The analysis of NHS contracts awarded since April 2013 raises two questions. First, how can the NHS succeed in commercial tenders? It is in this domain that it really loses out to the private sector. Second, how useful, in terms of the overall health economy, is commercial tendering?
My personal involvement has been with commercial tenders within the limited field of offender care. This has involved a NHS FT competing with other NHS providers, large private sector companies and the Third sector. Service stagnation and probably extinction would have resulted if the service line had not won multiple tenders.
Learning, quickly, how to compete, was essential. Anecdotally, success requires all of the following: an enterprise culture within the NHS organisation, designated bid teams, rapid financial modelling to underpin clinically desirable and defensible services, clarity of time-frames and responsibility for bid sign off as well as clinician availability and engagement with a process that may be both alien and personally distasteful. Tolerance for stress and a willingness to go the extra mile for one’s vision of health care is also very useful. The NHS, as a whole, may need help to gear itself up to this. Equally, withdrawing from competitive tenders that do not provide enough money to run decent services is vital. Winning an unaffordable service is a disaster for patients and services.
The jury is out as to whether running tenders and managing new contracts is better value for NHS money than improving the performance of existing providers with available “sticks and carrots”. Bidding success is gratifying to the winner but expensive to the losers, whoever they are. But competitive tendering does provide an opportunity to improve inefficient, outdated services; detailed new service specifications allow best practice to be embedded authoritatively in new contracts. These can make care costs transparent, in contrast to the vagueness characteristic of old style, block contracts. It may be an unpleasant reality that the nature of the organisation providing care, be it the NHS, the private sector or the Third sector (or some combination of all three) may not matter too much to the patient, if care is better. It matters philosophically as the Bevanite vision of the welfare state fades.
The NHS may no longer be the only, truly legitimate, health care provider but, from our experience, it can, at times, perform strongly against the private sector and others, without compromising its core values.
Annie Bartlett
Clinical Director (Jt) Offender Care, CNWL FT
Reader and Honorary Consultant in Forensic Psychiatry, SGUL and CNWL FT abartlet@sgul.ac.uk
Competing interests:
I am Clinical Director (Jt) of CNWL Offender Care and have responsibility for a range of offender health care services, including several specified in contracts awarded after competitive tenders by specialist commissioners, in London and the South East. I am Chair of the Health in Justice (NHSE London) Strategic Clinical Network which advices specialist commissioners in this field.
22 December 2014
Annie Bartlett
Reader and Honorary Consultant in Forensic Psychiatry SGUL and CNWL FT
Rapid Response:
The analysis of NHS contracts awarded since April 2013 raises two questions. First, how can the NHS succeed in commercial tenders? It is in this domain that it really loses out to the private sector. Second, how useful, in terms of the overall health economy, is commercial tendering?
My personal involvement has been with commercial tenders within the limited field of offender care. This has involved a NHS FT competing with other NHS providers, large private sector companies and the Third sector. Service stagnation and probably extinction would have resulted if the service line had not won multiple tenders.
Learning, quickly, how to compete, was essential. Anecdotally, success requires all of the following: an enterprise culture within the NHS organisation, designated bid teams, rapid financial modelling to underpin clinically desirable and defensible services, clarity of time-frames and responsibility for bid sign off as well as clinician availability and engagement with a process that may be both alien and personally distasteful. Tolerance for stress and a willingness to go the extra mile for one’s vision of health care is also very useful. The NHS, as a whole, may need help to gear itself up to this. Equally, withdrawing from competitive tenders that do not provide enough money to run decent services is vital. Winning an unaffordable service is a disaster for patients and services.
The jury is out as to whether running tenders and managing new contracts is better value for NHS money than improving the performance of existing providers with available “sticks and carrots”. Bidding success is gratifying to the winner but expensive to the losers, whoever they are. But competitive tendering does provide an opportunity to improve inefficient, outdated services; detailed new service specifications allow best practice to be embedded authoritatively in new contracts. These can make care costs transparent, in contrast to the vagueness characteristic of old style, block contracts. It may be an unpleasant reality that the nature of the organisation providing care, be it the NHS, the private sector or the Third sector (or some combination of all three) may not matter too much to the patient, if care is better. It matters philosophically as the Bevanite vision of the welfare state fades.
The NHS may no longer be the only, truly legitimate, health care provider but, from our experience, it can, at times, perform strongly against the private sector and others, without compromising its core values.
Annie Bartlett
Clinical Director (Jt) Offender Care, CNWL FT
Reader and Honorary Consultant in Forensic Psychiatry, SGUL and CNWL FT
abartlet@sgul.ac.uk
Competing interests: I am Clinical Director (Jt) of CNWL Offender Care and have responsibility for a range of offender health care services, including several specified in contracts awarded after competitive tenders by specialist commissioners, in London and the South East. I am Chair of the Health in Justice (NHSE London) Strategic Clinical Network which advices specialist commissioners in this field.