I report on the problems and perils of Competitive Tendering – which is increasingly being brought in instead of strategic planning and which can lead to poor quality services. This is timely because of Section 75 of the Health and Social Care Act

An excellent example is the project by the East of England Health Authority called Transforming Pathology Services, in this case the blood tests carried out for GPs.

Instead of working with the suppliers (local hospitals) to reduce costs they set up a competitive tendering process and the preferred bidder’s scheme involved transporting samples along  90 miles of congested roads including a section of the M25 to a site in Bedford where a new laboratory was planned. This would result in delays in diagnosis whilst saving less than 1% of the cost compared with a local service and would almost certainly cost more in the long run.

I am a retired consultant Haematologist and was a contributor to Lord Carter’s Report on Pathology which was widely quoted as the basis for this ‘transformation’. I was asked for my opinion by local GPs who feared the effect the scheme would have and I have now discussed the plans with most of the leading players.

Whilst most of them do not want to be quoted it is clear that the quality specifications in the tender and in subsequent discussions were not good enough and had it not been for local pressure we would have been at risk as described in my email to the CEOs of the PCT & CCG

“The proposed relocation of certain GPs lab tests from South Essex to Bedford involves risks which need to be addressed-

Risks in respect of patient safety.

1) Abnormalities will be indentified later.

2) Fewer abnormalities will be communicated to the GP in time for prompt action.

There will be delayed turnaround compared with the current time of 3 hours for the majority of routine haematology and biochemistry tests. This means GPs do not have to worry about classifying tests as urgent or routine and they know they can rely on us to phone abnormal results ( we have a clear list of relevant abnormalities) and they can get immediate clinical advice from consultants whom they know.

It is likely that results from CPS will be available much later in the day and therefore they cannot expect to be telephoned with expert clinical advice the same working day. We must ask them how they will deal with the unexpected abnormalities on our ‘Results to Telephone ‘ list.

We must also ask how they will deal with the fact that they may ‘phone when the surgeries are closed , the GP needs to be notified immediately and the answering service refuses to help. Fortunately local knowledge helps here as our network of informal contacts can help us to find a GP colleague when the answering service is unhelpful.

If it is essential to have an immediate clinical assessment and the GP cannot be contacted then a consultant can call the patient and when necessary, I have done this. It is not always easy to trace patients from the limited details GPs put on the request forms but we can normally locate a patient through the databases in the hospital.

I recall a newly diagnosed diabetic with a blood sugar of 35, the result becoming available at 3 pm on a Thursday afternoon, the blood having been taken at noon. That level, as a presentation in diabetes requires urgent treatment. The lab staff ‘phoned the surgery who were told by the answering service that the surgery was closed and that they must ‘phone back in the morning (many GPs take Thursday afternoons off). The clinical information stated ‘tiredness’ , the GP had not expected such a degree of abnormality. No telephone number was available; searching the Patient Administration System database did not reveal the patient but it did show patients with the same surname at the same address and therefore I was able to telephone his house.

His wife answered and advised that he was now asleep and it was difficult to arouse him. This suggested rapidly progressive diabetic pre-coma requiring immediate treatment. I arranged his admission straight away.

If his blood had gone to Bedford it is unlikely that the result would have been available during normal working hours so we can only speculate on what might have happened given the reduced levels of senior staff in highly automated megalabs and I doubt whether the lab personnel there would have been able to assess the clinical situation and/or arrange a speedy admission.

We do find unexpectedly severe abnormalities quite often, virtually every day, most commonly low platelets and that generally means a high risk of bleeding which can be prevented with urgent treatment.”

It is bizarre that the local labs were not given the contract – that appears to be because the winning bid was said to be ‘better’ – they did a better job of selling their services possibly because they have partners including SERCO who are experienced in marketing and local labs  are simply inexperienced at salesmanship.

The Result of the Competitive Tendering  process

Is still not known – CCGs who have to implement the plans are aware of the dangers and are working hard to broker a solution.

The problem could have been avoided by recognising that competitive tendering may mean the best sales team rather than the best provider wins the day.

In this case the best bid was still best of a bad job and the Health Authority should have realised this and entered constructive discussion with local hospitals that they could lose their services if they could not improve their offer.

In this example the bidding process was not fit for purpose.

I shall be happy to provide more information

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2 Comments

  1. There has never been any doubt that such tests must be carried out by the local hospital trusts. It will prove to be most effective and cheaper in the long run

  2. The whole system has been rigged in favour of the private sector, we have already outsourced the 111 service, PTS Patient Transport Service here in Gloucestershire, In every case the service is worse than when it was in the NHS. The 111 service have untrained personnel answering calls to a given script, which means when in doubt send an ambulance, as previously all calls were properly triaged by qualified clinicians. This has massively increased the burden on the Ambulance service.

    The PTS arrive hours late for appointments, were using tablets that were inadequate for their system and the batteries failed. In one case a patient waited 24 hours for a hospital appointment, the knock on effects of course to the hospital are obvious. They had vehicles with over 200,000 miles on the clock and five were unsafe because the damaged rear doors would not close and still drivers were being forced to drive them or lose their bonus payments, one ex Ambulance service driver refused and photographed the condition of the vehicles, which we sent to the local press to investigate.

    The other damaging situation is to the existing Ambulance service, flexibility and resilience are reduced because in extreme emergency situations where extra vehicles were required the service used PTS personnel as back up to transport people to hospital, this avenue is now closed to them. The case is amply demonstrated when an emergency incident in London meant that the London Ambulance service had to convey patients to hospital in a bus.

    The CCG is currently tendering the Out Of Hours service where a patient survey placed the service from fairly good to very good at 73% and even scored above the national trend. The CCG also says that they are satisfied with current local doctors and Ambulance service arrangement, but nevertheless are compelled by legislation to put it out to tender.

    The increased cost of the tendering process makes the whole exercise a farce and is merely a vehicle in my view to privatise what profitable pieces of the NHS there are.

    It is also apparent that Virgin health does not have provide any FOI, this is clearly rigging the so called market.

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