Calderdale Clinical Commissioning Group Governing Body was in self congratulatory mode on 10th July as they approved the award of a £4m, 3 year Wheelchair Services contract to an as-yet unnamed bidder.

The bidder’s name will be revealed at the end of the 10 day “standstill” that follows the Governing Body’s decision.- Update 30/7/2014 – The contract has gone to a company called Opcare Ltd.

The hospitals Trust, which currently provides wheelchair services to patients in Calderdale, Greater Huddersfield and North Kirklees, will lose the contract in September. The Trust already faces a £20m funding shortfall this financial year and the loss of this contract will further reduce its income.

The 3 Clinical Commissioning Groups (CCGs) – Calderdale, North Kirklees and Greater Huddersfield – have jointly commissioned the new Wheelchair Services.

Calderdale CCG Head of Quality Penny Woodhead gushed,

“This is the first time we are living true to the values of the engagement process. This is the first time the CCG has been able to demonstrate the values that are laid out in the engagement strategy.”

Martin Pursey, the CCG’s Head of Contracting and Procurement, described the award of the wheelchair services contract as “a useful test procurement”.

Calderdale CCG has “no loyalty to existing providers”

Plain Speaker asked if it was likely that, following the outsourcing of the wheelchair services contract, the proposed NHS shake up in Calderdale would also see the CCG having to put contracts out to tender for new care in the community services, like cancer care and end of life care.

In the East Midlands,  £1.2bn contracts for these two services have been put out to tender.  As a result, private health companies could well end up running these services.

This is one of the anxieties surrounding the proposed NHS shake up in Calderdale and Huddersfield, known as “Right Care, Right Time, Right Place.”

The CCG Governing Body Chair Dr Brook replied,

“The existing provider of wheelchair services wasn’t giving the service we wanted and this is clear in the Report. This was the reason for the re-procurement. We don’t have any loyalty to existing providers. Our duty is to get the best service for patients.”

3 months ago, Calderdale CCG said its “intent is to work with our strategic partners” – the hospitals Trust, Locala and the mental health Trust

Dr Brook’s comment contrasts with the Chief Executive Dr Matt Walsh’s statement at the March 2014 Calderdale CCG Governing Body meeting, when I asked a very similar question about whether the CCG would put the proposed new community care services out to tender.

Calderdale CCG’s Chief Executive Dr Matt Walsh replied,

“There are competition requirements that the Clinical Commissioning Group has to take account of and follow the law.

But our intent is to work with our strategic partners.

Any approaches to the market would need to be part of the public consultation.”

Hospitals Trust wheelchair services couldn’t meet rising demand without extra cash

Picking up from Dr Brook’s statement, Martin Pursey added,

“Wheelchair services have caused problems for us and the two other CCGs had the same issues and we started talking together about re-procurement.”

The problems for the commissioners were that the supply of wheelchairs couldn’t keep up with the demand and the CCGs had had to provide additional non-recurrent funding to the Wheelchair Services to clear the backlog.

A top-down privatisation ordered by the Department of Health in 2011

Martin Pursey says that commissioners’ dissatisfaction with the hospital Trust’s wheelchair services drove the decision to re-procure the service.

But according to the CSU’s Wheelchair Services Engagement Report, the initial impetus came from the Department of Health in 2011, as it prepared commissioners for changes introduced in the the 2012 Health and Social Care Act.

As part of this preparation, the CSU’s Report says the Department of Health required commissioners to “engage with patients, patient reps, healthcare professionals and local providers” about tendering services to Any Qualified Providers, and that one of these services was wheelchair services (for children).

The CSU’s Report says that in this engagement process, two complaints about children’s wheelchair services were received.

CCG claims that “existing service wasn’t working”, but majority of patient feedback was positive

At the CCG Governing Body meeting, Dr Matt Walsh said,

“Calderdale CCG did everything we could do to make the existing service work, but service users’ feedback was that the existing service wasn’t working. This led the CCG to consider re-procuring.”

The CSU’s Wheelchair Services Engagement Report reviewed patient feedback on wheelchair services, equipment and aids, through the Patient Advice and Liaison Service (PALS) and complaints.

It found that there had been no PALS, complaints or Patient Opinion postings on wheelchair services since April 2013, when Calderdale Clinical Commissioning Group started its life.

29 post-hip surgery patients attended focus groups about their post-discharge experience in February 2013, as part of the Calderdale and Huddersfield Strategic Review Engagement with Public, Patients and Carers about Long Term Care. All said their experiences had been good. All aftercare equipment at home had been arranged before their operation and staff had prepared patients in hospital on mobility issues.

The NHS Kirklees Intermediate Care Service Engagement Report, August 2012 also had good patient feedback.

As part of the CCGs’ re-procurement of wheelchair services, two public discussions in December 2013 were attended by 27 wheelchair users in total.  Although of course they came up with answers to the question “What isn’t working so well?”, they also praised the hospitals Trust’s Wheelchair Services for:

• continuity of care, having someone who knew them and understood their needs
• quick, responsive service
• good referral and assessment service
• providing wheelchairs that met their needs
• providing home assessments
• providing a quick repair service for faulty equipment

21 wheelchair users and carers also replied to an online survey last winter, although none answered all the questions.

Asked about improvements to wheelchair services, survey responses called for more staff and an increased budget.

Although the CCG Governing Body bigged up the fact that the re-procurement service specification gives wheelchair users what they’d said they wanted during the “engagement”, the CCGs haven’t provided an increased budget for wheelchair services.

The survey responses included praise for wheelchair services therapists. The CSU’s Wheelchair Services Engagement Report says of the survey responses that,

“the majority were pleased with the service”,

although a couple of negative comments were received.

Growing demand for wheelchairs outstripped the budget – but no funding increase for new contract

The Commissioning Support Unit’s Equality Impact Assessment of the Review and redesign of wheelchair services in Kirklees, found that Wheelchair Services staff identified that,

“funding and staffing levels restrict the number of clinics held each year. Where funding is received non-recurrently often extra clinics need to be put on to ‘catch up’ and allow assessments to take place for orders to be placed for equipment. Activity has out-stripped the recurrently funded budget.”

Although the backlog of wheelchair assessments and orders, and the extra costs of clearing it, were obviously an issue for the commissioners, there seems to be little evidence of patients’ problems with wheelchair services in the CSU’s Wheelchair Services Engagement Report.

This Commissioning Support Unit’s Report notes the CCGs’ “concerns” about wheelchair services being overstretched and overspending each year. It says that the reasons for the overspend are “unclear”, but in the next sentence says that over the last few years demand has outstripped current capacity.

The Wheelchairs Procurement Report to the Calderdale CCG Governing Body meeting also states that the number of people with disabilities is rising.

The growing demand for wheelchair services is down to the fact that in the last ten or fifteen years, the prevalence of severe disability and needs has increased and will go on increasing. This due to a number of factors, including increased survival of patients who suffer severe trauma and illness.

Since 2010, CHFT has faced unprecedented funding cuts through having to make £millions of so-called efficiency savings, and this has led to the loss of numbers of staff at the Trust.

The commissioners will pay the new wheelchair services provider the same as the existing contract for the Trust’s wheelchair services.

Of the four bidders, the successful bidder was the only one whose bid came within what the CCG calls the “financial envelope” – meaning the specified amount the 3 CCGs are prepared to pay for the service.

Martin Pursey said that there are penalties if the new provider fails to deliver what the contract specifies.

Costs of re-procuring wheelchair services

Putting out health services to private tender is costly, both for the organisations that bid for the contracts, and for the commissioners.

The commissioners’ costs come out of NHS funding, diverting money away from patient care. And where NHS organisations bid for contracts, the costs of making the bid also takes money away from patient care.

Plain Speaker has asked the hospitals Trust if they bid for the new contract, but has not yet received a reply.

Plain Speaker asked the CCG Governing Body about the costs of advertising and procuring the new wheelchair services, and about the costs to the Transformation Team of mobilising the new wheelchair services, before the Trust’s wheelchair services contract ends in September this year.

Martin Pursey said that the CCG pays the Commissioning Support Unit for support for Transformation and Procurement in a block contract that pays for outcomes, so it can’t identify the costs of the Transformation Team’s work in helping the new wheelchair services provider to get their service off the ground.

In relation to the costs of advertising and procuring the new wheelchair services, Martin Pursey said that the advertising was part of a package of support from the CSU and NHS England.

This package of support gives access to a contracts finder website which has replaced the now-defunct NHS Supply2Health website. The new contracts finder website links to the Bravo tendering system. The licensing charge for the Bravo tendering system is included in the CSU package.

The CCG has referred my questions about these costs to the CSU as a Freedom of Information request.

Here is the Wheelchair Services Engagement Report Dec 13 .