Revealed: millions paid to social care companies amid crisis in standards (The Guardian: 3 December 2016)

An investigation into the five biggest firms providing homecare services in the UK has found millions of pounds has been paid to some owners amid a crisis in standards of care.

An analysis of published reports from the Care Quality Commission, the care regulator for England, reveals that of the 192 domiciliary care services run by major companies, and inspected over the last two years, 80 were found to “require improvement”, with eight found to be “inadequate” and placed into special measures.

In services rated inadequate, people were found to be unwashed, unfed, unable to get out of bed and left at risk of harm. In some cases, medicine was not given on time or safely and services were described as unsafe and short-staffed. Yet, in the past five years, an analysis of care records and company accounts by Corporate Watch reveals evidence of £36m being paid to owners, with a further £34m in liabilities being stacked up in company more


NHS outsourcing contract collapses due to 'catalogue of failures' (The Independent: 16 November 2016)

A "catalogue of failures" resulted in the collapse of an £800 million NHS contract to outsource care of older and mentally ill people, the Commons spending watchdog warned.

An influential committee of MPs concluded that the NHS lacked expertise in procurement and it was "worrying" that untested contracting arrangements could form part of the plans being drawn up for further changes to services across England.

The Public Accounts Committee was scathing about the doomed deal between Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) and UnitingCare Partnership, which collapsed after just eight months.

The cash-strapped CCG awarded a five-year contract to UnitingCare, an NHS consortium of Cambridgeshire and Peterborough NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust, but the deal was scrapped in December 2015 after it ran into more


Capita support services remain a 'chaotic mess', warns GPC in new report (Pulse: 7 November 2016)

GP support services remain a 'chaotic mess' despite nearly a year passing since NHS England outsourced the services to Capita, the GPC has warned.

The GPC said that the Government has to 'get a grip' of the situation, which is 'putting patient care and safety at risk', with the warning coming as MPs are due to debate failures in Parliament tomorrow.

A snapshot survey of 281 GP practices carried out by the GPC found that problems with delivering patient notes and customer support persisted last month.

It found:

  • Almost one third (31%) of practices said they had received incorrect patient records;
  • More than one quarter (28%) of practices failed to receive or have records collected from them on the agreed date with Capita;
  • Over half (58%) of practices reported that new patient registrations were not processed within the required three days.
  • Eight in ten (81%) of urgent requests for records were not actioned within three weeks.

Meanwhile, more than one fifth of practices (23%) had not received medical supplies they had ordered on the expected date, like medicines and prescription pads and just over half (51%) of practices reported that customer service support staff were unable to resolve issues within an appropriate more


27,000 patients could lose their GP as chain hands back contract (Pulse: 31 October 2016)

Some 27,000 patients are at risk of losing their GP practice as a provider has decided to hand back a contract it says is 'not fit for purpose'.

Greenbrook Healthcare, which runs five practices in west London under one APMS contract, said it has been in discussions with NHS England since the beginning of the year to ‘address what support could be provided by them'.

But with no extra funding coming through, Greenbrook Healthcare - a private company which runs GP practices and urgent care centres across west and south London - has concluded that the best option is to end its 10-year contract nine months early, to ‘allow NHS England to look at the contract afresh’ more


Trust's radiology information system crashes for nine days (HSJ: 7 October 2016)

A trust has said it has no plans to pull out of its contract for a troubled radiology information system, shortly after its leaders considered terminating the deal early.

A paper to a meeting of the board of Dartford and Gravesham Trust at the end of last month said “in the longer term the trust plans to give notice on the RIS contract” provided by GE Healthcare.

It said the trust planned, as an alternative, to extend another IT system used at its Queen Mary’s Hospital site, to its main site at Darent Valley. The paper, a report by the quality and safety committee, said: “The business case is scheduled to go to the finance committee.”

However, the trust subsequently told HSJ it did not plan to pull out of the contract.

The system suffered a hardware failure, which saw the radiology information system, which serves all of Kent and Medway, out of service from 28 August to 5 September.

The collapse of the system resulted in a “significant reporting backlog developing”, according to a report to the Dartford and Gravesham board meeting on 29 September.

“This has led to complaints from clinics as patients have attended without their imaging report being available.”

The trust’s actions to cope with a significant backlog included triaging investigations for reporting, allocating additional staff to support reporting and outsourcing reporting.

However, when HSJ asked the trust about its proposal to give notice on the GE Healthcare contract, a spokesman said while the failure of the system “was of great concern to the trust and was discussed at board level”, it will not be “pulling out of the GE contract, which is a Kent and Medway wide agreement” more


Nurses forced to clean wards after private company fails to improve (HSJ: 3 October 2016)

Nurses at Nottingham University Hospitals Trust are having to clean wards after cleaners from a private company in order to maintain standards, the trust board has said.

At a meeting of the board last Thursday, the trust said Carillion, which won a £200m, five year estates and facility contract in 2014, had not made sufficient improvements.

The trust warned Carillion in July that it faces having the contract terminated if it does not turn the service around.

After the board meeting a trust spokeswoman said: “Nottingham University Hospitals Trust remains deeply concerned about the cleanliness of our hospitals.

“Following escalation of our concerns to Carillion we have instigated vigorous, additional interventions to focus Carillion on improving cleanliness to the required standards as quickly as possible.


'Gap' in CCG assurance process for Care UK contract (HSJ: 29 September 2016)

There was a “gap” in commissioners’ assurance process for an urgent care contract with Care UK and the provider’s staffing model was flawed, a review has found.

The report by Verita, published last month, also found that the urgent care centre was “often understaffed” and the staffing model “took no account of predictable peaks in demand”.

In 2011, Ealing Primary Care Trust awarded a five year contract to Care UK worth £3.9m to run the centre in Ealing Hospital.

In August 2015, Ealing Clinical Commissioning Group asked Verita to carry out an independent report following an investigation by ITV that accused the service of poor care.

The review identified a “gap” in Ealing CCG’s assurance process as it “failed to recognise deficiencies in a number of UCC audits” more


£380m Coventry hospital built without proper fire protection (NHE: 31 August 2016)

A major hospital in Coventry will need to undergo remedial work after it emerged that it was built without the guaranteed fire safeguards.

University Hospitals Coventry and Warwickshire NHS Trust said that it had carried out an investigation following a review of the fire safety separation at University Hospital, Coventry.

This found that the structures to prevent a fire spreading are not as robust as specified in the original plans.

University Hospital opened in 2006 as part of a £380m private finance initiative (PFI) partnership between the trust and developer Skanska.

The trust and Skanska are now working on a programme of remedial works.

In the meantime, it has taken steps to reduce the risk of a fire by increasing security patrols and rubbish collections and reminding staff of safety procedures. It has also developed an action plan with West Midlands Fire Service.

David Eltringham, chief operating officer at the trust, said: “Following a review of the fire safety separation at University Hospital, we learned of some potential issues with the infrastructure.

“As a result of these issues, we immediately launched an internal investigation to determine if any further steps needed to be taken to make the site safer.

“This investigation appeared to show that, in the unlikely event of a fire, the structures to prevent it spreading were not as robust as those specified in the original plan for the more


Out of hours provider to go into administration (HSJ: 13 May 2016)

An out of hours provider has been forced to end provision of services across the East Midlands after it announced it intends to file for administration.

Central Nottinghamshire Clinical Services said on Thursday it will stop its services in Leicester, Leicestershire, Rutland and north Nottinghamshire. It transferred them to other providers on Friday.

CNCS has stopped running out of hours services at King’s Mill Hospital

The news comes against the backdrop of pressure on general practice and out of hours services across the country. HSJ has been told that services in Leicester, Leicestershire and Rutland have moved to Derbyshire Health United, the out of hours provider for North Derbyshire, South Derbyshire, Hardwick and Erewash clinical commissioning groups.

Nottingham Emergency Medicine Service has taken over running out of hours services at King’s Mill and Newark hospitals in Nottinghamshire.

Care home support services, also provided by CNCS, have been transferred to Nottinghamshire Healthcare more


GPC demands practices be compensated for 'systematic failure' of support services (Pulse: 11 May 2016)

The GPC has told NHS managers that every practice should be compensated for the significant extra workload they have had to take on as a result of the ‘systematic failure’ stemming from the handover of primary care support services to the private provider Capita. 

The GPC sent a letter to NHS England most senior management to highlight the ‘serious and systemic failure’ of the relaunched primary care support service, for which it is ’ultimately responsible’.

Capita has said that they have introduced new procedures in a bid to alleviate the problems for practices.

Pulse has written extensively about the problems with Primary Care Support England, which has seen practices accumulating piles of uncollected patient recordsmissing payments, and left without vital practice supplies.

The GPC has raised these issues with Capita, but the letter states that interim solutions have heaped more workload and costs on practices and things have not improved ‘despite reassurances’ made weeks more


'Meltdown' of £330m outsource contract disrupts primary care (HSJ: 11 May 2016)

Vital primary care support services are in “meltdown” after NHS England contracted them out to Capita last year, prompting anger among providers toward the contractor and the national body.

The outsourcing giant took over primary care support in September following a competitive tender. The contract is worth £330m over seven years.

Capita’s bid depended on saving £21m a year, driven by centralising administration and technology functions.

However, there have been reports of the service getting dramatically worse since the beginning of 2016 as the old localised service centres have been closed and transferred to Capita’s new centres.

HSJ has heard GPs, community pharmacists and optometrists have all been affected. 

Chaand Nagpaul, chair of the British Medical Association’s GP committee, has written to NHS England to highlight “a multitude of serious complaints” from GPs. These have focused on Capita’s failure to supply essential supplies such as syringes and prescription forms, and to deal effectively with paper records moving between practices.

Dr Nagpaul said Capita “appears to have been considerably underprepared”. The poor service has increased practice workload and cost practices money, he said. He called for practices to be compensated.

He told HSJ: “This is a salutary lesson… it is another example of how the idea of outsourcing appears attractive in offering more for less, but that is based on a very simplistic view of how the NHS functions. The NHS has been very efficient and effective. The NHS functions on organisational memory, and you cannot just take a service over and run it better.”

Bob Morley, executive secretary of Birmingham Local Medical Committee, said there had been some instances of practices not being able to release paper records because couriers, subcontracted by Capita, had arrived without appropriate identification. He also said some practices had not been paid properly.

The situation was an “almighty mess”, he more


Is private equity really fit to run care homes? - Graham Ruddick (The Guardian: 4 May 2016)

These are crucial weeks for England’s care home industry. Homes across the country face a cash crisis, and they are about to find out whether the pressure on them is going to ease.

Since George Osborne announced in the autumn statement last year that councils could increase council tax by an extra 2% to pay for social care, care home operators have been eagerly anticipating a rise in the fees they receive from local authorities. The tax increases took effect from April, so the extra money for councils should start flowing to care homes imminently.

Well over 90% of local authorities have chosen to enforce the 2% tax hike. The extra cash is crucial for care homes. The chancellor introduced the “precept”, as it has been described, after warnings from leaders in the care home industry that homes could close because they were running out of cash.

Care homes are being squeezed by a fall in the fees that cash-strapped councils pay for residents, and a rise in staff costs. This squeeze has become more pronounced due to the introduction of the “national living wage”, meaning care homes have to pay all staff over the age of 25 at least £7.20 per hour.

Care home operators made a clear argument to the chancellor – if you want us to increase the amount we pay staff, then you have to help us fund it. This is why councils can increase council tax.

The funding issues for care homes are clear. The number of beds in care homes in the UK fell by 3,000 last year, the first decline for a decade according to research by industry analysts LaingBuisson. In addition, private residents now pay 40% more on average than publicly funded residents for like-for-like services, which critics claim is because care homes are trying to make up the shortfall from state-backed residents. There is also evidence that the quality of care in homes is deteriorating. The Care Quality Commission has found a third of Britain’s 18,000 care homes require improvement and 7% are “inadequate”.

The pressure on the industry was underlined last week when Four Seasons, the biggest care home operator, published its financial results. It has 440 homes, 18,500 residents, and 31,000 staff. It is a behemoth in the care home world. However, its results showed a £264m annual pre-tax loss for 2015.

Four Seasons is at the centre of the storm in the care industry. Not only is it feeling the squeeze from rising costs and falling fees, but it has been in private equity ownership for a decade, which has left it lumbered with interest payments of more than £50m every year and debts of more than £500m.

The situation brings back shocking memories of the collapse of Southern Cross, then Britain’s biggest care home group, five years ago. S&P, the credit ratings agency, warned last year that Four Seasons was going to run out of cash. It begs the question – is private equity really fit to run a care home? more


Ambulance privatisation descends into 'total shambles' (The Guardian: 12 April 2016)

Hundreds of patients including people with cancer and kidney failure have missed important appointments for treatment because ambulances did not arrive to take them to hospital, after privatisation of NHS non-urgent transport services in Sussex this month.

Some elderly patients have had to wait more than five hours for ambulances and been stuck at hospital for long periods after their appointments because the transport service, now run by the private firm Coperforma, has proved so unreliable.

Patients, relatives, NHS bodies and local MPs have severely criticised the service’s performance, and a trade union representing ambulance crews said it was an “absolute shambles”. The NHS organisations that awarded the four-year, £63.5m contract have now launched an investigation.

A host of problems have arisen since Coperforma replaced the NHS’s South East Coast ambulance service (Secamb) as the provider of non-emergency patient transport services on 1 more


NHS paid private provider £165,000 for single home visit under GP Choice scheme (Pulse: 1 April 2016)

NHS England has paid £165,000 for a contract that has seen a private provider carry out just one out-of-area GP patient home visit and 18 phone consultations since last July.

The West Midlands local area team awarded a contract to health and social care provider Primecare in July last year to provide home visits to patients who are registered in practices outside of their area as part of the GP Choice scheme. 

The contract was worth £165,253 upfront, with an extra £80 agreed for each GP visit and £30 for phone consultations, NHS England confirmed.

But Primecare was only required to carry out a single home visit during that time, NHS England admitted, with the contract expiring more


GP practices face £20,000 losses as federation goes bust (Pulse: 15 March 2016)

A GP federation providing APMS services for 37,000 patients has gone into administration after running into financial difficulties leaving local GPs thousands of pounds out of pocket.

Danum Medical Services Ltd (DMSL) is a private limited company set up in Doncaster by the 23 local shareholding practices - which DMSL’s website says ’equates to 63 individual shareholding GPs’ - which holds APMS contracts for six practices in the Midlands and Yorkshire.

The company previously held major contracts for an extended hours hub and GP out-of-hours services in Doncaster, but hadn’t managed to secure them again when the contracts expired and went out to competitive tender last year.As a result, one shareholding practice told Pulse they were facing losses in the region of £20, more


Private health provider goes into administration (Northern Echo: 15 March 2016)

Patients are facing an uncertain future after a private company that runs health care services in east Cleveland revealed it was in financial difficulty.

The future of Marske Medical Centre is in doubt after the private healthcare company which took over less than a year ago went into administration.

The contract to run the centre - which had been under the control of the South Tees NHS Foundation Trust - was awarded to Doncaster-based Danum Medical Services Ltd (DMSL) in April last year.

A spokesman for DMSL said: “I can confirm that DMSL has gone into more


Revealed: Failed Cambridgeshire provider asked for £34m bailout after just one month (HSJ: 10 March 2016)

The controversial Cambridgeshire older people’s services contract collapsed because the provider expected to be paid substantially more than had been agreed in the deal, an audit has found. 

The investigation into one of the largest deals ever awarded for NHS clinical services has also raised serious questions over the quality of advice received by Cambridgeshire and Peterborough Clinical Commissioning Group.

UnitingCare Partnership’s contract was worth £725m over five years. The contract, which was awarded to UnitingCare Partnership in November 2014, was worth £725m over five years, and collapsed after just eight months of operation in December.

UnitingCare was a limited liability partnership jointly owned by two local trusts: Cambridgeshire and Peterborough Foundation Trust, and Cambridge University Hospitals FT.

An audit by West Midlands Ambulance Service Foundation Trust, carried out on behalf of the CCG, found that one month into the contract the provider asked for an extra £34.3m for the year. This would have been worth 23 per cent of the £152m contract value for the first year of the more


‘Grave concerns’ over CCG’s finances following £800m contract failure (HSJ: 18 February 2016)

NHS England has raised “grave concerns” and demanded action on the financial position of the clinical commissioning group reeling from the collapse of the £800m UnitingCare Partnership contract, HSJ has learned.

The national commissioner’s intervention follows Cambridgeshire and Peterborough CCG’s 2015-16 financial forecast plummeting from a £4m surplus to an £11m deficit because of the high profile contract collapse, its latest board papers more


NHS watchdog signed off doomed £750m contract despite doubts (The Guardian: 26 January 2016)

An NHS contract worth £750m that collapsed in December after just eight months was effectively signed off by the regulator and NHS England, despite questions about its viability.

The contract – the biggest in NHS history – was the first designed to bring together hospital, mental health services and community care for adults and older people in Cambridgeshire, introducing a single point of contact for patients.

Signed in November 2014 after a 15-month procurement process that cost more than £1m, it was strongly opposed by local campaigners and trade unionists after several private bidders expressed an interest. Opponents feared it would mean transferring thousands of staff into the private sector.

In the end, the contract went to an NHS partnership called UnitingCare. It launched in April last year, promising to cut emergency admissions to hospital, saving millions of pounds. But by early December, all the partners agreed it was not financially sustainable.

In papers submitted to Cambridgeshire county council’s health scrutiny committee, Monitor revealed it had such grave doubts about the project that it only gave it the go-ahead the day before the launch. There were 34 outstanding issues remaining to be negotiated, a hearing of the committee was told last week. 

The senior GP in the clinical commissioning group (CCG) that awarded the contract, Dr Neil Modha, resigned last Friday, citing personal reasons. At the hearing of the health scrutiny committee the day before, he admitted that the obligations in the contract exceeded its value. “There was not enough money to cover all the services that were to be provided,” he said.

Questions will be asked not only about how the contract came to be approved but why it was not rescued. On some estimates, its collapse will cost the already hard-pressed local hospitals, community care providers and GPs up to £20m. The shortfall that had been identified was £9.3m. NHS England refused to find the extra more


John Lewis arrival sealed the end for GP firm as it walks away from contract and 11,500 patients (The Argus: 18 January 2016)

The long-awaited arrival of John Lewis to Brighton city centre may have the unintended consequence of leaving 11,500 patients looking for a new GP.

The Argus has learned that The Practice Group’s decision to terminate its contract for five GP surgeries in Brighton and Hove is based partly because of a need to relocate two of its surgeries under upcoming redevelopment schemes.

The company, which is set to leave the city at the end of June, currently has a practice based in Boots in North Street – a site which John Lewis bought last year and are set to submit a planning application for in a matter of weeks.


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)

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

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

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

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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