Category Archives: Campaign4Change

How much of NHS tax rise is destined for international IT companies?

By Tony Collins

Matt Hancock, the health secretary, told the BBC’s “Today” programme yesterday that part of the £20bn a year extra funding for the NHS will pay for “vital” new technology.

“The money is coming,” said Hancock in reply to Today presenter Justin Webb who asked whether it was right for the £20bn to be spent on technology rather than, say, more GPs.

Webb asked, “This money [for new systems] comes out the money recently announced for the NHS that I think people will have thought was for patient care but a significant amount of it will be spent on IT?

“Improving the IT does improve patient care,” said Hancock, “You need the best technology to get the most out of that [£20bn] money.”

Hancock said lessons from the disastrous £10bn NPfIT have been learnt and it’s time to move on.

“One of the problems of the history of bad NHS IT decisions is that people have run away from this subject,” said Hancock, “Leadership has run away from this subject in too many cases. We must all embrace it [new  technology].”

He said the new approach to NHS IT will be markedly different to the NPfIT.

“The £10bn NPfIT imposed a top down solution on every trust in the land.” The new plan means “required standards – data protection, cyber security and crucially standards of interoperability – but you buy the kit and crucially it has got to be able to work with the rest of the NHS’s IT”.

He said the new money will go into much more than having systems talking to each other. “Clinicians are demanding the sorts of changes we are proposing.”

In the short term, more than £200m will be spent to make a “group of NHS trusts into internationally recognised centres for technological and digital innovation”.

Justin Webb said the Hancock plan sounds much like the NPfIT – which Hancock denied.


NPfIT was a disaster for taxpayers but not for all international IT companies.

About £10bn was spent, much of it with IT companies and on consultants. Perhaps for this reason parts of the private sector have good reason to take a pragmatic view of public sector IT disasters.

And behind the scenes, the lobbying of senior officials over new NHS IT plans has become routine, from the sponsoring of break-off groups at party conferences to off-the-record events and briefings.

It’s unlikely Hancock will have been in the job long enough to have been lobbied personally but it’s likely his officials have – and for the best of reasons: to ensure they are keeping up with what’sh on the market and what new technology is capable of achieving in the NHS.

To his credit, Hancock acknowledged this week that the biggest problem with NHS IT is that systems do not talk to each other.  Indeed, he is fond of the vogue word beloved of NHS IT suppliers – interoperability.

Matt Hancock’s Telegraph article 6 Sept 2018

But much of what he said this week in his Telegraph article and speech at NHS Expo in Manchester could have come from the press release of an international IT company. That same press release has been issued numerous times over the past 20 years: about the spending of more money on an IT-led transformation while learning lessons from the past.

What ministers and the press releases rarely say – if ever  – is that the NHS’s biggest IT-related problems could be solved with only little money. There’s no need for self-aggrandizing announcements. No need to buy warehouses of new systems from IT corporations. It’s simply a question of finding the best and cheapest way to allow existing NHS systems to talk to each other: perhaps using secure web links in the way banks enable customers to see their accounts and carry out banking transactions.

Why don’t NHS England and the Department of Health and Social Care fund a joint practical study into the best and simplest way of linking existing systems – rather than spending money centrally on a new app for booking GP appointments – which sounds like a repeat of the NPfIT  “Choose and Book” system?

Too boring perhaps. No politician wants to announce a mere study, especially when one where there’s no big money involved, no guaranteed mention of either artificial intelligence or a new app and no mention of an IT-led transformation that will save the NHS hundreds of millions. And no mention of a paperless NHS by the end of 2018 or the use of leading-edge technologies for the benefit of officials’ CVs.

But, as Apple said, and Da Vinci was purported to have said, “Simplicity is the ultimate sophistication”.

Would that Hancock were lobbied to learn the main lesson from NHS IT disasters of the past 20 years: that the biggest reforms don’t have to be wrapped in big financial packages.

It won’t take much to make interoperability happen. But sorry – it’s a reform that doesn’t come with glory. No immortalised legacy for ministers.

Please Mr Hancock do not talk about artificial intelligence and new apps while people are dying because NHS systems don’t talk to each other.

For those who are faced with a tax rise to fund an extra £20bn a year for the NHS, “investment” in new IT from international suppliers will not be top of their list of priorities.

Given the pressures within the health service to meet increasing demands from an ageing population, perhaps the new maxim for central planning of NHS IT ought to be: do nothing other than what is absolutely necessary.

Nobody is inspired by technocratic talk. What inspires is the bringing about of a major common good at a surprisingly low cost.

BBC Today interview with Matt Hancock on NHS IT – 6 September 2018


£20bn for the NHS? – not spent like this please

Johnathan Lewis, CEO Capita (right) and Simon Stevens, Chief Executive, NHS England (left) at Monday’s Public Accounts Committee.

By Tony Collins

Capita apologies for working “blind” on NHS outsourcing contract – but no humility from NHS England

Capita’s CEO Johnathan Lewis was contrite and authoritative when he appeared before public accounts MPs in the House of Commons on Monday.

He apologised unreservedly for what the committee chairwoman Meg Hillier called “a shambles”, which was Capita’s £330 seven to ten-year contract to run a range of services for GPs, dentists and ophthalmologists, as well as handle invitations and test results for cervical screening.

Capita’s Primary Care Support Services contract began in 2015 and complaints about the service from medical practitioners began to flow months later.

Capita made mistakes, said Lewis who was supported by his colleague Stephen Sharp, who reports directly to Lewis on public sector contracts. One mistake was that Capita tried to save money too soon by folding the work of 47 local NHS offices with 1650 staff into three offices without fully understanding that each office had a different way of working and a different way of delivering NHS services.

[A similar mistake helped to floor the £10bn National Programme for IT in the NHS (NPfIT), where suppliers and Whitehall officials tried unsuccessfully to use computers to standardise working practices and services in hundreds of hospitals before they fully understood the widely-different approaches of each hospital.]

Lewis told the Public Accounts Committee on Monday,

“This was an extremely complex outsourcing of services that I think both parties would recognise were not fully understood when the work was outsourced – the volumes, the scope, the fact that the service was being delivered in different ways across the different regions that became NHS England. At the same time I recognise the pressure NHS England were under to reduce costs and hence the pressure on them to outsource.”

His colleague Stephen Sharp added,

“I think mistakes were made. During the bid stage, NHS England did say there were some inconsistencies and differences within the various operations. But once Capita got into all the offices and looked at it, the inconsistencies and differences were not inconsequential. It was more or less 45 different services being run from 45 different offices, so the closure programme, which we adhered to and carried on with, we maybe should have stopped. We just made the problem worse as we went along.”

Why didn’t you stop the office closures, asked Conservative MP Anne Marie Morris who added that “even the NHS said, ‘We think you need to stop’.”

Sharp replied,

“We were actually working blind for a period of time. It was only once the service had been running under our control for a few months that complaints started to come in and we started to see visibility that there were bigger issues than we thought there were.”

With hindsight he said he would not have closed offices “until we had got the procedures operating on a national basis”. He conceded that if NHS England and Capita had deferred closing offices, the first two years of savings of about £60m would not have been achieved.

Capita’s losses of £140m

Lewis said that Capita had invested £125m in the contract but, given the loss of profit margin, the losses would be closer to £140m. “We will not make money over the life of this contract,” said Lewis.

An MP asked: why not walk away?

Lewis replied, “Because we made a commitment to deliver this service and reputations depend on that commitment. We see the public sector as a segment of our market that helps us achieve a diversified revenue base. It is a segment where we have services and solutions, where we can create value for the taxpayer and that is why it is an attractive segment.”

Capita is now meeting 41 of the 45 KPIs and, though the company is making good progress against the remaining four KPIs, it doesn’t change the fact that “our initial execution on this contract was not good and for that we apologise unreservedly,” said Lewis.

There were failings on the part of NHS England too. Health officials were so anxious to achieve the savings from closing offices and replacing old IT that couldn’t be relied on that they failed to test new national, standardised working practices and services before they asked a supplier to implement this strategy.

The result was that officials at NHS England had no clear idea of how much work they were outsourcing. They left due diligence to Capita; and Capita admitted at the hearing it did not do enough due diligence at the bid stage. If it had understood how much work was involved it would have bid a higher price or not bid at all.

NHS England also failed to involve most of the potential end-users – GPs, dentists and ophthalmologists in the design and planning of new services that would directly affect them such as pensions and payments.

Lewis said.

“There are other stakeholders that have historically not been brought into this process to the extent that they should have been, such as the BMA [British Medical Association] in how we might implement the digitisation of pension payments and the management of its pensions, or the Confederation of Dental Employers with regard to ophthalmic payments.

“We want to bring them into the process in ways that they have not been historically because we think that that will ultimately lead to a more successful roll out of the technology… They rightly have influence over the process. If we are going to roll out a process for digitising the 20,000 paper documents that cover the process by which you get refunded for an ophthalmic prescription today, surely those people need to be involved in the final roll-out and configuration of that solution.”

Absence of humility?

When MPs questioned the top official at NHS England, Simon Stevens, there was little sign of humility, contrition or regret. He left an impression that the same problems could end up being repeated by a different supplier under a different contract. One Conservative MP Bim Afolami found himself “sticking up for Capita”.

Afolami said,

“Do you feel, Mr Stevens, that criticism of this contract is in any way unfair on Capita? The more I hear, the more I feel that Capita has taken the sharp end of this and NHS England, despite slight reputational difficulty, has saved £60 million. To what extent do you feel that you should take more of the blame here and Capita should take less of it?”

Stevens emphasised the £60m savings but made no mention any of the contract’s specific problems such as the thousands of patient records that went missing, dozens of women left off cancer-screening lists, the qualified GPs who were unable to work for months while the system delayed verifying their entitlement to go onto a “National Performers List”, the GPs who ran short of basic supplies or the GPs and ophthalmologists who suffered financial detriment because of delayed payments.

Said Stevens,

“First, let me say that this has clearly been a rocky road, and the National Audit Office accurately described the bumps along the way, which are regrettable. That should not obscure the fact that, notwithstanding the economic pain that Capita has experienced, the contract has saved taxpayers £60 million in lower administrative costs in the National Health Service over the first two years of its life … that £60 million of savings is not to be sniffed at; it is the equivalent of 30,000 operations.”


Campaign4Change has repeatedly criticised Capita’s performance on Barnet’s outsourcing contract, in part because Capita and the council have been markedly defensive – thin-skinned.

It was refreshing, therefore, to hear Capita’s newish CEO Jonathan Lewis being openly contrite over highly-visible failings in the NHS contract. He gave the impression to public accounts MPs of being a CEO who is determined to put right the failings for the sake of Capita’s reputation. The cost of correcting the problems seemed a secondary consideration.

With Lewis at the helm, Capita’s share price has continued to rise in recent weeks.

Less impressive at Monday’s hearing was Simon Stevens, NHS England’s chief executive, who seemed to imply that NHS England had done nothing wrong.  It was a reaction we’ve come to expect from top civil servants after an IT-related programme disaster. It’s never the fault of officialdom.

The reality is that NHS England was almost as culpable as Capita. NHS England rushed the whole outsourcing exercise – which doomed it from the start. It didn’t listen to critics who warned that primary care support services were too locally diverse and inherently problematic to standardise as part of a national  outsourcing deal.

Instead of first piloting and agreeing with GPs, dentists and ophthalmologists fundamental changes in working practices that would be needed across the country, NHS England went ahead with signing a co-called transformation deal with Capita.

NHS England paid only lip service to engagement with the new system’s end-users in the medical professions. By its own admission Capita, because of its own internal shortcomings, went into the contract blind.

What’s worrying is the way civil servants blithely repeat mistakes of the past and later say they did everything right.

The National Programme for IT in the NHS – NPfIT – failed in part because it was rushed, the implications of “ruthless standardisation” were not fully understood at the outset and there was a lack of proper engagement with potential end-users in hospitals and GP practices. All these same mistakes were made by Capita and NHS England on the Primary Care Support Services contract.

When ordinary human beings become senior civil servants there seems to be a requirement that they lose at a cellular level the facility to express humility and contrition. That loss is replaced by an overly prominent complacency. Whatever goes wrong is not their fault.

Stevens said in essence that NHS England did everything right. Through its unpublished project reviews, the Major Projects Authority – now the Infrastructure and Projects Authority –  endorsed NHS England’ s plans. All the so-called experts gave the outsourcing deal what Stevens called a “thumbs-up”.

It would have been surprising if Stevens had said the public sector was in any way to blame.

At least Capita has learned the lessons. It has a financial interest in doing so.

Ministers can learn from Capita’s candid chief executive

NHS England’s management of Primary Care Support Services contract with Capita – National Audit Office report

Monday’s televised Public Accounts Committee hearing with Capita’s Jonathan Lewis and Simon Stevens of NHS England

£837m wasted on Universal Credit IT?

By Tony Collins

Is Universal Credit an IT disaster or a qualified success for the government’s biggest agile programme?

A less obvious part of today’s National Audit Office report “Rolling out Universal Credit” raises a question of whether taxpayers have paid £837m on a computer system that wasn’t essential.

The so-called “live service” system has been built in part by the DWP’s major IT suppliers Accenture, IBM, HP and BT. It will be decommissioned in July next year. Instead the DWP will continue to use an internally-supplied agile “full service” system to support Universal Credit claims.

Amyas Morse, head of the National Audit Office, questions in today’s report whether Universal Credit is any better or more efficient than the decades-old benefit system it is supposed to replace. He says,

“Universal Credit has taken significantly longer to roll-out than intended, may cost more than the benefits system it replaces, and the Department for Work and Pensions will never be able to measure whether it has achieved its stated goal of increasing employment…

“Universal Credit has not delivered value for money and it is uncertain that it ever will.”

Whitehall officials and ministers including the then work and pensions secretary Iain Duncan Smith expected the roll out of Universal Credit to have finished by October last year. In fact only around 10% of the final expected caseload are currently claiming Universal Credit, says the report.

There are no plans to re-use most of the hardware or software that taxpayers paid for as part of the £837m “live service” system.

The “live service” was built on a foundation of existing DWP IT hardware and software. The new agile system which is called the “full service” is built largely from scratch. It’s the government’s largest ever agile development programme.


Universal Credit is supposed to simplify an overly complex benefits system. It  rolls six working-age benefits into one system but its current running costs are £699 per Universal Credit claim. Officials had expected it to cost £173 per claim by 2024-25.

The Department for Work and Pensions has spent a total of £1.9bn on administering the programme so far -and it’s at least five years from completion.

It looks likely that Universal Credit will take much longer than the 10 years it took originally to computerise the benefits system in the 1980s. That original benefits system, called “Operational Strategy” was supposed to cost £713m. It ended up costing £2.6bn.

In reply to its critics, the Department for Work and Pensions says the estimated savings of Universal Credit are much greater than the costs. But the National Audit Office has learned that the DWP keeps re-calculating its savings estimates upwards, sometimes for no sound reason.

Indeed the report finds that DWP officials are already overstating savings by “approximately £462 million each year”.

Other findings in the report suggest that:

  • The full business case was a piece of creative writing. The full business case is supposed to be a final check on whether the Treasury releases funds for a roll-out. But the Treasury had approved funds anyway, before the business case was signed off last month (May 2018). The report says the full business case was “produced at a time when the government was already committed to rolling out the programme using an agile approach”.
  • Officials have yet to fully understand the risks of fraudulent claims. DWP managers do not have the means to “enable them to identify potential fraud”. The report says DWP officials must “understand the causes of Universal Credit fraud and error identified to date and respond to these promptly”.
  • Officials are making up savings estimates as they go along. Savings estimates of introducing Universal Credit are put at £8bn a year but, says the report, “these benefits remain theoretical. We have significant doubt about the main benefits …”
  • The DWP has a cultural resistance to accepting criticism or bad news. It regards its critics as ill-informed. The DWP’s response to criticism is to say that “anecdote is stronger than management information”. The National Audit Office says that officials “often dismiss evidence of claimants’ difficulties and hardship instead of working with these bodies to establish an evidence base for what is actually happening”. The result, says the report, “has been a dialogue of claim and counter-claim and gives the unhelpful impression of a Department that is unsympathetic to claimants”.
  • A good news culture prevails. Says the National Audit Office, “The Department’s view of the success of Universal Credit contrasts sharply with those of the external organisations we spoke to.”
  • The roll-out is already six years behind its original schedule and is not due to complete until 2023 at the earliest. The report hints that the DWP ought to slow down even more. It says the DWP hshould “ensure the programme does not expand before business-as-usual operations can cope with higher claimant volumes”.
  • Five years into the roll-out the DWP has “enough functionality to run a basic system, but many processes are still manual and inefficient”.
  • The DWP “significantly overestimated the number of claimants that would be able to confirm their identity online”. Only 38% compared with its expected 90% succeeded in using Verify, the government’s online identity verification tool.


The National Audit Office has produced a superb, thoroughly-researched report.

It would be easy to conclude from its findings that Universal Credit IT has been a disaster.  In fact it’s a qualified success for the government’s biggest agile programme. A parallel “waterfall” project that was developed in case the agile system didn’t work is being decommissioned next year. The waterfall “live service” has cost £837m so far which appears to have been wasted.

Had the DWP and ministers not rushed Universal Credit in the early stages – which is what happened with the NHS National Programme for IT NPfIT – officials could have fully understood what they were doing and not needed to develop two completely separate systems in parallel.

The private sector would love the luxury of developing two completely different computers at the same time and adopting only the one it preferred. But having access to public funds, the DWP could afford to be profligate. And it has been – with impunity. In the public sector there is collective responsibility. No individual will be held responsible for spending £837m unnecessarily.

Indeed the DWP will tell MPs on the Public Accounts Committee that both systems were needed. The “Live Service” that will be decommissioned has enabled the DWP to obtain the benefits of Universal Credit earlier than would have been the case had it waited for an agile system to be rolled out.

But what benefits? The National Audit Office report questions the DWP’s benefit claims. Indeed the DWP’s poor record on accurate forecasting  of the costs and savings on IT programmes and the frequency with which its officials revise costs and savings figures on Universal Credit, are enough to cast doubt on the credibility of the DWP’s every public assertion or announcement.

Universal Credit IT is by no means a disaster story but with £837m of wasted spending and the numerous problems and risks the programme still faces, it can hardly be categorised as a success – unless you believe the DWP’s announcements, press releases and statements.

National Audit Office report – Rolling out Universal Credit


A system-wide problem with Horizon connectivity?

By Tony Collins

The Post Office has said in the past that its controversial Horizon system has not had system-wide problems.

This month, however, the system has had two serious widespread outages. On 10 May 2018, Computer Weekly reported that about 2,000 Post Office branches were unable to connect to the organisation’s computer system for a few hours on 9 May because of a connectivity issue.

A second problem last week affected “the whole network” according to a spokesperson at the National Federation of SubPostmasters.

“In the past two weeks we’ve had two instances, just under a quarter of the network was affected earlier in the month, and yesterday the whole network was down for a couple of hours,”

The spokesperson told BBC News that its members have suffered financially because of the problems.

“Sub-postmasters only get paid if they are serving customers so any downtime means they are out of pocket, and people are unable to send their mail.

“The Post Office uses a nationwide computer system to make sure all items are tracked correctly before being sent. If this suddenly stops working then it means potential delays to your parcel across all depots in the UK.”

Those reading Post Office statements on its Horizon system over the years could have gained the impression that the system was able to cope with every eventuality. These are some of the Post Office’s comments on the Horizon system:

“… Post Office maintains that Horizon is capable of handling power and telecommunications problems.”

“Horizon is operated by thousands of Subpostmasters, the majority of whom have not had any issue with the system or its effectiveness.”

“Post Office maintains that the fact that almost 500,000 users have used Horizon since its inception and only 150 have raised a complaint to the Scheme shows that it is fit for purpose.”

“Post Office considers it fair to assume that if a loss has occurred then it has been caused in the branch and is something for which, in most circumstances, a Subpostmaster is liable to make good.”

“… there is no evidence of systemic problems with branch accounting on Horizon. All existing evidence overwhelmingly supports this position.

“The very small number of sub-postmasters who have experienced issues with the Horizon system are a minute proportion of the tens of thousands of people who have been successfully using the system across the network of 11,500 branches on a daily basis since 1995.”

“It is also important to recognise, however, that to date this system has handled more than 45 billion transactions and that there have been issues with only a tiny, tiny number of them.”

“Our computer system has been used by around 500,000 people in our network over more than a decade, processing billions of transactions during that time for our customers.”

“We have now spent three years investigating and addressing various complaints by a small number of former postmasters. We have done everything and more than we committed to do at the outset. We set up an independent enquiry, which found no systemic flaws in the system …”

Last week, the Post Office said in a statement: “We’re really sorry for any inconvenience that the connectivity issues at some of our branches caused yesterday. The issue was resolved within a few hours, and our branches are now back to business as usual.”

 Legal action

 Subpostmasters are taking a group legal action against the Post Office through Justice for Subpostmasters Alliance. The subpostmasters and mistresses blame the Horizon system for financial losses that the Post Office has sought to recover from the individual Post Office branch owners.

Some branch owners lost their livelihoods and had their lives ruined. At least one was said to have committed suicide. Some were jailed, made bankrupt or died while awaiting justice.

The Post Office has claimed the number of complainants is “tiny”, but the actual number of subpostmaster-claimants is now 561.

A High Court hearing is planned for November 2018. It will hear from 12 potential “lead cases”, six of which were selected by Post Office Limited and six by Freeths solicitors who represent the claimants.

These individual cases will be decided ahead of the rest of the Group of 561 and will be used to demonstrate some of the key issues, in particular the fairness of the contract between the claimants and the Post Office.

Computer Weekly reported last month that a forensic examination of the Horizon system by specialists commissioned by the Criminal Courts Review Commission has raised further questions.

“The forensic accounting company hired by the Criminal Courts Review Commission to look more closely at the controversial IT system blamed by sub-postmasters for their wrongful prosecutions has completed its initial findings, and from this has decided to make further enquiries,” said Computer Weekly.


No computer system is infallible,. The Horizon system is decades-old and has had innumerable patches, additions and enhancements.

After two outages this month, one of which is said to have been network-wide, will the Post Office be able to continue with its claim that the system has not had any system-wide problems?

Indeed how credible in general is the Post Office’s case against 541 subpostmasters? At long last the answer to that question no longer rests with the Post Office. A decision on whether injustices that date back years can be corrected will rest with a High Court judge.

It’s a matter the Post Office ought to have settled long ago. Instead it has relied on the public purse to fund the perpetuation of a series of injustices.

Connectivity issue hits thousands of Post Office branches – Computer Weekly May 2018

Post Office hit by computer problems – BBC News May 2018

Justice for Subpostmasters Alliance


NHS England’s Capita contract repeats past blunders

By Tony Collins

A National Audit Office report published today on NHS England’s £330m Capita contract highlights blunders that will be familiar to anyone who recalls the mistakes and false assumptions that floored the £10bn National Programme for IT [NPfIT] in the NHS.

Labour MP Meg Hillier, who heads the Public Accounts Committee, said of the Capita contract,

“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.

“Neither NHS England nor Capita properly understood the scale of the challenge before agreeing the contract and are still in dispute over future payments.

“Yet again this is poor contracting by Government with one of its major suppliers and it must learn lessons.”

But will any lessons be learned? Those who have followed the problems that beset the NPfIT and the NHS Capita contracts will see a similar pattern of mistaken beliefs, false assumptions, flawed risk assessments and over-optimistic reviews on both deals.

The NPfIT was “dismantled” in 2011. The Capita contract, which was signed in 2015 and started in September that year, has improved, says the National Audit Office, but there are still disputes between Capita and NHS England over the supplier’s performance.

These are some of the main findings of today’s National Audit Office report NHS England’s management of the primary care support services contract with Capita. The Capita (and NPFIT) contracts were floored by:

– over-ambitious, unrealistic plans that were not challenged by anyone who was taken seriously

– too little involvement of prospective end-users

– – a lack of Whitehall understanding of how people worked at the coal-face

– inadequate piloting of proposed changes

– a false assumption that IT on its own can standardise diverse working practices

– a false assumption that IT suppliers will be able to take over and understand a complex and problematic safety-related public service while at the same time transforming it.

– a false assumption that the contract will make up for a suppliers’ inadequacies

– over-optimistic internal project “review” reports by civil servants for civil servants which will say what civil servants want them to say

– the wrong risks being assessed – in this case whether the savings would be achieved rather than whether Capita would provide a good service

– the alienation of medical professionals by the NHS’s issuing statements claiming the problems were teething when they were going on for years and getting worse.

Numerous complaints by GPs and their trade association the BMA and campaigning articles in Pulse magazine eventually caused NHS England to act on the contract.

[In the case of the NPfIT, a Whitehall and House of Commons reaction was eventually triggered by GPs, hospital staff and others complaining to Computer Weekly, national newspapers and broadcasters.]

Below are some of the detailed findings of today’s National Audit Office report on Capita’s NHS contract. My sub-headings on the lessons not learned from the NPfIT are in italics:

Was NHS England in control of Capita contract – or was Capita in full control?

  • Capita initially denied being in breach of service obligations
  • Capita argued there was no pre-contract baseline data on which to judge its performance
  • NHS England assured itself Capita’s improvement plan was fit for purpose – then found it was “ineffectual”.
  • Despite Capita’s improvement plan issues became “more widespread”.

National Audit Office report:

“On 27 May 2016, NHS England wrote to Capita formally expressing concerns about performance issues and seeking to enact the recovery arrangements set out in the contract. Capita initially denied being in breach of its service obligations. It argued that there were no baseline data from before the contract to benchmark its performance against and confirm whether service standards were being met. In its response of 17 June 2016, NHS England stated that the lack of performance data meant that Capita could not yet prove that it was meeting performance standards. It considered that there was enough evidence to place Capita in a formal process to rectify services, given the delays in setting up the customer support centre, the medical records service, and payments to opticians. However, NHS England considered that the improvement plan that Capita had developed would be sufficient to resolve the problems.
“NHS England formally intervened in Capita’s management of the contract in September 2016. It told us that by the end of summer 2016, it had become clear that Capita’s improvement plans were ineffectual in some key areas and that issues had become more widespread. NHS England served default notices, placing five of Capita’s nine services in a formal rectification process: the customer support centre; the medical records service; the patient registration service; the national performers lists service; and payments to opticians. It also embedded an ‘expert management team’ in Capita, to work alongside operational staff and provide additional oversight and support. 

Just because outsourcing together with standardising systems and working practices seem justified doesn’t mean you should

 NHS England aimed to reduce its costs by 35% from the first year of the contract and transform and modernise the service. The government’s mandate to NHS England required it to make significant reductions in its administrative running costs. NHS England also wanted to provide a high-quality and standardised service.
When NHS England took responsibility for primary care support services in 2013 they were being delivered by 1,650 staff from 47 local offices, managed under separate local arrangements, with no national leadership, no common standards in service specification or operating processes, and with limited data on performance. Services were supported by a 20-year-old IT system that NHS England considered was unsustainable and in urgent need of replacement, and many processes relied on the manual processing of paper‑based documents. NHS England considered that it would not be possible to deliver the required savings in‑house as it did not have the necessary skills in transforming services through better use of IT.

Major Projects Authority blunder – no wonder its reports are secret

The final review by the Major Projects Authority – which is now the Infrastructure and Projects Authority – noted that this was a well-run programme and that successful delivery appeared probable… The procurement was supported by commercial experts in the Cabinet Office … and was approved by the then Department of Health and HM Treasury

Don’t outsource until you know precisely what you’re outsourcing

  • NHS England didn’t understand the diverse local processes Capita was supposed to standarise
  • False assumptions were made
  • NHS England didn’t benchmark existing data before outsourcing
“NHS England did not know enough about the services it inherited to set achievable service specifications and performance standards from the start of the contract. This was a complex first generation outsourcing. NHS England lacked adequate data on the volume and cost of the services before the contract was awarded, and there were no consistent measures of performance. It told us that it recognised that there was variation in how services were delivered across the country, but that it did not have a detailed understanding of how local processes were different. As a result, it made a number of assumptions about the volume, cost and performance of the services in order to set service specifications and performance standards. To mitigate the risk around the robustness of the activity data, the contract included a clause to ensure that volume data could be reviewed in the first few months and, if necessary, the contract starting volumes could be revised. Capita only requested one ‘allowable assumption’ that permitted future adjustments related to uncertainty in the number of staff to be transferred


“Because of gaps in its knowledge, NHS England had to make a number of assumptions about the volumes and costs of the services before awarding the contract. For example, it used data on the number of GP practices and the types of contract they held to estimate the number of GP payments that would be needed and the volume of orders for NHS supplies. NHS England told us, that to mitigate the risk around the robustness of the activity data, the contract included a clause to ensure that volume data could be reviewed in the first few months and if necessary the contract starting volumes could be revised. It also told us that it provided all the information and service access that bidders needed to develop their bids and as a result Capita only requested one allowable assumption that allows for future adjustments in cases of uncertainty. This related to the number of staff to be transferred.
“NHS England also made assumptions about current performance in order to set service specifications and measures for assessing PCSE’s performance. The contract set out 58 performance indicators – 24 key performance indicators and 34 standard service levels. NHS England considers that the key performance indicators are more important, as failure to deliver them would result in greater operational and reputational loss to NHS England.
“The mobilisation period did not give NHS England and Capita enough time to assess whether Capita was ready to start transforming the service. As a result, neither NHS England nor Capita knew enough about PCSE’s performance when Capita started making changes to the service in March 2016.
“It took longer than expected for Capita to develop consistent information about its performance. The contract allowed a three-month period to assess how performance at the start of the contract differed from expectations set out in the performance measures. Where performance measures were not being met, Capita could propose variations or alternative measures. If agreed, these would be applied for a period of two years (known as the transformation period). However, NHS England told us that it took Capita five months to start providing consistent information about its performance. NHS England considers that the quality of Capita’s data has improved but it still has concerns about its quality and reliability.”

Another repeated NPfIT blunder – contracting out and transforming at the same time

“NHS England’s decision to contract with Capita both to run existing services and also simultaneously to transform those services, was high risk. Capita was incentivised through the contract to close existing services to minimise its losses but the interaction between running, closing and transforming services was more complex than Capita or NHS England had anticipated. This was a high-risk strategy, particularly for a set of incompletely understood services being outsourced for the first time.”

Savings at a personal cost and risk to patients?

  • Despite the massive disruption for GPs, opticians and dentists, 87 women being notified incorrectly that they were no longer a part of the cervical screening programme, a backlog of 500,00 patient registration letters, some 64% of GP practices saying they had received incorrect patient records in the last three months, 1,000 GPs, dentists and opticians being unable to work and a loss of earnings and missed and inaccurate payments to practitioners, the savings Capita was contracted to deliver were delivered.
“In the first two years of the contract, NHS England achieved savings of £60 million compared to expected savings of £64 million. NHS England has reduced the cost of delivering the service by 30% from £87.8 million in 2014-15 to £62.7 million in 2016‑17. In 2016-17, NHS England’s costs included £41 million made in payments to Capita. It also spent £22 million on other related costs such as buying NHS forms, records archiving facilities and managing the PCSE contract.”

Don’t cut staff until you know for certain you don’t need them. The worst time to cut staff is before the IT-related changes have bedded in. Until then, you’ll need more people – not fewer. 

“Performance issues emerged shortly after Capita started closing primary care support offices and making other changes to the service. In March 2016, Capita introduced a new online portal for primary care providers to use to order supplies. In April 2016, it introduced a new courier arrangement and labelling system for moving medical records, which replaced different local arrangements. These changes were poorly implemented and providers struggled with the new systems. There were also problems caused by shortages of stock in the NHS supply chain. These issues resulted in a significant increase in the number of calls to Capita’s customer support centre, which could not cope with the increase. Between December 2015 and November 2016, Capita closed 35 of the 38 support offices it inherited and cut staff numbers from 1,300 to 660.
“Capita underestimated the scale and nature of the task and the impact of closing sites and losing local knowledge. Capita acknowledges that it took longer than anticipated to make changes to primary care support services. It underestimated the number of staff that would be needed to deliver the services, in part due to inaccurate assumptions about the volume of activity. It originally anticipated that it would only need around 314 staff by March 2018, but its actual headcount was 736. Capita also acknowledges that it made performance issues worse, by continuing to close support offices in summer 2016 even though it was aware the customer service centre was struggling to meet demand. The site closures resulted in the loss of local expertise. Procedures in place to retain local expertise did not work effectively as the staff who were retained did not always understand the systems being used in other regions.
“Capita Business Services Ltd (Capita) acknowledges that it underestimated the number of staff that it would need to deliver PCSE and the time it would take to implement changes. Capita’s bid involved reducing the number of staff from 1,390 at the start of the contract to 314 by March 2018, in order to minimise its losses over the first two years of the contract (Figure 10). As at March 2018, it had 736 staff working on PCSE, as the number it originally forecast was insufficient. Capita told us that contributing factors to this underestimation included higher service volumes than predicted and the significant variation in how services were delivered, including by NHS England area teams. It has also taken longer than it anticipated to make changes to the service, because it underestimated the extent of variation in the way local support offices operated and the time it would take primary care providers to adapt to new ways of working.”

NHS England took months to act against Capita

“NHS England formally intervened in Capita’s management of the contract in September 2016. It told us that by the end of summer 2016, it had become clear that Capita’s improvement plans were ineffectual in some key areas and that issues had become more widespread. NHS England served default notices, placing five of Capita’s nine services in a formal rectification process: the customer support centre; the medical records service; the patient registration service; the national performers lists service; and payments to opticians. It also embedded an ‘expert management team’ in Capita, to work alongside operational staff and provide additional oversight and support.”

An appalling contract?

“NHS England’s performance measures did not cover all the service areas Capita were required to deliver. Without comprehensive service indicators, NHS England cannot tell whether the services meet the needs of primary care providers. NHS England did include performance measures in the contract, although these did not cover all the activities that Capita was required to deliver. A review of the contract, carried out by NHS England in March 2016, found that of 78 key activities that Capita was contracted to carry out, some 23 were not captured by performance measures and were therefore ‘invisible’ to NHS England. It identified that 13 of the 23 activities without performance measures could affect patient safety if not delivered to standard. NHS England are in ongoing discussions around extending performance monitoring (paragraphs 3.8 and 3.13).
“Performance measures lack indicators on providing a high-quality service, as NHS England’s focus was on efficiency. For example, the performance measure for payments to GPs measured whether Capita is making payments on time but not whether the payments are accurate.


“Performance measures do not always cover the end-to-end performance of PCSE. For example, the contract measures Capita’s performance in delivering patient records only from when the records are picked up from GP surgeries. They ignore any delays picking up the records – a particularly acute problem for GPs.”

What’s the point of a few KPIs in an appalling contract?

“There were still gaps in the performance measures used to monitor Capita’s performance when it started to make changes to PCSE. NHS England’s review of the contract, in March 2016, found that of 78 key activities that Capita was contracted to carry out, some 23 were not captured by performance measures and were therefore ‘invisible’ to NHS England. It identified that 13 of the 23 activities without performance measures could affect patient safety if not delivered to standard.
“NHS England’s performance measures were not flagging issues when stakeholders started raising concerns in April 2016. At this time, Capita was reporting that it was meeting all but 4 of the 49 performance measures set by NHS England. The stakeholders we spoke to consider that there is still a mismatch between Capita’s reported performance that takes into account factors that Capita considers to be outside its control, and the issues that they are experiencing on the ground.
“NHS England told us that service specifications lack detail in some areas which leads to disagreements, as they are open to different interpretations. Areas of misunderstanding include:
  • Performance measures. The contract allowed Capita to use less onerous performance measures during the transformation period, from February 2016 to August 2017. However, as the transformation is not yet complete, it is unclear whether Capita should still be using these measures. The measures that were to be applied from August 2017 set a higher standard of performance.
  • By May 2018, NHS England and Capita had still not agreed how to calculate 11 performance measures.
  • The method of calculating the volumes of services and payments. NHS England does not agree with the approach that Capita has used to calculate the volumes of services. It considers this approach to be inconsistent with the methodology described in the contract. The volumes being reported by Capita are significantly different to the baselines set out in the contract for some services.”

What’s the point of a contractual “target”?

“Capita’s contract with NHS England gave a three-month period to agree final service volumes and performance targets with NHS England. At the end of this period, Capita reported that it had not been able to collect sufficient information to complete this exercise.”

Problems escalate – and further contractual measures make things worse

“In March 2016, it (Capita) opened an online portal for primary care providers to order NHS forms and some medical supplies. However, the number of orders far exceeded its expectations and there were not enough vehicles to fulfil the orders. This also affected the movement of medical records, as the service used the same vehicles. There was also a shortage of stock in the NHS supply chain which resulted in further delays in fulfilling orders. As a result of these issues, the number of calls to Capita’s customer support centre was higher than predicted, and the centre could not cope with the increase in demand.
“In April 2016, Capita implemented a contingency arrangement for moving medical records, following the decision to delay the full roll-out in March. This involved a single courier collecting records from GP practices and taking them all to Capita’s Darlington depot for sorting before being distributed. All legacy local couriers ceased to operate at this point. There was a further increase in the number of calls to the customer support centre as GP practices raised queries about the new process.”

Incompetent risk assessment?

The biggest risk was whether Capita would perform – but NHS England put the focus of its risk assessment on the threat of not meeting the financial savings targets.

“NHS England’s assessment of the contract risk focused on the likelihood of it failing to achieve its financial savings target and did not adequately assess the risk of Capita failing to provide the service to a good standard. Gaps in the data meant that NHS England could not challenge whether assumptions in the contract were reasonable. NHS England considered that Capita had access to existing service expertise that they had used to inform and test their transformation plans. It did not bring in staff with senior-level skills in transforming a service, as it expected this expertise to sit within Capita .
“NHS England also did little to assess whether Capita had the necessary skills to transform services successfully. Capita had partnered with an existing provider of primary care support services, Anglian Community Enterprise, which Capita was to contract services from. NHS England told us that it therefore considered that Capita had access to existing service expertise that they could use to inform and test their transformation plans. NHS England did not bring in staff with senior-level skills in transforming a service, as it expected this expertise to sit within Capita.”

 Capita acts against NHS England’s wishes

NHS England did not have the contractual mechanisms to intervene in some of Capita’s service changes. Capita expected to make a loss of £64 million in the first two years of the contract. Its bid involved reducing the number of staff by two‑thirds by January 2018. Capita therefore had an incentive to close support offices and cut back on staff as quickly as possible, in order to minimise its losses in the first two years of the contract. In May 2016, NHS England wrote to Capita expressing concerns about the closure of support offices, and asked Capita to reconsider its plans to reduce its number of staff. Although Capita’s site closure programme required NHS England’s engagement throughout the process, the contract did not require NHS England’s agreement to close offices, and between May and November 2016, Capita closed a further 20 offices.
“NHS England was unable to stop Capita’s aggressive office closure programme, without cancelling the contract, even though it was having a harmful impact on service delivery.
“The contract provided incentives for Capita to close primary care support offices and cut back on staff as quickly as possible, so that it could minimise its losses in the first two years. However, NHS England wrote to Capita on 6 May 2016, expressing concerns about Capita’s plans to significantly reduce its staff numbers at a time when there were significant issues with its performance. It also questioned whether Capita’s plans to deliver efficiency savings over a period of a few weeks, to compensate for the reduction in staff, were realistic. Although Capita’s site closure programme required NHS England’s engagement throughout the process, the contract did not require NHS England’s agreement for Capita to close offices or reduce staff.
“Between May and November 2016, Capita closed a further 20 offices and reduced its headcount from 820 to 660 employees. Both NHS England and Capita recognise that Capita made performance issues worse in spring 2016, by continuing to close support offices, as this resulted in the loss of local expertise.”

Basic contract principles still not agreed – 3 years into the contract

“Basic principles about the contract are still not agreed, which limits NHS England’s ability to hold Capita to account. NHS England and Capita have still not agreed how to calculate the volume of work carried out in some areas, and how these data should be used to calculate payments owed to Capita for delivering the services. By May 2018, two and a half years into the contract, they have not yet agreed on how to calculate 11 performance measures. There is a contractual mechanism for putting a service in rectification but none for exiting the rectification process. Capita provided NHS England with reports in August and September 2017 setting out why services should be taken out of rectification, but NHS England has not formally responded to three of these service reports. NHS England told us that it was waiting for further evidence from Capita on two services before it could consider if rectification was complete.”

NHS England claims maximum service credits from Capita – but these are contractually capped

“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 compared with expected savings of £64 million, as the financial risk of increased costs sits with Capita. To date, NHS England has deducted £5.3 million from payments to Capita as penalties for poor performance. The financial penalties are capped at £480,000 a month and were applied in full between July 2016 and April 2017. NHS England noted in its 2016-17 financial statements that it expected that it may have to pay up to £3 million in compensation to primary care providers. Contract penalties have yet to be applied from May 2017 because NHS England does not accept Capita’s reported performance data due to disagreements about the scope of some of the measures. This disagreement only emerged once Capita’s self-reported performance no longer triggered maximum service credits.
“The contract allows NHS England to apply financial deductions if Capita does not meet certain performance standards from January 2016. For example, if Capita processes fewer than 98.25% of GP payments on time, it is deemed a moderate failure and triggers a minimum penalty of £10,800 a month. The maximum penalty that can be applied for service failures was £480,000 a month in the first two years of the contract. From year three, it is set at 20% of payments to Capita, excluding fixed investment changes. Figure 9 on page 28 shows that, by April 2017, NHS England had deducted £5.3 million from payments, represented 7% of the total payable to that point. The maximum penalty was applied between July 2016 and April 2017. Contract penalties have yet to be applied from May 2017 because NHS England does not accept Capita’s reported performance data due to disagreements about the scope of some of the measures.
“No contract penalties have yet been applied for the period after April 2017. Negotiations are continuing on the penalties to be applied for the rest of year two and beyond.”

Capita’s losses?

“NHS England and Capita have reached a settlement on the first two years of the contract but commercial discussions about the future of the service are ongoing. Both parties have agreed a full and final settlement of all known commercial issues for the first two years of the contract, to 31 August 2017. NHS England paid Capita an additional £3.2 million. Capita has absorbed significant additional costs in excess of the £64 million losses it anticipated in the first two years, resulting in a £125 million loss over this period, including write-offs and service credits. Since September 2017, there has been no agreement on the full basis of charging. Capita stopped invoicing NHS England for services from September 2017, but resumed invoicing in February 2018 on the agreement that it would not prejudice the commercial discussions.”

NHS England to blame as well as Capita

“As well as Capita, a number of other organisations, including NHS England, have contributed to the underperformance of PCSE services. For example:
“For the market entry service, Capita is required to provide NHS England with a file, so that they can make a decision about applications for new pharmacies within 70 days of receipt of the initial application. In November 2017, only 41% of applications were processed on time – either because applicants and referees had not provided key information, or decisions had not yet been received from NHS England.
“The performance of the medical records service has been affected by difficulties retrieving medical records held in NHS England’s archives as well as from current GP practices. It was also affected by poor implementation by Capita of the new national courier arrangement for moving records, and difficulties that GP practices experienced complying with a new labelling system.
“The performance of the national performers lists service has been affected by the lack of timely decisions on removals and suspension requests by NHS England’s area teams.
“NHS England acknowledges that some of the issues with GP payments and pensions are a result of legacy issues predating the contract with Capita. In particular, there are a number of inaccuracies and missing documents affecting GP pension records, which can affect the accuracy of payments.”

Take some services back in-house?

NAO recommendation: “Determine whether all current services within the PCSE contract are best delivered through that contract or whether some should be taken in-house by NHS England. Experience has now highlighted which services can most easily be delivered by Capita and which have more complex dependencies. The current commercial discussions present an opportunity to revisit responsibilities.”

Get the buy-in of service users (also an NPfIT failure)

NAO recommendation: “Secure user engagement in advance of service changes. Primary care providers are a valuable source of practical feedback and can offer insights that will improve service delivery, especially where changes through transformation are significant.”

Pilot changes properly (also an NPfIT failure)

NAO recommendation: “Pilot significant transformation changes effectively. Several changes to services were not initially implemented effectively. NHS England could profitably discuss with Capita when pilots would offer the greatest benefit.”

Don’t under-estimate risks (also an NPfIT failure)

NAO recommendation: “Create a joint risk register which would more thoroughly set out dependencies, mitigations, responsibilities and required actions. NHS England did not adequately assess the risk of service failure and Capita failed to recognise the scale and nature of the task it was taking on. A joint risk register would allow delivery challenges and actions to surface at an earlier stage.”

Risk-assess bidders

NAO recommendation: “Risk assess the likelihood of bidders being able to deliver their promises and challenge the targets and assumptions of bidders. This should include benchmarking bidders on their capability to deliver their promises, such as by examining past performance. There should also be sufficient modelling to understand the contractor’s cost drivers and incentives.”

Disputes continue …

“Whether Capita has met the criteria for services to be removed from the formal rectification process. Capita considers that services should be taken out of formal rectification, but NHS England thinks there are still issues that need to be resolved. NHS England told us that the contract does not set out the process for removing services from rectification. Capita provided NHS England with a report for each service in August and September 2017, setting out why it should be taken out of formal rectification. However, NHS England has not formally responded to three of these reports. It told us that it was waiting for further evidence from Capita on two services before it could consider if rectification was complete.
“NHS England told us it considers that PCSE’s performance has improved. In February 2018, Capita Business Services Ltd (Capita) reported that it was meeting 41 out of 45 of its mitigated performance indicators, where information was available after taking into account factors Capita considered beyond its control. Capita was reporting one severe failure, which was for not notifying opticians that they had submitted an invalid payment claim within 30 calendar days. In November 2017, Capita reported it was meeting 40 out of 43 of its mitigated indicators, with one severe service failure. NHS England has not accepted Capita’s reported performance since May 2017 for 11 measures where there is a difference of view about how it should be calculated.
“The unadjusted underlying performance provides a better indicator of the performance that primary care providers are experiencing on the ground. In February 2018, unadjusted performance was more variable (32 out of 45 indicators being met) with seven severe service failures. In November 2017, only 28 out of 43 unadjusted performance indicators were being met, with 10 areas of severe service failure. Paragraph 2.13 describes how unmitigated performance is influenced not just by Capita, but by other organisations, including NHS England.
“For the period from 1 September 2017, NHS England and Capita are currently in unresolved commercial discussions. The main areas of disagreement are:
  • price bands – NHS England and Capita do not agree on the methodology for calculating the volumes of services
  • uncertainties about which performance measures should apply and the methodology for measuring performance against these measures
  • whether contract changes should be made for services that Capita considers are outside the scope of the original contract; and
  • the financial costs of delays in delivering transformation and the dependencies on NHS England and NHS Digital to support transformation.
“Because of the absence of an agreed basis for charging, Capita stopped invoicing NHS England for services from September 2017. Capita resumed invoicing in February 2018 on the agreement that it would not prejudice the commercial discussions.”


Today’s excellent National Audit Office report makes invaluable reading for anyone who is involved in implementing a major IT-related project or programme.

The depressing thing is that lessons from the 1997 book “Crash” – a collection of post mortems of the world’s worst IT disasters – have changed little in 20 years.

Capita has its accountabilities – in the share price and the jobs of senior people on the NHS England contract, some of whom have been replaced, including the PCSS managing director.

Who will be held responsible at NHS England for failures on the Capita contract? Nobody, as you’d expect in the public service. Decisions to outsource GP support services – against the firm advice of many GPs – were taken collectively. The responsibility is therefore diffuse and unidentifiable.

Clearly NHS England has repeated many of the classic mistakes; and in years to come NHS England, or its successor organisation, will probably do the same again because there’s no such thing as an institutional memory.

One possible answer may be for those involved in making big decisions on IT-related contracts in the public sector to be mandated to read – and assimilate – today’s National Audit Office report on GP support services, knowing that the report unwittingly identifies so many of the classic IT-related project and programme blunders.

National Audit Office report on Capita’s Primary Care Support Services contract 

Are you happy paying to help with problem Capita contract?

By Tony Collins

This week, as Barnet residents go to the polls, how many will be influenced by the continuing national and local media coverage of the council’s mass outsourcing deal with Capita?

Barnet’s Capita contracts are a local election issue. The council’s conservatives and Capita say the outsourcing contracts have saved money and are performing as expected “in many areas”.

But a former local Tory councillor Sury Khatri , who has been deselected after criticising the Capita contract, described the deal as “disastrous”. Barnet has paid Capita £327m since the deals were signed in 2013. Capita runs council services that range from cemeteries to IT.

Councillor Khatri said,  “My time at the council has been overshadowed by the disastrous Capita contract that is falling apart at the seams. Four years on, issues still keep rolling out of the woodwork. This contract represents poor value for money, and the residents are being fleeced.”

Another critic of the Capita contracts is John Dix who blogs as “Mr Reasonable” and is one of several highly respected local bloggers. He has been studying the council’s accounts for some years. He runs a small business and is comfortable with accounts and balance sheets.

He writes,

“I have no problem with outsourcing so long as it is being done for the right reasons. Typically this is where it involves very specialist, non core activities where technical expertise may be difficult to secure and retain in house.

“In Barnet’s case this outsourcing programme covered so many services which were core to the running of the council and which in 2010 were rated as 4 star (good). Barnet has been an experiment in mass outsourcing and almost five years in, it appears to be a failure.

“Last night’s [19 April 2018] audit committee was a litany of service problems, system failures, lack of controls, under performance, a major fraud. Internal audit saying issues were a problem, Capita saying they weren’t.”

Shadow Chancellor John McDonnell has entered the debate. He has applauded Barnet’s Unison branch for its enduring, close scrutiny of the Capita contracts. Unison this week published a report on the deal.

Capita’s share price rises

Earlier this month the national press reported extensively on concerns that Capita would follow Carillion into liquidation.

Since the bad publicity, the company’s announcement of a pre-tax loss of £535m, up from £90m the previous year, £1.2bn of debt and a rights issue to raise £662m after fees by selling new shares at a discount, Capita’s share price has risen steadily, from a low a month ago of about 130p to about 191 yesterday.

Could it be that investors sense that Capita’s long-term future is secure: the company has a wide range of complex and impenetrable public sector contracts where history shows that public sector clients – ruling politicians and officials – will defend Capita more enthusiastically than Capita itself, whatever the facts?

A list of some of Capita’s problem contracts is below the comment.


Carillion, a facilities management and construction company, collapsed in part because the effects of its failures were usually obvious: it was desperately short of money and new roads and hospitals were left unfinished.

When IT-based outsourcing deals go wrong, the effects are usually more nuanced. Losses can be hidden in balance sheets that can be interpreted in different ways; and when clients’ employees go unpaid, or the army’s Defence Recruiting System has glitches or medical records are lost, the problems will almost always be officially described as teething even if, as in Capita’s NHS contracts, they last for years.

It is spin that rules and protects IT outsourcing contracts in the public sector. Spin hides what’s really going on. It is as integral as projected savings and key performance indicators.

When Somerset County Council signed a mass outsourcing deal with IBM, its ruling councillors boasted of huge savings. When the deal went wrong and was ended early after a legal dispute with IBM the council announced that bringing the deal in-house would bring large savings: savings either way. Liverpool council said the same thing when it outsourced to BT – setting up a joint venture called Liverpool Direct – and brought services back-in house: savings each time.

Barnet Council is still claiming savings while the council’s auditors are struggling to find them.

Spinmeisters know there is rarely any such thing as a failed public sector IT contract: the worst failures are simply in transition from failure to success. Barnet’s council taxpayers will never know the full truth, whoever is in power.

Even when a council goes bust, the truth is disputed. Critics of spending at Northamptonshire County Council, which has gone bust, blame secretive and dysfunctional management. Officials, ruling councillors and even the National Audit Office blame underfunding.

In March The Times reported that Northamptonshire had paid almost £1m to a consultancy owned by its former chief executive. It also reported that the council’s former director of people, transformation and transactions for services, was re-hired on a one-year contract that made her company £185,000 within days of being made redundant in 2016.  Her firm was awarded a £650-a-day IT contract that was not advertised.

In the same month, the National Audit Office put Northamptonshire’s difficulties down to underfunding. It conceded that the “precise causes of Northamptonshire’s financial difficulties are not as yet clear”.

Perhaps it’s only investors in Capita who will really know the truth: that the full truth on complex public sector contracts in which IT is central will rarely, if ever, emerge; and although Capita has internal accountability for failures – bonuses, the share price and jobs can be affected – there is no reason for anyone in the public sector to fear failure. No jobs are ever affected. Why not sign a few more big outsourcing deals, for good or ill?

Thank you to FOI campaigners David Orr and Andrew Rowson for information that helped me write this post.

Some of Capita’s problem contracts

There is no definitive list of Capita’s problem contracts. Indeed the Institute for Government’s Associate Director Nick Davies says that poor quality of contract data means the government “doesn’t have a clear picture of who it is buying from and what it is buying”. Here, nevertheless, is a list of some of Capita’s problem contracts in the public sector:

Barnet Council

A Capita spokesperson said: “The partnership between Capita and Barnet Council is performing as expected in many areas. We continue to work closely with the council to make service enhancements as required.”

Birmingham City Council

“The new deal will deliver a mix of services currently provided under the joint venture, plus project based work aimed at providing extra savings, with forecasts of £10 million of savings in the current financial year and £43 million by 2020-21.”

West Sussex County Council

A spokesman said, “Whatever your concerns and small hiccups along the way, I believe this contract has been and will continue to be of great benefit to this county council.”

Hounslow Council

A Capita spokesperson said: “We are working closely with the London Borough of Hounslow to ensure a smooth transition of the pensions administration service to a new provider.”

Breckland Council

“They concluded that planning officers, working for outsourcing company Capita, had misinterpreted a policy, known as DC11, which dictates the amount of outdoor playing space required for a development..”


Mark Francois, a Conservative former defence minister,  said Capita was known “universally in the army as Crapita”. But Capita said in a statement,

“Capita is trusted by multiple private and public clients to deliver technology-led customer and business process services, as demonstrated by recent wins and contract extensions from clients including British Gas, Royal Mail, BBC, TfL Networks, M&S and VW.”

Electronic tagging

(but it’s alright now)

A Ministry of Justice spokeswoman said: “As the National Audit Office makes clear, there were challenges in the delivery of the electronic monitoring programme between 2010 and 2015…

“As a direct result, we fundamentally changed our approach in 2015, expanding and strengthening our commercial teams and bringing responsibility for oversight of the programme in-house.

“We are now in a strong position to continue improving confidence in the new service and providing better value for money for the taxpayer.”

Disability benefits

A spokesperson for the Department for Work and Pensions said, “Assessments work for the majority of people, with 83 per cent of ESA claimants and 76 per cent of PIP claimants telling us that they’re happy with their overall experience…”


A Capita spokesperson said: “This issue has been resolved and all members affected will shortly receive letters to advise that they do not need to take any action. We sincerely apologise for any concern and inconvenience this has caused.”




BBC licence fee


Hundreds of IT-related deaths in the NHS every year? … why the full truth will never emerge

By Tony Collins

Two academics have given talks in London about the number of NHS patients who might have died because of IT-related problems.

Their comments come almost exactly five years after the Francis report into the “appalling suffering” of patients at Mid Staffordshire NHS Foundation Trust. The Francis report criticised an NHS culture that lacked candour and openness. Has that culture changed?

One of the academics was Martyn Thomas, a visiting professor in software engineering at Oxford, Aberystwyth and Bristol universities. The other academic was Harold Thimbleby, professor emeritus of geometry at Gresham College in London and professor of computer science at Swansea University.

IT is used in nearly every area of hospital activity, from storing and retrieving medical record to making appointments. Technology is also embedded in devices hat include MRI scanners and dialysis machines.

Speaking at a briefing before a lecture, Thimbleby said: “If you go into a hospital there isn’t a good word to describe how bad stuff in a hospital is and how unaware people are in hospitals of the low quality: they’re stuck with it. They’re over-worked, they’ve got a job to do and understanding the computer systems isn’t part of their job …”

He added that NHS computer-related deaths each year of between 100 and 900 people could be a big underestimate.

“Piper Alpha had 167 deaths and there was a public inquiry; Ladbroke Grove, the rail crash in Paddington had 31 deaths and there was a public inquiry; Grenfell, the fire last year had 71 years, and there is a public inquiry. Why don’t we have a public inquiry in the safety of hospital software?”

Thomas described how research in the USA has shown that 8% of all deaths are caused by errors in hospitals. In the UK, this could equate to tens of thousands of preventable adverse events in hospitals, he said.

He added that a significant proportion of clinical negligence claims in the NHS are due to poor and buggy computer systems that lead professionals into making mistakes – which are blamed on the professionals.

“That’s a lot of money going into liability claims; it’s a lot of trauma to patients and their families and it is a lot of trauma for staff because the staff get blamed and it really isn’t their fault.”

Thimbleby and Thomas called for better regulation of healthcare computers and more research into the implications of errors.

A Department of Health and Social Care spokeswoman told the Press Association,  “Patient safety is our priority, and our £4.2 billion investment in technology will help eliminate avoidable harm.”

But do hospitals generally report IT-related incidents that cause – or are suspected to have caused – harm?

Bath’s Royal United Hospital

Three year-old Samuel Starr died in the arms of his parents as his they read him his favourite stories at the local hospital.

At an inquest in 2014, his parents, and specialists, raised questions about whether long delays in arranging appointments on a new Cerner Millennium system at Bath’s Royal United Hospital, which replaced an old “TDS” patient administration system, was a factor in his death.

Ben Peregrine, the speciality manager for paediatrics at the RUH in Bath,  told the inquest:

“Samuel’s appointment request must have fallen through the cracks between the old and new system.”

After successful heart surgery at 9 months, Samuel should have had regular scans to see if his condition had worsened. But he didn’t have any scans for 20 months, in part because of difficulties in organising the appropriate appointments on Bath’s new Millennium systems.

Though there is no certainty, Samuel may be alive today if he’d had the scans.


A year after the inquest, one of the supplier’s announcements on its website was about the success of its go-live at the Royal United Hospital, Bath.

“Royal United Hospitals Bath NHS Foundation Trust and Cerner have been working together to implement Cerner Millennium Maternity functionality in a RECORD TIME! It took only three months from the start of the project to its “go-live”! This is a first in the UK!

“The success of this implementation was mainly due to the very strong collaboration between Cerner and the Trust’s team…”

The success was in maternity – not paediatrics where Samuel Starr was being treated – but there was no reference to any Cerner-related implementation problems at the Royal United Hospital.

Has anything changed?

As the Francis report into Mid-Staffordshire trust’s failings found in 2013, the NHS has its own “house style” for how it handles the reporting of its not-so-good news – or suspected harm – to patients.

The Royal United Hospital Bath has a “normal” NHS way of reporting IT-related matters. It has an NHS-specific “good news” house style that hasn’t changed in decades.

One Royal United board paper reported that it had “only” 14 breaches that month [November 2017] of its target for treating patients with suspected cancer within 62 days of urgent referral by a GP.

And anyone looking in the hospital’s board papers for details of its recent IT-related problems would have no answer to any of these basic questions:

  •  how many patients were affected?
  •  in what way were they affected?
  • what was done about it?
  • why did it happen?

On 7 November 2017, Royal United Hospital implemented what it called the “Big 3”. The first of the Big 3 was the “Cerner Millennium EPMA”. There was no explanation in the board papers, at least for the benefit of non-executive directors, of what EPMA meant (electronic prescribing and medicines administration).

The second of the big three was “First Net”. Again no explanation that it is a Cerner product that helps to support triage and tracking, ordering tests and recording results, integrating documents into the patient’s electronic medical record, providing discharge plans along with GP follow-up instructions and prescriptions and management reporting.

The third of the Big 3 was “order comms” which, again, had no explanation. Order comms replaces paper by allowing doctors and nurses to order things electronically such as x-rays and receive updates on their systems.

More importantly, the Royal United Hospital’s board papers omit to give any context of the Big 3 go-live. What will it provide that numerous go-lives and past updates haven’t provided? No answer.

The RUH was one of the first computerised large hospitals in the UK. It bought into the controversial Regional Information System Plan of Wessex Regional Health Authority. The Plan wasted millions in the early 1990s.

Subsequently Tony Blair introduced the ill-fated NHS IT programme – the National Programme for IT [NPfIT] in the NHS. In  2002, the Royal United Hospital bought into that too. It replaced its Wessex “TDS” system with the Cerner electronic patient system from BT, one of the NPfIT suppliers.

The NPfIT was dismantled in 2011 with losses of billions of pounds, though some hospitals including Royal United, continue to use updated NPfIT systems.

The new Big 3 go-live went well, according to a report to the Royal United Hospital board. It said the “systems went live within the proposed project timescales” and the go-live “was successful overall”. But there’s no explanation of what didn’t go well, merely a brief mention that a “unified focus was required to complete the project”.

If you look carefully amid the graphs, bar charts, diagrams and statistics of the board papers, it’s possible to see that not everything went well. There’s a chart that shows a significant fall in emergency patients seen within the target of four hours when the Cerner systems went live. The fall is shown on a chart that looks at first as if it’s positive news: it reports the results of a “4-hour maximum wait in ED (Emergency Department) – improvement trajectory”:

And the last paragraph of text that accompanies an obscure chart in a different part of the board papers says that the trust’s four-hour wait remains the “trust’s most significant performance issue”.

But “normal” NHS house style still unofficially requires an obscure use of language when things go wrong, as if patients are not involved. Hence there’s no mention in the hospital’s board papers of any patients that might have been affected by problems with the Big 3 implementation.

These are some extracts from the Royal United Hospital’s board papers:

  • “Negative impact due to Big 3 go live on the 7th November 2017 specifically affecting early flow, time to assessment and time to treatment. Improvement plan in place.”
  •  “Due to the Big 3 Go Live on 7th November, the ED Clinical Quality timing indicators are under review pending ED clinical validation and a workflow investigation. Upon successful data quality review, the ED clinical quality indicators will be reinstated in the Performance Report.”
  • RTT incomplete pathways in 18 weeks at 88.2% below the Trusts Improvement Trajectory and the 92% national standard. This is slightly improved performance from October.
  • Overall 4 hour performance not achieved for Majors or Minors.
  • The Board are asked to discuss November performance, noting the impact on performance from the ‘Big 3’ go-live. Some performance metrics are not shown for November on the scorecard as data is being validated following the ‘Big 3’ go-live. IT and BIU are working to resolve this.”


Thimbleby and Thomas refer to an unknown number of deaths in the NHS because of a variety of IT-related problems. Nobody has any real idea of the numbers.

That the truth is obscured is not the fault of NHS IT people. They deserve much understanding, even sympathy. They often have poor work environments – sometimes in grim pre-fabricated huts or decaying buildings overlooking the car park – that have the usual hospital disinfectant smells and equipment that would be welcomed by IT museum curators. This post is not directed at them.

It’s directed at the NHS culture of  board reporting that turns up the volume on good news and buries in impenetrable NHS house style bad news.

Thimbleby and Thomas are to be applauded for drawing attention to NHS IT-related deaths. The circumstances of Samuel Starr’s death show that NHS administrative problems can have fatal consequences – yet the NHS generally categorises administrative IT systems as having no patient safety implications.

Earlier this month the National Audit Office reported that thousands of clinical notes went astray under an NHS outsourcing contract with Capita. We were told that nobody was harmed.

Despite the Francis report into unnecessary deaths and suffering at the Mid Staffordshire NHS Foundation Trust in 2013, the NHS trust board culture, at least when it comes to reporting on IT-related problems, has not changed. These were some of the Francis report’s findings that are relevant to IT reporting to NHS boards today:

  • A culture focused on doing the system’s business – not that of the patients;
  • An institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern;
  • Standards and methods of measuring compliance which did not focus on the effect of a service on patients;
  • A failure to tackle challenges to the building up of a positive culture.

One of the main recommendations of the Francis has certainly not been implemented.

“Ensure openness, transparency and candour throughout the system about matters of concern.”

Thank you to Zara Pradyer for alerting me to articles about the NHS and IT-related deaths. Thank you also to a local newspaper journalist who alerted me to the trust board papers.

A tragic outcome for Cerner Millennium implementation at Bath.

NHS computer problems could be responsible for hundreds of deaths, academics claim

Francis report into Mid Staffordshire’s failings – executive summary

Deaths and electronic medical records

Government Digital Service loses “genius” and “national treasure”. Is Sir Humphrey winning campaign to dismember GDS?

,By Tony Collins

The dismembering of the Government Digital Service is underway, says Andrew Greenway, a former programme manager working on digital projects for the Cabinet Office. He now works as an independent consultant.

His comments in Civil Service World came, coincidentally, as another top GDS official prepared to leave.

Paul Downey, GDS’s Technical Architect – who is described by former colleagues as a “legend” and “national treasure” – has left to join the Ministry of Housing, Communities and Local Government.

Downey is the latest in a long line of leading government technologists to leave GDS, which will confirm in the minds of many that Sir Humphrey has won the campaign to stop GDS interfering in the 100 year-old autonomy of individual government departments.

Cabinet Office minister Francis Maude and entrepreneur Martha Lane Fox set up GDS in 2011 to break down departmental silos and have a “single version of the truth” for everything that government touches.

Former prime minister David Cameron said the creation of GDS “is one of the great unsung triumphs of the last Parliament”

Downey helped departments to create new digital services. He represented GDS on the UK government Open Standards Board. Formerly he was BT’s Chief Web Services Architect.

In reply to Downey’s tweet announcing his departure, Stephen Foreshew-Cain, former Executive Director of GDS, tweeted, “When people talked about standing on the shoulders of giants, they were talking about you.”

Mike Bracken, Foreshew-Cain’s predecessor as head of GDS, tweeted about Downey’s departure, “You’re a legend, my friend”.

Tom Loosemore, founder of GDS who, in 2012, wrote the Government Digital Strategy for GDS, also tweeted praise for Downey.

Loosemore left GDS in 2015 for the Co-op group. In an interview shortly after leaving, Loosemore said, “The shape of government needs to change … Businesses don’t run on siloed departments any more and neither should government.”

Liam Maxwell, National Technology Adviser at HM Government who used to be the government’s chief technology officer and who ran teams at GDS, tweeted,”You have been total inspiration to me and hundreds of others”.


Greenway said GDS retains people, prestige and power.  “There is no question that the civil service is in a much stronger position on digital than it was six years ago. Some of the work going on in government, including the teams in GDS building digital platforms, remains world-leading”.

Despite bleeding skills elsewhere, GDS has not experienced a terminal brain drain, says Greenway. “Many of those who have stayed are doing a heroic job in trying circumstances.”

But he added that officials working on digital programmes in other departments describe the GDS team as well-meaning but increasingly peripheral.

 It now looks as if the Department of Digital, Culture, Media and Sport will take over from GDS. But Greenway warns against replacing a weakened centre with diffuse departmental effort.

“The point of GDS was to have a single team that could act as the voice of users for government as a whole. To do that well, it needed a mandate covering data as well as design, operations and technology. It also had to have a clear mission. Increasingly, it has neither of these.

“The departmental shape of government gives no incentive for any non-central department to step in. It is a great shame that the two most well-placed advocates for an effective centre — the Treasury and Sir Jeremy Heywood — have proved unable or unwilling to stop the rot …

“The dismembering of GDS is underway.”


GDS was a great idea. But Sir Humphries tend not to like great ideas if they mean internal change. Permanent secretaries are appointed on the basis that they are a safe pair of hands.  Safe in this context means three things:

  • not spilling the beans however rancid they may be
  • valuing  department’s unique heritage, administrative traditions, staff and procedures
  • talking daily of the need for large-scale “transformative” change while ensuring it doesn’t happen.

Thus, for the past few years, GDS professionals have found that top civil servants want central government departments to continue to be run as separate bureaucratic empires with their uniqueness and administrative traditions preserved.

GDS technologists, on the other hand, want to cut the costs of running Whitehall and the wider public sector while making it easier for the public to interact with government. This puts GDS at odds with Whitehall officials who believe that each departmental board knows best how to run its department.

In the long run GDS cannot win – because it was set up by politicians who wanted change but whose stewardship was temporary while the will to dismember GDS comes from the permanent secretariat who do not welcome change and have the power to resist it.

More’s the pity because taxpayers will continue to spend a fortune on preserving departmental silos and huge, unnecessarily-complex technology contracts.

Andrew Greenway on the dismembering of GDS – Civil Service World

GDS deserves credit for its successes – Government Computing

GDS to lose some policy control? – Computer Weekly

Government Digital Service blog

Government Digital Service being “dismembered”

Capita’s problems were “preventable” says Royal London

By Tony Collins

Royal London, a Capita investor, said yesterday it has been “raising concerns about Capita’s weak governance with the firm for a number of years, and voting against many resolutions on director re-elections and pay consistently since 2014.”

Royal London is the UK’s largest mutual life, pensions and investment company. It managed £113bn of funds as of 31 December 2017. It owns a 0.44% stake in Capita.

Ashley Hamilton Claxton, Royal London Asset Mananagement’s Head of Responsible Investment, said in a statement,

“We welcome the honesty and transparency with which Capita’s new CEO has accepted the company’s past failings, and put a plan in place to simplify and improve the business. However, we believe this was preventable and have been privately raising concerns about Capita’s weak governance with the firm for a number of years, and voting against many resolutions on director re-elections and pay consistently since 2014.

“Until recently, Capita’s board flouted one of the basic rules of the corporate governance code, with a small board primarily comprised of management insiders. The result was a board that lacked the independent spirit to rigorously assess whether the company was making the right long-term decisions.

“Our concerns about governance were compounded by the complexity of the underlying business and the company’s acquisition strategy. Capita’s approach to remuneration also left something to be desired, with major losses in 2013 being excluded from the profit figures used to assess the bonuses paid to executives at the firm.

“The sea change in the board over the past 18 months has been welcome and has addressed the key issue of independence. It will be up to the new Chairman and the Board to ensure that Capita does not repeat the mistakes of the past, and that its strategy is fit for purpose during a particularly turbulent time for the outsourcing sector.”

Last week Capita issued a profits warning and announced plans to raise £700m from investors to reduce debts.

With Capita seeking to raise money and cut costs, where will this leave local government customers that are reliant on the supplier to cut the costs of running local services?

Barnet Council has, controversially, contracted out a large chunk of its services to Capita – and also gives the company tens of millions in advance payments in return for a discount on the supplier’s fees.

By becoming a “commissioning council”, Barnet has made itself wholly reliant on Capita, say critics of the outsourcing deal. Among other responsibilities, Capita produced the council’s latest annual accounts – including a financial account of its own services to the council. The accounts were not produced on time which created extra chargeable work for the council’s auditors BDO.

Capita has run into problems on a number of its major outsourcing deals. The National Audit Office is investigating its work on GP support services.

Councillor Barry Rawlings, leader of the Labour group in Barnet, said the profits warning and Capita’s low share price raised questions about how it may respond to further troubles.

He told The Guardian that Capita may be looking to cut back services it supplies.

“Capita handles all of the back office, enforcement, planning, environmental health, trading standards, estates, payroll and so on. Will that be part of their core services? We might be one of the only places they do some things. If they narrow their scope, what is going to happen to these services?

Conservative leader of  Barnet council, Councillor Richard Cornelius, said,  “Capita currently runs approximately 10 per cent of our services by value. They do not run the entire council as some reports have suggested.

“The council regularly reviews the financial status of its major suppliers as part of its contract management and contingency planning arrangements. This is what any responsible local authority would do.”

Capita’s share price has more than halved in the last month – from about 400p to a low on 1 February 2018 of 158p – but today rose by about 10% to 196.


When an outsourcing giant is looking to cut its costs and raise money to cover debts, how does that square with local government customers that also want to cut costs – which is why they outsourced to Capita?

Outsourcing can make good sense – when for example a global company like BP wants to standardise IT services across the world. It doesn’t always make sense when an organisation wants a service transformation while also cutting costs. Something usually has to give which, perhaps, Barnet Council and its taxpayers are slowly finding out.

Ministers told of major problem on Capita NHS contract more than a year later

By Tony Collins

Today’s Financial Times and other newspapers cover a National Audit Office report into GP clinical notes and correspondence, some of it urgent, that was not directed to the patient’s GP.

The correspondence was archived by Capita under its contract to provide GP support services. But patient notes were still “live”. They included patient invitation letters, treatment/diagnosis notes, test results and documents/referrals marked ‘urgent’.

What isn’t well reported is that ministers were left in the dark about the problems for more than a year. The National Audit Office does not blame anyone – its remit does not include questioning policy decisions – but its report is impressive in setting out of the facts.

Before NHS England outsourced GP support services to Capita in 2015, GPs practices sent correspondence for patients that were not registered at their practice to local primary care services centres, which would attempt to redirect the mail.

By the time Capita took over GP support services on 1 September 2015, GPs were supposed to “return to sender” any correspondence that was sent to them incorrectly – and not send it to primary care services centres that were now run, in part, by Capita.

But some GPs continued to send incorrectly-addressed correspondence to the primary care services centres. Capita’s contract did not require it to redirect clinical correspondence.

An unknown number of GP practices continued to send mail to the centres, expecting the centre’s staff to redirect it. A further complication was that Capita had “transformation” plans to cut costs by closing the primary care services support centres.

Capita made an inventory of all records at each site and shared this with NHS England. The inventories made reference to ‘clinical notes’ but at this point no one identified these notes as live clinical correspondence. Capita stored the correspondence in its archive.

In line with its contract, Capita did not forward the mail. It was not until May 2016 – eight months after Capita took over the primary care services centres – that Capita told a member of NHS England’s primary care support team that there was a problem with an unquantified accumulation of clinical notes.

It was a further five months before Capita formally reported the incident to NHS England. At that time Capita estimated that there was an accumulation of hundreds of thousands of clinical notes. When the National Audit Office questioned Capita on the matter, it replied that, with hindsight, it believes it could have reported the backlog sooner.

In November 2016, Capita and NHS England carried out initial checks on the reported backlog of 580,000 clinical notes. It wasn’t until December 2016 that ministers were informed of problems – more than a year after Capita took over the contract.

Even in December 2016 ministers were not fully informed. Information about a backlog of live clinical notes was within in a number of items in the quarterly ministerial reports. NHS England did not report the matter to the Department of Health until April 2017 – about two years after the problems began.

Even then, officials told ministers that clinical notes had been sampled and were considered “low clinical and patient risk”. But a later study by NHS England’s National Incident Team identified a backlog of 1,811 high priority patient notes such as documents deemed to be related to screening or urgent test results.

The National Audit Office says, “NHS England expects to know by March 2018 whether there has been any harm to patients as a result of the delay in redirecting correspondence. NHS England will investigate further where GPs have identified that there could be potential harm to patients. The review will be led by NHS England’s national clinical directors, with consultant level input where required.”

Last month Richard Vautrey, chairman of British Medical Association’s General Practitioners Committee, wrote to the NHS Chief Executive Simon Stevens criticising a lack of substantial improvement on Capita’s contract to run primary care service centres.

In December, the GP Committee surveyed practices and individual GPs on the Capita contract. The results showed a little improvement across all service lines, when compared to its previous survey in October 2016, but a “significant deterioration” in some services. Vautrey’s letter said,

“While any new organisation takes time to take over services effectively, the situation has gone from bad to worse since Capita took over the PCSE [Primary Care Support England] service almost two and a half years ago …

“This situation is completely unacceptable. As a result of the lack of improvement in the service delivery of PCSE we are now left with no option but to support practices and individual doctors in taking legal routes to seek resolution. While this is taking place, we believe it is imperative that NHS England conducts a transparent and comprehensive review of all policy, procedures and processes used by PCSE across each service line.”


It’ll be clear to some who read the NAO report that the problems with urgent patient notes going astray or being put mistakenly into storage, stems from NHS England’s decision to outsource a complex range of GP support services without fully considering – or caring about – what could go wrong.

It’s not yet known if patients have come to harm. It’s clear, though, that patients have been caught in the middle of a major administrative blunder that has complex causes and for which nobody in particular can be held responsible.

That ministers learned of a major failure on a public sector outsourcing deal over a year after live patient notes began to be archived is not surprising.

About four million civil and public servants have strict rules governing confidentiality. There are no requirements for civil and public service openness except when it comes to the Freedom of Information Act which many officials can – and do – easily circumvent.

Even today, the fourth year of Capita’s contract to run GP support services, the implications for patients of what has gone wrong are not yet fully known or understood.

It’s a familiar story: a public sector blunder for which nobody will take responsibility, for which nobody in particular seems to care about, and for which the preoccupation of officialdom will be to continue playing down the implications or not say anything at all.

Why would they be open when there is no effective requirement for it? It’s a truism that serious problems cannot be fixed until they are admitted. In the public sector, serious problems on large IT-related contracts are not usually fixed until the seriousness of the problems can no longer be denied.

For hundreds of years UK governments have struggled to reconcile a theoretical desire for openness with an instinctive and institutional need to hide mistakes. Nothing is likely to change now.

National Audit Office report – Investigation into clinical correspondence handling in the NHS.

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