NHS trusts that outsource the transcription of medical notes to South Africa, the Philippines and India received a sharp rebuke from health union, Unison, yesterday.

General secretary, Dave Prentis, speaking at the union’s annual conference this week, condemned the outsourcing as “a very dangerous practice.” The union has accumulated anecdotal evidence of potentially life-threatening mistakes made by overseas transcribers, including:

• confusing "hypertension" (high blood pressure) with "hypotension" (low blood pressure);

• confusing "A septic" (infected) with "aseptic" (not infected);

• mixing up "15mg" and "50mg" drug dosages.

Confidentiality is also a concern when notes are sent to countries that do not have the kind of data protection laws that operate in the European Union.

The issue of processing data offshore was raised earlier this year by Connecting for Health (CfH) chief executive, Richard Granger, when he expressed the view during a round table discussion in India that the lack of a regulatory framework for processing personal data in India was a constraint on the country’s large players.

He was quoted in the Economic Times of India as saying that the NHS had not crossed the line in terms of data being processed offshore and that data would not go outside the European Union until there is a regulatory framework in place.

Unison’s protest appears to relate to data processing outside CfH’s areas of responsibility. The union says that transcribers in South Africa, the Philippines and India are paid to transcribe NHS doctors’ dictations – but do not have the benefit of supporting medical notes, letters and prescriptions against which to check the accuracy of their transcriptions.

"It’s beyond belief," said Prentis. "It does not improve the service and the health and welfare of patients is being put at risk. Look what happened to hospital cleaning when it was privatised – a 50% increase in infections. The government needs to rethink this off-the-wall idea."

In addition to concerns about accuracy and confidentiality, the union says medical secretaries’ jobs are being put at risk. It cites the case of East and North Herts NHS Trust which, it claims, has issued redundancy notices to 160 medical secretaries, asking for 58 volunteers.

"With more staff and an unknown technology there is greater scope for error," said Unison head of health Karen Jennings.

"All the government is doing is looking for a cheaper workforce – yet it’s doctors and medical students in these other countries that are being used to do the transcriptions."

Prentis added: "Medical secretaries in the NHS work to 99.8% accuracy targets and once ‘phased out’ their knowledge and expertise will be lost forever."

James Fellowes, managing director of Dict8, a medical transcription firm that uses only UK medical secretaries for its service, said he was pleased to see the subject had been raised. “You can’t compare the skills of people who have worked in the NHS as medical secretaries for a long time with people who are offshore,” he told E-Health Insider.