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.


Half of GPs willing to resign NHS contracts (Pulse: 10 December 2015)

Almost half of GPs support mass resignation from the NHS in protest at the current state of general practice, a Pulse survey has revealed.

The survey of 922 GPs found that 49% are willing to resign their NHS contracts to highlight issues such as chronic underfunding, relentless bureaucracy and the ‘misrepresentation’ of doctors.

However, 35% of respondents said they were against the measure, saying that mass resignation could enable the Government to divide the profession and privatise the NHS.

It comes as senior GP leaders prepare for a crisis summit in 30 January, which will look specifically at ‘what actions are needed to ensure GPs can deliver a safe and sustainable service’ and after junior doctors forced health secretary Jeremy Hunt back to the negotiating with their threat to strike earlier this month.

GPs said they were angry at the lack of Government action as practices faced an unprecedented shortage of GPs, their income falling to the lowest level for nine years and many being forced to close down.

They said that a ‘new deal’ announced by the health secretary earlier this year has failed to deal with the problems many practices were having.

Dr David Goldberg, a GP in Merseyside, said: ‘Over the last few years all actions by the Government point to the fact that they are engineering a fight with doctors. The Government misrepresents us repeatedly. They misrepresent doctors’ work ethic but nothing could be further from the truth. The only option we have left is to post-date resignation letters en masse.’

Dr Karen Buchanan, a GP in North Tyneside, said: ‘I’m massively frustrated by the situation in general practice. To the point, after 20 years, where I’m not sure I can continue working in the NHS. I see the whole structure of general practice being dismantled, a structure that had been admired world-wide. The opinions of the workforce are repeatedly ignored by the Government. Money is being poured in to wasteful inefficient ”money saving” schemes. We may have less targets to reach but we are always the target for the media.’

But Dr Andrew Sant, a GP and medical director at Worcestershire Health and Care NHS Trust, told Pulse that resigning was not a solution and the profession should instead push for an alternative model of care: ‘This would probably be in a large provider working as an accountable or integrated care organisation rather than a practice.’


NHS will struggle to cope this winter, new analysis finds (Nuffield Trust: 10 December 2015)

Just 3.6 per cent of patients took up over a third of all bed capacity in acute hospitals in England last year, new analysis by the Nuffield Trust of pressures on the NHS last winter has found. The analysis comes on the day that NHS England publishes its latest monthly figures on how the Health Service is performing against a number of targets.

The patients in this group were likely to have been frail or elderly people who the system was not ready to return to their own homes or to nursing or residential homes, despite their medical treatment being finished.

This new figure for bed occupancy helps to explain why the Health Service still suffered a winter ‘crisis’ last year, the authors say, despite receiving record extra funding from NHS England of almost £700m specifically to deal with pressures caused by winter.  

The fact that no extra funding for winter is being allocated this year means the position will be even worse in the coming months, they argue. The Health Secretary Jeremy Hunt announced in November 2014 that the money was being awarded to the NHS to ‘make sure it is better prepared [for winter] than ever before’ - yet by January this year, a string of Trusts in England had declared major incidents or ‘black alerts’, whereby hospitals were closed to all new admissions, while performance against the four hour A&E standard was the worst in a decade.

The way in which this small group of patients was treated meant that bed occupancy rates in many hospitals were running far higher last winter than the 85 per cent generally recommended by experts as the maximum that should be reached in the NHS – which in turn held up the admission of patients from emergency departments, thereby preventing those arriving at the ‘front door’ of A&E from being seen quickly enough and causing the four hour A&E standard to be breached repeatedly. See Nuffield Trust report for further details..The A&E Winter Crisis: lessons from last year


Number of ambulance staff quitting almost DOUBLES leaving NHS facing crisis (The Mirror: 10 December 2015)

The NHS faces an ambulance staffing crisis because numbers of workers quitting have almost doubled, experts warn.

Thousands more ambulance staff and paramedics plan to leave imminently, with poor working conditions and low pay blamed for the mass exodus.

The Unison, Unite and GMB unions were calling on the Government to review salaries or face the “catastrophe” of strike action.

In 12 months over 2010/11 a total of 845 ambulance staff quit, say NHS figures obtained by the three unions. In 2014/15 that had soared to 1,545.

Unison head of health Christina McAnea said: “Paramedics are doing more than ever and asked to deal with a growing range of emergencies.

“But these responsibilities and skills haven’t been recognised by employers or the Government. With the background of NHS cuts and junior doctors’ recent threat of industrial action, it’s essential the Government doesn’t mislead staff over promises – or there could be industrial action in the ambulance service.

“ The NHS will rely on its ambulances as A&Es struggle to cope with winter pressures. If the Government doesn’t act, this crisis could turn into a catastrophe.”

A poll of more than 3,200 ambulance staff in England and Wales found three in four are considering leaving, while 94% feel their pay does not reflect their duties. The three unions, representing more than 20,000 ambulance workers, said inadequate pay and work conditions are the big causes of low morale.

A paramedic starts on £21,692 per year. The full wage rises to £28,180 after seven years. The unions will point out this and other issues to the NHS pay review body next week.

Unite said: “Underpaid ambulance staff are voting with their feet.” The GMB said: “The service needs proper investment and recognition of skills.”


NHS rationing 'is denying patients care' as cash crisis deepens (The Guardian: 8 December 2015)

Patients are being denied mental health care, new hips and knees, and drugs to boost their recovery from illnesses including cancer as the NHS increasingly rations treatments to try to overcome its growing cash crisis.

A survey of doctors reveals that three-quarters said they had seen care rationed in their area over the last year – including treatments such as speech therapy, operations to remove varicose veins, Botox to help children with cerebral palsy move better and even potentially life-saving stem cell transplant surgery.

Disabled children were having to use ill-fitting wheelchairs, teenage girls were banned from accessing medication to tackle male-style hair growth and women had been unable to access surgery to have breast enlargements or reductions as a result of growing restrictions across England, the research concluded.

Medical organisations said the findings showed patients were paying the price because an underfunded NHS was having to force them to wait for care or deny it altogether.

Dr Mark Porter, leader of the British Medical Association, said: “The NHS is being forced to choose between which patients to treat, with some facing delays in treatment and others being denied some treatments entirely. This survey lays bare the extreme pressure across the system and the distress caused to patients as a result.”

Almost four in five (78%) of the 749 doctors in England who took part in the survey – conducted for the Guardian by Binley’s OnMedica, a healthcare data and intelligence provider – said patients who were denied treatment suffered increased anxiety as a result.

One patient killed himself after experiencing a delay in receiving help with mental health problems. Another doctor told how “several teenage girls with hirsutism [male-style hair growth on the face, chest or back] have experienced severe psychological distress and bullying [after being denied drugs to treat it]. Some have self-harmed and been admitted to hospital as a result”.


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