative processes
GOSH and the PCT have worked together to find additional funding to increase numbers of medical staff, improve processes, and provide better administrative support. The Trust made a number of significant changes to the service once it had management control, including moving child protection medicals to the designated child protection unit we run jointly with the North Middlesex University Hospital. There are currently 5.4 doctors in the service, an additional full time post is being advertised and we are seeking still further funding.
GOSH-ICH Press Office: 020 7239 3125
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