What were two internationally renowned firms of beancounters doing at Mid Staffs shortly before the shit hit the fan? Robert Francis has studiously avoided taking any evidence in his Inquiry from the beancounters, so MedicalHarm has decided to ask the questions.
Shortly after the announcement of a full investigation into deaths at the hospital by the Healthcare Commission and the excellent Dr Heather Wood, Mid Staffs went scurrying to the beancounters for what was termed “due diligence”. In May 2008, PWC were “delighted” to accept the Board’s invitation and set out their fees with just as much delight. A “partner” would bill £2,980 per day, a “senior manager” £1,920 per day, and a mere “manager” £1,670 per day. What was this taxpayer money used for?
Witnesses at Mid Staffs have told Medical Harm they saw two smooth City “suits” walking around the hospital with clipboards. So what exactly did PWC achieve? Anyone familiar with the banking crash and the role of the “big four” audit firms should read on. Medical Harm has been contacted by several whistleblowers with respect to PWC’s involvement at Mid Staffs.
The beancounters set to work, interviewing trust employees and walking around the hospital with clipboards. After four months work, and well before the Healthcare Commission produced its damning report, PWC were delighted to report that “the Trust’s overall morality rate… does not appear to be high and does not vary significantly from the SMR average index”. This must have been just what the Board wanted to hear. The beancounters poured cold water on the Dr Foster figures, collected from hospital episodes, which showed a clear problem with mortality: 117 (2005/6), 123 (2006/7) and 113 (2007/8). Trebles all round. Get the File.
But the Healthcare Commission continued investigating. The evidence piled up of poor care in A&E, of the “dumping ground” where breaching patients were held, and of patients being left in faeces on the ward. It became hard for PWC to hold the line of defence. In March 2009, the Healthcare Commission published its damning report. PWC were called on to finally report to the Board of Mid Staffs months later. The final report of July 2009, disclosed to Medical Harm, makes no mention that “the mortality rate does not appear to be high”. Rather PWC claim, “it is difficult to link definitely high mortality rates with the quality of care being provided”. So that’s alright then. Get the File.
PWC were paid a whopping £233,874.35 for their work. Medical Harm asked PWC to justify its convenient findings on mortality, since it is now well acknowledged that care in A&E at Mid Staffs was “appalling” by Sir Bruce Keogh, a surgeon and the medical director of the NHS. The reply from the beancounters relied on their “senior clinicians” who had been part of the “team”. So we asked for the names of the clinicians and their level of medical expertise. Answer came there none. PWC had “no further comment”.
However, MedicalHarm had a copy of the engagement letter, and were aware that the medical expertise used amounted to one A&E consultant, and GMC Council member, Professor Chris Bulstrode. PWC said he had “taken the lead in interviewing a number of senior clinicians from various medical and surgical specialties at the Trust and observed clinical practice in the Emergency Department.“ When MedicalHarm contacted Professor Bulstrode he said he was worried about A&E care across the country, worried that Mid Staffs would become a lone example, and that he had played no part in reviewing the mortality figures.
But PWC were not the only beancounters in Mid Staffs. Monitor, the foundation trust regulator, was also paying KPMG in 2008 to conduct a “governance review”. Dr Heather Wood, who uncovered the deaths, told the Inquiry she had the impression that firms of accountants were conducting interviews in parallel with her, and getting to witnesses before her. We asked KPMG if they had rehearsed any witnesses, and they replied, “KPMG has nothing to say”. We asked PWC who said they “did not rehearse witnesses” and all of their witnesses had “already been interview by the HCC”.
So MedicalHarm is none the wiser. In evidence to the Inquiry an A&E nurse, Helen Donnelly, referred to the little prison cell known as the “dumping ground” where patients were put to be monitored to avoid breaching targets. This, she says, was an obvious example of “gaming” the stats.
As healthcare becomes a numbers game, how much would you pay the nodding beancounters in the window?