Examination of Witnesses (Questions 120
- 139)
MONDAY 14 JANUARY 2002
MR NIGEL
CRISP AND
MR ANDREW
FOSTER
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
| 
