IMPACT ON
PATIENTS
19. The inappropriate adjustments to waiting lists will have had
differing degrees of impact on the patients concerned. In some
cases, there was no impact, with patients waiting no longer than
they would otherwise have done, and unaware of any irregularities.
In others, patients waited longer than they should and their condition
deteriorated during the longer wait. Particularly serious are
those patients who were inappropriately suspended (at least 700
identified), were never put on the waiting list (at least 435
identified) or who were deleted from it (total number unknown).
If action had not been taken to correct these irregularities,
the trusts had no way ensuring that these patients received the
treatment they needed.[20]
20. At one end of the spectrum were trusts such as University
College London, where there were only five patients involved,
none of whom had their patient care affected, and South Warwickshire
General where, though the total number of patients was high, few
if any had their treatment delayed. At the other end, were trusts
such as Salford Royal Hospitals where over 200 patients were denied
the opportunity to be treated within 18 months, and Barts and
the London where inappropriate adjustments went on for a number
of years, posing potential threats to the patients affected because
their treatment was delayed.[21]
21. Once the inappropriate adjustments came to light, trusts took
prompt action to identify all patients who may have been disadvantaged,
and to ensure that they were the subject of remedial action. Such
actions included sending patients to other trusts and the private
sector for treatment, and re-instating suspended patients to the
waiting list.[22]
22. The Department of Health do not believe that any patients
died as a result of these cases, but they have asked trusts to
review the impact on patients. The Department expect that by the
end of May, the trusts will have reported back to them on the
extent to which patients who may have been harmed have been told
it was the result of waiting list manipulation, and the extent
to which cases have led to compensation to patients.[23]
ACTION TO
PREVENT A
RECURRENCE
23. In response to the Comptroller and Auditor General's Report,
the Department of Health took initiatives to ensure that any inappropriate
adjustments to waiting lists are identified and that effective
action is taken against individuals and within organisations where
similar cases occur in future.
- They introduced a series of triggers, for example where the
number of patients suspended from the lists totalled 10 per cent,
to identify cases for review.[24]
- They had asked the Audit Commission to initiate a series of
spot checks on waiting list statistics hospital by hospital, starting
in 2002-03.[25]
- Waiting times for all NHS consultants will be published on
the internet, so individual patients will be able to see if their
experience bears out claims on waiting times. They are also moving
to a system of booked admissions by 2005.[26]
- Any manager found to have distorted waiting figures will face
dismissal on grounds of gross misconduct. This will be supported
by a new mandatory code of conduct for NHS managers, as recommended
by the Bristol Royal Infirmary inquiry. Anyone breaching that
code will not be re-employed in the NHS. The Department are looking,
in particular, at how the Code will deal with people who resign
from one NHS Trust before disciplinary action has been completed
and then seek employment elsewhere in the NHS.[27]
In addition, they now have much better systems for whistleblowing
and are putting in place an inspection system through the Commission
for Health Improvement, and they will publish more information
on NHS Performance.[28]
24. In April 2002, in Delivering the NHS Plan, the Government
announced the creation of a new Commission for Healthcare Audit
and Inspection (CHAI), which will bring together the work of the
Commission for Health Improvement , the health value for money
work of the Audit Commission and the private healthcare role of
the National Care Standards Commission. The new body's role will
include validating published performance assessment statistics
on the NHS, including waiting list information.[29]
1
C&AG's Report, Inpatient and outpatient waiting in the
NHS (HC 221, Session 2001-02), paras 1-2; Q53 Back
2
45th Report of the Committee of Public Accounts, Inpatient
and Outpatient Waiting in the NHS (HC 376, Session 2001-02) Back
3
C&AG's Report, Inappropriate adjustments to NHS Waiting
Lists (HC 452, Session 2001-02) Back
4
Delivering the NHS Plan, Cm 5503 Back
5
C&AG's Report, para 2 and Figure 1 Back
6
C&AG's Report, para 2 and Figure 1 Back
7
ibid, para 3 Back
8
Qs 3-5 Back
9
C&AG's Report, Figure 1 Back
10
C&AG's Report, para 2 Back
11
Qs 11, 115-116 Back
12
Qs 11, 111-113, 184 Back
13
Qs 15-16 Back
14
C&AG's Report, para 2 Back
15
Qs 83-88 Back
16
C&AG's Report, para 2 Back
17
Qs 12-13, 17, 88-91, 100-104, 185-188 Back
18
C&AG's Report, para 2 Back
19
Qs 18, 30-34, 44-49, 88, 164-174 Back
20
C&AG's Report, para 25 Back
21
ibid, para 26 Back
22
ibid, para 27 Back
23
Qs 120-128, 144-145, 175-177, 197-204 Back
24
Qs 2, 82 Back
25
Qs 2, 117 Back
26
Qs 6, 105-106, 205 Back
27
Qs 13-14, 55-58, 87-91, 95-96, 100-104 Back
28
Qs 9-10 Back
29
Delivering the NHS Plan, Cm 5503 Back