Thursday’s must read stories, analysis and debate

How the UnitingCare contract collapsed

On Thursday we came a little bit closer to understanding how Cambridgeshire and Peterborough’s hugely ambitious, laboriously tendered, £725m five year contract for older people’s care collapsed after just eight months of operation.

UnitingCare Partnership, the limited liability company set up by two foundation trusts to run the new integrated service, expected to be paid more than the contract value. A month into the contract, they asked for a £34.3m bailout – the total agreed price for the year was £152m.

Cambridgeshire and Peterborough Clinical Commissioning Group fundamentally disagreed and, after months of negotiation, the contract collapsed with a £10m shortfall.

The new details have come to light in an audit commissioned by the CCG, published on Thursday afternoon. The report also highlights a series of problems with the procurement process, and singles out two issues relating to advice given by the Strategic Projects Team: UnitingCare was not required to resubmit its bid after it changed organisational structure to become an LLP; and it did not require the winning bidder to submit “parent company guarantees”, exposing the CCG to added risk when the deal collapsed.

Expect more on this subject: the local health overview and scrutiny committee has been taking evidence from Monitor and NHS England’s regional boss Paul Watson, and NHS England’s own investigation into the fiasco is due in a couple of weeks.

Some good news for Jeremy

Health ministers and experts on patient safety gathered in London on Thursday for an international patient safety summit hosted by health secretary Jeremy Hunt.

After previous comments suggesting Mr Hunt should apologise to junior doctors over the contract dispute, Professor Don Berwick today praised the secretary of state for his efforts on improving healthcare.

Professor Berwick told the gathered crowd he had had the opportunity to work with Mr Hunt on several occasions and added that of all the secretaries of state he had worked for, Mr Hunt was “the most committed and authentic” on his efforts to improve care.

ACO vs ACS

For all the excitement about it, there is one major downside to the idea of the “accountable care organisation”. It is the word “organisation”, and the pavlovian response it triggers in the NHS, which is to start talking at length about setting up new legal entities, or changing the rules governing foundation trusts.

The term “accountable care system” more accurately describes the original US vision of the ACO, which is for a network of providers acting as one. In this country, avoiding the O word could also focus attention on making the existing systems that comprise the NHS work better.

Some leaders are using “ACS” to describe their adoption of new care models. First we had the health economy around Morecambe Bay – a primary and acute care system vanguard.

Now Berkshire West – which is not a vanguard site – has published some details of its ACS plan in its board papers. Our understanding is that Berkshire West is only unusual in that its plans are fairly advanced and that NHS Improvement has taken an interest. Expect other areas to follow with similar plans, particularly as the sustainability and transformation plan process encourages health systems to explain how they will move towards new models of care over the next few years.