Landmark £800m outcomes based contract collapses after eight months (HSJ: 3 December 2015)

One of the biggest contracts ever put out to tender by the NHS has collapsed just eight months after going live, after commissioners and the provider consortium agreed it was not “financially sustainable”.

It has been announced today that UnitingCare Partnership has handed an £800m, five-year contract to provide older people’s care for Cambridgeshire and Peterborough back to Cambridgeshire and Peterborough Clinical Commissioning Group.

UnitingCare began running the services at the beginning of April this year.

The company is a limited liability partnership established by Cambridgeshire and Peterborough Foundation Trust, and Cambridge University Hospitals FT.

The deal is one of the largest ever tendered by NHS commissioners, and has also attracted attention for being an early, highly ambitious example of “outcome based contracting”, in which an element of payment depends on achieving agreed clinical outcomes.

A joint statement issued by Cambridgeshire and Peterborough CCG and UnitingCare today said: “Patients and frontline staff will see services remain despite a contractual arrangement between Cambridgeshire and Peterborough Clinical Commissioning Group and UnitingCare Partnership LLP ending.

“Unfortunately both parties have concluded that the current arrangement is no longer financially sustainable.

“We are clear that the innovative model of care for older people and people with long term conditions brings benefits for patients and the whole health and care system and we are all agreed that we wish to keep this model of integrated service delivery.

“The CCG will be working with providers of services in the coming days to ensure that there is a smooth transition for all concerned.”

HSJ revealed last year that the contract cost Cambridgeshire and Peterborough CCG over £1m to set up.

During the design and tender process the CCG had been advised by the NHS Strategic Projects Team – the unit which oversaw private provider Circle being brought in to run Hinchingbrooke Health Care Trust, as well as the abandoned procurements for George Eliot Hospital and Weston Area Health Trust.

The Strategic Projects Team is currently advising commissioners in South Warwickshire on a tender for community services.

The CCG was also supported by the COBIC consultancy, which has advised other CCGs seeking to bring in outcomes based contracts, including in Oxfordshire, Bedfordshire and Croydon.

A number of private providers, including Capita and Circle, initially expressed an interest in the Cambridgeshire and Peterborough tender but withdrew during the process because of the steep financial efficiencies required by the contract.


MPs round on ambulance firm Arriva after revelation it wrongly claimed £1.5m in bonuses (Manchester Evening News: 3 November 2015)

Greater Manchester politicians have blasted Arriva bosses for their handling of non-emergency patient transport after it was revealed the firm wrongly claimed £1.5m in incentive fees following the misreporting of performance.

As the M.E.N. revealed on Monday, Arriva chiefs have pulled out of the tender process for a new deal when the three-year contract comes to an end next summer following the gaffe.

The bus firm has paid the region’s 12 clinical commissioning groups £1.5m back in cash for good performance after it was revealed an error led to its standards being ‘overstated’.

Arriva bosses have held their hands up - and have confirmed they won’t be looking to renew the deal, having taken over the service in 2013 after undercutting the North West Ambulance Service by £ more


Arriva may face SFO fraud inquiry over NHS deal (The Independent: 8 November 2016)

Ministers have hinted that the transport giant Arriva could be subjected to a Serious Fraud Office inquiry after it inflated figures on an NHS contract. 

In September, Arriva self-reported that figures were wrong on a deal to provide non-emergency patient transport in Greater Manchester. This earned the group £1.5m extra in incentive fees for good performance – despite hundreds of complaints about its work last more


Reliance on agencies follows growing concern about shortages of NHS staff (Telegraph: 23 May 2015)

Ballooning levels of spending on agency nurses and doctors mean NHS trusts are paying the equivalent of £750,000 a year just to fill one post.

Hospitals have spent £3,200 for one doctor to cover a single shift, with payments of up to £2,200 for a nurse to work 12 hours.

A new report by NHS regulators reveals an £822 million deficit across the NHS, which can be blamed entirely on spiralling spending on temporary workers. During the last financial year, the health service spent a record £3.3  billion on agency staff. It was a rise of 31 per cent in one year, with spending at more than twice the levels planned.

The reliance on agency staff follows growing concern about shortages of NHS staff, particularly nurses and Accident & Emergency doctors.

Hospital managers say that, faced with a choice between leaving wards dangerously under-staffed or spending exorbitant sums on agency staff, they are forced into the latter.

But some have questioned the system which allows the market to dictate sky-high rates, with no effective caps on what the NHS will pay.


The Hinchingbrooke fiasco shows privatisation is no answer to NHS woes (The Guardian: 9 January 2015)

The great delusion of Andrew Lansley was to imagine that by bringing the market into the NHS, he could take the politics out. News this morning that Circle – the first private company to run an entire health service hospital – is manoeuvring to pull itself out will demonstrate precisely the opposite. The ramifications of privatisation could leave the service more electorally charged than ever before.

Parliament eventually imposed a deeply confused rewrite on the former health secretary’s bill, but his original masterplan – which David Cameron and Nick Clegg initially endorsed without bothering to read – was arrestingly clear. There would be a new healthcare market where funds followed the patients. NHS clinics and hospitals that couldn’t win enough customers would go to the wall, while new commercial entrants storm in. Holding the ring would be a remote regulator similar to that which oversees the electricity sector – with an overriding duty to “promote competition”. The thinking was that all those painful decisions that the experts always say are needed, but which the politicians have always ducked, would finally be settled as the unarguable consequence of choices made by patients themselves.

While it is true that the particular process that led to Circle assuming control of Hinchingbrooke hospital predates the Lansley reforms, tracing back to earlier New Labour flirtations with privatisation, its story nonetheless illustrates neatly why the Lansley plan was never going to work. Hinchingbrooke is in Huntingdon, where – as across much of the south of England – the local area supports more hospitals than a health service planner who was starting from scratch would go for. Every academic and thinktank report in health says that the way to make the NHS more efficient is “to move care closer to patients in their communities”, and away from general infirmaries. But the move is rarely made decisively, because no politician wants to shut things down. The pre-privatisation Hinchingbrooke quietly sank into being a basket case. Private enterprise spotted a chance to prove its worth, and – with some fanfare – rode in to “turn it round” more


The patients who can't leave hospital - because no one will make a profit (Guardian: 7 January 2015)

The case of Elizabeth Lee is typical - she arrived in Addenbrooke’s on 15 September after passing out at home. After several weeks of tests and treatment for a broken rib she was declared fit to go on 28 October, but 72 days on, she is still trapped in hospital. Officially she is a “delayed transfer of care” – a “DTOC” in NHS-speak – waiting, in theory, for the hospital to arrange a package of care support with Cambridgeshire county council to enable her to get back home.

She needs to have carers coming in four times a day to help her with some basic tasks as she cannot walk, the legacy of breaking her back after falling over on snow in the very cold winter of 1963-64. But the reality of her situation is much more complex, and is both gloomy and very sad.

Jenny Abel, the hospital’s lead clinical specialist practitioner for discharge planning, explains that it has proved impossible to arrange help for her, simply because of where she lives – in a village 15 miles from Cambridge. “We just can’t get the care for her,” admits Abel. “The problem is that, although it would be a 15-minute call to see Mrs Lee, it would take 20 minutes to get there from Cambridge and 20 minutes to get back, and that would happen four times a day.

“But because of that, and because there’s no one else in her village receiving a care package, all of the four care providers who provide those packages – private companies – are saying that they don’t have the capacity to do it. They don’t have enough carers, or they don’t have enough care [to provide to others] in that area to make it viable.”

Hence, someone who is keen and fit to leave the NHS bed she is occupying unnecessarily is unlikely to be able to do so any time soon, because no one can make a profit from her doing so. It is a situation the charity Age UK describes as madness, in which there are only losers and no winners. Crucially, it is causing entire hospitals to get clogged up, leaving them unable to admit new patients as quickly as they deem necessary.


Study finds flaws in the market for mental health services (University of Chester: 9 December 2013)

Why do private sector zealots choose to ignore the countless ways public money underpins daily life? (The Independent: 13 November 2013)

Competition rules over merger has cost NHS £1.8m, BMJ probe shows (British Medical Journal:15 October 2013)

Rail privatisation has failed – and the NHS is hurtling down the same track (The Guardian: 10 March 2012)

North-East MP calls for end to the 'creeping privatisation' of the NHS (Northern Echo: 8 October 2013)

Serco condemned over move to offload troubled GP service in Cornwall. (The Guardian: 11 October 2013)

NHS England warning: Monitor's proposals 'could put services at risk' (Health Service Journal: 10 September 2013)

CCGs 'urging GPs to refer to NHS trusts' against competition law (Pulse: 5 September 2013)

UK blood plasma company sale 'endangers NHS supplies' (The Guardian: 25 August 2013)


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