Examination of Witnesses (Questions 180
- 199)
MONDAY 14 JANUARY 2002
MR NIGEL
CRISP AND
MR ANDREW
FOSTER
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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