A senior manager responsible for clinical coding at a large trust, who alleged a firm of contractors had fiddled their results, has lost her employment tribunal.
Tina Young alleged she had been demoted because she had raised concerns about a firm brought in by Barts Health Trust to increase the sums it could bill commissioners for.
The band 8b manager said she had been told the day before a five week holiday that her role was being deleted and she was being moved to another department because of the issues she had raised over several years.
But in a judgement issued last week, an employment judge rejected Ms Young’s claim, saying while she had clearly suffered a detriment she had not proven it was linked to her allegations about coding firm DQIP.
The judge ruled her line manager had not “smirked” as he gave her the news, as she had alleged, and that he had told her the day before her holiday because the only alternative was her finding out via a third party while she was away.
The tribunal heard there had been a history of acrimony between the claimant and DQIP.
Ms Young had refused to sign a tender waiver appointing the company in July 2015 and later alleged that DQIP had claimed part of her team’s work as their own.
The tribunal ruled that the claimant believed she was raising a matter of legitimate public interest when refusing to sign the document, but not that she could have reasonably believed then interim finance director Chrisha Alagaratnam showed “negligence or breach of contract” in appointing DQIP.
The tribunal judgement said: “In evidence, the claimant explained that, in her experience, contractors would come in with a specific brief, but then remain in the organisation far longer than the work required under the original brief, costing the NHS money and avoiding the usual procurement process of tendering.
“In respect of DQIP, the claimant believed that the above pattern was happening from July 2015. For example, in respect of DQIP’s software, the Revenue Improvement System, this had originally been piloted in the trust; but then DQIP had used their position to enable them to sell this to the trust.”
DQIP continued to work for the trust without a tendering process because of continuing waivers until 2017.
The tribunal heard Ms Young’s claim that she had emailed her managers in November 2016 saying DQIP “were acting in a fraudulent way by overstating the income that they were bringing in each month. They were representing that they were achieving £114,000 per month, but, in her view, taking out the embedded value and the value of the internal team, this was only £16,000. She stated that this ‘must be fraudulent’.”
The tribunal judgement said it made no finding of fact on her allegations against DQIP.
A spokeswoman made no substantive reply when HSJ asked Barts whether it was satisfied DQIP’s estimate of the sum it had achieved for the trust was correct. The spokeswoman said: “The trust has and continues to be assured of performance via regular auditing”.
DQIP no longer trades as a company but two former members of staff were employed with another coding consultancy, which provides services to the trust. Ms Young is also still employed by the trust.
The employment judge said: “We found that the claimant is someone who cares a great deal about the NHS”.
The tribunal noted that DQIP’s review of the inhouse clinical coding department found it was partly responsible for increasing income through coding by £2m in 2015-16 and that “its successes were not recognised throughout the trust.”
A trust spokeswoman said: “The trust outsources when specialist skills are required for short term projects, to deliver specific training to its staff, or to make up for short to medium term substantive staffing deficits. This is the case with clinical coding where it is the trust’s responsibility to ensure correct and accurate clinical coding across the organisation, supported by appropriate audit processes, in order to fulfil our duty to record the work we undertake. “
She confirmed two former members of staff at DQIP were employed by Maxwell Stanley, who the trust now contracts with to provide “services including training and service development”. Maxwell Stanley and another firm, CEC Healthcare Coding, were appointed following a competitive tendering process, she said.
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