Friday, 29 March 2013

"NHS tendering 'a threat to patients' "?

I suspect many of you will not have access to today's Times but it has  a fascinating letter from Dr Hilary Cass (President, Royal College of Paediatrics and Child Health), Prof Sue Bailey (President, Royal College Psychiatrists), Dr Clare Gerada (Chair, Royal College of General Practitioners) and Prof Lindsey Davies (President, Faculty of Public Health).  Yes, the sort of people who you may be inclined to listen to if you were not deaf.

Their letter includes:
... we are concerned that Clinical Commissioning Groups will be forced to open services to competition against their will - creating an unnecessary bureaucratic and financial burden on commissioners, and unnecessary drain on vital NHS funding. There is also a real danger that the enforced tendering of one service may damage another independent service in a different part of the same organisation or care pathways which are key to providing high-quality healthcare to thousands of children and mental health patients every year.
We urge the Government to think again about how the section75 regulations are framed and their potential consequences. We want to see a full debate in Parliament and engagement with the Medical Royal Colleges and health professions to ensure these regulations are redrafted in the best interests of patients.
That's a fairly clear statement to the effect that key stakeholders have yet to be convinced on the way forward.

I have no reason to doubt the NHS procurement staff who, for many years, made clear that helping clinicians engage with professional procurement has been a major challenge; indeed many consider gaining their ownership of procurement initiatives the equivalent of winning an Olympic Gold.

Are these medical luminaries fighting against the changes as they see the erosion of their own vested interests or is patient care their sole motive? Are these very clever people, who appear to have resisted all forms of NHS reform, just creating yet another filibuster?

We also know from the recent Public Accounts Committee that consultants have not been the easiest to accept any form of personal performance management. Indeed they are now having their own contracts negotiated. Is this another oligopoly negotiating?

I have already expressed my concerns that change management to Clinical Commissioning Groups does not look as if it is being well handled. Then on Wednesday night's Newsnight we heard a GP admit the what keeps him awake at night is procurement - he also acknowledged the struggle in holding hospitals to account.

We can give the letter's signatories the benefit of the doubt and demonstrate how their concerns can be risk managed. Let's be honest the NHS has never been a silo without any private sector provision, for example, medical equipment and its maintenance, or even surgical gloves. Closer to home, the NHS appears to have been able to cope with NHS consultants having dual roles of private consultants.

To me the letter is a well constructed change management issue playing on emotions. The answer does not lie in a full parliamentary debate but in clearly and pragmatically setting out how the perceived risks can be addressed. Procurement should be able to address the risks as part of a cross-functional team with the medical profession. However, if the risks are too significant procurement should not be allowed to become 'the whipping boy' and a strategic make/buy decision should be made.

Unfortunately this should have been addressed much earlier and in an objective manner, while now we're working from what appears to be minds made up that 'it will not work' as opposed to ' what do we need to do to make it work safely for the benefit of patients?'  Strikes me this is a lesson for all those interested in procurement change and risk management.

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