Crisis on the wards at a British institution
With criticism by inspectors and claims of bullying, is Great Ormond Street Hospital's halo starting to slip?
Friday 11 June 2010
It is Britain's most famous hospital – the largest centre for research into childhood illness outside the US, and the largest children's cancer centre in Europe. Mention Great Ormond Street and the coins cascade into the collecting tins – to the chagrin of rival institutions who say it swallows an unfair proportion of medical donors' cash.
But there are fears that things may be going wrong at our most cherished medical institution. There are rumblings of discontent among its consultants, 42 of whom have signed letters of complaint about the management. Allegations of bullying and intimidation are swirling around the corridors and 20 disaffected consultants met last week at the British Medical Association (BMA). Next Tuesday, the chair of the Medical Staff Committee, Graham Davies, has called a meeting of all consultants in the trust to head off the growing storm.
The meeting comes at a delicate time for the hospital. Despite its superstar reputation, it has still not qualified as for the NHS foundation status that would give it the freedom to manage its own affairs. It has lurched from crisis to financial crisis and over the past two years its "quality" rating has been downgraded by the independent inspectorate, the Care Quality Commission, from "excellent" to "good" to "fair".
After five difficult years, the trust expects to make a surplus this year, it is concluding its public consultation on foundation trust status and expects to put in an application in the summer. If all goes well, it should become a Foundation Trust next April.
But there are several hurdles to be cleared. The trust was severely criticised in 2009 over Baby Peter, who died in 2007 under the care of Haringey social services after suffering prolonged abuse. The Care Quality Commission said doctors and staff employed by Great Ormond Street missed dozens of opportunities to detect the abuse and blamed poor management, inadequate staffing and training and failures in communication.
Out of that scandal has arisen another headache. Kim Holt, a Great Ormond Street consultant, was placed on special leave after complaining about inadequate staffing in advance of the Baby Peter tragedy. She has been on leave on full pay since November 2007.
An inquiry by NHS London last year found Dr Holt had acted properly and should be reinstated. It recommended mediation but six months later, Dr Holt has not been reinstated.
She has been backed by Lynne Featherstone, MP for Hornsey and Wood Green and newly appointed Minister for Women, and a petition with 2,500 signatures was handed to the Health Secretary. Ms Featherstone blogged this week: "Since I got involved with the excellent paediatrician Kim Holt... I have wondered whether the management would ever be brought to account."
Referring to reports that over 40 consultants had signed a letter of no confidence in Jane Collins, the chief executive of the trust, she said: "This would seem to back up everything Kim Holt has experienced."
Dr Holt, currently on secondment working in a different area of the trust, told The Independent: "The reason we are up in arms is because management are doing the same to other consultants. You cannot believe the bullying and intimidation. People do not dare to challenge management.
"I am a whistleblower. I was told in November 2007 that I was not being allowed back to my job on grounds of my health and relations with management. The NHS London report said it was not good enough and I should have been supported. For two years I was stuck at home. They are talking about me going back to my old job but are making me jump through hoops."
Four consultants are understood to have begun grievance procedures against the trust. Their complaints were discussed at the meeting at the BMA and subsequently a letter was circulated expressing concerns about named members of management, which collected 42 signatures.
A group of consultants took the letters to a meeting with the chairman of the trust, Baroness Tessa Blackstone, last week. But according to the trust, the group did not leave the letters with the chairman or respond to requests to send her copies.
When reports emerged last weekend that the signatories to the letters had demanded the resignation of the chief executive, Jane Collins, supporters of Dr Collins, who has held the post for nine years, sprang into action. By 1pm on Wednesday, 122 consultants – half of the 242 directly employed by the trust – had signed letters of support for Dr Collins.
Baroness Blackstone issued a statement to staff of the trust in which she said she had promised to look into the concerns of the group of consultants that had been to see her. But she said she had "not been forwarded the letter referred to in the media". She added that Dr Collins and her management team "have the complete support of the Board". It is understood some of the letters signed by the disaffected 42 consultants expressed no confidence in Dr Collins but others aimed at other managers or made lesser demands. Leaders of the trust will be hoping next Tuesday's meeting of the whole consultant body draws a line under the protest. But it is unlikely to settle all the issues around Great Ormond Street.
While it does extraordinary work, some consultants, although at the pinnacle of their careers, express a sense of embarrassment that the trust is not living up to its reputation. The hospital enjoys a massive charitable income – contributing £126m to the £321m cost of its redevelopment project (and a target to raise another £120m by completion due in 2016).
A spokesman said the trust "absolutely refuted" all charges of a bullying culture. Its downgrading to "fair" on the quality assessment was attributable to 30 children needing spinal operations, where there was a shortage of surgeons, breaching the waiting time limit, he said. With an improving financial position and high levels of patient satisfaction, its worst problems were over.
A proud history...
* Great Ormond Street Hospital was founded as the Hospital for Sick Children by Dr Charles West in 1852 in a modest 17th-century townhouse. It was the first children-only hospital in Britain, run as a charitable foundation for the poor. It provided training and education and Dr West wrote a handbook on paediatric nursing before Florence Nightgale wrote hers.
* In 1929, J M Barrie bequeathed the copyright of Peter Pan to the hospital for the remainder of his lifetime and the bequest was extended in his will. A condition of the bequest was that the sum was never disclosed but it is understood to form only a small part of the trust's overall charitable income.
* In 1940, the patients were evacuated to Tadworth Court, an annexe in Surrey, and other temporary accommodation outside London, and the hospital was used as a casualty clearing station for the local population during the Blitz. A newly-completed wing was seriously damaged by bombing and was narrowly saved from complete destruction when stoker William Pendle was able to turn off the hospital's flooded and damaged boilers before they exploded.
* The hospital became part of the NHS at its foundation in 1948. It has scored a number of firsts including the first successful gene therapy trial and the first stem cell supported trachea transplant. It runs the biggest heart transplant centre for children in world. The hospital staff of 20 in 1860 has grown to 3,500 today who treat more than 100,000 patients a year.
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