The must-read stories and debate in health policy and leadership.

Release the 2015 report

At its board meeting on Thursday, Great Ormond Street Hospital’s chair indicated the trust was drawing a line under its gastroenterology scandal, which saw children given potentially unnecessary invasive treatment instead of talking therapies.

But, since the organisation has never released the key report from 2015 into what happened to these kids, and how it came to happen, any line-drawing seems somewhat premature.

The board only discussed it at all because the Information Commissioner’s Office recently ordered them to release their first draft.

While complying with the law in this case, the trust discovered the published version of a 2017 report into the scandal, carried out for it by the Royal College of Paediatric and Child Health, was incomplete.

The version, which was provided to the trust’s board, NHS Improvement, NHS England and the Care Quality Commission, did not include scathing criticism from the parents of children treated by the service. Parents who felt abandoned as the trust dramatically cut the referrals it accepted and tried to find out whether patients had come to harm or not.

One parent said someone had encouraged “internal private referrals” to a service in Belgium. Another said the trust’s India-based admin team had sent their child’s notes to Australia. Another’s notes were sent to someone in the same town with the same name.

How did the mysterious omission of these complaints happen? How did (arguably) the world’s most famous hospital come to mislead its regulators like this?

Its report to the board meeting this week said it was unable to discover how the critical appendix was removed, and that staff who might know had left.

But when the redacted 2017 report was presented to the trust’s public board in March 2018, it was accompanied by a paper from then interim medical director Andrew Long. Dr Long is still employed by the trust, so could they not have asked him? Answer has come there none from the communications team.

The trust said in a statement that “we could have been more transparent”: a charming understatement, considering the ICO has ordered it be more transparent.

Why does this matter? The trust is taking all the necessary steps behind closed doors, right?

That is not at all clear. The 2017 report was supposed to assess what progress had been made since the 2015 report.

One of the 2017 report’s conclusions was staff “in some areas still perceived a culture that suppressed challenge from colleagues which made them fearful of speaking out”.

“Several indicated that there appeared not to have been any organisational learning or remorse from the situation or focus on actually what happened to those children and families.”

If the trust wasn’t open about the progress report, and staff felt there had been no “learning or remorse”, how can anyone be confident things have changed?

There’s one thing its new leadership team could do for a start - release the still-unpublished 2015 report.

Rumours of a merger between trusts in the north east have been doing the rounds for some time now, although the logistics of it and answers to other pertinent questions – such as the who, where, when and how – have not been quite clear.

But HSJ has now confirmed discussions about consolidating North Tees and Hartlepool and South Tees foundation trusts have indeed taken place recently and seem to be breaking out into the open. 

NHS Improvement has been involved in the talks and, according to South Tees FT chair Alan Downey, is “fairly enthusiastic” about the idea.

Mr Downey appears receptive towards the idea too – provided it makes financial sense.

He told HSJ: “My view is that it makes sense in due course for there to be a single Tees Valley trust, so we are happy to talk about structural change.

“However, there has to be a convincing business case, and the case needs to include a robust financial plan for addressing the underlying financial deficit in the Tees Valley healthcare system.

“That’s not just my view, it represents the consensus of the South Tees board and senior leadership team.”

The revelations come amid discussions of a longer-term development of an integrated care partnership in south Teesside, forming part of the Cumbria and North East Integrated Care System area.

Now it’s a question of whether they will manifest into something with more substance down the line.