NHS England Report on UnitingCare Failure – Other Major Contracts Should Be Reviewed

We have featured the Cambridgeshire “UnitingCare” health services contract a number of times here, most recently when we reviewed the recent Internal Audit report into the events. UnitingCare pulled out of the contract just eight months after it started, when that organisation – a specially created joint venture between two NHS Trusts - failed to reach agreement with the commissioners, the Clinical Commissioning Group, on financial matters.

Now, a report from NHS England has also addressed the causes and suggested lessons learnt. It is a good and clear report, and much of it re-iterates what was in the previous review. The most fundamental problem was that the contract was signed before there was real clarity on how much funding was available to run the service.  Similarly, the treatment of VAT was not clear, which has a major effect on the overall cost of course. Because of this, the contract when signed included a get-out clause. As the report says:

“An amendment to the contract, which was agreed in March 2015, established a process whereby financial revisions to the contract could be agreed for a period of six months after the commencement date. If the revisions were not agreed, then the contract could be terminated.”

But that introduced more uncertainty and gave the provider the exit route once that agreement could not be reached. As in the case of the audit report, there are some questions raised about the role of the various advisers to the programme. But the finger of blame is also pointed at the Gateway process, which is interesting:

“Despite the flaws which subsequently became apparent, the final Department of Health Gateway Review on this procurement commented that “the procurement process, so far, has clearly been undertaken professionally. It is a mark of success for such a high profile, high value procurement that it has reached this stage, maintaining competitive tension, whilst also receiving no challenges to the process’’ As a follow up to this review, NHS England should investigate specifically the current Gateway review process for detailed lessons learned”.

Poor judgement shown there by the Gateway reviewers – we wonder whether a. any of them were actually procurement experts and b. whether there were any external reviewers on the team rather than just other civil or public servants? Anyway, it’s not one to boast about on their cvs, that’s for sure.

So the recommendations in the report include looking at the role of the advisers, “the effectiveness of the Gateway review process, and the role of the CCG executive leadership, Governing Body and related audit functions throughout the procurement and contract period”.

Then the whole basis of “competitive procurement to achieve an integrated system wide solution consistent with EU law” is questioned – perhaps there are better alternatives?

NHS England should also look at whether more central assurance is needed – as the report says, the “consequences of failed contracts can impact on patients, staff, commissioners and providers and undermine working relationships for the future” so the impact resonates well beyond the local area when these failures occur. And finally, the report recommends a review of “all current and planned CCG and NHS England contracts of this sort as a matter of urgency, prior to entering into any new commitments”.

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First Voice

  1. Dan:

    Those extracts just show how much focus is put on running a compliant process rather than achieving the best commercial outcome.

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