Public Services > Healthcare

NAO probe critical of NHS SBS over undelivered clinical correspondence

David Bicknell Published 27 June 2017

Backlog of unprocessed items rose from 8,146 items in 2011 to 709,000; NHS England criticism of NHS SBS in NAO report may impact parties’ future working relationship


The working relationship between the Department of Health, NHS England and NHS Shared Business Services is under scrutiny following the publication of findings from a National Audit Office (NAO) investigation.  The NAO report looked at how the NHS Shared Business Services (NHS SBS) joint venture handled unprocessed clinical correspondence.

It follows NHS SBS informing NHS England and the Department of Health (DH) in March 2016 that it had discovered a backlog of approximately 435,000 items of unprocessed clinical and other correspondence.

The NAO investigation said that between 2008 and 2012, NHS Shared Business Services (NHS SBS) entered into contracts with 26 Primary Care Trusts (PCTs), which were to provide primary care support services, including redirecting clinical correspondence. NHS SBS is a limited company set up as a joint venture between DH and Sopra Steria, in which DH has a 49.99% share.

In 2015, NHS SBS had revenues of around £87m from its services to the NHS, of which the primary care support services accounted for approximately £12m. According to the NAO, NHS SBS calculates that the mail redirection service accounted for £193,000 a year of these revenues.

The investigation has so far found that as of May 31 this year, there are 1,788 cases of potential harm to patients in what NHS England and NHS SBS have identified is just under 709,000 items of unprocessed correspondence. The NAO says there has been no case yet of actual harm having been identified impacting a member of the public.

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

The NAO also explains that between 2008 and 2012, when NHS SBS entered into contracts with 26 Primary Care Trusts (PCTs) to provide primary care support services, only 21 of the 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.

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

However, over the subsequent four years the backlog continued to grow. 8,146 items in 2011 grew to 205,000 items in January 2014, then 351,000 items in June 2015, and 435,000 items by the time NHS SBS reported the incident to NHS England in March 2016. The figure later rose to 709,000 items after NHS SBS found more boxes of unprocessed clinical correspondence in its archives.

According to the NAO, 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 then informed NHS England and DH about the problem in March 2016. However, the department decided not to alert Parliament or the public about the incident. The NAO says this is because it considered it too early to understand the full extent of harm that may have been caused to patients. Eventually, DH told Parliament about the incident on July 21, 2016.

Health secretary Jeremy Hunt made a written statement to Parliament about ‘an issue with a mail redirection service’ at NHS SBS, advising that this was also disclosed in the department’s Annual Report, which made reference to ‘a large backlog of unprocessed correspondence relating to patients.'

Questions are now likely to be asked over how the long-term relationship between NHS England and NHS SBS may continue in the wake of this incident.

According to the NAO, 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.”

The NAO said that 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. However, NHS England's internal auditor concluded that there was no assurance that all unprocessed correspondence had been identified.

In a statement, an NHS England spokesperson said, “NHS England was deeply concerned to be belatedly informed by SBS in March 2016 about its backlog of unprocessed correspondence. We immediately set up a team, including clinical experts, to manage the incident, and all relevant correspondence has now been sent back to GPs for review. None of the patients whose cases have been reviewed to date have been harmed by the delay in correspondence."

An NHS SBS spokesperson said, “Today’s NAO report highlights a number of failings in the mail redirection service provided to NHS England. We regret this situation and have co-operated fully with the National Audit Office in its investigation. All of the correspondence backlog has now been delivered to GP surgeries for filing and NHS England has so far found no evidence of patient harm. NHS SBS no longer provides this mail redirection service.”

GlobalData Public Sector senior analyst specialising in healthcare Neharika Ralhan said, "While there are strong arguments to be made for NHS/private partnerships, incidents like these highlight the pitfalls of large scale outsourcing and further cast doubt on the governance in place within the NHS. The importance of IT governance both within NHS SBS and more broadly the NHS is a recurring theme with no solution being floated at present.

"In addition to the millions that have been spent to rectify the error of unprocessed clinical correspondence there is a clinical cost in the form of a lack of public confidence. These two factors place an increased financial burden on the NHS and risk similar future partnerships with IT vendors across the NHS and the wider public sector. There is a strong argument to be made for a code of conduct to be developed that outlines both the responsibilities and an escalation framework for those entities creating a public/private partnership."

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