Treasury Minutes Government response to the Committee of Public Accounts on the Fourth to the Eleventh reports from Session 2017-19 Cm 9575 March 2018 Treasury Minutes Government response to the Committee of Public Accounts on the Fourth to the Eleventh reports from Session 2017-19 Presented to Parliament by the Exchequer Secretary to the Treasury by Command of Her Majesty Cm 9575 March 2018 TREASURY MINUTES DATED 1 MARCH 2018 TO THE COMMITTEE OF PUBLIC ACCOUNTS ON THE FOURTH TO THE ELEVENTH REPORTS FROM SESSION 2017-19 © Crown copyright 2018 This publication is licenced under the term of the Open Government Licence v.3.0 exceptwhereotherwisestated.Toviewthislicence,visit nationalarchives.gov.uk/ doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected]. Where we have identified any third party copyright information, you will need to obtain permission from the copyright holders concerned. 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Print ISBN 978-1-5286- ID &&6 0/18 Printed in the UK by the APS Group on behalf of the Controller of Her Majesty’s Stationery Office Printed on paper containing 75% recycled fibre content minimum Government responses to the Committee of Public Accounts Session 2017-19 # Report Title Page 4 Clinical correspondence handling at NHS Shared Business Service 1 Department of Health and Social Care 5 Managing the costs of clinical negligence in hospital trusts 4 Department of Health and Social Care / Ministry of Justice / HM Treasury 6 Growing threat of online fraud 8 Home Office 7 Brexit and the UK border 12 HM Revenue and Customs / Home Office / HM Treasury 8 Mental health in prisons 15 Ministry of Justice / Department of Health and Social Care 9 Sheffield to Rotherham tram-trains 22 Department for Transport 10 High Speed 2 Annual Report and Accounts 26 Department for Transport 11 Homeless households 29 Ministry of Housing, Communities and Local Government / Department for Work and Pensions Fourth Report of Session 2017-19 Department of Health and Social Care Clinical correspondence handling at NHS Shared Business Services Introduction from the Committee The Department of Health is ultimately responsible for securing value for money for spending on all health services. NHS England has responsibility for arranging the provision of health services in England and for commissioning their provision. This includes primary care support services, for example, updating patient registration lists, processing contractual payments to GPs and redirecting correspondence. Until April 2016, NHS England contracted NHS Shared Business Services (NHS SBS), a private company part owned by the Department, to make sure that misdirected clinical correspondence was sent on to the correct GP in the East Midlands, South West and North East London. In March 2016, NHS SBS informed NHS England and the Department that it had found a backlog of correspondence which had not been redirected, some of which dated back several years. A total of 709,000 items of correspondence were eventually found to have been mishandled. NHS SBS missed many opportunities over at least five years to identify and rectify the problem. Based on a report by the National Audit Office, the Committee took evidence, on 16 October 2017, from the Department of Health, NHS England, and NHS Shared Business Services. The Committee published its report on 29 November 2017. This is the Government response to the Committee’s report. NAO and PAC Reports • NAO Report: Clinical correspondence handling at NHS Shared Business Services - Session 2017-19 (HC 41) • PAC Report: Clinical correspondence handling at NHS Shared Business Services – Session 2017-19 (HC 396) Government responses to the Committee 1: PAC conclusion: NHS England failed to appreciate the seriousness of misdirected correspondence and still has not put effective measures in place to ensure clinical correspondence is handled properly. 1: PAC recommendation: NHS England should set out how it will ensure that all clinical correspondence is correctly handled, processed and redirected, where appropriate. 1.1 The Government agrees with the Committee’s recommendation. Recommendation implemented. 1.2 NHS England has put in place a service to ensure that any correspondence or material, sent to the Primary Care Support England service (Capita) by GP practices, who have not applied the correct process, is promptly reviewed and returned to the sender or the GP with whom the relevant patient is registered. Where this is not possible, arrangements are in place to redirect the correspondence to an appropriate organisation to deal with it. 2: PAC conclusion: NHS England does not know the full extent of the problem as it continues to identify new items of misdirected correspondence. 2: PAC recommendation: NHS England should set out by 31 December 2017 how it can be sure that all unprocessed correspondence has now been identified. 1 2.1 The Government agrees with the Committee’s recommendation. Recommendation implemented. 2.2 Primary Care Services England (PCSE), the service provided through Capita, have confirmed that all erroneous documentation held by them has now been identified and is being processed as part of the incident. The Primary Care Support (PCS) Incident Team is also undertaking a review, again in conjunction with PCSE, of other documentation to confirm that all other potential sources of unprocessed correspondence have been identified and processed. This will be completed by March 2018. 3: PAC conclusion: Eighteen months after the problem first came to light, NHS England still cannot confirm that no patients have been harmed by the repeated failures in the clinical correspondence redirection service. 3: PAC recommendation: NHS England should write to the Committee by 31 March 2018 to confirm the results of the review and what action it will take in response. 3.1 The Government agrees with the Committee’s recommendation. Target implementation date: April 2018. 3.2 NHS England plans to write to the Committee, following completion of clinical reviews planned for 31 March 2018, to advise the final outcome of the clinical review process. This will cover both the NHS Shared Business Services and Primary Care Support England clinical correspondence elements. 4: PAC conclusion: It is unacceptable that NHS England has given up trying to find out whether any patients have been harmed simply because 2,000 GPs have not confirmed whether they have reviewed clinical correspondence about their patients. 4: PAC recommendation: NHS England should obtain positive assurance by 31 March 2018 from every GP reviewing correspondence that they have completed their checks and whether they have identified any cases where patients may have been harmed. 4.1 The Government disagrees with the Committee’s recommendation. 4.2 The Government does not agree with the Committee’s conclusion that NHS England has “given up” trying to find out whether any patients have been harmed. Nor can NHS England force an individual GP to respond. However, it can, and has, put in place alternative arrangements where that is not forthcoming. 4.3 A rigorous process, including taking appropriate legal and clinical advice, was undertaken before making the original decision not to pursue these returns. Following the Committee’s hearing on 16 October 2017, NHS England has written to GPs again asking them to submit returns to the Incident Team for their affected patients by 31 January 2018. Where these have not been received, any monies paid for work not done will be reclaimed and, more importantly, clinical triage of the correspondence affecting those patients will be undertaken by NHS England clinicians. 5: PAC conclusion: Attempting to resolve misdirected clinical correspondence has so far cost an estimated £6.6 million and the total cost is still unknown. 5: PAC recommendation: NHS England should write to the Committee by 31 December 2017 to confirm how it will ensure that in future all contracts with third party suppliers include adequate compensation in the event of any failure to deliver; and how much it will cost to deal with the additional items of unprocessed clinical correspondence that have been found since the NAO report. 2 5.1 The Government agrees with the Committee’s recommendation. Target implementation date: March 2018. 5.2 Future contracts with third party providers will continue to contain strong provisions for redress in the event of failure to deliver. 5.3 The cost of managing the clinical correspondence incidents is estimated at £9 million by the end of the financial year 2017/18, of which £6.6 million relates to the NHS SBS incident. Financial recovery from NHS SBS has continued to plan. 6: PAC conclusion: The Department’s weak oversight of its joint venture with Sopra Steria, a private company, meant that opportunities to identify the issues at NHS SBS were repeatedly missed. 6: PAC recommendation: The Department should set out for the Committee how the changes it has made to the governance of its six investments will ensure that it has adequate arrangements in place to oversee the services being delivered by these organisations. 6.1 The Government agrees with the Committee’s recommendation. Target implementation date: December 2018. 6.2 The Department has already increased its membership of the NHS Share Business Services Board. In parallel, the company has therefore made organisational changes to ensure accurate assessment and reporting of risk is embedded in processes across the organisation, and made structural changes to the management of risk to ensure appropriate focus and timely reporting to the NHS SBS Management Team and the NHS SBS Main Board. 6.3 In November 2017, the Department established a new Governance Framework for DHSC Owned Companies. This includes a periodic review of all shareholdings and as part of this the Department’s holding of shares in NHS Shared Business Services will be reviewed late 2018.