Friday, 4 September 2015

Questions to NHS Nottingham, the City's CCG

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Apr 2016 : North East England Cancer Scanning Contract
Not a question posed to the CCG, but bit concerning to read that a £80million cancer scanning contract in the North East of the UK went to a private company despite a NHS bid claiming they were £7million cheaper and would use a recently installed charity funded scanner. The NHS team challenged the bid process outcome and when Buzzfeed challenged NHS England on why they appeared to have chosen the more expensive bid, their comment was :

“NHS England is currently running a procurement process to ensure people who require medical imaging continue to receive a high quality sustainable service. “We are working with all parties to try to reach an agreement that is in the best interest of patients and allows continued use of the charity-funded scanner at the Royal Stoke University Hospital.”


Outcome of the process appears to be in this press release

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Aug 2014 : A variety of questions
Back in August 2014, sent the email below to NHS Nottingham, the city's Clinical Commissioning Group(CCG):

"Dear NHS Nottingham I've recently read a disturbing account of how, in Cornwall, a contract by Musgrove Park Hospital with Vanguard Healthcare has been terminated because of poor quality eye operations and am concerned that the NHS will have to pick up the cost of rectifying Vanguards mistakes. What reassurance can you give me that, in Nottingham :

a) Private companies working with the NHS will not be allowed to privatise profits while socialising the costs of mistakes.

b) Private companies will not be able to hide behind "confidentiality agreements" when they are working with the NHS.

Also, how can you ensure that these concerns actually reach the CCG?"

Having had to chase them for a reply several times since, finally got a response in September 2015, as shown below :

"In Nottingham City we hold contracts with a number of providers; NHS and private and we apply the same terms and conditions regardless. All providers of services (NHS and private) are tightly monitored, both in terms of their performance and the quality of the services they deliver. So should there be an issue of poor performance this would be picked up and managed.

Thankfully we have not found ourselves in a position where we have had to terminate a contract, such as the situation you describe in Cornwall. This is not to say that it could not happen but we work very hard to maintain the contracts we hold and prevent this from happening. Of course problems can occur with NHS providers, big hospitals for instance, so it is not necessarily connected with being a private profit-making concern.

We do not enter into confidentiality agreements with our providers and performance reports on our providers are presented to the CCG’s Governing Body and are therefore available to the public. If you are interested you can see these on our website on the Governing Body section.

There are a number of mechanisms for capturing any concerns about a provider. We receive regular performance and quality reports from our providers, there are hard data such as re-admission or repeat operation numbers which would alert us to any problems and then there are a number of sources of soft intelligence such as GPs and our patients who tell us when they think there is a concern about a service. We also work closely with other local CCGs, NHS England and the Care Quality Commission, all of whom are stakeholders in the business of ensuring good quality services for our patients."

To a layperson like BFTF, this all sounds broadly reassuring. Reading the NHS Nottingham "Patient Prospectus" shows the role of the CCG thus :

"..we are responsible for planning and buying healthcare services that meet the needs of the local population. To do this well, we have to make sure we understand what health problems affect people living in Nottingham City. We then plan and buy services that will help local people the most, and we involve patients, carers, partners and others throughout the process.

We are responsible for making sure that the health care provided is of a high standard, that it continues to make important improvements, that it offers value for money and that arrangements are in place to make sure people are looked after in the best way possible.

We also work with partners to focus on areas which have health inequalities and to identify ways in which we can make improvements for the future. For example, we would take action to improve life expectancy if children born in one area of the City were not expected to live as long as children born in another, or if people living in Nottingham had a higher chance of dying from cancer than people living elsewhere in England."


GP's, it seems, play a significant role in the CCG :

"Our Chair is a GP, and three more GPs sit on our Governing Body, together with a secondary care doctor from outside Nottingham, and an independent nurse. A fourth practising GP also attends Governing Body meetings as an advisor. All but one of our lead clinicians also regularly see and treat patients."


A table in the prospectus gives a handy summary of what the CCG commissions:

Summary of NHS Nottingham Commissioning


The prospectus also states what the CCG is NOT responsible for :

"Public health services have transferred to Nottingham City Council. These services include responsibility for prevention and health promotion, such as sexual health, smoking cessation and initiatives to target obesity and misuse of alcohol and drugs. The Council also has responsibility for planning and buying public health services for children aged five to nineteen. From April 2015 it will also commission services for children aged less than five years old. As with the NHS, these services are free at the point of delivery. We work very closely with the Council to improve the quality of health and health outcomes.

NHS England is now responsible for buying and planning primary care, and for managing contracts with GPs, pharmacists, opticians and dentists. It also commissions specialised services such as renal transplant and neo-natal intensive care services. "

A quick visit to the NHS England website shows that their mission, apparently is :

"NHS England commissions or buys primary care services for local communities. For example GPs, dentists, opticians, and pharmacy services. We also commission health and justice and military health services plus some specialised services. Our Customer Contact Centre can advise you about accessing these services...

NHS England does not commission secondary care. This includes hospital care, mental health services, out-of-hours services and community services such as district nursing. These services are commissioned by Clinical Commissioning Groups (CCGs). If you need advice about accessing secondary care, you should contact your local Clinical Commissioning Group."

BFTF wonders about funding, and in particular whether those services transferred to the Council have retained their funding levels. The search for information continues, and is likely to start with the NHS Nottingham Commissioning Strategy....

Update Sep 2015
Also asked the CCG how the managed conflicts of interest (for example, board members voting for services that they had a financial stake in). Very quickly received the following response:
The CCG has developed a specific Conflicts of Interest Policy to ensure that arrangements are in place to manage any conflicts and potential conflicts of interest. The policy applies to all employees and appointees of the CCG, all member practices of the CCG (single-handed practitioners, practice partners, or their equivalent) and to third parties acting on behalf of the CCG. A key part of our arrangements is the maintenance of our Register of Declared Interests and the register for our Governing Body members is available to view on our website [link].

The Governing Body and all Committees of the Governing Body (our key-decision making fora) all have an extract of the register (showing members' interests) included with papers at meetings. As an additional safeguard, we also have a specific item on every Governing Body and Committee meeting agenda to identify any conflicts of interest, or perceived conflicts of interest, in relation to any agenda item. This also ensures that any actions taken to manage the conflict are clearly documented.

To ensure awareness of this area, the CCG mandates training on conflicts of interest for all employees and appointees and we have previously run a Governing Body development session for Governing Body members on this area. The Conflicts of Interest Policy is available on our website at [link]

In addition, the CCG also has a Procurement, Patient Choice and Competition Policy that describes how the CCG will ensure that potential conflicts of interest are considered as part of the decision-making and procurement process. The CCG also requires that all potential bidders/contractors declare relevant interests as part of every procurement process.

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