The FT has published comment on a report this morning, saying:
The National Health Service competitively tenders contracts worth less than 2 per cent of overall clinical commissioning expenditure, according to new data that come as health leaders are seeking legal changes to end “overly rigid procurement requirements”.
I should say that, deep in the small print of the article it becomes apparent that the report does not cover all NHS procurement, and specifically does not cover the outsourcing of procrment services. It also notes that in terms of numbers of contracts the proportions are much more in favour of the private sector; it's just that the NHS gets all the big ones. But the message appears to be, within the uncertainties, that outsourcing is overall having less impact than expected.
So why has the report come out? It would seem that, again reading between the lines, the report has been produced to support the claim that more outsourcing would be of benefit just as the NHS is backtracking as fast as it can from the 2012 Health and Social Care Act requirement to secure quotations for all contracts worth more than £600,000 or so, which in NHS terms might be interpreted as ‘not a lot'.
Take it then that the outsourcers are worried that not only is the model not delivering for them, but that it might deliver even less. Given the general failure of outsourcing models that is now apparent right across the interface between the public and private sectors I think their hope is forlorn: this model is dying and for good reason. The fact is that outsourced models only save by doing one of three things. Those are providing a worse service; cutting staff costs; or reducing commitment to service renewal (R&D, training, etc). All are fatal to the quality of outcomes over anything but the very short term. And that's precisely why this model has to come to an end.
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This is very point salient that is probably related to a point I want make (as in what are NHS budgets being spent on and what is the VFM/patient benefit?).
I ate my shredded wheat this morning listening to Radio 4 news and the faux concerns of one Damian Green MP (you know, Theresa May’s most closest ally – the one with porn on his HMG laptop – allegedly).
I heard for example the idea postulated of the over 50’s paying 1% more NI (just for getting old and daring to live past 50 it seems) and some sort of levy or top up systems on society to cope with ‘better care’ for those with dementia whom Green thinks gets a bad deal (the answer as to why they get a bad deal rests squarely on the shoulders of Greens’ colleagues but he of course does not understand this being a macro policy dunderhead Tory).
All I can think of is that we are being prepped up to pay to exist because we are older or because of the frailties of being human.
It just goes to show that despite BREXIT, toxic Tory idiotology still exists – it is still a problem – they are still at heart a nasty, opportunistic , money grubbing and rather thick bunch of people who think that all the money in the world already exists (but its OK to print money to bail out private banks, prop up failing private pension pots and buy mates in Parliament when you are minority Government).
It is the Tories who need to stop existing: they and their faulty thinking are the problem, along with the Lib Dems and Blue Labour not to mention any of the Marxists who think that capitalism is just evil and cannot be reformed.
Honestly – I thought with BREXIT I’d heard and seen enough tripe to last me a lifetime – and now this – a levy on getting old and becoming poorly!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Please someone – wake me up – it’s got to be a nightmare – surely!!?
No, it’s real, unfortunately
PSR, I could not agree more with your penulitimate paragraph. I wish it weren’t real. But it is, and psychologically painful, at the very least.
Did we see this here? I might have got it from here actually, if so apologies but it won’t hurt to be reminded https://calderdaleandkirklees999callforthenhs.wordpress.com/2019/02/16/large-scale-integrated-primary-care-networks-what-lurks-beneath-the-buzz-words/
Can you please disclose how many public outsourcing projects you’ve been involved in, over, say the past 5 years. Either on the commissioning side (preferred) or the supplier side will do.
Maybe then you can tell us the reason for the problem with outsourcing models, with experienced inside knowledge, rather than making what appear (to someone who works in the area, on the commissioning side) to be uninformed assertions.
I have not been – although I have discussed a number with those who have been
But let’s be clear – do you really need more evidence of failed outsourcing than the mass we already have?
And why is it that onl;y those who have done such a project may comment on them? A, I also allowed no opinion on incest because I have never partaken of it? If so, why?
In the housing sector, there are plenty of housing associations and housing departments who have taken there home based care services back under their control because of failings in the outsourcing side as they pick up the pieces from poor service levels.
Housing Associations are one of the most cost conscious providers out there and if they are taking outsourced services back into control then there must be something significantly wrong with the outsourcing world at the moment.
Outsourcing is driven by competition and the competition is increasingly driven by cost.
If you pay people peanuts you get monkeys or at least people who do not want to be monkeys.
Precisely
You’re entitled to an opinion. It’s a question of whether it is an informed opinion or a superficial one.
I don’t think talking to un-named people in itself would give you much insight of what works, what doesn’t, or why (either way). In my view, you need to see it on the ground in person on live contracts to have much of a view. To say uniformly that outsourcing doesn’t work is a bit of a sweeping statement which is not persuasive.
Have you even read the current standard NHS contract? What do you think of it?
So tell me, as you want to express an opinion
A) Who you are
B) WHat you do
C) Who you work for
D) How many contracts you have done
E) How you gained from them
F) How society gained
G) How long term interests such as training were protected
H) How the holistic nature of the NHYS was protected
By your criteria this is what you have to do
So tell me, as you want to express an opinion
A) Who you are PROCUREMENT SOLICITOR (IN HOUSE – CONTRACT BASIS)
B) WHat you do PUBLIC SECTOR PROCUREMENT
C) Who you work for VARIOUS LOCAL AUTHORITIES – INCLUDING VARIOUS TOP 10 UNITARIES. LARGE AND SMALL COUNTIES. JOINT PROCUREMENTS WITH NHS VERY COMMON EG UNDER S75 ARRANGEMENTS. I’VE HAD 2 NHS APPOINTMENTS INCLUDING A CURRENT ONE.
D) How many contracts you have done FULL CASE LOAD. DON’T HAVE AN EXACT NUMBER.
E) How you gained from them DON’T UNDERSTAND THE QUESTION – I GET PAID.
F) How society gained THERE IS A COMMISSIONING NEED. NHS PROVIDER BODIES (PROVIDER TRUSTS) ARE MAIN BIDDERS, AND ARE USUALLY SUCCESSFUL. NHS DOESN’T DO COMMISSIONING VERY WELL IN MY VIEW, CERTAINLY MUCH WORSE THAN LOCAL GOVERNMENT OVERALL. BUT THAT’S NOT THE FAULT OF OUTSOURCING ITSELF. ANYTHING IS A BAD IDEA IF IT IS DONE BADLY.
G) How long term interests such as training were protected SOMETIMES IT IS IN THE SPEC, SOMETIMES NOT. AGAIN, THIS IS UP TO THE COMMISSIONER TO DO IT WELL OR BADLY. HARD WORK STIMULATING INTEREST IN THIS.
H) How the holistic nature of the NHYS was protected. WHAT DOES THAT MEAN? THERE IS A PRETTY STRONG INTENT TO ENSURE SERVICES TO PATIENTS IS FREE AT THE POINT OF DELIVERY. IS THAT WHAT YOU MEAN? NHS WORKS CLOSELY WITH OTHER BODIES SUCH AS LOCAL AUTHORITIES – DO YOU KNOW THIS? IN THIS SCENARIO, ‘HOLISTIC NATURE’ DOESN’T MAKE MUCH SENSE.
By your criteria this is what you have to do
So, the evidence you have to supply based on your experience is that the NHS does outsourcing badly.
That is what I said.
Thank you for agreeing with me.
And there is good reason for that: it is not set up to be fragmented by an outsourcing model. It is set up to be integrated. So outsourcing conflicts with its ethos. And so of course it is done badly.
Yo are doing a job that harms the NHS, by definition, and in practice, and by your own admission.
My point is that it doesn’t have to be done badly. NHS is bottom of the class in my view compared to other public bodies I’ve seen. Colleagues in local government across the country roll their eyes at NHS procurement practices.
There is no good reason the NHS can’t do better. Outsourcing itself as a concept isn’t the problem.
Part of the problem is over-centralisation. Further devolution of health services to local authorities would be a step in the right direction.
Can you please explain how my job harms the NHS? I’m not sure I’m responsible for the high centralisation and the poor quality of their procurement documentation. I’d change that if I could
Did you not note the name? It’s a national health service. Centralisation is then built in – and is exactly what people want. Postoce lotteries are not required
It must be deeply depressing to have a job that exists solely to promote failed dogma with the aim of delivering waste and excess cost – and that’s what you have
This Rentier capitalism gone mad – paying to be here – to have a right to be here!! That’s what it seems like to me.
Mr Hanson @ your reply at 2.15 pm
I think that the point is this: the NHS as designed is a clinical service and its capacity is meant to be aimed at delivering a clinical service, not a procurement of outsourcing service. The latter is a whole new resource drain on the original output of the NHS which was healthcare.
The introduction of false and unneeded market mechanisms into the NHS has not really helped the bottom line remit (health, well-being and making people better).
I also object to you saying that the ‘NHS could do better’ and is ‘behind’ other sectors.
This statement colludes with the Tory notion that everything is the NHS’ fault and the Government has no responsibility in any lack of NHS performance.
Both Tory and New Labour politicians have seriously messed up the NHS Mr Hanson. It is not the NHS per se that has messed things up – I suggest to you it is the people who are meant to be funding it – the Government and the stupid politicians who have tinkered with it rather than funded it properly because of neo-liberal dogma and free-market fundamentalism..
In my sector (housing) many have tried outsourcing and found it to be a waste of money which creates more trouble than it is worth.
We have found a mixed economy of in-house DLO and outside contractors is probably the best method at the moment when procuring goods and services to deliver services especially when it is your own organisation’s customer service reputation on the line.
If we really wanted outsourcing to work, we’d insist that those greedy idiots who invest in the outsourcing provider sector had to lock their investment in for a least 6 years and cap the rate return so that it is not only investors who benefit. This might make outsourcing more sustainable and avoid the catastrophic collapses we have seen in providers in the outsourcing sector.
Until outsourcing is stopped being seen as a gravy train I see no future in it. As long as it is being used as a medium by which to transfer public funding into private wealth accumulation it will always be the wrong way to provide services.
That is my view at least.
Thanks PSR