THOUSANDS of patients were bumped from waiting lists in an “appalling” large-scale manipulation of statistics by NHS Lothian.
An investigation ordered by Health Secretary Nicola Sturgeon also uncovered “inappropriate and oppressive management styles” which saw NHS staff under pressure to cheat the figures to avoid delivering “bad news”.
Two members of staff at the health board have been suspended and Ms Sturgeon hauled NHS Lothian chief executive James Barbour and chairman Charles Winstanley into her office yesterday and ordered them to put their house in order.
She has also started a fresh investigation into the management culture at NHS Lothian, which she said “must investigate the conduct and behaviour of senior management”.
Ms Sturgeon received the report from external auditor PricewaterhouseCoopers (PwC) on Tuesday and presented it to the Scottish Parliament yesterday.
She told MSPs: “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.”
She told the Evening News: “I am furious at this. We attach a huge amount of importance to waiting times, patients really value quick access to treatment and people across the health service have worked really hard over the past number of years to get waiting times down.
“So when I get a report that says a health board has been manipulating the figures to try and mask breaches of the waiting time guarantee, I feel angry on behalf of the patients. I saw both the chair and the chief executive separately and left them in no doubt how I feel.”
The PwC audit was ordered after reports that patients were being offered unrealistic appointments for surgery in England and removed from waiting lists figures when they declined.
Medical director Dr David Farquharson compiled a report which acknowledged that the practice had taken place, but said it was not being done deliberately to manipulate waiting times figures.
But an external audit into wider waiting times practices was ordered by Ms Sturgeon. It was first commissioned by the NHS Lothian board, but Ms Sturgeon insisted on taking over management of the auditors halfway through for fear the problems could go right to the top.
She told the News that the Farquharson report had rung “alarm bells” when it referred to the use of “administrative workarounds” by staff using patient records systems.
She said: “I found myself in the position where I thought there were extremely concerning things happening and I didn’t know at that stage whether they had been known about by the board or not. It didn’t feel right to leave the report in their control.”
PwC’s report revealed that manipulation of the waiting lists was far more widespread than suspected, with large numbers of patients being suspended from the waiting list to make sure they weren’t counted as patients not being treated within the waiting times target of 18 weeks from referral.
The practice extended to many different types of treatment, but auditors found general surgery, ear nose and throat, urology and ophthalmology to be particularly badly affected.
Lothians Conservative MSP David McLetchie said he was “appalled” by the revelations and demanded “heads should roll”.
He said: “This report is damning. It points to a management culture which prioritised the doctoring of statistics over the treatment of patients. It is also clear that for such a culture to take hold, pressure must have been exerted by senior management within NHS Lothian on more junior staff.”
It is impossible to know exactly how many patients were affected without reading each individual set of patient notes but, since the practice was stopped, the number of people missing the target has soared from a few hundred to around 5000.
Many patients didn’t know this had happened to them and many had longer waits for treatment as a result.
Ms Sturgeon stood by Dr Winstanley, however, and said she was confident he had not known about the problems within the organisation and appointed him to take charge of the new investigation into management culture.
Dr Winstanley said: “I accept in full the recommendations from this review and the comments made by the Cabinet Secretary. I apologise unreservedly on behalf of the board for these unacceptable practices.
“The Cabinet Secretary and I have spoken at length about the actions I have been asked to take and I can give an absolute assurance that these will be undertaken. It is essential that we act on this extremely sobering report. It is vital that we do whatever it takes to reassure the people of Lothian that the board has patients and patient care at its very centre.”
The report said a number of staff “made reference to inappropriate and oppressive management styles”. They were strongly discouraged from reporting “bad news” around waiting times issues, and the report said: “It was apparent from our interviews that clerical, supervisory and management level staff involved in the waiting times process, were under unacceptable pressure to find ‘tactical’ or paper adjustment solutions to waiting list issues, rather than addressing the root causes.”
There was a “don’t minute” culture which saw staff discussing the true waiting list breach figures verbally, but keeping written details of them away from the Board. On the charge of a heavy-handed management culture, Mr Barbour said: “Bullying and harassment have never been tolerated in NHS Lothian and we will be following up immediately any claims of this through our own internal inquiry, which is already well advanced.”
Dr Winstanley’s investigation into management culture is expected to be submitted to Ms Sturgeon by the end of April.
The 1234 people who were originally offered treatment in England have been treated, while patients who were more recently discovered to be affected by the practice of suspensions are in the process of being treated. NHS Lothian predicts that the excessive backlog in people waiting over 18 weeks will return to normal levels by June.
As a result of the scandal, every NHS board in Scotland will have to include a detailed audit into waiting times management as part of its internal audit.
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