The National Audit Office has today published the findings from its investigation into how NHS Shared Business Services (NHS SBS) handled unprocessed clinical correspondence. In March 2016 NHS SBS informed NHS England and the Department of Health (the Department) that it had discovered a backlog of approximately 435,000 items of unprocessed clinical and other correspondence. NHS SBS accepts it had a contractual responsibility to process misdirected clinical and other correspondence.
The key findings of the investigation are as follows:

  • As at 31 May 2017, the review of the backlog of correspondence has found 1,788 cases of potential harm to patients. NHS England and NHS SBS have identified just under 709,000 items of unprocessed correspondence. One-third of GPs have yet to respond on whether unprocessed items sent to them indicate potential harm for patients. No case of actual harm has been identified yet.
  • NHS England estimates the cost of the incident will be at least £6.6 million for administration alone, and is still discussing with NHS SBS how these costs will be split.
  • Between 2008 and 2012 NHS SBS entered into contracts with 26 Primary Care Trusts (PCTs) to provide primary care support services. Only 21 of these 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.
  • When NHS SBS took over the work of forwarding misdirected clinical correspondence from East Midlands PCTs in 2011, it inherited a backlog of unprocessed clinical correspondence. It found 8,146 items of unprocessed correspondence.
  • Over the next four years the backlog continued to grow, from 8,146 items in 2011 to 205,000 items in January 2014, 351,000 items in June 2015, and 435,000 items by the time NHS SBS reported the incident to NHS England in March 2016.
  • 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 informed NHS England and the Department about the problem in March 2016. The NHS SBS chief executive reported that staff considered this work to be ‘just filing’, although he stressed that this did not excuse the backlog.
  • The Department decided in March 2016 not to alert Parliament or the public about the incident initially as it considered it too early to understand the full extent of harm that may have been caused to patients.
  • 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.
  • 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. NHS England’s internal auditor concluded that there was no assurance that all unprocessed correspondence had been identified.

27 June 2017

Read the full report

Investigation: clinical correspondence handling at NHS Shared Business Services

Notes for editors

  1. NHS Shared Business Services is a limited company set up as a joint venture between the Department of Health (the Department) and a private company, Sopra Steria. The Department has a 49.99% share in NHS SBS. In 2015, NHS SBS had revenues of around £87 million from its services to the NHS.
  2. The NAO conducts investigations to establish the underlying facts in circumstances where concerns have been raised with us, or in response to intelligence that we have gathered through our wider work.
  3. Press notices and reports are available from the date of publication on the NAO website. Hard copies can be obtained by using the relevant links on our website.
  4. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Sir Amyas Morse KCB, is an Officer of the House of Commons and leads the NAO. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services. Our work led to audited savings of £734 million in 2016.

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