Managers betrayed by outsourcing, says union

The government expects private companies to form consortia to bid for places as approved commissioning support suppliers, NHS acting chief executive Sir Ian Caruthers has revealed.

Sir Ian was speaking last week as a controversial contract notice inviting companies to bid to provide 'primary care trust management services' was republished alongside new commissioning guidance.

The advertisement was reworded after the original was withdrawn when unions said it could mean companies taking over 'clinical services'.

The reworded notice calls for companies with a 'proven track record of supporting commissioning' for populations of over 90,000. The original had called for 'experience of managing a healthcare commissioning budget' of at least£300m.

Sir Ian said he did not think this would restrict the pool to just one or two large US companies such as UnitedHealth and Kaiser Permanente, as he expected 'consortia to develop' that would fit the criteria.

The commissioning framework, published on the same day as the revised OJEUadvertisement, suggested that boards might want to 'buy in' skills on actuarial and population risk, data harvesting and analysis, social marketing, opinion surveys, service evaluation and redesign and procurement.

However, unions have reacted with alarm at the reissued document despite the apparent removal of reference to management of clinical services.

Unison head of health Karen Jennings said the redraft was 'just as dangerous' as the original and Managers in Partnership national officer Jim Keegan said it was a 'betrayal' of the PCT management community.

'[Managers] now they have the spectre that, at worst, their jobs are going to be entirely outsourced to the private sector,' said Mr Keegan. 'This is scant reward for people who are keeping the NHS going through all this change and uncertainty.'

He said the money should be invested in training NHS managers who carry out the 'vast majority of commissioning' to 'embed' the resource in the public sector.

However, the overall commissioning framework has been given a cautious welcome by other NHS management representatives.

NHS Confederation policy director Nigel Edwards welcomed it as a 'helpful' document that gives organisations the 'space' to run their local NHS within a policy framework sensitive to local situations.

However he said there was a danger that officials in favour of targets and weekly reports, such as the prime minister's policy unit, could try and snatch back that freedom.

Mr Edwards said he hoped Sir Ian would block any such move.

And NHS Alliance chief officer Mike Sobanja has called for the Department of Health to paint a clear picture of where it sees the reform programme leading to 'put an end to accusations of Machiavellian motives to destroy the NHS'.

The framework also lays out incentives to bring in new providers to the NHS, as revealed by HSJ last week. These could include additional payments over and above the tariff, or offering contractual guarantees on income, activity or extended contract length.

Another incentive would be to reduce capital investment required from the provider by considering a 'variety of different ownership and service delivery models'. The document also floats plans for a 'quality bonus scheme' to reward providers with the best performance.

And providers could be prevented from seeking to axe essential services through the use of the 'terms of authorisation' model for foundation trusts, the document says.