NHS Shared Business Services – NAO Report on Clinical Correspondence Failure

We had previously picked up some details about the National Health Service Shared Business Services (SBS) clinical correspondence scandal but the publication of last week’s National Audit Office investigation has brought the events into the public eye, and shocking they are too.

SBS, jointly owned by the Department of Health (DH) and Steria Sopra, provides back-office services for many NHS organisations, those services including accounts payable, payroll, even some procurement activities, as well as some document handling and management activities.

The organisation took over the task of handling wrongly delivered correspondence for a number of Primary Care Trusts between 2008 and 2012. It inherited a backlog of such items, but basically failed to sort out the issue, which got out of control. As NAO says, “In March 2016 NHS SBS informed NHS England and the Department of Health that it had discovered a backlog of approximately 435,000 items of unprocessed clinical and other correspondence. NHS SBS accepts it had a contractual responsibility to process misdirected clinical and other correspondence”.

The one thing that nobody seems to have really examined is simply “why”? What was the rationale within SBS at operating level for this action in the first place, and then leading from that, how come it took years for this to come to senior management’s attention?  Did no-one wander round the premises and say, “what are all those boxes in that room”?

We’ve generally been favourable about SBS over the years. Whilst some clients have moaned about certain aspects of their work, they seemed to us to be doing the right things in terms of AP for instance, being early adopters of the Tradeshift platform and more recently looking to use Virtualstock to drive better stock management into the NHS. But this is a big failure for the organisation.

A couple of observations. One is the paucity of contract management here. Nobody seemed to be holding SBS to account. This task around handling the misdirected documents was not accompanied by a KPI for any client, so it did not seem to get much attention. It does also seem amazing that this did not get noticed by the client hospitals, surgeries and so on. Perhaps because there were so many small clients, and the problems for each were relatively minor or not really noticed, the issue just did not get raised up the priority list.

Secondly, in these days when nationalisation and public ownership is back in the public eye and looked at favourably again in certain quarters, this does remind us of the issues when the government owns “suppliers”. The DH and therefore the Minister (secretary of state) have a real conflict here. They / he is the ultimate 50% owner of SBS, so has a vested interest in keeping the problems quiet and playing down the failure. It is interesting that the Department “decided in March 2016 not to alert Parliament or the public about the incident initially as it considered it too early to understand the full extent of harm that may have been caused to patients”.

But the Minister is also the ultimate “owner” of the clients and patients who have suffered because of this incident. There is a potential conflict of interest there, not just for him but also for senior DH folk too.

I’m not saying that this would not have happened if SBS was totally in the private sector, but equally, public ownership, whole or part, does not mean that organisations are automatically free from making major errors and cock-ups like this one. And we suspect that cover-ups are more likely if the public sector owns service delivery as well as playing the policy and governance role. As talk swings again to nationalisation, we should remember that such an approach does not necessarily lead to greater accountability, openness or competence.

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  1. Sam Unkim:

    I would dispute that the NHS “owns” service delivery here.

    SBS “is what it is” and all us NHS staff have learned to live with that….

    J.H. is hardly likely to countenance criticism of ones of his darlings.

    How many suppliers and what percentage of invoices are being processed through Tradeshift by the way?

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