Quality | 2009.05.17
Great Ormond Street stung | Patrick Butler
A famous NHS name has taken a knock – but the Baby P tragedy was never Haringey\'s fault alone
For Britain\'s most famous hospital, the inquiry report into the National Health Service involvement in the Baby P case is humiliating and humbling. Great Ormond Street Hospital for Children NHS Trust is internationally renowned for its research and the quality of its clinical practice. By virtue of its high-profile charity fundraising campaigns, and a successful fly-on-the-wall TV documentary series, it has become synonymous in the public eye with excellence in child health. Its formidable brand, which the trust has been eager to exploit – both in the NHS market and worldwide – has surely taken a serious knock.
Yesterday the Care Quality Commission (CQC) – the NHS regulator – published the results of its investigation into health organisations involved in the care of Baby P, the 17-month-old who was on the child protection register of Haringey council in north London when he was battered to death in August 2007.
The child had over 60 contacts with public agencies in the months preceding his death. Of these, 35 were with the NHS, many of them with staff employed by Great Ormond Street Hospital (GOSH). The investigation found a catalogue of errors and failings that, in hindsight, may have proved disastrous for Baby P: inadequate staffing levels, shoddy training, dismal record keeping, poor communication with social services, and complacency about child protection procedures.
This raises uncomfortable questions about how much GOSH knew about the adequacy of its paediatric services in Haringey. In the year of Baby P\'s death, the trust had self-certified itself as "compliant" with national standards relating to child safeguarding as part of its annual inspection report. A report prepared for the board of North Middlesex University Hospital trust in January 2007 declared confidently that the partnership with GOSH was "going from strength to strength". North Middlesex\'s then director of nursing blithely told her board colleagues that "appropriate and effective" safeguarding structures were "embedded" in clinical practice.
Did GOSH and North Middlesex really not know their services were not fit for purpose? The London Evening Standard reported this week that four GOSH consultants had written to senior managers in 2006 warning of serious shortcomings in the Haringey paediatric services. The warning, the Standard claims, "fell on deaf ears".
GOSH\'s unhappy foray into Haringey – and it admits that serious problems remain, especially in attracting sufficient health visitors and other clinical staff – will raise questions about its management capacity and the viability of its commercial ambitions. GOSH aspires to maximise its income by exploiting its brand muscle and clinical expertise, selling its services to other hospitals. Its application to become a foundation trust is supposed to accelerate that process. How far that aspiration is now compromised will be interesting to see.
The CQC report also rebalances the view, espoused by the Sun newspaper and others, that culpability for Baby P\'s death lies solely with a handful of incompetent, politically correct social workers and their managers. This was always an absurd view: the failure to protect Baby P was a tragic accumulation of errors, exceptions, and misjudgments, some tiny and seemingly inconsequential, others major and far-reaching, on the part of social workers, police, health services, lawyers and family welfare workers. It will be little comfort to Sharon Shoesmith , the sacked Haringey director of children\'s services, who has been the prime focus of blame for the tragedy, that the CQC declared that "the NHS must accept its share of the responsibility".
For more information, please visit
http://www.guardian.co.uk/commentisfree/2009/may/13/baby-p-nhs-inquiry
