Tuesday 7 July 2015

public service and private profit

When I was an NHS consultant a colleague continually and perfectly legally took extra public money by the following means.

From time to time the number of people waiting for operations built up and the local hospital was given extra money to process surplus cases and bring the numbers down. As I was working flat out I couldn't help out, but my senior colleague who regularly took a half day off on Friday afternoons always volunteered. The senior doctors [consultants] involved were paid private practice rates, at that time £500 per half day. The junior staff and nurses were paid  normal rates and often no extra salary as their participation was included at no cost to the hospital as they were the "cover" team standing by for emergencies or ward calls.

Naturally, like most surgeons, my colleague himself did a lot of private practice in his spare time. Acutely aware that in a poor area he needed to keep the waiting lists long to get people to fork out for private ops, he needed to arrange matters so that no more patients than usual got NHS treatment despite the NHS paying him and his anaesthetist for extra work. He also wanted to reclaim his "sacrificed" half day back.

Doctors are generally clever people. For him it was simple. He would operate on a Friday afternoon, his usual half day off. He would keep a number of patients in over the weekend with strict instructions that only he could discharge them. On Monday, he normally had a full list of patients for an all day theatre. There would regularly be a bed crisis on the ward due to five day working, with many discharges going on while patients waited, with their suitcases, for a bed. Just before theatre started he would appear to personally discharge his Friday patients. He would assess the situation, and if enough beds were available he could prolong the stay of any patient by eg. sending them for another xray that he needed to review at lunchtime "just in case" or get another test, etc.. Several patients would then be sent home due to lack of beds. His whole day list would only last the morning and he would take Monday off instead of Friday, as would his anaesthetist as the afternoon list would be cancelled.

Hence the Welsh Government paid for the treatment of "extra" patients when in fact no more patients were treated than usual and the only real change was that a senior surgeon took his half day off on a different afternoon and got paid 500 pound extra per week for the duration of the project.. I recall the same doctor giving a presentation to other doctors on how one third of his patients had their operations cancelled because of bed shortages. Shocking!

According to official figures, of course, more patients were being treated and I presume the health minister was led to believe that the waiting lists, if they did not diminish, were suffering extra demand.

The hospital management was well aware of all that was going on but happy to tick the boxes.

To my shame, I finally complained about this greedy doctor only when he started discharging my NHS patients to admit his private ones. Looking into the matter I found he wasn't even declaring these clients as private patients and using NHS facilities, hip replacements etc. for nothing. I was outraged, but  the management perfectly happy to allow the situation to continue. I complained to the Audit Commission and suddenly I was the problem. They found in my favour and I've not worked in a hospital since.

I am cynical about public sector "improvement" plans and the facts and figures we are charmed by. It is easy for senior management in the public sector to hide incompetency, inefficiency and plain corruption. Someone has to recognise that it going on, and the career prospects for whistle blowers are not attractive. It is so easy to manipulate the system to pocket some extra cash, it is even easier to remain quiet about it, and silence any murmur of disquiet..

Most public servants, I believe, try their best to provide services to the public. However, in too many areas there is a more dangerous culture. It is easyer to spin the figures rather than provide real improvement. It is safer to turn a blind eye to public employees defrauding the public purse than to speak out. Eventually, as in the Betsi Cadwaladwr case the standards of patient care and staff morality are so awful that the truth finally becomes public, often not because of staff disclosure but the complaints of patients and relatives.  Surely our public services deserve better. If a low paid employee in public service steals a tiny amount of money or goods, they are sacked. If senior public servants steal hundreds or thousands of pounds from their employer, in my experience, they are protected rather than criticised, and rarely asked to pay anything back, Informants are punished and the bad behavoiur probably continues unabated to this day..

Time, I think, for a big culture change.

Sian Caiach, 


  1. Employees of PublicServices do not whistleblow lightly but when they do they expect their disclosures to be looked into and acted upon. But despite robust Whistleblowing Policies (as in CCC) and the supposed expectation that NHS staff speak up it's found that the Public Bodies do not want to know. Complainants & whistleblowers are all unwanted irritants and every effort is made to avoid proper investigation of concerns, whoever from! You are still trying to persuade Public Bodies to act in the public's interest through your position as a Carmarthenshire County Councillor, I wish you well!

    Jennifer Brown (whistleblower)

  2. This is not limited to public services, why do you think we still have banking scandals? From LIBOR rigging to PPI. as long as the "profits" were coming in and everybody and his dog were getting bonuses, whistleblowers and boat rockers were quietly silenced. There is no difference - white collar, white jacket, public or private sector. When people complain about the mess the banking crisis landed us in, my normal response is "first take the plank out of your own eye".

  3. Good point Geoff. There sre certainly many cases in the private sector too. The banking/financial scandals are a good example."Shoot the messenger" is a widespread and unltimately cancerous management culture.


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