Financial Balance Issue
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Although both the present government and the last Conservative administration have continued to put funding into the NHS at a level that exceeds the rate of inflation the media continues to run stories of cut backs, waiting list delays and a general deterioration in services. Why should this be? The answer is a simple one, with the developments in medical technology and the improvement in types of treatment available for a range of conditions the NHS is simply expanding at a faster rate than governments expand the investment going into the service. To try and bridge the gap between the available funding and the expectations that the public are being given by the politicians, the government requires NHS Trusts to achieve a yearly cost reduction savings target to achieve extra funding to help bridge the financial gap. In other words Hospitals are being asked to do what they currently do more cost efficiently, so that they can spend more money on doing things like developing new services and cutting waiting lists. The problem that St George's was suffering from was that the system being used by the NHS, Healthcare Resource Groups to calculate how much each hospital has to save is deeply flawed and because of the local patient admission policy in place at St George's had a particularly unfair impact upon the Trust for which I worked. As a result each year it has been more of a struggle for St George's to save million of pounds and still maintain the quantity and quality of clinical services that it provides to its catchment population. Increasingly to balance the books the Trust has been using scarce capital resources, that should have been used for maintaining vital plant and equipment, to pay the monthly regular wages bill with the result that the Hospital has no longer provided a safe environment for either patients or staff. Things got to such a pitch in 2002 that the hospital Chief Engineer Shane King felt constrained to write to St George's Board Members to point out not only the risks that the Trust was running by continuing to operate this policy, but also listing all the vital health and safety legislation that the Trust was not complying with. If you exam the e-mail you will find the list can only be described as alarming and in fact in the summer of 2003 entirely predictably, the air conditioning failed in a number of the hospitals theatres an event that gained significant press coverage. The funding problems had all previously been flagged up with Ian Hamilton in an e-mail I sent him on the 20th February, when I suggested that he and I clear our diaries to meet with the senior managers and clinicians to discuss the Trust's very serious financial situation. As was usual with Ian Hamilton, when faced with a serious problem he followed his usual pattern and did absolutely nothing and the meetings were not held. As a consequence the revenue budgets presented to the Trust Board at their meeting held in May 2002 depended on the achievement of a cost reduction programme of £4.5million which realistically had no prospect of being achieved. The annual meeting with the external auditor Simon Sharp of PricewaterhouseCoopers then followed in July and as I felt I was duty bound to, I told the external auditor that in my opinion that the Trust would not be able to balance its financial accounts for the year 2002/03 unless the Trust used some form of external funding. As confirmed in the statement given by Dominic Sharp the Trust's financial controller who was present at the meeting, Simon Sharp did not raise any query about what I had told him, so you can imagine my surprise when on the 29th July I was told by Ian Hamilton the Chief Executive and Colin Watts the Director of Human Resources that one of the reasons I was being asked to resign from my post was because the External Auditor Simon Sharp was not happy with my performance as Finance Director. I have to say I found it difficult to believe that this could have been true and I therefore telephoned Simon Sharp on the 30th July to ask him what he had actually said to the Trust and I took the precaution of tape recording the conversation so that I had an accurate record of what he said. If you would like to judge for yourself whether Mr Sharp acted reasonably please click here to view two letters that Simon Sharp sent in connection with my case and a copy of the transcript of the telephone conversation that I had with him. In any event it seemed quite clear to me that another main reason why the Trust was attempting to dismiss me from my post was because I had told the truth about the financial position and the probability that the Trust would not balance its financial accounts for the financial year 2002/03 and that view although truthful was not acceptable to my ambitious board colleagues, who had not wanted to pass bad news back to the more senior officials employed at the London office of the NHS. I leave you to read the letters from the external auditor and the transcript of our conversation to consider whether I was right or wrong in making that judgement.
You might also like to click here to read the local Wandsworth Guardian report on what has happened to the St George's Finances since I was dismissed from my post as Finance Director. In my Employment Tribunal hearing Ian Hamilton said that with my dismissal the finances of the Trust had improved. Well this article written on the 28th November shows that the protected disclosure I made was completely accurate and that far from there being an improvement in the Trust's financial position the situation Peter Homa the new Chief Executive said, " We should not underestimate the gravity of the situation".