Gag, cover up and secret privatisation: What is the real story behind the NHS clinical correspondence scandal

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NHS archives. Pic credit: Health IT Central

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A week ago the media was full of the huge scandal of over 700,000 clinical correspondence documents – including details of sensitive patient conditions – going missing and  instead of being delivered to GPs being dumped in rooms.

The story was originally broken by the  Guardian in February this year which revealed that NHS England was secretly working on how to sort out it  without disclosing the scandal to the public. Jeremy Hunt had made a perfunctory statement to Parliament in 2016 not disclosing the full state of affairs in July 2016.

Last week the National Audit Office published a very thorough investigation into the scandal – including discovering that somehow the NHS also lost  highly confidential reports dating back to 2005 which identified children subject to child protection orders which must never be disclosed to the public without the individual’s consent. And in 1788 cases it look possible that patient treatment could have been harmed as a  result.

The mislaid and unprocessed correspondence covers GPs and now abolished Primary Care Trusts in the East Midlands, North East London and South West England .

The NHS has paid GPs £2.6m up front  to examine the mislaid documents but they have yet to complete the work so a proper picture can still not be obtained.

In one bizarre incident some 205,000 documents were kept in a room marked “ clinical notes”. The report says: “A subsequent review found that the label had been removed by an SBS general manager because “you don’t want to advertise what’s in that room”.

“ NHS SBS told us that it was important that documents were held securely and therefore not having a label on the door was appropriate as part of this.”

Now this scandal is bad enough but in the small print of the National Audit Office report there lurked another extraordinary scandal – SBS  and its auditors, BDO, decided to frustrate the National Audit Office finding out what had gone wrong.

Both the company and the auditor refused to hand over the files unless the National Audit Office signed an indemnity letter – which  could get them off the hook should enraged patients decide to sue them for their negligence.

The NAO to its credit refused to do so and in its own report says, if it had, Parliament would not have been told the full story. As the report says:

“NHS SBS and BDO felt unable to share with us their reports into the incident unless we also signed a letter (which would indemnify them). This is common practice among audit organisations.

“We declined to sign any letter that would limit our ability to report on the incident.”

Instead the NAO used its statutory powers to force NHS England, which had copies of the documents after signing the indemnity letters, to hand them over.

Now NHS Shared Business Services was set up as a joint venture with the private sector  under the Blair administration in 2004 when John ( now Lord ) Reid was health secretary. It was an equal partnership between the  Department of Health and Xansa Ltd,a British outsourcing technology company 50 per cent owned by the staff. In 2007 it was taken over by Steria, a French  rival, with British staff pocketing millions of pounds as the French paid a 70 per cent premium on the share price.

In 2014 Steria merged with another French rival Sopra creating a French owned global conglomerate. They are now planning to take over a Swedish firm

But two years before Andrew Lansley, then secretary of state for health, quietly and without any public announcement, transfered a single share to the French company, so it became the majority owner and could dictate policy. Just to make sure the Department of Health, which had civil servants on the board, declined to take up the directorships on the grounds of ” conflict of interest”.

I asked BDO and NHS Shared Business Services why they had sought to frustrate the NAO.

BDO replied putting the onus on the privatised company  saying :

“BDO was in no way obstructive or concerned about making its reports accessible to the relevant third parties.” BDO has a contractual duty of confidentiality to clients as well as an ethical duty of confidentiality under the Code of Ethics of the Institute of Chartered Accountants in England & Wales (ICAEW). Therefore, unless required by law or regulation, we cannot disclose information to third parties (such as the NAO) without the express permission of our client. 

The letters dealing with obtaining the necessary consents and agreeing the basis for access are drafted in accordance with professional guidance issued by the ICAEW. As the NAO report acknowledges in its report (paragraph 3.19), this is “common practice among audit organisations”.

 Patients of the NHS are not a party to such letters and therefore their legal rights are completely unaffected.”

NHS Business Shared Services said :

“The recent 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.”

There appear to be contradictions in both statements.  I gather the safe delivery of clinical correspondence  is now in the hands of Capita.

 

Why we need disability campaigners like Lord Rix now

Lord Rix pc credit BBC

Lord Rix who died this week aged 92

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The sad death recently of Lord Rix highlighted how much progress a determined individual can make in a particular field.

As well as being famous for his slapstick comedy Lord Rix went on to have  a second career fighting for people with learning disabilities ending up as a vocal champion in the House of Lords

I knew Lord Rix in the 1980s when I was social services correspondent of The Guardian and he became secretary general of Mencap, the charity which campaigns for people with learning disabilities.

At the time there was enormous stigma attached to people who were then called mentally handicapped or even worse, Mongols, which was both derogatory and racist.

Most of them at the time were locked away in a network of hospitals for the mentally handicapped which people often confused with hospitals for the mentally ill.

Reports on the treatment and living conditions for people with learning disabilities  and people with mental illness  in these hospitals were then kept confidential. Believe it or not, not only confidential, but protected by the Official Secrets Act, opening a person to prosecution if they were published.

It was then that Lord Rix and myself decided that this should stop and the living conditions for these people should be revealed.

We set up about collecting as many official reports on conditions in these hospitals as possible – both for the mentally handicapped and the mentally ill- and then in one fell swoop the Guardian published a front page news story and a summary of each report.

The reaction to disclosure of official reports was to re-open with a vengeance why these people were being locked up and kept in very bad conditions – without much privacy in neglected hospitals tucked away in rural areas.

I even discovered some people who had been placed in a Lancashire hospital way back in the early twentieth century and diagnosed as  “mentally ill ” because they had illegitimate children – something that is complete anathema in the 21st century.  They were so institutionalised that the hospital was creating flats on its premises – in the hope that they could go back to live in the community. They had to learn how to boil a kettle.

To his credit the response of Kenneth Clarke, then the health secretary, was not to order an investigation into the leaks but to scrap the provisions of the Official Secrets Act that banned their publication. It also speeded up the movement of people with learning disabilities into the community.

Lord Rix who has rightly received many accolades was extremely brave in helping with this enterprise –  and changed the debate.

Today enormous progress has been made but I feel with need a new generation of campaigners to fight disability on a wide range of fronts. The disabled – not only with learning difficulties but with physical challenges- are still facing neglect by the NHS and social services. Government cuts in benefits  are designed by this pernicious government to penalise the disabled and limit mobility. The British tabloid media with an agenda that many disabled people are scroungers or frauds does not help. They will need to be particularly vigilant with Britain leaving the European Union – as many of the disabled friendly advances have been made on the back of EU legislation.

The new challenges are as big as the old.

 

How the NHS wasted £16m of your money on a botched privatisation that collapsed within months

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Meg Hillier MP:,chair of the Commons Public Accounts Committee, condemned the failings in the scheme

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New ways of  helping the elderly and mentally ill survive in the community and not continually end up in hospital is a cornerstone of government policy.

So when a limited liability partnership offered a cash strapped  NHS commissioning group an initiative which promised better services for these people and could save them £178m over five years it sounded too good to be true.

The trouble is it was. As a devastating report from the National Audit Office reveals today the £800m scheme  ran into trouble just four weeks after it was launched and collapsed seven months later. You can read the full story on the Exaro website.

The scandal of the £800m scheme run by UnitingCare Partnership for Cambridgeshire and Peterborough clinical commissioning group may not be an isolated instance.That is why sources at the National Audit Office have highlighted it in their report – because it exposes an alarming lack of financial expertise inside the NHS and a flawed system to monitor whether projects like this are financially feasible  andcan  be properly checked.

The promised aim of the project was to establish  tapering payments to the partnership – with £152m up front and less money later, ¬ so that the financially challenged commissioning group could put money to better use.

But within four weeks of starting the contract the partnership was asking for an extra £34m, blaming a delay by the commissioning authority in starting the work. When the money was not forthcoming the scheme collapsed after eight months and the NHS was forced to provide services directly.

The NAO report reveals that despite employing reputable financial companies and lawyers, basic errors were made – including a failure to realise that sub-contractors could not recover the VAT from the partnership – a cost that had not been factored into the contract.

Auditors also report that nobody had overall oversight of the contract.

No wonder both Amyas Morse, the head of the NAO, and Meg Hillier, the Labour chair of the Commons Public Accounts Committee have been withering in their criticism.

Amyas Morse said: “This contract was innovative and ambitious but ultimately an unsuccessful venture, which failed for financial reasons which could, and should, have been foreseen.”

Meg Hillier said: “The result is damning: a contract terminated before the ink had even dried out, at an unnecessary cost of £16m.”

What is disturbing is that the NAO point out that Monitor, the body which checks health bodies, had no locus to check whether the scheme was viable and NHS England were too remote to act.”

The report says: ““No organisation was responsible for taking a holistic view of the risks and benefits of this approach, or considering whether the anticipated longer‐term benefits were sufficient to justify additional short‐term support.“

What is really disturbing  is that £16m was wasted -plus £8.9m  on setting up a complex tendering operation and start up costs.

Far better to have spent this extra money on patient and community care – instead of throwing our money down the drain on a scheme that anyone would have thought to be too good to be true.

 

A worrying indictment of how child sex abuse cases are handled today

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This week the inquiry into historic child sexual abuse under New Zealand judge Lady Justice Goddard will start preliminary hearings which could last years. On Wednesday it starts with a hearing into allegations against the late Lord Janner. The following Wednesday there are two short sessions looking into abuse inside the Anglican Church and at Knowl View and other venues in Rochdale and on Thursday March 24  into child sexual abuse of people in the care of Lambeth Council. The details are here.

Last week a report came out from the United Kingdom  Child Sex Abuse People’s Tribunal- a very small scale investigation that took evidence from 24 people covering different types of sexual abuse with families, institutions and paedophile rings. What comes out – apart from horrific stories from the testimony of individuals – is a system not capable of sensitively handling the issue. As it says in this paragraph:

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That to my mind  is as important as the recommendations reported on Mail On line by  the Press Association here . These include a permanent commission,provision of advocates to survivors  proper links between mental health and  police investigating abuse  and a safe channel for victims yo give evidence anonymously.plus better training for police, the judiciary and the health service to handle cases.

This report deserves to be taken seriously as its steering committee was composed ,mainly of survivors themselves  aided by professional advisers and two experts, Regina Paulose, an American lawyer and former prosecutor and Alan Collins, a British solicitor with enormous experience in handling child abuse cases from Jersey’s Haut de la Garenne inquiry  to Australia and Kenya.

If the Goddard Inquiry really wants to tackle the issue they could  not do much better than take  this on board  when they start their hearings.

The full report can be found here.

 

 

 

 

 

Sneaky and Naive: The Department of Health’s plan to raise care home inspection fees

Care quality Commission

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While MPs were enjoying their Christmas break the Department of Health sneaked out a consultation paper planning a massive increase in compulsory inspection fees for care homes, privately provided ambulance services and hospitals.

As part of the spending settlement the ministry has decided to recoup the present £120m  a year subsidy given to cover compulsory inspections made by the Care Quality Commission. Altogether the ministry want to recoup some £780m over a ten year period. I have written about this in Tribune magazine

There is a subsidy is because the CQC has had to up its game and do more through inspections after the scandals exposed by  the Robert Francis report into Mid-Staffordshire NHS Foundation Trust and the Winterbourne View private home for people with learning difficulties exposed by BBC Panorama.

The Treasury wants to abolish this subsidy on the grounds that it must recover all the costs of inspections rather than part of them.. Superficially this sounds fine as NHS trusts will not to have to pay for the inspection of their own hospitals and ambulance services. Neither will 94 per cent of GP surgeries.

However increasing privatisation and outsourcing of services by local authorities and health trusts to private firms means that the bill for the inspections which already run into thousands of pounds could fall on councils and trusts who commission the services.

The paper reveals that 90 per cent of  care services are already privatised and privatisation is increasing in the NHS with private ambulance providers becoming the norm and mental health provision and other services being outsourced.

To try and justify this civil servants have tried to tell ministers that this could have nil effect on health provision.

This naive view is bolstered by the belief that care homes s will accept a cut in their profits to prevent an adverse health outcome caused by councils and health trusts having to cut the number of people sent there because of the increased cost of inspection fees.

This is contradicted by negotiations for the present year’s fee increases. The paper says:

“There is a risk that any increases in fees could have a destabilising effect on providers, as many providers are facing a tough financial climate, with increased running costs and reductions in income. During the CQC’s consultation into their fee levels for 15/16, 80% of providers opposed the proposed 9% fee increases for this reason. “

This is hardly surprising given that to run a care home on a profit, they already pay staff little more than the minimum wage and cash strapped councils are unlikely to pay them any more for residents. It puts into question whether running a care home  is a suitable business for the private sector. Soon they will soon have to pay the living wage. So would anyone believe they will absorb higher inspection fees into their profit margins.

 

The paper also discloses that the review will mean they will cut inspection fees for private dentists as they make a profit. It then naively assumes that the dentist will pass on the saving to patients. Does anyone believe that?

Whoever drew up these proposals cannot really live in the real world – no wonder ministers are told what they want to know rather than face reality themselves.

 

Child sex abuse survivors: a dangerous precedent to withdraw funding

 

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Graham Wilmer, head of the Lantern Project charity Picture reproduced courtesy Rory Wilmer Photography

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The recent media row over the alleged therapy techniques used by the abuse survivors charity, the Lantern Project, which led to the withdrawal of funding is a dangerous precedent.

The row pushed essentially by two newspapers by the Sunday Times and the Daily Mail ( see article here) could have much wider implications than just in the Wirral where the charity is based.

Essentially the allegations centred around two high profile survivors Esther Baker and one known as ” Darren” . Esther’s allegations are currently being examined by Staffordshire Police in a very detailed investigation which  has already led to one arrest and another person being interviewed under caution.

I am not going to comment further on the investigation particularly as the Solicitor General, Robert Buckland, has warned the media of ” the risk of publishing material that gives the impression of pre-judging the outcome of the investigation and any criminal proceedings that may follow, or which might prejudice any such proceedings.”

Indeed I am frankly surprised that both papers thought  they could comment on an active police investigation by casting doubt on the credibility of a survivor and perhaps there may be a case of drawing this to the attention of the Attorney General.

What more concerns me is the decision of the Wirral Clinical Commissioning Group to withdraw substantial funding for the charity in the wake of the Sunday Times allegations.

The reduction appears to be part of a £20m cut affecting other services but by withdrawing the £150,000 and stating firmly they disagree about the use of the therapy -Unstructured  Therapeutic Disclosure – which some people think can cause the medically  unrecognised false memory syndrome- is specifically aimed at cutting support to survivors. As it says “There is no recognition or recommendation of this approach by the National Institute for Health and Care Excellence (NICE).” And it questions whether the Lantern Project has the skilled staff to do this – even though the charity itself refers people back to the GPs in these cases.

However the effect of the withdrawal of the money  is not confined to just two high profile survivors – one of whom-Darren – doesn’t seem to have received the therapy anyway.

It turns out that the charity has been helping  at least 200 to 400 other families and provides or did provide a website forum for some 1000 survivors in the area. Wirral, faced with these other cuts, is not going to provide any money to other organisations – even if they could provide the services, which they can’t anyway.

Also its stance on staff could have implications for other groups that provide counselling to survivors.The Wirral decision on staffing required could provide an excellent excuse for a cash strapped NHS to withdraw support from other charities by saying they should employ psychotherapists as well as trained counsellors. And it is clear that the NHS is going to face a grim winter just providing  basic high profile services to the elderly and sick.

Those who have been concentrating on attacking the charity for supporting these two high profile cases seem to be totally unaware of the effect on other survivors who will now lose support.

They have not entirely been successful either. Norfolk Police Commissioner’s Office which is distributing the £7m to survivors organisations earmarked by the home secretary, Theresa May, is NOT withdrawing money from the Lantern Project, despite being briefed by Wirral CCG. And subject to a professional audit will continue to do so next year.

And the Daily Mail and Sunday Times coverage has had an unintended consequence- the Lantern Project has received £55,000 in two large donations from survivors or their families helped by the project. The money is part of  large compensation payments awarded by the courts on other cases taken up by the Lantern Project.

This means that the charity can continue to do some – but not all of its work. But the damage to services helping survivors has already been done.

UPDATE Dec 13: Since publication of this blog the Sunday Times (see below) has withdrawn its allegation that Esther Baker received the controversial Unstructured Therapeutic Disclosure at the time she made allegations of child sexual abuse. This does cast some doubt on  Wirral’s decision to withdraw the money.

sunday times correction

 

Spending Review: Caveat Emptor- Buyer Beware

George-Osborne1

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Today the Chancellor, George Osborne, launched the autumn spending review.

From the statement you might guess that he has climbed down over welfare spending cuts by abolishing his plan to cut tax credits, climbed down over big cuts to police budgets and acted to save the mental health budget and save the NHS from further cuts. All terribly good news along with more money for defence equipment, the security services, already announced.

But if you look at the figures he still planning  the same  huge level of cuts  but apparently with no pain.

For a start we are going to have no changes to the tax credits – yet there is going to be a change to the new universal credit which will replace a whole series of benefits. So the government will still be cutting the welfare bill by £12 billion. No details yet but it will be sneaked through when the figures are announced much later, hitting another group. And he is proposing to sell 20 per cent of the Department of work and Pensions estate- selling off  Jobcentres and benefit offices.

The NHS is getting more money but will have to make £22 billion of efficiency savings and provide a 7 day a week service. How? No details.

The police may not get their budget cut but the budget is not protected against inflation which is expected to start rising – so there is a hidden cuts inside this announcement.

And  the government claimed it had protected the science budget – but within hours engineers were announcing that a major demonstration project into carbon capture – which could save some coal fired power stations from closure – had been cancelled.

And both the extra money for defence and spending by HM Revenue and Customs – on equipment and tackling tax evasion- is going to be financed by axing thousands of civilian jobs in defence and closing down almost all local tax offices.

And while there is a £600m fund for mental health inside the NHS many voluntary organisations looking after the mentally ill and handicapped will be hit by the huge cut in local government funding.

There is more privatisation on the way – the rest of air traffic control, ordnance Survey and the Land Registry.

So what looks like a series of good announcements are often little more than smoke and mirrors. And in this budget it will depend more than most on the small print hidden in government announcements. Journalists are often fooled into first believing the initial message only to find it starts to unravel over the next few weeks when the policy bites. This is a Caveat Emptor Spending Review- buyer beware.