comment NAO reveals a side of the NHS that should give major cause for concern

Published: 20/12/2001, Volume III, No.5786 Page 19

This week's National Audit Office report on waiting-list irregularities at nine hospital trusts makes shocking reading. This compact little document has opened up a can of worms in just 30-odd pages.

Primarily it has revealed the lengths to which some individuals have gone to appear to be meeting key performance targets.

Covering up waiting-list 'failures' is not new. But it is the detail that is telling. In one case, patients waiting for treatment were offered dates that were deliberately unsuitable or even non-existent, to avoid breaching targets and risking reputations. There will be dismay at the efforts to hide or move the names of people who had waited many months for operations.

The report depicts an intolerable culture which the public has a right to challenge. It cites, among other things:

nmanagers who received pay-offs from public funds when leaving senior posts amid local investigations;

the inadequacies of employment procedures, with references failing to mention the findings of these investigations;

nthe unwillingness of some senior managers to accept responsibility for what happened.

All this gives the impression of an organisation that is far from open, transparent and accountable. It seems that some managers are more interested in preserving their career prospects than in the health and wellbeing of the patients they are paid to provide care for.

This report will further shake confidence in a system that is already struggling for credibility. At a time when all public services, from the railways to the Post Office, are in the dock, the NHS can ill-afford to be seen to be taking risks with people's lives for the sake of protecting its own.

The NAO is charged with making sure public money is properly spent. It is right to highlight the 'major breach of public trust' that has occurred in these trusts. Public confidence will be undermined in any public sector organisation where senior managers can receive substantial pay-offs after major failures in their workplace and then move on to other jobs within months .

The report's findings are perhaps a greater indictment of the system and government than of managers themselves. HSJ defends managers and argues for a reduction in the number of targets and pressures from the centre. But the deliberate misuse of power witnessed at some of these trusts cannot be defended.

Perhaps the NAO's most significant step was to name those associated with waiting-list irregularities. In doing so it has ensured that the NHS is not a faceless bureaucracy. But it has also made some managers nervous. There is no place left to hide for those who manipulate the system in an attempt to protect their jobs.

Overall it hasn't been a good week for managers. The former head of the Leadership Centre, Barbara Harris, has stepped aside in the wake of criticism of the management culture at her former trust.

Yet another Audit Commission report has attacked management failures - this time, in pharmacy services.

Managers have been called to account. It is time to rebuild confidence, and one way to do that and to ensure that they are beyond reproach is to follow the NAO regulators' recommendations.

This should start with the NAO's suggestions on procedures to follow when waiting-list irregularities have been discovered; on confidentiality clauses when contracts are terminated; on providing full reference details; and on the right of the NHS to claw back compensation if somebody is re-employed within the service.

Happy Christmas, everyone.