Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 120 - 139)



  120. How many of these patients, of the 6,000, affected by these irregularities will have died as a result of what has happened?
  (Mr Crisp) I do not believe that any have. We have taken this question seriously and the National Audit Office made the point in looking through the cases that in many cases this was a mere technicality, such as all the ones at South Warwickshire, for example, did not affect the time for treatment. In some cases there may be some patients who have suffered and we are asking the trusts to review that.

  121. So at some point we will know whether there have been any deaths?
  (Mr Crisp) We will have the information from the trusts of their assessment of it. I have no evidence that is the case at all at the moment. These cases have been worked through because everyone has been being provided with treatment plans if they were missed off the list for whatever reason.

  122. When do you expect to get that information?
  (Mr Crisp) Again, soon-ish.

  123. Can we have that as well?
  (Mr Crisp) Yes.[5]

  124. Have any of the patients who have been affected by these irregularities been told that it is the manipulation of the waiting list that has resulted in their delayed treatment?
  (Mr Crisp) I do not think I can give you a straight answer on that. I know that some have but the numbers that have I do not know.

  125. Do you not think it is your duty to tell them all that this has happened?
  (Mr Crisp) I would think where they are identifiable that it would be appropriate that they know. I suspect in most cases that has actually been done.

  126. Will they be offered compensation?
  (Mr Crisp) That is a matter for individual trusts to pick up.

  127. Do you not think, therefore, that the NHS should have a provision for liability?
  (Mr Crisp) No. If you look at it these are nine very, very different cases and I think individual trusts need to consider their own position on this, as in everything else, and that is a matter for them, but they really are very different.

  128. But they will all possibly involve compensation to these patients who have been inconvenienced?
  (Mr Crisp) No, I do not think that is the case. If you look at some of these, they are very much technical. The South Warwickshire ones did not involve patients being treated any later than they would have been treated otherwise, which is presumably the point that you will be wanting to make around compensation, or therefore coming to any harm. I think these are individual issues which need to be picked up by the trusts.

  129. Was the remuneration of any of the Chief Executives of the nine trusts involved in the irregularities affected by waiting list figures before these irregularities were uncovered?
  (Mr Crisp) I asked that question and we have reviewed that in most of the cases and have found that people did not get performance related pay, if that is your question.

  130. Yes, it is. How are these people remunerated if they are not remunerated on the basis of their performance?
  (Mr Crisp) Again, if you look at these individual cases you will find that many of them were in trusts which were not doing very well anyway and, therefore, they were not hitting their waiting lists. This is perhaps part of the reason why manipulation may have taken place. Therefore, if they were not hitting their waiting lists or their other targets they would not be getting performance related pay.

  131. But might they have had an increase in pay had they achieved better waiting list targets?
  (Mr Crisp) If they had achieved better waiting list targets?

  132. Yes.
  (Mr Crisp) Again, it depends on the circumstances because some trusts operate performance related pay and some do not. Not all of them are on a universal system. If in some cases they had managed to do things then they might have got a benefit but we have actually gone through to look at these.

  133. In these nine instances are there any instances where either (a) they did have an increase in pay as a result of their waiting list figures or (b) they would have had an increase in their pay if they had achieved better results?
  (Mr Crisp) The answer to the first one is we have not found any. The answer to the second one is I guess if people are hitting targets they are more likely to get performance related pay.

  134. But if they are not hitting targets, if they were hoping to try to hit targets by manipulating the waiting lists but they failed and they did not get the pay it is still criminal fraud, that is the allegation.
  (Mr Crisp) I think the allegation here is actually about 18 month waiters which by and large is not a specific target, it is a requirement, if I can put it like that. Performance related pay would be more likely to be available for people who have reduced waiting lists substantially. Many Chief Executives do not have provision for performance related pay in their contracts anyway, that is not universal.

  135. In response to Mr Williams' question about Barts you said that the Chief Executive and Chairman resigned. This Report only mentions one name and that is a relatively junior manager, the admissions manager. What was the name of the Chief Executive and Chairman who resigned?
  (Mr Crisp) I am not sure if I should be—They are on the public record. It was not in relation to this particular issue, it was in relation to a wider set of management issues around the trust which meant they decided they should resign.

  Chairman: Could you write to us on this?

  136. Can you confirm that they did not resign as a result of irregularities in the waiting lists?
  (Mr Crisp) My point in answer to Mr Williams was that it was a different trust board that considered things. The first trust board Chairman and Chief Executive, who were Chairman and Chief Executive during this period, resigned over a set of wider issues about the overall progress that the trust was making.

  137. But Mr Williams' point was that no senior trust member has resigned over these irregularities. Barts was the worst case of all these nine cases and nobody resigned. You gave the impression in response to Mr Williams that they had resigned in part due to these irregularities and now you are saying they did not resign.
  (Mr Crisp) I am sorry if I gave that impression. I thought what I said was that independent of this we had a wider review going on of the performance of Barts and its relationship with its neighbouring PCTs and its trust and health authority.

  138. Let's go back to the question Mr Williams asked then. Here it is said: "The Board concluded that there had been organisational failure and that it was therefore inappropriate to single out individuals for disciplinary action." They said that the whole methodology of manipulating figures had become custom and practice and therefore that was was a matter of corporate responsibility. Who is taking that corporate responsibility?
  (Mr Crisp) The Chair and Chief Executive had been in a post for about a month.

  139. I agree it should not be them. This was happening presumably before that month so who is responsible for that custom and practice?
  (Mr Crisp) The board, as I understand it, took the view that this was an unsatisfactory practice that had become custom and practice within that organisation, that they were new in this situation, but for different reasons, the two senior managers who appeared to be potentially implicated in this had already left and that therefore the most sensible thing they could do would be to say that "we are as an organisation are culpable, we need to put into place an action plan, not only about specific actions but about changing the culture of this organisation."

5   Note by witness: The process of contacting the NHS Trusts involved and asking for their assessment of those cases highlighted in this Report, is ongoing. Some of the cases refer to adjustments made 5 or 6 years ago and there are difficulties in identifying individual patients. We will continue to pursue this and will be happy to share the details with the Committee once the reviews are completed to the Department's satisfaction. Back

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