back to article NHS England fingered over failure to forward patient correspondence

NHS England is to blame for a backlog of 374,000 items of undelivered clinical correspondence following a move to Capita's Primary Care Services contract, the Public Accounts Committee has concluded today. The NHS has wasted £2.4m pounds reviewing the handling of misdirected clinical correspondence, after Capita commenced a …

  1. Aladdin Sane

    NHS England & C(r)apita

    A pox upon both their houses.

  2. Anonymous Coward
    Anonymous Coward

    True story.

    Late 2001, my optician wasn't happy about my field tests, and wrote to my GP requesting a specialist consultation.

    We moved beginning of 2002 - having informed all relevant parties.

    Come middle of 2002, wondered where the appointment was. Apparently it had been sent, not attended, and dismissed. Rebooked. Late 2002, same thing. Every time, of course, I was treble checking they had the right address. They did Re-re-booked.. This time, we had a forwarded letter from our old address with the appointment.

    Attended appointment. Stood over shoulder of person at the screen. Address was definitely correct.

    Follow-up appointment also went to old address. Rinse and repeated checks. Once again - all seemed OK.

    This went on for a few months.

    Finally, I was attending a consult between two doctors. The first doctor gave me my notes to give to the second doctor, on the next floor. I immediate had a nose, and discovered at the back of the file an A4 sheet of A4 labels with (can you guess ?) my old address on them. I removed the sheet, and all subsequent letters were correct.

    Fans of conspiracy theories might be interested to know that since that happened, I haven't found a single doctor, nurse, admin assistant or manager who has ever heard of labels being pre-printed. Apparently it's never ever happened. Of course I destroyed the sheet - I should have kept it.

    So that's 12 months delay in diagnosis of glaucoma. No idea how much was lost, but luckily I can still drive.

    1. Commswonk
      FAIL

      Re: True story.

      Half listening to Radio 4 earlier this morning it was reported that 3 health "think tanks" (Oh <deity> how I hate those two words) were recommending an annual increase in NHS funding of 4% above inflation.

      Why should we be forced to pay more so that this level of incompetence and indifference can continue unabated?

      The perpetrators of this sort of avoidable blunder (and there are far too many examples for comfort) should be out of work if not immediately at least after a formal warning to the effect that next time "you're out".

      In the same programme (Today) it was reported that a doctor who had beheaded (unquote) a baby during birth was to be allowed to continue to practise.

      We are all human, and thus vulnerable to making mistakes, but some mistakes are simply too big to permit those making them to remain employed. There is a simple catch - all for getting rid of people like that - bringing the organisation into disrepute, and it's high time that particular ban - hammer was used a bit more effectively.

      1. Mark Dempster

        Re: True story.

        >Why should we be forced to pay more so that this level of incompetence and indifference can continue unabated?<

        Because if you always go for the lowest bidder for any contract then you end up with problems like these.

        The only real solution is to bring everything back in-house where a single organisation can do a professional job

        1. Anonymous Coward
          Anonymous Coward

          Re: True story.

          Mark Dempster: The only real solution is to bring everything back in-house where a single organisation can do a professional job

          How old are you? The evidence of many decades of experience is that state monopolies DON'T do an any sort of professional job, in fact the absolute reverse. Sometimes they're better at hiding their incompetence, though. Does that count in support of your idea?

          1. Alan Brown Silver badge

            Re: True story.

            "The evidence of many decades of experience is that monopolies DON'T do an any sort of professional job"

            There, FTFY

            Private monpolies are as bad as (or worse than) government ones, as they're even less accountable for their actions.

            The fact that noone at Crapita thought to query things piling up says much.

      2. Diogenes

        Re: True story.

        Did that story mention the doctor was at the end of a TWENTY FOUR hour shift?

        1. Adam 52 Silver badge

          Re: True story.

          "Did that story mention the doctor was at the end of a TWENTY FOUR hour shift?"

          Maximum shift length in the NHS is 14 hours with breaks and the NHS adheres to the European 48 hour week. Plenty of other occupations do much longer shifts.

          That's not to say that a doctor will be fine after a 13 hour shift with no breaks, but it's a lot different to 24 hours.

          Also has very little relevance to failings in an administrative process, which is what the OP was referring to. Always annoys me when people defend NHS inefficiency by saying that the staff are working hard - we don't deny that, staff having to work hard is one symptom of a broken process.

    2. Anonymous Coward
      Anonymous Coward

      Another True story.

      Every so often I receive glaucoma-related hospital appointments for the previous owner of my house (who moved out over four and a half years ago). Having phoned up the hospital, they confirm that they have the new address on file ... and don't seem to understand why the appointments are being addressed to the long-obsolete old one. I still receive them from time to time. What else can I do? I don't officially know the new address owing to "data protection".

      I did hear a suggestion (maybe on Radio 4) that problems can arise when a patent has failed to de-register from an old GP practice when they move, and that sometimes the system can auto-magically pick up their old address from there... no idea whether that's what's happening here.

      1. Anonymous Coward
        Anonymous Coward

        Re: Another True story.

        Every so often I receive glaucoma-related hospital appointments for the previous owner of my house (who moved out over four and a half years ago). Having phoned up the hospital, they confirm that they have the new address on file ... and don't seem to understand why the appointments are being addressed to the long-obsolete old one. I still receive them from time to time. What else can I do? I don't officially know the new address owing to "data protection".

        Notify the information commissioners office, genuinely you should.

        What is probably happening is the local NHS trust have 100+ systems and one of them isn't fed from a master patient index which includes up to date demographics. So when you call up the person checks - on a system with an updated MPI feed and it looks fine on that system. But the one used by someone else to generate letters isn't getting an MPI feed.

        Only way to fix it properly is to involve the ICO.

        PS I work for the NHS, I know this is the only guaranteed way to sort it.

    3. ProperDave

      Re: True story.

      Whilst expecting our first sprog last year, at our local hospital I saw the pre-printed address labels for all the wife's ultrasound scans. There so they could save time filling in the appointment cards. I bet if we had moved during the pregnancy we would have had exactly the same issue you had.

      And this has just reminded me; we moved out of London for t'North a few years back. The wife's pre-payment prescription correspondence kept going to our old London address for almost two years after we moved, despite repeated complaints to the GP and NHS Business Services, with them claiming everything to be correct on their records.

      1. John Smith 19 Gold badge
        FAIL

        with them claiming everything to be correct on their records.

        Which no doubt they were.

        But no one was checking those against what was printed on the labels they were still using.

        Because if they did they'd have spotted they didn't match.

        System thinking.

        Yeah, we've heard of it.

    4. Adam 52 Silver badge

      Re: True story.

      "Late 2001, my optician wasn't happy about my field tests, and wrote to my GP requesting a specialist consultation."

      This is your problem right there. Why is the optician contacting your GP? Your optician should let YOU know and YOU should contact whatever healthcare provider you want to provide the service.

      Patients should be in control of their treatment, not some archaic old boys club.

      1. Doctor Syntax Silver badge

        Re: True story.

        "Why is the optician contacting your GP? Your optician should let YOU know and YOU should contact whatever healthcare provider you want to provide the service."

        The GP is, presumably, the OP's healthcare provider of choice, at least in the first instance although there may then be a further specialist referral. Secondly, the optician will be providing specialist information so a written communication of some kind is preferred - would it really be a good idea to rely on the patient remembering everything correctly? Thirdly, there's a lot of value in having the various providers cooperate and especially having one of them act as a central point to keep all the information together and the GP, who can be expected to have a longer term relationship with the patient being that person.

        "Patients should be in control of their treatment, not some archaic old boys club."

        What matters ultimately is quality of care. The local providers working relationships can contribute to that.

        Earlier this year SWMBO had a black patch appear in part of her visual field. There was some delay in getting an optician's appointment but as soon as he saw her he rung the local hospital and got an appointment there the same afternoon, she was seen then and operated on, successfully, next day for a partial detached retina. Both optician and consultant agreed time was of the essence to avoid permanent damage.

        You apparently see such an arrangement as being the operation of an old boy's club to the disadvantage of the patient. We saw it as an efficient handling of a problem avoiding her losing the sight of an eye. You can keep your view and my wife can keep her sight.

      2. Medical Cynic

        Re: True story.

        ""Late 2001, my optician wasn't happy about my field tests, and wrote to my GP requesting a specialist consultation."

        This is your problem right there. Why is the optician contacting your GP? Your optician should let YOU know and YOU should contact whatever healthcare provider you want to provide the service."

        NOOO!

        The right answer would have been for the optician [primary care] to refer direct to local hospital's Ophthalmology dept [secondary care]. They have the ability to do that.

        referral from one primary care body to another is just workload dumping on the GP.

  3. Christoph

    "However, as the Capita contract did not include redirecting correspondence, all such material arriving at Capita was stored, but not processed."

    They just bunged it in a cupboard and didn't bother to tell anyone about the problem?

    1. The Boojum

      Re: "concerns over its debts owed to private equity parent, Rutland Partners"

      Why should they? There wasn't a service level agreement in the contract for telling anyone about misdirected post.

      1. Commswonk

        Re: "concerns over its debts owed to private equity parent, Rutland Partners"

        Why should they?

        Common sense.

        Oh wait...

      2. Doctor Syntax Silver badge

        Re: "concerns over its debts owed to private equity parent, Rutland Partners"

        "There wasn't a service level agreement in the contract for telling anyone about misdirected post."

        Capita are definitely getting slipshod. In the old days they'd have got this added on as an expensive change to contract. It's not surprising they're losing money. If they keep missing things like this how will they be able to afford executive bonuses?

        1. Anonymous Coward
          Anonymous Coward

          Re: "concerns over its debts owed to private equity parent, Rutland Partners"

          "Capita are definitely getting slipshod. In the old days they'd have got this added on as an expensive change to contract. It's not surprising they're losing money. If they keep missing things like this how will they be able to afford executive bonuses?"

          I suspect we maybe seeing the result of this:

          Crapita: You need to pay an additional X to have any mail forwarded following the termination date

          NHS: No thanks

          Crapita: OK....

          And everybody ends up unhappy...

    2. Anonymous Coward
      Anonymous Coward

      This is why we shouldn't be using companies such as Crapita. If we have to outsource then we should be using companies that are grateful for the work and go above and beyond what is expected rather than some scummy company that puts it's profits above peoples lives.

    3. Locky

      Don't be ridiculous.

      They put them in storage, and charged back with an inflated admin cost

    4. handleoclast

      Re: They just bunged it in a cupboard...

      They just bunged it in a cupboard and didn't bother to tell anyone about the problem?

      They were doing things by the book. The book being Pterry's Going Postal.

      Be very careful not to go near that strange-looking machine in Crapita's basement.

  4. tip pc Silver badge

    outsourced the work and thought also the responsibility

    Public services seem to treat outsourcing of services as outsourcing responsibility too, replaced with an SLA that a manager can hold the outsourcer to task over.

    The problem is that the assigned public service contract manager is probably an aspiring business type and has no clue about the service that has been outsourced, but is fully aligned with charts and metrics and powerpoint etc. They need to insource the management of those contracts to ensure they are delivering what they expect to be being delivered, ensuring there is no room to dodge responsibility like its not in our contract to redirect that mail. Certain aspects are suitable for outsourcing but they are typically the low hanging fruit and when it goes wrong it too needs bringing back in house.

    We won't get service improvement in the NHS until it starts bringing stuff back in house.

    1. Peter2 Silver badge

      Re: outsourced the work and thought also the responsibility

      The problem is that the assigned public service contract manager is probably an aspiring business type and has no clue about the service that has been outsourced, but is fully aligned with charts and metrics and powerpoint etc. They need to insource the management of those contracts to ensure they are delivering what they expect to be being delivered

      Ok. In one paragraph you realise that the NHS Graduate management training scheme that streamlines arrogent and clueless university graduates into management leads to the people making decision having no clue about what the service is that's being outsourced. But you then expect the same people to manage that service effectively inhouse in the same paragraph?

      Here's a thought, sack anybody not competent to do their job, or trying to evade responsibility for their fuckups. I know that the unite union would declare WW3 over dismissing civil servants, but it's not sustainable to retain some people.

      1. tip pc Silver badge

        Re: outsourced the work and thought also the responsibility

        But you then expect the same people to manage that service effectively inhouse in the same paragraph?

        I really meant bring those services inhouse with any outsourced components managed by your own staff, concerned with actually getting a service rather than reviewing charts and reports.

        Here's a thought, sack anybody not competent to do their job, or trying to evade responsibility for their fuckups.

        plenty of managers at outsourcing companies doing a sterling job of ensuring they deliver no more than is contractually needed and ensuring the rest is chargeable extras. Their opposite numbers also do their best to make do within the constraints of the contract too, changing working practices to avoid excess charges. The problem is the contracts are too rigid, not fit for purpose and has stupid incentives for both sides, e.g supplier to be a sod to increase revenue and client to be a twat, greedy, expect free lunch etc to try and gain some perceived value. --------you want £1k for a small AD change, i'll make sure you complete all your small tasks within the sla and escalate as much as possible and moan at your boss for good measure!!

    2. Anonymous Coward
      Anonymous Coward

      Re: outsourced the work and thought also the responsibility

      >> We won't get service improvement in the NHS until it starts bringing stuff back in house.

      Nope. There will be no service improvement in the NHS until the job for lifers are replaced. How is it that the same bunch of twats that were there in the '80s before modern IT systems have survived mergers, the formation of Foundation Trusts, SHAs disappearing, Clinical Commissioning Groups arriving and so on. The same people always get the same jobs. The job titles change but nobody from outside the NHS has the 'relevant' experience of working in the NHS so the upshot is that the majority of the 'new' blood is drawn from the old pool of clots. (did you see what I did there :-))

      They are the problem. And they protect each other because they are the Peter Principle in action and simply cannot command the same salary elsewhere.

      Real life examples include:

      A strategy that has been beautifully bound and illustrated but the text has been truncated because it overran the square box it should have fitted in so the words just stop and don't make sense (and so realisation dawns that you might be the only person that has actually read it).

      HR actively concealing cock ups and protecting incompetence at a senior level / hanging the rest of the staff out to dry.

      Some one announcing a ground breaking plan to use the dedicated failover hosts in sql clusters to update the indexes during the day whilst the active hosts are busy serving the data. (The same guy was convinced that you had to disconnect both ends of a network cable to be able to say that the link was down, never mind the status of the *LINK* light).

      Investment only coming because there are NHS wide compulsory capital investment targets that are reported on that aren't being met but then IT are forced to migrate to recurring rental contracts that have to be funded from savings.

      Millions being spent on vanity projects, but not on capacity to back them up (but thats OK when you find there are only 13 actual sets of medical records enrolled in the system)

      What you have is an institutional problem that is both easy to fix and unfixable at the same time. You need to change the people. If the people can't change then they need to be changed. Simples.

      I predict that it will be completely different whilst being exactly the same for the next decade or until the NHS equivalent of Grenfall happens - and then it will be years before the root cause analysis is acted upon, meaning that they'll all get away with.

      AC cos.

    3. Anonymous Coward
      Anonymous Coward

      Re: outsourced the work and thought also the responsibility

      We won't get service improvement in the NHS until it starts bringing stuff back in house.

      Do you know anything about this? My partner works in healthcare management for the NHS & Civil Service in a VERY poorly performing NHS area. And the root of the problem isn't contractors, it is poor management by the public sector. If they insourced everything, it'd be even worse.

    4. Doctor Syntax Silver badge

      Re: outsourced the work and thought also the responsibility

      "We won't get service improvement in the NHS until it starts bringing stuff back in house."

      It depends on who's then doing it in-house. If it's the same lot of fungible managers who see things as a structure of cost centres and contract terms it won't change. If it's someone who sees things in terms of patients being treated then it might. The traditional hospital management largely depended on people who'd come up through the medical and nursing ranks.

  5. adam payne

    The committee blamed NHS England for its failure to communicate with GP practices about how they should handle misdirected clinical correspondence

    NHS England are certainly to blame for not communicating with GP practices but Capita isn't exactly innocent in this either. No redirecting in the contract so Capita just store them, the mind boggles!

    1. Anonymous Coward
      Anonymous Coward

      Read the report: Capita referred this to the NHS in May 2016. It took another 16 months for this to be referred up within the NHS to the senior management team.

      You can be sure Capita have gone to the NHS with a bill for sending the notes on but until they receive a direction to do so they are not allowed to forward the notes: they can only forward clinical notes in accordance with the instructions they have received (you'd complain if they did the wrong thing with them). No instruction: no action. Ask for an instruction and don't get one - still no action.

      Capita are always an easy target but in this instance the PAC have called the blame correctly.

      1. Terry 6 Silver badge

        For once it seems as if Crapita aren't (mostly) to blame. An NHS management team that lacked the imagination, understanding and planning skills to spot that there wouldn't be a seamless transition from old system to new. And it sounds like this was compounded by they or a different team being unable to identify or manage glitches when they occurred.

    2. Kane

      @ adam payne

      Whilst I agree in principal with what you say, why wasn't the basic function of mail redirects a part of the contract requirements? NHS England (and it's contract negotiation team) have to take responsibility here as well.

      1. Anonymous Coward
        Anonymous Coward

        Re: @ adam payne

        Whilst I agree in principal with what you say, why wasn't the basic function of mail redirects a part of the contract requirements?

        Because it is explicitly forbidden under NHS information governance regulations. It was formerly the practice to do so but it was deemed to be non-compliant and stopped about six months before Capita took over. This is down to practices not reading their circulars or deciding to do it the old way because it's easier, patient confidentiality be damned. The crux of the issue here is not Capita or NHS England, it is GP receptionists sending patient notes to the wrong recipient hundreds of thousands of times over.

        1. Adrian Midgley 1

          Re: @ adam payne

          No it isn't.

          General Practices have always had the destination of the notes concealed - patient leaves and registers elsewhere, the notes are called for by the health authority (by whatever name it is known that week).

          Our HA used to run the courier service, collect them, sort them, send them out again, of forward to the other HA if the patient had moved a long way.

          Since then assorted lashups have come in, but it still isn't the receptionists faults.

          1. Anonymous Coward
            Anonymous Coward

            Re: @ adam payne

            See this link for the current NHS England guidance which has only been in place for three years now. It's a simple enough process, not your patient? Return it to sender. If you send it on to an unauthorized third party it is you committing the IG breach.

            The PAC report actually acknowledges this, NHS England state they can't take action against the practices concerned simply because of the numbers of them involved.

        2. veti Silver badge

          Re: @ adam payne

          Whatever the cause, there's still a valid question in "why did nobody foresee and take measures to prevent it?"Apparently, it's something that simply never occurred to either NHS management or Capita, despite both organisations' vast wealth of experience in this field (dealing with GPs on the one hand, dealing with the public sector on the other).

          OK, you can't foresee everything. But you absolutely should try to, and when you fail, review why you failed and how you can do better next time.

          My suspicion, based on nothing more than a few years' experience in project management and a cynical nature, is that Capita deliberately avoided asking questions that it thought would complicate the project and jeopardise some arbitrary deadline. So even if they did think of it, they would have kept quiet. I may be completely wrong, but if so... well, let's just say there's an awfully big pattern of failure still looking for an explanation.

  6. Anonymous Coward
    Anonymous Coward

    Seems to me that this behaviour is quite common

    Step 1 - great idea to outsource function x

    Step 2 - simplify function x to keep the meetings to schedule and make sure there is not too much analysis to disrupt the assumptions

    Step 3 - ignore any role, function, process, or impacts of not doing the bits missed in step 2

    Step 4 - Sign contract and go for party

    Optional Step 5 - Resign and get a job somewhere else before impact of step 3 starts to realise.

    Its quite common, even in my own shop to assume the outsources will act as responsible "partners" rather than to the contract. assuming these players will simply become part of your "team" is nonsense as their job is not to help you, its to do as little as possible so as to be hard to argue they are out of contract.

    on the other hand, the providers (at least for professional services) I believe have a duty to report this stuff back legally, although this rarely seems to result in any kind of action (demonstrably)

  7. Terry 6 Silver badge

    Note to contractors out

    Signing a contract limits service It does not define a minimum service, it defines a maximum one.

  8. Jason Hindle

    There’s a lot of problems

    I had to spend a little time in Out Patients, at a hospital last year. A few days later, I received a copy of a letter from the consultant, addressed to my GP. Being in the same business as your average El Reg reader, and therefore being a picky bastard, I did of course check with said GP who was delighted with the letter I handed to her!

    To say the NHS is in a bit of a mess would be the understatement of the century. As far as I can tell, it’s mostly down to whichever government.

  9. Ptol

    NHS Restructuring...

    They all seem to be about providing ways for the existing most senior staff to obtain a cash lump sum, and allowing commercial entities to participate in the NHS care.

    Why do they want that? well the cash is needed to prevent a riot over the commercial participation. The commercial participation is needed to outsource the budget deficit to the commercial company, then these are the potential outcomes:

    1. The service adjusts to less funding by reduced clinical outcomes.

    2. The commercial service runs out of cash and goes bankrupt.

    3. The service is cancelled as its not cost effective, and a type of care is eliminated from the NHS.

  10. Anonymous Coward
    Anonymous Coward

    "Keeping us safe", "More money for the NHS", etc etc

    Quote: "The NHS has wasted £2.4m pounds reviewing the handling of misdirected clinical correspondence"

    So.......people may have died while Capita collect 330 million pounds, and then we spend an additional 2.4 million pounds to find out what happened (no doubt some of the latter sum going to still more outside consultants).

    Am I alone thinking that there is something COMPLETELY UNACCEPTABLE about this story?

    PS Take a look at item two here:

    - https://www.softwareadvisoryservice.com/blog/biggest-uk-government-project-failures/

  11. Anonymous Coward
    Anonymous Coward

    Appointment or not

    My colleague was just telling about his experience in booking / trying to book a follow up appointment. They couldn't manage this face to face so had to write to him. This they duly did, enclosing both the appointment letter and, rather handily, the cancellation letter for his appointment.

  12. Medical Cynic

    Pension debacle

    If you think the forwarding issue is bad, you should look at how badly Crapita has f*cked up the GPs' pension scheme.

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