back to article Capita contract probed after thousands of clinical letters stuffed in a drawer somewhere

The UK's National Audit Office is investigating a backlog of 162,000 undelivered items of clinical correspondence on the watch of Capita's £700m Primary Care Services contract. NHS logo affixed to building NHS: Remember those patient records we didn't deliver? Well, we found another 162,000 READ MORE In September 2015, …

  1. }{amis}{ Silver badge
    FAIL

    How? Why!!!

    How is this crap still happening you would of thought that anyone evolved in NHS paperwork would have made sure that they were not making the same mistakes after the last disaster!

    1. Simon Ward

      Re: How? Why!!!

      I suspect that brown envelopes stuffed with cash have a lot to do with it.

      I'm not cynical at all. Dearie me, no.

      1. HmmmYes Silver badge

        Re: How? Why!!!

        I dont.

        This smells more like idiots not being sacked in GPs and the NHS. Oh, and the people who wrote the Capita contract.

        1. macjules Silver badge

          Re: How? Why!!!

          Oh, and the people who wrote the Capita contract.

          Capita wrote the contract, under NAO Procurement Manual guidelines for Government Preferred Suppliers

          As they say, Oops ("Oh shit" if you are at NAO)

    2. Jon 37
      Facepalm

      Re: How? Why!!!

      If you outsource, you get what you ask for and pay for.

      No-one asked Capita to do anything with this paperwork, no-one paid Capita to do anything with this paperwork, so Capita didn't do anything with it.

      Doing something with this paperwork would have cost money, and by outsourcing you saved that money!

      This is outsourcing working as documented (but not as actually intended).

      1. Anonymous Coward
        Anonymous Coward

        Re: How? Why!!!

        In fairness, Capita probably asked their contact several times what to do with the paperwork but the people who understood it had been downsized in order to outsource their jobs to Capita.

        The whole situation incubates these clusterfucks. Capita are part of the problem but not the root cause, the root cause is the outsourcing epidemic.

        1. Anonymous Coward
          Anonymous Coward

          Re: How? Why!!!

          The people who would have known what to do we’re all made redundant last year!

      2. Stuart 22

        Re: How? Why!!!

        "If you outsource, you get what [their better paid lawyers decided] you asked for and pay for."

        FTFY. And of course if the penalties are less than the cost of doing the job, why do it? If they really screw up then Chris Grayling may be their answer ... just sayin'

        1. FidotheFrightful
          Unhappy

          Re: How? Why!!!

          Need a penalty clause contract , so these incompetents pay for their mistakes. Ah but the taxpayers deep pockets will pay.!

      3. stu 4

        Re: How? Why!!!

        "No-one asked Capita to do anything with this paperwork, no-one paid Capita to do anything with this paperwork, so Capita didn't do anything with it.

        Doing something with this paperwork would have cost money, and by outsourcing you saved that money!"

        got it in a nutshell.

        similar situation with TCS at BA (building the quality ticketing system):

        - requirements ask for service that processes the scanned ticket giving you access to gate.

        - requirements don't have non functionals (like... max response time)

        - TCS spent 2 months building service that takes 120 seconds on average per scanned ticket.

        - Not one of the geniuses asks the question 'er... I know there's no sla.. but it's like for scanning tickets..maybe as part of being a supposed professional I should ask'

        - service delivered into NFT where we (me) finds for the first time it's useless and has to be thrown away.

        - you pays peanuts, etc...

        1. Anonymous Coward
          Anonymous Coward

          Re: How? Why!!!

          TCS spent 2 months building service that takes 120 seconds on average per scanned ticket.

          Let me guess, Javascript?

        2. HmmmYes Silver badge

          Re: How? Why!!!

          Yeah.

          Ive sat in meetings where very expensive managers talk to very exoensive lawyers and discuss escrow, main man risk, invasion by Nork, etc etc. And not one bither with detail of the product thats to be delivered.

          Some times you just have to take the rusk, it never goes away.

          Maybe comoanies need to be prototyping then, when thry are gphappy, contracting out for scale and performance?

          1. tfewster Silver badge
            Joke

            Re: How? Why!!!

            Upvoted for "co-moanies" - e.g. Customers, outsourced staff who aren't allowed to do what they know is needed, and re-moaning in-house staff who can't get the outsourcer to do the needful because "it's not in the contract".

            The only happy people are 1) internal directors who got a bonus for cutting costs and 2) The outsorcerers. Apparently education Academy trusts have taken this to a whole new level. They take the money, then walk away from the contract if fulfilling the service would be too expensive.

            1. Anonymous Coward
              Anonymous Coward

              Re: How? Why!!!

              "education Academy trusts have taken this to a whole new level. They take the money, then walk away from the contract if fulfilling the service would be too expensive."

              Close - but you omitted the "distribute the money amongst the suppliers run by mates and relatives" stage.

              E.g. Lincolnshire 2012:

              http://www.telegraph.co.uk/education/educationnews/9232201/Academy-head-used-school-funds-for-luxury-flat-refurbishment-and-sex-games.html

              E.g. Birmingham (many years, Perry Beeches Academy Trust, this article from 2016)

              https://www.birminghammail.co.uk/news/midlands-news/calls-more-schools-oversight-wake-11803716

              E.g. Manchester 2014-16

              https://www.theguardian.com/education/2016/aug/16/academy-trust-chief-executive-collective-spirit-education

              Or akmost any month you choose since academies arrived, in the columns of Private Eye (sorry no links).

      4. Anonymous Coward
        Anonymous Coward

        Re: How? Why!!!

        Indeed. I hope Capita charged for the storage of this paperwork whilst the incompetent customer decided what to do.

      5. John Smith 19 Gold badge
        FAIL

        "In the absence of any agreed and contracted process for handling correspondence for "

        If you didn't ask for it (specifically, and in detail) you don't get it.

        Now I might think that "S**t's accumulating in our offices" would be a flag to contact someone in the DoH and ask them "What do you want done with it?"

        Did this happen?

        Maybe and the DoH asked "What's it going to cost?" or maybe they were told "We're not sure as the guy who deals with that stuff was let go two months ago."

        or maybe they didn't bother.

        Remember the Golden Rule of Outsourcing.

        "Everything the client forgets has to get done is another opportunity to charge for additional work. "

        1. Anonymous Coward
          Anonymous Coward

          Re: "In the absence of any agreed and contracted process for handling correspondence for "

          Need a penalty clause contract so Capita pay

          1. Anonymous Coward
            Anonymous Coward

            Re: "In the absence of any agreed and contracted process for handling correspondence for "

            "Need a penalty clause contract so Capita pay"

            No.

            Fine a company and nothing changes, the cost is passed on to their customers, employees, suppliers, etc. Nothing changes.

            Fine the individual managers that were responsible, and who should be (but frequently aren't) held accountable, and then there's a chance that behaviours will change.

            After all, the people in charge are clearly personally and individual responsible when things go right (that's why they have their personal and individual long term incentive plans etc, innit). So by the same logic they must surely also be responsible when things go wrong.

      6. the spectacularly refined chap

        Re: How? Why!!!

        No-one asked Capita to do anything with this paperwork, no-one paid Capita to do anything with this paperwork, so Capita didn't do anything with it.

        To be fair that isn't strictly true. I know this contract well, Capita are contractually not allowed to forward it to the intended recipient under NHS England Information Governance regulations. The change in procedure actually slightly predates Capita's involvement.

        The fault here is squarely with the sending practices, hospitals and other healthcare providers. If Capita are receiving thousands of clinical notes a month that is thousands of data breaches occuring every month in the wider NHS sending confidential data to the wrong destination.

        In this respect at least Capita are blameless. From my experience dealing with admin staff at care providers I can't say I'm surprised: many seem to have an inflated sense of their own importance and such niceties as following the correct procedure or obeying laws and regulations are entirely optional if you utter the words "clinical need".

      7. FidotheFrightful
        Unhappy

        Re: How? Why!!!

        Need a penalty clause contact so that these incompetents get clobbered. Ah but the deep pockets of the taxpayer will pay for these cock ups!

  2. m0rt Silver badge

    Sounds like some kind of national body, responsible for the health services to citizens is needed. That way everything can be subject to a centralized management process. That would also be able to handle funding that can be .... Oh wait....

  3. Gordon 10 Silver badge
    WTF?

    Some Sympathy here

    Heaven forbid but if I have read this right - if NHS England failed to communicate the correct address after Capita took over - then don't Capita share very little of the blame? Unless they were in charge of the comms as well of course then all bets are off.

    Defending Capita - I feel dirty right now...

    1. Anonymous Coward
      Anonymous Coward

      Re: Some Sympathy here

      Capita are the bloody arsehole of a system with all manner of bowel diseases.

      They're not the cause but it's not unrelated.

    2. Hollerithevo Silver badge

      Re: Some Sympathy here

      There's the issue of professionalism and coutresy. Someone at capita should have realised the seriousness of the problem and not stopped until they had an answer. You don't just shove this kind of stuff into a cupboard. Geez, it could have been their kid's medical records or their own, if the idea of strangers being injured didn't move them.

      1. Mark 85 Silver badge

        Re: Some Sympathy here

        It's the collision of two bureaucracies and that never ends well. Each assumes the other is dealing with an issue when neither aren't. Those employed by them, don't dare open their mouth to question anything. And so it goes...

      2. Ken Hagan Gold badge

        Re: Some Sympathy here

        "There's the issue of professionalism and coutresy. "

        Yes, if not also the general duty of care that all members of society are obliged to perform towards each other.

  4. HmmmYes Silver badge

    Capita dont come out of this looking good.

    But neither do the GPs and the NHS.

    And we pay these peple - Capita + NHS/GPs.

  5. Zog_but_not_the_first Silver badge
    Devil

    The devil you don't know?

    First Carillion, now Crapita. My sympathy is limited to the poor workers at the shitty end of these meltdowns but I'm wondering, "Why now?" Are there some US corporations waiting to pounce for the work as part of the Brexit avant garde?

    I know my suspicion gland is working overtime, but you know...

    1. Ken Hagan Gold badge

      Re: The devil you don't know?

      I think it is more likely that we're seeing how journalism works. There are always stories about bad stuff happening, but it your new story is "like the last one, but bigger" it is easier to persuade an editor to run with it. The result is that stories around a particular theme come along in groups, like the proverbial busses.

    2. Cpt Blue Bear

      Re: The devil you don't know?

      Maybe they are waiting to pounce, but its an effect rather than a cause - pure opportunism.

      What you are seeing is the effect of the same forces that got you Brexit manifest in a different way. There is no longer enough slack in the system to allow it to run properly. Its usually the product of management with an "efficiency" fixation pushing to do more with less until you pass some inflection point where it breaks down.

      My former boss likened it to a worn bicycle chain: you keep adjusting it until its overtight and fails catastrophically. He was a great source of colourful metaphors...

  6. This post has been deleted by its author

  7. Wolfclaw Silver badge

    Surely the common sense approach, yeh I know that is a bit of a tall order for the NHS, would be to have one central correspondence receiving center address that never changes, regardless of who is running the contract ????

    1. Lysenko

      Surely the common sense approach, yeh I know that is a bit of a tall order for the NHS, would be to have one central correspondence receiving center address that never changes, regardless of who is running the contract ????

      Perhaps one of those new-fangled "P.O. Box" thingies?

  8. John 110

    Meanwhile in NHS Tayside...

    The Tory MSP for NE Scotland is complaining about £100,000 worth of uneaten food in Tayside hospitals, claiming it's " further evidence of the health board’s inefficiency"

    Oh - and it's not privatised...

    It kinda puts a bill for £6m for sorting out a cock-up into perspective, eh.

    1. Jason 24

      Re: Meanwhile in NHS Tayside...

      £100,000 per year, and they are well under the 10% waste limit at 7.6%.

      Given they are £5,600,000 in the hole I don't think this bit of waste (within limits) is much of an issue.

      Neither of the articles I can find have said how much is spent in total, nor provide any comparison against other trusts.

    2. Arthur the cat Silver badge

      Re: Meanwhile in NHS Tayside...

      The Tory MSP for NE Scotland is complaining about £100,000 worth of uneaten food in Tayside hospitals, claiming it's " further evidence of the health board’s inefficiency"

      Judging by my last stay in hospital, it's more likely it's evidence of the food's inedibility.

      1. Terry 6 Silver badge

        Re: Meanwhile in NHS Tayside...

        The celeb chef James Martin did a little TV series on hospital food a year or so back. And his main conclusion was pretty much that moving to supposedly cost-saving cook-chill outsourced catering and closing hospital kitchens just lead to intolerable waste and poor patient nutrition. Just another consequence of beancounters making decisions.

        1. Boris the Cockroach Silver badge

          Re: Meanwhile in NHS Tayside...

          the local hospital here does cook-chill meals..........

          Bland and horrible is how I'd describe them (when actually edible)

          However Southampton has its own kitchens and does reasonable food..... but the catch is... the menu is the same everyday.. so by the time you've been there 5 days you've had everything on the menu......

          Anyway... back to capita ... oops forgot the r there

    3. boltar Silver badge

      Re: Meanwhile in NHS Tayside...

      "The Tory MSP for NE Scotland is complaining about £100,000 worth of uneaten food in Tayside hospitals"

      Someone should tell this clown that when people are very ill (which is usually the reason for a hospital stay as opposed to it being a w/e break) , they often tend not to be hungry and so if they are served a meal there's a good chance it will go to waste.

      Of course back in the day it would have been fed to the local farmers pigs so it wouldn't have mattered so much, but now with paranoid rules about foot and mouth and BSE you can't even do that so it just goes to landfill. Such a waste.

  9. JimmyPage Silver badge
    Flame

    Dead tree letters. In 2018

    was my first thought

    How come the entire Arab Spring was managed by Twitter in 2012 with a mobile and mainly anonymous population, and these clowns can't get letters letters FFS to a static address in the same unwar-torn country ????????

    There will be small "3rd world" countries looking at the UK wondering "and this is what we are supposed to aspire to ?"

    What on earth was I doing over 30 fucking years ago, diligently working on RFCs for email and email addressing ?????? I should have been taking Pitman instead.

  10. matjaggard

    Typo

    You have a typo in your headline. It's spelled "Crapita"

  11. Doctor Syntax Silver badge

    "Capita told us that, with hindsight, it believes it could have reported the backlog sooner,"

    Hindsight: the poor substitute for foresight.

    1. David Nash Silver badge

      it could have reported the backlog sooner

      Irrespective of their [lack of] contractual responsibilities, did nobody at Capita think, "hang on a minute, this could be important stuff, we better tell the NHS"

      1. Aladdin Sane Silver badge

        Re: did nobody at Capita think

        No they didn't, because Crapita give heartless bastards a bad reputation.

  12. Anonymous Coward
    Anonymous Coward

    not a problem limited to crapita

    this is a problem for outsourcing in general, in particular large multidimensional contracts where no one really knows the overall picture or the importance of individual processes. People that run the contract are disconnected from the reality of the jobs they have outsourced.

    The summary statement of "Clinical Correspondence" demonstrates this. Just a bod looking at medical looking notes and having no idea why they exist or what use they may be and adding a note to a list.

    I find this sort of situation alarmingly common...

    Also the "not obliged to, so didn't do it even though its bleeding obvious there is a problem" statement is alarmingly common for the bigger contracts. Probably the same causes.

    Overall the head-of gets a pat on the back for making everything cheaper (by missing out work that should be getting done) and the contractor gets a good rap for making it look cheaper.

    My experience is that the more disconnected the contract managers are from the processes and process consumers the more likely this effect is. Then only have to deliver the "appearance" of value.

    1. Terry 6 Silver badge

      Re: not a problem limited to crapita

      Yes

      Take a fairly complex set of interactions. Treat it a a mechanical one-dimensional operation. Define it in terms of just the visible formal processes. Employ some corporation of beancounters and lawyers to do the specified items listed. Move to a highly paid job in private industry before the poo hits the ventilation.

      1. Anonymous Coward
        Anonymous Coward

        Re: not a problem limited to crapita

        "Overall the head-of gets a pat on the back for making everything cheaper (by missing out work that should be getting done) and the contractor gets a good rap for making it look cheaper."

        ... and the experienced IT staff who do have business knowledge are sat on the sidelines and seen as troublemakers because of their distaste in outsourcing.

        Right up until "the poo hits the ventilation", and the contractor and "implementation team" have moved on and the business has realised it's not fit for purpose - then it's our problem (if we're still employed there).

  13. zaax

    The NHS messaging system is a mess. Other government departments have good working messaging handling systems why can't the NHS just copy them.

    1. tfewster Silver badge
      Thumb Up

      "Not Invented Here"

    2. HmmmYes Silver badge

      Because the NHS is full of special people who can never be held accountable for anything.

  14. Eclectic Man

    ICO angle

    I thought that holding on to correspondence that was not yours was an offence. Surely keeping it with no intention to do anything with it, when your contract does not include 'storage' of it is theft?

    Clinical correspondence is sensitive personal information under the DPA, and will soon be special category data under the GDPR. The ICO should be down on them like the proverbial tonne of bricks.

    1. Uberior

      Re: ICO angle

      Royal Mail have a legal obligation to deliver the mail to where it is addressed, it might not be yours, but it's been delivered to the correct place.

      The ICO issue is with the sub-prime health centre staff. Once a few of them are taken through the courts individually and fined for breaches concerning clinical correspondence, it might encourage GPs and their staff to take more care.

    2. Doctor Syntax Silver badge

      Re: ICO angle

      "the proverbial tonne of bricks."

      The proverbial version is a ton. 112 hundredweight.

      1. jfm

        Re: ICO angle

        The proverbial version is a ton. 112 hundredweight.

        20 hundredweight. 112lb in a cwt.

  15. Anonymous Coward
    Anonymous Coward

    Unfortunately the neoliberals have brainwashed the masses through their various quango 'think tanks' that anything in the public sector is bad - and the only solution is to allow a private firm to cut corners and generate a profit for their rich tax dodging owners.

    The solution is to bring this stuff back in house and remove the private sector from the NHS. It hasn't worked - and has cost a fortune in PFI's, shoddy services, jobs, and patient care. But oh no we can't do that can we - because some tax dodging bastard in a tax haven won't get an unearned rental from it. Sod the rest of us.

    1. Anonymous Coward
      Anonymous Coward

      The solution is to bring this stuff back in house and remove the private sector from the NHS.

      So you're proposing that GP services will be provided by salaried GPs employed directly by the NHS, and ending over half a century of privately provided GP healthcare? That'll be a big change I'll wager it will go badly.

      And by similar logic, you'll be banning NHS consultants from seeing private patients? Another set of unintended consequences to come there.

      1. Anonymous Coward
        Anonymous Coward

        Re: "you'll be banning NHS consultants from seeing private patients? "

        Sensible people have no problem with private healthcare, as long as it pays its own way in full without being subsidised in any way by the taxpayer-funded NHS.

        Y'know, maybe starting with (your example) having consultants choose whether they're working for the NHS this year, or for the private sector. And having the private sector ones use private sector facilities rather than scrounging off the back of the NHS ones.

        Y'know, starting with (for example) not allowing NHS facilities to clean up the mess when private facilities get it wrong.

        For example, by not allowing private sector "service providers" to cream off the easy/profitable work, leaving the hard stuff to be paid for by the taxpayer. ("Care home sector in crisis" ring any bells?)

        Maybe even not allowing taxpayer-funded students to work in the private sector till they've paid their training costs.

        But make private medicine pay for itself, in full, and haven't you got the historic US system, basically? And that's worked so well for the people of the USA hasn't it.

        When even the Daily Mail can see that the relationship between private medicine and the NHS is completely unsatisfactory, that the relationship resembles that of a parasite (private medicine) scrounging off its host before killing it, surely something must be wrong with the setup?

        1. HmmmYes Silver badge

          Re: "you'll be banning NHS consultants from seeing private patients? "

          Indeed.

          If I went to my previus employees and said OK, I work for 40h/w. However I want to go an work at a competitor the odd weekend or maybe evening, so Id like to get away from the office earlier...

          Im pretty sure what the response would be.

  16. Anonymous Coward
    Anonymous Coward

    Capita do have a responsibility here: one of informing the customer of the issue in a timely manner

    As others have hinted, its not a case of "its not in the contract, we ignore it" but "its obviously a problem and we are here to help resolve it".

    Capita force people annually to pass courses on this kind of thing...treating customers fairly is what its called.

    1. Anonymous Coward
      Anonymous Coward

      Re: Capita do have a responsibility here: one of informing the customer

      Those courses are for the minions to remind them of their place and to cover off certain legal requirements, I dont believe for one moment they were ever intended to give procurement personnel moral guidance or protect the customer from their own stupidity!

  17. Cynic_999 Silver badge

    Why the fuss?

    As Spock said, "The needs of the many* outweigh the needs of the few**"

    * CEOs, politicians, NHS management

    ** GPs, nurses, patients

    Anyway, who cares about people who are so poor that they can't even afford private medical treatment?

  18. Rol Silver badge

    Once all the business of the world is in the hands of a cartel of companies, the only products and services to be had will be substandard and overpriced.

    Just look at how Kraft has ravaged the food market, by buying up and shutting down the makers of quality goods, in an attempt to standardise a huge range of products to the lowest point they can legally get away with.

    Capita is the Kraft of the service industry, busily managing everyone's expectations downward.

  19. Anonymous Coward
    Anonymous Coward

    Crapita has an "r" in it

    Repeat after me:

    "Crapita has an "r" in it.

    "Crapita has an "r" in it.

    "Crapita has an "r" in it.

    ...

  20. Anonymous Coward
    Anonymous Coward

    This is the problem with outsourcing where the managers writing the contracts are so far removed from the grass roots of the process that they forget to include some of the most basic information.

    The company I work for is a subcontractor for a well known IT contractor and the contract they have signed with the client has so many holes that it will be impossible to work. It may well bring both companies into disrepute.

  21. John Brown (no body) Silver badge

    The body is planning to run an information campaign

    Maybe they could get someone to send a "test" message to the wrong group/list? A few Reply-Alls should make sure the message is received and burned into everyone's minds forever more.

  22. Anonymous Coward
    Angel

    Going Postal

    Let us commend Crapita for dealing with this so much quicker than Ankh-Morpork's post office.

  23. Anonymous Coward
    Anonymous Coward

    NHS England cocked up

    When issuing a 10 year contract to a company only interested in profit the inevitable will happen!

  24. Anonymous Coward
    Anonymous Coward

    A GP perspective

    These are letters sent to the wrong practice. We have no way to find the correct one.

    In the past we would send the letter to the PCS who have access to the patient’s correct GP name, for forwarding. The DOH decided not to contract Capita to do this, did not make it clear to GPs when thus would happen (changes rolled out across the country at different times) so practices carried on sending mail.

    Now there is no mechanism for forwarding the letters. Practices send the letters back to the hospital where the letter originated... who also do not have the correct address. If they are lucky they can phone the patient but otherwise the letter is never delivered.

    This is only one of a number of functions that the DOH 'forgot' to commission when the contract moved to Capita

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