Northern Ireland news

Department of Health sets up group to respond to damning inquiry findings into 'avoidable' children's deaths

Mr Justice O'Hara at the launch of the report into the 14-year inquiry into hyponatraemia-related deaths. Picture by Mal McCann
Seanín Graham

A "dedicated team" is to be established by the Department of Health to address the 96 recommendations of a devastating report which concluded that four children's deaths in hospital could have been avoided.

Forty-eight hours after the publication of the public inquiry into hyponatraemia-related deaths, health chiefs from across the north met yesterday to discuss the findings.

Sir John O'Hara QC, who headed up the inquiry, said there was an "indefensible" culture in which parents were "deliberately misled" by doctors and health trust chiefs intent on "avoiding scrutiny" and protecting their own reputation.

The deaths of Adam Strain (4), Claire Roberts (9), Raychel Ferguson (9) 18-month-old Lucy Crawford and Conor Mitchell, who was 15, took place between 1995 and 2003 at the Royal Belfast Hospital for Sick Children in Belfast.

Hyponatraemia occurs when there is a shortage of sodium in the bloodstream and the inquiry examined whether fatal errors were made in the administration of intravenous fluids to five children.

Richard Pengelly, the most senior civil servant at the Department of Health, said yesterday it had been a "devastating week" for the families and that public confidence has been damaged.

He confirmed that professional bodies who regulate doctors and nurses had been contacted following the release of the 684-page report, which details the health professionals involved in the children's care.

The inquiry's central recommendation was the introduction of a 'duty of candour' to force doctors and nurses to be honest about their mistakes.

Mr Justice O'Hara, who is now a High Court Judge, was scathing in his criticism of some health service witnesses who had to have the "truth dragged out of them".

Mr Pengelly said that an "early priority" for the new team will be the finalisation of "legislative and policy options" for an incoming health minister on the duty of candour.

The move was first recommended three years ago by former DUP health minister Jim Wells in the wake of an independent review by Sir Liam Donaldson on the need for reform of the north's health service.

"Building on a previous ministerial commitment to this principle, preparatory work on policy and legislation has been undertaken," the permanent secretary said.

"Trusts, as employers, will address issues relating to individuals named in the report. Contact has already been made with the independent National Clinical Assessment Service and the General Medical Council (GMC) and agreement has been reached on the approach in relation to the concerns raised by the inquiry regarding doctors' actions.

"The General Medical Council, which regulates all doctors in the UK, requires any doctor who is criticised in an inquiry to inform the GMC. We expect full compliance with this requirement. A way forward is also being discussed with the Nursing and Midwifery Council."

No doctor or nurse linked to the report has commented yet on its findings.

The report also warned of a "remnant culture of clinical defensiveness" and Mr Pengelly said "we must do all in our power to ensure a culture of openness and integrity throughout health and social care".

The Detail website revealed that Mr Justice O'Hara had to compel Department of Health lawyers to hand over documentation relating to fresh whistleblower allegations which allege that material may have been withheld from the inquiry.

Mr Justice O'Hara issued a ‘statutory notice' on January 23 - a week before the publication of his inquiry - to force lawyers from the Directorate of Legal Service to send him documents relating to the original complaint by the whistleblower.

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