My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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The problem for NHS Commissioners. Do what they are told by the DH or time to stand up for what you want to achieve for local people?

Filed Under (Primary Care Trusts, Secretary of State, Third party provision) by Paul on 18-12-2009

Yesterday I posted the news that the voluntary organisation ACEVO had taken a complaint about the Chief Executive of Great Yarmouth and Waveney to the Co-operation and Competition Panel. ACEVO made it clear that whilst they were complaining about his behaviour, they felt he had been ‘put in a difficult position’ by the Secretary of State’s personal preference that all re-tendered work should go to his preferred NHS providers.

It is worth going through how this has happened since many PCTs will be in the process of making or remaking decisions in this area.

Across the country PCTs are deciding what to do with their ‘provider arms’ of district nurses, health visitor and others. Over the years the DH has been not only been giving out confusing messages but has been dogmatic in its contradiction. Last week I commented that David Nicholson, the CEO of the NHS, had said that for these provider arms to become community foundation trusts was ‘nonsense’, whilst three years ago he was extolling their virtues in the operating framework. (The problem is not that he changed his mind. The problem is his certainty in imposing something one day – and then, with equal certainty, imposing its opposite a little while later).

PCTs have been working their way through this maze of contradictory advice and many had, by this autumn, come to a conclusion about what they wanted to do for their local people.

Great Yarmouth and Waveney PCT are one of many, and they signaled their intention to providers that they intended to invite tenders for its Community Services, currently being delivered by the PCT’s own provider arm. It held an information day on 5 October 2009, and informed providers that it intended to issue a Memorandum of Information and Pre-Qualification Questionnaire in October or November.

They obviously felt that the right way forward for their local people was to have an open competition to get the best management for their provider services from either the NHS, the third, or the independent sector. As they said in their later letter to potential bidders on November 24th

We indicated at the Information Day on 5th October that we intended to issue the Memorandum of Information and Pre-Qualification Questionnaire in October or November.  This has been slightly delayed owing to the issue of guidance by the Department of Health (DH) in mid October regarding the ‘NHS as preferred provider’

We have been in discussion with the DH and the Strategic Health Authority (SHA) to clarify the implications for NHS GYW’s planned procurement.  The outcome of this is that the PCT will now only be able to accept bids from NHS organisations. 

This is the crux of the problem. Having decided that the best way to meet the needs of its patients and population was to tender these services openly to all providers in the market, the PCT then reversed its decision because it felt that DH guidance told it to. They felt they were ‘only able to accept bids from NHS organisations.’

ACEVO continues the story in their complaint;     

In explaining this reversal, the PCT did not suggest that it had changed its view that tendering the service would be the best way to meet the needs of its patients and population. Rather, it attributed the reversal of its previous decision to the Secretary of State’s statement that “the NHS is our preferred provider”.

This is where a number of PCTs are at the moment. They want to do the right thing for their patients and the public but they are being given guidance by the DH to do something which comes from the Secretary of State’s personal preferences.

We now know that if they do what they are told and limit their choices to NHS providers there is a good case to be made that they will be engaging in anti-competitive behaviour and will end up, with the Secretary of State, in the dock

All the more reason to stick to your guns and do what is right for your local people. As ACEVO said

“I appreciate that the Secretary of State’s statement that ‘the NHS is our preferred provider’ has put you in a difficult position given that you had already come to the conclusion that competition between all sectors to deliver your community services would provide best value for patients and taxpayers in your area.”

In this case doing what you are told could get you into more trouble than doing what is right.

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