Today's NAO report into the provision of the out-of-hours service in Cornwall, run by Serco on what the report said is an ‘estimated’ £32m contract running from 2011 to 2016, comes after the CQC raised concerns in May about staffing levels following an inspection.
The NAO report said that when the PCT conducted a review into the service last June, it ‘found no evidence that the service was, or had been, systematically clinically unsafe’. But it said the PCT did find that during 2012 'Serco regularly had insufficient staff to fill all clinical shifts'.
Now, the NAO has called on the DH to ensure that all NHS bodies publish their whistleblowing procedures and to ensure that NHS bodies hold managers to account if whistleblowers suffer reprisals.
The report said that although Serco had a whistelblowing policy in place ‘evidence suggests that whistleblowers were still fearful of raising concerns’.
‘This is an issue that is not confined to the out-of-hours service in Cornwall,’ it said.
It called for the PCT and the CCG to review the contract with Serco to ‘link financial incentives more clearly to achieving essential quality standards’.
The report also said that the PCT and CCG should consider in discussion with Serco, whether to specify in the contract minimum staffing levels. It said that the CQC and ‘others’ had raised concerns about adequate staffing levels but that there is no national or local benchmark for this.
The report said: 'Whistleblowers played a significant role in bringing to the attention of the PCT and the media concerns about Serco’s provision of the out-of-hours service in Cornwall that had not been identified by routine management controls or by the PCT itself.'
The NAO report, whose authors spoke to whistelblowers, was ordered by the chairwoman of the public accounts committee Margaret Hodge.
Commenting on the report, she said: ‘Serco’s performance in a £32m contract to provide out-of-hours care in Cornwall has fallen unacceptably short of essential standards of quality and safety. Although no evidence suggests that patients have received unsafe care, it is shocking that there were not enough people on the job.
‘It is simply not good enough that neither Serco nor the PCT detected these problems. I find it deeply troubling that while a whistleblower policy was in place, in practice, Serco’s working culture meant that people trying to raise the alarm felt fearful of doing so. As the appalling failures in Mid Staffordshire demonstrated, it is essential that there are effective whistleblowing processes and the right culture across the whole of the NHS and its contractors.’
The GP who manages the service for Serco, Dr Louis Warren, said: ‘Over the last six months the GP out-of-hours service that Serco provides in Cornwall has been the subject of the most comprehensive scrutiny and exhaustive series of audits possible.
‘The NAO report has not only substantiated what the CQC and other reports have already shown - that the service is safe and well regarded by patients - but also confirms that we have taken swift and decisive action in response to the previous CQC report.
‘The only outstanding minor issue noted was that we need to take further action to increase the number of health advisors; our recruitment campaign will have this resolved by the end of March.
‘While whistleblowers highlighted concerns last year, I am confident that these issues have been addressed. We now have an outstanding culture and strong levels of staff engagement, where 79% of our team in Cornwall feel respected by their manager. That’s as good as any organisation in healthcare in the UK.’
A joint statement from the CCG and PCT, NHS Kernow and NHS Cornwall and Isles of Scilly, reads: ‘We welcome this comprehensive report from the NAO into concerns relating to the provision of the out-of-hours service provided by Serco, particularly the commitment to ensuring whistleblowers feel protected and able to contact us with confidence in future.
‘We will review all of the recommendations and ensure these are built in to how we monitor the contract to reinforce the quality standards set out nationally and locally for this service.
‘We recognise the need to ensure that safe staffing levels are maintained within this service going forward, recognising that providers have the responsibility for their staffing levels. Our role is to ensure providers’ services meet all key performance indicators and national quality requirements. We are working with Serco to ensure all actions within the NAO report are addressed.’