NHS outsourcing ‘put patients at risk of serious harm’

NHS England’s outsourcing of patient support services to Capita could have put patients at risk of serious harm, a report has said.

The National Audit Office (NAO), the UK’s public spending watchdog, said the Primary Care Support England (PCSE) contract to outsource back-office support services had failed to deliver in key areas and had “put primary care services and, potentially, patients at risk of serious harm”, although no actual harm had been identified.

In a report the NAO said neither Capita or NHS England had fully understood the complexity of the back office services being outsourced, causing both to misjudge the scale and nature of the risk in outsourcing these services.

Amyas Morse, the head of the NAO, said: “It is deeply unsatisfactory that, two-and-a-half years into the contract, NHS England and Capita have not yet reached the level of partnership working required to make a contract like this work effectively.”

Capita said it had “accepted accountability” for not meeting standards but that its performance has improved.

NHS England said the changes were “not without difficulties” but that it had made £60m in savings.

In 2015 NHS England outsourced a range of administrative and other back-office functions for 39,000 primary care practitioners to Capita through the PCSE contract, worth £330m over seven years. PCSE had aimed to reduce NHS England’s costs by 35% in the first year of the contract.

The contract also included the creation of an online service for submitting GP payments and ordering medical supplies.

However, by May 2016 primary care providers started raising concerns about the quality of service being provided, and by September of that year NHS England had put five out of the nine services being provided by Capita into a formal process to improve performance.

The report said NHS England did not know enough about the service it was looking to outsource to set achievable service specifications or service standards at the start of the contract. It added NHS England lacked adequate data on the volume and cost of services before the contract was awarded, and it did not understand how local processes differed.

NHS England also failed to create performance measures that covered all areas where Capita were required to deliver, the report said. A review of the contrat found that 23 of 78 key activities were not captured and “invisible to the NHS”.

The report said the decision to award both existing services and service transformation to Capita was high risk as the contract incentivised Capita to cut costs through closing existing services. NHS England did not have the contractual mechanisms to intervene in some of Capita’s service changes and Capita did not need permission to close primary care support offices, the report said.

The report said Capita underestimated the number of staff it would need and the impact that closing primary care support offices would have.

As a result of the contract’s poor performance, NAO said around 1,000 GPs, opticians and dentists were delayed from starting practice because of problems processing applications to the performers lists – a list of qualified medical practitioners. Failures to update the list and remove practitioners could have compromised patient safety, the report said.

Other errors included 87 women being notified incorrectly they were no longer part of a cervical screening programme, a high number of GPs (67% of those surveyed) reporting that urgent requests for patient data were not acted on within three weeks, and a similar number (63%) receiving incorrect patient data. There was also a backlog of 500,000 patient registration letters.

A Capita spokesperson said: “It has been acknowledged that performance has improved and Capita will continue to work with all parties to address the remaining service issues. We have accepted accountability for not meeting our high standards of service previously.

“Our new chief executive has made it clear that Capita previously has taken on some contracts that contained too many unknowns. Our new strategy will ensure we focus on doing fewer things better and securing business that we know can be delivered well.”

An NHS spokesperson said: “While not without its difficulties, by making this change over the past two years the NHS has successfully saved taxpayers £60 million… This £60 million in lower administrative cost has all been successfully reinvested in frontline NHS patient care.”

NHS England savings in the first two years of the contract were largely in line with the expected savings of £64m.

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