Sunday, 14 January 2018

The Fifth Column - the elite public employees who quietly take "little extras".

Much press publicity is given to those who "cheat" on benefits or are caught avoiding car tax etc. These are the small fry. My professional experience has been primarily in the N.H.S. but subsequently as a county councillor. Many well paid public servants are happy with their lot and I'm sure don't cheat the state. However, others are not playing by the rules 
Siân Caiach,.

 I lost my medical career as an Orthopaedic surgeon by reporting fellow Carmarthenshire Consultants for using their NHS sessions and NHS equipment and facilities for private practice without paying   for  it. I am sure my colleagues at the time will say its my own fault, I got fair warning that unless I shut up about the scam I would lose my job and never work as an orthopaedic surgeon again. I didn't believe they had that power, but they did.

Perhaps areas distant culturally and geographically from centres of government attract people who feel they deserve more? We are told that the rich are becoming richer and it is very disturbing when the ordinary taxpayer is already funding a number of these well paid elite  public servants when,they cannot control their own greed., and need to sneak extra financial perks under the radar, usually with management collusion.

Mark Vincent James

Carmarthenshire County Council has become renowned for the actions of County Council Chief Executive Mr Mark Vincent James who famously was discovered to have been given secret extra salary payments by the elected councillors on the Council Executive Board. The Wales Audit Office found that he should not have been given this money,  £28,700 in the form of a secret pay rise
to compensate him for the loss of tax relief on his large pension when  HMRC changed the rules and he was also found to be unlawfully funded in a libel action to the tune of £29,000. In order to get the Council Executive Board to fund his libel action Mr James promised to return any damages to the Council. When he was awarded generous damages, £25,000 then he changed his mind and has kept the money.

 Perfectly legal to keep that £25,000 plus generous interest awarded to him , but he had promised it to the Council. This leaves the Council in theory £82,700 out of pocket. The investigation of the unlawful payments also cost the Council a hefty charge of £51,000.  Total bill to us local taxpayers around £138,700.

All this is theoretically the responsibility of the senior councillors, at that time a coalition of Labour and Independent councillors, for approving these payments but I believe they were persuaded to do this by the senior officers present. Do Councillors suddenly decide to give dodgy pay rises which are not declared in the Executive Board minutes?

This case is well described in the blog

Let me give you an example I observed in the NHS where actions were I believe immoral, certainly financially advantageous, but not actually unlawful.

I worked in Llanelli  with an orthopaedic surgeon called Joel Adams, an American who had moved to the UK. The NHS would address growing local waiting lists by allowing "waiting list initiatives," where doctors would be funded to run extra clinics or theatres sessions in their own time and would be handsomely rewarded using private practice pay rates.

Now, the problem for Joel was that in a relatively poor area of Wales, the demand for private operations is driven by the waiting lists. He had a good private practice, in part because I did not do any private practice myself and he took all the local requests. But he also had a way of claiming the extra public waiting list funds to fill his pocket without actually affecting the general waiting list at all,

I worked 5 full days a week and was on call every other night and every other weekend and had a brood of young children. I wasn't interested in extra money. The basic consultant salary was at that time £60k p.a.and I thought quite adequate for the job, Unlike my colleagues I did not negotiate extra salary grades which they felt entitled to for working in the backwater of West Wales. So I was putting in more hours, seeing more patients and doing more operations for less money than my colleagues. I didn't even claim travelling expenses to outlying hospitals, clinics, meetings etc for all the years I worked there.My secretary calculated I had missed out on more than £5,000. Totally committed to the NHS, I felt that I could afford the travelling and that the NHS needed the money more than I did.

Joel often took half days off and never worked Friday afternoons. If offered waiting list initiatives he arranged an extra theatre for a half day - Friday afternoon. A number of patients would be selected and operated on, usually quite simple cases who could normally be discharged within a day or 2. Joel left instructions that the patients should stay over the weekend as he wished to discharge the patients himself personally on Monday morning. He then found reasons why some should stay a little longer. For instance, ordered a new x-ray "just to check" or extra medication or a new type of dressing  or splint which would need time to be arranged. These patients would not then leave immediately and "blocked"  beds   His Monday full day theatre list was then shortened as there were not enough beds for all of them to be admitted before he went to theatre. These patients were sent home to wait longer. He and his anaesthetist could then take Monday afternoon off.

So Joel got paid handsomely at private practice rates, operating on  extra patients but managed the ward so that his next list was halved. The Government was informed that the Waiting list initiative had resulted in whatever number of "extra" cases being operated on, but not that  a similar number of other cases were cancelled from the next list. A  deceit that made one Consultant surgeon and the Consultant anaesthetist a fair amount of extra money for no actual extra effort. Joel even produced an audit  study which he presented to other doctors showing that on Mondays over 30% of his patients missed operations and had to be sent home . He blamed the management, but in fact he was manipulating the situation to fill his own pocket. This sort of scam is organisationally invisible unless you have very good managers who can closely monitor the overall figures and successfully challenge the senior people involved.  It did not happen then and I believe would not happen now.

Joel and other consultants were also doing things which were much clearer examples of thieving off the NHS .Operating on private patients in NHS time and unbeknown to theatre staff, getting drugs, xrays and tests for free for private patients and also using NHS implants at no cost to the surgeon.

That's what actually got me in trouble when my complaints were investigated by the Audit Commission, although, like in Carmarthenshire County Council Case, the Auditors found  the complaints were valid but were not minded to act against the perpetrators, in this case greedy doctors and compliant management and accepted the promise that they would do better in the future..

I was suspended for 3 years, treated like a criminal, Joel showered me with complaints and was supported by the Medical Director and all of the other surgeons on this scam. For them it was not a theft of public money and resources but a perk that they deserved  for working in this area, Many of their colleagues in other areas made huge fortunes from private practice so why not increase their profit margins here at public expense?. At the time the average private practice income of UK orthopaedic surgeons , over and above an NHS salary, was said to be over £300k p.a.

I imagine that the local surgeons were already adding generously to their NHS salary through external private practice, but it wasn't enough, they felt they needed to rip off the public purse. The medical director at Prince Philip Hospital, Dr Peter Thomas, explained to me that it should be regarded as a work benefit, a payment in kind ,and couldn't I understand that poor Joel was on his third divorce and was paying a lot of alimony? Dr Thomas also told me that he believed, from conversations with other surgeons that they might leave the trust if they did not get these perks.

Recently I was contacted  advise about safely "whistle blowing" on a similar sounding current scam.  Allegedly , consultant Surgeons and Anaesthetists in a local hospital were similarly operating on private patients in NHS theatres who are admitted to NHS wards and displace non paying patients.  My sources also believed that the clinicians were not paying the full cost of these procedures , thus subsidising their private practice. I would have loved to have said "Go on, tell the management, you will be fine" but I felt I had to advise the informants to not make the disclosure as it could well be the loss of their jobs, reputations and future work prospects.

If this is going on , and  I have no  proof  personally that it is happening, I suspect the management would be  aware, either colluding or turning a blind eye.. Financially injuring senior public servants in their wallets by exposing their "extra perks"is a very dangerous thing to do.

The people who are ripping off the public in these ways generally believe they are entitled to these extra perks.  They feel they are Princes and Princesses and need to be pampered.  Lesser employees could be dismissed if they were found to steal a minor item or even found smoking in a toilet.  The rich people on the top of the  grades throughout the public services are at or near the pinnacle of their careers, generally well  respected and very influential. Many of them are surely happy with their generous salaries but clearly some want more, and are prepared to stretch or break the rules, and worryingly, appear to feel no shame.

If we had a culture where whistle blowing in the public sector was seen as a constructive act, these practises would not happen. Policies on whistle blowing are useless when they are routinely countered by harassment, allegations of misconduct and other discrimination against informants.

Where exposing financial wrongdoing in public service is regarded as snitching on the high and mighty who's position gives them  entitlement  to these "extras", the facts will be obscured and usually covered up. The public money will still  be wasted on the greedy.  Other staff with knowledge of the scams will feel implicated and collude to hide or deny the truth, especially when they see how whistle blowers are treated.

In times of economic austerity we should surely not tolerate the misuse of any public funds? it is disturbing, especially when the motivation appears to be the greed of people already well paid. In the NHS it is time that private practice is only offered in private facilities and in the doctor's own time and without equipment taken or "borrowed" from the NHS.    

1 comment:

  1. The dark cloak of confidentiality allows abuses to proliferate. Toothless "watchdogs" are part of the problem. The revolving door between lucrative public and private posts encourages people not to rock any boats in case their careers are damaged, thereby institutionalising corruption (or self-preservation, as they might prefer to say). Independent journalism would help -- but not enough people are prepared to fund the not inconsiderable costs.


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