APPENDIX 2
Supplementary memorandum submitted by
the former Chairman and Non-Executive Directors of Stoke Mandeville
Hospital NHS Trust
We feel that it is important that we should
tell you of some of the problems which Stoke Mandeville Hospital
NHS Trust faced during the year 1999-2000 which culminated in
it breaching the Government's 18 months' waiting list target.
They included:
1. Being without a substantive Chief Executive
from June 2000 until January 2001 and the resulting substantial
workload that the Acting Chief Executive/Director of Operations
was carrying.
2. A massive agenda which included one major
and two smaller PFI schemes; the reconfiguration of clinical services
and a proposed amalgamation of Trusts.
3. Cumulative cuts in budget over the previous
three years which resulted in the closure of two wards, two theatres
and the loss of 60 nursing and support posts.
4. A major outbreak of MRSA which closed
22 beds in February 2000 and prevented joint surgery for three
weeks.
5. Lack of staff leading to the closure
of 20 of the 100 surgical beds.
6. Lack of nursing home and other community
provision resulting in 20 of the 100 surgical beds being blocked
at any one time.
7. An increased number of referrals and
increased complexity of cases both spinal and orthopaedic e.g.
joint revisions/primary hips.
8. The absence through illness/maternity
leave of three Assistant Directors of Operations and the inability
to replace them on a temporary basis.
The policy of the Trust Board was clear and
reinforced regularly at meetings, namely that no 18-month waiters
would be allowed and that there were to be no irregularities in
the management of its waiting lists. Information on the overall
position against all Government targets, including numbers of
15, 16 and 17 month waiters was given each month to Trust Board
members and waiting lists issues were a major feature of Trust
Board meetings. Until October 2000, the Chief Executive of Stoke
Mandeville Hospital NHS Trust was an acknowledged expert in waiting
list management.
The Trust was required to deliver all the Government
targets and pressure on management was immense. The hospital needed
support and help, which was promised by the Region but not delivered.
Indeed, it would be fair to say that the SE Regional Office and
NHS Estates through their actions added to the workload and pressures
on the Trust.
When the breach of the 18 month target was discovered,
the Regional Office were immediately informed. There was no delay
and no attempt to cover up. We would contend that there was no
"collusion in fraudulent mismanagement of waiting lists on
a wide scale at all levels of the organisation going back to 1998",
which the Regional Chairman stated to the Chairman was the finding
of the National Patient Access Team in February 2001. This finding
was submitted to Ministers and was the basis on which the Chairman's
resignation was required. The final report from the NPAT Team
excluded all reference to fraud and collusion and none was found
by the District Audit investigation.
Three of the four Non-Executive Directors resigned
because of the failure of the Regional Chairman to consider their
advice and in protest at their Chairman's enforced resignation.
Everyone involved with the hospital deeply regrets
that some patients waited more than 18 months for treatment. Of
the 131 patients involved, 64 were systems or administrative errors.
They should not have occurred but they were not deliberate and
there was no attempt to cover up. Twenty-four remain unclassified
owing to the unavailability of notes as the patients were receiving
treatment. The remaining 43 were deliberate suspensions. There
can be no excuse for the suspension of the 15/20 unauthorised
suspensions by a middle manager. There is, though, some disagreement
as to whether the remainder should have been counted as breaches
of the 18 month target. Some of these patients were offered alternative
appropriate treatment plans but preferred to wait longer and some
patients were awaiting the second of a bilateral procedure and
were suspended until they were medically fit. The procedures followed
at Stoke Mandeville in relation to these patients was similar
to that followed elsewhere in the Region, however, District Audit
counted both these categories as breaches.
We feel that there were serious shortcomings
in the manner in which the problems at Stoke Mandeville Hospital
were handled by the SE Regional Office that exacerbated an unfortunate
situation to the detriment of the NHS, the hospital, its patients
and staff.
We hope that lessons will be learnt as to the
way problems should be handled in the future.
Signed by:
Gillian Miscampbell OBE DL
Past Chairman
Stoke Mandeville Hospital NHS Trust
Ian Taylor TD DL
Past Vice-Chairman
Stoke Mandeville Hospital NHS Trust
Alison Phillips OBE
Past Non-Executive Director
Stoke Mandeville Hospital NHS Trust
Glyn Andrews
Past Non-Executive Director
Stoke Mandeville Hospital NHS Trust
December 2001
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