The “phased withdrawal” of Coperforma from providing Sussex’s patient transport service has been greeted with a sigh of relief from unions and many patients. But it leaves many questions unanswered.

Coperforma took over the £16m a year contract in April after being awarded it through a competitive tender in which it was ultimately the only contender. The contract specified a model in which the organisation and booking of transport was separated from the provision of ambulances and crews. This matched Coperforma’s business model but was an innovative way of working that put off many other bidders. Other providers which attended a meeting where the proposed model was explained were apparently amazed at how the tender was written. As delivered by Coperforma, it would rely on a pool of small subcontractors and the use of technology to direct them to the next “job”. Some ambulance staff said the technology did not work in parts of the county with poor mobile phone reception.

Almost as soon as the contract transferred, there were severe performance issues

Unions expressed concerns even before the service mobilised, as Coperforma appeared to get subcontractors and sites organised late in the process. At least one of its subcontractors – VM Langfords – had to expand rapidly to deliver additional staff and vehicles. It went into liquidation within weeks of the contract starting.

This sort of prime contractor model may seem attractive to CCGs. But it comes with a loss of control over the “end point” – the patient journey – but not with the loss of responsibility. The lead CCG – High Weald and Lewes Haven – has been criticised.

Almost as soon as the contract transferred, there were severe performance issues, inconveniencing both patients and hospitals which found appointments were missed – including some for time dependent treatment such as dialysis. Hospitals had to keep staff late to ensure these were carried out and arrange additional transport for patients. This meant additional costs and it is not clear if they can all be recovered.

A report commissioned by the CCGs looked only at the mobilisation phase, not the contracting, but recommended there should be a “plan B” and phased mobilisation for other major procurements and that that the CCGs should use an independent professional consultation oversee “technical aspects”, as well as seeking independent assurance that the service was ready to roll. This raises questions over whether CCGs are well placed to do this kind of specialist procurement, given that they are only likely to run a similar procurement once every few years.

Will the whole tendering, delivery and exit from the contract ever be fully examined?

Questions remain over the cost of the failed contract. South East Coast Ambulance Service had originally said it could not continue with the contract past this April because it was not adequately funded. It seems unlikely that South Central Ambulance Service would be happy to take over (as it is doing) – with the set up costs it must have incurred – without additional funding. It is also unclear how long it will provide the service for or if it will go out to tender again. South Central is better placed to run it than South East Coast, which has multiple problems.

The CCGs will likely have to put more money into the patient transport service, raising the inevitable question of what will be cut to fund it. And will the whole tendering, delivery and exit from the contract ever be fully examined to see what lessons can be learnt?

Analysis: Commissioners have questions to answer over failed contract