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CSP warns of risk of fragmentation as NHS outsourcing grows

There is a growing risk that patient services may fragment as a fresh wave of NHS trusts in England is to be taken over by external contractors, warns the CSP.

‘The CSP remains extremely concerned that a system with multiple providers could work against the government’s stated aim of better integration,’ said Claire Sullivan, CSP assistant director of employment relations and union services.

The society’s concerns follow a decision in May by Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) to put its entire older people’s care pathway out to tender.

This could either be as a single contract or four separate ‘lots’.

The CSP is also worried about the impact of other large contracts being introduced elsewhere in England.

The Cambridgeshire approach is as an example of the ‘lead provider’, ‘prime vendor’ or ‘prime contractor’ arrangement.

Worth up to £800 million over five years, it will replace six separate existing CCG contracts with NHS organisations. The contract will cover four hospital trusts, a mental health trust and a community services trust.

‘The CSP believes this could lead to fragmentation of care; a plethora of different standards against which the quality of care can be judged; poor monitoring of non-NHS providers and a wide variation in employment conditions and pay,’ said Ms Sullivan.

The contract will cover acute unplanned care, community services, long- term and respite care, , community services, older people’s mental health services and end of life care. It may also include NHS continuing care, occupational therapy, and intermediate care and re-ablement services. 125 physiotherapists employed by the trust could be affected.

The CCG said it was considering bids from a range of providers, including NHS organisations, the voluntary and private sectors, and that the contract would go to ‘the best possible provider’.

The current provider, Cambridgeshire Community Services NHS trust, is positioning itself by forming a partnership with private healthcare providers Capita and Circle to bid for the contract to provide integrated services across Cambridgeshire and Peterborough.

It says the partnership ‘brings together the best of the private and public sector, seamlessly combining CCS NHS Trust’s, Circle’s and Capita’s core strengths in clinical experience to improve care for patients, alongside technology led innovation, administration and customer service expertise’ (See Cambridge Community Service NHS).

The CSP joined the British Medical Association, which like the CSP wants the NHS to remain publicly provided and funded, in speaking out on this development.

Dr Mark Porter, BMA chair, recently told The Guardian: ‘The unacceptable damage to patient care that occurred in out-of-hours provision in Cornwall demonstrates that there are still worrying flaws in how non-NHS providers are monitored once they take over the running of NHS services.’

Dozens of clinical commissioning groups are devising similar ‘lead provider’ contracts for entire care pathways in England, according to research by the Health Service Journal.

Under this model, the organisation delivering services, rather than the prime contractor, is the employer and will be responsible for employees’ terms and conditions. ‘NHS Standard Contract: guidance to clinical commissioners states: ‘The CCG retains responsibility for the services commissioned but it is reliant on the prime contractor to hold subcontractors to account.’ (See NHS England, page 9 Annex 1.)

  • In the South West, social enterprise company Sirona has won the contract for delivering services currently provided by South Gloucestershire Community Health NHS trust. Sirona also took over community services in Bath and North East Somerset in October 2011 that were formerly provided directly by the NHS.
  • The latest takeover means 450 NHS staff will transfer to Sirona as part of the five-year contract.
  • Weston Area Health NHS Trust in Somerset is facing a possible privatisation similar to the franchise model in Hinchingbrooke, Cambridgshire, run by Circle, leading to a local campaign to keep it in the NHS.  
  • Bedfordshire CCG named the stock market listed Circle as preferred bidder for a ‘prime vendor’ contract.
  • It would lead a ‘partnership’ for an integrated MSK service worth £120m. Sub-contractors would be GP-led Pennine MSK, independent healthcare provider  Horizon Health Choices, the Arthritis Care and the National Rheumatoid Arthritis Society and Luton and Dunstable NHS FT.
  • The CCG said this previously involved 20 contracts across primary, secondary and community services.

Worried about what’s happening in your area?

  • More information and resources on how you can try to ensure the best interests of patients and CSP members are served in the face of growing competition in the NHS in England at NHS Changes
  • If you’re working in the NHS, please contact your steward if you become aware of outsourcing proposals in your trust. 
  • If you’re a CSP member seeking advice on bidding for contracts and developing a business case, please take a look at the resources available here: CSP Your Business
  • The CSP is encouraging CSP members to sign an e-petition on the government website calling on all bodies delivering public services, including NHS services outsourced to non-public sector providers, to be subject to Freedom of Information requests to help ensure there is accountability and transparency by private companies spending taxpayers’ money.

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