As the fall-out from NHS Lothian’s waiting list fiddle continues, David McLetchie says trust needs to be restored for both patients and staff
Last year, I was contacted by a constituent concerned about his five-month wait for a minor operation at St John’s Hospital in Livingston. I duly took up his case with NHS Lothian and was surprised to be told that he had turned down two prior appointments, one because he was on holiday and one because he was asked to go to the Western General Hospital as opposed to his preferred option of St John’s.
My constituent vehemently denied this and so I pointed out to NHS Lothian that the record was clearly incorrect and asked how this could have happened. In response, it was acknowledged that a mistake had been made but that it was impossible to determine how or why this had occurred. Well, we know now.
Following the publication of the PricewaterhouseCoopers report, it is clear that my constituent was the victim of a systematic falsification of records by classifying him and others as unavailable for appointments.
In short, NHS Lothian was fiddling the figures to paint a rosy picture of a health board meeting its targets and performing well. There was a concerted effort to distort the truth about patient care in NHS Lothian.
Yet what should worry us is that was the product of a management culture which put cover-up before care and which was oppressive and overbearing.
In this regard, the report makes for grim reading. Some staff members refused to be interviewed at their place of work, or insisted on the presence of a union official. Indeed, I have received an anonymous e-mail in the last few days from a member of staff describing an environment of fear and intimidation, which rings all too true in light of the report.
I continue to have concerns about whether we will really get to the bottom of this matter.
On Wednesday in the Scottish Parliament, I shared the anger of Nicola Sturgeon at what has happened and she is right to demand changes.
However, I am concerned about the independence of the investigation she has ordered the chair of NHS Lothian to carry out. Given that an independent audit was required to uncover the scale of the problem, there needs to be an independent investigation which goes to the very top of the management tree if the public is to have faith in the outcome.
Administrative staff at NHS Lothian prioritised monthly waiting times statistics over patient care, but this is not the work of a few mavericks. Middle and senior managers suppressed key facts to keep the truth from NHS board members.
For such practices to have occurred, the overall ethos of the organisation must have shifted towards meeting performance targets at the expense of all else.
It is simply not enough to determine who falsified the records and discipline them. We need to find out who was responsible for a culture whereby staff felt they could no longer tell the truth because there is no place in the NHS for such people. That is why I have said that heads must roll.
This is about restoring trust and confidence in our NHS in Lothian. What happened was not just a betrayal of patients but a betrayal of more than 20,000 NHS employees who do their utmost week in, week out to deliver high quality care to us. We deserve better than this.
• David McLetchie is a Conservative MSP for Lothian
PRACTICE NOT PERFECT
The first hints of scandal emerged in October 2011, when it was alleged that NHS Lothian had offered patients surgical appointments in England and, when they refused, had suspended them from the figures for waiting list targets.
A report on the matter by medical director Dr David Farquharson admitted this was happening, but said it was not a deliberate method of massaging the figures.
But a subsequent external audit, carried out by PricewaterhouseCoopers, found that staff had systematically cheated the waiting times figures for as many as 5000 patients.
The biggest problem was with “retrospective amendments”, when staff went back and marked patients as being unavailable for treatment during periods of time which had already passed. This meant they no longer appeared to be breaching the 18-week target for the time from referral to treatment.
This was routinely done in large numbers just before NHS Lothian was due to report its waiting times figures to the Scottish Government.
When the practice was uncovered and stopped, around 5000 extra people were revealed to have exceeded the 18-week guarantee.
“What angers me about NHS Lothian’s behaviour is not just that it’s a betrayal of their own patients – and it is – but it also undermines the reputation of thousands of NHS staff across the country who have worked so hard to reduce waiting times”
NHS Lothian chairman Dr Charles Winstanley: “I apologise unreservedly on behalf of the board for these unacceptable practices”
Margaret Watt, chairwoman of the Scotland Patients Association, on the bill to clear the backlog, which already stands at £4.8m and looks set to rise: “Of course it’s got to come out of somewhere – that’s going to knock the budget. It has to have an effect on other services. Where is it going to come from? It should come out of the chief executive’s salary”
Royal College of Nursing Scotland director Theresa Fyffe:
“Senior managers must take responsibility and learn from this experience to allow the organisation to move on”