A Freedom of Information request has revealed 52 NHS staff have been paid £2m by their hospitals in gagging orders which ban them from reporting significant failures of private healthcare providers operating NHS contracts, against the public interest. The Head of NHS England, Sir David Nicholson had previously testified before the Public Accounts Committee that no such orders had been issued. He has appeared before the committee again this afternoon, receiving tough questions on the ongoing scandal.
The Gagging Orders
Tory MP Steven Barclay, a leading member of the Public Accounts Committee has accused NHS Chief Sir David Nicholson of either failing to ask the appropriate questions of his staff, or being ‘complicit in a cover up’ of failure and paid-for silence within the increasingly privatised NHS.
In March this year, Health Secretary Jeremy Hunt was forced to ban the issue of gagging orders on NHS staff after it was revealed more than £15m had been spent silencing 600 NHS staff. However, this figure did not include ‘Judicially Mediated’ gagging orders – those which had been signed off by a judge or senior lawyer, rather than the Department for Health. It was revealed last night that 52 such orders had been made, some costing the taxpayer as much as £500,000.
This is in stark contrast to Sir David Nicholson’s previous testimony to the Public Accounts Committee in March this year, when he stated that he had only come across one instance of these orders, indicating they were extraordinary measures rarely employed.
North East Cambridgeshire MP Mr Barclay told The Daily Telegraph: “It is simply not plausible that the man who was supposed to be running the NHS was seemingly unaware that employees threatening to speak out were being offered golden goodbyes in return for a vow of silence…What patient safety concerns have been covered up (by these gagging orders)? How many lives have been put at risk?”
Why the Silence?
We do not yet know what these staff were paid to remain silent about, but given recent discoveries which people were not paid to remain silent about, we should brace ourselves for the worst.
Last year, Serco – the private firm delivering out of hours GP service in Cornwall – admitted it had grossly understaffed its service, failed to meet performance and so falsified more than 250 reports to the NHS. The firm had essentially lied to the NHS about completing procedures, calls and follow ups, which it had neglected to perform.
It was discovered later that the contract with Serco provided no mechanism by which to even fine Serco, let alone end the contract, so they remain un-punished, delivering a service they have demonstrated they are unfit to manage.
Paediatric Services (surgery and care of sick children) at the BMI Mount Alvernia hospital in Surrey, which held a contract for referred NHS patients was found to fail eight out of nine care standards by the Care Quality Commission. The watchdog discovered what it terms ‘life threatening’ failures at the hospital, stating that “Medical, surgical and some nursing practices at BMI Mount Alvernia Hospital were so poor that people were put at significant risk…One of the most serious concerns was the care of children admitted for surgery”. Failings included children being operated on without parental consent, a child being given a nerve block on the wrong side of their body before surgery, resuscitation teams failing to respond to emergency calls, and children being operated on by a surgeon without gloves and whose shirt-sleeves were stained with the blood of other patients. While NHS referrals to the hospital have ceased, BMI retains its £200m a year contract to provide services to the NHS.
These are just two failures amid a growing pile of failures which the NHS is paying for, both in rectifying medical mistakes made by private firms, or compensating those who have suffered.
Private firms now have a massive and increasing stake in our NHS. Private firms treat almost one in five of NHS patients for certain conditions, carrying out 17% of hip replacements and hernia repairs, 10% of all trauma patients (broken limbs etc.) and 6% of all gall bladder removals in England.
With NHS staff being paid for their silence – how many other failures do we know nothing about? This leaves the entire responsibility for discovering malpractice and underperformance in the hands of the Care Quality Commission (CQC) – itself in crisis.
The CQC watchdog has little over 2,000 staff; they are responsible for monitoring 174 NHS Trusts, employing more than 1.4 million staff, managing 4.6 million hospital admissions leading to surgical care each year, let alone the private providers. A staff survey this year found that just 16% of the 1,473 respondents at the CQC felt the regulator was well managed, just 14% had confidence in the decisions made by the Executive team and a mere 8% felt change was well managed. Yet it is this woefully under staffed, poorly managed unit which is the only system we have for identifying healthcare failures, while NHS Executives pay staff to keep their mouths shut.
It is an outrage.
Nicholson Must Go
Nicholson was also in charge of the Mid Staffordshire Healthcare Trust at the time that patients were seriously mistreated, in large part due to major staff cutbacks in aims of gain Foundation Trust status. More than 4,000 people died at Stafford Hospital between 2005 and 2009, and police believe that as many as 300 (1 in 14) of these are the result of ‘criminal neglect’. A recent Public Inquiry reported ‘appalling and un necessary suffering of hundreds of people’ by the Trust. Findings in the report included seriously ill patients left lying in their own urine and excrement for days at a time, forced to drink water from vases to avoid dehydration, and being given the wrong medication.
This scandal was only uncovered due to the higher than normal deaths recorded at the hospital and a subsequent investigation by the Healthcare Commission, not Sir David Nicholls or any of the staff within the Mid Staffordshire Healthcare Trust which ran the hospital.
There have since been repeated calls for his resignation, leading Nicholson to promise to retire in 2014. MP Barclay did not mince his words when speaking to the Telegraph today ‘he must stand down now’.
To allow such a clearly failed leader to retire with full pension and other benefits after such an appalling decade of performance beggars belief. He must go, and he must go now. But we should not pretend that the departure of Nicholson signals the end of this issue, merely one small part of cleaning up the mess of a commercialised NHS where private companies use commercial confidentiality to avoid accountability for providing value for money and quality care.