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Tuesday, 15 January, 2002, 10:09 GMT
Code of conduct for NHS managers
A nurse tends a patient
Some patients 'disappeared' from waiting lists
A zero-tolerance approach to NHS managers who fiddle waiting lists is to be introduced, the head of the health service has said.

NHS chief executive Nigel Crisp said it was not acceptable that some managers had been re-employed elsewhere in the service after resigning because they were under investigation.

He told the Commons Public Accounts Committee that he also wants an end to big pay-offs to such individuals and a managerial code of conduct was being introduced.

Responding to questions about allegations that waiting lists were manipulated to show better results he also promised greater openness to prevent similar action in the future.

The committee called Mr Crisp in after a National Audit Office report alleged that up to 6,000 patients in nine hospitals had been affected by the practice.


Mr Crisp said he regarded the waiting list 'fiddles' extremely seriously and the significance of the action for those patients affected could not be underestimated.

NHS chief executive Nigel Crisp
Nigel Crisp was 'shocked' by the findings
Promising clearer guidelines he said: "We're introducing a management code of conduct so that if somebody is adjudged to have broken the management code of conduct in one setting as a manager in the NHS, they should not be employed as a manager anywhere else in the NHS."

But Mr Crisp said the key to patient satisfaction would come from better whistle-blowing systems inside the NHS, an independent inspection system and the publication of waiting list information on the internet.

"I think giving patients information is probably the single biggest safeguard we can bring in," he said.


It's the lowest form of cynicism for managers to protect their own backs and their own jobs at the risk of extending and aggravating the suffering of patients waiting for treatment

Alan Williams
Mr Crisp told MPs he found the report's findings shocking and that very serious issues had been raised, damaging the reputation of honest, hardworking NHS managers.

He said very important lessons had been learned from the NAO report and patients should be able to expect better from NHS management.

MP's on the Committee expressed anger at cases of NHS managers who were found manipulating waiting list figures and then allowed to resign with compensation packages.

Alan Williams, Labour MP for Swansea West, said: "It's the lowest form of cynicism for managers to protect their own backs and their own jobs at the risk of extending and aggravating the suffering of patients waiting for treatment."


Pressure is no excuse for doing these sorts of things

Nigel Crisp
Mr Crisp denied claims, backed by Conservative leader Iain Duncan Smith, that the problems were caused because waiting list targets put too much pressure on managers.

He said: "There is no evidence that it was pressure. If it was, everybody would be doing it.

"Pressure is no excuse for doing these sorts of things."

Mr Crisp said he did not believe any of the 6,000 patients affected had died as a result, although he was asking the trusts involved to establish whether any had suffered.

Whether compensation should be paid to any of them was a matter for the trusts, he said.

'Organisational failure'

The National Audit Office report said waiting lists were manipulated, on purpose or as a result of "organisational failure", so patients did not exceed the government's 18 month limit.

At the Surrey and Sussex Healthcare Trust it is claimed patients were asked when they would be on holiday and then deliberately offered appointments at those times.

Elsewhere it is alleged patient records were systematically amended and patients removed from waiting lists.

The NAO report said that while some patients may have been unaffected by the actions, others "may have deteriorated during the longer wait".

'Spot check'

Guilty trusts
Barts and the London
Guy's and St Thomas's, London
Plymouth General Hospital
Redbridge Health Care
Salford Royal
South Warwickshire General
Stoke Mandeville
Surrey and Sussex Healthcare
University College London
Following the report Mr Crisp said trusts will face rigorous checks to prevent further fiddles.

He said: "We're putting in place spot check arrangements for trusts, and we're also making sure that we tighten up our procedures to deal properly with it when it does happen."

The checks are set to be carried out by the Audit Commission from later this year, according to the Department of Health.

Waiting lists

On Friday it was announced the total number of patients waiting to be admitted to NHS hospitals in England rose by 10,100 (1%) in the 12 months to November 2001.

The number of English residents waiting more than one year fell to 33,000, some 14,800 (31%) lower than November 2000.

The number of patients who had been waiting for longer than 18 months was 23.

See also:

26 Jul 01 | UK Politics
Ministers savaged over waiting lists
26 Jul 01 | Health
Ministers blamed for NHS failings
19 Dec 01 | Health
How the figures were fiddled
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