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Chronology of a scandal: Antek Lejk’s role in the out-of-hours deaths scandal at NHS Cornwall

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The Chair of Norfolk and Suffolk NHS Foundation Trust (NSFT), Gary Page, has been claiming that the role of Antek Lejk in the out-of-hours scandal at NHS Cornwall was peripheral.

However, we have spoken to clinicians and campaigners in Cornwall who have told us that Antek Lejk was central and a driving force of what they called ‘the disaster’.

The chronology below shows what can be expected with Antek Lejk as CEO of NSFT.

The Chair of NSFT demanded ‘evidence’ of what happened at NHS Cornwall but when campaigners offered him a copy of this chronology, he refused to read or accept it.

Today, a bereaved mother, NSFT governor and mental health campaigner was verbally abused in a quite inappropriate and vicious manner at a governors’ committee meeting. The Chair, Lead non-executive director and and Lead Governor did not stop the abuse. When we write about incompetence or massive pay increases as services are cut, NSFT claims that the comments are ‘personal attacks’. When a mother whose son died whilst a service user of the NSFT is verbally abused as she raises safety and governance concerns, they say nothing. This is utter self-serving hypocrisy.

Over the next few days we will provide links to the sources we have referenced.

1999-2002 – Antek Lejk – CEO of Local Health Partnerships NHS Trust

This small trust was a precursor of the Suffolk mental health trust which merged with Norfolk to form Norfolk and Suffolk NHS Foundation Trust (NSFT). This is Antek Lejk’s last job delivering front line NHS services – more than fifteen years ago.

2002-2003 – Antek Lejk becomes CEO of Cornwall Care Ltd

A third-sector care home provider.

2003-2006 – Antek Lejk – Chief Executive of West of Cornwall PCT

March 2006 – GPs write to Antek Lejk expressing concerns about awarding of the out-of-hours contract to Serco.

Pulse reported:

“GPs in Cornwall have raised serious concerns over out-of-hours in the county after the contract to provide the service was won by a private provider.

A letter from Cornwall and Isles of Scilly LMC to West Cornwall PCT accused the new provider, Serco, and the county’s trusts of causing ‘needless fears and suspicion’ among GPs by failing to communicate on their plans.

GPs do not know what level of cover will be provided by Serco, whether doctors will be triaging, how many cars will be used and which primary care centres will be provided.

Dr Robert Harvey, Cornwall and the Isles of Scilly LMC vice-chair, said ‘lack of knowledge’ had pushed GPs to speak out.

He said: ‘It’s cultivated an unfortunate atmosphere of mistrust, which is needless.’

Dr Harvey’s letter to Antek Lejk, chief executive of West of Cornwall Primary Care Trust, added that many GPs had concerns over the contract going to Serco, and asked on what criteria it was chosen.”

March 2006 – GP writes to Pulse magazine making allegations about secretive process and exclusion of clinicians in process

“From Dr Mark McCartney

Pensilva, Cornwall

I was interested to read your story about the changes in out-of-hours care in Cornwall (News, 9 March) where you report the PCT lead as saying that April rotas had now gone to GPs.

If accurate, I am afraid it is typical of the misinformation we have had about the changes happening in Cornwall.

While it is true that rotas have been sent to GPs, the reality is that they are blank spreadsheets with no names on them.

Dr Robert Harvey’s quote accurately reflects this: ‘It’s cultivated an unfortunate atmosphere of mistrust, which is needless.’

I have attempted to obtain more information about the tendering process under the Freedom of Information Act, but have been refused copies of the Serco bid on the grounds that it is commercially sensitive.

GPs who do not work for the out-of-hours organisations should not be complacent about this.

Other aspects of our work are potentially up for tender in the future, and PCTs have shown their power and lack of accountability in awarding contracts to the preferred large private providers.”

April 2006 – Allegations made that selection criteria amended during commissioning process to favour Serco over GP co-operative:

Pulse reported:

Three PCTs appeared to change the process by which they chose a new out-of-hours provider for Cornwall in a way that favoured a private firm, an internal audit has suggested.

A memo detailing the auditor’s findings, seen by Pulse, said Central, North and East, and West of Cornwall PCTs altered the way they weighted bidders’ responses to a quality control questionnaire which formed a key part of the evaluation of potential providers.

At an initial meeting on 5 December last year, the existing provider, GP co-operative KernowDoc, was ranked first on its answers to 59 questions relating to the out-of-hours service to be provided. Serco, the eventual winner of the contract, was placed fifth.

But the auditor said different systems were then used to calculate the weightings in advance of a meeting a week later, after financial and service delivery risks were identified as main issues.

The move had the effect of promoting Serco to equal second in the ranking of bidders, alongside KernowDoc and two other organisations.

The memo sent by David Phyall, head of internal audit, stated: ‘The records of the meeting on 5 December suggests that this mode of action and the methodology followed was altered or modified during the course of the evaluation, which tends to undermine the objectivity of the process.’

It added: ‘Unfortunately, to an uninitiated observer, this may appear that the process was amended to give the desired result.’

But local GPs said they had serious concerns as a result of the auditors’ conclusions.

Dr Robert Harvey, vice-chair of Cornwall and Isles of Scilly LMC, said: ‘We remain concerned decisions on large amounts of public money and the employment of local GPs are made behind closed doors and information is withheld on grounds of commercial sensitivity.’

April 2006 – GPs working for out-of-hours service in Cornwall see their pensions slashed by more than 50% after transfer from co-operative to Serco:

Pulse reported:

“An investigation has been sparked by concerns over pension arrangements for GPs employed by the KernowDoc out-of-hours co-operative in Cornwall, whose jobs were transferred to Serco Health after it beat the co-operative in a tender process.

Doctors working for the company receive a stakeholder pension with matched contributions up to 6 per cent but GPs had previously received 14 per cent under KernowDoc.”

October 2006 – September 2008 – Managing Director of Community Services NHS Cornwall and Isles of Scilly

October 2006 – GPs raise concerns about Serco’s performance of out-of-hours contract at NHS Cornwall.

Pulse magazine reported:

“A privately run out-of-hours service in Cornwall has received about 80 complaints from patients since it took over from a GP co-op in April.

The service, run by Serco, had been provided by KernowDoc since the 1990s but the co-op lost out in a competitive tender.

GPs have expressed concern about the length of time it now takes for patients to receive home visits or to be called back.

Dr Mark McCartney, a GP in Pensilva, Cornwall, said: ‘I am concerned that Serco has admitted to not reaching the national standards for telephone triage, particularly the 60-minute ringback target.

‘The level of complaints seems to be at least three times what one might expect for a similar-sized organisation, and this does worry me. I hope the PCTs are being rigorous in their monitoring of the situation.’

The company said there had been ‘teething problems’ but that it was working to address the complaints.”

December 2006 – Serco misses most of its targets and concerns raised about non-English speaking doctors and alienation of local GPs.

Pulse reported:

“A private firm controversially awarded a contract to provide out-of-hours services in Cornwall is missing almost all of its targets.

The Kernow Urgent Care Service, run by Serco, is missing targets for emergency, urgent and non-urgent home visits, figures from the county’s PCT show.

Only 55 per cent of emergencies received a visit within one hour in the peak holiday month of August.

Minutes from Cornwall and the Isles of Scilly PCT reveal the company has now reverted to a GP rota system formerly used by co-op KernowDoc to help overcome staffing problems.

The company has also vowed to ‘use only English-speaking doctors’, the minutes said.

A spokeswoman for the PCT said the service had improved but admitted it had not been performing ‘as well as could be expected’.

January 2007 – Christmas cover in Cornwall criticised as ‘unsatisfactory’

Pulse magazine reported:

A privately-run out-of-hours service in Cornwall has been criticised by GPs for failing to cope with demand over the Christmas period.

Many callers were unable to get through to the Kernow Urgent Care Service (KUCS), run by Serco, or faced long waits for callback.

Dr Mark McCartney, a GP in Pensilva, Cornwall, said the service had been ‘unsatisfactory’.

January 2007 – MPs hold debate in Westminster Hall into unsatisfactory out-of-hours service in Cornwall

Pulse reported:

Last week concerns reached Parliament with MPs holding a special debate on the service in Westminster Hall.

However, the PCT was unable to detail what alternative services it could put in place if SERCO was found not to be fulfiling its contract. ‘We have not ruled out any possibilities,’ a spokesperson said.

SERCO took over from GP co-operative KernowDoc, which had been providing the service for nine years, in April 2006 because it could provide it more cheaply.

Dr Andy Stewart, a GP in Callington and Gunnislake, east Cornwall, who was one of the founders of KernowDoc, said he did not think GPs would now want to step in and take over. ‘I don’t think anyone would be prepared to,’ he said.

Ninety per cent of GPs believe the quality of the out-of-hours service has worsened since SERCO took over, a survey by MP for Falmouth Julia Goldsworthy found.

The survey by the Liberal Democrat MP also found that nearly 80 per cent of the 70 GPs who replied were receiving more complaints about out-of-hours services since SERCO took over.

Matthew Taylor, MP for Truro and St Austell, told the debate in Westminster Hall last week that formal complaints had risen from four a month to up to 27 a month.

4 July 2007 – Dr Daniel Ubani applies to be admitted to the performers list of NHS Cornwall and Isles of Scilly.

18 July 2007 – Dr Daniel Ubani admitted to the performers list by NHS Cornwall and Isles of Scilly which allowed him to practise medicine anywhere in England.

The CQC later reported:

‘The PCT did not require EU GPs to provide an IELTS certificate or provide evidence that they intended to work locally. The information that Dr Ubani supplied in support of his application did not detail how much of his time was spent actually working as a GP and what kinds of patients he treated. During the inquest in to the death of Mr Gray the director of the primary care support agency at the PCT stated that they had written to the referees Dr Ubani had provided asking for further details of his work experience. In fact the letters that were sent to the referees simply asked them to confirm that they had written the reference.’

July 2007 – Dr Daniel Ubani withdraws his application to be admitted to the performers list of NHS Leeds.

The CQC later reported:

‘Dr Ubani had initially applied to join Leeds PCT performers list, via the West Yorkshire NHS Central Services Agency. He was not accepted as he had only achieved a score of six on the IELTS language test and he had failed to supply evidence that he was going to work in the PCT area. Dr Ubani was contacted during the application process and informed that one of his references was not admissible as the doctor had no experience of Dr Ubani’s working as a GP. He was also advised to offer a referee with previous experience of the NHS. Dr Ubani withdrew his application in July 2007 at around the same time he was accepted on the performers list at NHS Cornwall and the Isles of Scilly.’

September 2007 – March 2011 – Director of Partnership Commissioning and Primary Care NHS Cornwall and Isles of Scilly

16 January 2008 – David Gray, 70, suffering from kidney stones, dies in Cambridgeshire after receiving a lethal dose, ten times the recommended, of diamorphine from Daniel Ubani, a Nigerian-born German doctor approved to practise medicine in England by NHS Cornwall. It was Dr Ubani’s first and only shift working in the UK.

16 January 2008 – Sandra Banks, 59, is given the wrong medication for a migraine and has to be admitted to hospital after being treated by Dr Ubani.

17 January 2008 – Iris Edwards, 86, is found dead after being treated by Dr Ubani.

15 April 2009 – Dr Daniel Ubani given nine-month suspended sentence in Germany for causing death in the UK

20 September 2009 – NHS Cornwall complacently told The Guardian it still hadn’t implemented and saw no need for English language tests, even after the deaths of two people and the conviction of a doctor for negligence

The Guardian reported:

The way he got the job is likely to reinforce demands for tighter rules. Ubani tried to join the Leeds list in 2007. He first referred authorities to his English-language website promoting his clinic for plastic surgery and anti-ageing medicine but the trust refused to make exceptions.

Ubani did not achieve the scores demanded when he took a test, nor did he satisfy the place of work requirement. In July he withdrew his application.

Within weeks, he joined Cornwall’s list. This trust did not demand an intention to work locally from new applicants until later in the year. It still does not require English test results.

Cambridgeshire NHS, within whose area Ubani did his shift, says it always demanded proof of competent English from applicants to its list.

Whether Ubani would have passed its requirements cannot be known. NHS Cornwall and Isles of Scilly said it “does not require doctors applying to join its performers list to have undergone an English language competency test if they are from an EEA [European Economic Area] country and they can provide evidence of their knowledge of English.”

Asked what evidence Ubani provided, a spokeswoman said: “Competence in English is something that is normally picked up during the application process.”

Even when a national newspaper called asking about patient deaths, NHS Cornwall couldn’t be bothered to implement proper checks.

February 2010 – Cambridgeshire Coroner told that recruitment problems caused privatization of out-of-hours provision had caused NHS Cornwall to have recruitment problems

The CQC report stated:

During the inquest, the director of the primary care agency at the PCT stated that they had received 48 applications from foreign GPs to join the performers list during the year that Dr Ubani applied. The high number of applications was a result of the local out-of-hours provider losing the contract which meant that local GPs were less willing to work in the service. The contracts manager at the PCT told us that the PCT had subsequently removed around 40 GPs from the performers list, a number of whom were from overseas.

Antek Lejk was at the heart of the privatization process and Director of Partnership Commissioning and Primary Care at NHS Cornwall and Isles of Scilly.

4 February 2010 – Cambridgeshire Coroner finds that David Gray was unlawfully killed by a doctors who was “”incompetent and not of an acceptable standard”

The death amounted to ‘gross negligence and manslaughter’.

Dr Ubani was approved by Cornwall PCT.

The subsequent CQC report found that:

‘During the inquest in to the death of Mr Gray the director of the primary care support agency at the PCT stated that they had written to the referees Dr Ubani had provided asking for further details of his work experience. In fact the letters that were sent to the referees simply asked them to confirm that they had written the reference.’

Antek Lejk was the Director of Partnership Commissioning and Primary Care.

February 2010 – Coroner makes Section 43 recommendations to prevent future deaths:

2) Guidance be given to all PCTs reminding them that all PCTs must be satisfied under regulation 6 (2) (b) of the National Health Service (Performers List) Regulations 2004 (“Performers List Regulations”) that each PCT must be satisfied that performers have sufficient knowledge of English to be able to work as a doctor.

NHS Cornwall did not do this.

3) Guidance must be given to all PCTs that in assessing applications to join performers’ lists, they must be able to demonstrate that they have applied regulation 6 of the Performers List Regulations robustly and that they have an appropriately qualified person responsible for ensuring this is done in each PCT.

NHS Cornwall did not do this.

5) That steps be taken to remind PCTs that it is a mandatory requirement under Regulation 6 (2) (a) that the PCT concerned must be satisfied that performers intend to deliver services in its area.

NHS Cornwall did not do this.

6) That guidance be given to all PCTs recommending that PCTs should, when considering an applicant’s suitability to join the Performers List, consider whether he has failed to progress other applications by him to other PCTs and whether any such other applications have been turned down.

The NHS in Leeds had previously evaluated Dr Ubani and rejected his application. NHS Cornwall did not.

7) That guidance be given to all PCTs requiring risk assessment in respect of every non-UK based doctor in out of hours care such risk assessment to include assessment of a) the doctors degree of experience working in the NHS, and b) whether the doctor gained accreditation to do general practice in his home state under any acquired rights system, rather than by examination or accreditation.

Dr Ubani had no experience of working in the UK and was supposedly a cosmetic surgeon.

March 2010 – Even after the deaths caused by Dr Daniel Ubani, NHS Cornwall did not formally review how doctors were admitted to the performers list until more than two years later.

11th March 2010 – Antek Lejk called to appear before the Health Select Committee of the House of Commons

Q35 Dr Stoate: I want to ask Mr Lejk a specific question about Dr Daniel Ubani. The current rules are that if a doctor is registered anywhere in the EEA they are entitled to go onto the GMC’s Register. No question. However, in order to be a GP in this country they have to be on a performers list and, as we have heard before, that is the responsibility of Primary Care Trusts. In order get on a performers list the PCT must be satisfied of the clinical skills of that doctor and their performance in the language. What checks did your PCT make in putting Dr Ubani on the performers list?

Mr Lejk: I think what we acknowledge is that at that time we were not as rigorous as we are now because we were making assumptions around the assurances that come from GMC registration and also, being an EU national, there was the whole debate about how you could apply the language test. We have now changed our system so that anyone who does not have a qualification from an English speaking country will automatically have to provide evidence of a language test.

Q36 Dr Stoate: My question is not about what you do now. My question was what checks did you make because you were responsible to ensure his clinical standards and language skills were up to speed. What checks did you make?

Mr Lejk: At the time we had no reason to feel that he was not competent.

Q37 Dr Stoate: You had no reason to think that he was competent, either.

Mr Lejk: Yes and we acknowledge that our systems were not as tight as they should have been so we have had to tighten them up since.

Notice the language: Mr Lejk said ‘we have had to tighten them up’ as in ‘been forced to tighten them up’ rather than ‘we have tightened them up’. Language does matter. Was Mr Lejk’s language that of a professional who see safety as paramount or that of a bureaucrat who saw safety as a costly inconvenience?

Q38 Dr Stoate: Did you know at that time he had already been refused from another performers list?

Mr Lejk: No, we did not.

Q39 Dr Stoate: You made no checks about that at all.

Mr Lejk: No, we did not.

Q40 Dr Stoate: I suppose you have already answered this in a way, but what are you going to do to make sure it never happens again?

Mr Lejk: Like I say, not only are we tightening up our arrangements around language competency, we are also not assuming that just because somebody is a qualified doctor that they are going to be fit to practise and have the skill level. We have set up a new panel with a medical director and myself who review all the cases including every 12 months reviewing those who are already on the list.

Q41 Dr Stoate: What are you doing to ensure that they are qualified as a GP rather than just qualified as a clinician?

Mr Lejk: We do follow-up checks. Not only do we look at what they have presented to us, but if we have any questions about whether their experience in another country is equivalent we will follow that up to make sure that there is an equivalence there.

Q42 Dr Stoate: He was a cosmetic surgeon, how does that make him qualified to be a GP?

Mr Lejk: As I say, under today’s arrangements that would not have happened.

June 2010 – General Medical Council (GMC) holds fitness to practise hearing into Daniel Ubani.

July 2010 – Care Quality Commission finds that ‘Cornwall PCT had admitted Dr Ubani to its performers list without requiring proof of language competency and with limited checking of his references which meant that Dr. Ubani could work anywhere in the UK’

December 2010 – Doubts raised over whether Daniel Ubani had ever passed his medical exams.

GPonline reported:

German police records seen by GP show that the state examination office that holds records for the Freidrich-Alexander University in Erlangen Nuremberg where Dr Ubani trained has no record of whether, when or where he sat his medical exams.

A doctors’ chamber in the region where Dr Ubani now practises in Germany hoped to assess him in a fitness-to-practise hearing, but was blocked from doing so after a legal ruling.

In an email seen by GP the Westfalen-Lippe Doctors’ Chambers expresses regret about the decision. A spokesman wrote: ‘The fitness-to-practise interview would have provided the opportunity for Dr Ubani to have dispelled the doubts over his medical qualifications which stem among other things from the events in England. Dr Ubani has missed the chance to dispel our doubts.’

Meanwhile, the GMC recently asked the university examination office to confirm whether Dr Ubani had passed his medical exams, but also drew a blank.

However, the GMC could not obtain the information because it was no longer entitled to after removing Dr Ubani from the UK GMC register.

A spokeswoman at Dr Ubani’s practice in Witten, Germany, told GP he was unavailable for comment.

April 2011 – March 2013 – Regional Director of Community Health Partnerships – South of England

This is a branch of the Department of Health building NHS properties in conjunction with private property developer, mainly based offshore.

The properties are sixty per cent privately-owned.

April 2012 – Care Quality Commission becomes responsible for regulating out-of-hours provision and whistleblowers immediately contact the CQC about concerns about out-of-hours services in Cormwall.

Before 2012 there was no independent monitoring.

As soon as the CQC took over the role from Cornwall NHS, the problems with Antek Lejk’s dangerous privatization emerged. We believe the issues were systemic and longstanding.

6 March 2013 – National Audit Office (NAO) finds safety and whistleblowing concerns and that Serco manipulated its performance reporting

The NAO found:

Serco regularly had insufficient staff to fill all clinical shifts. It also frequently redeployed some GPs, taking them out of the cars available for home visits and using them to cover clinic shifts instead.”

“As a registered provider of out-of-hours care, Serco has a legal obligation to meet essential standards of quality and safety, which include having sufficient numbers of appropriate staff. In July 2012, however, the Care Quality Commission concluded that the out-of-hours service did not have enough qualified, skilled and experienced staff to meet people’s needs.”

“When it re-inspected the service in December 2012, the Care Quality Commission found that the number of clinical staff employed had increased since the previous inspection. Nonetheless, Serco needed to take further action to comply with the essential standard on staffing because there were not enough health advisers employed to meet people’s needs and to meet the national quality requirements relating to call handling time. Health advisers are non-clinical staff who handle incoming calls.”

A forensic audit by a specialist Serco team, covering data between January and June 2012, found that two members of Serco’s staff made 252 unauthorised changes to performance data (0.2 per cent of all interactions) during the six-month period which were inappropriate or where there was no evidence to justify the change. The changes affected 20 of the 152 separate performance measures reported to the primary care trust for those six months.”

“Whistleblowers played a significant role in bringing to the attention of the primary care trust and the media concerns about Serco’s provision of the out-of-hours service in Cornwall that had not been identified by routine management controls or by the primary care trust itself. Serco had an established whistleblowing policy in place, but evidence suggests that whistleblowers were still fearful of raising concerns.”

April 2013 – January 2016 – Executive Director of Community Health Partnerships – South of England

This is a branch of the Department of Health building NHS properties in conjunction with private property developer, mainly based offshore. The properties are sixty per cent owned by the private sector.

February 2015 NSFT becomes the first mental health trust in the country to be placed in Special Measures

January 2016 – April 2018 – Antek Lejk becomes Chief Officer of South Norfolk CCG

September 2016 – April 2018 – Antek Lejk becomes Chief Officer of North Norfolk CCG

October 2016 – NSFT leaves Special Measures

August 2017 – April 2018 – Antek Lejk appointed Executive Lead of Norfolk & Waveney Sustainability & Transformation Partnership (STP)

October 2017 – NSFT becomes the first mental health trust to be placed in Special Measure twice

We believe that the failure of South Norfolk and North Norfolk CCGs to fund the recommended quality improvements at NSFT played a key role in its repeated failure.

Since NSFT went into Special Measures again, it has been forced to close another 36 beds due to staff shortages.

The CQC has twice found that NSFT has insufficient staff and beds.

Since the CCGs were established, referrals to NSFT have risen by 48 per cent. NSFT’s share of the Norfolk NHS budget has fallen by 8.3 per cent.

May 2018 – present – Antek Lejk appointed Chief Executive of Norfolk and Suffolk NHS Foundation Trust

Despite the opposition of service users and carers who found Antek Lejk unappointable.

We suspect that Antek Lejk’s salary has increased by 25 per cent but NSFT refuses to disclose.

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