Committee of Public Accounts

Press Notice No. 47 of Session 2003-04, dated 16 November 2004


Mr Edward Leigh MP, Chairman of the Committee of Public Accounts, said today:

"Patient safety is paramount and so it is important that NHS Trusts can suspend clinical staff whilst conducting investigations. But too many suspensions cases have dragged on and on, wasting large sums of taxpayers' money.

The average length of exclusion from work for suspended doctors was 47 weeks and 19 weeks for other clinical staff. Astonishingly there were 30 cases where exclusions lasted over two years. The annual cost to the NHS, at £40 million, is much too high. And very long cases can be damaging to the clinicians involved. They face depression, erosion of skills and lasting career problems even if totally exonerated.

The Department of Health and the NHS as a whole need to get a much better grip on the management of all exclusions of clinical staff and resolve cases within at least the existing six month target."

Mr Leigh was speaking as the Committee published its 47th Report of this Session, which examined the scale and cost of exclusions of NHS clinical staff, case material illustrating difficulties in managing exclusions, and the scope for improving the management of exclusions.

Between April 2001 and July 2002 over a thousand clinical staff at NHS hospital and ambulance trusts in England were excluded from work for more than a month. The annual total cost to the NHS is £40 million. For the clinician, exclusion can result in depression, their family can be adversely affected, and they may also lose important clinical skills, requiring substantial retraining before returning to work.

The Committee found that prior to the National Audit Office's Report this time last year, the Department of Health had no appreciation of the full scale and costs of exclusions of clinical staff as its monitoring was limited to formal suspensions of doctors lasting more than six months and was itself largely inaccurate up to 2000.

In 1995 our predecessors examined the case of Dr Bridget O'Connell, who was suspended for 11 years. They severely criticised the management of the case, and called on the Department of Health to review how new guidelines were operating, which the Department agreed to undertake by 1997. The Department's new guidance finally issued in December 2003 is welcome but it has taken ten years to produce and is incomplete, as it only applies to doctors, not other clinical staff.

If exclusions did not exceed the six month limit set by the Department, £14 million annual savings would be realised. Some cases have taken more than two years, including cases where patient risk is not a factor.

Despite our predecessors' concerns, payments to clinical staff who resign have sometimes been inappropriately covered by confidentiality clauses to the detriment of local accountability.

The National Clinical Assessment Authority, fully operational since April 2003, has helped improve the management of exclusions in a number of cases but has had mixed success in resolving legacy cases. The Authority only covers doctors, and the Department should consider extending its remit to other clinical staff.

Trusts are failing to undertake the specified employment checks when recruiting staff and are therefore putting patient safety at risk. In addition, there are weaknesses in communicating concerns to other potential employers where staff are excluded and many trusts fail to complete their inquiries if excluded clinicians leave.

It is a cause of concern that a significantly higher proportion of ethnic minority consultants are excluded. As part of their diversity policy, trusts should monitor the ethnicity of excluded staff and if a disproportionate number of ethnic minority staff are excluded, should investigate the reasons.

Click here to view Report