THE chaos that engulfed the region’s NHS in the wake of the waiting times scandal has been laid bare in a damning report which reveals patients being treated by the private sector at public expense may have been put at increased risk.
Last year, it emerged that waiting list figures had been fiddled and that thousands of patients had been waiting too long for treatment, leading to NHS Lothian spending millions on private providers to clear an unprecedented backlog when it could not cope with its own resources.
The health board had previously offered assurances that tough standards for outside operators would be put in place, but an internal probe, ordered by chief executive Tim Davison and released under freedom of information legislation, shows that:
• Consultants from unapproved firms were hired, with no checks on their criminal records or competency;
• Multi-million pound contracts with private hospitals were allowed to expire but patients would still be sent through their doors;
• Private doctors were given remote access to patient records, leading to suspicions that they were using log-ins while performing private work in breach of the Data Protection Act;
• Invoices from private firms were barely checked, while some patients were sent to private providers without prices being agreed in advance.
NHS Lothian said that following the audit, which was completed in July and found that “significant improvement” was required in all four areas examined, processes had been tightened up.
But unions today hit out, saying they had previously raised concerns over many of the issues identified and had received assurances from health bosses that no problems existed.
David Forbes, a regional organiser for Unison, said that the document revealed that NHS Lothian had a “frightening lack of control” over the way patients being sent outside the NHS were treated.
“The issues highlighted are fundamental to patient safety,” he said. “They rushed into bed with the private sector, and it’s put folks at risk.
“We were constantly assured that everything was in order, but this shows the whole thing was in chaos. We very reluctantly supported the use of the private sector on the understanding that rigorous controls would be put in place.”
In the report, it is stated that before concerns were first raised about waiting times, in late 2011, NHS Lothian had not intended to use private providers significantly. However, thousands were sent into the private sector at short notice within months, with arrangements set up under “exceptional circumstances”.
Four providers – Spire Healthcare, BMI Healthcare, The Edinburgh Clinic and Nuffield Hospital – shared more than £11.5 million in 2012-13, for almost 3500 cases.
The audit raised fears that NHS Lothian may have been charged for services not provided, that contracts were not adequate to protect the health board, that patient records could have been accessed inappropriately and that appropriate assurances around clinical governance had not been given.
Labour Lothians MSP Sarah Boyack said the audit had shown “a lack of proper control of multi-million pound contracts with the private sector”.
“This internal audit is deeply worrying,” she said. “Although NHS Lothian is now improving its management systems, I’m concerned that these significant failures of governance occurred in the first place.
“I’m particularly concerned that firms whose contracts had run out were still used, that there weren’t adequate cost controls and that there weren’t proper quality checks on all facilities used or the handling of NHS patient data.”
Since the audit, a new system of checking invoices has been introduced and contracts agreed with private providers.
Jim Crombie, NHS Lothian’s director of scheduled care, said: “This audit was instructed by our chief executive in recognition of the significant and unique pace and scale of challenge we had faced in working to reduce waiting times.”
PUBLIC VERSUS PRIVATE
AS well as sending patients to private hospitals, NHS Lothian spends millions on Medinet – which supplies temporary staff to work in NHS Lothian facilities.
The health board wants to gradually reduce its reliance on the private sector, by boosting staff and capacity in key areas.
However, recent figures have revealed that the 12-week target for patient treatment is being
missed with increasing regularity.
In the current financial year, the health board plans to spend £13.5 million on private providers, which could be a significant feature of NHS treatment in Lothian for years to come.