Great Ormond Street Hospital 'puts gagging order on concerned doctor' Her friends told the Guardian she felt she was "hounded out" by the hospital after she emailed senior managers, including chief executive Dr Jane Collins, a detailed account of her concerns that a lack of junior doctors, inability to fill some rotas, poor staff morale and a lack of co-operation between different departments was putting patients at risk. Dr Cass told the newspaper that she had signed the confidentiality agreement "under duress," but had only done so in order to ensure that she could continue to undertake training at GOSH in children's palliative care so that she could set up a new service offering such care for terminally-ill children. Dr Cass" friends say that her opposition to Dr Collins's plan to cut 30 of the hospital's 200 junior doctors was a key issue. Only 10 of the planned 30 posts eventually disappeared after she argued for their retention, her friends say. GOSH, which has a new senior management team in place following Dr Collins's departure last autumn to become chief executive of the charity Marie Curie, said in a statement: "Patient safety is always our top priority and there is nothing in the agreement that precluded Dr Cass from raising concerns about patient care. Dr Cass has emphasised to us that if she had had any evidence of on-going threats to direct clinical care, she would have had no hesitation in speaking out. The grievances raised by Dr Cass after she had left the trust were unrelated to patient care and concerned the way she felt she had been treated by the trust. An independent external investigation into the grievances was conducted and considered by a grievance panel comprising an independent NHS chief executive, an independent NHS HR director, the deputy chief executive and a non-executive director. The majority of grievances were not upheld. The panel did not uphold the grievances related to Dr Cass" role and responsibilities within the trust at the time. The settlement agreement was jointly entered into between Dr Cass and the trust in order to draw a line under those grievances and to allow both parties to move on. The trust also wanted to prevent a lengthy employment tribunal incurring costs that could be better spent on patient care. Any concerns raised by Dr Cass in 2007 while she was at the trust were acted on. At the time she raised concerns all Trusts were considering how best to organise their workforce to comply with the European Working Time Directive on junior doctors. This issue was widely covered in the news. This was three years before the settlement agreement with Dr Cass. Dr Cass and the trust continue to work closely together to improve children's care.