Sir Nigel Crisp NHS Chief Executive
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Because of everything that had happened to me I thought it would be appropriate to bring the matter to the attention of Sir Nigel Crisp the Chief Executive of the NHS. I felt this would be a particularly sensible thing to do as Sir Nigel had been prominent in making public statements about the action the NHS would take in relation to it's employees that it found fiddling hospital figures (See BBC Report January 2002). Sir Nigel also gave evidence to the House of Commons Public Administration Select Committee on January 30th where in answer to the question from Ian Liddell-Grainger MP, "If you come across people you realise are bullying because they have got to hit these targets, what will you do to managers?" (Sir Nigel Crisp) "Well, you will perhaps have seen there is a code of conduct....". (ILG) Which you brought out. (Sir Nigel) "....for managers which sets out the standards of behaviour that we expect. I cannot remember the exact words in there, but there is something about respect and respect for working with people within it. It is for the individual employers, i.e., the trust boards or the health authority boards or whatever actually to deal with breaches of that and with allegations about that". (ILG) "What if they are doing the bullying?" (Sir Nigel Crisp) "If that were the case, then we have a whistle-blowing system which can be used".
In addition I thought Sir Nigel might have been sympathetic to my case because of the experiences that had taken place at the John Radcliffe Hospital. A senior nurse, Colette O'Keefe, who has been on sick leave for a year, alleged she and her children had been threatened after raising concerns about public care and the considerable harm that was happening to patients. As a consequence an independent external review was set up into the Cardiac Services being provided at the John Radcliffe (Since putting this link on this website the open and accountable NHS have removed this report from the world wide web so that the public can no longer access the report. In the near future I will scan into this site a full copy of the report so that the public can again see what happened at the Radciffe and the conclusions about over what period the problems developed). This report reviewed what had happened at the John Radcliffe during the 1990's including the period when Sir Nigel Crisp was the Chief Executive (See Crisp CV John Radcliffe CE 1993 to 1997). The report came to a number of conclusions but found that in terms of nursing the success that the John Radcliffe had enjoyed in the 1980's and early 1990's started to change in 1993 and that from the mid 1990's the relationships between the surgeon's in the cardiac unit started to deteriorate. There was also a disciplinary hearing in 1997 into approximately £33,000 of allegedly fraudulent claims for on-call and emergency work going back several years. The external review also found that an alleged event in 1997 was never properly investigated with the consequences that it rumbled in the background continuing to fuel the internecine feuding between the consultant staff. A significant number of staff who gave evidence spoke of their feeling that the "drinking club culture", emerged in the early 1990's. The whole situation at the John Radcliffe was reported in the press at the time and the conclusion was that the failure at this hospital could be clearly attributed to failure of an arrogant and complacent management who had allowed the development of a 'blame culture' in which staff were 'encouraged to cover up errors for fear of retribution. The Guardian articles are still available on line if you would like to read them. Guardian Article One. Guardian Article Two.
In
the light of Sir Nigel's public pronouncements and his history at the John
Radcliffe I therefore felt confident that the NHS Chief Executive would investigate
my case and I wrote to him on 23rd December
2002 pointing out that I had been dismissed in breach of my contract and
without any right of appeal. As by the end of January I had not received the courtesy of a reply I wrote to him again on the 27th January copying my
letter to Andrew Foster Head of the Audit Commission and supplying him with
documented evidence of the wrong doing that had taken place at St George's
and calling on Sir Nigel to set up a proper investigation and pointing out that
no one from the NHS outside of St George's had contacted me at all to offer any
assistance. This time I did receive a reply from him but it was a disappointment. He acknowledged the points that I had raised about having
made protected disclosures about the cancelled
operations issue and the financial
balance issue and that I had was claiming that my case had not been handled
according to the Management Code of Conduct (in giving evidence under oath at
the Employment Tribunal Catherine McLaughlin stated that the Code of Conduct was
not widely accepted within the NHS), but said that no action could be taken
before the result of my Employment Tribunal was known. It seemed to me
that this reply was completely out of step with the spirit of the
remarks that Sir Nigel had made to the Public
Administration Select Committee on 30th January 2002 in answer to Mr
Liddel Graninger's questions about bullying within the NHS and Mr
Brennan's question regarding the article "Silent
Pressure" I had written for the Observer and where I had said, "We
need to replace the targets culture with a system of intelligent
accountability". Sir
Nigel replied, "Can I widen this because obviously I cannot possibly talk
about an individual case and a particular set of allegations for which there is
no evidence produced." A quite extraordinary statement for him to make,
given that I was in correspondence with him telling him that I had written
evidence to support everything I had said and he was refusing to take any action
on it.
I therefore
wrote again to Sir Nigel on the 23rd February
this time much more forcibly pointing out that the Trust Board had not followed
either their own procedures or those of wider NHS, I pointed out that John
Parkes who was at the heart of the cancelled
operations issue had been appointed to the post of Chief Executive
while I had been thrown out of my job. I also told him that as a result of
my investigations I
had come up with evidence of other wrong doing including quite specifically the
fact that the Director of Estates at Kings Healthcare NHS Trust was someone who
had left St George's a few years earlier following an internal audit
investigation that I had conducted which had shown him to be guilty of numerous
and serious breaches of the Trust's financial regulations. Did Sir Nigel
live up to his public rhetoric (see
BBC or House
Of Commons)? No he did not. In fact he sent me a letter
dated 27th March 2003 in which he said, "It is my advice that for I or
the Department to try and undertake its own investigation will muddy
the waters prior to the
Employment Tribunal hearing and there is a risk that such an investigation may
interfere with the Tribunal's processes". In other words forget the rhetoric,
if you whistle blow you are on your own and have to resort to taking action in
the courts. He also went on to say
that in relation to my claim that, "you have received information which
illustrates wrong doing by individuals within the NHS. However, the
information which you have provided is so vague to make it impossible for me to
comment further, or to investigate the issues should that be
necessary". This despite the clear statement in my letter that the
Director of Estates at Kings Healthcare NHS Trust had left his employment with
St George's directly following a period of suspension and the completion of an
adverse internal audit investigation. Finally even
more extraordinarily his letter concluded with the sentence, "Whether or not
the Trust chooses to recruit a particular employee or terminate the employment
of employee, is their own decision and responsibility. It is not
something with which I am empowered to interfere". Well if that is
the case how can Sir Nigel make good his promise that, "A
zero tolerance approach is to be introduced for managers who fiddle waiting
lists", when in his letter to me he states quite clearly that the
employment of managers is not something he can interfere with.
Not satisfied with Sir Nigel's reply I communicated with him again, sending him an e-mail on the 31st March. The reply I got from Sir Nigel this time was clear and unequivocal, "Until that decision (Employment Tribunal) is available, there seems to be little benefit in us rehearsing further in correspondence, the issues we have already discussed". It would therefore have seemed as if Sir Nigel Crisp had washed his hands of me. However, following my appearance on the BBC Hardtalk programme when I explained to TimSebastian, what help and response I had received from Sir Nigel Crisp surprise, surprise I received a detailed reply from him dated 1st May 2003, although this time the letter was addressed to Mr Perkin rather than to Ian as had been the address used on the earlier communications from Sir Nigel. This time Sir Nigel changed his tack altogether saying that because I had said it would be inappropriate for John Bacon the Director of Health & Social Care to investigate the matter he would now ask the South West London Strategic Health Authority to look into the matters that I had raised. This required me to write to Sir Nigel again on the 6th May because I had already commenced legal proceedings for defamation against Melvyn Esterman a former employee of the South West London Strategic Health Authority and that authority was defending those proceedings. I explained therefore that it would be totally inappropriate for me to supply that body with any information. I also supplied to Sir Nigel Crisp with this letter an e-mail dated 18th June 2001 that showed that the London Regional Office had been party to providing a temporary loan to a health authority, with the deliberate intention of misleading the public and Parliament in pretending that two NHS Trusts had achieved the financial targets when in fact they had not. Sir Nigel sent me an undated reply when he suggested that the Leicestershire, Northamptonshire and Rutland Strategic Health Authority should look into the matters I had raised. After receiving this letter I was told by a member of the St George's Board that Sir Nigel Crisp's proposal had been discussed in the confidential part of the St George's May Board meeting. This information finally convinced me that despite his experience at the John Radcliffe and his public pronouncements that should have meant that I could rely on Sir Nigel's impartiality, I really could not have any faith in Sir Nigel Crisp acting fairly at all. A view that was reinforced at the Employment Tribunal when the Trust's barrister Simon Devonshire cross-examined me on the contents of a letter I had written to Sir Nigel Crisp and suggested that I had been making wild allegations about senior figures in the NHS. If you have time to read the letters I have written and posted to this website, you can decide for yourself whether the matters raised are of serious concern or whether they are as Mr Devonshire suggested merely wild allegations designed to embarrass senior NHS officials. In view of Sir Nigel's behaviour I wrote to him yet again on the 27th May requesting that he appoint an independent QC to investigate the information that I had supplied to him. To make sure that Sir Nigel Crisp was in no doubt at all about what had gone on in relation to the issue of Kings Healthcare NHS Trust I communicated with him again on the 8th July to inform him in detail of the reasons why the Kings Estates Director had left St George's and perhaps more worryingly that a journalist Martin Halle had told me that Kings Healthcare NHS Trust had said that St George's had given good references for the individual concerned and that Mr Halle had tape recorded a conversation with Andrew Dillon the Chief Executive of the National Institute For Clinical Excellence where he had admitted that he gave that reference. Despite as you will see from the e-mail spelling out in great detail the issues that should be of concern to Sir Nigel he has not responded to me and has also not acceded to my request that an independent QC to be appointed to investigate the matters I have raised with him. I leave it to you to decide if his decision is compatible with a Chief Executive of an organisation that likes to claim that it is open and accountable and supports whistle-blowers?
On the Sir Nigel also appears to be having trouble with his bed numbers. Check out the article published in the Times on Tuesday 4th November 2003.
UPDATE: On the evening of the 11th November 2003 I sent Sir Nigel Crisp a copy of the e-mail that the London Evening Standard had decided to run a story about on the 12th November. My last e-mail to Sir Nigel was that dated 8th July and was one that never received the courtesy of a reply. However, the involvement of the media had it's usual dramatic impact on Sir Nigel and after not replying to my e-mail of the 8th July, he replied to my e-mail of the 11th November on the same day sending me a reply at 6.59pm. How's that for a response, somewhat different from the usual wait, or the not uncommon failure to reply at all. Sir Nigel states in his e-mail that he has already started an investigation, yet you can see from the fact that he did not reply to my e-mail of the 8th July when I asked for an independent investigation to take place that this is a somewhat disingenuous statement for him to make. I think that this is a clear demonstration of what is wrong with the management of today's NHS under Sir Nigel Crisp's leadership. His response to being supplied with evidence of wrong doing is not to set up an independent investigation, but is instead to do as little as possible, only changing that strategy if and when the media make public the details of that wrong doing. I have e-mailed a reply to Sir Nigel and if Sir Nigel responds I will post it to this website, although because there is no immediate media attention I will not be holding my breath for another same day reply.
I never received a reply to my latest e-mail to Sir Nigel sent on 12th November 2003, instead I received a letter dated 17th December from Nicolas Garcia of the Department of Health informing me on behalf of Ministers and Sir Nigel Crisp that the inquiry they are prepared to countenance is an NHS internal one to be headed by David Sissling the Chief Executive of the Leicestershire, Northamptonshire and Rutland Strategic Health Authority. Surely given the view of managers in the service, as evidenced by the Jon Sudworth's BBC Television report, and the BBC website report , that in achieving government targets, bullying and intimidation within the NHS is widespread with the pressure coming from the top level. Having an inquiry chaired by an independent QC is the only way the public can be truly reassured that the reporting of clinical activity against government targets is being conducted with honesty and integrity. I am sure you can draw your own conclusions as to why Ministers and Sir Nigel Crisp are so determined that despite the mass of evidence that there is a problem, they will not allow an independent inquiry to take place and are anxious that the only review that takes place is internal to the NHS thereby ensuring that they can control the publication of its findings. Click here to read the full details of the Sissling Inquirey.
Sir Nigel Crisp also on Wednesday 26th November gave evidence to the Public Accounts Committee. Click here to see my comments on what he had to say about funding the NHS and click here to read the e-mail I received from the National Audit Office which supports the views I have expressed about the flaws in the calculation of HRG's (Healthcare Resource Groups) which are used to determine by how much individual hospitals have to reduce their spending. You will note that Sir Nigel did not touch on these issues when he answered the questions of the PAC. My views about HRG's have subsequently been endorsed by the Wandsworth Council Health Overview and Scrutiny Committee.