Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 200 - 206)



  200. It may not have greatly affected their waiting time, who is to say, but it may have caused a great deal of anguish to have had operations cancelled, not being given clear dates, being put on a suspended list. The end result might be that they got their operation when they were going to get it anyway but in the meantime there are 6,000 people out there who may well have had a pretty miserable time.
  (Mr Crisp) If you look at the South Warwickshire case, and I take that as a particular case, there were no dates involved, this was a delay in terms of putting people onto a waiting list and it did not affect their outcome in terms of when they would have been treated. The point that I am making here is that these are nine different cases and they do concern the relationships between individual trusts and their neighbouring organisations and in some cases what has happened here is that the trust simply did not report the numbers into the system, they did not do anything to the patients in any sense or any way at all, they simply did not tell us they had ten 18-month waiters or 15 waiters in this category. That has no impact at all on the patient, that is about the trust and the relationship between the NHS organisation and the NHS centrally. As I said earlier, I believe that the route into this is to give much more information to patients. We will put in checks and balances to make sure that we scrutinise—

  201. This is a great place to start. Why do we not give more information to patients now? Let's contact the 6,000 patients. You might leave off the ones in Warwickshire and drop 2,000 from the list and take the 4,000 and say in this new, open NHS that this bad thing has gone on in the past—
  (Mr Crisp) I hear the point and I take it seriously. The point that I made earlier was that we will be giving all patients the opportunity to see the length of waits for individual consultants in all hospitals in the country. That will provide a lot of information and will enable us to make sure that this sort of thing does not happen again.

  202. If they go into hospital in the future they will be kept well informed, they will not be told what has happened in the past?
  (Mr Crisp) I take the point you are making seriously, and you obviously hear the point that I am making. The technical case of they simply did not report you were on the waiting list to the Chief Executive of the NHS, that may or may not be something we want to tell patients, we need to tell patients.

  203. The amazing thing is I think the very first PAC meeting I came to six months ago was with you when we were talking about compensation and litigation and the one overriding message from the NAO Report at the time was that if the NHS did more to inform patients and offer apologies and so on, you could dramatically reduce the litigation bill. I am not a lawyer but I imagine you have got a few hundred cases coming your way, although it will probably be in ten years' time and it will be your successor who will be explaining why they were not offered an explanation and offered an apology rather than yourself.

  (Mr Crisp) Again, if you had been here earlier in the meeting you would have heard me say that part of the PAC last time was also talking about how do we give patients openness and so on and I was saying how we are carrying that forward. I hear the point you are making about these particular patients. I am at a disadvantage in that I do not know what has actually happened in these nine trusts. I am not saying that I am not going to do anything about it, I am simply telling you that after 400 questions, this is the 401st, I do not have a briefing on it.

  Mr Osborne: I knew we would get there in the end.

  Chairman: Thank you very much. There are one or two more questions, I am afraid, but we are almost at the end and you have done your best to answer our questions. You will understand that the Committee is still worrying away at this problem of compensation and your lack of control over the trusts. We take this very seriously, that you will have sufficient power to require trusts to act properly so that patients know what happens. I think my colleague, Mr Williams, has one more question he wants to put to you on that subject.

Mr Williams

  204. It follows on from what Mr Gibb said. As the Chairman has indicated, these are trusts that have breached the relationship there should be between them and their patients and, therefore, I do not think the Committee are sanguine that they can be relied upon to ensure that their patients are fully informed if they have suffered as a result of these instances. In the case of Barts it did say that it caused patients to wait for treatment longer than the urgency of their condition would suggest was reasonable, or possibly even safe, and the inquiry noted that these actions were potentially dangerous to the patients. I think it would be irresponsible—I do not mean this in an unpleasant sense to you—if we did not ensure that no-one could turn around to you or to us and say we have not monitored this situation, as I think Mr Gibb would like. Therefore, I would be grateful if you could require each of these hospitals to be told they are to notify you in the event of cases arising where there is reasonable evidence to suggest that patients may have suffered as a result of this situation. I can ask you to do it or I can instruct you to do it and tell us, but I would happily leave it to you if you would take on responsibility for doing it.
  (Mr Crisp) I did say in the course of this that there were some unanswered questions that we were still following up and I did actually say that this was one of the questions. What I had not done was take the point about talking to patients. I did say we want to know from the trusts whether they believe or have any evidence of anyone being damaged or harmed through this process and when we have got that I will happily provide that to this Committee.

  Mr Williams: Are you happy with that, Mr Gibb?

  Mr Gibb: Yes.

Mr Rendel

  205. One follow-up question on what has been said just now about giving patients more information. I take on board your comment that if patients have a lot more information about what waiting lists should be and they find that they are having to wait a lot longer that may throw up information about somebody fudging the waiting lists in the way that they have been doing in these nine cases and it may help to prevent that in the future, but how is that going to work in practice if, for example, a consultant has a number of patients coming forward for operations and some of them will have a clinical priority which is clearly higher than others? It may be that a patient with a fairly low clinical priority gets put off for several months and ends up waiting for perhaps nine or 12 months when he or she can see that the consultant's average waiting list is only two months. If they then ring up and say, "Hang on a second, I have been waiting five times as long as I should have been", what is going to happen then?
  (Mr Crisp) There are two things that are happening here. The first one is putting that information on the Internet. The other one is, of course, we are moving to a system of booked admissions so patients will have a date at the point when the decision is made that they need to be admitted, which will be even more helpful and in the long run that will deal with your question. In the short term your question is obviously an important one and that is partly why we are going to have to pilot this because we will find that some unexpected things will happen. As somebody said earlier, will that not just mean that waiting lists will equalise, things will change because people will be referred? I think the point is it will put the power with patients to ask those questions and to say, "If you are saying that the waiting list for my consultant is six months, why am I waiting nine months or ten months or 12 months," or whatever. That is the first step in changing the system is to start to put the pressure on it externally. If we can get onto booked admissions I think we will solve this problem but, as we know from our earlier meeting, that is three years off.

Geraint Davies

  206. On 19 November you made a point that there was not consistent methodology in terms of waiting list measurement across different trusts. In light of the importance of this Report and that Report will you now be putting out instructions to trusts on the precise definitions of how to measure waiting lists in terms of methodology, because otherwise people may come under fire inadvertently for doing the wrong thing?
  (Mr Crisp) We do. I cannot remember the exact point at the earlier session, but we do put out definitions and we refine them wherever we see there are problems. As a result of both that Report and this Report we will be making them even more clear for people, which I think is a very important point. I do take these points about openness as being very important, I have said it several times, and I think this will provide a lever to make things happen. The transparency about definitions will also be very helpful and I think, finally, the issue that this Report has revealed for us is that in a small number of cases people have manipulated the figures for whatever reason so we need to have higher standards because cases like this are damaging to the NHS and also to the patients, and we will be introducing arrangements to make sure we get higher standards.

  Chairman: Thank you, Mr Crisp. Mr Bacon asked you earlier the basis on which Mr Colin Jones was dismissed from Oxfordshire Health Authority and Nuffield NHS Trust. I understand that this may be relevant because it relates to the quality of the legal advice that is available to NHS employers so we would like you to write to us later with the basis on which he was dismissed.[8] May I thank you, finally, for appearing before us and for obviously taking these matters very seriously and for promising to take action to rectify them. Thank you very much.

8   Ev 22-23, Appendix 1. Back

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