MPs criticise waste of public money on suspensions
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《英国医生杂志》
The House of Commons Public Accounts Committee has attacked the NHS for allowing too many doctors and other clinical staff to be suspended for as long as two years on full pay while disciplinary proceedings occur.
Between April 2001 and July 2002, 1063 clinical staff were excluded in England, 208 of them doctors, says the report, echoing statistics published last year by the National Audit Office (BMJ 2003;327:1065).
"Astonishingly, there were 30 cases where exclusions lasted over two years," said Edward Leigh, MP and chairman of the committee, in his report published last Tuesday.
"The annual cost to the NHS, at ?0m , is much too high. And very long cases can be damaging to the clinicians involved."
Five cases have each lasted for a total of 11 years and one of them is still continuing, costing the tax payer more than ?.5m to date, says the committee, citing the report from the National Audit Office.
If the exclusions were limited to six months, as suggested by the Department of Health, it would save the public ?4m a year, said the report.
The report, however, recognises that the legalistic nature of the existing disciplinary guidance has slowed down proceedings and that the new guidance issued by the Department of Health in December 2003 should improve the situation. Further guidance is due once negotiations with the BMA are completed, it acknowledges.
The committee also criticises NHS trusts for inappropriately issuing confidentiality clauses when staff resign, which "to the detriment of local accountability" prevent interested parties from checking how much has been paid out, it says.
And it criticises the Department of Health for dragging its heels on issuing new guidance on handling suspensions. The committee had, in 1995, examined the case of Ilford paedicatrician Dr Bridget O扖onnell, who was suspended for 11 years after complaining about patient care (BMJ 1995;311:527). The allegations were eventually withdrawn, but she took early retirement.
The committee recommended a review of the guidelines, which the department agreed to pursue in 1997. But this was only produced in December 2003.
The committee acknowledged that the National Clinical Assessment Authority has, since April 2003, helped improve the management of exclusions, but it covers only doctors. The Department of Health should consider extending it to include other clinical staff, the committee suggested.
It also criticised trusts for failing to undertake specified employment checks before employing new staff and, therefore, potentially putting patients at risk. In many cases, however the concerns were not around clinical competence but to do with whistle blowing or where there had been a breakdown in the clinical team.
And the committee抯 report highlights the high proportion of consultants from ethnic minorities who were suspended—although they comprise a fifth of all consultants, they account for more than a third of all consultants excluded for more than six months.
Edwin Borman of the BMA抯 Joint Consultants Committee said it was in the interests of doctors, patients, and taxpayers to stick to the agreed time framework for settling suspensions. "Suspensions must be used solely to protect patients, and only as a last resort," he said.
A framework agreed with the BMA for handling concerns about doctors?performance says that hospitals must have clear reasons for suspending medical staff, and suspensions should be time limited, he added.
The Management of Suspensions of Clinical Staff In NHS Hospitals and Ambulance Trusts in England is available at www.publications.parliament.uk/pa/cm/cmpubacc.htm.(London Lynn Eaton)
Between April 2001 and July 2002, 1063 clinical staff were excluded in England, 208 of them doctors, says the report, echoing statistics published last year by the National Audit Office (BMJ 2003;327:1065).
"Astonishingly, there were 30 cases where exclusions lasted over two years," said Edward Leigh, MP and chairman of the committee, in his report published last Tuesday.
"The annual cost to the NHS, at ?0m , is much too high. And very long cases can be damaging to the clinicians involved."
Five cases have each lasted for a total of 11 years and one of them is still continuing, costing the tax payer more than ?.5m to date, says the committee, citing the report from the National Audit Office.
If the exclusions were limited to six months, as suggested by the Department of Health, it would save the public ?4m a year, said the report.
The report, however, recognises that the legalistic nature of the existing disciplinary guidance has slowed down proceedings and that the new guidance issued by the Department of Health in December 2003 should improve the situation. Further guidance is due once negotiations with the BMA are completed, it acknowledges.
The committee also criticises NHS trusts for inappropriately issuing confidentiality clauses when staff resign, which "to the detriment of local accountability" prevent interested parties from checking how much has been paid out, it says.
And it criticises the Department of Health for dragging its heels on issuing new guidance on handling suspensions. The committee had, in 1995, examined the case of Ilford paedicatrician Dr Bridget O扖onnell, who was suspended for 11 years after complaining about patient care (BMJ 1995;311:527). The allegations were eventually withdrawn, but she took early retirement.
The committee recommended a review of the guidelines, which the department agreed to pursue in 1997. But this was only produced in December 2003.
The committee acknowledged that the National Clinical Assessment Authority has, since April 2003, helped improve the management of exclusions, but it covers only doctors. The Department of Health should consider extending it to include other clinical staff, the committee suggested.
It also criticised trusts for failing to undertake specified employment checks before employing new staff and, therefore, potentially putting patients at risk. In many cases, however the concerns were not around clinical competence but to do with whistle blowing or where there had been a breakdown in the clinical team.
And the committee抯 report highlights the high proportion of consultants from ethnic minorities who were suspended—although they comprise a fifth of all consultants, they account for more than a third of all consultants excluded for more than six months.
Edwin Borman of the BMA抯 Joint Consultants Committee said it was in the interests of doctors, patients, and taxpayers to stick to the agreed time framework for settling suspensions. "Suspensions must be used solely to protect patients, and only as a last resort," he said.
A framework agreed with the BMA for handling concerns about doctors?performance says that hospitals must have clear reasons for suspending medical staff, and suspensions should be time limited, he added.
The Management of Suspensions of Clinical Staff In NHS Hospitals and Ambulance Trusts in England is available at www.publications.parliament.uk/pa/cm/cmpubacc.htm.(London Lynn Eaton)