The health service in Staffordshire has gone through a turbulent decade and sadly a solution to having stable, sustainable acute care is as far away as ever.  This is despite many millions spent on external consultants in various roles over the same period telling the NHS what it should do and mostly being wrong.

Against this background the proposed outsourcing of control over cancer and end of life care through a ten year contract should sound very loud warning bells.  The record is not good elsewhere as the current fad of using procurement methods has not got far in Cambridge, Bristol, Nuneaton (George Eliot) or Weston; all places where activists and trade unions combined to challenge and won – at least for the time being.

A major concern ought to be about the cost of incompetence as major procurements are being derailed because even the most basic of requirements were never put properly in place.  If the Health & Social Care Act says Clinical Commissioning Groups have to have arrangements in place to secure involvement (and it does) then how on earth can those running these procurements imagine they can ignore it?  If a public body fails to agree a proper procurement strategy then it is likely to fail in various obvious duties around proper use of £millions of our money.

And  adding to these worries the health service has an abysmal record in contracting with the private sector as PFI, ISTC, NPFIT  show.  The NHS either does not have or does not use the expertise required to ensure good contracts are put in place and properly monitored – leaving us to be ripped off by private providers.

It is a scandal that those spending, or rather wasting, our money and those paid a great deal to advise them are not only performing badly; they are too arrogant to admit it and so never learn from their errors.

But if we leave aside incompetence and the lack of accountability we still have major issues around what is proposed in Staffordshire.  This is about more than deciding which organisations provide services. It goes to the heart of how priorities are set and how resources are allocated – and outsourcing such decisions, almost certainly to a private sector organisation, is madness as well as undemocratic.

The procurement documentation could not be clearer where it sets out that “the provider will assume responsibility for managing provision of cancer care/end of life care, in expectation of streamlining the service model”.  Stage 1 of this impending farce “requires a prime contractor/service integrator to manage the contracts for all the service”. (And we thought that was what commissioners did!)

Anyway, the best organisations at contracting for this kind of “integration” are in the private sector, where integrators have been around for two decades at least.  It is almost inevitable that this contract will be won by one of the well known players.  It is implicitly assumed that the NHS is not able to provide the management of such integration – because if it was there would be no need to go out and procure a solution!

So a private company will take change of commissioning publicly funded services.  How accountability then runs is opaque.  How all the duties placed on the CCGs as commissioners get translated through the contract is opaque.  How the public and patients will be engaged and involved will presumably depend on what is written into the contract and then on the extent to which the “integrator” decides it’s in their interest to take these bureaucratic obstacles to performance and profits into account.

And if in a few years time when there are better ideas about how to integrate services across the locality, widening either the services involved or the geographical spread, then the 10 year contract will block any such changes – however desirable they might be.

The original ideas around service integration in Staffordshire got some degree of public support, got the backing of Macmillan and then (last year) got selected as one of 14 schemes anointed by the great and the good.  It was a sensible set of ideas.

But someone somewhere decided the way to achieve the noble ends was through this £billion outsourcing approach.  There was no engagement and no consultation about that.  There is no proper record of what was decided and when either – at least not  in the public documents.  The experts running the exercise are the same experts who have failed with other major procurements.

We can despair or do what has been done elsewhere, use their incompetence against them and block the process.  In the NHS there is so much guidance, so many duties and so much hot air spouted about engagement, public and patient involvement, openness and transparency etc  that it is virtually impossible to run a procurement exercise without failing some reasonable expectation along the way.  But we should go beyond just challenging the process we should explore how those who have responsibility can be held publicly to account – which they don’t like at all.

And better still would be to elect a Labour government that had already given a public warning as a commitment that it would halt any procurements of this nature that had not led to contract signature before the election.

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2 Comments

  1. The direction of travel in the NHS has been obvious as the rest of the public services, Britain has been systematically asset stripped over the last forty years.

    Naomi Klein’s book “The Shock Doctrine” spelled the process out years ago.

    This is not all happening by co-incidence but by design, the underfunding is deliberately creating the conditions to achieve it.

    Tell Labour you want it spelled out here and now what their agenda is, I believe it is the same as the Tories and need convincing otherwise.

  2. Mark says:

    I’m not sure that’s what Prime Provider relationships are about. The idea, essentially, is that one main provider takes responsibility for a pathway and manages sub-contracting relationships with other NHS bodies, 3rd and Private Sector providers while taking accountability for what is delivered to the commissioner. This spares the commissioner the need to manage multiple contracts across a single pathway, with providers often blaming each other for failings in delivery. I’d be disappointed if a good FT didn’t secure the contract in question, though it’s not out of the question that it may go private.

    In any event, private organisations won’t be commissioning services. The prime provider will be subcontracting and performance managing against the commissioning agreement put in place with the NHS buyers.

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