• Join up scrutiny of CCGs and providers to get more “holistic” picture, says Cambridgeshire CCG lead
  • Neil Modha’s comments follow publication of audit into how £725m flagship deal collapsed
  • Dr Modha says CCG gave NHS England “all the information” about UnitingCare deal before it went live

REGULATION: The accountable officer at the commissioner which oversaw the collapsed £725m UnitingCare contract has urged NHS England and NHS Improvement to join up their scrutiny processes to avoid another similar failure.

Cambridgeshire and Peterborough Clinical Commissioning Group accountable officer Neil Modha spoke to HSJ following the publication last week of an audit into the collapsed older people’s services contract, which was cut short just eight months into a five year deal.

Neil Modha

Neil Modha

Dr Modha said the CCG gave NHS England all the information it needed

The audit suggested better information sharing between providers and commissioners could have helped identify the significant differences in opinion over how much the contract would cost at a much earlier stage.

While NHS England oversaw a “gateway” process for the CCG, and Monitor carried out a similar process for the NHS owned provider UnitingCare Partnership, these processes were not joined up sufficiently, Dr Modha said.

“Having a process that joins up [commissioner and provider side scrutiny] and looks at the situation more holistically does make sense. That could be the learning [locally and nationally],” he said.

The audit, carried out on behalf of the CCG by West Midlands Ambulance Service Foundation Trust, revealed UnitingCare, the provider owned by two Cambridgeshire foundation trusts, had asked for an additional £34m just one month into the five year deal. The additional funding was worth 23 per cent of the £152m contract value for its first year.

UnitingCare submitted a business case to Monitor for its plans but this was not shared with the CCG, the audit said. The assumptions in the business case were never compared with UnitingCare’s original bid for the contract, despite the CCG and the regulator being in contact about the deal before it went live in April 2015, the audit said.

It said: “As the audit report observes, the fact that the CCG did not see the [UnitingCare] business case approved by Monitor meant that the CCG did not know that there was a fundamental mismatch between the financial assumptions that were in excess of the CCG’s expectations and the UnitingCare bid.”

The audit said the discrepancy between what the CCG and the provider believed the contract would cost to run was a surprise to commissioners. It eventually proved to be an unbridgeable gap, resulting in both parties declaring the deal financially unviable in December 2015.

Dr Modha defended his CCG against accusations made by Paul Watson, NHS England’s Midlands and East regional director, that the contractual arrangement had been too complex. Dr Modha said NHS England had been given full sight of the plans long before they went live.

“It would be fair to say the CCG did everything and gave all the information within that [NHS England] gateway review, including talking about the model we were developing and the mobilisation period, etcetera. We fully worked with the [gateway review process] to make sure they had all the information,” he added.

“[The complexity of the model] was not really an issue that was brought up before. Outcomes based commissioning was very popular… People were very interested in [this model] and if in the future it could be rolled out across the country.”

Asked if the CCG could have achieved the changes without such a complex arrangement, Dr Modha said: “Having [tried to go through] what we saw as step by step changes, we thought that actually going for a big transformational change [rather than piecemeal step-changes] was the right thing to do.”

UnitingCare was jointly owned by Cambridgeshire and Peterborough and Cambridge University Hospitals FTs.