Is the UK’s most famous children’s hospital sometimes more concerned about its reputation than patient care?

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I was interested to read this week a news piece in the British Medical Journal concerning the senior paediatric consultant Dr Hilary Cass [1]. Dr Cass used to work at Great Ormond Street children’s hospital in London. In 2007, she objected to planned cuts in the number of junior doctors at the hospital. She subsequently filed a grievance claim against the hospital managers, and then launched a claim for constructive dismissal.

She ended up leaving Great Ormond Street hospital in 2009 to take a post at another London hospital. However she and Great Ormond Street struck a deal to enable to train in palliative care (care focusing on the relief of suffering and pain, usually in terminally ill individuals) at the hospital. This was, apparently, so that she could set up a palliative care service at her new hospital.

Documents obtained via the Freedom of Information act reveal, though, that Dr Cass’s training was contingent on her signing a gagging clause, which forbade her making “any statements derogatory of GOSH [Great Ormond Street Hospital].” According to the piece in the BMJ, Dr Cass signed the agreement “under duress.” The agreement stated that Great Ormond Street hospital could cease to provide the agreed benefits, including the palliative care training, if Dr Cass raised “any existing protected disclosure with any third party.”

This, to my mind, is a sorry state of affairs, especially in light of recent news stories in the UK about ‘whistleblowing’ in the health service. What has become clear is that some doctors and other health professionals are fearful of raising concerns about patient care lest they are treated badly and suffer personally and professionally.

Part of the reason I am writing about this story is because it reminded me of an exchange I had last year with Great Ormond Street’s then Head of Communcations, Stephen Cox. He emailed me about a piece I had written here. The story concerns the tragic death of a child which was initially put down to child abuse, but in fact turned out to due to rickets (bone disease caused by vitamin D deficiency). The rickets had been missed by doctors at Great Ormond Street. Stephen Cox’s email asked me to amend my piece, essentially claiming that the doctors were not at fault by failing to spot rickets on the X-rays. He included an amendment from the BBC website (which I think Great Ormond Street had drafted), and suggested I do the same.

I emailed one of the lawyers closely involved in this case (he had acted for the parents) to seek his opinion. In short, he claimed that the doctors simply missed the diagnosis, and this was perhaps they were trained at a time was rickets was thought to be a thing of the past.

I felt the right thing to do was to leave the post as it stood, and I heard nothing further from Great Ormond Street’s Head of Communications.

Subsequently, the child’s parents were cleared of any crime, and a child who had been taken into care was returned to them. The judge who presided over the case, Mrs Justice Theis, criticised Great Ormond Street hospital for what she described as sub-optimal care.

At the time, I felt that Stephen Cox’s email to me was little more than a damage limitation exercise. Reading about Dr Cass’s experience with Great Ormond Street only helps to strengthen this idea in my mind.


1. Great Ormond Street Hospital gagged doctor who raised safety concerns BMJ 2013;347:f4253 [hr]

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