(8 years, 1 month ago)
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Mr Geoffrey Robinson (Coventry North West) (Lab)
I thank the Speaker for granting this debate. It is timely, because while the issue has been raised by local GP practices and their senior managers in Coventry, I am well aware, following a gracious call from the Minister’s office and given the presence of other hon. Friends, that the problem has a wider significance and that it has echoes in many other parts of England, at least. I thank Jane Moxon and others who came to see me—all very senior practice managers in Coventry. They alerted me what is evidently a growing problem throughout the country.
The Minister, who is aware of the situation emerging across the country, kindly asked whether she should address the wider issue, or concentrate on Coventry. The topic of the debate is the impact on patient care and the health service in Coventry of the privatisation of the thoroughly well-executed existing service for GPs in our area. The same thing is happening in other areas, however, and I will be very happy to give way to my hon. Friends. Sufficient time is available—not that I want to detain you unnecessarily, Madam Deputy Speaker, or the Minister or other Members, but if there is interest, I am sure that we can accommodate others, such as my hon. Friends the Members for Coventry South (Mr Cunningham) and for Coventry North East (Colleen Fletcher); all three Coventry Members are properly on parade this evening to take part in the debate.
The position was very simply summarised by the senior practice manager from Broomfield Park, Jane Moxon, when she came to see me. She acted as chair for the group, and still does. Warwick University is in the same position: students from the EU face the loss, absence or lateness of their patient records. Allesley Park hosted our meeting; Kevin Arnold is the practice manager there. They have all alerted me to the fact that GPs are simply unable to do their job without having their patients’ records to hand.
An excellent manual service was provided under the national health service, but the Government were taken in by the lure of apparent savings and the prospect of cutting 40% from a £1 billion bill, and they contracted the work out to Capita, of all people. Only last week, we saw what could happen in the absence of a properly thought-through privatisation programme. These contracts are gaily handed out to companies that do not have the skills, preparation or sheer commitment necessary to provide the service.
Karin Smyth (Bristol South) (Lab)
I am grateful to my hon. Friend for initiating this debate. I have been contacted by my GP practices in Bristol South about this issue. In a previous role, I worked in a commissioning group and I have employed GPs. The arrangements for doing that are very complex, requiring specialist local knowledge and a lot of experience. Does he agree that the decision to put the entire service out to a national tender was driven by a desire to make massive wholesale savings, and that the savings target completely ignored the service need locally? Does he also agree that we are in a very poor situation across the country? I hope that the Minister can address that point.
Mr Robinson
My hon. Friend speaks pointedly to the issue. She is absolutely right in every respect, and I thoroughly agree with her. I would go a little further and say that the irony is that we have ended up with a terrible service that is costing more than the previous service ever would, because the company was not properly prepared, did not have a commitment to providing the service, and was unable to do so, and because of the competing and irreconcilable claims about short-term gains in the form of profits and illusory savings for the health service.
Kate Green (Stretford and Urmston) (Lab)
The situation in Coventry that my hon. Friend describes is also being experienced by GP practices in my constituency. GP practice managers have told me that the system was trialled in west Yorkshire and proved unsatisfactory, yet the contract was rolled out regardless. Does my hon. Friend not agree that that is a further irony?
Mr Robinson
Well, we learn something every day. I did not know that, and I am grateful to my hon. Friend for bringing it to my attention. That fact was not mentioned to me in Coventry, where people felt that the new system had been sprung on them completely without trial. When I was a Minister, I was a great supporter of the idea of trialling programmes. After all, we trialled them for a purpose, which was to see whether we were ready for them and whether the contractor was able to provide them. However, that seems to have been ignored in this instance. I shall say a few words at the end of my short contribution about learning lessons. This is not the first time we have been in this position. It is not as though we have suddenly discovered that contracts are not easily transferred, and there are lessons to be learned.
Colleen Fletcher (Coventry North East) (Lab)
Does my hon. Friend agree that this problem does not just affect GP practices in Coventry? It has also had an adverse impact on individual residents, including people who have requested a copy of a late relative’s medical records from the primary care support service. Partly because of the service’s failure to appoint a medical adviser to deal with such requests in the Coventry area, many of those people have been forced to wait for more than twice the maximum 40 days that it should take to process such a request. It is utterly unacceptable to put anyone through that kind of delay, but it is inexcusable for it to happen to anyone who is already in an extremely vulnerable position following the death of a relative.
Mr Robinson
I entirely agree with my hon. Friend, who puts her finger on another aspect of the situation that reveals the true motives of private sector contractors. They are not in it to improve the service and make real savings; they are in it for short-term profit. I have nothing against the private sector making profits—I am all for it—but the irony is that the companies cannot make a profit from a proper service, so they turn to such measures as imposing a £40 charge for access to a deceased relative’s records, as my hon. Friend mentions. They do not have to impose that charge—I think it used to be left to the GP’s discretion—but they now insist on it, and people have to pay postage and delivery charges on top, which is a disgraceful pursuit of short-term gain at the expense of the people they are meant to serve.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Gentleman on bringing this issue to the House. Capita holds the contract for locums for the NHS; no one questions their ability, but does the hon. Gentleman have any concerns about the scheme’s value for money? The Government should look at filling those vacancies from within the NHS, making a saving and keeping that money in the NHS for NHS services.
Mr Robinson
Just as I am in favour of a profitable private sector, I am in favour of savings in the NHS. We all know that we have to make savings, but let us make real savings from properly thought-through programmes. The NHS is often the best place to carry them out. We should not have badly planned impositions from the private sector, which does not know what it is going to do or how to do it.
We have to learn the lessons. It is not as if we have not had plenty of examples, as we saw in our debate last week on another private sector company that reviews benefits. That case was an absolute disgrace, but let us not get diverted on to that, because we had a good debate on it last week. Let us stay with the problem before us tonight. I look forward to hearing what the Minister has to tell us, but I must warn her that I have a few things to say yet; I have only just started. Correct me if I am wrong, Madam Deputy Speaker, but I understand that the debate can go longer than half an hour. I do not want to detain the House, but I urge any Member who wishes to contribute to do so, because we have at our disposal at least double the normal time. If I say that to the dismay and disappointment of the Minister, I am sorry, but we will not delay anybody unnecessarily.
Others have been in touch with me on this subject. I am pleased to say that the good old BBC was made aware of an issue and initiated an excellent survey of what is happening in Norfolk, Suffolk and Essex. The survey was carried out by Nikki Fox, who did a good job and presented a programme on this. She discovered that no fewer than 9,000 records had been lost. Some had been found flying loose on the ground in a car park. God knows what happened to the others—nobody knows. Some 9,000 patient records have gone missing in those three counties alone. It is very much to Mr Paul Conroy’s credit that he has written to me issuing a challenge, which I will come to later, to fulfil our public duty to reveal what has happened, which, as is usually the case, others are trying to hide. Capita says that it is unaware of the problems, yet three counties are up in arms and the BBC has conducted an exposé; it beggars belief.
No fewer than 20 practices in Coventry and Warwickshire have been surveyed, and every single one of them has said that there has been a more or less serious deterioration in services. NHS England itself has now stated that patients could be at risk. The whole purpose of tonight’s debate is to reveal that risk and to urge Capita to correct the problem.
Kate Hollern (Blackburn) (Lab)
I thank my hon. Friend for securing this debate. I have been approached by several GPs in Blackburn who feel that the service they are providing to the public is going under. They can no longer cope with the burden placed on them. Would it be in order to ask the Minister whether she can urgently step in? GPs are under a lot of pressure right now, and this added burden is a false economy and could put patients at risk.
Mr Robinson
I entirely agree with that. We see the problems extended across the border, and indeed they are not peculiar to any one part of the United Kingdom. By their very nature, they are systemic and infect, for want of a better phrase, the whole country, and I am pleased to welcome the Member from the Scottish National party to—
Mr Robinson
I am so sorry, dear. I shall not live that one down in a hurry, but I thought I had detected a Scottish accent. I welcome my hon. Friend to the debate. She is the only one who did not tell me she would be participating tonight, Madam Deputy Speaker. I do apologise, but I cannot correct Hansard and I am afraid to say that the error will stand. I am sure she will forgive me, even if others may enjoy the mistake I have made.
There is no doubt that we are facing a major threat with this situation, and we hope we can stop it before we get to a major incident or catastrophe of some kind. That is the point of tonight’s debate. There is no doubt that this threat exists in Coventry, and we want to see what the Minister has to tell us about it. It is also clear from the interventions, which I have been pleased to take and to respond to, that this problem is widespread in England as a whole. As we have heard, in Bristol and in Manchester, and in the constituencies of those others who have made interventions, the problem is growing, not waning. Given the situation, we have to take steps.
Although we have risen to the challenge put out by Mr Paul Conroy, it is not enough for any Member just to speak up and expose this situation. That is a public duty we have as Members of this House, and the BBC has a duty as the national broadcaster to speak about these problems. We have all had experience of this. Not only have I had my business experience, but I have had experience of problems of this kind while in ministerial office and from others. Everybody in the country knows—it is no secret—that these privatisations, unless they are carefully controlled and well thought out, go wrong, so why do we keep doing them? This particular one involves Capita—it is in the hot seat tonight. It should know what this is about by now, as it has been through several of these and got them all wrong—Capita seems to learn nothing either. Ministers change, and it may be that the Minister knows about it but then gets moved. That is the nature of our appointments system, and I would not want to change anything there, but the civil servants who run these Departments should start to understand these things.
Contract management has many attractions to Ministers and to Government, who contract the problem out and lose direct responsibility for things. Everybody then heaves a sigh of relief and closes the file as if the thing is nothing more to do with them, but that is an illusion, because it comes back to bite them harder than it would have done had they kept the problem under their direct responsibility. It is an illusion to think that we can contract out. The responsibility for a contract remains with the person issuing that contract, and where it is for a major national public service, that contract must be taken seriously. What I did learn in the private sector is that the best companies spent more time preparing the bids for a contract, the assessments of the validity of the contracts and the validation process for a contract than they ever spent in negotiating the thing, which civil servants and Ministers often like to think they are good at. They say, “We had a hard-nosed negotiation on that one. We got them down from Y to X and we saved all this. It is great. We really screwed the private sector, didn’t we?” That is all a total illusion.
The most important thing when we do a contract of this complexity and of this kind is to get to the basis of the issues: to see who is really competent to take it on; who can make the savings that are being claimed in the real world; and who can do the other elements of the contract that have to come into play in a difficult situation competently. It is a question of competence.
Kate Green
My hon. Friend brings his extensive business experience to the debate about value for money when issuing private contracts. Does he agree that whatever the cost savings that may apparently be achieved under this contract, the cost to GPs and to practice managers of coping with the chaos, chasing records and trying to contact the help desk but failing to get through has been substantial? Does he also agree that those GP practices deserve compensation for the additional costs they have incurred?
Mr Robinson
I entirely agree with every single word my hon. Friend says. I would add, by way of a warning, that it is not a question of trying to punish the private sector by making it pay for this. Capita has to put the necessary resources into trying to correct the problem, and that must be its first priority. Something must give in the drive for profit, the drive to cut the costs of the services and the drive to improve the services. Those are irreconcilable objectives to start with, and in rectifying them the first thing that has to go is the drive for profit. Capita must realise that when it comes to put this right, it has to put the resources behind that. Compensation for GPs is important—I do not disagree with my hon. Friend for a minute on that—but I put it secondary to the provision of resources to get the contract right. I am sure that she would agree.
One other aspect of this shows an unacceptable, unpleasant and displeasing aspect of the privatisation process. It appears—I do not know this first hand—that Capita has turned to CitySprint to deliver these things. The effect of that is that we are employing drivers with no contracts, no sickness benefits and no breaks. This continual turning of the screw downwards is leading to a low-wage, low-productivity, low-output and impoverished economy. The workforce is suffering from that and it seems to be characteristic in many areas. For the public service to be involved in that process and almost to accelerate it, tightening that screw, is unacceptable.
This is another aspect of the commitment to negotiation and to the evaluation and validation process. The Government must learn to consider the quality of the service being provided and the quality of the means by which they intend to provide that service. CitySprint does not measure up to the standards we would expect from a good public sector contractor or employer.
To return to the main theme of tonight’s debate, what do we learn from this? The Government—principally the civil service, but Ministers, too—must learn to evaluate and validate the process of contracting out services. They cannot be driven by short-term savings, which are invariably illusory, but must consider the quality of the underlying contract. That is an art that must be learned, but I think it can be.
Karin Smyth
My hon. Friend is being generous with his time. I do not know whether he is aware that the Public Accounts Committee recently held an evidence session on the contract awarded to UnitingCare in Cambridgeshire. Many of the issues he has rightly outlined about the scoping of such contracts and expertise within the NHS were highlighted, particularly as regards whether the expertise was there to do the sort of detailed and specialist work he mentions. Should that expertise be built back into the NHS, so that it can conduct those contracts in the spirit of good public service as opposed to yet more taxpayers’ money being spent on expensive external consultants?
Mr Robinson
We are ranging wide of the debate, but again I have to say that I entirely agree with my hon. Friend, and I saw something about that Public Accounts Committee hearing. That is absolutely right; the problem is getting these lessons learned by the Government. I do not know what it is; it is as if there is an institutional or cultural inhibition leading to resistance to doing the technical job properly. People can be brought in to do it, but—I think that this was my hon. Friend’s point—there is a wealth of knowledge and expertise about the health service in the NHS that needs to be released and employed. Being able to do that is the art of management.
That is my plea. Yes, we want to bash Capita tonight, but more than bashing Capita and hitting out at incompetence and inexperience in the civil service, the real point of tonight is to tell Capita it is in disgrace and needs to get this right. It is obviously a nationwide—an England-wide—problem and it is not just restricted to Coventry. Capita’s overriding No. 1 objective is to put it right. That is our message tonight: “Get your finger out, put it right. Put the resources into putting this whole problem right and do not go for the short-term solution.”
Mr Jim Cunningham (Coventry South) (Lab)
I will just make one or two observations because my hon. Friend the Member for Coventry North West (Mr Robinson) has covered the subject very well. Like him, I have received representations. Since the last reorganisation of the NHS, problems such as this seem to be coming to light. There is a pattern. There was the problem with Concentrix and benefits, which of course is nothing to do with the NHS. We had debates about that a couple of weeks ago. Now this problem with Capita and primary care support is emerging.
When the Government look at such companies, they should look at a schedule of terms and conditions for the service they are going to deliver, the people they are going to employ and their qualifications, and whether people will be employed on zero-hours contracts. I have heard all sorts of stories about companies that subcontract out to smaller companies. That is where the problems start to arise.
There was a ruling a couple of weeks ago on taxis after a case was brought by a trade union. It may well mean that there will be a problem with zero-hour contracts, holiday pay and so on. The Government should look at that when they award contracts.
Like my hon. Friend, I have had GPs in Coventry complain to me about the inadequacy of the services, delays across the board and records being lost. Even the British Medical Association has accused Capita of failures. These delays are making it impossible for GPs’ surgeries in my constituency and across the country to do their job properly. For example, a surgery in my constituency faced delays in receiving patients’ notes. As my hon. Friend has mentioned, that can go on for a long time, and if someone is terminally ill, the situation can be life-threatening. Doctors sometimes have to meet patients without records or knowledge of their medical history, so they have to rely on the patient to provide their history. Patients at the end of the day are not doctors; they can only express in layman’s terms what they think is wrong with them. They need qualified doctors.
Colleen Fletcher
Does my hon. Friend agree that the difficulties experienced by GP practices are being compounded by the inability of Primary Care Support England service centres to deal with inquiries about ongoing problems either by phone or email? Staff from one practice in Coventry said that any response to emails was unusual, long-awaited and often failed to address the question posed. This type of comment is echoed time and again by exasperated practice staff across the city.
Mr Cunningham
My hon. Friend puts it very adequately. I and all my colleagues behind me have all experienced that and the Minister as a constituency MP may well have experienced something like that because it is widespread.
At the end of the day, GPs are having to bear the brunt of the failings of Capita. It is unacceptable that a private company can bid for an NHS contract without the infrastructure in place to deliver. I have already explained to the Minister what that means. Will she allow GPs to be given additional support and help to cope with overstretched services? As I said, a lot of this came about with the last reorganisation of the health service. When people provide a service that is funded on the basis of a policy of cuts, they can expect people to take shortcuts. The patient is important, the GPs are important, but the employment rights of those people who are subcontractors or sub-subcontractors should be upheld.
The Minister should really look into this. I detect a pattern of Government contracting out of services and problems developing with those services. I have already mentioned the problems with the benefit service. Sometimes services are contracted out because Ministers do not want to be answerable at the Dispatch Box. We have had that in the past. The Minister says, “I am not responsible.” We try to get through to the company that is providing the service for the public; we cannot get through to them and the Government pass the buck. I had that last Christmas with Concentrix, but that is another debate. I will end my comments there.
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I congratulate the hon. Member for Coventry North West (Mr Robinson) on securing a very important debate. As the hon. Member for Stretford and Urmston (Kate Green) said, his business acumen was clearly on display. The importance of this debate is clear from the presence of a clean sweep of Coventry Members, but I know that the issue is important to colleagues across the House, so I am pleased to respond to the debate this evening.
I will start with Coventry, as it is in the title of the debate. Coventry is at the forefront of providing extended access to GP services seven days a week through the GP access fund, and it is doing excellent work to ensure that frail or elderly patients can avoid unnecessarily long hospital stays, using integrated neighbourhood teams to make sure that patients have the right primary and community care in place. As has been made clear by the speeches and interventions that we have just heard, excellent primary care such as this relies on effective and efficient support services. The hon. Member for Coventry North West is therefore right to be concerned that the service provided by Capita under the primary care support services contract in Coventry and elsewhere has so far fallen well short of the standards that we expect, and GPs have borne the brunt of these failings, as we have heard today.
It is true, as the hon. Member for Bristol South (Karin Smyth) said, that NHS England needs to make efficiencies. I was pleased to hear that the hon. Member for Coventry North West supports that in principle, and I am happy to confirm that all the savings that are made through this contract are ploughed straight back into frontline NHS services.
It was always clear that Capita’s services needed to be at least as good as those that they replaced. Quality was always part of the tender process. The contract was let via a competitive tendering process, which was subject to scrutiny not only by the Department of Health but by the Treasury, and the bids were assessed for quality, not just cost. Capita put forward the most credible of any of the bids accepted on the short list, and at the time both the Department and NHS England had every confidence that the programme would be a success. However, it is evident that Capita was inadequately prepared for delivering this complex transition.
Mr Robinson
First, does the Minister agree that part of the process preceding the award of the contract should have been to assess whether Capita was ready for it? That is precisely the point that I was trying to make and that my hon. Friends referred to in the debate. Secondly, how can the Minister talk of savings? How can any savings have been made when 9,000 patients records have been missing for more than two months, without which they cannot attend doctors surgeries? It is illusory to speak of savings. There are none, unless the Minister would care to tell us where they are and how they came about. I would be pleased to hear that.
Nicola Blackwood
The hon. Gentleman’s point about scrutinising whether Capita was competent as part of the tendering process is purely common sense and obviously that should have been done as part of the process. If he will allow me, I will come to the other points in the course of my speech. I would like to concentrate on how we resolve the problem that we find. We need to make sure that GPs and their patients receive the service to which they are entitled.
We want to restore acceptable services, and the contract contains sufficient financial incentives to ensure that Capita shares that goal, which is an important part of the contract and process. Let us be clear that the problems encountered with medical record transfers and overdue payments are entirely unacceptable. The Department shares that view. Both Capita and NHS England are co-operating fully with the Information Commissioner’s Office to address the implications for information governance, and I accept the need for urgent action to address the impact that this is having on patients and practitioners. That is why I have been holding regular meetings with Capita’s chief executive for integrated services, Joe Hemming, its new managing director for primary care support, Simon England, and NHS England’s national director for transformation and corporate operations, Karen Wheeler, and I will continue to hold such meetings.
Both NHS England and Capita openly acknowledge that the service has not so far been good enough. NHS England has demanded and received rectification plans from Capita for the six most affected service lines and has embedded a team of seven experts within Capita to support it as it resolves these issues.
As the hon. Member for Coventry North West said, it is also about having the right resources in the right place at the right time. Capita has informed me that it is adding around 500 more full-time equivalent staff to the service, at its cost, and that it is improving the training provided to ensure that new staff understand the importance of the service to both patients and practitioners.
I know that these problems have caused great inconvenience and distress, but with reference to risk—the hon. Member for Bristol South raised this point—NHS England has assured me that it is not aware of any direct cases of patient harm that can be attributed to service issues. However, NHS England is working closely with regional and local medical directors, so that we can be assured of patient safety. In particular, Dr Raj Patel, medical director of NHS England Greater Manchester, has joined the embedded team to ensure that clinical risks and concerns are appropriately addressed.
The priority now is to deal with any backlogs, particularly with medical record requests, and to ensure that services are stabilised with the capacity to deal properly with new requests. There has been progress on that, which is encouraging. The backlog of medical record requests has reduced from 17,262 to 3,465 in the past two weeks. Capita assures me that it has an effective triage system in operation for new requests and is confident that the situation will not recur. However, I will be monitoring the situation closely.
Kate Green
On the point about reducing the backlog, which is something the Bodmin Road practice in my constituency has raised with me, it is not just Capita that needs to put in extra resources; the GP practice is now receiving an onslaught of incoming records, but it does not have the personnel to manage them.
Nicola Blackwood
The hon. Lady is absolutely right to raise the impact on GP services in recent weeks and months, and I will move on to that point later.
Capita has piloted a new way to move medical records. I think that is the pilot in west Yorkshire to which the hon. Member for Stretford and Urmston referred, but it was not a pilot for the overall Capita project. Capita assures me that ultimately it will be more reliable and secure by tracking the end-to-end movement of every record. It is piloting that approach in west Yorkshire and plans to be ready to roll it out nationally in March 2017. I am aware that some GPs were left short of basic supplies as a result, including syringes, and that they have had to source those from other suppliers at their own expense. NHS England tells me that it has reimbursed practices for any costs incurred from having to buy local supplies of needles and syringes.
I know that many of the hon. Members’ GP constituents have experienced frustration with Capita’s contact centre. I share those frustrations. Capita assures me that the contact centre has improved the way it responds to urgent queries by investing in more staff, improved processes and enhanced training. Capita is confident that these measures will deliver a quality service to customers. We will monitor its progress closely, including through meetings.
Karin Smyth
I am listening carefully to the Minister, and it is obviously reassuring to know that Capita, NHS England and the Minister are having these conversations at a national level. In those discussions, has any consideration been given to my point about the loss of local, specialist knowledge and expertise? Is any consideration being given to putting back some of those local arrangements, given the importance of primary care to the entire system?
Nicola Blackwood
I shall come a little later to the problems with the existing system that meant it needed to be replaced. However, the hon. Lady’s point about the value of institutional knowledge, especially among NHS workers and personnel in other roles, is very important. They have been engaged in a lot of consultation processes as we try to put this issue right with NHS England and Capita. If the hon. Lady writes to me, I will be happy to give her more detail.
I also expect Capita to address issues with the courier service. I am aware of several steps that have been taken to ensure that all practices receive regular collections and deliveries. Both NHS England and Capita have taken steps to demonstrate that they are committed to restoring their reputation and re-establishing a quality service, and I am encouraged to see them working in partnership to do so. That said, I recognise that GPs, and ophthalmologists in particular, have suffered financial detriment as a result of late processing of payments. NHS England is working with Capita to explore what can be done to support affected stakeholders, and I have made it clear to Capita that I expect it to consider compensation as an option.
Some have suggested that the old model for provision of primary care support should be reinstated, but we must remember that it relied on localised services that did not connect with one another, with much duplication across processes. The quality of these services varied greatly—in some areas, it was outstanding; in others, it was quite poor. That was simply unsustainable. Furthermore, the system was unable to generate useful management information and so, honestly, issues such as the ones that we now face would be very unlikely to have surfaced. They would have gone unreported.
A new model, with efficient and modernised processes, is the right approach to deliver to our primary care providers the service that they deserve. The Department and I will continue to closely scrutinise Capita and NHS England as they work to resolve current problems and build a quality service that is sustainable. I acknowledge fully that there is a long way to go before the service can be considered acceptable and that Capita has much to do to earn the trust of practitioners and patients.
This is clearly a live issue. I want to be clear today: I am listening. The issue is at the top of my priority list and will remain there until I am satisfied that an efficient and effective service is being delivered that meets the needs of patients and providers.
Question put and agreed to.