Page last updated at 20:56 GMT, Monday, 12 April 2010 21:56 UK

Great Ormond Street report on Baby P 'not disclosed'

By Tim Donovan
BBC London Political Editor

Detailed criticisms of the failings of Great Ormond Street Hospital over Baby Peter were never disclosed to the original inquiries into the toddler's death, it has emerged.

Baby Peter Connelly
Baby Peter died from repeated abuse, despite 60 visits from authorities

An independent report into the practice of one of its doctors, along with its management of paediatric services in Haringey, was not submitted to the original serious case review nor considered by the later Joint Area Review (JAR) ordered by the government.

Dr Sabah Al-Zayyat, a consultant locum employed by Great Ormond Street, examined the toddler two days before he died on 3 August 2007.

The report concluded that the unusual bruising to his back and neck and an infected lesion on his head should have alerted her to abuse, and she should have removed him to a place of safety.

Great Ormond Street Hospital (GOSH) said it had shared the report with all appropriate bodies.

The hospital and its partner the Haringey Primary Care Trust originally told the case review that no actions by its staff could have averted Peter's death.

'Isolated' doctor

It was six months before they commissioned the independent report from two leading paediatricians, Professor Jo Sibert and Dr Deborah Hodes, which was carried out between February and May 2008.

Tim Donovan reports on how Great Ormond Street Hospital kept key Baby P findings from official inquiries

Only then was a summary passed to the serious case review.

The summary hinted at the difficult working conditions at the St Ann's clinic, which was managed by Great Ormond Street Hospital, and described Dr Al- Zayyat as "isolated".

There was no nurse to help her and she had no background notes nor access to any electronic records showing Peter's previous hospital visits where abuse was suspected.

No Haringey social worker attended the examination and Dr Al-Zayyat said she was led to believe that the woman accompanying Peter's mother was a foster carer rather than a friend.

The summary contained recommendations including to:

• Improve the level of medical staffing

• Review guidelines for assessing children suspected of being abused

• Employ a highly qualified nurse

• Ensure appraisals review whether doctors are up to date with child protection duties

But the full report detailed wider problems with the community paediatric service in Haringey where Great Ormond Street employed and managed the paediatric consultants.

It questioned whether the hospital should have appointed Dr Al-Zayyat, suggesting she did not appear to have the "competencies" to deal with child protection cases.

Four cases

She did not have the recognised certification, demonstrating sufficient experience in child protection, and did not receive training to achieve it within six months, a condition of her employment.

Some of this was later touched upon by a report into the health service's failings over Baby Peter which was not published until May 2009.

Dr Al-Zayyat's specialism was neuro-disability and she only examined Peter that day because a colleague was ill.

Up to then she had only dealt with four child protection cases at the clinic.

The report also found a shortage of consultants and that there was no clear system for prioritising cases, referred to the clinic, of children suspected of neglect or abuse.

It was more than three months before Peter was seen, a key factor given that social workers placed so much importance in it resolving whether there might be a "metabolic" explanation for Peter's frequent bruising.

The authors were surprised that there was no separate named doctor for child protection at St Ann's and called for one to be appointed "urgently".

The role was a key one, advising on the priority of referrals, diagnosis in complex cases and disseminating good practice.

There was poor communication with North Middlesex Hospital, where Great Ormond Street also managed the paediatric consultants. The report said the two clinical centres should be "brought together".

'Beefed up'

The report written by Professor Jo Sibert, of Cardiff University, and Dr Deborah Hodes, a senior consultant paediatrician in Camden, was completed in May 2008.

But its findings were not included in the JAR ordered by Children's Secretary Ed Balls at the height of the controversy over Baby Peter in November 2008. There was one mention of Great Ormond Street Hospital in the report.

Mr Balls drew on the JAR as the basis for sacking Haringey's children's director Sharon Shoesmith, a decision she is challenging at the High Court.

Sharon Shoesmith
Ms Shoesmith was sacked in December 2008

Hundreds of documents including 17 previous drafts of the JAR were released last week, suggesting - say Ms Shoesmith's lawyers - the case against her and other social workers was "beefed up" while criticisms of the NHS and the police were removed or down-played.

The Department of Children, Schools and Families said it could not comment because of Ms Shoesmith's continuing legal action.

The health inspectorate the Care Quality Commission said it received the report while the joint area review was being done, but that it was not deemed relevant to that review.

However, the commission said it did consider and include the findings of the report in its own report which was published last May.

A spokesman said: "Joint Area Reviews focus on how well services are working and working together at the point of inspection.

"The GOSH report related to a single individual and activities around a specific incident in the past rather than current safeguarding systems and was therefore not considered relevant to include within the JAR."

Baby Peter's mother, Tracey Connelly, 28, her partner Steven Barker, 33, and Barker's brother Jason Owen, 37, were all jailed for their part in his death.

The three were all convicted of causing or allowing Peter's death.

The child was found dead in his cot at his home in Haringey in August 2007. He had more than 50 injuries, including fractured ribs and a broken back.

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