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NHS Shared Business Services

Volume 622: debated on Monday 27 February 2017

(Urgent Question): To ask the Secretary of State for Health to make a statement on the loss of confidential NHS correspondence by NHS Shared Business Services.

On 24 March 2016, I was informed of a serious incident involving a large backlog of unprocessed NHS patient correspondence by the company contracted to deliver it to general practitioners’ surgeries, NHS Shared Business Services—SBS. The backlog arose from the primary care services GP mail redirection service that SBS was contracted to run between 2011 and 2016. However, in three areas of England—the east midlands, north-east London and the south-west of England—this did not happen, affecting 708,000 items of correspondence. None of the documents was lost and all were kept in secure storage, but my immediate concern was that patient safety might have been compromised by the delay in forwarding correspondence, so a rapid process was started to identify whether anyone had been put at risk. The Department of Health and NHS England immediately established an incident team led by Jill Matthews, who heads the NHS England primary care support services team.

All the documentation has now been sent on to the relevant GP surgery, where it is possible to do so, following an initial clinical assessment of where any patient risk might lie. Some 200,000 pieces were temporary residence forms, and a further 500,000 pieces were assessed as low risk. A first triage identified a further 2,500 items that had potential risk of harm and needed further investigation, but follow-up by local GPs has already identified nearly 2,000 of those as having “no patient harm”. The remainder are still being assessed, but so far no patient harm has been identified.

As well as patient safety, transparency for both the public and this House has been my priority. I was advised by officials not to make the issue public last March until an assessment of the risks to patient safety had been completed and all relevant GP surgeries informed. I accepted that advice, for the very simple reason that publicising the issue could have meant GP surgeries being inundated with inquiries from worried patients, which would have prevented them from doing the most important work—namely, investigating the named patients who were potentially at risk.

For the same reasons, and in good faith, a proactive statement about what had happened was again not recommended by my Department in July. However, on balance I decided it was important for the House to know what had happened before we broke for recess, so I did not follow that advice and placed a written statement before the House on 21 July. Since then, the Public Accounts Committee has been kept regularly informed, most recently being updated by my permanent secretary only last Friday. The Information Commissioner was updated in August, and the National Audit Office is currently reviewing the response. I committed in July 2016 to keeping the House updated once the investigations were complete and more was known, and will continue to do so.

Let us be under no illusions: this is a catastrophic breach of data protection. More than half a million pieces of patient data—including blood test results, cancer screening results, biopsy results, and even correspondence relating to cases of child protection—were all undelivered, languishing in a warehouse, on the Secretary of State’s watch. It is an absolute scandal.

Time and again this Health Secretary promises us transparency; today, he stands accused of a cover-up. The Department of Health knew about this in March 2016, so why did it take this self-proclaimed champion of transparency until the last day before the House rose last summer to issue a 138-word statement to Parliament? That statement said that just “some correspondence” had not reached the intended recipients. When the Secretary of State made that statement, was he aware that it amounted to more than 700,000 letters? If so, why did he not inform Parliament? If he did not know, does that not call into question his competence?

What guarantees can the Secretary of State give us that no more warehouses of letters are yet to be discovered? Was the private contractor involved paid for the delivery of the letters? If so, what steps are being taken to recover the money? How many patients were harmed because their GP did not receive information about their ongoing treatment? Do patients remain at risk? The Secretary of State talks about NHS England’s ongoing investigation into 2,500 items; when are we likely to know the outcome?

We understand that Capita now has the contract to deliver these services. What scrutiny is the Secretary of State putting Capita under so that it does not happen again? Is it not better that, rather than this relentless pursuit of privatisation, we bring services back in-house?

Two months into 2017 and the Health Secretary lurches from one crisis to another: hospitals overcrowded and waiting lists out of control. He cannot deliver the investment that our NHS needs; he cannot deliver a social care solution; he cannot deliver patient safety; and now he cannot even deliver the post. He has overseen a shambles that puts patient safety at risk. Patients deserve answers and they deserve an apology.

The hon. Gentleman is reasonable and sensible, but sadly those commendable sides to his character have not been on display this afternoon, not least because I answered a number of his questions before he read out his pre-prepared script. He said that there had been a catastrophic breach of data protection. Let me remind him that no patient data were lost and all patient data were kept in secure settings. I know that it is a great temptation to go on about the privatisation agenda, but may I gently tell him that, since SBS lost this account, this particular work has been taken in-house? It is being done not by Capita, but by the NHS—so much for the Government’s “relentless pursuit” of the private sector.

More seriously, the hon. Gentleman is quoted in this morning’s edition of The Guardian as saying:

“Patient safety will have been put seriously at risk.”

As he knows, patient safety is always our primary concern, but if he had listened to my response he would have heard that, as things stand, there is no evidence so far that patients’ safety has been put at risk. [Interruption.] Well, we have been through more than 700,000 documents, and so far, we can find no such evidence. We are now doing a second check, with GPs, on 2,500 documents—so a second clinical opinion is being sought—nearly 2,000 of which we believe will not show any evidence, and we are now going through the remaining ones.

Let me say that it was indeed totally incompetent of SBS to allow this incident to happen, and we take full responsibility as a Government, because we were responsible at the time. None the less, the measure of the competence of a Government is not when suppliers make mistakes—I gently remind the hon. Gentleman that that did happen a few times when Labour was running the NHS—but what we do to sort out the problem. We immediately set up a national incident team. Every single piece of correspondence has been assessed, and around 80% of the higher risk cases have been assessed by a second clinician.

The hon. Gentleman then went on to suggest that the Government have been trying to hide the matter. If he had listened to what I said, he would have heard that I did not follow the advice that I got from my officials, which was not to publicise the matter. I actually decided that the House needed to know about it. It was only a week after I was reappointed to this job last summer that I not only laid a written ministerial statement, but referred to the matter in my Department’s annual report and accounts. He said this morning that I played down the severity of what happened, but what did that annual report say? It said that a “serious incident was identified”, and it talked about

“a large backlog of unprocessed correspondence relating to patients.”

It could not have been clearer.

This Government have always cared about patient safety. We have listened to the advice of people—as the hon. Gentleman would have done had he been in office—who said that if we had gone public right away, GP surgeries could have been prevented from doing what we needed them to do, which is making detailed assessments of a small number of at-risk cases. That was why we paused, but as soon as we judged that it was possible to do so, we informed this House and the public and we stayed absolutely true to our commitment both to patient safety and to transparency.

This is undoubtedly a very serious incident, but I welcome the detailed and thorough steps that the Secretary of State has taken to protect patient safety. However, he will know that there are ongoing problems with the transfer of patient records. GPs and hospitals spend endless hours chasing up results, investigations and letters on a daily basis. Is it not time that patients were given direct control of their own records, and will the Secretary of State provide an update on that to the House?

I thank my hon. Friend for her sensible contribution. She is right that, although the process of sending on these particular documents has been taken in-house, other parts of the contract were taken on by a company called Capita—[Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) cannot stop, can he? Let me repeat that the work in question has been taken in-house. The other work, which is being done by Capita, has had some teething problems, of which we are very aware. We know it has been causing problems for GPs. The Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood) has been meeting Capita and people relating to that contract on a fortnightly basis to try to identify the problems.

My hon. Friend the Member for Totnes (Dr Wollaston) is right that the aim in the long run is to give people control of their records. I am proud that, under this Government, we have become the first country in the world to give every patient access to their own records online. From September, people will be able to do that without having to go to their GP’s surgery.

I am sure that everyone across the House is glad that these 750,000 incidents have not, so far, resulted in patients suffering. Frankly, that is luck, rather than plan, for which we should all be grateful. This is yet another situation similar to that of Concentrix and others we have seen. When we are outsourcing and taking on these companies, what is the basis of the contract and what is the governance? The Secretary of State mentioned the other incidents of transferring data when a patient moves to another GP’s surgery, and that has also been an issue. When will data in England become more digital so that things are not sent by post? We have not used that method for several years in Scotland, and it is holding back the entire primary care and hospital system here. When will the Secretary of State’s vision for that come about?

The hon. Lady is always very good at telling the House things that Scotland does better than the NHS in England; there are, indeed, some. She is a little bit coyer about things that Scotland does less well than the NHS in England. If we put aside those issues, I think we can both agree that the sooner the NHS across the whole UK goes electronic, the better. That has been a big priority for this Government, and we have made big progress. More than two thirds of hospital A&E departments can now access a summary of people’s GP records, and we are going further every month.

As the affected patients could have moved anywhere in the country, will my right hon. Friend assure me or let me know, either today or by writing to me, whether any of my constituents in Bury North have been affected?

I do not have the information about Bury North patients immediately to hand, but I am happy to write to my hon. Friend to tell him whether we think any of his constituents have been affected.

I raised my concerns about the contracting out of the patient record service to SBS back in 2011, and I was told by the Secretary of State’s predecessor that this was about saving money. Will he tell us how much money has been saved, given all the problems, and how many of the 708,000 patients affected are in the south-west?

The south-west was one of the regions affected, as I mentioned in my statement. I am happy to write to the right hon. Gentleman to tell him exactly how many patients I think were affected in the south-west. I gently say to him that the use of the private sector was championed when his Government were in office and when he was a Health Minister. I know that this is not very fashionable in his party at the moment, but on this side of the House, we think that if we want the NHS to be the safest and best in the world, we should be open—

Order. The right hon. Member for Exeter (Mr Bradshaw) is shouting noisily from a sedentary position. I cannot imagine that that is an offence that I would have committed when I sat on the Opposition Benches. I just do not think it would have happened. I do not know what has happened to standards.

Objection to the manner and content of a ministerial response is not a novel phenomenon in the House of Commons.

There have been cries of privatisation from the Opposition. Is not the truth that in 2007, Her Majesty’s Revenue and Customs lost the entire collection of child benefit records, affecting 25 million people? Is not the point that all data holders, whether in the private or public sector, must hold our private information securely?

That is absolutely the point. What people will be wondering is, when we were faced with this issue, which was indeed serious, did we react as quickly as we could to keep patients safe? I believe the answer is yes. Did that happen under the last Labour Government? I will leave the House to draw its own conclusions.

The Secretary of State just stated with great authority that no patient data were lost. I would be interested to know how he can be so certain, given that all these data were missing for a long time without anybody noticing. What controls are in place now that were not in place then that mean he can make that statement with such confidence?

I welcome the hon. Lady to the House. I do not know whether she has done a Health question with me before, but let me say to her that we are assured that the data were not lost: they were kept in a secure setting, which means they were safe, they were not breached and they were not accessed by anyone else. What should have happened, but did not, was passing on the data to the right GP surgery, and that is why we have taken all the steps we have to try to make sure patients are kept safe.

My right hon. Friend may recall times when we found ourselves in opposition and hoped we had a huge success on our hands, and the image that springs to mind at present is of foxes and shooting them. Does he agree that the Department he so expertly guides now needs to focus its attention on using electronic data for all our citizens and patients, rather than dealing with spurious Opposition problems?

As ever, my right hon. Friend is thinking extremely intelligently about the problems we really face. The hon. Member for Richmond Park (Sarah Olney) asked about the security of the data files, but the security of electronic files is the issue we are going to have to think about much more seriously as we give everyone access to their electronic records, and because of the known issues around hacking. This is an issue we are taking very seriously and doing more work on.

I wrote to the Secretary of State on this subject on behalf of the Jubilee medical centre in Croxteth, in my constituency, on 13 January. I have not yet had a reply from him, but perhaps he could respond today to the point I raised about staff safety. We have had the issue of patient safety, but what about the potential danger to staff from these records not being available about patients?

I would like to reflect on the hon. Gentleman’s question in a bit more detail rather than giving an instant answer, because, to date, no one has brought to my notice particular issues about staff safety, but that is always something we take extremely seriously. We are aware of the extra administrative pressure on staff caused by needing to go through records where there is a higher risk of harm to patients—indeed, we have given GP surgeries extra resources to cover that additional time—but I will look into the issue the hon. Gentleman raises.

Since at least 2015, it has been a statutory requirement to use a unique and consistent identifier on health and social care records. Given that that would, as the hon. Member for Central Ayrshire (Dr Whitford) said, help with putting data electronically on health and social care systems, will the Secretary of State update the House on the issue?

I am very happy to do so. Clearly, when we are all able to access our health records electronically, there are potentially huge benefits for patients. In particular, people with long-term conditions who use the NHS a lot would be able to take more control of what happens and also to spot mistakes, which sometimes happen in medical records—that is one of the big findings from the US, where people have had more widespread access to electronic records for longer. The issue is the security with which people access those records online, and we are looking very closely at the systems used by banks, for example. Those are pretty robust, but we are looking at whether we can have systems that are even more robust, because it is very important that patients have confidence that only they and those they give permission to can access those records.

Can the Secretary of State tell us a little more about which areas in the east midlands have been particularly affected? Given the opaque and byzantine structures of the NHS, can he specifically tell the House which member of his ministerial team had the job of keeping watch on NHS Shared Business Services?

The Minister responsible is the Under-Secretary, my hon. Friend the Member for Oxford West and Abingdon. This case happened before she was in post, so I took personal responsibility given it was such an important issue. I will write to the hon. Gentleman with more details about how the east midlands has been affected.

Does the Secretary of State agree that it is vital that we move towards a fully paperless national health service, but that it will be very difficult to do so as long as national health service trusts cannot talk to each other electronically? Radiological images, for example, are often not available when consultants see patients, who therefore have to have the test again, which is contrary to all the precepts of good practice in the Ionising Radiations Regulations 1999.

My hon. Friend is absolutely right. This is a very big part of our transformation plans for the NHS. Where the NHS does well internationally is in out-of-hospital records; our GP records are among the best of any country’s. GPs have done a fantastic job over the past 15 years in keeping all their records electronically, and they provide a lifetime snapshot of a patient’s history. Where we are less good is in our hospital records, where one can still find paper records in widespread use. That is not just very, very expensive but—he is quite right—unsafe at times.

I used to work in a pathology lab, and it absolutely pains me to think of those results generated by the hard work of pathology staff languishing in a warehouse somewhere, unseen by anybody. If GPs do not get lab results, they will ring the laboratory and ask for them, so has the Secretary of State made any estimate of the time wasted in phone calls from GP surgeries to pathology labs?

I am sure that, regrettably, because of what happened extra work was created for GPs. However, because of GPs’ commitment to their patients, it appears that in the vast majority of cases patient harm was avoided. When results do not come through that a GP is expecting, the GP chases them to make sure that the right thing is done for patients—but of course, as the hon. Lady rightly says, at the cost of extra work.

Does my right hon. Friend agree that had the then Labour Government not made such a catastrophe of implementing the NHS computer system, such records would have been digitised many years ago and problems with storage of paper records would not have impacted on the patients who are currently suffering?

My hon. Friend speaks wisely. Many members of the public will be faintly amused to hear Labour Members say how important it is that we move to electronic health records. The NHS IT project was an absolute catastrophe, costing billions of pounds. The intention was right but the delivery was wrong, and that is what we are trying to sort out.

I understand that large numbers of patients in north-east London were affected by this failure of the service. How many of my constituents were affected, how many of them were cancer patients, and how many would have been subjected therefore to an inordinate delay in receiving referrals for treatment? Can the Secretary of State give that itemised breakdown to all Members of Parliament who will have constituents affected by this?

I am very happy to write to hon. Members in the areas affected with any extra information that we are able to provide. However, I reassure the hon. Gentleman that to date we have not been able to identify any patient in any part of the country who has come to harm as a result of what happened.

It is a shame that the synthetic outrage from Labour Members was not apparent when they were calling for a public inquiry into deaths in Mid Staffordshire, or, officially, the worst ever IT white elephant disaster, with £12 billion of costs uncovered by the Public Accounts Committee in 2013. Has not my right hon. Friend observed the appropriate parliamentary accountability protocols? He not only employed clinical expertise but came to the House in July, his officials updated the PAC in September, and he came here again today? There is no cover-up.

I am grateful to my hon. Friend. As he rightly points out, this was a judgment call, because going public at a very early stage about what happened risked overwhelming GP surgeries, with GPs being unable to investigate the most serious cases as quickly as possible. That is why I received very sensible advice to hold back, but I did decide that the House needed to know before the summer break, which is why I made the effort.

A number of GP practices in Wirral West have made clear to me their concerns about Capita’s handling of confidential patient records. There have been cases of patient records being delayed when they move to another practice, and in some instances confidential records have not arrived at all. As my hon. Friend the Member for Liverpool, West Derby (Stephen Twigg) has said, there is also concern that, if a patient is a risk to a doctor because of a mental health issue, that has not been flagged up to medical staff. That is a very serious risk to put staff under. Does the Secretary of State share the view of the chair of the British Medical Association’s GP committee, who said that this is

“an example of what happens when the NHS tries to cut costs by inviting private companies to do work which they don’t do properly”?

The hon. Lady makes very important points about the need for the rapid transfer of records when people move GP surgeries. I gently point out to her—I am sure she was asked to ask her question—that the reality is that, because of the failures of this contract, we have taken this work in-house. It is not about the Government pressing on with privatisation irresponsibly, or whatever it is that she is trying to say. This work is now being done in-house.

We have an excellent Secretary of State and the Government seem to have taken the appropriate action. My only concern is what he said about his Department’s officials recommending that this House not be informed. Under Gordon Brown and Tony Blair, I remember that we would get 80-odd written statements on the last day of term. May I gently suggest to the Secretary of State that it would have been better if the written statement had been made earlier in the week so that Members could have considered whether an urgent question was appropriate?

In ordinary circumstances, my hon. Friend’s point would be completely fair and reasonable. He may remember that certain other things were happening at that time last year and, as I have said, it had been only a week since I had been reappointed to my post, so there were a number of other issues. However, my priority was to make sure that we did not go away for the summer without the House being informed of the situation.

The Secretary of State says that he has paid people—I assume that they are GPs—to clear the backlog. How much have you paid the GPs, and do you intend to recoup that money to the NHS?

I have made no such payment and I have no plans to recoup anything, but the Secretary of State might have.

I regret to say that the £2.2 million has not gone to you, Mr Speaker, but it has been paid to GPs for the extra administrative work that needs to be done. That is fair payment for the extra time that they are taking. It is, indeed, a cost to the taxpayer, but it was the right thing to do.

Will the Secretary of State reassure the House that appropriate staffing resources have been made available throughout to deal with the backlogs, not just nationally but in the east midlands?

We have always been concerned to make sure that, because of the extra administrative work involved in going through more than 700,000 records, other patients using the NHS do not find that their care is delayed. We made extra resources available for GP practices so that they could do that without interrupting the ordinary work that they have to do for their patients.

Surely the Secretary of State agrees that if everything were going swimmingly in the NHS, if we were investing in it like our European neighbours and if people were confident that their A&E departments and trusts were safe and that the whole health service was not in trouble, with privatisation biting into it, this issue could be put in perspective. But the NHS, under his watch, is in chaos. That is why we are so worried about this issue.

Let me gently remind the hon. Gentleman that, because of the decisions this Government have taken, we are actually now investing more than the European average in the NHS, which would have been much more difficult to do if we had followed his party’s spending plans. He tries to characterise our approach as one of suggesting that the NHS does not have problems. We think the NHS has some very big problems—it is working very hard to tackle them—but we are providing more doctors, more nurses, more funding and more operations than ever before in its history.

May I commend the Secretary of State for his response to the situation once he was told about it and welcome his pledge to provide constituency-wide data to the House? However, my constituents in Kettering will be amazed that, for five years, no one spotted that 700,000 records had gone missing. How was that discovered, and why in the three areas did such a large amount of data in effect disappear from public view?

I wish I could give my hon. Friend the answer to that question. I think it is completely extraordinary that for such a long period it was not noticed that the data had gone missing. It was discovered towards the end of the SPS contract. There are lessons for the NHS—this relates very closely to what other hon. Members have said—about the dangers of over-reliance on paper rather than electronic systems, with which it is much easier to keep track of what is happening. [Interruption.] Let me say to the hon. Member for Leicester South (Jonathan Ashworth), who continues to make comments from a sedentary position, that when it comes to making the NHS electronic, people will compare his Government’s records and ours and will say which is better.

I am sure all Members will be able to identify with people with anxiety caused by waiting for test results or diagnoses—I certainly can—so does the Secretary of State concur that it is scant consolation to those 700,000-odd people to be told that their letters were not lost, but are residing in a warehouse somewhere?

It is a completely unacceptable lapse of efficiency, and this supplier is no longer performing that job for the NHS. Of course it causes many people frustration when the information they are waiting for does not reach their GP’s surgery. However, the most important thing, as the hon. Lady and I would agree, is the safety of patients. That is why our biggest priority has been not the administrative inconvenience, frustrating though it is, but making sure we understand whether any patients have actually been put at risk.

This morning, I was very pleased to tour the new clinical assessment unit that was opened last month at Crawley hospital. That was made possible partly because the hospital used to store paper records in that space, but has now moved to electronic records. May I commend the Secretary of State for increasing the drive to using electronic rather than paper records, and urge him to redouble his efforts?

I am very happy to follow my hon. Friend’s advice in that respect. I think we all know that although the proper use of electronic records creates huge opportunities, we have to carry the public with us and make sure they are confident that the data will be held securely. That is why we have introduced the new post of a National Data Guardian, Dame Fiona Caldicott, who is the patients’ watchdog in this area.

NHS Shared Business Services Ltd exists for one reason only, which is to deliver £1 billion in savings by 2020. The results of this Government’s ideological obsession with savings and austerity have surely now been laid bare for all to see, and we are quite lucky that this did not, quite literally, kill anyone. Will the Secretary of State agree to meet the Chancellor urgently to discuss increased funding for a health service that is being starved of the resources it needs to run effectively?

The result of our “ideological obsession” with savings and austerity is that we have increased spending on the NHS twice as fast in England as the hon. Lady’s party has in Scotland.

As the Secretary of State is aware, patient safety is paramount. For the benefit of my constituents, will he confirm that patient safety was throughout the process and remains his primary concern?

My hon. Friend is absolutely right—that has been our primary concern. It needs to be our primary concern as we examine the lessons that need to be learned in both the setting and the monitoring of contracts with the private sector, which were clearly deficient in this case.

The Secretary of State was responsible for the entirety of the contract, yet has come to the House to respond to the urgent question and told us that he does not know how the situation came to light to NHS England, and that he has no answers. Mr Speaker, do you think he should have been better prepared today? What assurances can he give us that he now has controls in place to monitor any future contracts?

The hon. Lady should have listened to the facts when I told her. When this came to light, more than 700,000 records were checked: 2,500 of the higher-risk ones are being checked by two clinicians—80% of them have already been checked. A huge amount of work has been done to clear up the situation. I completely agree with her that it was unacceptable that it happened in the first place, but I gently say to her that we are not the first Government to be let down by suppliers.

A few moments ago, the Secretary of State alluded to teething problems with the Capita contract. I must tell him that GP practices in my constituency told me only a couple of weeks ago that those problems not only continue but are worsening. How much longer will the Secretary of State give Capita to perform under the contract it has with the Department of Health? If it cannot perform, how quickly can we expect the Secretary of State to decide to take that work back in-house?

If Capita does not perform what it is contracted to do, we will take all necessary measures, including ending the contract. The hon. Lady is right that there have been a number of problems with that contract in its early days. We believe that the situation on the ground is beginning to improve, but a lot of progress still needs to be made.