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Report on mishandled medical correspondence

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NHS SBS, NHS England, Department of Health, The Public Accounts Committee, report, staggering failureNHS England and the Department of Health both failed in their oversight of NHS Shared Business Services.

The Public Accounts Committee published its report on the failures in the handling of sensitive clinical data last week.

Proper handling of clinical correspondence – including blood test results, cancer screening appointments and child protection notes – is an essential part of administering care for patients, and as Parliament’s own website put it: ‘the failures in the handling of sensitive clinical data by NHS Shared Business Services Limited (SBS) are staggering‘.

Even as the Public Accounts Committee was looking into problems dating back at least three years, NHS England was uncovering more mishandled correspondence.

And 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 Public Accounts Committee was deeply unimpressed by the ‘lack of grip’ NHS England still has on the handling of clinical correspondence, and dismayed to be informed of a further backlog of 162,000 items which need to be assessed.

And the Public Accounts Committee’s evidence session was also frustrated by the late provision of additional information by the NHS England Chief Executive.

NHS England leads the NHS’s work nationally ‘to improve health and ensure high quality care for everyone’. Simon Stevens is NHS England’s CEO and he is accountable to Parliament for over £100 billion of annual Health Service funding.

It would have been more helpful, the Committee pointed out, if this information had been supplied in time to allow Members to consider it. The Committee said it will return to this subject once it has further information.

NHS Shared Business Services Limited (NHS SBS), the company contracted to redirect up to 700,000 items of mail a year, badly failed the patients and General Practitioners (GPs) for whom it was supposed to be redirecting correspondence.

Almost 2,000 patients are still being assessed by NHS England to determine whether they have suffered harm as a result of the delay in handling their correspondence. NHS England has assumed  without evidence – that a further 102,000 patients have suffered no harm as a result of the delay.

The Committee welcomed NHS SBS’s admission that it made mistakes and that the service it delivered was not good enough. However, NHS England and the Department of Health both failed in their oversight of NHS SBS.

The Department of Health is ultimately responsible for securing value for money for spending on all health services.

NHS England has responsibility for arranging the provision of health services in England and for commissioning their provision.

This includes primary care support services, for example, updating patient registration lists, processing contractual payments to GPs and redirecting correspondence.

Until April 2016, NHS England contracted NHS SBS – a private company part owned by the Department of Health – to make sure that misdirected clinical correspondence was sent on to the correct GP in the East Midlands, South West and North East London.

The Department of Health holds 49.99 per cent of the shares in NHS SBS, and Sopra Steria holds the remaining shares – and the Department of Health is entitled to three seats on its board but did not take up two of them.

The Public Accounts Committee found that the Department of Health’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.

Ben Bradshaw MP raised concerns about NHS SBS’s performance in the House of Commons in 2011.

He suggested that the quality of primary care support services that were already being run by NHS SBS were worse than those that they replaced, and were getting even worse.

The former Minister for Health, Andrew Lansley, assured him that the contracts with NHS SBS were underpinned by robust management arrangements, including key performance targets to measure the quality of the service that they provide.

Despite this, the Department of Health did not review how well NHS SBS was delivering the contracted services.

The Department of Health has since told the Public Accounts Committee 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.

And the Committee has now in its report recommended that the Department of Health 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.

In March 2016, NHS SBS informed NHS England and the Department of Health that it had found a backlog of correspondence which had not been redirected, some of which dated back several years.

A total of 709,000 items of correspondence were eventually found to have been mishandled – and NHS SBS missed many opportunities over at least five years to identify and rectify the problem.

Commenting on all this, the Public Accounts Committee’s 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,” she continued.

“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,” she added.

“Even then, taxpayers could be landed with the bill for further costs arising from fines or negligence claims.”

To read the full report, click here.

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