Tracking everything that’s new in care models and progress of the Five Year Forward View, by our senior correspondent on integration David Williams.
We’re back after two weeks away. To help you catch up with developments in new care models, this newsletter will be a little heavier on links to recent integration must-reads.
The fortnight in new care models
- This week’s devolution intrigue: NHS England says it will jump in if A&E performance falls below a certain standard in Greater Manchester. This new provision underlines the fact that NHS England still feels responsible for what goes on, devo or no devo – and that what autonomy Simon Stevens giveth, he also can taketh away.
- Jon Rouse, Department of Health social care boss and former council chief executive, has been appointed chief officer for the Greater Manchester devolution project.
- I write at length below about South Warwickshire CCG’s procurement for out of hospital care. They’re not the only ones launching new tenders though: Camden has also gone to market to find a single provider of a joined up musculo-skeletal services in the past week.
- Birmingham’s new mental health service for young people aged 0-25 went live on 1 April. The contract caused a big row locally during 2015-16 because it transferred services for young adults from the local mental health trust to a consortium of providers including Birmingham Children’s Hospital and the Priory Group. Although services have now transferred, we’ve heard negotiations are still ongoing about how much “bridging funding” will go to the mental health trust to help it cover stranded costs.
- Are we moving towards a new era of peace, love and understanding between the NHS and local government? Not to judge from NHS England’s decision to offload the cost of some HIV drugs onto councils. This may make short-term sense for a service desperate to avoid blowing its departmental budget, but it will enrage local government, whose financial challenge is at the very least as great as the NHS’s. In the future, if joint commissioning of health and social care is going to happen across the country, relationships will be key. Trust between both parties will be vital. This move represents a significant expenditure of goodwill by NHS England.
- A few weeks ago I decried NHS England’s failure to publish data on Better Care Fund performance. Sadly, my protests have not yet yielded positive results. “The Better Care Support Team aim to publish the BCF Data Collection and Performance Report for Quarter 2 2015-16”, says the website. Click here to watch the tumbleweed blow.
- One of Norman Lamb’s favourite ministerial themes was how much the NHS could learn from mutuals. Late in his tenure at the Department of Health, he and Chris Ham from the King’s Fund launched a programme to explore this further. The programme found there’s little chance of any NHS provider trusts adopting a mutual model as long as VAT and corporation tax liabilities apply. Expect similar issues to surface in relation to new organisational forms being established by vanguards. For the playing field to be levelled, a tax exemption would have to be created for mutuals supplying into the NHS. It is hard to see how such an exemption could be justified only for mutuals as opposed to other types of company, and applying only to the NHS and not to other public services.
- Nearly all CCGs will take on primary care commissioning by 2018. That’s handy because it will be pretty difficult to get new care models adopted across the country without GP and acute commissioning in the same place, and rolled together in the sustainability and transformation plan process.
Competitive tendering at the crossroads
Is competitive tendering still considered a legitimate way to get transformational service change done in the NHS?
Recently, there have been signs of risk aversion in the wake of the Cambridgeshire older people’s contract failure/debacle/fiasco.
Jim Mackey issued a warned to all those contemplating similar “trendy” innovations. A big deal in Staffordshire has been delayed while final arrangements are agreed, and adding to this narrative, Staffordshire’s other big tenders – its huge cancer and end of life care contracts – remain on hold while NHS England reviews them.
However, there seems to be no national policy in place to enforce caution.
And so, a CCG in the West Midlands has embarked on an ambitious public procurement that looks a lot like the Cambridgeshire one, albeit for a smaller population. South Warwickshire CCG is advertising for a new provider of older people’s out of hospital care. The deal will be outcomes based, and seeks to link community and mental health services for frail older people.
Notably, the Strategic Projects Team is advising the CCG. This advisory team was subject to criticism in the first audit of the Cambridgeshire deal, and are involved in the paused Staffordshire contract.
There are two reasons why it’s a strange time to embark on a new procurement exercise.
First, the sustainability and transformation plan process is (supposed to be) under way. It is hard to understand why a single CCG would act alone to create a single long term contract, which impacts on other major local players, rather than wait until there is a local/regional plan for the whole health system.
Second, Cambridgeshire is still under investigation. NHS England’s first review into the episode was published on Friday. But a further report has yet to be produced focusing on the quality of advice the CCG received, the role of the CCG’s leaders, and the oversight from the Department of Health. It would seem sensible to fully understand all the lessons of this affair before embarking on a similar project.
Given the stakes, and the fact that the tender will take a year or two to complete, waiting two or three months for the final review to come out and the STP to be completed would be reasonable.
The CCG argues that it needs “transformation in the out of hospital system”, as a “fundamental component of a sustainable health and care economy”. It says it needs a single provider to deliver integrated, timely services that are tailored to the needs of individual patients.
It also says – at some length – that the tender process has been developed in accordance with NHS procurement and competition regulations.
The latest review of the Cambridgeshire contract is short, readable and well worth a look. On competition and procurement, it includes a very interesting recommendation for NHS England.
The authority should: “Consider which is the most appropriate process to achieve an integrated system wide solution consistent with EU law. There are advantages to formal procurement including transparency and focus. However, this requires capacity and capability to carry out the procurement, robust costing and other information to inform the contract and financial flexibility of bidder organisations to manage risk.”
A few weeks ago I wrote that in Cambridgeshire tendering itself wasn’t the problem, it’s the way the NHS goes about tendering. This latest review raises a troubling set of questions: what if the NHS can never be good at tendering, and if it can’t, are there alternatives?
Expect to hear more about this soon. This is a live discussion and I’ll be pleased to hear any feedback, and as ever I’ll include as many responses and comments from readers as I can. Let me know what you think.
David Williams, senior correspondent, integration
- BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHSTRUST
- BIRMINGHAM CHILDREN'S HOSPITAL NHS TRUST
- Chris Ham
- Competition and co-operation
- East of England
- Manchester devolution plan
- NHS Birmingham South and Central CCG
- NHS Cambridgeshire and Peterborough CCG
- NHS Camden CCG
- NHS England (Commissioning Board)
- NHS South Warwickshire CCG
- Norman Lamb
- Priory Group
- Service design
- SOUTH WARWICKSHIRE NHS FOUNDATION TRUST
- Virgin Care
- West Midlands