Among files at the National Archives at Kew is JA 536/633, about a 1993 conference about preventing crime in the National Health Service. Behind it was a study which laid bare the counter-fraud and security shortcomings in the NHS.
The background was numerous serious crimes in and around hospitals: murder, rape, kidnappings of new-born babies. In 1992 the Department of Health commissioned KPMG to audit crime prevention at Countess of Chester Hospital, which the ministry later described as โunhelpfulโ. The Department then employed specialist crime prevention consultants Sheena Carmichael and John Drummond, who studied six hospitals, taking three days at each, including an after-dark site survey. They found that more or less everything that could be at fault, was.
Procedures for reporting and recording incidents were โlargely ineffectualโ. Yet as the consultants wrote, โyou cannot manage a problem unless you can measure itโ. Responsibility for security was seldom defined; and often it was too far down the organisation anyway. The consultants reported that security, loss prevention and the protection of staff from violence, should be a โmanagement issueโ, as taken up in the conferenceโs title and its audience.
ID badges
Hospitals, the consultants found, had too many entrances and exits, open too much of the time – for example, when cleaners were at work. Doors might have access codes, which staff gave to patients to go outside to smoke a cigarette. All hospitals the consultants visited had identity badges, whether brought in during the Gulf War of 1991 or after a breach of security; but none made effective use of them. Only one hospital insisted that the visiting consultants had a badge. When a hospital consultant once challenged the visiting consultants, on a ward, he was not badged.
Senior management were not in touch with accident and emergency (A&E) departmentsโ problems. A&E staff felt โhighly vulnerableโ. Hospitals used large sums of money, without accountability, a โclassic opportunityโ for fraud as the consultants put it. As one manager told the consultants, hospitals were like a โsupermarket without tillsโ โ linen, cutlery, even wheelchairs went missing. Also mentioned was โtelephone abuseโ (before the era of everyone owning a mobile phone, staff might use land-lines for their own affairs). And staff got little or no training around security.
โTip of icebergโ
The NHSโ then management executive, with an eye on their reputation and self-preservation, noted that the report provided โammunition for the press and others who would seek to sensationalise the problemโ. Yet the consultants had stated that they had only โskimmed the tip of a very large icebergโ. They urged the making of a link between loss prevention and security. It was for example an exception rather than the rule for written references to be verified by telephone, which let in the risk of forged references.
Staff were โpunchbagsโ for the friends and relatives of the sick, yet it was rare for management to be supportive of prosecutions. While managers described violence as โwater off a duckโs backโ, those at the โsharp endโ felt that managers didnโt understand. A&E departments were lacking in situational crime prevention.
Speaker
The opening speaker of the conference, at the QE2 Centre at Westminster, was the Conservative minister Baroness Cumberledge. On file a civil servant described her as โvery keen to be seen to doing something positiveโ.
Quotation
A draft copy of the consultantsโ report had a quotation on the front cover: โShould those recommendations be implemented we believe that it would be possible for the average hospital to release ยฃ100m a year for patient careโ. The consultants evidently wanted to show what good could result from better fraud and violence prevention. A civil servant had it removed, saying it couldnโt be justified (and was embarrassing to admit?!). The consultants had admitted their work was based on anecdotes, what they had heard on their visits, itself a commentary on how little those in authority knew of the problems and losses. Another clue to how badly informed the Department of Health was: a civil servantโs remark in the file after a meeting of Tory Norfolk MP Ralph Howell and the health secretary Virginia Bottomley. The civil servant noted Howellโs โcontinuous single mindednessโ about theft and fraud in the NHS; โperhaps the secretary of state may wish to ask him directly if there is any inside information he has that would be in the interest of the service to divulgeโ.
Earlier
As early as 1982, health authorities running hospitals had been asked by the ministry to develop โcomprehensive security strategiesโ and keep them under review. An NHS security manual was issued in 1984, and a new edition issued in 1992. Some hospitals employed security guards; installed CCTV and attack alarms for staff. One higher profile example was by Thorn Security, a โhospital eyes surveillance systemโ at Stoke Mandeville.
