WHISTLEBLOWERS played an important role in highlighting problems with Cornwall's out of hours doctor service which led to action being taken.
That is the finding of the National Audit Office (NAO) which today published a report commissioned by the Public Accounts Committee into what happened at Serco.
Among the concerns raised was that Serco had been unable to fill shifts with appropriately qualified staff, with the result that the out-of-hours service was unsafe.
Whistleblowers also highlighted that some Serco staff had been altering figures to improve performance figures.
The NAO statement said: "A clinical review of the service in June 2012 found no evidence that the service was, or had been, systematically clinically unsafe.
"During 2012 Serco regularly had insufficient staff to fill all clinical shifts. It also frequently redeployed some GPs, taking them out of the cars available for home visits and using them to cover clinic shifts instead."
A Care Quality Commission report in July 2012 found that the service did not have enough qualified, skilled and experienced staff and a subsequent inspection in December found that while the number of clinical staff had increased Serco needed to take further action as not enough health advisors were available to take calls.
The NAO statement added: "Serco has not consistently met the national quality requirements for out-of-hours services set by the Department of Health. Performance against the requirements declined significantly following the introduction in May 2012 of NHS Pathways, as required by the primary care trust, a new system for assessing patients' needs when they call the service. Serco has since taken steps in response to the problems, including using more clinical staff to support the health advisers handling calls, and performance is now recovering.
"Whistleblowers raised concerns that Serco staff were altering data about the performance of the out-of-hours service. A forensic audit by Serco, covering every interaction which passed through the switchboard between January and June 2012, found that two members of staff made 252 unauthorised changes to performance data. This represented 0.2 per cent of all interactions with patients during the six-month period.
"As a result of the data changes, the performance Serco reported to the primary care trust was overstated in seven instances. Serco and the primary care trust have since taken steps to strengthen internal controls aimed at preventing or detecting data changes.
"Whistleblowers' concerns had not been identified by routine management controls or by the primary care trust itself. Serco had a whistleblowing policy but evidence suggests that whistleblowers were still fearful of raising concerns. Serco and the primary care trust have since reminded all staff of the importance of raising concerns and the protection available to whistleblowers."
Dr Louis Warren who manages the Serco service 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."In a joint statement NHS Kernow and NHS Cornwall and the Isles of Scilly said: ""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."
That is the finding of the National Audit Office (NAO) which today published a report commissioned by the Public Accounts Committee into what happened at Serco.
Among the concerns raised was that Serco had been unable to fill shifts with appropriately qualified staff, with the result that the out-of-hours service was unsafe.
Whistleblowers also highlighted that some Serco staff had been altering figures to improve performance figures.
The NAO statement said: "A clinical review of the service in June 2012 found no evidence that the service was, or had been, systematically clinically unsafe.
"During 2012 Serco regularly had insufficient staff to fill all clinical shifts. It also frequently redeployed some GPs, taking them out of the cars available for home visits and using them to cover clinic shifts instead."
A Care Quality Commission report in July 2012 found that the service did not have enough qualified, skilled and experienced staff and a subsequent inspection in December found that while the number of clinical staff had increased Serco needed to take further action as not enough health advisors were available to take calls.
The NAO statement added: "Serco has not consistently met the national quality requirements for out-of-hours services set by the Department of Health. Performance against the requirements declined significantly following the introduction in May 2012 of NHS Pathways, as required by the primary care trust, a new system for assessing patients' needs when they call the service. Serco has since taken steps in response to the problems, including using more clinical staff to support the health advisers handling calls, and performance is now recovering.
"Whistleblowers raised concerns that Serco staff were altering data about the performance of the out-of-hours service. A forensic audit by Serco, covering every interaction which passed through the switchboard between January and June 2012, found that two members of staff made 252 unauthorised changes to performance data. This represented 0.2 per cent of all interactions with patients during the six-month period.
"As a result of the data changes, the performance Serco reported to the primary care trust was overstated in seven instances. Serco and the primary care trust have since taken steps to strengthen internal controls aimed at preventing or detecting data changes.
"Whistleblowers' concerns had not been identified by routine management controls or by the primary care trust itself. Serco had a whistleblowing policy but evidence suggests that whistleblowers were still fearful of raising concerns. Serco and the primary care trust have since reminded all staff of the importance of raising concerns and the protection available to whistleblowers."
Dr Louis Warren who manages the Serco service 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."In a joint statement NHS Kernow and NHS Cornwall and the Isles of Scilly said: ""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."
