Annex A > Chapter 4 - National Accountabilities and Roles > The National Framework: responsibilities for healthcare > The Performance Management Directorate
<< previous | next >>
The Performance Management Directorate
69 A Directorate within the DoH dealt specifically with `performance management'. The potential significance of this for the Inquiry arises from a letter of 21 July 1994, in which Dr Doyle wrote to Professor Gianni Angelini, Professor of Cardiac Surgery, University of Bristol, as follows:
`It has recently been brought to my attention that there are concerns about the mortality rates for paediatric, especially neonatal and infant, cardiac surgery performed at the BRI. ... If there is a problem and, for any reason, you are not able to reassure me that it has been resolved, the circumstances are such that I would be obliged to seek the help of colleagues in the Performance Management Directorate, who would doubtless raise the matter formally with the Trust. It is highly likely that some sort of formal enquiry would follow.' [89]
70 Counsel to the Inquiry asked Dr Doyle:
`Q. So the performance [that the Performance Management Directorate addresses] is to be understood in the sense of keeping to financial targets, is it?
`A. Primarily financial, but there are also other elements, other guidances that have gone out to Trusts, so if there is a clear failure of Trust management in any issue, then the performance directorate would certainly want to be involved because in whatever area of Trust management there is a clear breakdown, this then becomes the responsibility of the Trust Board, the Chairman, the Chief Executive, to deliver on those bits of guidance that have gone out to the Trusts. So they would certainly want to know about clear evidence that a Trust had failed in its duties. If a Trust failed to resolve a situation like this, that is a failure of Trust management.
`Q. So performance management, largely financial but also other management aspects. What would they do? What could they do?
`A. I think that would depend on the circumstances. Clearly the Secretary of State has the right to set up any form of investigation or enquiry.
`Q. That is the Secretary of State. What about the Performance Management Directorate?
`A. The Performance Management Directorate is an arm of the formal mechanisms for managing the NHS.
`Q. What could they do to alert the Secretary of State that you could not?
`A. If they had become aware of the problems, presumably they would have alerted other colleagues in the Department to the problem.
`Q. Why could you not do that?
`Q. Not why did you not, but why could you not?
`Q. So the Performance Management Directorate is a directorate which exists for the purposes you have mentioned. It had no more power - I think is what you are implying - than you did to act, the acting in circumstances where there is a failure of management control consisting of notifying other people who may be able to apply such pressure as they have at their disposal?
`A. Their formal job within the responsibility of the Department was to look at the management of Trusts. Mine were very difficult responsibilities, to look at policy development in cardiac services. So they did have a formal requirement to look at the performance of Trusts.
`Q. What was it about the problem as you understood it to be that made you think there may be a failure of management?
`A. If the Trust failed to tackle a clear issue for which there was a clear mechanism for dealing with it and allowed that problem to go unresolved, that, in my book, is a failure of Trust management.' [90]
71 Dr Jane Ashwell, Senior Medical Officer, was asked about the role of the Performance Management Directorate:
`Q. You will have seen ... the letter from Dr Doyle to Professor Angelini we looked at earlier, if I can look at it again. It is UBHT 0052 0287, the last paragraph on that page: "If there is a problem and for any reason, you are not able to reassure me that it has been resolved, the circumstances are such that I would be obliged to seek the help of colleagues in the Performance Management Directorate, who would doubtless raise the matter formally with the Trust. It is highly likely that some sort of formal inquiry would follow." You heard Dr Doyle explain what that directorate was and why it might have been an appropriate body to intervene. Do you agree with the evidence he gave about that?
`A. I do not think it was my opinion at the time that the Performance Management Directorate actually dealt with clinical practice. It would be much more concerned with financial management, corporate governance, those kinds of issues. That was my opinion.' [91]
<< previous | next >> | back to top
Footnotes
[89] UBHT 0052 0287; letter from Dr Doyle to Professor Angelini, 21 July 1994