An investigation into the unfortunate death of a three year-old child at a hospital in Stafford has indicated that a further inquest is required.
The report attacked a closed-door culture within the NHS, and suggested that there may have been serious cover-ups at Stafford Hospital.
Among the most serious allegations of the independent report were suggestions that the hospital had forged statements from staff in order to avoid a negative verdict.
Three-year-old Jonnie Meek, from Cannock, died at Stafford Hospital while being fed via his stomach in August 2014.
The parents of Meek believed that their son had died due to an allergic reaction to a type of milk that has made him sick previously.
A trust investigation into the issue had denied this conclusion, with a post-mortem and a coroner’s inquest ruling that pneumonia was the apparent cause of Jonnie’s death.
But paediatrician Dr Martin Farrier, who carried out the review, said the parents’ explanation was the most likely, and called for a new inquest to examine the evidence.
Farrier suggested that the explanation that the family had received had been poor, and that “there is little evidence of the open culture that is aspired to by the NHS” at Stafford Hospital.
At the time of his death, Meek’s parents had complained about the way their son was treated, and ultimately discovered that statements from health workers had been falsified.
The independent report criticised the Mid Staffordshire Trust, which was dissolved in November 2014, for its failures to consider the concerns from Jonnie’s parents.
Farrier was also critical of the Derby Teaching Hospital Foundation Trust, which had apparently been uncooperative with regard to providing a nurse for interview.
“Two different trusts. Two different times. Neither trust had a reason to hide. Both responded in the same closed, unhelpful manner. The NHS has been widely criticised for this behaviour. I found myself in the same position as Jonnie’s parents. On the outside, unable to find a way in to ask simple questions. Blocked by fear.”
Farrier is an associate medical director at Wrightington, Wigan and Leigh Foundation Trust, and pointed to troubling cultural issues within the NHS.
“I consider that problems of a closed culture within the NHS continue to exist. Expectation of blame leads to defensive behaviours. There should be an expectation within NHS organisations that they will openly cooperate with reviews of care performed within the NHS.”
Andrew Donald, chief officer at Cannock Chase clinical commissioning group, which supervises the services, indicated his acceptance of the report, and also a willingness to improve openness and communication in the future.