Conclusions and recommendations
1.NHS England failed to appreciate the seriousness of misdirected correspondence and still has not put effective measures in place to ensure clinical correspondence is handled properly. Forwarding clinical correspondence was not identified as an important activity by NHS England or NHS Shared Business Services (NHS SBS). NHS England did not ensure that the contracts it held with NHS SBS included key performance indicators for the redirection service. In May 2015, NHS England wrote to GPs in the areas served by NHS England’s in-house primary care service to tell them that correspondence sent to the wrong GP practice should be returned to the original sender, but did not check that the new policy was being followed. NHS England estimates that around 5% of GPs are not adhering to the new process and continue to send misdirected correspondence to the new contractor, Capita.
Recommendation: NHS England should set out how it will ensure that all clinical correspondence is correctly handled, processed and redirected, where appropriate.
2.NHS England does not know the full extent of the problem as it continues to identify new items of misdirected correspondence. When dealing with the original backlog, NHS England relied on third parties to provide it with assurance that all items had been found. In 2016, its own Internal Audit concluded that it could not be sure that all misdirected correspondence had been identified. Despite this, NHS England did not immediately order a further search. NHS England has now identified another 150,000 items of unprocessed correspondence. NHS England has also found a further 12,000 items of correspondence that was misdirected by NHS SBS as part of the transfer of the primary care support service contract from NHS SBS to Capita.
Recommendation: NHS England should set out by 31 December 2017 how it can be sure that all unprocessed correspondence has now been identified.
3.Eighteen months after the problem first came to light, NHS England still cannot confirm that no patients have been harmed by the repeated failures in the clinical correspondence redirection service. The clinical review of the backlog of 709,000 items of correspondence that was mishandled by NHS SBS is still ongoing. By October 2017, from the 709,000 items, there were still nearly 1,000 cases of potential harm and a similar number of cases are awaiting final clinical review after potential harm had been identified. NHS England plans to send the additional 162,000 items of misdirected correspondence to the correct GPs by the end of December 2017 for their review. NHS England expects to complete the clinical review of these items by the end of March 2018.
Recommendation: NHS England should write to the Committee by 31 March 2018 to confirm the results of the review and what action it will take in response.
4.It is unacceptable that NHS England has given up trying to find out whether any patients have been harmed simply because 2,000 GPs have not confirmed whether they have reviewed clinical correspondence about their patients. In February 2017, NHS England paid 7,330 GP practices a total of £2.5 million to cover the cost of the time GPs spent assessing the potential for patient harm in items of mishandled correspondence. NHS England did not follow its own procurement policy when it agreed with the British Medical Association that GPs would be paid in advance for reviewing the correspondence. Despite receiving payment from NHS England, by October 2017 around 2,000 GPs had still not confirmed to NHS England that they had completed their review of 102,000 items of correspondence. NHS England has given up trying to find out from GPs whether patients may have been harmed by the delay. NHS England has written to GPs who have not reviewed clinical correspondence about their patients to inform them that it is assuming that they have completed their review and have not identified any patient harm.
Recommendation: NHS England should obtain positive assurance by 31 March 2018 from every GP reviewing correspondence that they have completed their checks and whether they have identified any cases where patients may have been harmed.
5.Attempting to resolve misdirected clinical correspondence has so far cost an estimated £6.6 million and the total cost is still unknown. To date it has cost in the region of £6.6m to find and assess the 709,000 items of correspondence mishandled by NHS SBS. NHS England estimates that it will cost another £1 million to assess the additional 162,000 newly-reported items of misdirected correspondence. The total cost is dependent on how many more cases are found and how complex they are to resolve. NHS SBS has agreed to cover NHS England’s costs in dealing with the incident, although these do not include any potential future fines or negligence claims from patients who have suffered harm. However, NHS SBS has not agreed to pay any form of compensation over and above NHS England’s costs.
Recommendation: NHS England should write to the Committee by 31 December 2017 to confirm:
- how it will ensure that in future all contracts with third party suppliers include adequate compensation in the event of any failure to deliver; and
- how much it will cost to deal with the additional items of unprocessed clinical correspondence that have been found since the NAO report.
6.The Department’s weak oversight of its joint venture with Sopra Steria, a private company, meant that opportunities to identify the issues at NHS SBS were repeatedly missed. The Department holds 49.99% of the shares in NHS SBS, and Sopra Steria holds the remaining shares. The Department is entitled to three seats on its board but did not take up two of them. 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. The Department told us that it is has recently reviewed how it governs all six companies in which it is involved since the issues with NHS SBS emerged and confirmed it has now taken up two of the three available seats on the NHS SBS board.
Recommendation: The Department should set out for the Committee how the changes it has made to the governance of its six investments will ensure that it has adequate arrangements in place to oversee the services being delivered by these organisations.
27 November 2017