Truth was the first casualty on Ward Four after Grantham Hospital finally called in Lincolnshire police to investigate the mysterious deaths and collapses on their childrens’ ward in the Spring of 1991. Yesterday’s report by Sir Cecil Clothier has only partially healed the damage.
Ever since the police began to uncover evidence that Nurse Beverly Allitt had been systematically attacking the children in her care, the key question has been: how could she have got away with it? The answer to that is charged with political implications. And the response to it by the Department of Health has been defined by secrecy.
There are many who believe that Nurse Allit’s success as a killer was the direct result of the Government’s failure as a manager of the National Health Service – that she exploited a hospital which was underfunded, demoralised and distorted by commercialism. This belief is shared by the parents of many of her victims, by some of the detectives who investigated the murders, and by nurses, doctors and managers who worked at Grantham Hospital in 1991. Sir Cecil’s report does not confront it.
Over and over again, through the 130 pages of his report, the truth peeks out shyly and then quickly runs away. There are areas which he has failed to explore; there are others which he has explored without uncovering all of the facts; and there are facts which he has disclosed without accepting their implications. And where he has succeeded in nailing both the facts and their meanings, his results have been skilfully turned around by the spin doctors of the Department of Health.
Sir Cecil is forthright in detailing a “catalogue of lapses” which lay behind Nurse Allitt’s attacks: the ward sister who was a bad leader; the two consultant paediatricians who failed to work together to find out what was wrong; the ward manager who was “dilatory and ineffective”; the senior management for its “general laxity” and indecisiveness; the pathologist, the coroner and the coroner’s officer who failed to uncover the truth about any of the four children who died. And then he stops.
At the Department of Health yesterday, Sir Cecil was asked twice to explain whether there was anything about Grantham Hospital which meant that it was peculiarly vulnerable to these kind of lapses. This took him to the heart of the political issue – that any district hospital would be just as vulnerable to collapse in the face of an unexpected crisis, whether it took the form of a murderous nurse or a mystery virus or a bomb going off in the town centre. But twice he refused to answer. It was beyond his mandate, he said.
Sir Cecil makes recommendations which have a national application; but he makes no criticism which might have national implications. At one point in his report, he begins to discuss the NHS reforms but then he explains that “by agreement with the Department of Health and Trent Regional Health Authority” he is confining himself to examining the immediate response of health authorities to news of the events on Ward Four. It is a comment which must chill the parents who complained that his work was being supervised by the very departments whom they wanted to blame.
He confronts the history of understaffing at Grantham Hospital and, at one point, he records: “We were told that in these respects it was on the borderline of viability”. But he refuses to connect any of this history to Nurse Allitt’s ability to get away with murder. For example, he quotes from correspondance between doctors about the shortage of emergency equipment on the ward and then dismisses their significance. “These, and other letters, although again signalling the degree of impoverishment of the ward, are not relevant to our inquiry, addressing as they do, preparedness to respond to the collapses rather than their cause.”
At point he comes within a sentence of making the connection. “In a better staffed, better organised ward, with regular reviews of procedures and practices, we believe there might have been a better chance of earlier suspicion and detection of criminality.” And then, suddenly, in contrast to his forthright criticism of individuals, he adds. “But of this, there can be no certainty”.
There is a curious parallel between the failure of the doctors to collect up the fragments of evidence which would have pointed to foul play and Sir Cecil’s own reluctance to gather together the evidence which would indicate that this was a failure of the hospital as a system and not merely a failure of personnel. He confirms that nearly every department involved was found wanting.
The pathology department took 15 days to test a supposedly urgent blood sample. The radiology department never received crucial X-rays and failed to spot evidence in others. The occupational health department said Nurse Allitt was fit for employment without having access to her records. There were not enough nurses and not enough Registered Children’s Nurses. The drugs procedures ignored national guidelines. It is all there in Sir Cecil’s report. But he never tells us why.
There are several particularly contentious questions on which he simply offers no facts at all. According to senior managers of the hospital, there was an intense internal debate about whether or not they should close Ward Four. Since this took place at the point when they had finally decided that there was clear evidence of foul play and that they should call in the police, their decision to leave the ward open exposed them to criticism. They say that it was the Regional Health Authority which instructed them to do this – the same Regional Health Authority which established Sir Cecil’s inquiry. Sir Cecil makes no comment. It may be that there are very good reasons for this. The report offers no clues.
Similarly, there was considerable concern within Lincolnshire police that when they were called in, they were given a letter from one of the Ward Four consultants, Dr Charith Nanayakkara, which, in Sir Cecil’s words “played down the possibility that someone was deliberately harming children on the ward”. The second consultant, Dr Nelson Porter, was convinced that there was foul play. So why were the police given only one version of events? What on Earth would have happened if they had accepted Dr Nanayakkara’s account? Sir Cecil makes no comment.
This report is not a whitewash. Sir Cecil has diligently uncovered almost all of the errors which occurred within Grantham Hospital. He says his mandate prevented him from going further. In their handling of his report, the Department of Health did their best to ensure that no one else was tempted to try.
In their press statements, they buried his criticism of the hospital. There is no reference anywhere in Virginia Bottomley’s statement to the “catalogue of lapses” nor to the details of the staffing and funding which persuaded Sir Cecil to refer to the hospital surviving on “the borderline of viability”. Her statement to the House of Commons was similarly slanted.
The parents of the Nurse Allitt’s victims have started the long slog to the European Court in an attempt to secure a ruling that the terms of Sir Cecil’s inquiry were unjust. But many of them have had enough and concede privately that they have done as much as they can. Yesterday, once more, the story of Beverly Allitt remained a political affair, in which the truth was an unwelcome visitor.
* Nick Davies is the author of Murder on Ward Four, published by Chatto and Windus.
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