When Kim Holt returns to her job as a senior community paediatrician on Tuesday after a four-year absence, she will be carrying a framed letter in her favourite battered Mulberry briefcase.
It is tangible evidence, should she need it, of the fierce battle she has fought with one of the most prestigious children’s hospitals in the country. Sent from executives at the world-famous Great Ormond Street Hospital, London, it is worth its weight in gold because it offers a grovelling apology for ‘the distress’ they have caused her over the past four years.
‘I will hang it on my wall to remind me, should I feel wobbly, that despite everything that I’ve endured, I was right to do what I did,’ she said.
Dr Holt, 52, was forced from her job as the designated doctor for children in care at St Ann’s Hospital in Haringey, North London, in 2007, after she and three other doctors wrote to management warning that staff shortages and poor record-keeping would lead to a tragedy.
Six months later, her worst fears became reality when an inexperienced doctor who had replaced her at the clinic failed to spot that Baby Peter was the victim of serious physical abuse. Dr Holt believes that had she or a more senior consultant been available to examine him, the 17-month-old boy would not have been sent home, where he died 48 hours later.
A tall, handsome woman, whose gentle, quiet manner masks a fierce determination to do the right thing, Dr Holt found herself caught in a firestorm after Great Ormond Street took over the community health service in Haringey. She became a whistleblower, she says, because she feared something terrible would happen to a child and was devastated when the warnings went unheeded.
In her first interview since learning two weeks ago that she would get her job back, Dr Holt maintains the quiet dignity that has sustained her over the past four years.
‘I don’t want to gloat or be smug about this, but it feels very good to know that I’ve been vindicated. I’ve never done anything wrong. All I ever wanted to do was protect my patients.
‘It’s a miracle that I’m able to return after all this time. The whole thing has been like a nightmare and caused a huge strain on my family. For a long while I struggled with depression – I was crying all the time, I couldn’t sleep and lost interest in all the things I used to enjoy.
‘My family also suffered – my husband had to watch helplessly as I changed, for the worse, before his eyes.
‘I was so consumed with work that I didn’t realise my youngest daughter was dyslexic and had not been coping at her secondary school. She was acting up and truanting, because she felt unable to burden me with her problems when I was going through my own hell.
‘Had I not been so diverted, I would have spotted that something was wrong much earlier. I’ve emerged from this stronger and more confident, but I’m also angry because it was all so unnecessary.
‘It has been a nightmare and caused a huge strain on my whole family’
‘I’ll never get those lost years back. Four years of my family’s life disrupted, and my career threatened. They tried to push me out simply because I told the truth. It was all about protecting the name and reputation of the Great Ormond Street brand.
‘I was called dishonest, but my first duty as a doctor is to my patients, not my employers.
‘I will now work at Bounds Green Clinic, not St Ann’s, because they’ve relocated part of the service to a new refurbished block, so it’s a new start for me. It also helps that many of the people I have had real difficulties with have moved on, otherwise I would have been terrified to go back.’
That would have been a serious loss to her profession. For in many ways, Dr Holt, who exudes genuine warmth and empathy, is ideally suited to her vocation.
Colleagues say she is a committed, intuitive and skilled clinician. Indeed, 3,000 medical professionals and supporters up and down the country signed a petition calling for her reinstatement.
Looking after those younger than herself has been ingrained in her since childhood. The eldest of four children – her sister Kate was born blind and one of her twin brothers died at six months old – she was happy to help her mother with her younger siblings.
‘I did a lot of caring as a child, which made me more sympathetic to people with special needs,’ she says. ‘It may sound a bit twee, but by the time I was 16 I knew that I wanted to do something to help people.’
Although she was born in Coventry and spent her early years in the city, Dr Holt grew up in Guernsey, where her father Raymond Fensome and mother Dorothy ran a guest house. At the age of 18 she left The Ladies’ College, a private girls’ school on the island, to spend a year doing voluntary work in Botswana, before taking up a place as a pre-med student at St Bartholomew’s Hospital in London.
‘I always knew that paediatrics was my destination after I became a consultant in 1994,’ she says. Her first job was at the Royal Manchester Children’s Hospital in Salford. By then she had been married for three years to her high school sweetheart David, the son of an Air Force Group Captain. They had met when he boarded at a private boys’ school in Guernsey.
David, also 52, works as a senior manager for a finance company in the City. ‘He’s very reserved, but has been totally supportive and encouraged me to fight back and speak publicly about what has been going on,’ Dr Holt says.
‘He said from the start they were out to get me, because as a manager he could read the signs, and he was right. I could never have survived this ordeal without him.’
The couple have four children. Ben, 23, suffers from cerebral palsy as a result of his premature birth but lives independently, while daughter Olivia, 19, is at university in Bath studying architecture. The younger two (who Dr Holt does not want named) are aged 16 and 11.
‘They offered me £120,000… I felt it was just a bribe to buy my silence’
Dr Holt was working in community service in Sheffield when she saw the position at St Ann’s advertised in the British Medical Journal in 2003.
‘I applied because it was connected to Great Ormond Street, which made me feel it would be of a very high standard.’ Her duties included acting as the medical doctor for the local authority, as well as giving advice to children up for adoption.
From the outset, she considered the service to be thinly staffed and chaotic. ‘I was shocked from day one by how badly and poorly organised the regime was,’ she says.
‘On the first day my colleague called in sick and I covered her clinic, only to discover there was no system of booking patients.
‘I had no idea what was going on. It was a complete mess – there were no notes for the children I saw.’
Because Great Ormond Street had recently taken over the clinic’s management, Dr Holt believed they were going to improve things. But instead, they were left to continue muddling through without any signs of improvement.
‘I suppose community child health is a Cinderella service compared with the glamour of Ormond Street’s complex life-saving operations and celebrity supporters,’ she says.
Indeed, to some, the partnership that began in 2003 seemed rather an odd one. The cash-rich and revered Great Ormond Street, with its Bloomsbury site in the heart of academic London, and where it is building a smart, shiny new medical unit, is the rock star of hospitals and, as it turns out, rather intolerant of dissent.
‘If our fears had been heard, we could have prevented the tragedy’
In contrast, the clinic at St Ann’s Hospital is a shabby Victorian edifice in Tottenham, one of the country’s most deprived areas and the flashpoint for the summer’s riots.
‘I worked 60 to 70 hours each week,’ says Dr Holt. ‘My typical day was from 7.30am to 5pm.
‘Administrative work such as writing reports had to be done at home. I was so tired all the time that I became irritable and withdrawn. I was barely sleeping.
‘I tried talking to my senior manager, who was dismissive and aggressive.’
The situation became critical in 2006 when budget cuts left Dr Holt and her staff feeling increasingly anxious.
‘We had just four consultants instead of the required six and my case load just kept growing. By the end of the year we were down to just two doctors. We didn’t have the capacity to follow up cases properly and I was worried that some might fall through the cracks.
‘My manager’s response was invariably aggressive. Rumours began to spread that I was a nuisance, and I was asked why I had to keep complaining when everyone else was ok? But that wasn’t why people didn’t speak out. They kept quiet because they were scared. It was a kind of passive aggressive bullying.’
Matters came to a head one night in February 2007, when she broke down sobbing in a restaurant. ‘My husband and I had just been to the cinema near our home in Muswell Hill to watch Borat. It was a comedy and I had enjoyed it, but suddenly I couldn’t stop crying.
‘David said: ‘‘You can’t go on this way. You’re burnt out.’’ I just felt so despondent. It was the worst feeling ever. I felt I was becoming a different person, that I was in danger of breaking down.’
Her doctor told her to take a month off. But, she says, Great Ormond Street refused to let her return to her post, citing the fact that she was stressed and could not handle the workload. ‘I did not see it coming. I went for a meeting about my return and was devastated when they said the situation still needed to be resolved.’
Dr Holt believes that she was being punished for whistleblowing. But when the Trust offered her £80,000 as compensation if she left quietly, she refused.
‘They said it was in my best interests, but I felt it was a bribe to buy my silence, because it included a gagging order preventing me from talking about the clinic, Haringey or the hospital,’ she says.
‘If I had taken the offer, all the public-interest issues I had highlighted about the way the clinic was running would have been hidden. I felt it was all wrong and against good clinical practices.’
After the death of Baby Peter the offer went up to £120,000 – but again, Dr Holt refused.
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, who was doing Dr Holt’s job at the childdevelopment centre.
Baby Peter was sent home and a letter went to Great Ormond Street Hospital referring him for investigation for a possible metabolic disease. His mother, Tracey Connelly, her boyfriend and his brother were convicted in 2008 of causing or allowing his death.
Dr Holt says: ‘I believe that if our concerns as doctors had been taken seriously at the time we raised them, we could have prevented that terribly tragedy.
“Several of the failings found by the inquiries into his death were 100 per cent the same as the failings we complained about the year before he died.’
In 2009 a report commissioned by NHS London exposed the background of ‘administrative chaos and personal hostility’ that contributed to the clinic’s failure.
It supported Dr Holt’s complaint that financial cuts had ‘not been adequately considered’ by managers at St Ann’s and that excessive workload, failure to offer follow-up appointments and a lack of notes put patients at risk.
The hospital’s response was to advertise her post – later retracted after complaints
from the British Medical Association (BMA).
‘One of the difficulties a whistleblower has is that you are left to negotiate with your employer after being exposed.
There is no protection. You are just vulnerable – out in the cold,’ says Dr Holt.
‘The BMA has been brilliantly supportive. It is thanks largely to them that I not only got the grovelling letter of apology two months ago, but got my full pay throughout and have kept my job.’
Her victory, however, is bittersweet. ‘The disappointing thing is that I risked everything but very little has changed. Did it have an impact, and did people understand? I don’t really think so.
‘But I remain committed to looking after the health and welfare of children. After what I have been through I won’t back down now.’
Community health care in the borough was taken over by the Whittington Hospital in north London earlier this year.
Last night, a spokesman from Great Ormond Street said: ‘We have said repeatedly that Dr Holt was unable to return to work in Haringey because of a breakdown
in relationships between her and her colleagues in the service at the time.
‘An NHS London report found that her concerns were taken seriously by the Trust.’