What is going on in England’s biggest health economy, by Ben Clover

Mystery in north east London

Publically disavowed by all, worked around by Jeremy Hunt – the Health and Social Care Act continues to make its presence felt in different parts of the NHS.

It is, after all, the law.

And it partly explains some of the mysterious goings-on in north east London over a £55m elective care contract.

In July 2015 Care UK referred the commissioners of outer north east London to Monitor, claiming their award of an electives contract previously held by the private provider to a nearby acute trust was improper.

The complaint outlasted the actual life of everyone’s favourite competition regulator, and was left to NHS Improvement to make a judgement, which it did last month.

Except that it didn’t.

It looked like Monitor/NHS Improvement had issued a judgement last month, finding for Care UK, but in fact the CCGs had folded and decided to give the work to Care UK after all.

So it was re-tendered? Nope, Care UK get a 15-month extension to its current provision, then it will be put out to tender again.

NHS Improvement has managed to get away without issuing a judgement on the commissioning skills of the CCGs after they changed their plea to guilty.

But guilty of what? What changed?

The CCGs claim that, 10 months after the complaint was made, they learned all of a sudden about issues in the elective waiting times performance of Barking, Havering and Redbridge University Hospitals Trust, which they had planned to give the contract to.

(In their words: “Since the commencement of the investigation the CCGs have arrived at a better understanding of the challenges that BHRUT faces which raises issues about whether it would be appropriate to make the contract award to BHRUT.”)

Just recently apparently.

BHRUT hasn’t reported its waiting times figures nationally since August 2014. Its elective waiting times problems have been known about for some time. But Waltham Forest, Barking and Dagenham, Havering and Redbridge CCGs – its local commissioners – only just found out?

They didn’t realise this when the contract was awarded to BHRUT? Or when Care UK raised its complaint last July? Not when HSJ reported in January that Monitor had basically found the commissioners guilty on at least some of the charges brought by the private provider?

No, according to the commissioning support unit doing press for the CCGs, they only realised BHRUT was not the provider for this job when HSJ reported the trust had more than 1,000 patients waiting more than a year.

This was in March and obviously a big deal. Big enough to scrap the contract over. So they snapped into action and two months later said they would instead extend Care UK’s contract.

Their undertakings and NHS Improvement’s acceptance of them leave all of Care UK’s complaints unaddressed (or in NHS Improvement’s words: “We have therefore closed our investigation without determining whether any such failures occurred.”).

It’s worth reminding ourselves what those accusations were.

They are that commissioners:

  • had not followed due process in agreeing to sub-tariff prices;
  • had failed to take quality sufficiently into account; and
  • discriminated against Care UK by not running a competitive tender for other services.

You can see why NHS Improvement, which has other things on its mind, wouldn’t want to get into public discussions of price and quality and whether everything we get from hospitals should be commissioned – it’s all a bit 2012.

The CCGs claim extending Care UK’s contract “enables [BHRUT] to use the elective care treatment centre to manage the current levels of demand”.

I asked them how stripping BHRUT of the contract would do that. The CCGs weren’t very clear and stopped answering emails.

Care UK has some significant figures in its ranks, including former DH man Jim Easton, and had been running the North East London Treatment Centre since 2007 before the work was put out to tender again.

It seems as if some kind of deal has been struck but we’ll have to wait a little while to find out what it was.

Irony corner

In an inversion of the kind of arguments that were heard in the Lansley era about the unscrupulous cherrypicking and loss-leading tactics of the independent sector, private firm Care UK claimed that it was the one undercut by Barking, Havering and Redbridge to win the contract, heedless of the quality implications.

Serious allegations, and ones you would think would need to be considered. Instead NHS Improvement has acted like they were never made, after the CCGs backed down.

The treatment centre Care UK operates out of is owned by NHS Property Services. The landlord could technically still make life difficult for its tenants by not extending the lease for the unit, which adjoins BHRUT’s King George Hospital. The undertakings that had to be signed by the north east London CCGs’ chief officer Conor Burke three times (once for each CCG he leads) stipulated that the commissioners must help to ensure this happens.

The local MPs have been broadly supportive of their embattled local NHS provider.

But irony lovers take note: if BHRUT had got its way and won the contract it would have hastened the drive towards King George becoming an A&E-less “cold site”, focused entirely on elective work and outpatients.

And local MPs hate the idea of the A&E being closed there (and you do wonder where all the patients would go, with the trust’s A&E performance already among the worst in the country).

London Eye features a look at what’s going on in England’s biggest health economy. London has the best and worst regarded hospital trusts in the country. It has excellence and dysfunction in commissioning and primary care. I will cover all of this.

Please get in touch totip me off about stories you think I should cover: ben.clover@emap.com.