A private company hired to perform various back-office tasks for the NHS in England failed to deliver on key aspects of its service, which potentially put patient safety at risk, according to a new report.
Capita, which has been contracted to provide various support services across England including a role in the NHS cervical cancer screening programme, wrongly told dozens of women they were no longer a part of the cervical screening programme, according to a new National Audit Office (NAO) report.
As part of a wide array of services, Capita has been contracted by NHS England to provide lists of patients eligible for screening to GPs and send out invitation and recall letters and test results to patients. This involves sending out millions of documents.
But the NAO report states that service failures led to 87 women being incorrectly notified that they were no longer part of the cervical screening programme. The report adds that “no actual harm has been identified”.
Our new report has found that #NHS Englandâs decision to contract with #Capita both to run existing primary care support services, but also simultaneously to transform those services, was high risk:https://t.co/WF86ycWuER pic.twitter.com/lby6k2x3yH— National Audit Office (@NAOorguk) May 17, 2018
It comes after a major blunder in the NHS breast screening programme which saw hundreds of thousands of women not sent their final screening invitation.
It has been estimated that as many as 270 lives could have been lost as a result.
Meanwhile, the NAO report was also critical of other aspects of the service provided by Capita.
It said that patients could potentially have been put at risk due to problems with the “performers list” – a list of GPs, dentists and opticians practising in the NHS, including whether they are suitably qualified and have passed other relevant checks.
“The failure to update performers lists may have compromised patient safety in cases where practitioners should have been removed,” the authors said.
Problems with the list also led to hundreds of health workers being unable to work. In 2016, delays in processing new applications for the lists resulted in around 1,000 GPs, dentists and opticians being unable to work.
As well as keeping these health workers away from the front line, it also meant that NHS England has been forced to pay out for “lost earnings” due to the delays.
As part of its contract, Capita also organises GP and pharmacy payments and GP pensions, the moving of medical records – for example if someone changes GP practice – payments to opticians and providing NHS stationery, pre-printed forms, and needles and syringes for primary care.
The NAO report states the estimated value of NHS England’s seven-year contract with Capita for nine primary care support services is worth £330 million.
The contract was agreed in 2015 with the aim of reducing primary care support service costs by 35%, with a view to modernising the service.
But the service has suffered a number of setbacks, including doctors reporting problems with the transfer of medical documents, and problems caused by shortages of stock in the NHS supply chain.
The NAO report concludes that NHS England has largely secured the financial savings it expected – in the first two years of the contract, NHS England made savings of £60 million.
But the authors of the report wrote: “NHS England has not yet secured the transformation that it wanted.
“The service to primary care practitioners, including Capita’s delivery of PCSE, has fallen a long way below an acceptable standard.
“This had an impact on the delivery of primary care services and had the potential to seriously harm patients, although no actual harm to patients has been identified.”
The authors acknowledge that Capita’s self-reported performance against the contract has improved.
But they questioned whether some of the services should be taken “in-house” by NHS England.
Neither NHS England nor Capita fully understood the complexity and variation of the services being outsourced. As a result, both parties misjudged the scale and nature of the risk in outsourcing these services.NAO chief Amyas Morse
Amyas Morse, the head of the NAO, said “Neither NHS England nor Capita fully understood the complexity and variation of the services being outsourced.
“As a result, both parties misjudged the scale and nature of the risk in outsourcing these services.
“While NHS England has achieved financial savings and some services have now improved, value for money is about more than just cost reduction.”
Commenting on the report, Henrik Overgaard-Nielsen, the British Dental Association’s chairman of General Dental Practice, said: “NHS England needs to take ownership over the grotesque mismanagement at Capita.
“Hundreds of NHS dentists have been unable to provide care for patients, or support their families, because officials were fixated on quick savings.”
Meg Hillier, chairwoman of the Public Accounts Committee, said: “Trying to slash costs by more than a third at the same time as implementing a raft of modernisation measures was over-ambitious, disruptive for thousands of doctors, dentists, opticians and pharmacists and potentially put patients at risk of serious harm.”
In a letter to NHS England, the British Medical Association (BMA) said: “An increasing number of concerns are being raised with us relating to incidents of doctors being unable to work and one incident of an unqualified doctor being added to the list.”
Dr Richard Vautrey, chairman of the BMA’s GP committee, said: “This damning report lays bare the scale of the failures impacting patients, services and GPs due to this poorly thought-out and woefully-run programme delivered by Capita.
“Earlier this year our members called for elements of this service to be taken back in-house, and this report is now recommending the same. With this as an option, we are now asking NHS England how it plans to resolve the shambles that is Capita’s running of Primary Care Support England.”
An NHS England spokesman said: “While not without its difficulties, by making this change over the past two years the NHS has successfully saved taxpayers £60 million, as the NAO themselves confirm.
“This £60 million in lower administrative cost has all been successfully reinvested in frontline NHS patient care, and has helped fund the equivalent of an extra 30,000 operations.”
A Capita spokeswoman added: “The report notes that several organisations and legacy issues all contributed to under-performance.
“It has been acknowledged that performance has improved and Capita will continue to work with all parties to address the small number of remaining service issues.
“We have accepted accountability for not meeting our high standards of service previously.”