Public Services > Central Government

Patients failed by ‘staggering’ mishandling of sensitive data, says PAC

David Bicknell Published 29 November 2017

Report into clinical correspondence handling at NHS SBS says NHS England must ensure all GPs reviewing mail complete checks for patient harm


The Public Accounts Committee (PAC) has strongly criticised NHS England and the Department of Health for their weak oversight and stewardship of NHS Shared Business Services (NHS SBS)

In a critical report published today, the PAC took aim at both organisations over the handling of clinical correspondence, which is said is “an essential part of administering care for patients.”

It said NHS SBS, which was contracted to redirect up to 700,000 items of mail a year, badly failed the patients and General Practitioners for whom it was supposed to be redirecting correspondence.

The PAC said 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. It added that NHS England has assumed - without evidence - that a further 102,000 patients have suffered no harm as a result of the delay.

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

It concluded, “The failures in the handling of sensitive clinical data by NHS SBS are staggering. Even as the committee was looking into problems dating back at least three years, NHS England was uncovering more mishandled correspondence.

“We were 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.

“Our evidence session was frustrated by the late provision of additional information by the NHS England chief executive. It would have been more helpful if this information had been supplied in time to allow Members to consider it. The committee will return to this subject once it has further information.

In its conclusions, the PAC said NHS England had 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 SBS, it said.  NHS England did not ensure that the contracts it held with NHS SBS included key performance indicators for the redirection service. In May 2015, the committee said, 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, the committee said.

It recommended NHS England should set out how it will ensure that all clinical correspondence is correctly handled, processed and redirected, where appropriate.

It also argued that NHS England does not know the full extent of the problem as it continues to identify new items of misdirected correspondence. It said that 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.

It recommended that NHS England should set out by December 31 how it can be sure that all unprocessed correspondence has now been identified.

The committee also concluded that 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 and NHS England expects to complete it by the end of March 2018. The PAC said 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.

The PAC also said it was “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, and it wants NHS England to obtain positive assurance by the end of March from every GP reviewing correspondence that they have completed their checks and whether they have identified any cases where patients may have been harmed.

Taking aim at the Department of Health, the PAC said its weak oversight of its joint venture with Sopra Steria 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 and the department is entitled to three seats on its board but did not take up two of them.

Although an MP, Ben Bradshaw, raised concerns about NHS SBS’ performance in the House of Commons, the PAC said the department did not review how well NHS SBS was delivering the contracted services.

It said 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.

Commenting on its concerns, PAC chair Meg Hillier 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.

She added, “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.”



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