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.

 

Ever play bingo, go to the pub,do shopping: no patient transport for you

Campaigners for better patient transport at transportforall assembly in London on October 7 pic credit: Christa Holka

Campaigners for better patient transport at transportforall assembly in London on October 7 pic credit: Christa Holka

A damning report, Sick of Waiting  by the transportforall, the excellent body campaigning for disabled people to have proper access to transport across the capital, reveals what everybody thought but nobody knew: disabled people have a lousy patient transport service in London.

As I report in this week’s Tribune magazine a survey of 200 disabled patients found that 37 per cent had missed an appointment due to failures by patient transport and almost half had arrived late for appointments over the past two years. Nearly all of this, as the report shows, was provided by newly privatised services.

A staggering 90 per cent had never been told that they could be eligible for financial help to get to hospital under the Healthcare Travel Costs Scheme while more than half were never told about patient transport when they booked an appointment.

But the health trust that really took the biscuit was Hillingdon Hospital Trust.Not only did they provide one of the worst personal examples of being ultra unhelpful – but they revealed that they had a questionnaire to weed out those they did not want to provide patient transport.

The personal case involved Robin who had previously been taken to hospital by a brother and Hillingdon expected this to continue. But the brother had moved to Spain. And guess what, Hillingdon expected him to come back and take her ( no doubt quoting cheap flights by easyjet – I made that latter point up!)

But the most extraordinary example was the disclosure through a freedom of information request was a questionnaire used by Hillingdon to assess whether people should get patient transport in the first place.

This included the questions ” Do you go shopping?” and “do you ever (my emphasis) go to the pub/cinema/ bingo? ”

I put this to the press office of Hillingdon and they replied: “The Trust does not discriminate against any of its patients. On occasion – for example where someone is very clearly able-bodied – the hospital’s transport team will ask people how they usually get around.

“This is to see if they are capable of getting to and from hospital without using patient transport as we want to ensure this valuable resource is available for those that really need it. This is in line with guidance from the Department of Health.”

I then sent back their own response to the FOI which listed the questionnaire they gave to ALL patients requiring transport. And the press office admitted they didn’t even know about it when they replied disclaiming the story.

They promised the transport manager would respond. And then they found he had taken leave of absence. So might I if a pesky journo was asking embarrassing questions about a dodgy practice.

Perhaps Hillingdon is overrun with bingo playing, binge drinking, shopaholics all demanding hospital appointments, but I very much doubt it.

Of course not all trusts were as bad as Hillingdon. The report praised Guys and St Thomas’s NHS Foundation Trust for its excellently managed patient transport service and the Royal Marsden came out well.

But far too many didn’t and some of the stories of the way disabled people were treated were callous and heart breaking.

Transportforall is laying down a new patients charter, demanding minimum standards, minimum waiting times and real transparency about the services provided by the private  and public sectors. Nor is this confined to London. The report cites problems in Kent, Manchester,Dorset, Devon, Cornwall, Coventry, Somerset, Lincolnshire, Derbyshire, Leeds and Suffolk..

It is time this issue went right up the political agenda. As the report says:” a national solution is needed”.

What about it, Jeremy Hunt and Andy Burnham?

 

 

 

Andy Burnham becomes first shadow cabinet minister to back child sex abuse inquiry

Andy Burnham: backing an inquiry pic credit:Wikipedia

Andy Burnham: backing an inquiry pic credit:Wikipedia

Andy Burnham, the shadow health secretary, has become the first member of Ed Miliband’s shadow Cabinet to back an over arching inquiry into child sexual abuse.

Over the weekend he was joined by Hilary Benn, the shadow communities secretary and Emily Thornberry, shadow attorney general. With others this brings the number of MPs backing the inquiry  to 118. Impetus for the inquiry has been heightened following the latest sickening disclosures about Jimmy Savile’s predatory behaviour from Broadmoor secure hospital to other 27 other NHS trusts.

Andy Burnham made his views very clear when he was challenging Jeremy Hunt, the health secretary, over the publication of the Savile investigations in Parliament yesterday as well as confirming to Tim Loughton, one of the Mps and former children’s minister, that he was supporting his letter to Theresa May, the home secretary, calling for the inquiry. There is a  full report by my colleague Alex Varley-Winter on the Exaro website with an up to date list of names.

There next question is whether more of the Shadow Cabinet will back the idea.

 

 

Is your NHS boss a tax avoider? You’ll soon find out

NHS bosses: subject to tax avoidance inquiry

NHS bosses: subject to tax avoidance inquiry

The tax avoidance scandal that shook up Whitehall is soon to spread to the NHS. As reported earlier following the exposure of Ed Lester, the former head of the Students Loan Company, for channelling his salary through a personal service company to avoid  paying national insurance and tax at source. The practice was still going on in Whitehall two years after the event and 125 civil servants who quit have been reported to Revenue and Customs.

 Now the NHS is to face the same scrutiny. Reports in Exaro News and Tribune last week highlighted the issue – with the findings now likely to be sooner rather than later.

An inquiry has been ordered by Jeremy Hunt, the health secretary, after Danny Alexander, Chief Secretary to the Treasury requested it.

Some two years ago a lesser inquiry – just into board members of NHS bodies – revealed some 28 out of 84 people were on this bandwagon. Earlier examples included   Robert Clarke, finance director at NHS Professionals, which supplies temporary workers to the health service, was paid at least £534,000 over three years through a personal-service company.

Another former chief executive of NHS Professionals, Neil Lloyd, was paid £631,000 off payroll over three years.

This time the Health Department sounds uncompromising. A spokesman said:

 “Tax avoidance will not be tolerated, and there is no excuse for it in the NHS, or any other part of the public sector.”

The Trust Development Authority, which provides guidance on governance to NHS trusts, is working with Monitor, which regulates the running of health bodies, to carry out the investigation to ensure that the use of off-payroll contracts is in line with guidance.

targeted is anybody earning over £58,200 a year or has been in post for more than six months and being paid through a personal service company.

In my view it cannot come soon enough. Tax avoidance deprives the Treasury of cash that could be used for better public services. Tax avoidance in the cash strapped NHS is actually depriving hospitals and communities of vital cash. All these people also earn a fair whack. They are not those forced to take a one per cent pay rise and see their living standards go down. On the contrary through tax avoidance they get richer on the backs of others.

 

Why the Tories have only themselves to blame for not reining in BBC excesses

Last week top BBC figures cut a pathetic stance in front of the Public Accounts Committtee. But two years ago Jeremy Hunt, the culture secretary, actually PREVENTED the National Audit Office from getting direct access to their accounts. Don’t take my word for it, see the actual correspondence between Sir Micheal Lyons, Chris Patten, Jeremy Hunt, and Amyas Morse, head of the NAO released under Freedom of Information to Exaro News. How dare Maria Miller now say she wants direct access to accounts, it could have been done two years ago

Westminster Confidential

Remember the great fuss from the Conservatives on how they were going to hold the BBC to account, expose those mega salaries paid to Graham Norton and Jeremy Paxman and make sure the taxpayer got the best value for their money from the BBC.

Well if you beleive  culture secretary Jeremy Hunt and Lib Dem culture spokesman Don Foster, it will be all happening from next year in the new cash frozen agreement to fund the BBC. He has spent the last year telling us about his success in allowing Parliament’s National Audit Office the right to launch any inquiry it likes into whether the BBC is value for money.

To quote him directly: “It is right that licence-fee payers have confidence that the BBC is spending money wisely, so I am pleased that the NAO now has the right to full access to BBC information. Its new power to decide which…

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How bungling ministers are closing down specialist help for child abuse victims

Graham Wilner: Picture reproduced courtesy Rory Wilmer Photography

Graham Wilner: Picture reproduced courtesy Rory Wilmer Photography

Last week  I wrote a blog showing how David Cameron had failed to implement immediate help for people who witnessed child abuse. Downing Street responded by saying that there was £10.5m was available to help.

Not only has this proved to be wrong . But the situation  is far worse than I could have imagined. The government is closing down what specialist support that might be available just when the police led by the  Metropolitan Police Paedophile Unit are expanding their investigations so people all over the country  are being contacted about historic child abuse – whether over Savile or the Fernbridge and Fairbank operations or  further allegations against music schools or Roman Catholic priests.

Now I have learned from Graham Wilmer, pictured above, that we are just a week or so away from the closure a pioneering project in Merseyside, the Lantern project. This project ( see http://www.lanternproject.org.uk) is unusual since it is run by a person who was sexually abused in his youth. It is also a specialist site.

Mr Wilmer is alarmed about  the situation facing people now being contacted by the police who cannot get help. See my article in Exaro News (http://www.exaronews.com/articles/4909/child-sex-abuse-groups-offering-support-services-face-closure)  for the full story.

But his experience of government support under the coalition is appalling. First the funding of his centre was halted by the justice department under Ken Clarke. Then he was advised to apply through the Cabinet Office under Francis Maude who pushed him to the Big Lottery. But the Big Lottery would not fund him for bureaucratic reasons – and only the use literally of the old boy’s network – did he get any cash.  He rang Gus O’Donnell, then Cabinet Secretary, who used to be head boy at his old school to explain the situation. An hour later,he says, £29.000, was promised to the charity.

The money was given to put on a course to train health professionals in giving proper support to people who had been abused as children. But the NHS re-organisation under then health secretary Andrew Lansley, meant that the local primary care trust, was being abolished and did not send anyone on  the course. Its successor body may have some money under Jeremy Hunt next year, but by then the centre will be closed.

As he said: “We will be closing down in two weeks time. The outgoing government did promise to set up a national strategy which would include funding for child sexual abuse but this was cancelled by the new government.”

His will not be the only none. Fay Maxted, chief executive of the Survivors Trust, said: “A significant number are going to have to close as they are funded by private trusts and money from the lottery and this is not forthcoming.

So far from the government supporting victims and witnesses to child sexual abuse – they are actively  hindering any help. Cynics might think the ministers might not care because after all some of the alleged paedophiles are linked to the Tory  and Liberal Democrat parties in the past. I do not think this is case but people could be forgiven for thinking it.

This situation is a disgrace and the present coalition government has not got a grip on the scale of the problem. Hang your heads in shame Francis Maude, Jeremy Hunt and the present justic secretary, Chris Grayling. You don’t seem to have clue about what is happening.

How Jeremy Hunt plans to implement Lansley’s sick funding scheme for NHS

new health secretary Jeremy Hunt: Supporter of switching NHS cash from poor to the rich elderly

Four months ago I wrote a blog (see http://wp.me/pHiYZ-xu)  revealing a dastardly plan to switch NHS funding away from the poorest parts of England to the wealthiest areas under the guise of helping the elderly.

The scheme which drew attacks from Labour effectively meant tearing up the funding formula adopted since Clement Atlee which saw that the poorest deprived areas got more cash than the wealthy. To implement it Lansley was planning to get a health quango to recommend the changes. Thankfully since then nothing has happened..until today.

Jeremy Hunt, the newly appointed health secretary, it turns out is a passionate believer in such a scheme – as it would give loadsa state money to his own constituents in Surrey at the expense of Labour voting people in places like Newcastle upon Tyne and Sunderland.

I am indebted to a contact for alerting me to this information on Jeremy Hunt’ s own blog.

In his own words he says:

the real problem lies with the inherent  bias in the Government’s NHS funding formula of areas like Surrey. Guildford and Waverley’s population is weighted 9.1% upwards for market forces and 2.0% upwards for age structure but is weighted 25.3% downwards for additional need. The result of this is that the former Guildford & Waverley PCT’s target allocation per un-weighted head of population was £1,176, 15.3% less than the England average of £1,388. This means that even in an area with a large population of older people, the Royal Surrey is losing out”. Jeremy Hunt website (24 July, 2007, http://www.jeremyhunt.org/campaignshow.aspx?id=112&ref=50)
The extend of what this means is brilliantly explained in a user-friendly map by Dr Eoin Clarke – see http://eoin-clarke.blogspot.co.uk/2012/09/camerons-new-man-in-charge-of-nhs.html.
So this reshuffle may mean an even worse future for the NHS from the man who befriends Rupert Murdoch. It will great news for  the Tory voting upper middle classes  from Esher to Guildford, but every, very bad news for deprived areas where Labour has a huge majority. It will allow Tory voters to live longer in safe seats and contribute to Labour voters dying  before their they have another chance to vote.Clever man, Mr Hunt. You can quiz him, by e-mailing at huntj@parliament.uk

Why the Tories have only themselves to blame for not reining in BBC excesses

Jeremy Hunt : Playing a blinder in making sure the public don't know too much. Pic Courtesy: The Guardian

Remember the great fuss from the Conservatives on how they were going to hold the BBC to account, expose those mega salaries paid to Graham Norton and Jeremy Paxman and make sure the taxpayer got the best value for their money from the BBC.

Well if you beleive  culture secretary Jeremy Hunt and Lib Dem culture spokesman Don Foster, it will be all happening from next year in the new cash frozen agreement to fund the BBC. He has spent the last year telling us about his success in allowing Parliament’s National Audit Office the right to launch any inquiry it likes into whether the BBC is value for money.

To quote him directly: “It is right that licence-fee payers have confidence that the BBC is spending money wisely, so I am pleased that the NAO now has the right to full access to BBC information. Its new power to decide which areas of activity to scrutinise will increase transparency while maintaining the BBC’s independence.”

In fact this statement is the worst kind of spin and churnalism. The hilarious fact is that the national papers that were critical of the BBC, the Daily Mail and Daily Telegraph plus for that matter the Huffington Post website  ( see it here http://huff.to/vDq6y5 ) fell for the whole thing, hook line and sinker.

How do we know this to be true? Well reluctantly after both the NAO and culture ministry had refused to reveal it,  all the correspondence between the remarkably named Amyas Morse, head of the National Audit Office, Jeremy Hunt and the Chris Patten, chairman of the BBC Trust and his predecessor Sir  Michael Lyons, were released under a  Freedom of Information request to Exaro News, the new investigative website I work for. You can see  the two detailed factual articles at http://www.exaronews.com/ .

What they reveal is that Amyas – the nearest person we have in Britain to ” Mr Taxpayer” was engaged in a bloody war of attrition with the BBC and Mr Hunt on behalf of you, the licence fee payer, to get proper unfettered access to the BBC and that he lost.

At one stage he was extremely fed up.  In Whitehall language he wrote, ” “I am concerned that audit access that depends on continuing agreement between the government and the BBC rather than on statute leaves important matters unresolved and may mean that, in practice, the coalition’s proposals may not take things much further forward in terms of independent scrutiny of the BBC.”

In even more stark language he said:”“I am disappointed that it remains your view that my reports should reach Parliament via the BBC Trust and secretary of state.” “It raises the possibility that the BBC Trust or the secretary of state could redact material or, indeed, not publish the report.” You can  download all the letters at the Department of Culture, Media and Sport website See http://bit.ly/ujwp60 if you want to trawl through them.

The reason why this public official is so cross is plain to see. Why he might have the right to investigate what he likes, he is shackled by what he can find out. For a start all those BBC stars can protect their deals from public scrutiny because he has no statutory right of access and cannot override the Data Protection Act.  Even the Royal Household is not so well protected from this and the mega salaries, also paid by the taxpayer, and  the rest of Whitehall can be  scrutinised.

Also no other organisation  examined by the NAO can delay the publication of a critical report by running off to the secretary of state.

Hunt also rejected giving the right of the NAO to audit the BBC accounts – something I am told auditors find extremely useful because  throws up very quickly information when money is misspent.

  He told Morse: “I do not intend to give the NAO statutory access. “I am not persuaded that I should require the BBC to appoint the NAO as its external auditor. I do not consider this is a necessary step in ensuring that the government commitment on NAO access is achieved.”

 Finally he put a gun to his head: ” “If we do not reach agreement, the NAO will not have access to the BBC at least until there is another chance to review the agreement in 2016.”

Hunt has played a blinder over this. He convinced the media that he is Mr Good Guy when actually he is a baddie. The trouble is that  it is you, the licence payer, who have been conned. You could tell  him if you want to. His e-mail is jeremy.hunt@culture.gsi.gov.uk.

BBC bosses: Squandering £160m of our licence fee

Broadcasting House: Part of the BBC's wasted £160m Pic Courtesy:vam.ac.uk

Update: Since this blog was written Chris Patten, chair of the BBC Trust, has decided to curb the very high levels of executive pay at the BBC – a first step to deal with the problem. But he will need to tackle how the managers control non journalist spending – such as IT contracts and property moves which cost licencepayers £160m.

Don’t get this blog wrong, this is not  an attack  on the BBC for wasting licence payers money on programmes. It is an attack on how the BBC has wasted  tens of millions of pounds by not controlling the money it spends on the boring bits – the money spent on property, studios and digital equipment that go to make those programmes possible.

Two recent reports from the National Audit Office – the body that on our behalf examines whether our taxes are spent wisely –  make very disturbing reading. They are into the BBC’s handling of some £2 billion of cash that is being spent on moves from  London  to Salford and Glasgow  and back to Broadcasting House in London and into cutting edge digitisation of  TV. I have written about this at length in The Journalist – the National Union of Journalists magazine  see http://bit.ly/mCekbZ .

In a nutshell they show that up to £160m was wasted on these plans because of delays, a botched private tender and exposed a  bad management attitude at the top.

As the auditors, not known for colourful phrases, said on people handling the  studio move to Pacific Quay, Glasgow :“It was sometimes difficult to engage senior staff in decision-making about their area as some seemed to either not fully understand their responsibilities or take them seriously enough.”

To put in context the money lost was enough  to run both BBC News Channel and BBC4 – or in radio terms the entire cost of running Radio Three and Four – for a year. That bad.

The reason why it matters is that the BBC is now having to make cuts to meet the government’s spending targets. Journalists are going to be sacked, programmes and parts of the BBC World Service , radio  and TV channels closed down. It can ill afford to make mistakes in its boring  bits.

I don’t mind paying a licence fee to hear Jim Naughtie and John Humphrys confronting a less than straight politician on the Today programme or  see  Ian Hislop and Paul Merton take the piss out of  Boris Johnson on Have I got News for You? I certainly am keen on Panorama exposing scandals in private care homes. I like to be entertained by comedians like David Mitchell or the lewder Russell Howard on Live at the Apollo or dramas like Case Histories, Waking the Dead etc.

I do mind paying a licence fee for some useless manager to spend millions giving IT contractor  Siemens a monopoly tender  to digitalise TV which then falls apart. Or giving some  property company £46m extra cash because  BBC managers can’t get their act together to move back to Broadcasting House in time and have to extend their leases at Bush House.

So I think it is time the corporation got a grip on this. And what are they and Jeremy Hunt, the culture secretary, doing. Trying to bind the hands of the very body exposing this waste from doing its job properly.

Over a  year in government nothing has been done. The head of the National Audit Office who has the wonderful name of Amyas Morse wrote to Mr Hunt last September trying to get three basic things done on behalf of viewers and listeners.  He wanted  unfettered access to information to the BBC, the right to decide what he wanted to investigate and the right to publish his findings when he and not the BBC wanted.  Hardly revolutionary stuff.

Not granted yet. So how about some interactive reaction. If you think the man from the audit office should get  his access on our behalf –  send him an email at  enquiries@nao.gsi.gov.uk  marked Amyas Morse ( as it says on their website). You think  the BBC Trust is blocking this email trust.enquiries@bbc.co.uk or contact its chairman Lord Patten at pattenc@parliament.uk .

Finally you could remind Jeremy Hunt that he is supposed to have sorted this. Try jeremy.hunt@culture.gsi.gov.uk .  It is time the BBC had a metaphorical bomb put under it so it  gets its act together and doesn’t waste another £160m.