Published: 03/06/2004, Volume II4, No. 5908 Page 4

Non-executive directors in Oxfordshire were told they could be 'surcharged' if their decision to reject a deal with a local independent treatment centre led to the collapse of the contract, HSJ has been told.

Last week South West Oxfordshire primary care trust non-executive director Jane Hanna quit her post, claiming the trust's governance was being undermined by 'threats' and 'inappropriate pressure' from Thames Valley strategic health authority and indirectly from Whitehall.

Ms Hanna's claims centre on the deal behind the mobile ophthalmic independent treatment centre run by the South African firm Netcare UK, due to open next year.

Ms Hanna and former chair Professor Martin Avis say the trust board was pressured into supporting plans for the centre, which formed part of the£114m national ophthalmic chain.

Ms Hanna, a lawyer, said the SHA threatened to fine those against the move if their actions cost the deal, though the details were not made clear. She told HSJ that she and Professor Avis were at a meeting of the SHA when they were told they would be liable for the cost of the contract if the deal collapsed.

'We were warned we would be surcharged. It was basically a threat. I asked what the basis for that surcharge would be and they starting talking about how the details of surcharging had not been worked out as it was new territory. I told them it could not be a relevant consideration for the board unless it was in writing. I asked them to put it in writing, which they refused to do, saying it would never be put in writing.'

Professor Avis told HSJ: 'They never carried out the threat but I suppose we were potentially talking about a couple of million pounds for [the PCT's] part of the contract. Nationally it was over£100m. I do not think it was ever spelt out but the implication was that we would be liable personally.

He added: 'There was apparently enormous pressure on the Department of Health to make sure everyone in the NHS signed up to the treatment centre programme. There was a fear [at the DoH] that the other bidders could object because the terms of the contract, in their view, would have changed if we or anyone else withdrew.'

NHS chief executive Sir Nigel Crisp dismissed claims that the PCT fell victim to inappropriate levels of pressure, telling Radio 4 on Tuesday: 'It sounds like somebody who is exaggerating to make a point.'

Minutes later he walked out of the interview because the discussion had moved from the principles behind the national treatment centre programme to the specifics of South West Oxfordshire, according to the DoH.

On 27 November, several weeks after the surcharging discussions, the PCT board voted to oppose the creation of the treatment centre, but that decision was reversed weeks later following an agreement by Thames Valley SHA to take on the project's financial risk.

Ms Hanna said: 'We were told very clearly that the PCT had no choice but to approve the treatment centres, but that national initiatives of this kind had to be presented as local decisions.'

She added: 'It is a serious issue. I can no longer be confident that [the PCT] is complying with its responsibilities on local decisionmaking or that the decisions we are taking are rational, legal, publicly accountable or would withstand parliamentary scrutiny.'

Her claims are supported by former SHA chair Jane Betts, who resigned in March.

She told the Radio 4 this week:

'We were under tremendous pressure. It felt as though it had to happen at all events because the centre wanted it to happen - Whitehall wanted it to happen.

'They were getting anxious over the number of PCTs which had actually signed up for a contract they had [negotiated]. They wanted [the rejection] reversed quickly.'

A ministerial source said no minister was involved in pressuring trusts to sign up to the ITC contract. He also denied that the national contract with Netcare UK would have been threatened if South West Oxfordshire PCT did not support it.

Thames Valley SHA refused to comment on the specifics of the case, but in a written statement said: 'Part of the SHA's role is to assist in implementing national health policy.We advise our trusts and PCTs regarding the benefits of new initiatives.

'It is then their responsibility to consider all information and opinion to reach a democratic decision.'

Words from on high: how Professor Avis quit Professor Avis stood down at the end of March after being told by the NHS Appointments Commission that he would have to reapply for the post, which shocked him, he told HSJ .

'In December I was assured by the SHA chair that there would be no problem with my reappointment. In January I was told there was a problem but the explanation of the problem was never made clear. I was told that it had nothing to do with my personal qualities as a manager.

According to the [then] regional chair of the NHS Appointments Commission [Bernard Williams, who was appointed Thames Valley SHA chair in April] the message had come from on high that I would have to contest the post.'

Mr Williams was not available for comment, but NHS Appointments Commission chief executive Roger Moore dismissed any suggestion that a message on whether to recommend that a nonexecutive post should be contested could come from 'on high'.He said the commission's decisions were made entirely separately from government.