Examination of Witnesses (Questions 200
MONDAY 14 JANUARY 2002
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
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
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.
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 irresponsibleI do not mean this in
an unpleasant sense to youif 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
(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.
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.
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.
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