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Private contractor fiddled data when reporting to NHS, says watchdog

Category : Business

Serco staff falsified performance figures 252 times, according to National Audit Office

Serco, the leading private contractor of government services, fiddled its data when reporting to the NHS on targets it had failed to meet, according to the National Audit Office (NAO).

The independent watchdog’s investigation into Serco’s out-of-hours GP service in Cornwall, published on Thursday, comes after the Guardian revealed last May that whistleblowers had concerns that the privatised service was regularly so short-staffed as to be unsafe and that its performance data was being manipulated.

Following those reports, the chair of the parliamentary public accounts committee, Margaret Hodge, asked the NAO to investigate. It found that Serco had regularly had insufficient staff to fill all clinical shifts.

The NAO points out that a review by the NHS commissioner, the Cornwall primary care trust (PCT), found no evidence that the service was systematically unsafe, but concluded safety depended on the service being fully clinically staffed on a regular basis. The watchdog says clinical staffing levels have improved recently.

This picture appears to be contradicted, however, by documents leaked to the Guardian by whistleblowers this week. They show rotas with large numbers of shifts for doctors, nurses and call handlers unfilled throughout February and the first weekend in March. Staff have told the Guardian that shifts are still regularly unfilled. Serco denied this claim and said the information on rotas was inaccurate, and “selectively edited to deliberately misconstrue staffing provision”.

Between January and June 2012, Serco staff falsified data 252 times, the NAO report says, based on Serco’s own forensic audit of 107,000 patient calls over the period. Serco told the NAO the changes were “unacceptable” and unauthorised and were the work of two individuals in the Cornwall service who had now left. Staff are now banned from using a “dummy account” which enabled them to change raw data in the logs.

Hodge said it was shocking that Serco “did not have enough people on the job”. She said: “I find it disgraceful that Serco staff fiddled the figures on an astonishing 252 occasions between January and June 2012. This tampering presented a false, much rosier picture of its poor performance.

“In one instance, Serco falsely claimed that 100% of emergency callers received a face-to-face appointment within 60 minutes when, in reality, it was only 75%, falling short of the performance standard.”

The NAO report criticises the PCT’s failure to monitor the company closely enough. It fell to whistleblowers to expose the failings through the media, despite a climate of fear in the Cornwall service, it says.

The PCT is now checking the Serco audit, which only covered the first six months of 2012, when the company had already been told it was under scrutiny. The trust said it would ensure all the NAO recommendations were built into its monitoring of the contract.

Staff have told the health regulator, the Care Quality Commission (CQC), that the data manipulation went back four years or more and was much worse before 2012.

Earlier audits by the CQC were severely critical of Serco for failing to meet minimum legal requirements in four areas. While three of these had improved at its most recent inspection in December, it was found to be still failing on staffing levels for call handlers.

Serco’s Cornwall manager, Dr Louis Warren, said: “The NAO report has not only substantiated what the CQC has already shown – that the service is safe and well regarded by patients – but also confirms that we have taken decisive action. The only outstanding minor issue noted was that we need to increase the number of health advisers; our recruitment campaign will have this resolved by the end of March.”

He said the company had addressed the culture among workers and strengthened whistleblowing policies. “The service is always staffed appropriately to meet demand,” he added.

Andrew George, the Liberal Democrat MP for St Ives who blew the whistle on Serco to the CQC, called for the service to be reviewed by the new clinical commissioning group that will replace the PCT when it is abolished. “Failure to staff the service adequately and safely has happened even since Serco was criticised last year,” he said.

The parliamentary committee will hold a hearing on the NAO’s findings in April.

Serco announced this week that its pretax profits rose by 27% to £302m in the past 12 months.

Andrew Abbott, director of operations for NHS Kernow, said: “Serco has strongly refuted the claims made in relation to unfilled clinical shifts and there is no evidence from the data we receive that indicates otherwise. We will discuss this matter through our regular performance monitoring meeting with Serco, which is also attended by GP leads.”

Private prison firms look to cash in on Canada asylum crackdown

Category : Business

Advocates urge Canadian government not to go further down the route of privatising immigration detention

Dramatic changes to Canada’s immigration laws expected to come into effect in December will mean that asylum seekers face more restrictions and have less time to make a claim. Advocates fear this will lead to more detentions and further opportunities for private prison operators to cash in.

Immigration detention is a growth industry around the world, and some of the biggest private security and prison firms are the beneficiaries. In Canada, increased government use of by immigration detention has refugee lawyers and advocates worried, particularly after the passage of the tough new immigration laws in June.

Serco is one of the biggest players in the immigration detention business worldwide. The company, which provides public services to governments around the world, including Canada – where it runs everything from the Ontario driver’s education and licencing program to military bases in Newfoundland and Labrador – has been lobbying Ottawa on the subject of immigration service delivery.

“The government has indicated that they expect to make increased use of detention for refugee claimants,” said Janet Cleveland, a psychologist at McGill University in Montreal who studies the effects of detention on asylum seekers.

“We have a very strong position saying people should not be incarcerated when they’re not criminals,” said Cleveland, adding that this approach should be extended to asylum seekers entering the country. “Incarceration is absolutely unjustified because there’s essentially no flight risk.”

Asylum seekers hope to be accepted as refugees, added Cleveland.

The changes to Canadian law come after nearly two years of Stephen Harper’s Conservative government signalling its intention to crack down on human smuggling and after months of the immigration minister, Jason Kenney, warning of “bogus refugees” taking advantage of Canadian generosity.

Detention is mandatory in cases in which the identity of the claimant cannot be established, human smuggling is suspected or if the claimant arrived in the country by “irregular arrival”. According to some critics, these criteria could include all asylum seekers coming to Canada.

Canadian border officials can order asylum seekers held for an initial two-week period, then for as much as six months before review. The Harper government’s original plan called for one year’s detention, before it pulled back in the face of a chorus of opposition from civil groups.

“Is that coming out of the need to detain people who are seeking refuge in Canada, or is that being driven by companies… who stand to profit tremendously [from] incarcerating people?” said Justin Piché, an assistant professor of Criminology at the University of Ottawa who is also a prison-policy blogger.

In June, during a parliamentary debate on the new legislation, Kenney insisted that “no immigrant is imprisoned in immigration detention centres. All immigrants are free to leave Canada at any time. It is not imprisonment.” But a 2012 Global Detention Project report on Canada lists it as one of the only western countries that actively and increasingly detains asylum seekers in correctional facilities, including maximum-security prisons, in apparent contravention of international human rights norms.

The ability to claim asylum is not a criminal offence. As an immigration lawyer, Douglas Cannon, put it when speaking to the Times Colonist newspaper: “It’s a right.”

The Guardian made repeated requests to speak with Kenney but the minister was unavailable to comment.

‘The Heritage Inn’

Officially, Canada has four immigration holding centres (IHCs): one in Laval, near Montreal; one at Vancouver International Airport; a high-security IHC for security certificate detainees in Kingston, Ontario; and the Toronto Immigration Holding Centre. The last-named used to be an airport motel, and it is sometimes referred to by its past name, “the Heritage Inn”.

The multinational security firm G4S, which was recently in the spotlight for understaffing security at the London Olympic Games, has the contract to provide security at the IHCs in Toronto and Laval, while the Corbel Management Corporation has had the contract to manage the Toronto facility since 2003. Government records show that contract to have been worth more than $19m between 2004 and 2008. The Toronto IHC recently underwent an expansion, to increase its capacity from 120 to 195 beds. The renovations were completed in September, according to a spokesperson for the CBSA.

Perhaps the most curious lobbying effort around immigration detention comes from BD Hamilton and Associates, a boutique real-estate firm that shares its address with a private surgical clinic in Toronto. According to its registration, the company was seeking to “work with the Government of Canada to build a refugee detention centre in Toronto”. Bridget Hamilton, who is listed as the principal of the company, was a director of the Corbel Management Corporation until 2009. Her husband, Dr James Hamilton, is president and medical director of the clinic.

“The proposal called for a P3 [public-private partnership] arrangement that was to be financed by Hamilton and Associates and potentially other Canadian registered/incorporated investors,” said Emily Wehbi, of the prominent lobbying firm National Public Relations, the registered lobbyist for BD Hamilton.

The government rejected Hamilton’s proposal in June, according to Wehbi, but records show the company is now seeking to “work with the Government of Canada on the escorted removals process” of deportees.

In March, Rick Dykstra, parliamentary secretary to the immigration minister, met Serco executives who flew in from the UK. Kerry-Lynne Findlay, the parliamentary secretary to the justice minister, also attended the meeting.

“They’ve [Serco] never had the opportunity to speak with officials… about services that they deliver from an immigration and citizenship perspective,” said Dykstra, who was quick to point out that the meeting wasn’t about detention specifically but instead aimed to “broaden our horizons about the services they [Serco] have to offer, to see if there’s a way in which somewhere down-the-line they could assist the Canadian government.”

In September 2010, Kenney toured two Serco-run detention centres in Australia, as part of a fact-finding tour into Australia’s anti-human smuggling initiatives. He tweeted that he had “learned a lot”.

In April 2011, detainees at the Serco-run Villawood facility in Australia rioted in protest at the length of their detention. A month before, a protest that authorities labelled an attempted breakout by asylum seekers detained at Serco’s offshore Christmas Island facility had resulted in a number of buildings being burned to the ground and detainees being injured after police used bean-bag rounds and tear gas.

Serco declined requests to comment on this story.

Janet Cleveland believes it would be a mistake for Canada to go further in the direction of privatising immigration detention, by following the lead of Australia and the US. “My presumption is that the conditions would be far worse.” she said. “There would be less control, less oversight and so on.”

Justin Piché said: “By planning, by touring these different facilities, by having meetings with these different companies, it suggests that perhaps they [the Harper government] don’t expect this bill to deter anything, and what they’re in fact doing is creating a useful crisis in the form of mandatory detention that will be resolved by privatized detention facilities.”

Letters: Hospital closures are about privatisation, not patient care

Category : Business

Professor Tim Evans must live in an ivory tower (Shut one in three hospitals to improve care, says top doctor, 22 September). Most medical staff are just coping with the workload now, and opening hospitals for full services all weekend would necessitate more staff. These hospital closures are about increasing opportunities for privatisation.

The evidence is very clear that if you want to save lives you need to have hospitals near to patients. Death rates rise 20% for every seven miles a patient travels. For two days this year when flash floods hit Gateshead, no one was able to travel far. If we had only had a casualty department in Newcastle rather than Gateshead itself, it is difficult to imagine what might have happened.

Later this year Queen Elizabeth Hospital Gateshead is going to stop providing 24-hour inpatient care to children, and it has just been announced that there will be no overnight emergency care. For patients who use public transport this is a problem and for those who have to drive and who fall ill during rush hour this will mean at least an hour more on their journey time. It would be helpful if innovation was based on evidence rather than political expediency.
Dr Helen Murrell
Newcastle upon Tyne

• Go into the red and you haven’t got enough money to pay for staff and services. Achieve a surplus, and you are hoarding cash. NHS organisations can’t win, so it is high time we got away from a simplistic debate about how many NHS and foundation trusts break even each year (NHS has cash reserves of £4bn, report shows, 20 September).

Foundation trusts are now the majority of hospital providers, have the freedom to run their own affairs, and can generate a surplus to reinvest in patient care. Unlike other NHS trusts they are also allowed to run a short-term deficit, and this can sometimes be a sensible way of managing their finances. Of the 21 foundation trusts operating a deficit in 2011-12, 13 planned to be in deficit, nine are planning to return to surplus in 2012-13, and five had deficits of below £1m (on average less than 0.3% of turnover).

It is therefore misleading to use the number of foundation trusts in deficit as an indicator for assessing the NHS as a whole. As the independent regulator of foundation trusts, we use a more sophisticated risk rating which indicates that 11 foundation trusts are currently in some financial difficulty – fewer than one in 10 – and those with the most acute difficulties are receiving specialist help.
David Bennett
Monitor

• When procuring the contract for the out-of-hours GP service in Cornwall the PCT would have specified a level of service and bidders would have extrapolated their costs from the staff numbers required to support that level of service (Serco provided false data hundreds of times on GP service, 21 September). The fact that Serco subsequently skimped on their staffing levels suggests that they had undercut other bids that had been prepared more realistically.

The PCT’s statement that despite failing to meet service targets and lying about it Serco’s service was “fundamentally safe and effective” is bizarre. We can only presume that the PCT was profligate with public money in pitching its service levels too high in the first place.
David Marcer
Gloucester

£1bn tagging programme has failed to cut reoffending – senior police officer

Category : Business

Schemes have only enriched security companies including G4S, says officer as ministers prepare another £3bn worth of contracts

Nearly £1bn has been spent on the electronic tagging of criminals over the past 13 years with little effect on cutting offending rates, offering little value for money and serving only to enrich two or three private security companies, one of which is G4S, a senior police officer has claimed.

Chris Miller, a former expert on tagging at the Association of Chief Police Officers, who stood down as Hertfordshire’s assistant chief constable last year, said that much of the potential of electronic monitoring to keep communities safe in Britain has not been realised.

“The current contracting arrangements for electronic monitoring have all but squeezed innovation out of the picture and stifled progress,” he writes in a foreword to a report by the Policy Exchange thinktank published on Monday.

“Electronic tag technology used in most cases today is hardly any different from what it was in 1989, when it was first used in the UK. The future arrangements must not be allowed to continue to hold us back,” writes Miller. He says the problem has centred on a “sclerotic, centrally controlled, top-down system that has enriched two or three large suppliers, that lacks the innovation and flexibility of international comparators and that fails to demonstrate either that it is value for money or that it does anything to reduce offending”.

The Ministry of Justice has spent £963m on tagging contracts over the past 13 years. Two companies, Serco and G4S, have taken the bulk of the work, putting ankle and wrist tags on more than 100,000 offenders every year, mainly to monitor their compliance with night-time curfew orders which do little to cut reoffending during the day.

Ministry officials are about to invite bids for contracts for the next nine years, thought to be worth up to £3bn. The Policy Exchange report, Future of Corrections, says one in four police forces regards electronic tagging as ineffective.

“In the US there are a number of localised suppliers, meaning that the police and probation service are given the most up to date GPS technology to track the movements of a criminal 24/7,” said Rory Geoghegan, the report’s author.

He said in the US ankle bracelets had become smaller, smarter and more durable and were GPS-enabled so that police can pinpoint offenders’ locations at all times, but the lack of competition in Britain meant the taxpayer was losing out.

“We desperately need to create a real market so that the police can get the technology they need to cut burglary, cut robbery and other crimes that have a massive impact on victims and community,” he said.

Miller said that, as Hertfordshire’s head of crime, he had tried satellite tracking technology for prolific offenders, polygraph testing of internet child pornography users, and alcohol diversion programmes for those caught drunk in public places. But each initiative had been greeted in Whitehall with reactions ranging from incredulity to downright obstruction.

The Policy Exchange pamphlet argues that the police and crime commissioners due to be elected in November should be given the power to decide how much money, if any, is spent on tagging and who should provide the services.

Letters: G4S fiasco: a stark warning of what lies ahead

Category : Business

Alongside the points made by Polly Toynbee (After G4S, who still thinks that outsourcing works?, 17 July), there should be a national debate into the guards’ proposed terms of employment. As stated by Nick Buckles, the G4S chief executive, they were to be hired on a day-labouring basis. So no certainty of work or income and yet expected to be available for the whole Olympic period.

No wonder so many of them thought better of it. Either it messes up benefit arrangements and/or it prevents availability for a more permanent job. This focus on making the most profit out of a contract by paying the least to the workforce is not new. This time it has badly backfired on G4S and will cost them dear, both financially and reputationally. Whoever in the government knew or didn’t know about the likely dangers of such a back-loaded programme, they almost certainly knew of these employment arrangements. Shame on them all.
Margaret Prosser
Labour, House of Lords

• The G4S debacle is a stark warning of what lies ahead. When private companies deliver public services, ultimately they answer to thirsty shareholders, not the taxpayer. It’s inescapable: profit maximisation is a legal obligation for such companies.

We can’t undo decades of policymaking that has got us to this point, but we must open up the debate beyond public v private – there is another player. Social enterprises have been operating in public service markets for years. Some of those born in the 80s are now multimillion-pound organisations, and unlike private firms they exist for the people. They reinvest their profits to benefit the communities they work in, have strong track records of delivering quality public services in health, waste management and leisure, and are accountable to the taxpayer. Social enterprises not only hold the key to safeguarding our public services, they also ensure that taxpayers’ money benefits the 99%.
Peter Holbrook
Chief executive, Social Enterprise UK

• An article announced that Serco had won the contract to operate “community payback” in London (Report, 14 July). I was disappointed that the obvious correlation to the G4S Olympic security contract was not drawn. Surely the G4S fiasco shows that private sector does not necessarily mean efficiency and savings, as the ideologues assert. Who will step in at the last moment if Serco gets it wrong?

Community criminal justice services, usually run by the probation service, do not lend themselves to calling in the army. The government has already been heavily criticised for the disorganised geography of the community payback lots. We wait to see who will win the bid for the south-east lot, which runs from Norfolk to Hampshire, an arbitrary area to say the least. But with Serco winning London they obviously have an advantage for the future contract.

It’s time to stop dismantling the probation service for sheer ideological reasons before serious damage is done.
Carole Brownsey-Joyce
Branch chair, Surrey and Sussex Napo (the union for family court and probation staff)

• The vilification of G4S may well be deserved. However, as someone who has studied the security industry for a long time, I believe the decision to award the contract to one provider seems even more incompetent. The guarding industry is riven with high labour turnover, low commitment of staff, and long vetting and training periods for guards. It is not unusual for a student with no criminal record to take several months to be vetted because they cannot provide evidence of a period of employment (and sometimes might be rejected).

Guards not turning up for duty and switching to other jobs for a few pence more is common practice. Providing 10,000 guards was bound to be one of the greatest challenges ever in the UK security industry. Using one contractor was a huge risk. The guarding contract should have been broken up into multiple contracts, spreading the risk. Putting all their eggs in one basket was the greatest folly. Critics should look to who made this decision.
Dr Mark Button
University of Portsmouth

• I hope the G4S shambles has finally destroyed the fallacy that economic and social efficiency depends on paying bosses extremely high salaries to ensure you get and keep the best, while paying workers as little as possible to keep them insecure and desperate enough to work hard. If G4S had offered workers good earnings and the opportunity for more than two or three weeks’ employment, people may have found it worthwhile actually turning up for work. If they had paid their management on the basis of performance they may have had leadership able to recognise and communicate if they developed a problem.
Peter Hutchinson
Chalfont St Giles, Buckinghamshire

• So, John Reid and Paul Condon are directors of G4S (Diary, 13 July). At what point did Mr Reid (former home secretary) realise that G4S was “not fit for purpose”? At what stage did Mr Condon (former Met commissioner), with his vast experience of police systems and techniques, realise that G4S’s methods were woefully inadequate?
Terence Padden
Cheadle Hulme, Cheshire

• Omnishambles and hypershambles (Simon Hoggart’s sketch, 17 July) still don’t quite do the job. When you have done something as badly as possible, it should surely now be said you have made a complete G4S of it.
Patrick Baker
Gloucester

• Have I missed something? Is G4S being paid nearly £300m? For supplying 10,000 security guards for the duration of the Olympics? Is that nearly £30,000 per guard? It would be interesting to know how much of the £30,000 is being allocated to overheads and equipment.
Tom Jones
St Austell, Cornwall

Letters: Health Act is not about privatising the NHS

Category : Business

The comment piece by Jacqueline Davis, co-chair of the NHS Consultants’ Association and a founder member of Keep Our NHS Public (Accountable to whom?, 29 May), is deeply wrong. The Health and Social Care Act is not about privatising the NHS but about making sure patients get high-quality healthcare, free at the point of delivery. It is the first piece of legislation in the history of the health service that actually prevents discrimination in favour of private health companies over the NHS. It is premature to draw conclusions on Serco’s performance until the Care Quality Commission has concluded its investigations, and to imply that the alleged issues are a result of the act is false – the Serco contract was signed when the previous government was in office.
Andrew Lansley MP
Secretary of state for health

• We are constantly told that the government in its localism agenda wants decisions and control to go to the local level. What, then, are we to make of the decision, slipped out by Andrew Lansley in a written statement in January, that NHS properties such as community hospitals, health centres and clinics are to be removed from local control by April 2013, and vested in a new national NHS property services company? This company will manage the NHS estates and sell off those it deems surplus.

Surrey alone will see 73 estates seized

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Letters: Contracts and care in the NHS

Category : Business

In your article (Private healthcare firm probed over ‘unsafe’ GP services, 26 May) you make a series of serious allegations including the suggestion that the GP out-of-hours service in Cornwall is somehow unsafe. I believe that this service is being carried out to the highest standards. It is a valued part of the NHS and I am proud of the professional team who carry out this work.

Like any responsible healthcare provider, we strive to learn from our experience and work to continually improve the service that we provide. We are well aware of a substantial number of the allegations considered by the Guardian; these have been raised before, fully investigated by us and by a number of independent bodies, and found to be false and without foundation. In particular, an independent audit commissioned by the Cornwall PCT found that there was no substance to any allegations of altering figures or manipulating data.

Recently, this contract was found to be one of the best-performing such contracts in the UK by the Primary Care Foundation, as part of its national quality benchmarking exercise that considered the performance of over 100 such contracts. These external audits are reinforced by patient feedback. Since the new service started, we have not scored less than 95% in the monthly patient satisfaction survey, and over 86% of patients rate the service either excellent or good.

I want to reassure people in Cornwall that we remain fully committed to providing the best possible care for patients.
Valerie Michie
Serco Health

• One wonders what the effect has been on the local hospital A&E department of what appears to be a skeleton out-of-hours service provided by Serco in Cornwall – how many people faced with a six-hour wait for a doctor would opt for what might be a four-hour one in A&E? My own one contact with Serco was on behalf of an elderly relative who, on a Sunday afternoon, felt unwell and was convinced this was due to a heart malfunction. The Serco response to my telephone call was to advise me to ring for an ambulance as “our doctors do not have the equipment necessary to monitor heart conditions”. My immediate thought was: why not? Surely it should be part of their contract to carry such equipment to eliminate non-urgent calls on the emergency services. I called the ambulance and within half an hour my uncle had had an ECG test and been cheerfully told he had the heart of a 21-year-old, and the paramedics were on their way to a real emergency.
Ruth Stephens
Perranporth, Cornwall

• A kneejerk reaction of NHS good, private bad will not solve anything, particularly with contracts going increasingly to private providers. The part of the equation that really needs looking at is the commissioning process. Here in Cornwall I have experience of a very good treatment facility which is privately provided. The nearest (but not near) one for the same treatment is an NHS facility that is not up to the same standards of treatment or comfort. Which patient goes where is a postcode lottery; there is no choice as the distances are too great.

The commissioning body needs to be independent (so much money involved) and to know what is needed (with independent clinical input), and have feedback from patients. It also needs to be continually monitoring that corners are not being cut. With good commissioning, NHS or private loses significance if both are free at the point of delivery. As I have found, sometimes it can be a lot better – and for less cost. The idea of GPs as commissioning bodies, however, doesn’t raise hopes as they are unlikely to be either independent or to have sufficient knowledge of what is needed.
Name and address supplied

• Your report says: “The terms of the contract are deemed commercially confidential, as is the competitive bidding process, so they are not open to public scutiny”. Can someone please explain why this is so? If public money and the outsourcing of a public service are involved, why aren’t the contract details and bidding process publicly available? How can the principles of transparency and democratic accountability be exercised in an atmosphere of inappropriate secrecy? I can understand why exceptions may be made for national security issues, but why elsewhere?
Tony Clewes
Walsall

Care Quality Commission: the NHS watchdog

Category : Business

Body looking into allegations against Serco is tasked with oversight of the health service and all its contracters

Serco investigated over claims of ‘unsafe’ GP service
Cornish complaints raise questions over drive to NHS care
Cornwall out-of-hours case study: Eve Tonkin

The body that regulates both NHS and private health and social care services in England is the Care Quality Commission.

Established in 2009 in a merger of previous regulators in a bonfire of the quangoes initiated by Labour, it has been dogged by controversy. It was set up with a much smaller budget than the three regulators it replaced but with a much larger number of care providers to register.

Its chief executive, Cynthia Bower, resigned in Febraury after criticism that the watchdog was not fit for purpose. She was criticised in an earlier role for failing in oversight of the Mid Staffordshire hospital, where hundreds of patients died as a result of poor care.

The CQC was also condemned for failing to investigate a whistleblower’s allegations of abuse at a Bristol care home which was later exposed by Panorama.

The Department of Health and the House of Commons public accounts committee have both conducted reviews of the regulator published in the last few months, which are highly critical of its performance. Its ability to carry out inspections was specifically questioned by the PAC.

Whistleblowers on the Cornwall out-of-hours service run by Serco under private contract to the local primary care trust have been frustrated that there has been a gap in regulation.

Out-of-hours services were only required to register with the CQC in April this year. Before that the only oversight was through the primary care trust that commissioned them.

The Cornwall PCT’s own performance was last measured in October 2009 by the CQC, when it downgraded the quality of its commissioning from “good” to “fair”.

Whistleblowers have also expressed concern as to whether the inspection will now be wide enough. The CQC said that its inspectors would make a judgment about whether a service complied with standards at the time of the inspection, and would look at records of staff training, records of care received, and shift rotas but would not normally look at historic performance data unless it was considered to have a bearing on how care was currently being provided.

In a further blow to the CQC’s reputation, it sacked one of its inspectors in April and referred the matter to the police after an internal investigation prompted by a care home owner. The inspector was subsequently arrested on suspicion of bribery and money laundering, having allegedly pressurised owners of care homes to pay for favourable inspection reports.

A spokesman added that the CQC’s progress in improving its own practices had been recognised by the DoH in Febraury and that it had increased its inspection team.

• Have you been affected by changes to out-of-hours GP services in Cornwall? Contact felicity.lawrence@guardian.co.uk to share your experiences

• Are NHS services where you live being put out to tender? Help us build a picture of what’s happening to the health service by filling out this form

Serco investigated over claims of ‘unsafe’ out-of-hours GP service

Category : Business

Exclusive: Firm set for NHS contracts allegedly massaged data
• NHS watchdog inspection after whistleblower tip-offs
• Serco says concerns about service are without foundation

Cornish complaints raise questions over drive to outsource care
Care Quality Commission: the NHS watchdog
Cornwall out-of-hours case study: Eve Tonkin

A leading private health company, poised to win much of the new wave of NHS outsourcing contracts, is under investigation for allegedly providing an “unsafe” out-of-hours GP service, and over claims that it manipulated results where it failed to meet targets.

Serco, which runs a large range of outsourced services for the government and local authorities, was subject to an unannounced inspection by NHS watchdogs in Cornwall last month in response to whistleblowers who claim that it:

• allowed queues of up to 90 patients at a time to build up at its telephone helpline;

• met its targets, in part, by adjusting figures to blame delays on patients;

• rang at least one patient who had waited too long to see a doctor to give them a new waiting target instead;

• repeatedly took visiting doctors off roving duties in order to operate clinics and hotlines because it had too few staff on duty to cover the county.

Many of the concerns appear to be supported by evidence gathered in a Guardian investigation that has drawn on data from computer records, drivers’ logs, internal correspondence and interviews with several sources connected with different parts of the Serco operation in Cornwall who have asked to remain anonymous.

Serco has also confirmed some of the allegations. But it denies that the service is unsafe and says it is acting within the terms of its contract with the local primary care trust, which allows it to adjust waiting time figures according to who was to blame and make “comfort calls” to patients who have waited a long time. It did not comment on the whistleblower reports of how many patients were left waiting to be assessed at its call centre.

The Guardian has learned that the health regulator, the Care Quality Commission (CQC) made an unannounced inspection of the service in April, shortly after it took on responsibility for registering out-of-hours GP services under new rules. It was unclear until then who, if anyone, was able to monitor Serco’s performance independently of the primary care trust (PCT) that commissioned it.

Both Serco and the Cornwall NHS PCT vigorously denied that patient safety was ever at risk. They said that the allegations are not new and that the claim that performance data have been manipulated has already been rejected by an independent audit for the PCT. They added that they have been advised that if the CQC had serious or urgent concerns for patients’ safety they would have been raised immediately, and that they have not been raised.

The PCT remains confident that the service is adequately resourced and meeting national standards. Bridget Sampson, director of primary care for Cornwall, said: “We are disappointed that rumours still persist around the quality of service provided by Serco. Patient surveys show a high level of satisfaction with the service and an independent audit did not find any evidence of data being changed. The contract provides a value for money, high quality service for patients with equitable access to GP appointments out of hours.”

However, critics of the service said they have been pressured to keep quiet and say Serco has launched an investigation of email traffic to see who has leaked information to the press. Serco said any monitoring of emails was within the law and was to protect patient confidentiality.

Dr Gareth Emrys-Jones, a retired BMA council member and former chair of the GP co-operative that used to run the out-of-hours service for Cornwall as a not-for-profit company, was one of several people who contacted the CQC.

“I have been approached by a significant number of people representing all classes of employees at Serco who felt unable to whistleblow directly but who perceived the service to be unsafe because of a lack of clinicians and inadequate cover for the needs of the patients of Cornwall,” he said. “They have cited incidents where it appears that data has been altered in order to achieve compliance with quality standards that they knew had been missed. These related to an extended time period and were not one-off incidents. I was concerned for the staff and for the service because if the allegations are true it would have serious implications.”

The CQC investigation comes as the NHS undergoes radical restructuring now that the government’s controversial health and social care bill has been passed.

Under coalition policy, all 52 newly formed PCT clusters in England are required this year to identify at least three of their community services to put out to competitive tender in a process that will lead to a rapid increase in private sector involvement in the NHS. Serco, which generated revenue of £4.6bn in 2011, is likely to bid for many of the NHS contracts.

Serco first won the Cornwall contract in 2006 with a bid that valued it at approximately £6.1m a year over five years. It was awarded a further five-year

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Cornish complaints raise questions over national drive to outsource NHS care

Category : Business

Allegations in Cornwall are still being investigated as health services go out to tender in line with new policies

Serco investigated over claims of ‘unsafe’ GP service
Care Quality Commission: the NHS watchdog
Cornwall out-of-hours case study: Eve Tonkin

When the co-operative of doctors from surgeries across Cornwall that ran the out-of-hours GP service lost its contract with the local primary care trust in 2006, they were not sure why, but suspected money played a large part.

The winning bidder was Serco, the private contractor that is a leading provider of services to government and local authorities in many sectors – from defence to prisons and education – but a relative newcomer to health. The terms of the contract are deemed commercially confidential, as is the competitive bidding process, so they are not open to public scrutiny.

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