Unaccountable accountants
More bad news is on its way for NHS chief David ‘no accountability’ Nicholson. The report of the joint health overview and scrutiny committee (JHOSC) for six south west London councils into financial mismanagement at Croydon Primary Care Trust is imminent. It will show how the buck is passed when financial disasters happen, and question what ‘grip’ Nicholson really has on the money.
When is an accountant not an accountant? When he is not qualified. This fact escaped Croydon’s director of finance Stephen O’Brien and chief executive Caroline Taylor (Eyes Passim) when they appointed former nightclub owner Mark Phillips as interim deputy finance director. Under lax supervision and failure of both Deloitte and the Audit Commission, Phillips was able to report a £5 million surplus in the 2010/11 accounts when there was at least a £22m deficit. Ernst and Young were called in by NHS London when Croydon insiders, including director of public health Dr Peter Brambleby, and managers from surrounding PCTs, raised concerns.
Ernst and Young’s inquiry cost the NHS £1m and went into considerable detail. A summary with recommendations was published by NHS London and discussed at its board, but when JHOSC asked for authorship and for someone to come and explain it to them, both NHS London and Ernst and Young declined, each claiming it was the other’s report. In Nicholson’s NHS, no one has to be personally accountable. It’s always the system’s fault. The version of Ernst and Young’s report discussed at NHS London’s Board concluded that no-one was personally responsible for any failing, no-one gained personally, and no patient services were adversely affected.
Given that the last of these was not even in the terms of reference for Ernst & Young, and they had no epidemiologist or clinician on their team to test it, Brambleby asserted that none of these statements could be true and blew the whistle to then Secretary of State, Andrew Lansley, and Chief Medical Officer Dame Sally Davies. He observed a systematic culture of dishonesty and bullying in the NHS, and cited personal experience from other posts (Eyes passim). He also retracted the relevant chapters of his last two annual reports on the grounds that he could no longer trust the finance data on which they depended. This is unprecedented. Lansley and Davies simply asked the SHA for its opinion and wrote back to state the matter investigated and closed. Whistle-blowers are not heeded in the NHS.
In Croydon, the accountable officers were particularly hard to call to account. The JHOSC was frustrated by non-appearances from Phillips, O’Brien and Taylor, as well as no-shows from PCT chair Toni Letts, PCT audit committee chair David Fitze, and NHS London’s director of finance Paul Baumann. So where were they? Taylor had been promoted to run the North Central PCT cluster and O’Brien secured a post with a Trust in Essex. Phillips was taken on by Baumann to be NHS London’s interim financial controller, before moving on to join Taylor. Baumann was promoted to Nicholson’s NHS Commissioning Board. The only serving NHS officer to appear before JHOSC was the SW London cluster chief executive, Ann Radmore, but she brought a lawyer along and refused the JHOSC access to any Croydon finance staff who had served under Phillips. She has been promoted to run London’s Ambulance Service.
Croydon is one of London’s largest boroughs in terms of population and NHS budget. The PCT scored above average in most performance indicators. It had been entrusted with hosting the budget of London’s specialist services. No-one took notice when former audit committee chair John Power (a former parachute regiment colonel with public and private finance experience) was pressured out for asking awkward questions. Alarm bells failed to ring when Professional Executive Committee chair, Dr Ravi Sondhi, absconded with money borrowed without authorisation from the out-of-hours service (and is now suspended by the GMC). If PCTs like Croydon can fail to report truthfully up the line, what assurance is there that Nicholson has any grip? The JHOSC report will make uncomfortable reading for the local population and for Nicholson, who recently mislead the Public Accounts Committee over the Gary Walker case (Eyes passim). Walker raised safety concerns as a whistleblower in a letter to Nicholson, Nicholson told PAC he didn’t. When the letter was shown to the press, Nicholson retracted. His next appearance before PAC should be revealing. But Nicholson can always claim he knew nothing about Croydon. It’s always the system’s fault.