Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 20 - 39)



  20. In that case can you now tell me how many board members have been dismissed since you were made aware of the contents of this Report?
  (Mr Crisp) What we have done since I have been aware of the contents—

  21. That is all I want to know.
  (Mr Crisp) Since December 19, none.

  22. None. If you look then at the case of Barts, if you look at page 12 the inquiry found lack of managerial ownership and control, lack of accountability, lack of clarity regarding roles and responsibilities, lack of trust board awareness, lack of internal reporting of problems and constraints, lack of clear audit trail and a lack of clear senior managerial leadership, otherwise everything was okay there. Are you telling me that a report like that does not merit sackings at the very top?
  (Mr Crisp) Let me talk about Barts & the London. At the same time as this was effectively happening, from the Department we had put in our own inquiry into a very wide range of issues at Barts & the London. As a result of that inquiry ultimately both the Chair and the Chief Executive decided to resign. That is not referred to within this but that is because, as you said, there were a catalogue of issues around Barts & the London. In addition, you will see from this Report that the three most senior managers—I think it was three in this case—who were involved in this, or appeared to be involved in this, had actually left by the time the investigation was completed and were not re-employed.

  23. You can have that many people who conveniently decide to resign, which is part of the cover-up, allowing them to resign, and yet we are told in paragraph five that the actions caused patients to wait for treatment longer than the urgency of their condition would suggest was reasonable, or possibly even safe, and these actions were potentially dangerous to patients and you tell us that all the board has done is sit back and watch some senior officials resign. If I can go on to the next question.
  (Mr Crisp) May I respond? The Chair and the Chief Executive are not some senior officials.

  24. Let me put in context what I am about to say. In paragraph seven, that same board considered in February last year the need for disciplinary action when they considered the Report, the board concluded that there had been organisational failure, therefore it would be inappropriate to single out individuals for disciplinary action. It seems that it was a sort of spontaneous institutional collapse of morality but that no-one actually made a decision at any time that contributed to that collapse of morality. Does that sound like a board exercising its functions properly?
  (Mr Crisp) I think what this Report does not distinguish is that it is a board of a different membership. I think by February 2001—I will have to check this, I have not got it written down in front of me—the previous Chair and Chief Executive had resigned by that time. In fact, I know that they had resigned by that time. So the Chair and Chief Executive—

  25. At what stage did they resign?
  (Mr Crisp) They resigned at some stage during the year 2000 and I cannot give you the date.

  26. Was the inquiry under way then?
  (Mr Crisp) The bigger inquiry was under way, the one I said that we had set up to look at the whole issues to do with—

  27. So they ducked and ran?
  (Mr Crisp) I do not think it was at all like that. I think this was a question of a number of issues coming out of that inquiry in the light of which they took the view that it was appropriate that they should resign. This was, therefore, a new board, a new Chair and a new Chief Executive who were, therefore, considering what had happened in the past, the previous Chair and Chief Executive had gone, the two Directors of Operations, who were the senior managers, potentially involved in this had also left. It seems to me that the board took the only decision that it could take in those circumstances, that the only person left within their employ was a relatively more junior manager. This is not a satisfactory state of affairs by any measure.

  28. As I say, the board then ducked and ran, there was no disciplinary action against them and they may well be working elsewhere in the health service, I do not know. What about in the case of Surrey? In the case of Surrey they deliberately connived at fiddling the records by asking people when they were going on holiday and then when they got it in writing when people had their holidays booked they phoned them and offered them dates for appointments in their holidays and when they could not accept them they took them off the list or suspended them. Similarly, they phoned them with non-existent cancellations offering very short notice appointments and, again, when they were declined they were suspended from the list. Surely that is corrupt and if it is corrupt it should have been acted upon. What action was taken against the board and what action was taken against the management as opposed to negotiating comfortable resignations for them with settlements?
  (Mr Crisp) Again, if you look at this case in detail, and I am not pretending this is satisfactory, you will understand that, and also that I am shocked by some of the things that I have seen here and we need to do better.

  29. I am sure you will.
  (Mr Crisp) What happened in this case was that for a range of wider issues an agreement was reached with the Chief Executive that she would leave before these issues were discovered. What then happened was the trust took the view that the highest priority was to tackle the issues for the patients, get them treated absolutely as quickly as possible, which is true of all these cases, and given that the Chief Executive had left it was inappropriate to discipline anybody else within this situation. That was the view that they took.

  30. This looks like a conspiracy of convenience, these resignations. The resignations mean that they have entitlements to notice, to pension settlements, possibly to redundancy or departure deals, as we have seen. What comes over is the sheer duplicity of the whole set-up, the gagging clause that the Chairman has referred to. I sat in the two hearings way back in 1994, one in relation to education and one in relation to a consultant, where this Committee ruled that gagging clauses were inadmissible. That was in 1994. Your predecessor accepted that recommendation. That was in 1994 but it was only in 1999 that you issued guidance. Why did it take five years to give guidance and why is it now in answer to the Chairman you have had to already backtrack and say "of course, it is only guidance"? Why has it taken so long to do too little? Not you, the organisation.
  (Mr Crisp) I understand that. The first point is I thought, and somebody behind me might check for me, that we had issued guidance before 1999. If I am not able to give you that assurance now I will make sure that we send you a note afterwards. The point is, I am not backtracking, this has always only been guidance. I am sure you know the relationship between the Department of Health and the NHS and that most of what we do with the service is to give guidance as to how things should be done. In certain cases the Secretary of State takes power of direction.

  31. How soon can we expect action to ban such agreements?
  (Mr Crisp) Soon.[1]

  32. Okay, let us know immediately it is done and let us have copies of whichever rules you issue. In conjunction with the gagging clause there were one or two other corrupt arrangements where references were agreed as part of the deal to persuade people to enter into the gagging clauses so they could not squeal against their senior managers and their colleagues and, in addition to giving them references to go to other employers who were going to take on possibly incompetent staff, they also used taxpayers' money to make settlements that most of us here would feel these people were not entitled to. This is why I say this is corrupt rather than incompetent.
  (Mr Crisp) There were two cases, three if you include the case where the person resigned before this came to light, where payments were made as part of compromise agreements. Let me just deal with the confidentiality clause issue in the case of Plymouth. At the top of page 18 you can see the confidentiality clause. It starts "Mindful of its obligations to permit this Agreement to be subject to proper public scrutiny," ie, this Committee and others, "the Employer will. . ." do various things. I have spoken to the Chairman about this and I asked the Chairman of that trust why they did not follow the guidance. There was a clear view expressed that they were aware of the guidance, but they had misinterpreted it. They were aware that confidentiality agreements should not be entered into where there was any risk of gagging whistle-blowers, but what they were concerned about, in their view, was that it was appropriate to have an agreement with a departing employee which prevented them talking badly, effectively, about the trust. There are two different issues there. We will be making it clear that confidentiality clauses, in the words you have used, "have got no place in the public sector", with the possible minor exceptions (which are your exceptions) where there is commercial interest.

  33. You have chosen two examples—
  (Mr Crisp) There are only three.

  34.—Of pulling together all of what I call "corrupt" efforts to obtain silence because in the case of Plymouth they agreed a reference for senior management who resigned, but for none of the three individuals did the reference refer to the findings of the inquiry reports. So there is the use of the reference as a further inducement to persuade people to keep quiet. Then in addition, as the Chairman has implied, they kept them on pay for three months at a cost of £67,000, so they gave them £176,000 compensation to buy their silence. This trust squandered a quarter of a million pounds of taxpayers' money partially to protect its own back.
  (Mr Crisp) The agreements were £146,000 rather than a quarter of a million—

  35. That was because there was a refund.
  (Mr Crisp) There was a refund of £30,000.

  36. There was a refund of £31,000.
  (Mr Crisp) I am just reflecting that that was the figure rather than the quarter of a million.

  37. The quarter of a million is when you add together the "gardening" leave they were given and what is not mentioned here, but I assume were the pension entitlements and other fringe benefits they had over the time they were on gardening leave.
  (Mr Crisp) In a moment I will ask Mr Foster if he would just explain what guidance was given because guidance was given before 1999 on conditions of service. However, in this case, and having gone through this in some detail with the chair, I am aware of the decision-making process that the board went through and there are a number of considerations, including, as again your chair has indicated at the start, fairness towards employees and making sure that we have first of all in our mind fairness towards patients, that is our top priority, but also fairness towards employees. It is right that these things should be investigated, it is right that they should then go through a disciplinary procedure. What happened in this case is that the board took the view, having received advice on it, that it was better, it was less costly, there was less disruption to the trust to reach a compromise agreement as a pragmatic way forward, rather than to go through the disciplinary procedure and hold people properly to account and maybe inflict some other damage. That is not the way we will do it in the future but that is the position and that is the series of decisions that this board made over that period.

  38. Do you not think that the sacrifice of a few clearly responsible heads might underline that you mean what you say and, secondly—and I finish on this because my time is up—the Department of Health has produced a press release saying that waiting list manipulation is unacceptable and it says: "In future, any manager found to have deliberately distorted waiting figures will face dismissal on grounds of gross misconduct." We obviously welcome that. Can you tell us—because your Executive covers only England and the NHS covers Wales and Scotland—whether that ruling includes Scottish and Welsh trusts but, nevertheless, do you know if this stronger disciplinary conduct will apply in Wales and Scotland as well as in England?
  (Mr Crisp) I should have remembered to get myself briefed on Wales and I did not. I do not know the answer to that, I am afraid.

  Mr Williams: It is not your responsibility.


  39. Thank you. Mr Williams. You mentioned, Mr Crisp, on the question about confidentiality clauses a very important word, the word "soon". We will probably need further particulars on what "soon" means and you may have to write to us.
  (Mr Crisp) Indeed we will.[2]

  Chairman: Mr Bacon?

1   Note by witness: We intend to issue directions during 2002. Draft directions are currently with the Department's solicitors prior to consideration by Ministers. Back

2   Ref footnote to Q 31. Back

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