Time to End the Stafford Saga

NHS Commissioning Privatisation

As news arrives from Cambridge of yet another privatisation inspired project going horribly and expensively wrong let’s hope people in Staffordshire, South Warwickshire, Southport and elsewhere are thinking long and hard.

The Stafford Cancer contract saga is long running and is now so hopelessly flawed that it should simply be wound up. The use of a complicated procurement process which was supposed to be about a competitive dialogue between various qualified providers bringing new ideas has ended with a negotiation with the obvious NHS providers. The attempt to outsource commissioning has been unpicked.

It matters because even if everything else is ignored (and it should not be) then the commissioners and providers of cancer services are to be locked into a complex legally enforceable contract for ten years. So for ten years as the rest of the NHS tries hard to evolve and develop collaboration through vanguards, devolution and other imaginative attempts to make services better the cancer services in Staffordshire and Stoke will be locked out; bound together by the guesses made now.

It is fair to accept that when the saga began there were the best of intentions; you can accept that cancer services in the area were not as good as they should have been. What would have helped would have been some kind of root cause analysis of why this was the case. Still, work began quite purposefully on what better services should be like and some consultation and engagement took place.

Embedded in the ideas being developed was to use a lead provider model, where some of the commissioning decisions are moved from the commissioner to a lead provider who takes on the role of integrating services. Nothing wrong with the idea although it shows a weak commissioner. Anyway the project got approval from NHS England. As was said at the time:-

Five of Staffordshire’s Clinical Commissioning Groups (CCGs) are teaming up with Macmillan Cancer Support to transform the way people with cancer or those at the end of their lives are cared for and supported.

The project will look at commissioning services in a new way – so that there would be one principal organisation responsible for the overall provision of cancer care and one for end of life care.

Then it came to light that the commissioners were to use a competitive tendering approach to find the lead provider. What they were asking for is set out below as taken from the contract noticei. In the Financial Times it was reported that:-

The NHS is embarking on its biggest and most wide-ranging outsourcing of services so far by inviting companies to bid for £1.2bn in contracts to provide frontline cancer treatment in district hospitals and care for the terminally ill.

The deals could see the private sector delivering all cancer and end-of-life treatment for children and adults across Staffordshire and Stoke on Trent. This will involve diagnosis and treatment such as radiology, radiotherapy, breast screening, chemotherapy, nursing and surgery for patients in hospitals, hospices and at home.

Two years later a lengthy process using FoI has now established that there is no proper record of how the decision to use competitive tendering was taken, no proper business case was prepared (even though this was a contact for over £600m), no options appraisal was carried out into the best method to use and there was no attempt by the CCGs involved to follow their arrangements to involve service users in decisions about how services are organised. The whole process was built on sand.

Fast forward to today and we have the CCGs involved through the procurement/project process negotiating with the NHS providers of the services and carrying out due diligence. It is possible that by early next year the contract could be ready for signature.

Hopefully before signing anything the CCGs will wake up and insist on a full (final) business case and publish it and get some independent expert assurance of what is in the case as would be required in any such major exercise involving £600m. Even then once the actual details of what the contract requires are established then there has to be a proper engagement with the service users taking more months.

But why bother? The failure of the contract in Cambridge hangs over the Staffordshire experiment. There, after much negotiating a contract was finally agreed with just the NHS providers that were left and it failed within a matter of months.

Come on Staffordshire give it up.

i A two-stage, ten-year contract to transform the provision of cancer care in Staffordshire and Stoke. Stage 1 will be fee based, for up to two years, and requires a prime provider to manage all the services along existing cancer care pathways with a view to: managing and improving data quality and collection to establish detailed baseline information about activity and costs; understanding patient and payment flows; achieving a limited set of service outcomes focused on improving the patient’s experience of the service and ensuring equality of access and treatment. Achievement of the Stage 1 aims will trigger the commencement of Stage 2.
In Stage 2 the provider will assume responsibility for the provision of cancer care, in expectation of streamlining the service model. Performance will be against ambitious clinical and service outcomes, with payment based on achieving stipulated outcomes. Service provision (Stages 1 and 2) will initially be for four tumour sites (bladder, lung, prostate, breast) with a requirement to provide services in respect of all tumour sites by contract year 5.