Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 140 - 159)



  140. What date were the recent Chairman and Chief Executive of Barts appointed?
  (Mr Crisp) I think you will find that this was an acting Chair and Chief Executive in the interim period before the substantive Chair and Chief Executive were appointed, so there was a very, very substantial set of management changes.

  141. You refuse to tell me who the Chairman and Chief Executive were who resigned, for various reasons. Who were the two Directors of Operations who resigned?
  (Mr Crisp) I think they are named in here and, I am afraid, if they are not, I do not know their names.

  142. One is named in Appendix 2 and that is the Admissions Manager. It just seems that that is the culture, a point other colleagues have brought up, that you are very happy to name and blame relatively junior people, yet particularly when they use the phrase "it became a matter of corporate responsibility", there seems to be an almost institutionalised cover-up to protect these very senior people.
  (Mr Crisp) I think that is unfair. The people who were chosen to be named here were chosen by the National Audit Office, not us. I can tell you the names of the two Directors of Operations (who were on a job share) who were referred to in this if you would like me to do that, that information is available, and we have three Chairs and three Chief Executives over this period within Barts and the London and we can provide you with those names, but it was not our choice. Indeed, we would have preferred not to see junior members of staff named here but this is not my report.

  Mr Gibb: My time is up.


  143. On that point of naming, the fact of the matter is that these inappropriate adjustments had been made, and this process was going on whilst these people were resigning, and therefore I think Mr Gibb is entitled to ask for their names if he wants to. You can either give us the names now or, if you do not know them, you can write to us.
  (Mr Crisp) I will write to you on that basis partly because I cannot remember the chair's name.[6]

  144. Mr Gibb also raised another important point that possibly the condition of some of these patients was exacerbated because of the way that they were treated and he wanted and we want reassurance that they will or have all been told what went wrong because there could be issues of compensation involved here and if their condition was exacerbated, surely they should be entitled to compensation? How could they receive compensation if they do not know what happened?
  (Mr Crisp) As I say, I think there are some issues that we have still got to pick up with the trusts around that and we will ask those questions. The point I have made is that for the vast majority of these patients we know that is not the case and the National Audit Office has said that is not the case. If there are particular cases, they are for the individual trusts to deal with because each of these cases is different.

  145. Well, you have a responsibility as well. I do not think you can just shuffle it onto the individual trusts.
  (Mr Crisp) The responsibility for compensation is with the trusts. My responsibility (which I did say I would be exercising) is asking them whether they had identified any patients who were in this category.

  Chairman: Thank you. Mr David Rendel?

Mr Rendel

  146. What would you expect trusts to do in order to meet the 18-month waiting list target or 15 month waiting list target or in future the six-month target if they think they are likely to go above it?
  (Mr Crisp) The first position is to tell us. If by that you mean the immediate action, I would be expecting people to contact their regional office and indeed pass on the information to me and indeed for 18-month waiters we have a requirement that it is passed on to me.

  147. What can you then do?
  (Mr Crisp) We centrally ask them pretty straightforward questions about what they are doing about it and whether they have used all the resources that they have got, how they are handling this, how are they going to make it happen, are they using the private sector, all that set of questions.

  148. So if they have a patient who is about to go above the 18-month target waiting time, you would expect them, for example, to use the private sector straightaway?
  (Mr Crisp) I would expect them to do two things. Firstly, I would expect them to make sure they got that patient treated just as soon as they could. The second thing I would expect them to do is to explain to us—

  149. What does "just as soon as they could" mean? If you tell them they can go private, presumably they can do it tomorrow?
  (Mr Crisp) They can do that anyway. Maybe they can get it tomorrow or maybe not, but what you do know is that most of these 18-month waiters are for people who have got some quite specific sort of complaint. Therefore, if you have a particular problem with a shoulder you may not be able to get it done in the private sector tomorrow or, indeed, the patient may not be prepared to travel the distance to get the operation done in the private sector. It will depend on the operation as to "just as soon as possible".

  150. If a patient comes up to 17 months and they can see they are going to go above 18 months and private treatment is available, then you will say that that patient should be treated at once privately?
  (Mr Crisp) And that is what happens. If private treatment is available locally, they probably do that and it does not come to us. We get very few cases of 18-month waiters. The other question I ask is how has this been allowed to happen?

  151. If what you say happens and they can go and have patients treated privately, that presumably means then that the NHS is using money to treat somebody privately who has reached the target limit rather than treating somebody who has greater clinical need who has not?
  (Mr Crisp) No. If you are wanting to pursue the question of clinical priorities, we are clear, and we are clear because the vast majority of the trusts do this, that you can balance your waiting lists so you hit not only the clinical priorities but also make sure that you deal with the long waiters. That is the point of my second question so that when somebody tells me they have got an 18-month waiter I am saying, "What are you doing about that patient?" And, secondly, "Why are you in that position?" If you are in that position, tell me how you are employing all the good practice that Mr Gibb referred to, for example have you got the Modernisation Agency visiting and are you making sure that it does not happen? We do know from the vast majority of trusts that you can run a balanced waiting list.

  152. Presumably they would not have ever got to that position unless they reckoned that that patient was not getting treatment this month because they have always got somebody who has a higher priority, either because they had waited even longer or because they were of a higher clinical priority. You cannot get to 17 months unless you are constantly taking the decision that there is always somebody else who has got a higher priority.
  (Mr Crisp) That is the reason why they are waiting relatively long, but more likely what has happened is they have had a slot and for some reason it was cancelled. It may have been cancelled on the day or something of that sort because an emergency came in. There are very few cases where 18-month waiters have not already had a date and, in fact, they had usually had a date that had been cancelled because a more urgent patient came in at the time because urgent patients take priority. But we need get the balance right between—

  153. When they get to 18 months then you are prepared to say there should be special measures taken to push that person, if necessary, through a private hospital rather than spending that money on what previously up to that 18-month point should have been a priority?
  (Mr Crisp) If we have got to that point then they will doing that as part of a wider set of issues, and that is the point of my second question. If they have got a problem with one patient, have they got a problem with several or have they got a problem with urgent patients? What are they doing about that? If your point is trying to make me say that we distort our priorities at that point for political reasons or something of that sort, I think what we do is we say what is the problem in this trust? Why have we got to this situation? Is it an individual who has been overlooked? Is it an individual who through some bad luck has been cancelled?

  154. I do not see how you can possibly avoid changing your priorities against clinical guidance if you are to have a waiting list system of this sort. Can I move on, I do not want to waste all my time, and can I refer you to an article in The Sunday Telegraph this Sunday which said that at the John Radcliffe in Oxford a few years ago patients were being marked with an "M" to show they had a management priority and that they were to be treated whatever happened in order to make sure they improved the waiting list times. Firstly, can I have your assurance that that does not happen any more?
  (Mr Crisp) I do not know. I am not aware of the practice so I would not have thought that happened. A management priority? As opposed to a clinical priority?

  155. Did you see the report in The Sunday Telegraph?
  (Mr Crisp) No.

  156. That does worry me.
  (Mr Crisp) I read an awful lot of newspapers but nobody has drawn that one to my attention, I am afraid.

  157. That is staggering. There was an absolutely clear report that people were being marked with a letter M to give them management priority above clinical priority. If that was not drawn to your attention I hate to think how the NHS has been managed.
  (Mr Crisp) They have been running quite a lot of stories, have they not, and I have seen some. I do not remember the particular point, nobody drew it to my attention.

  158. As far as you know, that does not happen any more? Can I have your assurance that as far as you are concerned there is not a trust under your control, so to speak, or your guidance where anybody is ever given a management priority above a clinical priority such that waiting list targets are met?
  (Mr Crisp) We are very clear what we have told people to do which is to give clinical priority. There are methods for doing that, not least because on every operating list you have got room for some major patients and some minor patients, and you need to balance your operating list and you can get in lower medical priority patients at a reasonable pace.

  159. I do not know how I can follow that up, Chairman, because it staggers me that he does not know about it but we will leave it for a moment. In answer to Mr Steinberg you said at one point that some people felt that they needed to cheat and that was the unfortunate reason why this has arisen, they could not overcome the 18-month problem unless they cheated. You then went on to say that you do not know why they felt that. Is that correct?
  (Mr Crisp) I think I also said I can only speculate, I have no idea.

6   Ev 22, Appendix 1. Back

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