GARETH Davies looks at the damning report into financial mismanagement at NHS Croydon, released last week...
UNABLE to speak to key figures, powerless to force them to give evidence and denied access to vital documents, the committee behind this week's report into the financial mismanagement at NHS Croydon could easily be said to have wasted its time.
But, as an insight into the depressing lack of accountability in our local health services, the report is far from irrelevant.
The Joint Health Overview and Scrutiny Committee's findings expose what has been described as a "deliberate" cover-up of a £28 million misreporting of finances at the primary care trust (PCT) in 2010/11.
It shows that ever since the scandal was uncovered, the NHS has systematically done everything in its power to avoid taking responsibility.
Caroline Taylor, the trust's £145,000-a-year former chief executive, refused to give evidence to the committee and then threatened legal action upon seeing its draft findings.
Health Secretary Jeremy Hunt has now been asked to compel Ms Taylor – given the top job at another failing trust only last month – to answer questions about why the trust posted a £5.54 million surplus when it had actually overspent by £23 million.
While the committee has singled her out as the "accountable" officer, its report catalogues numerous attempts to avoid responsibility; from the same lack of co-operation from two finance officers and two current Croydon councillors, to NHS London using legal loopholes to send just one member of staff – accompanied by a lawyer – to give evidence during the three-month investigation.
It also claims the £1 million report set up in the wake of the scandal, which prompted the scrutiny investigation, was not the review conducted by Ernst & Young.
The committee has learnt the document was NHS London's interpretation of the independent report – an allegation the trust denies. When the committee asked to see the original, it received no reply.
Committee chairman Jason Cummings said: "We have been faced by a wall of silence from key witnesses in the NHS and subsequently there are still some questions that remain unanswered.
"In particular, we still don't know why the accounts were altered and whether patients had been directly affected.
"This cannot be right, and now we call on the Department of Health to carry out rigorous investigation and ensure the relevant officers can be publicly held to account."
The review was conducted by six local authorities in southwest London, led by Croydon Council.
But its efforts to get to the truth have been hamstrung by the lack of co-operation from key figures.
Stephen O'Brien, director of finance, refused to take part. During a long period of absence he left Mark Phillips, the interim deputy director of finance, in charge of the trust's cash.
Mr Phillips, a former nightclub owner and unqualified accountant, was found in the initial report to have made "unwarranted adjustments" to the agreement of balances. He, too, declined to answer questions.
Croydon Council leader Mike Fisher said: "If this was a local authority I can guarantee that the leader and the chief executive would probably be out of the door or would at least be in front of the council answering very serious questions about what had gone on.
"Here you have individuals who have moved on to other highly paid jobs within the health service who haven't even thought it necessary to turn up and answer questions, despite the fact that in some way their actions led to this huge discrepancy in the accounts."
While the committee rounded on all three executives, it was less scathing in its criticism of councillors Toni Letts, former chairman of the trust, and David Fitze, in charge of the audit committee, who also snubbed invitations to appear.
The panel disagreed with NHS London's insistence that there was no adverse impact on healthcare in Croydon, mainly because practices were so poor it was impossible to track where the money had been spent.
It called for future committees to be given the power to compel witnesses to attend, and Clinical Commissioning Groups, the GP-led organisations that replaced primary care trusts at the start of April, are recommended to review qualifications of all staff who have responsibility for finances.
But, with much of the report punctuated with disclaimers, it looks like the detail of what went on at NHS Croydon will remain away from public scrutiny.
When asked whether the report had ultimately been a waste of time, Cllr Fisher said: "What the report has done is shine a light on the NHS and has shown there's a lack of accountability.
"They would have liked to have gone further but what this shows is that its very difficult to get at the truth."
EX-CHIEF BEMOANS A 'SORRY TALE'
A FORMER health chief who resigned because of due to his misgivings over how the trust's finances were being run says the "sorry tale" lifts the lid on the lack of accountability in the NHS. Dr Peter Brambleby turned whistleblower after stepping down from his role as Croydon's director of public health in February last year. He told the Advertiser of "systematic dishonesty" inside the NHS, described how his concerns were ignored by Caroline Taylor, then the chief executive, and that financial mismanagement led a screening programme for heart disease and stroke to be scaled back. Crucially he warned: "I am convinced it will happen again." Reacting to the scrutiny committee's report, Dr Brambleby said this week: "The failure of senior officers of NHS Croydon and NHS London to give account for their stewardship of public funds is unacceptable. "In my view, people who do not subscribe to the principles of openness, accountability and honesty should not be employed in public service. I share the committee's alarm that not all lessons have been learnt learned and that appointment procedures are so lax that some of those responsible for accountancy malpractice may still be working in other parts of the NHS." Dr Brambleby said NHS London had demonstrated "weak leadership" and set a "bad example" by failing to ensure accountable officers like Ms Taylor gave evidence. He said: "I am glad councillors have comprehensively rebutted the false assurances given by NHS London that no one was to blame, that no one profited and that no service was harmed." "The NHS will not be safe for patients, nor provide value for money for taxpayers, until it adopts a culture where mistakes are quickly admitted, openly investigated, and honestly reported so lessons are learned."
SCATHING criticism over a lack of accountability and openness has prompted a familiar response from the NHS. NHS London, which commissioned the Ernst & Young review, closed down as an organisation on March 31 as part of the Government's health reforms. Speaking on its behalf, NHS England repeated the same line used in face of previous criticism – the £28 million discrepancy was a systems fault and no individuals were to blame. Forensic "NHS London commissioned an independent firm of accountants to do a detailed and forensic investigation into Croydon PCT's finances," a spokesmanperson said. "This investigation took over six months, and included the examination of more than 600,000 documents and detailed interviews with all those involved. "The report made it very clear that mistakes were made, but found no evidence that individuals were at fault. It concluded that this was a failure of the financial system and a failure of oversight." NHS England also backtracked on an explicit assertion made by Ann Radmore (who signed off the accounts as chief executive of NHS South West London) that the misstatements were "deliberately" hidden, a statement she made in front of the committee. A spokesman said: "NHS England understands that Ann Radmore is on public record correcting any misunderstanding around the use of the word 'deliberate'. "To clarify, the systems and processes were poor. Staff followed these poor systems and processes correctly, taking the actions that were described in these systems. "The Ernst & Young report explains that there were errors and incorrect accounting and an overall lack of operational control – in effect, there was not competent management of the accounts. This is what caused the problem."