Health Policy InsightEditorial Friday 13 July 2012: An honest man writes to the Health Secretary
I know slightly and admire greatly Dr Peter Brambleby. An interview with him for this site can be found here.
When we last met at recent a Wellards seminar at The Kings Fund, he told me he had left NHS Croydon PCT and Croydon Council, where he was joint medical director.
Peter added that he was feeling very happy that he had done so.
We now know a bit more about why.
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NHS Croydon's 'discovered' deficit his the news in HSJ last November, making it the first area where the CCG is certain to inherit a deficit. NHS North Yorkshire And York is the second.
The Croydon Advertiser has obtained the text of Peter's letter to the Secretary Of State For Health, which can be read here and is copied below.
An interview by the paper with Peter can be found here, and more details can be found here, here and here.
Peter Brambleby has form on blowing the whistle on bad practice. He did it in 2004 at NHS Norwich regarding the Norfolk and Norwich PFI, and again in 2008 at NHS North Yorkshire & York. He has integrity to burn, and is letter to the Secretary Of State follows below.
The Secretary Of State's reply will be very illuminating, I am sure.
Rt Hon Andrew Lansley CBE MP
Secretary of State for Health
House of Commons
London SW1A 0AA
5 July 2012
Dear Mr Lansley,
Re: Failure of financial management and corporate governance in NHS Croydon and NHS London; systematic dishonesty and bullying in the NHS.
This is a “whistleblowing” letter. I write as the former director of public health for Croydon – a joint post with PCT and Council which I held from March 2010 to my resignation from the NHS on 29 February 2012.
The issue that prompted my resignation was concern about serious financial irregularity in the PCT of which I was an executive member, in particular the role of a long-serving interim deputy finance director. This had led to a breakdown of trust within the senior management team, loss of financial and commissioning grip, failure to prioritise investment in areas of greatest need, impaired relationship with the Council, and inability for me to carry on in a way I felt was ethical. My difficulties were compounded by the hasty and inept way that PCT transition was conducted in London, in particular with respect to lines of accountability for DsPH.
By way of background, I was (and still am) a supporter of the direction of current reforms, and a strong advocate of health and well-being boards. I gave evidence to the Health Select Committee’s report on commissioning in January 2010, calling for a greater role for GPs and local authorities – both of which are cornerstones of your policy. I spoke to you at one of your round-tables during the “listening exercises” and helped the NHS Confederation with theirs. I think most of my colleagues in the Faculty would attest to my good standing professionally. I am best known for my work on “programme budgeting” and therefore have a stronger interest than most in tracking investment and outcome. I confess to a record of speaking out against bullying and corruption – most notably in 2004 when, as DPH for Norwich, I exposed the secret changes in specifications to the Norfolk and Norwich PFI hospital that had put patients at risk, and then in 2008 as DPH for North Yorkshire and York where I was interviewed on Sky News after the SHA instructed my board to choose patient priorities in ways that avoided bad headlines (and you appeared on that broadcast).
The issue that prompts this letter is that, although the concerns raised by myself and others were eventually the subject of an external audit by Ernst and Young, and I was a witness to that inquiry, I believe the matter is now being played down by NHS London and SW London cluster.
Not a single individual has accepted personal responsibility or shown they have learned.
£ millions are now known to have been mis-reported in the accounts (and failed to be detected by Croydon PCT’s internal and external auditors).
£ millions remain unaccounted for.
There has been insufficient acknowledgement of the underlying culture that allowed this to happen, for example the many junior finance staff who knew their superior was not acting professionally but declined to speak out or were not heard.
I am convinced it will happen again, or has already happened. PCTs and hospitals are engaged in a grim game of “pass the parcel bomb”, hoping their financial deficit explodes in someone else’s lap (or better still, an empty chair during the reconfigurations). In the NHS’s bullying culture no-one dares admit mistakes, or that they don’t know, or that the system is not working.
You will probably have been briefed already on the E&Y audit and the response from NHS London and NHS SW London. Rather than try to précis those, or my subsequent correspondence, I attach here my personal appeal to local NHS chairs, their response, and my reply. You will see that:
In my opinion NHS London has conducted a whitewash. They may wish to spare you (and themselves) embarrassment, but this is dishonest and counter-productive in the long run.
I will be contacting my recent employers at Croydon Council and PCT to retract the chapters of my two annual public health reports that relate to programme budgets because I now know the financial figures were falsified and my conclusions may be invalid. I understand the former is very angry already, and rightly so. I will be informing the Faculty of Public Health and Chief Medical Officer of this development which I believe is unprecedented.
To ensure proper balance, openness and accountability, I am placing my perspective on this affair in the hands of the media who have carried this story, or previously reported my work.
I will inform the General Medical Council that I am escalating concern in these ways. Although I have retired I remain on the GMC register and as such it is my duty to report and press for action where I believe avoidable harm may ensue for patients, as is the case here.
I hope you will take note. I hope you will act. I look forward to your response.
Thank you,
Yours sincerely,
Dr Peter Brambleby
MBBS, DCH, FRCP (Edin), FFPH