WARNINGS of under-staffing and poor communication at the clinic where doctors failed to spot Baby P's broken back were made months before the toddler's tragic death, a report has revealed.

Concern was raised by one of four consultant paediatricians who worked in the paediatric department at St Ann's Hospital, in St Ann's Road, as early as 2006 prompting the independent report published by NHS London today.

Investigators found their fears were "genuinely and reasonably held", concluding that issues of excessive workloads and communication in paediatric services "could have been been managed more effectively in the interests of patient care".

Dr Kim Holt, one of the senior consultants to raise the alarm, claimed the Peter Connelly, known as Baby P, could have been saved if managers had listened to her.

The toddler was examined by locum paediatrician Dr Sabbagh Al Zayat who failed to spot the 17-month-old had a broken back. He died two days later.

The clinic, run by Haringey Primary Care Trust — now NHS Haringey — and staffed by Great Ormond Street Hospital, had cut the number of permanent doctors from four to just two in the months preceding Peter's death.

But the report found that "genuine attempts" were made to address the concerns.

Dr Kim Holt said: "Our concerns throughout were for the quality of care for the children being seen at the clinic. We followed internal trust channels, only going outside when they had been exhausted. I hope now that everyone will be able to learn from this report and move on. I want to contribute positively to improving services for children in Haringey, which was always my objective.

"I also hope that in future it will be far easier for NHS staff, in Haringey or anywhere, to speak out in the interests of their patients, particularly those who have no voice of their own."

In a statement Great Ormond Street Hospital said it welcomed the report, adding it would resolve outstanding issues "swiftly and amicably".