By splitting resources, patient representatives and selected governors attended three meetings in London on 29 September 2016 – NHS England and NHS Improvement (“NHSI”) Board Meetings and a private meeting at the National Audit Office (“NAO”).
NATIONAL AUDIT OFFICE
Four patient representatives and a governor met two senior officials: for legal reasons, we are limited on what we can report.
WORK IN HAND
The NAO described its current position in relation Southern Health.
- Continuously monitoring the Trust.
- Talent Works contract and Katrina Percy’s salary are issues of “value for money,” which is one of their remits.
- Raised the issues with NHSI and await a response.
- In ‘listening mode’ and would use what we said to aid interpretation of information received from others, including NHSI.
- The officials responded to concerns about NHSI’s honesty and transparency with confirmation that they have powers to seek information directly.
- Will use data for other Trusts to benchmark consultancy spend at Southern Health relative to others.
- They confirmed that all works of above £20k should go through competitive tendering.
- They cannot commit to what they do next or timescales: very much depends on the information they get back and what they find.
We had the impression it was early days and they were giving people (in the NHS) an opportunity to do the right thing before they took a more heavy-handed approach if it proved warranted.
AREAS OF CONCERN
We addressed five major areas of concern, noting also Trevor “Honest John” Spires and his position at the Rural Payments Agency, which the NAO has seriously criticised already inter alia for, “Poor and dysfunctional leadership and wasting public money“: read more →. Where have we heard that before?
Talent Works Contract:
We posed the following questions about the contract with Talent Works:
- Were proper procurement process followed for the tendering of this work in 2011 and 2015? FOI response to a governor provides heavily redacted tender documentation?
- Are there any notes on the evaluation of competing tenders that justify the award to Talent Works?
- Who were the other bidders?
- What were the decision criteria?
- Is it usual for “call off” contracts to grow by such a large extent? They are usually used where the scope of work is unclear and develops during the engagement.
- Why wasn’t a scoping study commissioned and then the next phases bid competitively? This is normal commercial procurement practice.
- Was the contract properly managed with appropriate governance oversight on payments made for work delivered?
- What where the roles of the Finance Director, Audit Committee and Internal and External Auditors in this process? It would not appear to be in line with Southern Health Standing Finance Instructions that limit growth of contracts to 10%.
We have since submitted a new FOI request to clarify some of these points.
Carolan Consultants Contract:
Carolan Consultants is a trading name of WorkGuru Ltd – read about its services here→
Engaged to carry out an “appreciative inquiry” study into family experiences. The contract was quoted at £22,500 (FOI1284), but one payment of £22,500 was made in 2015/16 and a second of £22,500 in 2016/17 (FOI1409), making a total of £45,000 (excluding VAT). There was no competitive tendering and there is no evidence of a second contract being agreed.
There are several issues arising from FOI1284, which warrant further study.
Unusually large payments to GPs:
It is evident that Southern Health makes small payments to GP practices and pharmacies in the community to support specific initiatives. Smoking Cessation and Service Integration and Joint Working are two such initiatives. 28 surgeries received payments for “Service Integration and Joint Working” in the first half of 2016/17 (FOI1409).
However, an abnormally large payment of £29,950 was made during 2015/16 to Dr J A Barton and Partners in Gosport for “Service Integration and Joint Working” (FOI1409). This practice now operates as Forton Medical Centre following the retirement of Dr Barton. Both practice names share the same telephone number. In addition, the Forton Medical Centre practice received £4,372 in the first half of 2016/17 for the same purpose: this is more consistent with other surgeries (FOI1409).
Dr Barton was the subject of a very high profile case in 2010: she was found guilty of overprescribing medication to elderly patients at Gosport War Memorial Hospital, which accelerated their deaths. Although spared by the GMC, she voluntarily removed herself from the medical register in 2011.
- Why was the former name of the surgery used for the large payment (when the new name is used elsewhere), particularly given the bad history?
- Why is there a need for such a large payment to be made?
We noted that Dr Lesley Stevens, Medical Director at Southern Health is a partner at the Forton Road practice. (Southern Health Annual Report and Accounts 2015/16).
In addition North Baddesley Surgery received £15,800 in the first half of 2016/17 for “Service Integration and Joint Working.”Sarah Schofield, Chair of West Hampshire Clinical Commissioning Group was a partner at North Baddesley Health Practice until early 2015. Again, what was the need for such a large payment.?
Payments to legal and consultancy firms (including for Inquests and to Deloitte):
The Trust spent £550,000 in 2015/16 and £214,000 in the first half of 2016/17 on external legal support. Why is this necessary?
This would include support for their attendance at Inquests, and in preparing letters to members of the public, patients and governors threatening legal action. Mitigation of reputational risk is their key consideration – not patients.
In comparison, the Trust withdraw legal support from members of staff prepared to give evidence against the Trust, for example at Connor Sparrowhawk’s inquest. The Trust left his family to pick up a bill of £78,982 (excluding VAT) for legal support for Trust staff on top of the families own bill. Read more→
At a Family Listening Day in London on the 22 September 2016 hosted by the CQC and facilitated by the charity Inquest, a family member produced a letter from the Department of Justice. It was a response to the concern that financial support for legal costs is not offered to families despite the Trusts funding highly aggressive lawyers and barristers to represent the Trust. The DoJ response was that an Inquest should be an informal legal process not normally requiring legal representation of the parties. Why therefore are Trusts permitted to spend so greatly on lawyers for the purpose it seems of protecting their reputation?
Katrina Percy’s salary in her ‘new’ role:
What is the justification for KP’s salary in her new role? Professor Chris Hatton has suggested that the maximum salary of a top job grade is £99,000. Why does she get double that? Why also is she apparently maintaining executive director-level pension benefits?
Board Capability Review:
Upon his appointment Mr Smart commissioned two reviews of board capability by external consultants. Through FOI responses one of these firms, YSC Ltd, has received £116,000 to date. This level of commitment is in excess of his approval level.
Was due process followed in getting this level of expenditure approved and in appointing the successful bidder? Their brief and report are not in the public domain. To the best of our knowledge and belief, the Consultants did not approach any bereaved families, other patient representatives or governors to obtain evidence.
The Chairman of YSC Ltd, Gurnek Bains lists his outside interests as, “In spread betting (on anything) and in creative photography.” “Anything?” – effectively, Gurnek your Board Capability Review has bet on patients’ lives.
Jeremy Kyle and his lie-detector expert would have been cheaper – and more effective!
And the result – another three months angst for bereaved families and other campaigners before the inevitable happened and Percy had to go anyway. So that was money well spent!
VALUE FOR MONEY
We pointed out that all this money is being spent items of questionable value when, for example there is an inability to provide effective training to front line staff in Basic Life Support and Epilepsy Awareness and a serious shortage of beds.
Also, the Trust closed Woodhaven Hospital (a ‘state of the art’ purpose designed and built hospital for adult mental health patients) on the basis of unrepresentative occupancy data to support the business case for conversion to a forensic unit at a cost of £3 million. The Trust expected to earn money by taking in forensic patients from other areas. Read more in ‘Hansard’ here→
The demand turned out to be over-estimated, so that (apart from housing patients from other units at threat of closure by the CQC while building alterations went on) it has remained largely empty. Far from raising income, huge overspends (believed to be in the order of £6 million) are now being incurred by Southern Health due to a woeful shortage of beds for adult mental health patients and out of area placements (including in the private sector).
[Redacted] acknowledged the large number of FOI requests he has lodged and stated this was the only way he could get information. There was no communication from the Lead Governor, who should supply this information. He stated he only learns of key events by watching the BBC News and believes the Trust has spent £20,000 blocking Governors from taking action.
WHAT HAPPENS NEXT?
The NAO will continue to monitor developments and confirmed that the information received was useful. They took copious notes but could not say how it might develop or when. They noted also:
- The NAO has an ongoing programme of work on mental health, which is still in the scoping phase.
- Both officials have very close connections with South Hampshire so there was a sense of personal engagement with issues relating to Southern Health.
- We will continue to supply any evidence arising to the NAO.
And so on to NHS Improvement – a meeting to be reported separately – along with NHS England.