An external review into the care of Ayaan Haroon, a five-year-old who died at Sheffield Children’s Hospital in March 2023, has concluded that his treatment did not meet expected standards. The report, produced by consultancy Niche Health and Social Care Consulting, identifies a series of clinical and governance failures but concludes they were unlikely to have changed the outcome.

Ayaan was admitted to the hospital with a lower respiratory tract infection and died eight days later in paediatric intensive care from overwhelming disseminated adenovirus bronchopneumonia. He had a history of breathing difficulties and had been hospitalised five times previously for respiratory illness.

The review identifies several serious concerns. There was a 12-hour delay in starting specialist oxygen therapy. Escalation to paediatric intensive care was delayed, in a way the report says may have marginally reduced his chances of survival. Clinical staff failed to respond to blood results showing significant deterioration. Governance structures were described as weak, and bereavement support provided to the family as substantially inadequate. Record-keeping came in for particular criticism, with reviewers warning that the practice of omitting names, dates and times from records would not withstand legal or professional scrutiny. The report makes 22 recommendations in total, four of which call for national improvements including on the use of life support equipment and bereavement care.

Ayaan’s father, Haroon Rashid, has rejected the report in full. He said it contained no apologies and no acknowledgement that any failings had occurred, and described both the draft and final versions as whitewashed and sanitised. He has also raised wider concerns about how independent investigations are commissioned, arguing that families currently have no say in who is appointed to investigate a death and that this needs to change.

Those concerns centre on Niche itself. The family asked the trust to appoint a different firm during the investigation. The trust declined. A Freedom of Information request has shown that Niche conducted 152 of 265 independent NHS investigations between 2014 and 2024, accounting for more than half of all those instigated. The firm’s involvement in a similar case at the same hospital previously drew criticism from Wes Streeting, now health secretary, who described a Niche report into the death of another five-year-old, Yusuf Nazir, as “whitewashed and sanitised” while he was shadow health secretary.

The concerns about Niche’s work are not limited to the family’s account. During review of the draft report in 2025, the hospital’s own paediatric immunology and infectious diseases specialists wrote to trust executives warning of significant factual and scientific inaccuracies. One key finding in the draft had suggested that Ayaan carried a mutation of the HACE1 gene that affected his immune system. The hospital’s own experts said they had investigated the claim and found no evidence that HACE1 deficiency affects immune function, concluding that Niche had misinterpreted the scientific literature. The error had direct consequences for the family. Ayaan’s sister shares the same gene, and the claim prompted the family to arrange urgent testing for her.

Sheffield Children’s Foundation Trust said it was committed to learning from the investigation and acknowledged the profound impact of losing a child. Its executive medical director said the trust appreciated how difficult independent reports were for affected families and would work to implement the lessons identified. Niche said the report was balanced and proportionate, critical of material aspects of care, and that all 22 recommendations had been formally accepted by the trust.

The case raises questions that go beyond one family’s loss. How independent investigations into NHS failures are commissioned, the concentration of that work among a small number of firms, and the absence of any formal role for families in selecting investigators are all issues this case has brought into sharp focus. Whether the current framework is fit for purpose is a question NHS England has yet to answer directly.

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