Whilst NHS England ploughs ahead with its digital agenda and continues to make promises about plans for a paperless NHS, it has emerged that it can’t seem to even get to grips with paper-based correspondence, following a debacle with privately contracted NHS SBS.
A report released today by the influential Public Accounts Committee states that even as it was looking into problems dating back three years, NHS England was still uncovering more mishandled correspondence.
Central to the problem, which is a recurring theme in central government outsourcing, is NHS England’s governance of the relationship with NHS SBS (which is a joint venture with Sopra Steria, in which the government owns a minority shareholding).
NHS SBS inherited a small backlog of unprocessed mail when it took over the redirection of clinical correspondence in 2011, following the abolishment of Primary Care Trusts.It was estimated that by June 2015, the backlog for just one region (East Midlands) was 351,000 items of correspondence, with similar backlogs found in other areas.
Obviously, patients not receiving details of their care could be harmed as a result.
The Committee’s assessment notes that regular reports about the size and the extent of the backlog were issued within NHS SBS and that senior people were aware – but that no plan was developed to deal with it.
NHS SBS told the Committee that it thought that dealing with the correspondence was a “low value, less important activity” and that it “did not recognise the significance of the backlog or its potential impact on patients”.
The managers that were aware of the problem did not follow NHS SBS’s formal processes, and as a result no formal response to the issue was formulated. Senior managers withheld information about the backlog from the board for years.
NHS England set up a National Incident Team (NIT) immediately after it was told about the backlog in March 2016. In April 2016 the NIT reviewed the unprocessed correspondence, where high priority items, including cervical screening results and child protection notes, were assessed and returned to GPs as a matter of urgency, with a request that the NIT be told promptly if the patient had come to harm as a result of the delay.
NHS England agreed with the British Medical Association that GPs would be paid in advance for reviewing the backlog of correspondence. In doing so, NHS England broke with its own policy of not normally making payments in advance. In February 2017, NHS England paid a total of £2.5 million to 7,330 GP practices for the time spent assessing the potential harm to their patients.
However, by October 2017, around 2,000 of those GPs had still not confirmed whether they had reviewed the clinical correspondence about their patients.
NHS England has identified 5,562 cases from the 709,000 items of backlogged clinical correspondence require further clinical review as there is evidence of harm suffered by the patient.
NHS England also still does not know the full extent of the problem, as it continues to identify new items of misdirected correspondence. It has identified another 150,000 items of unprocessed correspondence and a further 12,000 items of correspondence that was misdirected by NHS SBS.
So far the situation has cost an estimated £6.6 million, but the total cost is still unknown.
Public Accounts Committee Chair, Meg Hillier MP, said:
We will never know the scale of emotional distress caused to patients by the shoddy handling of NHS clinical mail—a failure in service delivery which stretches back years and has still to run its course.
It beggars belief that those tasked with tackling a rapidly expanding backlog of correspondence did not recognise its real-world significance.
NHS England eventually stepped in but, even now, huge volumes of mail are still to be properly assessed and we are far from confident health officials are on top of the issues. The hunt for further correspondence, and therefore potential cases of harm to patients, continues.
NHS England is keen to conclude investigations into the earlier backlog, yet its proposed method for doing so—effectively assuming some 100,000 patients have suffered no harm—is highly questionable.
NHS England must obtain positive assurance from every GP reviewing correspondence that they have completed their checks and whether they have identified any cases where patients may have been harmed.
While we recognise the potential impact on GPs’ workload, this is work GPs have already been paid to carry out. It is vital to the well-being and peace of mind of patients that all necessary steps are taken—and quickly.
Even then, taxpayers could be landed with the bill for further costs arising from fines or negligence claims.
A familiar story
What’s incredible (or maybe not) about this story, is that the public sector continues to enter into these private partnerships with companies and then appears to take a hands off approach, with woeful governance procedures in place – despite a long history of cock-ups that end up costing the tax payer money.
As early as 2011, Ben Bradshaw MP raised concerns about NHS SBS’ performance in the House of Commons. Despite this, the department did not review how well NHS SBS were delivering the contracted services.
Equally, despite owning 49.99% of NHS SBS’ shares, and having the right to take up 3 sears on NHS SBS’ board, the Department of Health has only taken up 1 of these 3 places since 2014.
In addition to this, when dealing with the original backlog, NHS England relied on third parties to assure it that all material had been found. NHS SBS also used its internal auditor to check whether the process it had followed had successfully identified all archived materials.
In September 2016, NHS SBS’s auditor concluded that it could provide reasonable assurance that all unprocessed correspondence had been found, but when NHS England had its internal auditor check that the NHS SBS internal audit report was reliable, it said that there was “no assurance” that all misdirected correspondence held by the company had been identified.
NHS England did not order a further search.
I realise that automating and digitising processes, such as patient correspondence, could help avoid situations such as this in the future. However, it’s the government’s handling and governance of contracts – and it’s general blaze attitude to risk – that concerns me. I don’t believe that this will be the end of these project disasters.
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