Select Committee on Public Accounts Minutes of Evidence


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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