Outsourcing in the NHS, a risky business?

Having had experience in (unsuccessfully) attempting to obtain an ‘Immediate Necessary Treatment Form’ and associated records that had been forwarded from a temporary GP to my client’s permanent GP via NHS Wales Shared Services Partnership, I was not surprised when The National Audit Office yesterday published the findings from its investigation into how NHS Shared Business Services NHS SBS (a similar body providing support services to GPs in England) handled unprocessed clinical correspondence.

The costs of the incident are estimated at ‘£6.6 million for administration alone’, with discussions ongoing about how these costs will be split between NHS SBS and NHS England (in either case the tax payer will be the loser). Money aside, the investigation continues and there is a real risk that harm to patients may have occurred as a result of correspondence that has been lost, destroyed or misdirected.

The summary below is taken directly from the ONS website, where a summary and full report can be viewed.

“The National Audit Office has today published the findings from its investigation into how NHS Shared Business Services (NHS SBS) handled unprocessed clinical correspondence. In March 2016 NHS SBS informed NHS England and the Department of Health (the Department) that it had discovered a backlog of approximately 435,000 items of unprocessed clinical and other correspondence. NHS SBS accepts it had a contractual responsibility to process misdirected clinical and other correspondence.
The key findings of the investigation are as follows:

As at 31 May 2017, the review of the backlog of correspondence has found 1,788 cases of potential harm to patients. NHS England and NHS SBS have identified just under 709,000 items of unprocessed correspondence. One-third of GPs have yet to respond on whether unprocessed items sent to them indicate potential harm for patients. No case of actual harm has been identified yet.

NHS England estimates the cost of the incident will be at least £6.6 million for administration alone, and is still discussing with NHS SBS how these costs will be split.

Between 2008 and 2012 NHS SBS entered into contracts with 26 Primary Care Trusts (PCTs) to provide primary care support services. Only 21 of these contracts explicitly included a service to redirect clinical and other correspondence which had been sent to the wrong GP or other clinical providers. None of the contracts contained Key Performance Indicators to measure how well NHS SBS was delivering the service.

When NHS SBS took over the work of forwarding misdirected clinical correspondence from East Midlands PCTs in 2011, it inherited a backlog of unprocessed clinical correspondence. It found 8,146 items of unprocessed correspondence.

Over the next four years the backlog continued to grow, from 8,146 items in 2011 to 205,000 items in January 2014, 351,000 items in June 2015, and 435,000 items by the time NHS SBS reported the incident to NHS England in March 2016.

Managers at NHS SBS had been aware of the clinical risk to patients since January 2014 but did not develop a plan to deal with the backlog. NHS SBS informed NHS England and the Department about the problem in March 2016. The NHS SBS chief executive reported that staff considered this work to be ‘just filing’, although he stressed that this did not excuse the backlog.

The Department decided in March 2016 not to alert Parliament or the public about the incident initially as it considered it too early to understand the full extent of harm that may have been caused to patients.

NHS England were dissatisfied with NHS SBS’s co-operation in understanding the facts and causes of the incident. NHS England did not consider that NHS SBS’s internal review gave it sufficient assurance that the cause of the backlog had been appropriately investigated and the causes clearly established. NHS England considered that NHS SBS was being obstructive and unhelpful in providing the access NHS England sought. NHS SBS told us it planned a cooperative and collaborative approach with NHS England but that it was restricted by the legal requirements of its contracted internal auditor. It was September 2016, six months after the incident was disclosed to NHS England, before full agreement was reached for NHS England’s internal auditor to access the material required for its review.

NHS SBS’s internal auditor confirmed that it could provide reasonable assurance as a result of the process followed by NHS SBS, that all archived materials had been successfully identified. NHS England’s internal auditor concluded that there was no assurance that all unprocessed correspondence had been identified.”