The procurement exercise in Staffordshire which outsources the commissioning of £1.2 bn of NHS services has at last made the mainstream media. An announcement has been made that it has been decided that the next stage of the procurement will now get under way with a full blown EU procurement (competitive dialogue). The decision was made in private for reasons which are unclear, so there is no public record.
The procurement has of course already been under way for some time with the request to submit pre-qualification questionnaires in March. But there was absolutely no information about any of the details. Leading up to the announcement there has been a flurry of activity as the CCGs involved try to put right the numerous defects in the way they have gone about this exercise. They have also got together to establish a special web site to promote what they are doing – though it too lacks the necessary information.
There is no record in any CCG minutes of how the key decisions were made and no papers setting out why; but there is no obvious justification for such secrecy.
The formal procurement is for two contracts; one for Transforming End of Life Care and the other for Cancer Care. The contracts are for 10 years and are for an “integrator” (lead contractor) to manage existing contracts for two years and then to take full responsibility for the management of the provision of care. The integrator can be a private body and given the requirements this is the most likely outcome.
Before the procurement a lot of good work had been carried out around the need to improve services and to integrate provision and in general the aims are not disputed. The way the CCGs have gone about approaching the implementation of worthy aims is hugely controversial and potentially unlawful.
It is totally unclear how the decision was taken to use a major competitive procurement exercise rather than use the existing powers that commissioners have to arrange the provision of services. The decision to go down a route that opens the door to a private provider effectively taking over the commissioning role has never been discussed.
The fear that private sector organisations would take over CCG responsibilities and make decisions over provision of services was much discussed during the passage of the H&SC Bill and after the pause there were reassurances that this could not happen – well it is happening.
The clear danger of having 10 year contracts of this sort is clear even to those who are relaxed about greater private provision. The NHS is undergoing a period when major changes are necessary as care moves from hospital to the community and as barriers between social, physical and mental health are dismantled – everyone agrees on this. But if commissioners have given away their right to manage provision they can’t respond they can only look to contract variations and disputes with their lead contractor. It is pretty fundamental that decisions about the allocation of resources and the priorities that are set cannot be made by private sector organisations under some contract – it just doesn’t work like that!
The duties on CCGs to have proper arrangements in place to allow discussion with patients and the public are clear enough. How services are commissioned and how decisions are made about who provides what are clearly matters on which patients and the public (and staff) have the right to be involved.
As with other procurements that have fallen apart we again see CCGs charging ahead without having in place the necessary framework of proper information disclosure and governance and paying, at best, lip service to public and patient involvement.
It is not just essential but also arguably a legal requirement for the CCGs to stop what they are doing and to consult properly about what they are proposing to put in place. If after such discussions they decide to proceed through competitive procurement of a lead contractor model then they have to ensure openness and transparency in every step they take along the way. They have to involve patients and users in setting out requirements, defining criteria and in evaluating the responses from potential providers. They have to make public all the necessary information and stop hiding behind spurious claims to commercial confidentiality – it is up to the CCGs to make arrangements to ensure openness not hide things. They have to show that what they do is consistent with the policies they have established (and formally agreed) and with the various assurances that have been set out by Ministers and the various quangos who oversee the NHS and what it does.
Only if this is done can anyone have an honest view on whether what results is really in the best interest of the patients and our NHS.
There is a real danger here. If the route to integration is by using private providers as surrogate commissioners then the whole drive to a worthwhile aim is totally undermined.