CHILD PROTECTION
286 BMJ | 6 AUGUST 2011 | VOLUME 343
Baby Peter Connelly had bruises on his face and
back and a two month old lesion on his head
when he was seen by Sabah Al-Zayyat, a locum
consultant paediatrician, at the child develop-
ment centre at St Ann’s hospital in T ottenham,
north London, on 1 August 2007. The bruises
were typical of abuse, according to the two
leading paediatricians who later reviewed Dr
Al-Zayyat’s work at St Ann’s, and should have
raised suspicion—particularly in a toddler who,
as the notes showed, was on the child protection
register.
It was the last chance to save his life but it was
missed. He was sent home, and a letter went to
Great Ormond Street Hospital referring him for
investigation for possible metabolic disease. Two
days later, aged just 17 months, he was dead. A
postmortem examination found eight fractured
ribs; a broken back; an area of bleeding around
the spine at neck level; numerous bruises, cuts,
and abrasions, including a large gouge in his
head; a tear in his frenulum that was partially
healed; and missing nails. One ear lobe had
been pulled away from his head, and a tooth was
found in his colon. In November 2008 his mother,
Tracey Connelly, her boyfriend, and his brother
were convicted of causing or allowing his death,
and a media storm erupted.
The case of Baby P—his full name was not
released at first—became a cause célèbre. The pic-
ture of the blond, blue eyed toddler in his bright
blue pullover who was so let down by health
professionals and social services sparked public
outrage. Government ministers looked for some-
one to blame. Attention focused mainly on the
social workers rather than the doctors who had
seen Peter, and Haringey’s director of children’s
services, Sharon Shoesmith, lost her job.
How could a consultant paediatrician have
missed the obvious signs that Peter was being
battered? He had already been to North M iddlesex
Hospital three times in his short life, and hospi-
tal staff had diagnosed non-accidental injuries on
one of those visits. But Dr Al-Zayyat was unaware
of this—there was no record of those hospital
visits in the notes. Nor did she have the train-
ing required in the job description for the post of
community paediatrician which she held. There
were only two consultants in a clinic which was
supposed to have four, and there was no one
in the crucial post of “named” doctor for child
protection. In short, concluded Jonathan Sibert
and Deborah Hodes, who were commissioned to
review the case, the state of affairs was “clinically
risky” and “the present arrangements for seeing
child protection cases at St Ann’s cause grave
concern.”1
The doctors at St Ann’s were employed by the
world famous Great Ormond Street Hospital, a
centre of excellence with an international repu-
tation. Seen as one of the world’s great children’s
hospitals, Great Ormond Street now finds itself
at the centre of a murky whirlpool of allegations,
accused of management cover-up, bullying and
targeting of staff who raise safety concerns, and
trading on its reputation.
Newspaper articles, BBC reports, an NHS
whistleblowing special in the magazine Private
Eye, and even an editorial in the Lancet
2
charge
the hospital with concealing the extent to which it
failed Baby Peter by not passing on the full, highly
critical, report by Professor Sibert and Dr Hodes to
the first serious case review set up to learn lessons
from the tragedy.3 Government minister Lynne
Featherstone called on the chief executive officer,
Jane Collins, to resign and demanded that health
secretary, Andrew Lansley, launch an investiga-
tion into the alleged cover-up. Her call was sup-
ported by an unknown number of anonymous
consultants at Great Ormond Street Hospital in
a letter to the Lancet last month.4 But Mr Lansley
has now vetoed an investigation. A Department
of Health spokesperson said: “These matters
have been extensively investigated. GOSH [Great
Ormond Street Hospital] has acknowledged and
apologised for its part in those events. The Secre-
tary of State does not believe it would be benefi-
cial to revisit these events once more.”
Community outreach
Children from all over the UK and indeed the
world come for treatment to Great Ormond
Street’s Bloomsbury site, in the heart of academic
London, where it is building a shiny new medical
unit with donations from, among o thers, the fam-
ily of billionaire Lakshmi Mittal, one of B ritain’s
richest men. Just a few miles to the north is St
Ann’s, a Victorian edifice in Tottenham serving
Haringey, the 10th most deprived of England’s
354 districts. In 2007, 36.4% of its children were
officially deemed to be living in poverty.
Great Ormond Street sees children with rare
and complex disorders who could probably be
treated nowhere else in the UK. The decision to
get involved in community paediatric services in
Haringey was, says Michael Burch, specialty lead
for cardiology at Great Ormond Street, taken with
good intentions but in retrospect was a mistake.
“I don’t think the trust had previous knowledge
of working in complex community matters.
While I think they wanted to get teaching hospi-
tal expertise and ivory tower teaching hospital
medicine out into Haringey, I think it’s just very
difficult to do that. People at the time thought it
was a very noble gesture to try to get involved
with a very deprived borough and to try to offer
help from the service, but it clearly didn’t work
that way.”
Barbara Buckley, one of the two medical
directors at Great Ormond Street Children’s
GREAT
ORMOND
STREET
AND
BABY P:
WAS
THERE A
COVER UP?
Four years after the death of
“Baby P,” arguments are still
continuing about the response
of the UK’s leading children’s
hospital. Clare Dyer reports
bmj.com
ЖHead to head: Has child protection become a
form of madness? (
BMJ
2011;342:d3040)
doc2doc
ЖEvidence based child protection?
http://bit.ly/pJfmHY
