The NHS is wasting millions of pounds every year suspending clinical staff unnecessarily, a report suggests.
One if five of those suspended are doctors
A survey by the National Audit Office has found over 1,000 clinical staff were suspended on full pay for at least a month last year.
Trusts spent £11m paying these workers to stay at home and another £29m on legal fees and agency cover.
But many were needlessly suspended with 40% returning to work months or even years later, the NAO said.
Trusts suspend clinical staff for a variety of reasons, including concerns over the care they provide to patients, their relationship with patients or their personal conduct.
The move is designed to protect patients. However, the NAO report suggests some trusts suspend staff for other, sometimes spurious, reasons.
In some instances, doctors and nurses have been banned from coming to work simply because of a personality clash with their manager.
A waste of time and money?
Dr Martin Samuels and Professor David Southall were suspended from University Hospital of North Staffordshire NHS Trust after a preliminary inquiry into "a serious complaint" in 1999.
Neither doctor was invited to respond. An internal inquiry subsequently exonerated them. But the doctors were suspended for 20 months and 27 months respectively at a cost of £750,000.
Officials at the NAO surveyed hospital and ambulance trusts across England.
They found that between April 2001 and July 2002, 1,063 clinical staff had been suspended on full pay for at least a month during this period.
Of these, 20% were doctors and 53% were nurses or midwives. The remainder were allied health professionals, such as paramedics.
Most doctors who are suspended are on so-called "gardening leave" for at least six months.
A disproportionate number are from ethnic minorities. The average suspensions lasts around 11 months. But some are excluded for as long as four years.
Nurses and other clinical staff are generally suspended for much shorter periods of time. Their cases are concluded on average within five months.
The NAO criticised trusts for allowing cases to drag on for months, causing costs to spiral.
The average cost of excluding a doctor is £188,000. The average cost of excluding other clinical staff is £21,000.
The NAO said the NHS could make an immediate saving of £14m if it ensured all cases were dealt with in six months.
Miss Briony Ackroyd, a consultant breast surgeon, was suspended from her job at University Hospitals Coventry and Warwickshire NHS Trust in February 2000.
She was investigated by the General Medical Council. She agreed to have her performance regularly appraised by a consultant colleague.
But the trust did not reinstate her and in April 2002, she asked the chief medical officer to intervene.
In January, she reached an agreement with the trust whereby she resigned. She is now retraining as a GP. Costs are estimated at £825,000.
The report also found that even when clinical staff are suspended, trusts are not doing enough to warn other parts of the NHS if an individual poses a risk to patients.
For instance, one in five trusts stop their investigation if the staff member resigns before they are finished.
Just one in three tell the regulatory authorities if they have had problems with staff, who are not doctors.
Many trusts fail to carry out proper checks on individuals before they give them jobs.
The NAO called for the Department of Health to issue new guidelines to trusts on how to deal with suspended staff.
"There is evidence of many cases of exclusion being allowed to drift on without resolution or proper management," said Sir John Bourn, its comptroller and auditor general.
"This represents a serious waste of resources for the NHS and can harm the career and even personal well-being of the accused clinicians themselves."
Conservative MP and chairman of the Commons public accounts committee Edward Leigh, which is expected to consider the report, said it made "appalling reading".
"It is in everyone's interest - patients, clinicians and the taxpayer - for cases of suspension to be settled quickly and openly."
England's Chief Medical Officer Sir Liam Donaldson said the costs of suspending staff are "the price we have had to pay to ensure patient safety".
But he added: "We want to remove the need for suspensions save in the most exceptional circumstances.
"It is in the interests of all concerned to ensure that alternatives to suspension are carefully considered."
The Department of Health and the British Medical Association have been working on new guidelines for trusts.
"Many doctors suffer both professionally and personally under the current system," said Dr Paul Miller of the British Medical Association.
"It is vital that all cases are resolved at least within six months. This is in the interest of patients, the NHS and doctors."
Alastair Henderson of the NHS Confederation, which represents health service management, said: "We want to see a reduction in the number and length of suspensions and fully support the proposed new framework between the government and the BMA to achieve this."
The National Patients Safety Agency said trusts should think carefully before suspending staff.
"This report highlights the fact that, contrary to expectation, suspending NHS staff is not always in the interests of patients if the decision to suspend is not well-founded," said Sue Osborn, its joint chief executive.