The Cambridgeshire contract fiasco must be explained

The older people’s pathway redesign for Cambridgeshire and Peterborough was a colossal project: to transform care for older people across the geography of England’s second largest clinical commissioning group. These are the services for the cohort of patients with the greatest and sometimes most complex needs. And those are the patients who are both most at risk of, and most at risk from, hospital admission.

The truth is that for a contract to be handed back this rapidly it can never have been financially sustainable

Last week we learned that this ambitious contract had spiralled into failure, just months after it took effect. However, beyond this, neither commissioner nor provider has proven willing and able to give an explanation for this rapid collapse, and this is troubling.

To recap: Cambridgeshire and Peterborough CCG spent over a year – and around £1m – tendering the service, in the hope of finding a single provider to improve older people’s care by joining up disparate specialist services.

The contract was innovative: it aimed to move beyond payment for activity and instead identify a capitated sum for the patient population. Part of this payment in future years was to be dependent on health outcomes.

And it was huge, being worth £800m over five years.

While other outcomes based contracts have been tendered in the NHS, Cambridgeshire attracted attention because it was big, complex and began early in the life of CCGs, in mid-2013.

After going live in April, the deal lasted just eight months before provider and commissioner agreed that it was “no longer financially sustainable”.

No further explanation has been given. The truth is that for a contract to be handed back this rapidly it can never have been financially sustainable, but neither party has  attempted to explain why this was the case.

How big was the deficit? Where were the unaccounted for costs, and how were they missed?

When a contract of this importance to some of the most vulnerable people in society fails, it is not enough to shrug and walk away

Did the CCG not offer enough money for the services – and the level of transformation – they were commissioning? Or did the provider win with an unrealistic bid? Either scenario reflects extremely badly on the local system. Their failure to explain what has happened – or their unwillingness to – looks even worse.

At the least, a fuller explanation is owed to the 1,200 staff who were transferred to new employers because of this deal, after two years of uncertainty over the future of their jobs.

The situation compares unfavourably with the collapse earlier this year of the management franchise at Hinchingbrooke Health Care Trust – another Cambridgeshire deal born of a complex procurement exercise involving the Strategic Projects Team. In that case, private provider Circle moved rapidly to explain its reasons for walking away, and its subsequent disagreements with the Care Quality Commission took place in public. The fact that all the players in Cambridgeshire’s latest drama are public sector organisations is not a good reason for silence – if anything, we should expect greater transparency.

Cambridgeshire and Peterborough were among the first to grasp the nettle, and they got stung

When a five year contract of this size and this importance to some of the most vulnerable people in society fails, it is not enough to shrug and walk away. The £1m-plus spent on setting this up – and the amount of senior NHS leadership time devoted to the tender – make this a matter of national public interest.

Changing the model of care and the system of incentives in the NHS is extremely difficult, necessary work. Cambridgeshire and Peterborough were among the first to grasp the nettle, and they got stung.

As NHS England develops capitated, outcomes based contracts for national rollout, it is important to understand and explain what has gone wrong in Cambridgeshire so the lessons can benefit the health service as a whole.