Clinical chief speaks out over procurement process

THE Herald and Gazette met with Coastal West Sussex Clinical Commissioning Group’s (CCG) clinical chief officer following the decision to stop the existing musculoskeletal (MSK) procurement process.

Dr Katie Armstrong, clinical chief officer of the  Coastal West Sussex Clinical Commissioning Group
Dr Katie Armstrong, clinical chief officer of the Coastal West Sussex Clinical Commissioning Group

In the interview, which can be found below, Katie Armstrong said the CCG had learned a lot over the course of the process and insisted it had not been a waste of time.

The withdrawal of Bupa CSH, the CCG’s preferred bidder for the five-year £235 million contract, prompted the CCG to stop the procurement process, which to date has cost around £350,000. The decision was made at a Clinical Commissioning Executive (CCE) meeting last Tuesday.

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Dr Armstrong said: “The decision to halt the existing procurement process does not impact on the CCG’s desire to introduce the new service. The MSK service model was designed by clinicians and patients and is a strong and well-supported model.

“The CCG will keep all options open, with an aim to introduce the service as quickly as possible. We will begin discussions with current providers of MSK services as our preferred approach.”

Marianne Griffiths, chief executive of Western Sussex Hospitals NHS Foundation Trust, said she was pleased the CCG’s preferred approach was to work with current providers of MSK services, including the trust.

She said: “We look forward to working collaboratively with the CCG and other NHS partners to develop an innovative model of care, which will further improve care for all patients of musculoskeletal services.”

The CCG’s GP locality directors, executives and lay-members were all present at the meeting. They discussed the legal advice around whether the withdrawal of the preferred bidder meant the CCG needed to go back to the other bidders, start a further procurement exercise or whether the CCG was able to commission the service in another way.

All current contracts have been extended to the end of September.

Could you clarify the legal situation?

The honest truth is that NHS procurement and the legal situation surrounding it are really, really complex. The clear advice we’ve been given is that we need to stop this existing procurement. The major reason being the time that has elapsed since we started it and the need for some fundamental change in what we are looking for on the back of the information we now have and the impact assessment.

What we’re now working through is how we best deliver the change for patients. It’s now how do we do that as rapidly and efficiently as possible. Our preferred option is to work with our existing providers. I want to be clear that none of the options that face us are without risk. The straightforward legal advice is to reprocure, but what we are now doing is balancing that against the need to support our existing providers and understand who is the most capable of providing that service.

What would you say to people questioning the credibility of the CCG and what makes you sure this time you’re going to get it right?

I think it’s important as an organisation that we learn from everything that we do. No doubt there are lessons for the CCG in this but I think in terms of our credibility, we are committed to listening to what patients tell us in the first place, which is that services aren’t working, and we are committed passionately to delivering that change for patients. That is absolutely what we’re doing and that’s what makes us credible.

In some ways it isn’t our fault that the NHS is a very complex place and that the NHS faces incredible challenges at the moment. All of us are working in an environment where there is huge demand on services, where funding is flat and where we’re all in a very difficult position. Therefore, that makes it imperative that we do think about how we change services. The difficulties we’ve faced demonstrate how difficult and complex it is to make clinical change happen in the NHS.

Would you say the procurement process to date has been a waste of time?

I think I could understand the simplistic view of ‘if this is where you’ve ended up why didn’t you do this in the first place?’ I think it’s easy to go back in retrospect and retrofit things. I think we just have to say we acted on the best guidance at the time, trying to do things in a way that would best deliver for patients. We’ve learnt a lot through the process and we’ve learnt a lot through the conversations we’ve had from a set of different providers that have challenged our thinking to improve the model we now have. I don’t think this has been wasted time. We’re now absolutely clear about the clinical model we need, the financial envelope and the contractual way we do it, and about how we get the best out of this contract that’s paid on outcomes rather than the existing contract that’s paid based on the number of people that go through the door.

Would you say the cost of the procurement process to date (£350,000) has been a waste of money?

I think context is important. I understand as soon as you hear £350,000 it sounds like a huge amount, which it is. I think you need to take it in the context of the scale of the budget, so a five-year contract that’s £235 million. The money we’ve spent is less than 0.2 per cent. We have to acknowledge if you’re going to do a process that involves whole-scale change and redesign of services that does take time and money and resources.

When the CCG made the decision to go with Bupa as the preferred bidder, we were absolutely crystal clear we wouldn’t sign a contract with them until we were understood how secondary care services were going to be provided. That was why we then, jointly with Western, did the impact assessment. Our commitment has been to see the change happen for patients. We saw in the model that Bupa had a real fantastic opportunity. What we were supporting was Bupa trying to find a way with the trust to make this work and the trust were trying to find a way with Bupa to make this work. At the end of the day that wasn’t possible and that’s a great shame, but our job was to support that to happen. Let me be clear, we were never going to sign a contract that would destabilise the hospital.

Do you accept the CCG has made mistakes along the way, and what would you do differently if you could go back?

Every organisation has to learn from everything it does and, absolutely, as a CCG we want to learn lessons from this. If I were to cite one thing from a personal point of view it would be about the way we engaged with the public. We spent a lot of time talking to patients about what the service should look like so we had a lot of patient and public input on service design, but what we didn’t do is talk to the public about how we were going to commission and procure that service. What I apologise for is I completely underestimated the public interest in how we commission, and I heard that absolutely loud and clear.

Will Bupa be taking any legal action following its withdrawal?

At this point there’s no indication Bupa will take legal action. As they withdrew under the terms of the contract we wouldn’t expect there to be.

Will a new contract be implemented by September?

We’re having active conversations with our providers. Now what we need to do is see our existing providers show us and prove to use that they are able to deliver the change that I know they are committed to. We’re hoping to get those negotiations concluded as quickly as possible but it’s a big service change and needs time to be implemented.

In my conversations with the leaders of the existing providers there’s a really strong commitment to make this happen.

My biggest frustration is that we have a nuclear model that’s really exciting and I think it will be really brilliant for patients, but I just want to see it happen.