More than £8m of public money has been spent on the first year of the Mid Staffordshire Foundation Trust public inquiry, HSJ can reveal.
HSJ issued freedom of information requests to all organisations involved in the inquiry.
The Care Quality Commission was the biggest spender, clocking up £860,146 in legal fees by the end of May, followed by NHS West Midlands, which has so far spent £497,181 on legal advice and representation. The trust itself has spent £235,633.
Witnesses from the Department of Health have yet to be called to the inquiry. However, the department has already spent £158,738 on legal advice and anticipates spending a total of £448,000 by the time the inquiry is due to finish at the end of the year.
The inquiry’s running costs stand at £6.4m. It was originally due to report in March but is now almost a year behind schedule, meaning costs will continue to rise.
The £8m bill does not include the costs borne by organisations in staff time preparing information and attending the inquiry. HSJ understands senior figures have spent significant time preparing for their appearances.
The DH’s spending so far includes £40,000 paid to law firm Hempsons for advice provided to NHS chief executive Sir David Nicholson’s office in January this year.
Sir David was interim chief executive of Shropshire and Staffordshire Strategic Health Authority, which was responsible for the trust before the creation of NHS West Midlands in 2006. He is expected to give evidence in September after the inquiry’s summer break.
The CQC’s spending includes £326,211 paid to law firm Bevan Brittan for representation and £533,934 to Mills & Reeve to represent staff from the regulator’s predecessor body, the Healthcare Commission, many of whom criticised the CQC in their evidence.
NHS West Midlands’ costs also cover employees of Shropshire and Staffordshire SHA. However, the trust itself did not fund legal advice for 11 former employees who gave evidence to the inquiry but left before last December.
The remit of the inquiry – set up by health secretary Andrew Lansley last June – is to examine the role of “the commissioning, supervisory and regulatory organisations and other agencies” in relation to the trust from 2005-09.
Organisations deemed to have sufficient interest in the proceedings were granted “core participant” status by the chair, which allows them to submit questions to be put to witnesses. They typically have a representative at every hearing.
Of the £6.4m running costs, about £3.5m has been spent on legal services. This includes the legal bills of the inquiry team as well as three of the other core participants: Cure the NHS, Action Against Medical Accidents and the Patients Association, which were granted their costs by the chair, Robert Francis QC, at the start of the inquiry.
The first inquiry into failures of care at the trust was held in private and reported in February 2010. It cost £1.7m
The Bristol Royal Infirmary Inquiry into children’s heart surgery, which reported in 2001, three years after it was set up, is estimated to have cost £14m. The Shipman inquiry, which lasted almost four years and produced five reports, cost £23m.
Antony Sumara, who recently left his role as Mid Staffs chief executive, questioned the level of spending on lawyers and queried rules that mean only core participants’ recognised legal representatives can give instruction to the inquiry counsel on what questions to ask witnesses on behalf of their clients.
“It would be better if those rules were relaxed. What it means is you have to have very expensive persons there every day but the bottom line is [this inquiry] has got to be done. Value for money will be judged on the outcome,” he said.
He also questioned the approach of some bodies, claiming the priority should not be to “defend the interests of the organisation” but to learn from what had happened.
A solicitor working for one of the core participants told HSJ the most time-consuming part of the work was keeping up with the volume of submitted documents. They insisted legal experts brought a structured approach to examinations.
When the inquiry opened in November, the chair estimated it had received about a million pages of evidence. Statements are drafted by the inquiry’s legal team following interviews with witnesses and then sent to witnesses’ legal teams for approval.
Last week it was announced the inquiry will hold seminars in the autumn to consider lessons for the future before a full report is presented next year.
In addition to DH witnesses, the inquiry is yet to hear from the trust’s former chair of governors Toni Brisby and chief executive Martin Yeates, who is said to be in poor health.
Core participant spending
|Core participant||Spending so far (£)||Witnesses/expected witnesses||Average cost per witness (£)|
|NHS West Midlands||497,181||19||26,167|
|NHS South Staffordshire||293,647||4||73,412|
|Mid Staffordshire Foundation Trust||235,633||9||26,181|
|Department of Health||158,738||14||12,211|
|NHS Litigation Authority||52,263||2||26,132|
|Health Protection Agency||42,190||2||21,095|
|National Patient Safety Agency||20,815||2||10,408|
*including spending on Healthcare Commission employees
Note: Monitor’s legal costs are covered by indemnity insurance. The Royal College of Physicians is not subject to freedom of information legislation, however they have informed HSJ they have not yet incurred costs for legal advice. The public purse has also covered the costs of Cure the NHS, Action Against Medical Accidents and the Patients Association but no breakdown of their costs is available.