Medical emergency
I believe a single procurement issue could determine the result of the next election.
Let’s extrapolate from the current coalition ‘honeymoon’ to 2014 – and let me stress this is not what I want (or even expect) to happen. But it is a possible scenario…
The economy has barely recovered. Cuts have been more painful than expected, with a major effect on schools, universities, police forces, and defence. Strikes and the odd riot have become commonplace. There is a festering resentment of the NHS from other public sector workers – and many taxpayers – who wonder why, given its ring-fenced status, it does not seem to be delivering. And then, one after another, a series of high-profile stories hit the press.
- Having been handed funding powers, the largest GP consortium in the health service runs out of money 10 months into the year and begs for more. The press discover it has been paying £3,000 a day to a top US consulting firm for “procurement advice”, and the same firm has entertained many of the GPs in the consortium to a lavish day out at Wimbledon.
- Another consortium is found to have the highest death rate post-heart attack in the country after awarding the contract for heart surgery to a controversial Romanian company who are pioneers in a ‘revolutionary low-cost treatment’.
- The EU starts legal action against the UK for persistent breaches of its regulations in the awarding of health contracts. These include cases where GP consortia have ignored EU rules, failed to advertise opportunities, or awarded contracts improperly and where there were clear conflicts of interest. Payouts to suppliers who challenge procurement decisions start to rival medical negligence claims as a burden on the public purse.
- A GP consortium is found to have awarded contracts for health advice on exercise and lifestyle to a lady who is also known as Madame Thrash and performs regularly at ‘specialist’ burlesque evenings. The News of the World is disgusted at this waste of taxpayers’ money and features three pages of photographs to emphasise their horror.
- A new breed of GP consortia managers, many ex GPs or PCT bosses, are found to be earning more than the prime minster, or in some cases, more even than a junior executive at the BBC. Some combine this role with their regular GP work and are now making £250,000 plus a year. Indeed, GPs salaries have grown by 25 per cent in three years since their 2011 ‘tough’ new contract was agreed.
With poll ratings sinking, the third health minister in 18 months tries desperately to change the commissioning system, but with the election looming, all is lost….
As you can tell, I am really not sure about the idea of GPs commissioning services. Having PCTs as the commissioners was far from perfect; but a lot of effort has gone into trying to develop procurement skills in those organisations, and there was at least a sensible degree of demand aggregation in that structure. A total of 500 GP consortia in the proposed new system; that’s an awful lot of procurement events to go wrong…
I hope for his sake, the health system, and the taxpayer that health secretary Andrew Lansley knows what he is doing and has some really clear plans for how this is going to work, how capability is going to be built, and how the new ‘system’ is going to be monitored, governed and regulated. If those elements are not in place, then this has the makings of a disaster.
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[...] and starting again. I have my doubts; and I do believe it could be political dynamite. Read the full blog here, but a couple of scenarios from my SM post in terms of what could go [...]
The trouble is that ‘giving those at the sharp end control over budgets’ is a populist political line. The reality is, as you clearly understand, that medical professionals are no more qualified in Procurement that we are in medicine. The same principle applies in Education where teachers and school business managers often make very bad procurement decisions. Here’s a thought – lets all do what we’re qualified to do, shall we?
Jason
You are spot on. More work for us consultants I predict though – oh sorry, I forgot, consultants not exactly flavour of the month!
The GPs are pretty smart negotiators when it comes to their own income though so I suspect they will also extract something there in order to ‘take on the extra responsibility’!
Jason, Peter
Not withholding your comments, there is a strong argument that governance of Public money failed so far. This political dynamite as you call it applies a common sense of asking those who are at the heart of service to decide how best to distribute available budget. There are plenty of monitoring tools that can be utilised to ensure accuracy, fairness and purposfullness of financial management.
Renata
I know what you mean but…in a conventional procurement situation, we would ask the budget holder / stakeholder/ production manager or similar to play the lead role in defining the specification of what we are buying – with some input from us in procurement. I think it absolutely right that GPs and hospital staff should play a key role in doing that equivalent task in Health.
But this new system then asks the GPs to design the tender process, engage with the market, run a supplier selection process (probably under EU rules ), negotiate and implement the contract, and manage supplier performance.
Now I think the GPs will quickly realise they haven’t got – and don’t want to get – the skills required. So …bonanza for the consultants / US health insurance firms, or PCT people who have just had large redundancy cheques being re-engaged as ‘GP commissioning managers’. And remember, there will be 500 of these new units as against 150 PCTs.
I also have concerns about the pure running-cost economics of the change in procurement strategy – more here
http://blog.procurement-excellence.com/gp-commissioning-the-savings-dont-stack-up/comment-page-1/#comment-2652
It would be useful to go back about seven years to the first IRSPP workshop in Budapest. I chaired a number of sessions including one very interesting one on the Dutch Health Service. The Dutch model is very much based on giving responsibility out to practices and ‘colleges’ eg midwifery, and colleagues were struggling with how to get procurement to the table to help cut health costs (which were becoming a large constituent of the GDP). We concluded that the (then) current arrangements and governance left no opportunities. However in summing up, I turned to my Dutch colleagues and asked them for a personal view on HOW GOOD were the services provided. They admitted they were excellent and cited low infant mortality/high proportion of home deliveries – Midwives decide whether the mother to be needs hospital treatment. So, GP Commissioning could be a good thing; subject to GPs having the skills.
i think that if the Procurement Body(PB) found in each country can educate the populace about the aim of PB especially in reducing waste and ACHIEVING VALUE FOR MONEY..
Am with the GHANA HEALTH SERVICE and implementation of the PROCUREMENT ACT laid down procedure in daily activities is not actually practised – it is done partially.
I hope that procurement professionals should be fully supported by the appropriate body.
Miss Golda Quartey, I do not agree with your assertion. If you care to know the Public Procurement Authority of Ghana recently used the Procurement systems of the Ghana Health Service as a documentary to show the true principles of the implememtation of the Act663 of 2003. I will prefer you saying your facility Management is rather not allowing you as a person to practice what you have learn with regard to procurement. please ensure you get your facts before you put it on the web.