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Lessons must be learned on UnitingCare, but more deals can go ahead – Stevens

The collapse of a major contract to provide elderly care does not mean similar deals cannot go ahead in the future, but does mean lessons should be learned, the chief executive of NHS England has said.

Appearing before the Public Accounts Committee (PAC), Simon Stevens said that the collapse of the UnitingCare contract in Cambridgeshire showed the importance of resolving issues before contracts are solved and of ensuring proper oversight.

Cambridgeshire and Peterborough CCG commissioned UnitingCare, an NHS consortium of Cambridgeshire and Peterborough and Cambridge University Hospitals NHS foundation trusts, to provide elder people’s services in 2014.

The contract was worth £800m and was due to run for five years, but it fell apart after just eight months.

At the PAC inquiry, Stevens said that “there may need to be ways of bringing organisations together in a shared endeavour” in similar deals in the future as part of NHS efficiency reforms.

He also said that although the contract had failed, that didn’t “intrinsically” mean other contracts would in the future.

However, he argued the UnitingCare deal showed that procurers must design the service framework before signing a contract, instead of specifying the details of services after a deal has gone through.

Future procurers should also “drive the issue” on what exactly services should look like, Stevens added.

One of the issues was that UnitingCare didn’t have the data from its predecessor, Cambridgeshire Community Trust, on what services it was expected to provide, so Stevens said similar deals should be conducted with an “open book” approach to data.

Furthermore, the CEO said NHS procurers needed to improve their commercial knowledge, and that NHS England and NHS Improvement should do a better job of regulating deals.

The National Audit Office (NAO) report into the deal’s collapse said that there is an increased risk of similar failed deals as the Five Year Forward View is implemented.

However, health minister Lord Prior has promised the NAO’s findings will inform a new NHS contracting framework.

Pressure in the system

Aidan Thomas, chief executive of Cambridgeshire and Peterborough FT, also appeared before the committee.

He admitted that UnitingCare had undervalued its bid for the contract in order to ensure it received it.

“We bid as low as we thought we could reasonably do,” he said, adding that the trusts were driven by ‘pressure’ to resolve their financial difficulties.

“There was pressure in the system at the time to get the whole thing going,” he said. “There was a need for the economy to deal with its financial problems and this contract, if it had been allowed to work, should have dealt with some of that.”

According to an internal audit, the deal fell apart after UnitingCare asked for an additional £34.3m above the money it had already agreed on.

Thomas admitted that the trusts had known they would need to ask for more money after the contract was signed, but said that they did not know the “specific amount”.

Tracy Dowling, chief officer of Cambridgeshire and Peterborough CCG, was asked by the committee whether the UnitingCare deal was driven by a desire to ‘outsource’ difficult decisions about care for elderly patients.

“They outsourced the responsibility for transforming care pathways and change, which can be difficult to achieve,” she replied.

(Image c. Chris Radburn)

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