Demands for inquiry after fresh claims hit Alder Hey

New concerns have been raised about its surgical record and bullying culture

Nina Lakhani
Sunday 09 January 2011 01:00

Patients' groups and MPs are demanding a fresh inquiry into procedures at the Liverpool hospital previously at the centre of one of the worst scandals in British medical history.

Alder Hey Hospital has been accused of withholding information about patients, failing to investigate questionable surgery and allowing a culture of bullying.

Whistleblowers working at the hospital claim they have been sidestepped and their complaints ignored. The Alder Hey Children's Foundation Trust denies this, saying it has "robust clinical governance systems... to ensure the highest levels of patient safety".

But this newspaper has been in touch with lawyers, parents and health workers involved in an internal review into the surgery department at the hospital. Their criticisms include the hospital failing to investigate properly serious cases in which children died and others needlessly suffered serious harm after surgery; evidence that information has been withheld from families, lawyers and health regulators; and claims that doctors and nurses who speak out against substandard care and inadequate investigations face being bullied, undermined and disciplined.

The Independent on Sunday has been told that an internal review into one department uncovered a "distressing and unpleasant" culture of poor leadership, bullying and high stress levels. MPs called this weekend for an independent inquiry into the allegations.

Bill Cash, Tory MP for Stone, Staffordshire, voiced concerns in Parliament after constituents raised the alarm about the treatment of a whistleblower who worked at Alder Hey. "In light of these most recent investigations by The Independent on Sunday, there is a very powerful case for the Secretary of State to instigate a formal investigation into the whole matter," he said.

The revelations are particularly worrying as £20bn in NHS spending cuts rattles public confidence about patient safety.

The children's hospital has spent years regaining public trust after the scandal in which hundreds of organs and tissue samples were removed from dead babies without their families' permission between 1985 and 1998. The trust was criticised during a public inquiry for failing to supervise properly the pathologist at the centre of the scandal and failing to follow up complaints.

Peter Walsh, chief executive of the patient safety charity Action against Medical Accidents, said: "It is disgraceful if yet again the concerns of patients' families and staff are being ignored and, worse still, the hospital is covering up concerns and victimising whistleblowers... This is the kind of culture and failure in regulation that allowed the scandal at Mid Staffordshire to happen. Somehow, it has become 'politically incorrect' for regulators to intervene and get to the bottom of problems."

Alder Hey is world renowned and provides specialist care for 200,000 sick children across the North-west every year. Its quality of care has been rated excellent by the health regulator for the past six years. Mortality rates across the surgery department are better than average when compared with other children's hospitals, according to information provided by the trust.

But internal documents seen by the IoS show clinicians have repeatedly raised concerns about a number of serious surgical cases to senior officials, including the former chairwoman, at the trust and the University of Liverpool over the past two years. This includes a case where the trust failed to investigate allegations about a baby who died hours after an operation that the surgeon was warned could risk the baby's life. Nearly half of all complaints about the trust over the past five years have involved the surgery department, according to its own figures.

In spite of this, the trust has assured regulators and ministers that concerns about the baby's death among others were properly investigated, and unfounded. The Care Quality

Commission (CQC) said it was "fully satisfied" that the trust correctly followed up concerns raised by a whistleblower last year and that is has no concerns about quality and safety at Alder Hey. A Department of Health spokesperson said that the IoS's findings "have raised some issues of serious concern... The regulator, the CQC, has been made aware of concerns, and is satisfied that Alder Hey NHS Foundation Trust currently complies with all essential quality and safety standards."

The trust dismisses allegations that serious incidents, near misses and deaths are not always discussed in formal meetings recommended by national guidelines as the best way to learn lessons and improve standards. But the IoS has been told of incidents where doctors or nurses who raise concerns about a child's care are not always invited to participate in the meetings, which could result in vital information being missed. The IoS has identified parents kept in the dark by the trust, at times unaware of concerns raised by clinicians regarding the care of their child.

"We are confident that we have robust clinical governance systems in the trust to ensure the highest levels of patient safety and conform to national Department of Health standards," said Louise Shepherd, Alder Hey's chief executive.

Tory promises to strengthen legal protection for public sector whistleblowers have not been implemented. At Alder Hey, as at other NHS organisations reported in this newspaper, staff who speak out against poor practice can face punishment and find their careers blighted. And contrary to NHS policy, the identity of whistleblowers has been exposed to trust managers.

A recent internal review heard stories from dozens of staff members who disclosed details of intolerable stress levels, poor leadership and bullying and harassment within the surgery department. A respected counsellor at the trust, Alan Phillips, was granted permission to carry out the confidential inquiry after a stress awareness session for theatre staff "opened the floodgates" to large numbers of people coming forward with "distressing and unpleasant" experiences.

Mr Phillips told an undercover IoS reporter: "Patient safety is a major theme that's coming through. Stress and working hours, conditions, the leadership – they are considered so severe that they are potentially detrimental to patient safety... I've got several quite worrying examples... The second theme is the safety of the staff themselves, people worried about nervous breakdowns, self-harming, etc... a couple of people saying they are worried about the mental health of staff with the potential to commit suicide. [This is a] very, very serious thing to happen.

"The third theme is whistleblowing. If something doesn't happen, people are saying they're going to be forced to go outside the trust. And a fourth theme is violence and aggression against colleagues because of tempers and people at the end of their tether."

One paediatric surgeon was suspended for a year after continually highlighting patient safety concerns. Shiban Ahmed was suspended in March 2009 by Alder Hey and University Hospital of North Staffordshire and forced to undergo psychiatric assessments amid unfounded rumours about his mental health. He was reinstated in April 2010, with no explanation about his suspension.

Mr Ahmed withdrew from his employment tribunal in October because of escalating legal costs. Despite this he has continued to highlight ongoing concerns to senior officials and doctors at the trust, MPs and the CQC. Alder Hey is pursuing him for its legal costs.

Graham Brady, Conservative MP for Altrincham and Sale West and chair of the 1922 committee, said: "When a senior and well-respected consultant like Mr Ahmed raises concerns, it must be in everybody's interest to investigate these concerns. Instead, Mr Ahmed has set out evidence that he has been placed under pressure not to speak out. It is vitally important that all of these issues are properly investigated and bought out into the open."

Several trainee surgeons took the unusual step of raising concerns about a colleague, Pierina Kapur, to a senior doctor responsible for trainees at Alder Hey. They reported that she regularly avoided surgical procedures, instead relying on colleagues and more junior staff to cover for her lack of confidence and skills. Miss Kapur has been involved in at least two cases where children suffered severe complications from surgery. The IoS has learnt that there remain ongoing "concerns" about her work.

John Pugh, Southport MP and chairman of the Lib Dem parliamentary health committee, said: "To protect the reputation of the hospital and the safety of patients means you have got to ask the awkward questions and challenge where necessary establishment complacency. That may not a great way of getting on in the NHS but it's what the public want and need.

"This shows how difficult it can be to get the NHS to own up to mistakes and to protect genuine whistleblowers. If there is a culture of bullying those who have expressed concerns, then the hospital board's failure to notice or deal with it is very worrying."

Alder Hey's medical director, Dr Sian Snelling, said: "The safety of our patients is our highest priority. We are extremely proud of our best-in-class mortality rates and have achieved the highest standards of safety by the NHS Litigation Authority, something no other paediatric trust has achieved... The trust has clear policies and procedures in place concerning complaints and concerns. We fully embrace national policies encouraging staff to be open in communicating with parents and carers if there has been cause for concern. The trust strives to provide any information to parents and families about their child's care or any evidence of clinical incidents."

The Baby

Baby Mohammad Yousaf Nassar was born on 16 October 2009 weighing 6lb

He needed surgery because a prenatal scan detected two conditions involving his kidneys and anus, but which were not life threatening. He was transferred to Alder Hey for specialist care on the day he was born.

Despite a number of planned operations, he was bright and alert, with no major problems apart from those which doctors said were treatable. After his third operation, his parents were told that their son's bowel had been accidentally cut while he was being sewn up. "He said it was just a little cut, like you get on your finger, and that it would heal as he grew," said his father, Nassar Yousaf.

A few days later the baby started struggling to breathe. Tests were conducted, but they all came back negative, said Mr Yousaf. A blood test showed he had contracted E. coli, but his parents were never told how he could have contracted it. "The doctors said his stomach was fine, that his kidneys were getting better, and there was nothing wrong with his heart, so we were never that worried."

After leaving his son asleep on 1 December, Mr Yousaf received a call in the early hours of the morning. His son was dead. "After he died his doctor said that he hadn't thought he would make it when he came into hospital, so why did they operate on him? His kidneys and bowel problems were getting better. He was alert, responsive. All the tests they told us about were clear, including the heart scans, and yet his cause of death is cardiomyopathy."

The family was offered but refused a post-mortem, in line with its religious beliefs, but an independent expert has told the IoS that the baby's cause of death should have been further investigated. Mr Yousaf said: "I keep getting flashbacks of how he looked in my arms when he died. I need to know why he died so unexpectedly." NL

The Consultant

Pierina Kapur, 44, who trained as a surgeon at Alder Hey between 2001 and 2004, was found guilty of misconduct by the General Medical Council last year after she wrongly removed 90 per cent of a baby girl's bladder, mistaking it for a hernia

Alder Hey says it holds no record of any complaints about Miss Kapur, but at least three colleagues verbally reported their concerns while she was still a trainee, the IoS has learnt.

Miss Kapur did not realise her “catastrophic mistake” during the operation on the seven week- old baby in October 2008, which caused “irreparable damage”. She was not struck off by the GMC because patients should “not be deprived” of her medical services, it said. Instead, she was must be supervised during hernia operations until her medical director is satisfied that she is safe.

But this tragedy came two years after the case of Logan Cockroft, seven, from Burnley, who nearly died after Miss Kapur failed to notice that she had skewered his large intestine while inserting a feeding tube into his stomach. The GMC was apparently unaware of this earlier error, in what should have been a routine operation.

The life-threatening mistake was noticed 10 months later by a surgeon at Alder Hey after Logan’s weight dropped to 12lb and his mother, Jill, insisted on a second opinion.

Central Manchester University Hospitals NHS Foundation Trust has recently admitted that “sufficient investigations were not carried out to determine the cause of Logan’s infection” in a clinical negligence case bought by his parents. Mrs Cockroft notified the GMC about Miss Kapur’s mistake with Logan using an online referral form in 2010. “I should have followed it up, I know, but I was so disgusted that she wasn’t struck off, that I didn’t think there was any point.” NL

History: A century of care and controversy

1914 Alder Hey opens, intended as a workhouse for infirm paupers

1941 The world's first neonatal surgical unit opens

1999 Alder Hey's part in the national organ retention scandal comes to light. Body parts from 800 infants and 1,500 foetuses were retained and stored without permission

2001 Redfern report criticises Alder Hey bosses for failing to supervise a rogue pathologist and not properly dealing with complaints

2003 £5m out-of-court settlement for Alder Hey families

2004 Concerns are raised about trainee surgeon Pierina Kapur. She qualifies as a consultant in 2005 but goes on to remove accidentally the wrong organ from a baby in 2008

2008 Whistleblowers start raising concerns about surgery department

December 2009 Baby Mohammad Yousaf Nassar dies at Alder Hey at the age of six weeks

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