HOSPITAL NHS TRUST
Stoke Mandeville Hospital is situated near Aylesbury
in mid-Buckinghamshire. It is home to the National Spinal Injuries
Centre and is an Acute General Hospital serving the needs of the
population of mid-Buckinghamshire and parts of the adjoining counties
of Bedfordshire, Hertfordshire and Oxfordshire. It hosts the Regional
Burns Unit as well as well-established sub-regional specialities
of Plastic Surgery, with clinics in Northamptonshire, Bedfordshire
and Hertfordshire, and ophthalmology, rheumatology and orthodontics.
It has about 520 beds and 2,170 wte staff. Around a quarter of
a million patients attend the hospital each year.
Its site was, until 1999, approximately 90 acres
and its buildings include wartime huts that suffer from subsidence,
(six wards had to be taken out of use as a result in 1997-98)
and are in constant need of repair. Backlog maintenance across
the site is a significant issue. The Remaining buildings are 1970s
Oxford method frame buildings, the National Spinal Injuries Centre
built in 1995 as a result of the Jimmy Savile Appeal and some
recent modern buildings such as the Maternity Unit. The most recent
Cancer Care and Haematology Unit opened in 2001 was, like the
Spinal Injuries Centre, built by charitable donations raised locally
Stoke Mandeville Hospital became a Trust in
1994. On 27 June 1994, Tom Sackville, the Minister for Health
wrote to the then Chairman of Stoke Mandeville Hospital NHS Trust
saying that the Business Case for capital development had Government
approval. In June 1995, in a written answer to a question from
David Lidington, the MP for Aylesbury, he replied "this scheme
(Stoke Mandeville Redevelopment) has received Full Business Case
Approval and is planned to start from 2 December 1995."
Later that summer, the Trust was informed that
their scheme needed to be tested against a potential PFI option
and that they should run the Treasury funded scheme in parallel
with a PFI scheme. This was done, though the field of potential
consortia was not strong as this was a scheme which had already
been approved for Treasury funding. In October 1995 Stoke Mandeville
was informed that there would be no Treasury money for the scheme
and the Trust would need to pursue a PFI solution. In 1996 following
the collapse of the consortium the Trust advertised again and
by July 1997 the Trust were just about to go to Preferred Bidder
status with a second consortium. Meanwhile approximately £3,500,000
had been spent on the infrastructure required such as roads, drains,
a roundabout etc. In 1997 the General Election took place and
the Labour Government was elected. A stop was put to all PFI schemes
whilst the new Government assessed the position and despite heavy
pleading, SMH was not one of the 12 schemes, which were considered
sufficiently advanced to gain approval. In 1998 SMH advertised
for the third time for a PFI partner. That scheme has now reached
the point of moving to Preferred Bidder status but has been temporarily
on hold, as it has been one of the three pilot schemes involved
in exploring alternative options for the management and future
employment of Facilities Management staff.
There are three elements to the Stoke Mandeville
Hospital site. About 40 acres to the south which belong to the
Trust, the remainder being split into two tranches which were
leased to the Trust but stayed in the Secretary of State's ownership
in 1994 when Stoke Mandeville Hospital gained Trust status. The
presumption then was that, as the hospital was about to be redeveloped
and would not require its full site, the surplus land would be
sold and the proceeds would go some way to funding the Treasury
approved scheme. Of the two tranches leased to the Trust but remaining
in the Secretary of State's ownership, the middle tranche currently
has the North corridor wards, the Coronary Care Unit and the Gastroenterology
Unit all in wartime huts, and an operating theatre. The most northerly
tranche accommodates a number of doctor's residences and three
nursing accommodation blocks.
In 1998 the Anglia and Oxford Regional office
sold, on a single tender basis, the most northerly tranche of
land to Persimmon Homes for housing development, without advertising
the site and without any reference to Stoke Mandeville Hospital
who were in occupation of the site. It was a transaction that
the Trust Board considered did not comply with guidance or best
practice. When it learned of the sale, the Trust Board raised
the question of the probity of the Regional Office's action with
both the Regional Chairman and Chief Executive. NHS Estates (Leeds)
later commissioned an Independent Enquiry by solicitors into the
transaction. The Trust Board was not allowed to see their Report,
which we understand criticised both individuals and the process
that had been followed by the Regional Office. The Trust Board
was, however, told by both the solicitors and NHS Estates (Leeds)
that no blame attached to Stoke Mandeville Hospital, its Board
or its employees. At a meeting held with representatives of NHS
Estates (Leeds) and a Regional representative of NHS Estates in
May 2000, the Board was promised an immediate letter for the record
exonerating the Trust. Despite many reminders and much pressure,
no letter was forthcoming until very recently, when a letter was,
we are told, received by the new Trust Chairman.
As a result of the sale, the Trust was required
to replace both the doctors' and nurses' accommodation that were
on the Persimmon site. Negotiations took place with a number of
Housing Associations and separate PFI bids were made for their
replacement. In 1999, the Trust Board selected the Beacon Housing
Association as the preferred bidder. However, the SE Regional
office, who had taken over from the Anglia and Oxford office,
stopped the deal going ahead, on the basis that the Trust should
consider building on the site sold to Persimmon or the site still
in the Secretary of State's ownership, options which had never
before been offered to the Trust. Indeed, the Trust had been requested
to clear the Persimmon site as soon as possible so as to give
vacant possession to Persimmon. The Trust was told that the NHS
Estates wished to renegotiate the deal with Persimmon. Because
of the delay, substantial sums of money had to be spent on the
old nurses' accommodation to make it acceptable for existing nursing
staff and also fit for the nurses who were coming from the Philippines
to ease the nursing shortage at Stoke Mandeville. As a consequence
of the late intervention by NHS Estates, the scheme had to be
re-advertised and started again from scratch.
To date neither the main PFI bid for the redevelopment
of the hospital nor the PFI bids for the doctors' or nurses' accommodation
have, as far as we can ascertain, been signed off.
In 1997-98 the Trust had reduced its maximum
wait in all specialities to no more than 12 months. This was highly
regarded by the local GPs and was in part instrumental in its
success during the fund holding years. The Hospital's performance
was the best in the County. The same year Bucks Health Authority
decided that there was a need to equalise access across its three
acute hospitals. Stoke Mandeville's income from Bucks Health Authority
was reduced by £2 million. As a consequence and in order
to balance the Income and Expenditure account, swingeing cuts
were made, which included the closure of two wards, one surgical
and one long-stay elderly, and two operating theatres, the loss
of nursing posts and a tightening of the budget for management.
Altogether 60 posts in nursing and support jobs were lost. Savings
were made but with inevitable detriment to the waiting list position.
In the year 1998-99 the Trust, as a result of very tight management,
met its targets albeit with some difficulty. In 1999-2000, Stoke
Mandeville was required to make a further saving of £1.6
million. There was always the underlying threat from Bucks Health
Authority and the Regional Office that they would not approve
Stoke Mandeville's PFI bid unless Stoke Mandeville Hospital met
all its financial duties year on year. Additionally, the Regional
Office and Bucks Health Authority insisted that fully worked up
savings plans were in place, thus demonstrating that the PFI scheme
would deliver the required savings. The Trust always held that
savings at this level were unachievable given the number of patients
requiring treatment and the deficiencies of the site. However,
the Trust did achieve a further £1 million plus of savings
in the year 1999-2000, ending with a deficit on the I & E
account of £866,000. Despite this, through rigorous management,
it met almost all its waiting list targets.
The Trust was awarded a whole hospital Charter
Mark for its excellence in Public Service in 1996 and again in
Management of Stoke Mandeville Hospital was
well regarded by the Region and the cost of management, as a proportion
of income, placed it among the most efficient in management cost
terms. From 1997-99 Ken Cunningham, the Chief Executive of Stoke
Mandeville Hospital NHS Trust was appointed Chairman of the Anglia
and Oxford Region Waiting List Task Force and was their representative
on the National Waiting List Action Team. In 1999 he was appointed
as a Member of the SE Regional Patients Access Team.
As a result of his Regional Waiting list responsibilities
Mr Cunningham was regularly absent from Stoke Mandeville Hospital
supporting other Trusts with waiting list problems. The Nursing
Director of the Trust was also the Chairman of the Bucks and Northants
Education and Training Consortium and the SE Regional Office's
Nurse Champion for Improving Working Lives. She too was regularly
absent on Regional duties during 2000. It is a matter of record
that the absence of these two senior executives caused difficulties
and the Chairman of the Trust, Gillian Miscampbell, raised her
concerns with the Regional Office as to the amount of Stoke Mandeville
Hospital senior management time being used by the Regional Office.
Stoke Mandeville Hospital Trust Board always
paid strict attention to the waiting list situation. Monthly reports
were presented to the Trust Board by the Executive showing the
overall situation against all Government targets, with specific
information as to 15, 16 and 17-month waiters. Until the February
2001 Board meeting, when it was told of the Northamptonshire patient,
no 18-month waiters or problems were notified.
The policy of the Trust Board was clear and
reinforced regularly at meetings, namely that no 18-month waiters
would be allowed and that all steps must be taken to prevent 18-month
waiters occurring. This was stated regularly at Trust Board meetings
and at individual meetings between the Chairman and Chief Executive.
Attention was drawn to irregularities which were taking place
elsewhere. This was the subject of discussion by the Trust Board
and strict instructions were given that there were to be no irregularities
in the management of Stoke Mandeville's waiting lists. In parallel
with this, the Trust was cultivating a "no blame" culture
in its endeavour to learn from mistakes and improve safety and
Regular reports were also presented to the Board
was to waiting lists, the bed position, activity, staffing and
the problems the hospital had in admitting elective patients.
Discussion of these issues formed a major part of Trust Board
meetings and very full briefing papers over and above the Board
papers were provided to Board members. The Board relied on the
information provided to it by the Executive. There was rigorous
scrutiny of the information and data provided in which the Community
Health Council representatives, who attended the Board meetings
In April 2000 the Trust was made aware of three
potential 18-month waiters. In accordance with the Trust's policy
of openness and honesty, these potential breaches were immediately
notified to the Regional office. In the event, no breaches occurred.
However, the Trust Board were assured that steps had been taken
by the Chief Executive, Ken Cunningham and the Director of Operations,
Sue Nicholls to ensure that there would be no repeat of the problem.
In addition the Region sent a representative to Stoke Mandeville
in June 2000 to verify the waiting list situation and agree the
management action that had taken place. We understand that she
expressed herself satisfied with the steps that were being taken.
On 1 June 2000, Ken Cunningham was seconded
for six months to Surrey and Sussex NHS Trust as Acting Chief
Executive. It had major waiting list problems. Such Nicholls became
Acting Chief Executive. She maintained her role as Director of
Operations. Paul Martin, Chief Executive of the Two Shires Ambulance
Trust joined Stoke Mandeville as Acting Deputy Chief Executive
on a seconded basis to gain experience in the Acute sector. As
Paul Martin was only due to be with Stoke Mandeville until November
and had no experience of an acute hospital, he undertook specific
projects that were time limited.
Three of Stoke Mandeville Hospital's four Assistant
Directors of Operations were absent over extended periods of time
through sickness or maternity leave, putting additional strain
on Sue Nicholls in her Director of Operations role.
In August 2000, Surrey and Sussex advertised
their Chief Executive post and Ken Cunningham was appointed. He
gave six months notice at the end of October. It was acknowledged
by the Regional office that Stoke Mandeville had a very extensive
agenda and was short of management resources. The Chairman, Gillian
Miscampbell, was asked to release Ken Cunningham immediately but
refused to do so unless and until the Region provided additional
support to Sue Nicholls. The Region gave assurances that support
would be forthcoming if the Chairman released Ken Cunningham.
The Chairman wrote to Barbara Stocking, the then Chief Executive
of the SE Region, on 13 October, "As you know, the very strong
advice that I am getting from both the clinicians in this hospital
and from Non-Executive members of the Trust Board is that, bearing
in mind the agenda we are facing over the next six months, we
cannot continue with the present management arrangements till
next April. Their strong view is that Ken Cunningham should work
out his notice so as to enable this Trust to fulfil its agenda."
Assurances were given that support would be forthcoming and the
Board was told that it should commence procedures to find a replacement
No support was forthcoming from the Region until
in mid-December it was agreed that Lynda Atkins would join SMH
from the Regional office as Acting Director of Operations on 8
January and that Paul Martin would extend his secondment until
February 2001 to enable him to complete some of the projects in
which he was involved.
For some time work had been being undertaken
by clinicians on a potential clinical reconfiguration of services
between Stoke Mandeville Hospital and the South Bucks Trust because
of the clinical advice, which was coming from the Royal Colleges,
and the training needs and working hours of junior doctors.
In late December 2000, the two Chairman were
summoned to see William Wells, the Chairman of the SE Region,
and told that the Regional Office had decided that the two Trusts
should amalgamate. This was just before the scheduled interviews
with the shortlist of candidates for the Chief Executive's position.
As a result, two of the short listed candidates withdrew. During
January 2001, meetings took place between the two Chairmen and
two Chief Executives and on 7 February they were all summoned
to see William Wells and Ruth Carnall, the Acting Regional Director
of the SE Region, and told that it had been decided that the two
Trusts were to amalgamate in April 2002.
This was always a very tight schedule and required
a substantial amount of work if it was to be achieved. Stoke Mandeville
expressed concern at the timescale in the light of the agenda
it was already coping with and suggested that, bearing in mind
the procedures that need to be followed and the consultation period
required if an amalgamation was to take place, that either October
2002 or April 2003 were more realistic. However, we were told
that the April 2002 date had to be achieved, notwithstanding the
fact that the reconfiguration of clinical services discussions,
which had been taking place for some time, between clinicians
at the two hospitals, would not have been completed before the
public consultation process commenced.
We understand that it has now been admitted
that April 2002 is unrealistic and that the date has been put
back to April 2003.
23 January 2001
A patient from Northamptonshire rang to enquire
when she would be treated. Investigations showed that she had
seen a consultant some 23 months previously and there had been
an error between the consultant/his secretary, which resulted
in that patient being omitted from the waiting list.
The patient was immediately give a "to
come in" date. The Chairman and Trust Board were told of
the situation the moment the information of the breach came to
light and the Regional office was also informed. An investigation
was started by the Hospital into what had gone wrong.
A thorough investigation led by Acting Director
of Operations, manned by Stoke Mandeville Hospital and the local
Primary Care Group staff, was established. Further breaches were
identified, firstly of a similar nature with that consultant's
list. Stoke Mandeville Hospital staff undertook a continuing thorough
investigation of all aspects of waiting lists and daily reports
were made to the Regional Office. There was no question of cover-up.
The Hospital requested an independent review
from the Regional Office.
Wednesday 7 February
Sue Nicholls (Chief Executive) and Gillian Miscampbell
(Chairman) were summoned to the Region at 9 am for a half hour
meeting with William Wells (Regional Chairman) and Ruth Carnall
(Regional Chief Executive), together and then separately. William
Wells told the Chairman that, "she must consider her position;
that she had two optionsresign or be sacked." Ruth
Carnall told Sue Nicholls that she could not continue as Chief
Executive of Stoke Mandeville. As the Chairman was going to leave
on 9 February, a meeting with William Wells was fixed for Monday
26 February, on the Chairman's first day back.
Thursday 8 February
Stoke Mandeville Hospital Trust Board met on
its regular monthly meeting. This was followed by a meeting between
the Chairman and the Non-Executive Directors. The purpose of the
meeting was to report the content of the meeting with the Regional
Chairman, William Wells, and the option of "resign or be
Friday 9 February
The Chairman went abroad on leave. She returned
on Saturday 24 February.
Saturday 10 February
The Non-Executive Directors wrote to William
Wells, the Regional Chairman, with a copy to Ruth Carnall, the
Acting Chief Executive, saying "if failures are attributable
to a Board Member, then they are attributable to the whole Board:
we have collective responsibility and have collectively accepted
in good faith the regular reports which have been made to the
Board on this important issue." The Non-Execs set out the
agenda facing the hospital and their view that "Given the
excessively heavy agenda that the Trust is now shouldering, the
removal of the Chairman and Chief Executive would have devastating
consequences for . . . that agenda"
The replies from William Wells and Ruth Carnall
were dismissive. William Wells described the letter to Gillian
Miscampbell on the 26 February as "a silly letter from your
Tuesday 13 February
The National Patient Access Team (NPAT) visited
Stoke Mandeville for one day from 7.30 to 3.30. They interviewed
12 people. They did not interview or ask to interview the Chairman
or Non-Executive Directors.
Wednesday 14 February
The NPAT report was sent to Ruth Carnall, Regional
Director of the SE Region. Stoke Mandeville Hospital was subsequently
told that the Report had been submitted to Ministers. No draft
or copy of the document was shown to the Chairman or any of the
Stoke Mandeville Directors.
Monday 26 February
Gillian Miscampbell met William Wells. She was
informed that the report was shocking; that it was the worst case
ever; 160 long waiters had been identified, some going back four
years. She was told that the Report was with Ministers and that
there were findings of collusion in fraudulent mismanagement at
the highest level. She was told that the situation was unforgivable
and her position untenable. That the evidence of fraud and collusion
would count against her with the Minister. William Wells quoted
"this manipulation of the waiting list appears to be collusion
on a wide scale and at all levels of the organisation since 1998".
Gillian Miscampbell was told that both Ken Cunningham and Sue
Nichols were implicated and that, whilst the Region would do their
utmost to "save Ken, Sue Nicholls would have to go".
She was also told that she had the choice of being sacked or could
resign. William Wells said that he would not wish for Gillian
Miscampbell, after her long service, the ignominy of the Minister
telephoning and sacking her, but that she would be sacked if she
did not resign.
She was denied access to the Report on the questionable
grounds that it was with the Minister. William Wells had a copy
in his hand from which he quoted. The Chairman insisted on seeing
the NPAT report before reaching a decision and it was agreed that,
in common justice, she should have that opportunity. There was
a Trust Board meeting on Thursday 1 March. It was agreed that
she had to take that meeting and that the Report would be sent
to her on Friday 2 March. She would consider it over the weekend
and would speak with William Wells on Monday 5 March with her
decision. On return, the Chairman informed the Non-Executive Directors
of the content and outcome of the meeting with William Wells.
William Wells wrote to the Chairman after the
meeting but sent it to the wrong address so that she never got
the letter and only received a copy in response to another letter
on 23 April. The letter said "The National Patients Access
Team has now produced its report and I regret to say that their
findings are that there has been a significant manipulation of
the waiting lists which appears to arise from collusion on a wide
scale and at all levels of the organisation since approximately
1998. Manipulation of the waiting lists on the scale which has
been perpetrated by your Trust over the last three years is completely
unacceptable and I hold you personally responsible as Chairman
of the Trust Board".
Wednesday 28 February
Gillian Miscampbell wrote to William Wells,
in the light of what he had told her was in the Report, which
neither she nor anyone at Stoke Mandeville Hospital had been allowed
to see, that it was "her intention to submit her resignation",
but that she would speak to him on Monday when she had had a chance
to see the Report.
Thursday 1 March
Stoke Mandeville Hospital had its regular Trust
Board meeting. The Chairman arrived home late afternoon to find
a fax from William Wells saying that he had seen the Minister,
who had accepted her resignation, which had not been submitted,
and that her "resignation would take effect from early next
week and would be reasonably contemporaneous with the publication
of the report" which she had not been allowed to see.
Friday 2 March
The NPAT Report was faxed to Gillian Miscampbell
in the late afternoon. A meeting was held with the Non-Executive
Directors who were apprised of the Report's findings. Non-Executive
Directors have never been sent a copy, and would not know to this
day of its contents unless the Chairman had shared information
Gillian Miscampbell considered the Report over
Sunday 4 March
Gillian Miscampbell wrote to William Wells "Firstly
may I make it absolutely clear that I have not yet resigned. Your
letter and discussion with the Minister was somewhat premature".
The letter stated that she was not prepared to resign and refuted
any question of any charge of collusion or involvement in wrongdoing.
"You really cannot expect me to resign and at the same time
publish an unsubstantiated allegation." The letter went on
to say that Gillian Miscampbell recognised that, "as Chairman,
I am accountable to the Secretary of State for the performance
of the Trust and I understand the political imperatives of having
someone to blame. If, however, I am to be required to resign,
I should tell you that any question of implied dishonesty on my
part will be vigorously disputed by me and that this matter must
be resolved before I am asked to take a decision. I am not prepared,
after 20 years' service to the NHS, to have my good name brought
into question by an unfounded allegation."
Monday 5 March
William Wells telephoned Gillian Miscampbell
and agreed that she was justified in her concern and it was agreed
that William Wells would write a letter exonerating the Chairman
and Non-Executive Directors. His letter said, "I can confirm
absolutely that the allegations as to how waiting lists were mismanaged
bear no implications as far as the Chairman and Non-Executive
Directors of the Trust are concerned. The details of the management
of the waiting lists are not the responsibility of the Chairman
or Non-Executive members of the Board; as a consequence any allegations
that are made in the report do not apply to the Chairman or Non-Executive
However, as you realise and agree, the fact
that there are a significant number of over 18 month waiters at
Stoke Mandeville is the responsibility of the Chairman and Non-Executives
and it is for the failure to deliver an essential plank of Government
policy that the Chairman should resign".
The Region gave no publicity to this statement.
The briefing from the Region led to radio and
television items and articles in the media of "mismanagement
of the waiting lists, cover up, Chairman resigned".
(It should be noted that William Wells' letter
of 5 March said that the Chairman "should resign". In
a fax to her dated 1 March, he said "I have discussed this
with the Minister and he accepts your resignation". Subsequently,
the Minister confirmed 6 March as a matter of record as the date
on which the Chairman resigned).
Tuesday 6 March
Resignation of Gillian Miscampbell took effect.
Wednesday 7 March
Three of the four Non-Executives resigned. Their
offer to meet the Regional Chairman had been ignored and their
advice dismissed out of hand. A further reason was the process
and treatment of the Chairman, Gillian Miscampbell.
Thursday 8 March
The replacement Chairman was introduced to Stoke
Monday 5 March
Sue Nicholls attended a meeting with Ruth Carnall
and was again told that she could not remain in post. She was
shown a letter from the Director of the NPAT Team saying that
reference to collusion should be dropped from the NPAT Report.
She agreed to step aside pending an external enquiry.
12 April 2001
Gillian Miscampbell wrote to Ruth Carnall asking
to see the letter from the Director of the NPAT Team, "As
Sir William quotes that statement as the basis on which my resignation
was required, in common justice, I believe I am entitled to see
that letter and to know if the current version of the NPAT Report
still includes that statement, or if, as I have heard, there has
been some amendment to the Report dated 14 February."
Gillian Miscampbell received a copy of the final
version of the NPAT report which excluded the sentences "On
available evidence, this manipulation of the waiting list appears
to be collusion on a wide scale and at all levels of the organisation
since approximately 1998" and "Staff at all levels of
the Trust either colluded in the inappropriate suspension of patients
or should have known of the problem." These two sentences
had been in the NPAT Report that had been sent to Ministers in
February and as William Wells told Gillian Miscampbell on the
26 February "The evidence of fraud and collusion would count
against her with the Minister".
26 April 2001
Ruth Carnall, Regional Director wrote to Gillian
Miscampbell saying that "As a former Chairman you were not
involved in day-to-day management and will not therefore be expected
to know about detailed management arrangements. Copies of the
Report . . . include the full text . . . The only change is in
the reference to "collusion". This has been deleted
as it is an inference, rather than established fact".
District Audit was asked to do an investigation
by the new Chairman of Stoke Mandeville Hospital. They took evidence
from a number of people including the past Chief Executive, Ken
Cunningham, and produced a Draft Report, on which comments were
made by most of those who had been given a copy. As far as we
can tell, no account was taken of any of the comments made by
the previous Chairman, Non-Executive Directors, Mr Cunningham,
or Miss Nicholls; as a result the Report is, in our view, significantly
The Trust treated 22,000 elective patients each
year. Of the 131 patients identified as long waiters, systems
errors, where patients were wrongly classified or legitimate suspensions
had not been lifted, accounted for 35 patients. This represents
0.19 per cent of the patients successfully treated. Administrative
errors accounted for 29 patients, 0.13 per cent of those patients
successfully treated. Whilst any errors in administration or systems
are to be deeply regretted, it is difficult to know how that would
compare with any other Trust, which underwent the same degree
of scrutiny. Twenty-four patients are unclassified owing to the
"unavailability of their notes as the patients were receiving
treatment". Neither Stoke Mandeville Hospital's new management
nor District Audit have been able or been prepared to give detailed
information in respect of the 43 suspended patients. It has been
impossible to ascertain how many of them were patients waiting
the second of a bilateral procedure, patients who self deferred
having declined a reasonable treatment plan or those patients
who were suspended without reason.
There can be no excuse for this third category,
which we understand amounted to 15 to 20 patients. They should
not have been suspended and why Sue Thornton, the Business Manager
for General Surgical Specialities, inappropriately suspended them
will never be known. She was not given instructions to deal with
these patients in this way by either her immediate superior, Nigel
Pearce or by the Director of Operations/Acting Chief Executive,
Sue Nicholls or Ken Cunningham. On previous occasions when she
had problems admitting a long waiter, she had brought the matter
to the attention of her superiors for resolution. The Trust Board
policy was clear. Patients had to be treated before 18 months
and no irregularities in management were allowed. We understand
that she has now retired. Despite the criticisms that may now
be properly made as to her actions in relation to 18-month waiters,
it should be noted that she was a good theatre sister and had
done excellent work for the hospital in helping to set up the
Day Surgery Unit, before being promoted to the position of Business
Manager, General Surgical Specialities.
As to the first category, the patients who were
awaiting the second of a bilateral procedure, the practice employed
at the Trust was in common use throughout much of the South East
Region. A second procedure was suspended until such a time as
the patient was medically fit to undergo the procedure. This policy
has, we understand, now been enshrined in the Trust's new Waiting
List Policy, which has been signed off by the Modernisation Agency.
The second category was patients who could not
be treated under their named consultant if the 18-month deadline
was not to be breached. These patients were offered alternative
treatment plans that included treatment by their consultant in
the local private sector, treatment by another consultant within
the Trust or treatment within a neighbouring Trust. Many patients
accepted one of these alternatives but those who did not were
suspended on a self-deferral basis. Prior to suspension, the patients
gave their informed and written consent to this course of action,
preferring to wait for their named consultant to treat them. Post
suspension plans were agreed with them and their GPs were informed.
District Audit counted both these categories of patients as breaches
of the 18-month rule.
Some of the breaches arose because District
Audit opted to apply Patient Charter definitions for calculating
the total wait rather than Korner definitions, which have always
been used at Stoke Mandeville and many other Trusts in the Region.
All Trusts are required to base their monthly performance reports
to the Regional Office on Korner definitions and as a result it
has been common practice to manage waits using the same definitions.
As previously stated, neither the Trust nor District Audit have
been able to provide information to support their declaration
of 131 18-month plus waiters and as a result it is not possible
to ascertain how many of the alleged breaches have arisen for
It is to be deeply regretted that Stoke Mandeville
Hospital failed in its duty to treat all patients within the 18-month
target but some consideration needs to be given to the problems
the Hospital faced:
The agenda the hospital management
faced was enormous. Through no fault of its own, it had had to
manage three attempts at a major PFI redevelopment with all the
attendant problems and workload.
It was also running separate PFI
proposals for doctors' and nurses' accommodation, which because
of the land issues had to be re-worked, and a separate project
for a Private Patients Unit.
There were major land and building
problems because of the elderly nature of the estate, and the
dubious arrangements for the sale of the leased land.
The re-configuration of services
and the demand for the amalgamation of Stoke Mandeville Hospital
NHS Trust and South Bucks NHS Trust by April 2002.
The increased number of referrals
to the hospital over the past two years confirmed by the recent
visit and audit by the Modernisation Team.
The increased number of complex operations,
both spinal and orthopaedic eg hip revisions which can take approximately
six hours if bone grafting is required, compared to one and a
half hours for a primary hip.
The need to meet the overall target
of no more than 5,101 patients on the waiting list plus the other
waiting list targets, against the background of the shortage of
beds, staff and appropriate theatre time.
A major MRSA outbreak which necessitated
closing 22 surgical beds in February 2000 and prevented joint
surgery for three weeks.
A shortage of staff which resulted
in about 20 of the 100 surgical beds being closed at any one time.
A failure of provision in the community
which resulted in a further 20 surgical beds being blocked at
any one time.
The loss of its Chief Executive and
the failure of the Regional Office to fulfil its commitment to
The amount of Executive management
time that was being provided to the Region by the Chief Executive
and the Director of Nursing.
The absolute requirement to meet
its I & E Budget if the Region and Bucks Health Authority
were to sign off the PFI proposals.
The cumulative cuts in Stoke Mandeville
Hospital's budget over the previous three years and the effect
on the Hospital as a result of those cuts by way of loss of beds,
theatre time and staff.
The absence through illness or maternity
leave of crucial Assistant Directors of Operations and the inability
to replace them on a temporary basis.
The very substantial workload which
Sue Nicholls and the management team were carrying.
The District Audit Report did not find that
there was "collusion in fraudulent mismanagement of waiting
lists on a wide scale at all levels of the organisation going
back to 1998", as was stated by the Regional Chairman and
alleged in the original NPAT Report. It did find that "there
was no indication that a major problem was developing or that
concealment was taking place" and it concluded "that
from the information available to them, Board Members could not
have suspected any concealment. Had they done so, we are confident
that a serious view would have been taken".
As Chairmen and Non-Executive Directors of the
Trust, we have complete confidence in the probity of both Mr Cunningham
and Miss Nicholls. Had either of them known of the 18-month problem,
we would have been immediately informed.
One middle-ranking member of staff suspended
15 to 20 patients without any authority so to do because, as we
understand it, she misguidedly thought she was protecting the
reputation of the hospital. There were a number of administrative
and systems errors, which should not have occurred. There were
also a number of patients who, in our view, should not have been
counted as 18 month plus waiters as they had either preferred
to self defer or were waiting for a second procedure.
Stoke Mandeville is an excellent hospital. The
way this matter was handled took no account of the well being
of the hospital, its patients and staff. No one should condone
wrongdoing and no one on the Trust Board would have done so. The
actions taken, apart from the real damage that was done to individuals,
damaged the hospital's reputation, its ability to keep good staff,
its ethos and being. It has also led to a growing concern within
the Health Service generally of the "Blame and Shame"
culture which has led to a number of people being required to
resign though no blame could personally be attached to them. Ministers
appoint and can remove Chairmen, but given that position, Ministers
have a responsibility to act reasonably and fairly in the public
interest. There are also questions as to whether the way this
matter was handled met the standards of probity, governance, natural
justice and fairness that should be mandatory in the Public Service.
Everyone involved with the hospital deeply regrets
the fact that a number of patients waited longer than 18 months
and that the Government's target was breached.
However, the hospital and its staff needed support
to overcome the problems, some of which had been needlessly exacerbated
by the Regional Office.
One has to ask who has benefited from the manner
in which this matter was dealt with, certainly not the NHS, patients
or indeed Stoke Mandeville Hospital and its hardworking. committed
and conscientious staff.
Gillian Miscampbell OBE DL
Stoke Mandeville Hospital NHS Trust
Ian Taylor TD DL
Stoke Mandeville Hospital NHS Trust
Alison Phillips OBE
Past Non-Executive Director
Stoke Mandeville Hospital NHS Trust
Past Non-Executive Director
Stoke Mandeville Hospital NHS Trust