More than 1,700 people may have been harmed by an NHS contractor’s loss of almost 709,000 pieces of medical correspondence, including patient records and cancer test results, an investigation has found.



But the real total could be much higher, as almost a third of the documents have still to be assessed to see if long delays in analysing them damaged human health, according to a report by the National Audit Office (NAO) into what MPs have called “a colossal blunder”.



The NAO – Whitehall’s spending watchdog – launched its inquiry into the unprecedented loss of such a huge amount of sensitive and medically important correspondence after the Guardian revealed in February that it had occurred.

The lost documents also included treatment plans, details of changes to what drugs patients should be taking, child protection notes and the results of various kinds of diagnostic tests.



Its report is a critique of incompetence and dubious decision-making over years by NHS Shared Business Services (SBS), a private firm jointly owned by the Department of Health that delivered letters between hospitals and GP practices and also between GP surgeries.



It also highlights two key conflicts of interest faced by Jeremy Hunt, the health secretary, over the scandal – and raises questions about whether he sought to cover up its true scale.

“NHS England and NHS SBS have reviewed just under 709,000 items of unprocessed correspondence,” the NAO said.

“As of 31 May 2017, the review of the backlog of correspondence has found 1,788 cases of potential harm to patients.”

However, family doctors who have been paid £2.5m to determine if the mislaying of letters has harmed patients have yet to give their judgment in 218,120 (31%) of cases. As a result, “NHS England expects that the number of patients who may have been harmed will increase when more GPs respond”, the NAO added.



“It is a disgrace that this service failed so badly that patient care was being compromised,” said Dr Richard Vautrey, deputy chair of the British Medical Association’s GPs committee.

“Patients will rightly be angry that this private company, contracted by the NHS, has failed practices and patients to such an extent.”



Although no cases of harm directly attributable to the blunders have yet been confirmed, “NHS England is still investigating the cases where potential harm has been identified”.

However, it will not know exactly how many patients did suffer harm until the end of the year “because the nature of the subsequent clinical review work to investigate cases of potential harm requires review by multidisciplinary clinicians, access to patients and discussion with GPs”.



The correspondence went missing between 2011 and 2016. Of the 1,788 patients who may have been harmed as a result, 333 have since died. But there is no evidence that the backlog of documents, which increased steadily during that time, contributed to their death, the NAO added.



“This is a total scandal,” said Jonathan Ashworth, the shadow health secretary.

“For a company partly owned by the Department of Health and a private company to fail to deliver half a million NHS letters, many of which contained information critical to patient care, is astonishing.

“There remain over 1,700 incidents of possible patient harm unaccounted for. This is a staggering catalogue of mistakes on this government’s watch.”

The NAO said SBS first recognised in January 2014 that patients may have come to harm as a result of what was at the time a fast-rising backlog of undelivered paperwork.

However, despite staff raising concerns, the firm – which is 49.99% owned by the Department of Health – did not alert the department or NHS England until March last year, 26 months later. SBS was then “obstructive and unhelpful” to NHS England in the inquiry it then instigated, the NAO found.

A review of the health department’s governance arrangements in relation to SBS, undertaken by its own internal auditor, later found it had not taken up two of its three seats on the firm’s board.

The auditor also found that “there is a conflict of interest between the secretary of state’s responsibility for the health service as a whole and his position as an NHS SBS shareholder”, the NAO added.

Efforts to analyse the missing correspondence and finally deliver it to the relevant GPs, as was supposed to happen in the first place, have so far cost £6.6m.

But the final bill could be much higher if the Information Commissioner’s Office decides to fine the NHS bodies involved and, especially, if patients have to be paid compensation.

Hunt did not alert MPs to the scandal until July 2016, and then only in brief, vague terms, which gave no sense of the scale of lost correspondence or risk that patients were harmed.

He was summoned to the Commons to make an urgent statement on the affair in the wake of the Guardian’s disclosures in February.

In a short statement. the Department of Health said only that: “As the NAO report highlights, patient safety has been our first priority and no cases of harm have been identified to date.

“Alongside NHS England, we have been very mindful of appropriate transparency while working to make sure this does not happen again. Last year the health secretary updated parliament and the public accounts committee was informed.”

An NHS SBS spokesman said: “Today’s NAO report highlights a number of failings in the mail redirection service provided to NHS England. We regret this situation and have cooperated fully with the National Audit Office in its investigation.

“All of the correspondence backlog has now been delivered to GP surgeries for filing and NHS England has so far found no evidence of patient harm. NHS SBS no longer provides this mail redirection service.”