NHS on highway to hell? Conflict of interest question hangs over £515m ambulance contract

A key employee at West & South Yorkshire and Bassetlaw Commissioning Support Unit is at the centre of allegations that the CSU has failed to uphold public service values. Together with a private company whose director also works for the WSYBCSU, the CSU is commissioning a £515m 5 year urgent care ambulance service.

Sarah Fatchett, who has been Chief Operating Officer at the CSU & has led the CSU’s IT services since the CSU was set up, is also a founding director of 365 Response Limited, a company founded in 2012 to manage urgent care ambulance services. As of August 2013, it had £300 capital.

Together with WSYBCSU, 365 Response Limited is behind a contract (advertised on Supply2Health) for a £515m 5 year National Framework Agreement for Health and Social Care Transport (an urgent care ambulance service).

WSYBCSU and 365 Response Limited have instructed NHS Shared Business Services – Procurement  to advertise the £515m, 5 year contract.

The advertisement on the Supply2Health website invites transport providers to apply for accreditation as part of a National Framework Agreement, in order to be allowed to bid for contracts to provide urgent care ambulance services across the country. The estimated start date for this service is 1 Jan 2014.

The urgent care ambulance service will be run by 365 Response Limited and overseen by WSYBCSU. Urgent care ambulances will be provided by companies that have  been accredited as part of the National Framework Agreement.

Ms Fatchett has recently been working some days a week at the CSU and some days at 356 Response Limited, in order to “put distance” between her roles, according to a spokesperson at WSYBCSU. She is due to leave her job at the CSU on Thursday 28th November 2013).

The Commissioning Support Unit/365 Response Limited “Innovation Pact”

WSYBCSU has issued the following statement:

The CSU  have a Register of Interests, on which Sarah has registered her involvement with 365 Response. All her interests have been declared and managed in line with NHS guidance on conflict management and regulations.

Sarah Fatchett’s role as Chief Operating Officer was particularly focused on getting the CSU up and running for 1 April 2013, and subsequently leading a number of our services.  It was announced in late summer that Sarah would be leaving the CSU, to focus on 365 Response. At that point she formally reduced her role to part time whilst working her notice period to ensure that there was an identifiable split of duties.  She has focused on ensuring a smooth handover and transition to the new Technology and Intelligence director. Sarah leaves the CSU on 28 November 2013.

Alison Hughes, WSYBCSU Managing Director, said:

“Before Sarah joined the CSU she had developed a business idea which will enable CCGs to commission differently in order to improve the quality and cost effectiveness of patient transport. She has always been open about this and has made sure that she has adhered to the strictest governance procedures. The time is now right for Sarah to pursue this opportunity full time. The CSU is working with Sarah to bring this idea to market, as part of an innovation pact between our two organisations.”

Despite being listed on the Supply2 Health ad as one of a very long list of “other involved commissioners”, Calderdale Clinical Commissioning Group says the urgent care ambulance service contract is nothing to do with them. Calderdale CCG’s Chief Finance Officer Julie Lawreniuk said she will ask WSYBCSU what it’s about. (Update: Information provided by Ms Lawreniuk following her questions to WSYVCSU is included here.)

If Calderdale CCG knows nothing of this contract, are other NHS organisations on the long list of “other involved commissioners” equally in the dark?

CCCG rates its relationship with WSYBCSU as a “serious risk” – the highest category of risk. It has been at this level for months so they seem unable to reduce this serious risk, that WSYBCSU will not deliver the commissioning support that they need.

How the £515m urgent care ambulance service would operate

A Managed Transport Bureau – advertised by NHS Shared Business Services-Procurement, in Prior Information Notice CP4/13/0085 – would oversee the National Framework Agreement and its operations.

Information on the 365 Response Limited website shows that the  Managed Transport Bureau  will in fact be operated by 365 Response Limited and overseen by WSYBCSU:

“Once accredited on the framework suppliers will be subject to on-going governance and quality assurance through the managed service, clinically led by 365 Response, which in itself will be overseen by the NHS West and South Yorkshire and Bassetlaw Commissioning Support Unit to ensure transparency across the operating model and to utilise existing expertise and skills within the system.”

Set up in the summer of 2012 at a registered address in North Yorkshire that is shared by 53 other companies, 365 Response Limited had £300 capital on 21 August 2013, according to Companies House website. Despite its modest capital, the 365 Response Limited company website says that the company:

“work with a network of providers [of transport for] urgent care – not an emergency service nor a routine one – but one created for the increasing demand in between… for Health and Social Care professionals to access”

Also a Director of 365 Response Limited and working for the NHS is a Wakefield GP and software company director, Dr Chris Jones.

A phone call to Wakefield Clinical Commissioning Group’s Practice Support Unit has confirmed that Dr Jones  is chair of Wakefield CCG’s Locality 6 Clinical Network. His IQUS company website says that he is also commissioning lead for Wakefield CCG for 111 and Director of IQUS.

IQUS is a software company whose main products are  i-healthbooker, “a new innovative solution for Clinical Commissioning Groups” and Rota Master, a biometric time keeping gadget that monitors attendance and presence of unscheduled care providers.

NHS Protect

A spokesperson for WSYBCSU emailed me their procedures for making sure that public service values – aka Nolan principles – prevail: NHS Protect operates the NHS Fraud and Corruption phone line;  members of the public and CSU employees can call this phone line. The spokesperson also clarified that the NHS Business Services Authority, which employs all staff at all CSUs, also employs all staff at NHS Protect.

Employees at WSYBCSU who want to whistleblow can also contact a named Counter Fraud Specialist at WSYBCSU. This WSYBCSU Counter Fraud Specialist is “part of NHS Protect”, according to a spokesperson at WSYBCSU. The same spokesperson also said, “NHS Protect are our partners.”

Calderdale Clinical Commissioning Group: “this is nothing to do with us”

At the 14th November meeting of Calderdale Clinical Commissioning Group (CCG) Governing Body, I asked the Chief Officer Dr Matt Walsh why his Report  didn’t include any information about Calderdale CCG’s involvement in commissioning the £515m 5 year National Framework Agreement for Health and Social Care Transport.

The Supply2Health advertisement states that,  in addition to the Lead Commissioner, NHS Shared Business Services -Procurement,  “other involved commissioners” include Calderdale CCG.

Along with what looks like every other Clinical Commissioning Group, Local Area Team and NHS Foundation Trust in the country.

Dr Walsh said that “it’s a judgement call” about what goes in the reports and he can’t include everything.

Julie Lawreniuk, the Chief Finance Officer, added,

“It’s nothing to do with CCCG – the Commissioning Support Unit has initiated the proposal with another organisation and the CCG will find out from the CSU what it’s about.”

So why does the advertisement say that Calderdale CCG is one of the commissioners for the urgent care ambulance service?

And are the “other involved commissioners” listed in the advertisement as much in the dark as Calderdale CCG?

The leader of Calderdale Council, Cllr Tim Swift, recently tweeted me that he too is in the dark about this £515m 5 year National Framework Agreement for Health and Social Care Transport.

Other questions also demand answers, such as

  • if there is a need to spend £515m over the next 5 years on urgent care ambulance services, why has the NHS ambulance service been cut to the bone since the Coalition government took power?
  • what kind of imminent shake up of the NHS is going to need £515m worth of urgent care ambulance services over the next 5 years?
  • is this the kind of NHS the public wants and is there any democratic mandate for these changes?

Why has the NHS ambulance service been cut to the bone since the Coalition government took power?

One of the Prior Information Notices on the Supply 2 Health website says that this intended £515m 5 year National Framework Agreement for Health and Social Care Transport,

“is an innovation to support winter pressures and additional predicted ambulance demand.”

It’s strange that  NHS Ambulance Trusts have suffered serious cuts over the last few years, when there is such a “rising demand for urgent care transport” that West and South Yorkshire and Bassetlaw Commissioning Support Unit thinks there is £515m worth of urgent care ambulance work over the next five years for “transport providers” to apply for.

Yorkshire Ambulance Service NHS Trust has been cut by  £46 million over five years, and a new operational model in Yorkshire threatens to downgrade all ambulance staff, removing professionally trained technicians from ambulances altogether and replacing them with untrained drivers, with only basic first aid training.

Because Unite raised concerns about patient safety earlier this year, the Ambulance Trust management derecognised Unite, which called successful one-day strikes on 2 April and 7 June.

Why is the NHS going to need £515m worth of urgent care ambulance services over the next 5 years?

Massive impending changes in the organisation of the NHS and Social Care are behind this bid for £515m worth of “urgent care” ambulance services over the next 5 years.

These changes seem to be based on the Kaiser Permanente model in the USA – a model which has been trawled as the future for the NHS since early New Labour days.

In a 1974 White House Oval Office discussion of Kaiser Permanente’s model of healthcare,  the White House domestic affairs adviser John Ehrlichman explained to President Nixon:

“All the incentives are toward less medical care, because the less care they give them, the more money they make.”

Soon after this conversation, Ehrlichman was imprisoned for his role in the Watergate scandal.

Inspired by this Kaiser Permanente model, NHS specialist services are to be grouped in fewer hospitals  – including A&E, which is to be reorganised into a two tier system.

If this goes ahead, people in Calderdale  will have to travel longer distances to A&E in Huddersfield, where the amalgamated specialist A &E centre is apparently to be located.

Hospital stays will be much shorter. Patients will be discharged sooner. Elderly patients with complex health needs will be sent from hospital to Care Homes where telehealthcare gadgets will allow their vital signs to be monitored remotely by a “multidisciplinary team”. Other patients with chronic health problems will also be swiftly discharged and issued with telehealthcare gadgets for remote monitoring at home.

GP services will be grouped into “localities” that will share a variety of primary care services – not all GP centres/surgeries will have the full range of services. These locality-based GP services will include unplanned care, as the Calderdale CCG Governing Body meeting on 14 Nov 2013 made clear.

Patients will be encouraged to care for themselves at home using telecare and telehealth gadgets.

And so on.

All this adds up to a future need for far more “urgent care” ambulance services, as GPs, social care workers and so on will need to ferry their patients urgently hither and yon.

One of the Prior Information Notices for the National Framework Agreement contract specifies this urgent ferrying will be between the patients’ homes, hospitals, GP and Urgent Care Centres, Hospices and Social Care settings.

Has the Coalition government actually asked us if this is how we want our NHS and Social Care services to operate? Is there any kind of democratic mandate for what’s going on here?

Still, it could be great news for the proposed Managed Transport Bureau aka 365 Response Limited, its overseer WSYBCSU and the private “urgent care” ambulance providers getting a bite at £515m of public money over the next 5 years.

CSUs are due to be privatised themselves in two years time. I guess this “Innovation Pact” is all part of the run up.

Updated 20 November 2013 with statement from WSYBCSU

Updated 21 November 2013 – Section on Calderdale CCG’s “serious risk” assessment of its relationship with WSYBCSU cut and rewritten as separate article –Here

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