Negligence by NHS doctors perpetuated gross sexual abuse

Doctors treating two daughters who were made pregnant 19 times by their abusive father failed repeatedly to follow professional guidelines on alerting the authorities to suspected rape. Failings by the authorities in the case of a Sheffield father who forced his daughters to bear him nine children included breaches of medical codes and ignoring the recommendations of an inquiry into a recent incest case.

Gordon Brown spoke of the nation's outrage yesterday as he vowed that lessons would be learnt from the “unspeakable” abuse. The Prime Minister said that any necessary changes would be made to the system as a result of the case, in which the 56-year-old businessman — known in court as Mr X to protect his daughters' identities — received 25 life sentences for rape. His crimes against his daughters, committed over at least 25 years, have been compared with those of the Austrian rapist Josef Fritzl.

“The whole country will be outraged by those unspeakable events that have been reported as happening in Sheffield and in other parts of the country and will be utterly appalled by the news of the systemic abuse of two sisters by their father over such a long period,” Mr Brown told MPs at Prime Minister's Questions. “People will want to know how such abuse could go on for so long without the authorities and the wider public services discovering it and taking action.”

The Times has learnt that the repeated failure of health professionals, social workers and the police to intervene, breached a key recommendation of an official review four years ago into an case of rape and incest with disturbing similarities.

In 2003 a man from Swindon was jailed for 15 years after fathering six children by his eldest daughter during 30 years of abuse. The inquiry into the failure to halt the abuse found serious failings in the way the agencies worked together and shared information despite growing suspicion about the origin of the children. It recommended that in future cases of suspected rape within the family, agencies should prepare a family tree and a chronology of significant events.

Details of the case involving the sisters from Sheffield show that, after one of them had given birth, doctors began questioning whether the baby's father was also the father of the newborn's mother. They failed to follow procedures set out by the General Medical Council dictating that authorities should be alerted in such cases.

Doctors in hospitals in South Yorkshire and Lincolnshire who became aware of the family's history of recurrent genetic disorders also advised the sisters on separate occasions not to have more offspring with the man fathering the children. Two of the nine children died within hours of being born because of conditions caused by genetic defects. Nicholas Campbell, QC, for the prosecution, told Sheffield Crown Court this week: “Someone in the hospital asked whether the father of the child was her own father. The daughter was terrified and she denied it. “Her mother was present and she collapsed on the floor crying out, 'no, it can't be true', but at no time did she ask her daughter questions about the identity of her child's father.”

A Serious Case Review is being carried out into why social services in Sheffield and Lincolnshire, and the police in both counties, failed to protect the girls despite warnings. Lincolnshire Social Services admitted yesterday shortcomings in the work of their staff, which allowed the abuse to continue for 25 years. Peter Duxbury, director of children's services at Lincolnshire County Council, said that the way information was shared between the authorities had changed since the family lived there and that nowadays the case “would have been dealt with in a different way”.

The role of schools and teachers will also be examined as part of the case review. On one occasion in 1988, burn marks on the face of one of the girls were spotted at their school but were put down to bullying. The other daughter suffered a broken arm but stayed off lessons to conceal her injuries.

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Australia: NSW public hospitals in crisis: report

A landmark report into the state of NSW public hospitals says they are "in a period of crisis" and on the brink of demise unless radical reforms are made. Commissioner Peter Garling, SC, said in his report, tabled in Parliament today, that cultural change was needed from the top down. "To start with, a new culture needs to take root which sees the patient's needs as the paramount central concern of the system and not the convenience of the clinicians and administrators," Mr Garling said. "Given the demographic changes and rising costs, it is the case that we have entered into a period of crisis for a public hospital system which has always been free and accessible to all. We are on the brink of seeing whether the public system can survive and flourish or whether it will become a relic of better times," he said.

The NSW Health Minister John Della Bosca said the first report into NSW public hospitals, released today, was a "landmark report" that would improve the way health care is delivered. Mr Garling, SC, has made 139 recommendations in his report, which focus on improving patient care and safety, Mr Della Bosca said. He said it was critical to take pressure off emergency departments and staff. He has recommended several changes in the way emergency departments operate, including that patients who do not require treatment within 30 minutes be seen by a doctor other than an emergency specialist.

Mr Garling has also recommended the Federal Government fund emergency "primary care centres" that should be set up in all hospitals to treat less urgent cases. "In my view, if it is all right for you to wait for an hour or more to be seen in an emergency department then you probably didn't need to be seen by an emergency specialist. "Many other well qualified doctors can help you." He said patients who were in the more urgent categories of one, two and three should be channelled through the emergency department and patients in categories four and five should be channelled to "primary care centres" to be set up within hospitals.

Mr Della Bosca said the Government would respond formally by March. "The Government will carefully consider this report. It is a first and important document," he said.

Mr Garling has also recommended that hospitals should have a "safe assessment room" for mental health patients close to the emergency departments. Mr Garling said a culture of bullying was "endemic" in the health system. "Almost everywhere I went, I was told about incidents of bullying. Many witnesses asked to be allowed to give their evidence in private."

He said NSW Health should establish a casual medical workforce within 12 months through a centralised register and annual performance reviews for all doctors. Mr Garling said a single health service, called NSW Kids, should be set up within six months for newborns and children needing acute care to "ensure that children of Walgett get as good care as do the children of Woollahra and Wollongong".

He has also said that all hospital staff should wear colour-coded uniforms or vests identifying in large print the role of the health professional" after the inquiry repeatedly heard that patients were confused about who was responsible for their care or even if they were a doctor or nurse.

Other recommendations include that NSW Health refund patients the cost of medication to treat hospital-acquired illness after discharge after the inquiry that only about 60 per cent of medical staff adequately washed their hands.

He said there should be an audit system for measuring how hospitals compile patient records many complaints were heard about poor record keeping and note taking.

The inquiry was called after scathing criticism from Deputy State Coroner Carl Milovanovich that systemic problems had contributed to the unnecessary death of teenager Vanessa Anderson at Royal North Shore Hospital. Vanessa, who was hit by a golf ball in 2005, died from respiratory arrest due to the depressant effects of opiate medication after a doctor misread her chart.

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