27.09.16
Cambridgeshire and Peterborough CCG failed to assess UnitingCare risks
The deal with UnitingCare collapsed because Cambridgeshire and Peterborough CCG failed to properly monitor the risks, a new NHS England review into the scandal has concluded.
UnitingCare, a partnership between Cambridgeshire and Peterborough NHS FT and Cambridge University Hospitals NHS FT, signed an £800m deal to deliver older people’s services in 2014.
It was intended to run for five years, but was cancelled the following year because it was not financially sustainable, costing the CCG £10m.
The review said that when the contract was being drawn up, it was not clear who was meant to evaluate the risks of the deal. Both the CCG and the strategic project team of legal advisers assumed the other organisation had responsibility.
NHS England added that Wragge and Deloitte, firms providing advice as part of the strategic project team, were not invited to meetings of the Older People’s Programme Board, and the advice the CCG received did not cover key areas such as tax.
In addition, there was a ‘silo approach’ to evaluating the risks. For example, the legal evaluation workstream identified the dangers of UnitingCare becoming an LLP during the process, but this was not communicated to the financial workstream.
Cambridgeshire and Peterborough CCG ignored early warnings about financial risks associated with the deal because it assumed that financial risk rested with the successful bidder.
The report said: “This was not a commercially sound position to take given the limitations in the available financial information and the risks to the CCG of entering into a financially unviable contract. In our view the CCG did not fully consider the financial envelope risks or implications of bidder financial failure.”
It also said that the CCG was pressured to commission services quickly because of concerns about existing services.
The report said that in future deals, Cambridgeshire and Peterborough CCG and NHS England should ensure that the CCG retains “ownership of decisions” despite “outsourcing procurement functions” and obtaining independent advice.
In addition, it said the CCG should ensure it is able to independently evaluate the quality of advice it receives and that it has adequate risk management processes in place. All members of the governing body should also ensure that they have access to all the information needed to make decisions.
Tracy Dowling, chief officer of Cambridgeshire and Peterborough CCG, said: “There was a recognition, shared by our stakeholders and partners, that we needed to change the way older people's and adult community services were provided. The UnitingCare contract was an innovative model based on an Outcomes Framework and was designed to deliver measurable improvements in people’s health. This approach had strong support from our partners in the NHS, local authorities, and voluntary sector.
“There have been a number of published reviews into the contract failure. Each of the reviews has recognised the complexity of the procurement and each has made recommendations for all of the organisations involved - not only for the CCG, but also other NHS organisations, regulators, and the wider NHS - to learn from. We have accepted the findings from all of the reviews.”
A NHS England spokesperson said: “We commissioned these reviews to ensure trusts and CCGs learn the lessons from what happened in Cambridgeshire. NHS England and NHS Improvement will be scrutinising future local approaches in the light of these findings.”
The first report into UnitingCare NHS England commissioned recommended a review of other large-scale CCG contracts to ensure similar mistakes aren’t made, and a National Audit Office report warned that there is a risk of similar deals happening as a result of introducing a greater use of integrated care to deliver the Five Year Forward View.
However, in a recent appearance before the Public Accounts Committee, Simon Stevens, the head of NHS England, said that lessons would be learned from UnitingCare, but similar “shared endeavours” could take place.
(Image c. Chris Radburn from PA Images)
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