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September 9, 2018

Medicine Balls, Private Eye Issue 1475, 27July 2018
Filed under: Private Eye — Dr. Phil @ 9:56 am

Oh GOSH

In this new era of candour and transparency in the NHS, how hard is it for the media to expose poor practice? Very, if you’re taking on a national treasure. On April 18, 2018 tucked away at 10.40 pm, ITV Exposure screened ‘Great Ormond Street: the Child First and Always?’, a documentary collaboration with the Bureau for Investigative Journalism.  It revealed that consultants in GOSH’s Department of Gastroenterology had been misdiagnosing and overtreating young patients with Eosinophilic Gastrointestinal Disease (EGID). Children had been prescribed powerful immunosuppressant drugs and/or put on highly restrictive diets too quickly and left on them for too long. This was well known within ‘gastro circles’ for years and was documented in a Royal College of Paediatrics and Child Health (RCPCH) review in 2015. So why did it take nearly three years to surface?

When hospitals realise they have a problem, they can invite a Royal College in for ‘independent expert opinion’ safe in the knowledge that the Trust senior management ‘owns’ the report and can ether refuse to disclose it or heavily redact it. Reputation management still trumps transparency in the NHS. When the RCPCH returned to GOSH in 2017 to check for improvements, it found it hadn’t even shared its 2015 report with key members of staff, never  mind parents or the public. However,  journalists working on the story managed to get a copy and when they started challenging GOSH, it spent £130,000 of public money on an aggressive defence from Schillings to try to muzzle the exposure. This resulted in interminable delays to the documentary and when it finally aired it contained compelling evidence from consultant whistle-blowers, patients and parents of the harm done but no interview from GOSH, no mention of the legal threats, no-one called to account by name and no mention of what the commissioners and regulators knew and when.

GOSH rightly shared the urgent concerns letter and critical report from the RCPCH with the Care Quality Commission (CQC), which had recently inspected GOSH yet staff had not apparently raised these concerns with inspectors, which makes a mockery of the inspection process. The CQC was fully aware that, according to independent experts, the gastro service‘was not being delivered to the standard we expected’ which ‘results in children undergoing invasive procedures and treatments which could unnecessarily compromise their physical or psychological well-being.’ In addition, staff were fearful of the consequences of putting a name to their concerns. When the CQC report appeared, it mentioned that the RCPCH review had taken place and that the GOSH had acted on it, but made no mention of the serious concerns. Unbelievably, it rated medical services (which includes gastroenterology) as ‘outstanding’ and praised the trust for its ‘open and transparent culture’.

The CQC’s inept report raised reputational eyebrows at NHS England which commissions specialist services from GOSH and had seen the RCPCH report. Dr Andy Mitchell, medical director for London at NHS England, wrote: “I believe there is a significant reputational issue here, not only for GOSH but for the CQC,” he said. “Seems to me this could attract a lot of attention, much more than the Leicester/epilepsy saga.” (a reference to the overdiagnosis and overtreatment of children with epilepsy– Eyes passim). GOSH also commissioned two reports into long-standing concerns about safeguarding across the Trust, an aspect of care which the CQC had somehow praised. One review found a tick-box culture in which safeguarding had been delegated to a committee by the hospital board and there was little evidence of learning from mistakes. “There was universal agreement that the level of record keeping, body maps and safeguarding medicals is far below the standard required. This has serious medico-legal implications. Some children with bruises and fractures were sent home in breach of procedures, and “a number of children presented with ritual burns and the response varied”. A child with a non-accidental injury after an alleged assault was “not examined adequately” and referred back to the local service.  A further review confirmed these findings.

GOSH, like many other trusts, is sinking under the weight of demand but it should have sorted out the problems in its gastro department long ago. Instead, it closed the department to most new referrals, a damage limitation exercise that has caused chaos in surrounding hospitals, and it fiercely defends its reputation.  If hardened hacks struggle to hold it to account, what chance anxious parents? Meanwhile in 2018, the CQC finally noted GOSH’s‘defensive approach when challenged on performance and safety’, and rated the leadership as ‘Requires Improvement’. So does the CQC.