NHS Procurement Consultation Requirements and Brexit

I guess procurement colleagues are excited/appalled in equal measure regarding the implications of BREXIT on procurement practice. But that aside (and I know that’s a big ask) I’m interested in the relationship between procurement policy guidance and consultation best practice.

If we agree that at very least procurement policy is ‘up in the air’ as we contemplate abandoning EU treaty law, general principles of contract law will surely remain: equality of treatment, transparency, mutual recognition and proportionality.

So what does this mean for consultation and engagement? Are procurement and consultation separate processes or can they overlap? Could this even be desirable/good practice? Andy Mills blog pic

On a recent A&G contract for a CSU, NHS England’s Programme Assurance Team required evidence of “deliverability (of the service change) on the ground and affordability in capital and revenue terms“. The CSU proposed that market engagement could provide such evidence and that this activity should run in parallel with public consultation. Whilst I think this is possible it’s not ideal as one process runs the risk of affecting the other. What do others think?

In the meantime I know tCI are considering recruiting procurement specialists to their associate team in order to provide clients with advice in this important area.

This blog was originally published by The Consultation Institute 

 

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Its a curious thing…

I’ve started this blog a few times as I reflected on a recent piece of engagement work for a public health department within a Local Authority. The curiosity I was considering was how a discipline steeped in issues such as inequalities could find the principle of engaging with people who use services, stakeholders, residents so difficult to execute. But perhaps it’s not so surprising coming, as they have , from the NHS where Commissioners were drawn kicking and screaming into meaningful engagement and consultation processes. By the way as if further proof of this I’ve just looked through the presentations to a local CCG ‘patient engagement event’…..and disappointed to see they are still pushing PPGs as the primary way to get involved in their decision-making process when there is so much good practice going on elsewhere myhealth

Perhaps the gap between theory and practice should have been filled by engagement professionals with a toolbox of evidence based approaches and practical tips to make it easy for commissioners. Actually I think much of the time they/we make it harder not easier. Talking to commissioners sometimes remind me of holidays in France when I’d spend ages preparing my schoolboy French to go and ask for something at the campsite shop and despite thinking I’d perfected the pronunciation I remained unintelligible until I drew a picture.

My reference point is simple; public services should be run based on the principle of as much public involvement as possible. Tax payers have a right to have a say and decision-making is better when it’s based on user experience. The commissioning cycle provides a framework to consider this;

Commissioning/engagement cycle

In the Local Authority I’m working in we have used this framework to plan for the engagement of young people at each stage

Activity Detail Action Timeline
Needs Assessment/Option Appraisal Consult via focus groups and surveys to establish the needs of the local community in regard to sexual health services.Target Groups:

  • Young people who are cared for and care leavers.
  • Young people with special educational needs or disability.

 

Andy Mills to provide discussion guidelines.Young Advisors to assist in facilitating consultation depending on availability.

 

TCS to facilitate consultation with cared for young people and care leavers.

10th October 2014
Procurement Evaluation Panels to meet to consider tenders Develop process to involve YA in scoring of tenders (interview process) Mid November
Mobilisation and Contract Management Service Users to provide o-going mechanism to ensure service meeting needs of clients Use techniques such as ;Mystery shopping to test experiences of services users Mobilisation from Jan 15, contract goes live July
Review See above

With thanks to Laura Goodfellow at the Children’s Society

If the comments above were about the ‘carrot’, then there’s a ‘stick’ too. Here are some areas where decision-making by public bodies has been challenged on the basis of poor public engagement or consultation. Known as the Gunning or Sedley principles after case-law from 1985, ‘consultations’ should be at a time when proposals are still at a formative stage, sufficient information should be provided to enable intelligent consideration and an intelligent response. Adequate time should be given for this purpose and the product of the consultation should be taken into account during decision-making.

So we can wait until the judicial process compels public health to engage with people who use their services, stakeholders and residents or we can take a moment to consider how to do so meaningfully before we re-commissioning substance misuse, smoking cessation, weight management, school health, health visiting services etc

Footnote;

Local Authorities took responsibility for a range of public health activity as a result of the Health and Social Care Act 2013. Many contracts which were subject to novation to Local Authorities have not been subjected to market testing for many years (if ever). Local Authority CEOs and elected members have therefore required this process to be undertaken within a 2-3 year window (we are now in year 2)

organisations with expertise and capacity should consider offering support to public health departments often lacking these skills in order to design and implement meaningful engagement at all stages of the commissioning cycle.

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Patient power in the NHS

Hi all, again haven’t blogged for a while……but I’ve been working on this paper with OPM. It highlights how patient power can be used to transform all levels of the health service – from shaping policy and system reforms, effecting service delivery changes, to transforming the dynamic between patients and their healthcare providers. In it we draw on OPM’s own experiences, as well as good practice examples from a recent OPM-hosted seminar, and consider how the health service can put the needs and wants of patients at the heart of everything it does through effective patient and public involvement.

Link

Shared Decision Making – the response of a whole health economy

Hi all haven’t blogged for a while…..so here’s one we made earlier. I wrote this with Ewan King from the Office for Public Management (OPM)….not sure if he’s published it yet?

Presented increasingly as the way care should be delivered – not least in the NHS England CCG Assurance Framework and the National Patients in Control Programme, Shared Decision Making’s (SDM) time has come. Defined as ‘an approach where clinicians and patients make decisions together using the best available evidence’ (Elwyn et a BMJ 2010), SDM can be associated with a narrow set of skills and tools (in particular patient decision aids [PDAs]) used by doctors with patients rather than something that requires the whole NHS system response.

It is however, increasingly accepted that in order for wider system reform goals such as integrated /pathway commissioning or commissioning for outcomes, SDM provides a valuable framework to work within. SDM is now being seen as an integral part of a treatment pathway stretching from primary care through acute and back into the community.

It was exciting therefore to have the opportunity this week to speak about shared decision making to senior health system reform leaders – senior GPs, leaders of the CCG, acute sector managers, a regional NHS England representative and those from the Academic Health Science Network and the local Medical School – from a single local health economy – Wirral.

Wirral has been at the forefront of patient engagement and patient involvement for some years – and many of its local hospitals and GP practices are seen as innovative leaders. This group of senior leaders were brought together by a local GP with an interest in SDM. Our presentation covered findings from recent Wirral –based research we have conducted on SDM (in the sponsoring GP s practice), and nationally for Health Foundation: our slides are attached.

The discussion was fascinating and moved from initial scepticism and challenge into broad acceptance of the principles and that more could and should be done to promote SDM in clinical interventions. But perhaps more importantly the group reflected on how SDM should feature much more in pathway design as clinicians need to share clinical decisions across disciplines and with service providers from the voluntary and community organisations and patients themselves. For instance, there was a lively debate about how the growing tide of patients – sometimes needlessly – being referred into secondary care could be stemmed somewhat by the introduction of intermediary expert advisors who would see patients referred into secondary care before they see a consultant to explain the full range of options available to them, including less expensive community based options that might prove just as effective.

One suggestion was that there needed to be ‘expert intermediaries’ between the GP making the referral into secondary care and consultants who are often have little time to fully explore care options with the patient. At the moment, the argument was made, too many patients arrive to see a consultant having been referred their GP without a good understanding of what the alternatives are to surgical (and often very expensive) care options.

The discussion went on long into the evening and were greatly supported by academic and Med school colleagues  one of whom had undertaken a study tour on SDM at a renowned US treatment centre which fully embraces SDM as a critical part of the patients planned recovery.

The barriers to system implementation are however myriad and complex: the lack of consultant and GP time to fully embrace SDM; the capacity of some patients to consider complex information or too much information; the lack of focus in commissioned contracts on SDM; and the difficulty of layering SDM into complex care pathways. 

The lack of evidence to inspire doctors to adopt SDM was also a hurdle: ‘Is there any evidence that this will save money, and if so, in which areas, for what conditions, and over what time period.’

There was immense potential in some of the ideas that were discussed to overcome these hurdles. We hope to do some further work on exploring potential for SDM in the Wirral and will keep you posted.

OPM are hosting a seminar: Realising the power of patients to produce tangible and radical reforms: Moving from the possible to the essential in the new NHS on the 27 of March

 

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What do CCGs do…more importantly what do you do…..?

I was talking to a colleague who works for a CCG recently and who was asking me to come and talk to some of her GPs in their protected learning time, about substance misuse service re-design. I said I had been working with the Commissioning Managers at the CCG and was assured that substance misuse was a priority (well alcohol misuse was anyway). My friend said ‘ yes but you still need to talk to the GPs ‘cos they won’t all agree with the CCG commissioners’. Now one of the things I could see the sense of in the new landscape was the boiling down structures into a straightforward connection between patients and commissioner via the GPs. Common sense then suggests that commissioning decisions about lots of patient care is done collectively hence a CCG.

However, in reality it may be a really big ask for GP commissioners to balance what they feel needs to be commissioned, informed by day-to-day contact with patients, with conflicting guidance from NHS England on policy or indeed evidence base. I just wonder if the latest guidance on patient and public involvement trans-part-hc-guid1 will resonate in a CCG under pressure from its own members to deliver improved patient care?

On a connected matter I mentioned the above conversation to my mate Dave who is building my website at the moment and he said ‘well never mind what does a CCG do, i don’t understand what you do…….’ I suppose that’s a downside to the AMP business model, its difficult to sound flexible and adaptive without appearing a bit shifty and vague. My concern about this problem has been compounded by the need to express myself more on my webpages…..I actually find it a bit difficult talking about what I do. Whilst in public service ( I like that term) I was extremely proud to work within the NHS, although not delivering care I was a Manager doing the stuff that difficult to explain to people outside of public service. Things like needs assessments, evidence reviews, commissioning plans, service designs, performance reviews, governance audits.

Now i’m a civilian or even more alarmingly a private sector provider I need to be clearer about what I do because the customer needs to know what they are buying. So……

…..’I’m Andy Mills, I work for AMP who provide user insight, qualitative research and consultancy services to private, public and voluntary sectors’

How’s that?

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Better than working……

A probably misplaced aversion to Facebook has led me to the position of having a Twitter account, LinkedIn page, website and now a blogsite. Still got no idea what I’m doing but no-one is going to die if I get myself in a mess (although I agree that’s a fairly low bar to set.)

Anyhow here goes…..well 6 months into ‘not having a real job/being unemployed’ as various family members categorise my situation, and things are going ok. AMP is up and running, I’ve done some work and been paid for some of it too.

I’ve actually done some really interesting stuff, stuff that I wanted to do rather than what I had to do. Even better I’ve done my bit and then someone else has had to deal with the frustrations of implementation.

Having said that I’ve got a huge amount of sympathy for what is going on down in sunny Wiltshire where the NHS, Local Authority and the Government are all in a bit of a mess about re-designing services. Whilst working on some service redesigns recently I’ve heard the phrase ‘its not rocket science’ and although redesigning drug services and urgent care are indeed not rocket science its not difficult to get folk to agree what needs to be done. The trouble comes when you come to do it. Local politics, lack of funding, Government policy, rules/regulations/procedures, all conspire against really good people trying to do their best for people who use their services.

Its a scary thought for someone who has been in public service for 20+ years and believes in state provision but I really think the private and VCF sector have got a huge opportunity to ‘just get on with it’ in terms of providing agile and value driven services.

I was talking to an urgent care commissioner in London recently and he said if he was going to make a difference to the service experience people have, he would use the new ‘winter monies’ which have mysteriously been found to fund any of the high street pharmacy companies to open pop-up shops. I think he’s right,……I bet they could get low tech/low risk services provided from a shop unit in reasonable nick in about a week and have it providing services where/when people want them.

Last week I went to an event hosted by a CVS where they pitched a consortium business model to commissioners. It was a bit more nuanced than that but the idea seemed completely new to commissioners who were bowled over by it. Again these sorts of arrangements mean that services can be provided by small organisations supported by larger ones who are able to carry the risks associated with competitive tendering.

So whilst the mega public services are tying themselves in knots why not have a look round for some alternative approaches to redesign offered by the private and VCF sectors?

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