'Confused and opaque' NHS England insufficiently accountable to the public, says MP report (Pulse: 10 November 2014)
NHS England is ‘confused and opaque’, and lacks enough accountability to the public, an influential group of MPs has warned.
As the largest public body in England, with an annual budget of £95.6 billion, NHS England’s accountability to the public ‘should not be in any doubt, but the current arrangements for it are extremely complicated and still evolving,’ the Commons public administration select committee (PASC) said.
It singled NHS England out in its report on arm’s-length public bodies released today, saying it was a prime example of the ‘inconsistent and cluttered system of quangos, executive agencies and non-ministerial departments’, that were ‘poorly understood even in central government and where accountability is confused, overlapping and neglected, with blurred boundaries and responsibilities’.
NHS whistleblowing 'problems persist' (BBC News: 22 September 2014)
Whistleblowers still face real problems in speaking out in the health service - despite the push to create a more open culture, campaigners say.
Promoting whistleblowing was a key recommendation of the public inquiry into the Stafford Hospital scandal.
A number of steps have since been taken in England, but Patients First warned that a "culture of fear" still existed. It has produced a dossier of 70 cases, highlighting problems like bullying and mismanagement of complaints. The document is being handed in as part of Patients First's submission to an independent review of whistleblowing, which was set up by the Department of Health in England and is being led by Sir Robert Francis, who was in charge of the Stafford public inquiry.
Overcharging by outsourcing giant Serco costs NHS millions (The Independent: 28 August 2014)
Outsourcing giant Serco is embroiled in a fresh misuse of public funds scandal after a company it set up overcharged NHS hospitals millions of pounds.
Internal documents leaked to Corporate Watch indicate Britain’s biggest pathology services provider, which was established by Serco in partnership with Guy’s and St Thomas’ hospitals, overcharged the NHS for diagnostic tests.
The venture - first called GSTS and now trading under the name Viapath - has also been dogged by allegations of cost-cutting and clinical failings. Internal documents show increasing concern amongst senior consultants who claimed that staff cuts and a lack of investment since privatisation left some laboratories close to disaster.
In internal emails clinicians said the company had an “inherent inability… to understand that you cannot cut corners and put cost saving above quality.” The trust and Viapath say the problems have now been resolved. But this only happened after the intervention of senior medical staff and changes to the structure of the joint venture that reduced Serco’s role.
Whistleblower treatment is often 'shocking', say MPs (BBC News: 1 August 2014)
The treatment of employees in public services who have raised concerns about wrongdoing has often been "shocking", a group of MPs has said. The Commons Public Accounts Committee said whistleblowers had often been subjected to bullying and harassment.
Its report called for whistleblowers to be offered legal and counselling help and for "swift sanctions" to be imposed on staff who victimised them. The government said it was acting to ensure people felt free to speak out.
The report highlighted the "important" role whistleblowers had played in uncovering details about the Hillsborough disaster and the Mid Staffordshire NHS trust scandal.
The committee said whistleblowing was a "crucial source of intelligence to help government identify wrongdoing". However, it found there had been a "startling disconnect" between policies encouraging whistleblowers in theory and what happened in practice.
NHS 'falling short on complaints handling' (BBC News: 8 July 2014)
The NHS still has a long way to go to improve the way it handles complaints, although there are signs of improvement, a survey suggests.
The NHS has been heavily criticised over its complaints system in the wake of the Stafford Hospital scandal.
The poll of 4,000 people in the UK by Populus for consumer group Which? found just a quarter were happy with the way their complaint had been handled.
But this was a rise from 16% two years ago.
The survey showed more than half felt their complaint had been ignored - more than in other parts of the public sector - and 43% were "dissatisfied" with the outcome.
But four in 10 who have had a problem reported not even complaining - although this was again a slight improvement on the picture two years ago.
Improving complaints handling was one of the central themes of the public inquiry into the poor care at Stafford Hospital.
Bristol NHS campaigner Daphne Havercroft barred from register (BBC News: 1 July 2014)
An NHS campaigner in Bristol says she has been removed from a hospital trust's register of members for being a "vexatious complainer".
Daphne Havercroft said her "removal" from the Register of Members University Hospitals Bristol NHS Foundation Trust was because she "asked questions".
The trust said she had "breached" its constitution "by acting in a manner contrary to the trust's interests". Mrs Havercroft said as a member of the public she had "a right to campaign".
NHS blunders led to Devon toddler's death (BBC News: 26 June 2014)
A string of blunders by NHS workers led to the death of a three-year-old Devon boy, a review has found.
Sam Morrish died in December 2010 from a treatable condition because four health service organisations made mistakes, the Parliamentary Health Service Ombudsman (PHSO) said.
He died of severe sepsis after a "catalogue of errors".
Sam's parents also said they had "serious concerns about the competence and accountability" of the ombudsman. Ombudsman Dame Julie Mellor said that had Sam received the appropriate care, he would still be alive today.
Cricketfield GP Surgery, NHS Direct, Devon Doctors Ltd and South Devon NHS Trust were all criticised.
Failures included inadequate assessment of the toddler, not recognising that he was vomiting blood and a three-hour delay before he received antibiotics at hospital.
One-fifth of hospitals 'may be covering up mistakes' (BBC News: 24 June 2014)
A fifth of hospital trusts in England may be covering up mistakes, a government review suggests.
The analysis of reporting incidents shows 29 out of 141 trusts were not registering the expected number of safety incidents.
The review said this may be a sign of a "poor" safety culture.
Health Secretary Jeremy Hunt said it was important hospitals were "open and honest", and that patients had a right to know about problems with reporting
The data has been released as part of the Department of Health and NHS England's drive to improve safety in the NHS.
In March, Mr Hunt set the target of saving 6,000 lives over the next three years by reducing the number of serious mistakes.
He asked trusts to join the Sign up to Safety campaign and draw up plans to halve "avoidable harm" such as medication errors, blood clots and bedsores by 2016-17.
He said this could stop a third of preventable deaths in the coming years - equivalent to 6,000 lives saved.
NHS chiefs admit major breaches saw security of millions of patient records compromised (The Telegraph: 8 April 2014)
NHS officials have admitted that sensitive medical data covering millions of patients has been stolen despite claims that the national records database has never been compromised. Freedom of Information (FOI) disclosures reveal a string of security breaches - including the theft of an unencrypted laptop, holding details from the hospital records of more than eight million NHS patients, which could identify individuals. Plans for a giant database of GP records have been put on hold for six months amid concerns about the security of the data, and fears of its potential misuse.
The FOI disclosures reveal four security breaches involving hospital records since 2009. They include a major incident in 2011 in which a laptop containing details of 8.3 million patients was stolen from an unlocked store room at the headquarters of NHS Central London strategic health authority.
A report on on the breach reveals that there was enough detail in the records to identify individual patients.
Drugs companies buy NHS patient data, register reveals (The Telegraph: 3 April 2014)
Some of world's biggest pharmaceutical companies have bought NHS patient data, a new register has revealed. Drugs corporations including Bayer, Baxter, AstraZeneca and Roche are among dozens of private firms sold information, as well as Bupa, the healthcare provider.
The Health and Social Care Information Centre (HSCIC), which in charge of NHS data, said the list was part of a “drive towards greater transparency and building public trust". However, privacy groups said it fell short of providing patients the “full picture”. In total, 104 health and social care organisations, such as NHS trusts, and bodies like universities and charities were included, alongside 56 private firms. The HSCIC’s register lists each organisation, the type of data handed over, the legal basis for release and the purpose for which the data was provided.
Emma Carr, deputy director of Big Brother Watch, said of the register: "Patients still aren't being given the full picture. Parliament was told that every agreement made would be published, yet hundreds appear to have been left out. There also appears to be a complete failure to mention details of police access.”
Atos ‘misled ministers’ to win lucrative contract assessing disabled for benefits (The Independent: 20 March 2014)
The controversial private outsourcing firm Atos misled the Government in its official bid to win a multimillion-pound contract to assess the needs of disabled benefit claimants, MPs have claimed.
In its tender document, submitted to the Department of Work and Pensions, Atos suggested that more than 700 healthcare providers, including 56 NHS hospitals, had contractually agreed to provide accommodation where assessments for new Personal Independence Payments could take place. It claimed the “hyper-local” network would mean that no disabled claimant would have to travel more than 60 minutes to attend an assessment, with “over 90 per cent of claimants able to reach the centres in 30 minutes”. But the Public Accounts Committee heard that, since the scheme was launched, over 40 per cent of all claimants have had to travel for more than an hour to reach an assessment centre, with only 40 per cent being able to reach a suitable location in less than 45 minutes.
Personal Independence Payments began to replace Disability Living Allowance in April last year. Most people applying for PIP have a face-to-face assessment to determine eligibility, which is carried out by Atos Healthcare and Capita Business Services. But a report from the National Audit Office found claimants were waiting an average of 107 days, and terminally ill patients 28 days, for a decision on their cases – much longer than had been predicted.
“You only managed to work with a quarter of the trusts you named in the document,” the committee’s chair, Margaret Hodge, told her. “If there had been one or two falling out then I could have accepted your argument – but only a quarter?” She then asked: “Is it usual to lie in the tender document, Ms Coleman?” ...see more
NHS hospital records used by private marketing firms (The Independent: 3 March 2014)
Hospital records are being used by private firms advising companies how to target their marketing, it has emerged. The disclosure came amid furious debate about the future of a national project to share GP and hospital records, which has been delayed for six months.
Publicity materials from one marketing company state that Hospital Episodes Statistics – the records held of every NHS hospital visit – have been used to help firms to “tailor social marketing or media awareness campaigns”. The documents suggest the sensitive data would be used to target people on social media websites such as Facebook. Individuals might end up receiving spam and junk mail. The marketing firm Beacon Dodsworth said it had not been able to access raw data, but analysis of the hospital trends, integrated with other information, had been provided by NHS officials. Phil Booth, from the campaign group medConfidential, said: “How can the NHS defend this use of data? The last thing most people want is to be spammed by medical firms.” It also emerged that a full set of records, covering all hospital episodes in England, was handed to a set of management consultants, who uploaded it to Google servers based outside the UK. Campaigners questioned whether it was safe to have all such records stored outside the UK.
Lack of clarity over where NHS savings go, say MPs (BBC News: 12 February 2014)
The NHS is in the middle of an efficiency drive with savings expected to be reinvested in front-line care and making services more productive. More than £10bn has been saved in the first two years with another £4bn forecast in 2013-14. But the Health Select Committee said there was little evidence it had been used wisely. The cross-party group of MPs said the plan had been to transform the way services were delivered to make the NHS sustainable in the long-term. But it said, to date, much of the savings had come from "straightforward" measures such as pay freezes and cutting funding to hospitals. It said as a result, the pressures on the NHS and social care system were now greater than they were a few years ago.
Revealed: Independent experts overseeing care.data have approved 31 releases of identifiable patient data since April (Pulse: 17 January 2014)
Requests for identifiable patient data have been approved more than 30 times since April by the group of independent experts which will oversee access to confidential records uploaded to the controversial care.data scheme. A Pulse analysis of applications to the Confidentiality Advisory Group (CAG) reveals there have been 31 releases of confidential patient information since April 2013 - 12 of which were to bodies outside the NHS. The frequent releases of data under the little-known Section 251 exemption are significant because a similar process will govern the release of identifiable patient data once GP records are extracted via the care.data programme. NHS England announced last year that it plans to sell care.data access to private companies and researchers for a nominal £1 - and private companies will be able to make applications to access identifiable data via the Section 251 process.
Manchester Hospitals under threat from new law (Manchester Evening News: 19 January 2014)
Despite opposition from a wide range of patient groups, charities and doctors, the government is currently trying to rush through a new rule that will make it far easier to close hospitals without proper consultation; a move that could have a profound impact on people in Greater Manchester.The new clause, which will form part of the Government’s Care Bill, allows a trust special administrator to take action in relation to a failing NHS organisation, like a hospital, that has direct impact on another part of the NHS. These new powers could have a real practical impact by allowing the complete redesign of services – effectively what the local NHS does – without any input from those who work in or use the NHS in the affected area. Clause 118 also increases the role of the health secretary in these matters and effectively reduces the independence of struggling NHS organisations from ministerial interference if they, or a provider near them, enters the failure regime. The British Medical Association opposes the hospital closure clause, saying it would allow the health secretary to “force changes through the back door”.
Further NHS reforms will reduce say of doctors and patients (The Guardian: 7 January 2014)
Polly Toynbee: Sunlight is the best disinfectant. So says Jeremy Hunt, keen to ferret out bad treatment, if only for nefarious political purposes. "No decision about me without me," pledged his predecessor, Andrew Lansley, while uprooting the NHS with no one's by-your-leave. Both upheld the NHS constitution to "put patients at the heart of everything the NHS does" and to be "accountable to the public, communities and patients". But all that will be overridden by clause 118, hastily tacked onto the care bill, which returns to parliament this week.
Maybe such pieties were never realistic in a rationed NHS (or any private system)that can offer only what available funds can buy. Money is at the heart of decisions about what's best for patients, although politicians pretend otherwise. Better by far to be open about this eternal truth and conduct honest public debates about tough priorities. But clause 118 will shut down public involvement. What's more, it uproots Lansley's chaotic reorganisation by giving absolute power to trust special administrators (TSAs), free to close, merge or privatise hospitals regardless of doctors, patients or the public.
Amendments to Care Bill a new threat to CCGs, hospitals and accountability (Socialist Health Association Blog: 30 November 2013)
The government used the existing regime in Lewisham and found that the law only applies to the failing Trust, making their unjust and unpopular plans illegal. They now want to change the law to ensure that any future Trust Special Administrator process can deal with the whole health economy as well as the failing Trust. The new plans, slipped into the Care Bill and going through the Commons now, have huge implications for Clinical Commissioning Group freedoms and patient and public participation and involvement. The rules are unchanged from the previous regime (bad enough in itself). It allows for a rapid set of decisions across a potentially wide geographical area, enabling the Trust Special Administrator to reconfigure large areas at a stroke. It will include financially healthy as well as unhealthy Trusts. In the rest of the amendment, the restriction of accountability is draconian. There is no referral to scrutiny and no patient and public involvement – at all – is needed: the statutory obligations of commissioners to involve and consult patients and the public in planning and making service changes do not apply in respect of the trust special administration regime. NHS England can decide on the Trust Special Administrator’s plan if local CCGs cannot agree. NHS England would have the final say.
NHS boss latest to duck responsibility for ‘Scandalous’ NHS Croydon chief (Croydon Advisor: 27 November 2013)
NHS boss Sir David Nicholson has become the latest health chief to duck responsibility for former head of NHS Croydon Caroline Taylor. Sir David, chief executive of NHS England, said he had "no powers" to compel Ms Taylor to answer questions about a £28m mismanagement of the trust's finances. He claimed not to have the authority to intervene because she was no longer employed by NHS Croydon, which was replaced by Croydon Clinical Commissioning Group in April. The response appears to end all hope that Ms Taylor can be compelled to explain what happened. The Joint Health and Overview Scrutiny Committee (JHOSC) wrote to Mr Hunt in May and asked him to compel Ms Taylor to give evidence after she refused to cooperate with their investigation. In his reply, received last week, he said there was no “accountability line” from chief executives of primary care trusts (PCT) to the Secretary of State. The “accounting officer”, he said, was Sir David. After being contacted by the Advertiser this week, a spokeswoman for NHS England said: “As the Secretary of State’s letter makes clear, the regulations relating to overview and scrutiny committees do not give them the power to compel former employees of health bodies to attend meetings. “Sir David, who is now Chief Executive of NHS England has no powers to compel Caroline Taylor to attend the Croydon overview and scrutiny committee.”
Mount Denys consultation was 'flawed' (Hastings Observer: 8 November 2013)
The future of Mount Denys care home, the adjacent Pinehill Centre and the Isabel Blackman Centre have all been under scrutiny as part of a county council bid to save £27.8million on adult social care. A four month consultation period for has been under way since early July. A review of Pine Hill and the IB Centre will conclude in December whether to develop, close down or leave them as they are.
On Tuesday, East Sussex County Council cabinet will decide whether to approve the recommendations. However county councillors representing Hastings claim the consultation period was not thorough enough and are angry that members who may have no ties to Hastings are making decisions which do not affect them.They are strongly opposed to any changes and threatening to call the item in for closer scrutiny.
GPs threatened with court action over lack of reimbursements as NHS England forced to step in for NHS Shared Business Services (Pulse: 5 November 2013)
NHS England has been forced to step in and contact suppliers after five practices were threatened with bailiffs due to problems with late or overdue payments, Pulse has learnt. The practices in Doncaster were told to forward any unpaid bills to the area team after they were given court orders due to unpaid bills for basic services - such as rent and heating - because they were not reimbursed for them by NHS Shared Business Services.
LMC leaders said at least five of the 44 practices in the city had been given court orders, and warned that the problems have been ongoing since April and have shown no signs of improving. Doncaster LMC medical secretary Dr Dean Eggitt said NHS England’s local area team had been ‘good’ in trying to help practices with the court orders and bills via an interim solution. ‘These are all reimbursable costs, such as practice premises and heating, all that sort of stuff that is usually reimbursed. Some of the bills that have been coming through for practices to pay run into hundreds of thousands of pounds so it is impossible for practices to pay these.’
Lack of enquiry into failing Private Hospital in Guildford (The Guardian: 28 October 2013)
The failings at the private BMI Mount Alvernia hospital in Guildford have led to no inquiry, even though BMI is the largest private hospital group in the UK, and a significant share of its revenues comes from treating NHS patients. When the Care Quality Commission (CQC) inspected the hospital in January this year it found that "medical, surgical and some nursing practices were so poor that people were put at significant risk. This risk was, on some occasions, life-threatening". There were not enough nurses, staff were not properly trained, records were not being kept, samples were incorrectly labelled, out-of-date blood was used in a transfusion, resuscitation equipment was broken, no checks were made that all instruments had been removed at the end of operations. One surgeon reportedly refused to wash his hands between patients, saying he had "low infection rates".
Yet, until the CQC's concerns were made known, both private and NHS patients were being sent there for surgery. The chief executive of BMI has since apologised and assured everyone that all the failings have been fully addressed. But a follow-up inspection in May found it still failing to meet three minimum safety standards; and six other BMI hospitals have also recently had less serious but significant adverse CQC reports on matters affecting patient safety.
Serco condemned over move to offload troubled GP service in Cornwall (The Guardian: 11 October 2013)
Serco, the private contractor that falsified its NHS data in Cornwall, is looking to pass on its troubled GP out-of-hours service in the county to a subcontractor. The Guardian has learned that Serco has been in talks with the NHS to hand delivery of the service to Devon Doctors, a not-for-profit enterprise run by GPs in neighbouring Devon.
Serco's negotiations over subcontracting follow a Guardian investigation which revealed it had falsified its performance data when reporting to the local NHS trust so that it appeared to meet targets in the contract that it failed to achieve.It had originally won the contract with a bid that undercut the local GP co-operative by £1.5m. Whistleblowers later raised the alarm over safety,highlighting an occasion when only one GP had been on duty for the whole county for the night.
The contract was originally awarded to Serco by the NHS primary care trust for Cornwall. The PAC ruled it had been deeply ineffective in writing and managing the contract and did not impose any penalties when Serco's failings were discovered, instead making bonus payments to the company. Serco was given a further five-year contract in 2012, which has four years still to run. When the PAC reported, the company volunteered to pay back the bonus payments to the new Kernow clinical commissioning group (CCG), which took over responsibility for Cornwall's services as part of the government's NHS restructuring earlier this year. Under competition rules, the CCG cannot end the contract without re-tendering it, a costly process that could take up to a year.
Devon Doctors also declined to comment. It is a social enterprise providing out-of-hours GP services to Devon, with the majority of its shifts covered by GPs who work for Devon practices. It originally bid for the Cornwall contract and although it beat Serco on other criteria, it lost out on price.
Doctors face being gagged from concerns about NHS privatisation (Daily Mirror: 10 September 2013)
Doctors face being gagged from raising concerns about privatisation of the NHS under the Government’s lobbying reforms, Britain’s top medic has warned. A proposed cap on spending “for election purposes” could stop them speaking out about the impact on patient safety of private companies running NHS services, British Medical Association chairman Dr Mark Porter has warned. Under current proposals for the new lobbying legislation, doctors could be considered to be trying to influence an election even without expressing support for any particular candidate – leading to a cap on campaigning costs for the BMA, which represents 152,000 medics. Dr Porter said: “Privatisation of the NHS is a key issue which is bound to be an election topic. Doctors have a right to say what they think about how the NHS is run for patients. ”
Atos fitness test whistleblower explains motivations (The Guardian : 31 July 2013)
Greg Wood decided that he could no longer tolerate working for the fitness-for-work assessment firm Atos earlier this year when he was asked, for perhaps the 10th time, to change a report he had made on a claimant, in this case making it unlikely that the individual would be eligible for sickness benefit.Last week, the government revealed that the quality of reports written by Atos assessors had fallen to "unacceptably poor" levels. He had harboured concerns about aspects of the work he was expected to perform for several months, but finally decided to leave because he felt the company was unethical to put pressure on a doctor to change the conclusions of an assessment.
His decision to blow the whistle on practices within Atos made headlines in May, because he was the first Atos-employed doctor to put his career on the line and articulate concerns about a system that has been criticised by charities and claimants for years. Wood gave strong evidence to the BBC to suggest that the methods used to assess whether individuals are eligible for the new incapacity benefit – employment and support allowance (ESA) – were "unfair" and "skewed against the claimant". Since he is not revealing any official secrets, he has no qualms about speaking out, but he says becoming a whistleblower is not necessarily a positive move for a continued medical career. He is not currently working as a doctor, and is focusing on writing a book on Iraq. He describes the whole assessment process as an "embarrassing shambles", but does not think Atos is necessarily to blame. He thinks a system whereby private companies are contracted in to perform sensitive tasks for the state is inherently risky.
There is an increased risk of fraudulent behaviour by health care providers in the ‘New’ NHS (LSE: 20 June 2013)
Mark Button explains how the government’s reforms to the NHS will increase the risk of fraud. To make matters worse, no effective sanctions regime currently exists to deal with health care providers that are found to have supplied false or misleading information.
NHS body unaccountable for extension of Harmoni contract (Hackney Gazette: 19 June 2013)
Doctors have slammed the NHS body which extended Hackney’s contract for out of hours (OOH) care to Harmoni, for ignoring evidence that the private company was not meeting national targets for call answering and clinical assessment. Hackney GPs spent two years drawing up plans for the City and Hackney Urgent Healthcare Social Enterprise (CHUHSE) – but just seven weeks before it was due to go live on April 1, NHS North East London and the City (NELC) decided to let Harmoni continue running the OOH service for another nine months during a tendering process.At the time a spokesman for the NELC said its priority was to ensure local people received services that are “safe and of the highest quality”. But last month Care Quality Commission (CQC) inspectors declared Harmoni was guilty of running the OOH GP service for North Central London with so few doctors they were potentially placing patient’s safety at risk.
Will Healthwatch give patients a better deal? (The Guardian: 29 May 2013)
The community watchdog will have to work hard to realise the patient-centric dreams of Andrew Lansley and Jeremy Hunt, writes Julie Bailey - "In 2003, they were abruptly replaced in England (but not Wales) by Patient and Public Involvement Forums (PPIF), reporting to the Department of Health. In 2005, these were replaced by Local Involvement Networks (LINks), which were funded by local government, and were aggressively local, with no central controller. Now, there is yet another change, the fourth in eight years, towards Healthwatch, the community watchdog which really is going to realise the patient-centric dreams of Andrew Lansley, Jeremy Hunt, and me."
Night GP Service ‘staffed by nurses’ (The Guardian: 13 May 2013)
According to a whistleblower, Harmoni, the largest provider of out-of-hours GP services in England, is using senior nurses when doctors cannot be recruited to work the shifts. The private healthcare company regularly employs advanced nurses to work eight-hour overnight shifts covering districts of up to 150 square miles (approx 250,000 patients), the whistleblower claims. Claims first published in The Daily Mail include that in times of extreme staffing shortages, there has been just one advanced nurse practitioner working overnight in North Somerset, locum doctors have been flying in on easyJet from Europe, or driving from elsewhere in Britain to perform back-to-back shifts round-the-clock, terminally-ill cancer patients have waited eight hours for a doctor to visit them at home and administer pain relief; and foreign doctors with a poor grasp of English have been used to plug gaps in the rota. The whistleblower said that working for Harmoni was like "taking a loaded gun and sitting with it because at some point it's going to become so unsafe it's going to go off".
Who will hold NHS contractors to account? (The Guardian: 23 April 2013)
Hunt questioned over risk to NHS after privatisation of UK's blood-plasma company (The Guardian: 29 December 2013)