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Wednesday, 19 December 2018

Fraud case underlines need to review NHS recruitment process - watchdog

Written by Jemma Crew and Ryan Hooper

The case of a convicted fraudster who rose from the ranks of nurse to chief executive has been highlighted by a watchdog as cause to review how NHS trusts are employing "fit and proper" directors.

Paula Vasco-Knight (pictured) was given a suspended prison sentence at Exeter Crown Court in 2017 after she admitted abusing her position to pay her husband, Stephen Vasco-Knight, just over £11,000 from her budget for a leadership improvements document which was never completed.

Vasco-Knight, from Liverpool, had been in charge of South Devon NHS Foundation Trust and was the national lead for equalities and diversity for NHS England in 2013 when the fraud was committed. Her husband also received a suspended jail term for his role.

A Parliamentary and Health Service Ombudsman report published on Wednesday found the Care Quality Commission (CQC) must review how it ensures trusts are not making errors when recruiting to top positions.

The report came after whistleblower Clare Sardari complained that the CQC - which itself regulates health and social care services in England - failed to adequately oversee the re-employment of Vasco-Knight following a separate serious misconduct accusation.

Ms Sardari raised a "genuine concern" in 2014 that Vasco-Knight arranged for the appointment of a relative's partner into a post at the South Devon NHS Foundation Trust and failed to disclose her knowledge of the candidate.

Vasco-Knight resigned after an employment tribunal found the whistleblower had been prevented from returning to work while she persisted with her complaint.

The following year she was employed at a new trust where she was later promoted to "interim chief executive".

Ms Sardari complained about the CQC's regulation of the Fit and Proper Persons Requirement (FPPR), which requires NHS Trusts to make sure their directors are "fit and proper" to carry out their duties.

One of its aims is preventing directors who have committed misconduct from moving around the NHS.

She complained that, if the CQC had better handled the situation, the chief executive would not have been able to get another job in a different NHS trust.

An investigation launched by the Ombudsman found the CQC's handling of the FPPR "was not transparent, fair or proportionate and it amounted to maladministration".

The regulator was criticised for its poor record-keeping, and was found to have dismissed tribunal criticisms of Vasco-Knight, while giving her apology and references undue prominence.

The CQC's decision to close the case was "flawed", it found, adding that the seriousness of the failings "raises the possibility that the failings go beyond this case".

Rob Behrens, the Parliamentary and Health Service Ombudsman, said: "This case shows that CQC's approach to making sure NHS trusts are employing the right people at director-level needs reviewing.

"The public and NHS staff must have confidence that NHS leaders are fit and proper to do the job and that whistleblowers will not be penalised for raising concerns.

"We need fair, transparent and proportionate oversight that stops leaders who have committed serious misconduct from moving around the NHS, and makes them accountable for their actions."

The Ombudsman partly upheld Ms Sardari's complaint, recommending that the CQC apologise and offer her £500 "in recognition of the injustice caused to her".

It must also report improvements it has made within eight weeks.

But the report said it would be "speculative" to consider what would have happened had the CQC robustly considered the trust's actions.

Ian Trenholm, CQC chief executive, admitted the way the CQC and the wider NHS organisations handled the "challenging" case did not meet the whistleblower's expectation.

But he said the regulator had "concerns about the approach adopted by the Parliamentary and Health Service Ombudsman which led to some of the findings of maladministration".

He said: "There was a considerable amount of contradictory evidence for the trust to assess. This included an Employment Tribunal decision, which was not consistent with other pieces of evidence.

"Under existing FPPR regulation our role is to consider whether the trust acted reasonably in coming to their conclusions about the weight that should be attached to various pieces of evidence, rather than whether we would have reached the same conclusions.

"We judged the trust had performed its obligations reasonably when faced with this difficult situation.

"We are disappointed that the PHSO came to a different conclusion."

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