Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 180 - 199)



  180. I think it is very important that we do not try to stop people getting compensation by signing confidentiality clauses.
  (Mr Crisp) I do not think for a moment that was what was in people's minds from the discussions that we have had, but let us cross check the record on that.
  (Mr Foster) It is likely that they would have been acting on the advice of employment lawyers and that would have been the prime consideration. We will check.

  181. One final question, if I may. Most of the employees concerned, not necessarily the Chairman and so on, have been re-employed by the NHS. I think there is only one who has not been re-employed by the NHS.
  (Mr Crisp) No, that is not true. Two of the three at Barts have not been re-employed.

  182. I thought they were Chairmen of the Board.
  (Mr Crisp) It was a job share of the Director of Operations and those two have not been re-employed. It is more than that. Some have been re-employed.

  183. Clearly a number have.
  (Mr Crisp) Some have, yes.

  184. If I were a trust and I had it reported to me that somebody had lost their job as a result of being involved in this sort of thing, I would need an awful lot of persuasion to re-employ such a person and yet it seems that they have found it on the whole quite easy to get re-employment. Does that not say something about the difficulty that NHS trusts are having at the moment to get good management staff? If they are happy to employ people who have been thrown out in this sort of situation it is staggering and it is very worrying that they are having to employ people who have been thrown out and they cannot get anybody better.
  (Mr Crisp) I think some of the people here, with the exception of the incident that we are talking about, have had a great deal of management experience and skill and people have taken the view, in the knowledge of what has happened and probably in the knowledge of some discussion with the individuals about why it may have happened, to go back to your earlier point, that on balance that was the right way for them to go. That is not what we would be expecting to happen in the future for the reasons we talked about earlier.

  Mr Rendel: Thank you very much. Can I ask for a couple of notes. Mr Crisp did say earlier that there is going to be standard format of investigation and I wonder if we can have a note as to what that standard format of investigation will be. Also, on how many of the nine trusts concerned do treat private patients in those trusts as well, following up what Mr Steinberg said.[7]

Mr Osborne

  185. Can I apologise for not being here for the bulk of the meeting but I had a meeting about job losses at the edge of my constituency which was only arranged today. I have tried to gather some of the areas that have been covered. Can I begin with a written question that I asked Mr Hutton, or rather I asked the Secretary of State for Health but Mr Hutton replied. I asked the Secretary of State for Health under what circumstances an NHS trust can withhold the employment history of staff seeking employment in another part of the NHS and I got the answer "All NHS employers are expected to carry out thorough pre-employment checks on all staff they employ. The checks include taking up references which must be accurate and truthful." For how long has that been NHS policy?
  (Mr Crisp) I do not know how long it has been NHS policy but we could find out. Certainly that is what we need to do and what we need to reinforce. One of the things that we have talked about in your absence is that some of the human resources issues here, and that is why I have the Director of Human Resources with me, need to be followed up with the force of direction rather than just guidance. There will be something in the new arrangements that is specifically referring to references in the way you have talked about but having the force of instruction.

  186. You have just said "something we need to do", but, with respect, the question I asked was is it that NHS service employees are expected, ie expected now, and expectation is not the same as guidance, is it? You are not guiding them, you are expecting them.
  (Mr Foster) The policy you describe there is a very longstanding policy for the NHS that we should take appropriate employment checks but the guidance, technology, systems and procedures for doing so is constantly updated. Indeed, we are due to issue updated instructions about pre-employment checks across a wide variety of fronts in the near future, not related to this issue at all, on things like protection of vulnerable adults and so on. We have to constantly react to changing legislation elsewhere to make sure that our guidance and instructions to trusts is most up to date. It is not new, it is just that it changes frequently.

  187. If it is not new that references must be accurate and truthful, how could a trust issue a copy of a reference which made no reference to the waiting list adjustment incident for which Mr Riley in South Warwickshire was suspended? If it is a longstanding policy to provide accurate and truthful references it seems strange that there is no reason as to why he had been sacked.
  (Mr Foster) Indeed, and that is one of the failings that has been revealed in this Report. That is why the next set of guidance relating to these issues is to be mandatory rather than merely guidance.

  188. Have you considered disciplinary proceedings against the people who negotiated these settlement contracts?
  (Mr Crisp) That is a question that I am following up. The answer is yes. Again, in the press release that we issued initially we did say that we were looking at whether there was room for any further action on any of these cases, including any potential for clawing back money in the cases where that had not happened.

  189. What I am talking about is not the people who adjusted the waiting lists but the other people at the trust.
  (Mr Crisp) The Board?

  190. Who negotiated the severance. Do you have any timescale of when you might come to some conclusions on these things?
  (Mr Crisp) I regret to say I have probably said "soon" on a number of occasions this afternoon because there are about half a dozen or so outstanding issues, of which this is one.

  191. I have no problems with "soon".
  (Mr Crisp) The point is we need to deal with these things and move on. I would want to do it quicker rather than slower.

  192. Can I ask you about investigations by the National Patients Access Team. At paragraph 14, on page five, it says in the second half of the paragraph: "At two further trusts the National Patients Access Team had previously identified weaknesses in waiting list management and areas for improvement; though in both cases no further detailed enquiries were undertaken . . ." Can you explain that?
  (Mr Crisp) Yes. I am just looking for a note on the particular case because we have asked that question as to why we did not discover it. I cannot immediately find the note. The basic point was NPAT had been invited to go in and look at a general range of issues to do with waiting lists, not to do with the issue of potential manipulation of figures specifically. It is also worth saying that the potential manipulation of figures in some cases has been quite difficult to spot, unless you are specifically looking for that, because it is a relatively few number of patients added to a suspension list. They have been looking at the wider range of waiting list policy, given advice, given recommendations, and then moved on and have been invited back late.

  193. So even, to use the jargon, the NPAT teams, if that is not a contradiction in terms, had identified weaknesses in waiting list management but there were no further enquiries undertaken?
  (Mr Crisp) The process has been, firstly, that the problems have been identified, possibly by the trust itself. As a result of the problems being identified there has been agreement that the NPAT should go in, should look at the overall systems, should look at the ways in which we manage waiting lists, which are very often to do with people issues rather than numbers on forms. They are actually the sort of issues Mr Rendel was referring to of how do you manage a waiting list so that you make sure the long waiters are coming down as well as the clinically important waiters are coming down. There is a lot of good practice around that. That is what they will have gone in for. They were not sent in specifically to look at alleged manipulation. As I say, that can be quite difficult to spot because it may be small numbers.

  194. In the case of Salford Trust, which is Appendix 6, paragraph four, it says here that the first problems with waiting lists were identified in October 1998 by the Data Quality and Coding Unit and then they were visited by the NPAT in November 2000, again about waiting lists. There must have been alarm bells ringing that they had got a big problem in Salford with waiting lists and yet it was not until 5 July 2001 that a District Audit was called for.
  (Mr Crisp) Yes.

  195. So that is three years and that includes three years in which 435 gastro-intestinal patients awaiting endoscopy procedures were not included, 148 of whom were inappropriately suspended, and I imagine they were in a fairly serious condition to be in hospital, so they knew they had a problem at Salford.
  (Mr Crisp) As you know, Salford is one of the two cases which has not yet concluded and therefore we need to look in detail at the investigation here and look at what disciplinary action has been taken. It is worth noting that in October 1998 I do not think NPAT was in existence.

  196. The Data Quality and Coding Unit was and maybe it still is in existence.
  (Mr Crisp) There was advice available and you are quite right, the problems there have been going back some time.

  197. Can I finally ask about what my colleagues Mr Gibb and Mr Rendel talked about, the 6,000 patients, just because I have missed this. What exactly are you doing to contact the 6,000 patients to let them know that this Report has been published and there has been a problem and we have had a parliamentary hearing on the subject?
  (Mr Crisp) As you are probably aware, there has been more publicity in these cases in advance of the NAO Report because each of these cases has been a very big local cause célébre because they were identified before the NAO Report and the NAO Report has reported on them. So there has been a lot of local press. The points that I made are that, firstly, in some cases these were very technical small adjustments, like the Warwickshire ones where patients clearly were not affected. In some cases there is a suspicion or a suggestion that patients were affected materially in some way. We are going back to the trusts to ask them to report back to us on that in some detail so that we know what the position is and we know how and when the patients have been informed. I do not think that those were particular questions or it was a particular question that was picked out by the NAO Report, and therefore we are now doing that.

  198. Therefore your roundabout point is that "unless it is serious we are not going to get in touch with them"?
  (Mr Crisp) It depends. There will be judgments to be made when we get there.

  199. You are there now, are you not, you have got 6,000 patients whom you know have in some way or other been badly treated by the NHS and I would have thought it was fairly routine. If there is a problem with a particular operation or procedure in a hospital, you regularly contact hundreds of patients, so it should not be beyond the wit of the NHS to contact these 6,000.
  (Mr Crisp) That is perfectly true. What I do not know sitting here is what has been done in all of these cases already and therefore a judgment needs to be made, but if I think of the South Warwickshire ones where the length of time they waited is not materially affected—and I am not sure whether they have been informed or not and it may be appropriate to inform them—let the local people make that judgment when we see it.

7   Note by witness: Discussion continues within the Department as to the fine detail of the standard format of any future investigation. We expect these discussions to conclude shortly. We accept the key principles that the investigations should be independent and external. We will be happy to share the details with the Committee once finalised. All of the nine trusts concerned treat private patients. Back

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