The private healthcare company Circle Holdings has secured a £74 million deal to provide orthopaedic services in London.
Circle Holdings will take over the contract on a five-year basis, despite previously struggling to deliver similar NHS services satisfactorily.
The company notably pulled out of a contract to run an NHS hospital just last year, which will lead some people to question the validity of this latest public-private partnership.
Many will also review the deal as indicative of the general trend towards outsourcing in the public healthcare system.
Indeed, the deal represents the first time that the Greenwich Clinical Commissioning Group has commissioned all orthopaedic activities from a private sector company.
Greenwich Clinical Commissioning Group is responsible for commissioning most of the healthcare services for Greenwich.
Under the terms of the new contract, Circle Holdings will be responsible for managing musculoskeletal services for over 275,000 people.
Savings of £12 million will be made over the five-year period that the contract will run, which makes the likelihood of renewable quite high, if indeed Circle is able to improve upon its previous performance.
Steve Melton, Circle Holdings’ chief executive, was effusive about the prospects of this new multi-million deal.
“Circle’s selection validates our record of managing integrated [muscular skeletal] services, which we successfully pioneered in Bedfordshire. Circle looks forward to working closely with the [Greenwich Clinical Commissioning Group] and local providers to ensure the delivery of an integrated, high quality muscular-skeletal service for Greenwich patients.”
Yet not all will share the perspective of Melton, particularly at a time when private sector involvement in the NHS is very much in the spotlight.
The Labour leadership candidate, Owen Smith, has reiterated the position of Jeremy Corbyn that there should be minimal private sector involvement in the public-run healthcare service.
This is despite the fact that Smith had previously worked in the pharmaceutical industry before becoming an MP.
According to Department of Health figures, the amount of funding that has been diverted to independent sector providers more than doubled from £4.1 billion in 2009-10, Labour’s last year in government, to £8.7 billion in 2015-16.
Naturally political opponents of the Conservative party have attributed this to the existing government, although it can be said in mitigation that considering the financial difficulties of the NHS, identifying an alternative solution will be far from elementary.
Other prominent NHS contracts have been offered to such providers as Virgin Care, while Circle already provides orthopaedic services in Bedfordshire as well as running a number of private hospitals.
A judicial review into the imposition of the junior doctors’ contract will be held in September, after a campaign group successfully argued the case to be within the public interest in court.
Justice for Health manage to raise £120,000 to cover unanticipated court costs, and successfully convinced a High Court judge that a full, expedited judicial review is a necessity.
The campaign group was established by five junior doctors, including two trainee GPs, and argued that the Health Secretary does not have sufficient power to impose such a contract and its resulting conditions on junior doctors.
Justice for Health has urged self secretary Jeremy Hunt to make crystal clear whether he intends to adopt the new contract via NHS trusts, or actually physically impose it on junior doctors.
Although no explicit date has been set for the case, it is expected to convene in September, with the junior doctors’ contract due to commence one month later.
Health Secretary Hunt indicated his intention to impose the contract on junior doctors earlier this month, after British Medical Association-backed conditions were rejected by an open referendum.
But despite the intentions of the Cabinet Minister, it now seems doubtful that it will be legally possible for the contract to indeed be imposed.
Doubts had previously mulled over whether it would be possible for the case to continue, following financial difficulties for the Justice for Health team.
Department of Health lawyers made what some have considered to be an unreasonable move, requesting additional security costs on Wednesday, just 24 hours before a case management hearing to determine the case was to proceed.
But the group was able to raise the sum in an emergency crowdfunding campaign, eventually securing the legal results that they desired.
Justice for Health commented favourably on the news in a statement, indicating their hopes that the junior doctors contract imposition could be overturned.
“Today we have had a good day in the High Court challenging Mr Hunt’s position on imposition, the judge has heard our initial proposals and granted us a full, expedited judicial review hearing expected in September. The judge remarked that this is an important case that has merit and needs to be heard in the public interest.”
Health secretary Jeremy Hunt has previously confirmed that foundation trusts have the technical powers to determine their own staff pay and conditions.
But he told MPs earlier this year that collective bargaining would be key to this process going forward.
“The reality within the NHS is that we have a strong tradition of collective bargaining, so in practice trusts opt to use national contracts. As the secretary of state is entitled to do, I have approved the terms of the national contract.”
Reports have indicated that consultants working in the NHS in England could expect to be offered a new contract within the next few weeks.
Government ministers have reported on what they describe as constructive negotiations, as the health service, British Medical Association and Conservative party engaged in discussions.
Ministers want to remove a clause that lets consultants opt-out of providing non-emergency care at weekends as part of their plans for a “seven-day NHS”.
But although this will be seen as a major coup by the government, there is little evidence that it is able to satisfy the desires of junior doctors in their ongoing row.
The talks with consultants’ leaders at the BMA began in autumn and slowed down at the turn of the year.
However, there have been reports that the two sides are nearing an impasse over the last few weeks, and momentum from discussions has now apparently yielded a potential contract.
Negotiations have been led by NHS Employers for ministers, and the central issue during discourse has been the removal of the weekend opt-out that consultants currently enjoy for non-emergency care.
The government is of the opinion that this is a significant barrier which prevents consultants from working at weekends, although the British Medical Association particularly contests this position.
Indeed, the BMA suggests that 90% of consultants already engage in some form of weekend working, and that the position presented by the Government is in fact misleading.
However, the negotiation should also be seen as part of a bigger picture, with the BMA concerned that negotiations could effectively isolate junior doctors.
It is also important to emphasise that talks remain ongoing, and that no contract has been offered to consultants as of yet.
A Department of Health spokeswoman commented: “We want to introduce a fairer contract for consultants that better reflects their role as leaders in our NHS and helps to ensure patients get safe, high-quality care every day of the week. Talks with the BMA over proposed amendments to consultant contracts have been constructive.”
The collapse of a major contract worth £750 million has prompted massive question marks over the process to award it and a thorough investigation.
And after the regulator and NHS England signed off the massive deal, despite questions about its viability, both are being held culpable for wasting money.
Not only was this £750 million figure a huge number, it was also in fact the largest contract in NHS history.
At the time that the deal was agreed in Cambridgeshire, the contract was intended to ensure that hospital, mental services and community care could collaborate more closely.
Eventually, a single point of contact for patients in these areas was envisaged, when the contract was signed in November 2014.
The procurement process which led to this contract could not be described as perfunctory, considering that it lasted for 15 months and cost over £1 million.
Yet it was strongly opposed by local campaigners and trade unionists, as critics of the deal believed that it would result in thousands of NHS workers being forced to transfer to the private sector.
Ultimately, the contract was awarded to an NHS partnership known as UnitingCare. This company launched in April, with a pledge to cut emergency admissions to hospital; ultimately saving the NHS millions.
However, in early December, all the partners agreed it was not financially sustainable.
The problems with the contract had been envisaged ahead of its ultimate award. Monitor had expressed serious doubts with the project, and only gave its rubber stamp to the deal days before it was ultimately launched.
Additionally, there were 34 outstanding issues remaining to be negotiated, a hearing of the committee was told last week.
The senior GP in the clinical commissioning group that awarded the contract, Dr Neil Modha, resigned last Friday, admitting that the contract had failed to deliver fundamental promises. “There was not enough money to cover all the services that were to be provided,” Neil stated.
Two inquiries are now underway to try to establish why the contract was allowed to go ahead, despite the obvious fiscal problems that were evident seemingly before it was even agreed.
Daniel Zeichner, Labour MP for Cambridge, commented that it is essential to get to the bottom of what caused this massive failure.
“Apportioning blame is not necessarily helpful, and we don’t want to lose the innovation that was coming on stream. But it’s clear there was a mighty panic over who would pay. It would be better to have a genuinely independent review carried out by the National Audit Office.”
As questions continued to be asked, Cambridgeshire CCG is conducting an internal audit, while NHS England holding an inquiry into the strategic projects team.
This is merely the latest problem with private sector healthcare contracts, after a similar collapse of an agreement in Hinchingbrooke last year.
Keith Spencer, chief executive of UnitingCare, reflected on the lessons learned.
“There are lessons for everyone, the clinical commissioning group and the hospitals and NHS England, and it is very important that everyone learns from them. No one wanted this contract to terminate. UnitingCare, its partner trusts and the CCG have worked tirelessly over many months to find a resolution to the funding shortfall which ultimately caused the contract to be terminated.”
A five-year NHS outsourcing contract worth in excess of £800 million was ended after only eight months owing to problems with the company involved.
UnitingCare won a competitive tender to run the contract to supply older people and adult community healthcare in Cambridgeshire.
The contract began on first April, but has been terminated in the last few days owing to the poor financial performance of the company.
Jo Rust from the union Unison commented that “it’s evident that they can’t make financial cost savings” that were promised when the contract began.
Patients in Cambridgeshire have already been informed that promised services will be disrupted.
The institution is part of Cambridge University Hospitals, which runs Addenbrooke’s and Rosie hospitals.
With the Cambridge University Hospitals Experiencing problems as a result of the termination of the contract, alternative arrangements have been made.
Older people’s services have been transferred back to Cambridgeshire and Peterborough Clinical Commissioning Group.
Commenting on the problems, Dr Neil Modha, the chief clinical officer of Cambridge University Hospital stated that “both parties” had decided to end the contract because “the current arrangement is no longer financially sustainable”.
Modha added that “we all wish to keep this model of integrated service delivery” and “services will continue and not be disrupted”.
Considering this potentially embarrassing situation it is perhaps unsurprising that UnitingCare has remained quiet about the issue.
The organisation affected is a consortium of Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) with Cambridge University Hospitals NHS Foundation Trust.
When the contract was signed back in April, it represented the end of a lengthy and stringent procurement process, which involved three organisations being shortlisted.
It was hoped that the new £800 million agreement would lead to an improvement in patient care in Cambridgeshire.
With the contract responsible for urgent care for adults age 65 and over, including inpatients and accident and emergency services, there’s no doubt that this was a significant contract, and its cessation is a blow to the Cambridge region.
Following the decision to end this contract, campaigners have opposed the transfer of NHS services to a private company.
It has been noted that the commissioning of the partnership in the first place cost over £1 million, with the tender process central to this expenditure.
After the cancellation of the contract, it is now hard for even the most adamant defender of the arrangement to deem it anything other than a waste of money.
The long-term plans for the Cambridgeshire region with regard to replacing these services has yet to be announced.
Junior doctors have engaged in a mass protest in London, as conflicts with the government over proposed contract changes escalates.
The British Medical Association contends that the plans of the Conservative government will lead to a significant drop in the salaries of junior doctors.
However, the Health Secretary Jeremy Hunt, has stated that the union is misleading its members, and that the proposals will be beneficial for junior doctors in terms of reducing their maximum weekly working hours.
Unquestionably there has been huge pressure on doctors of all levels of seniority in terms of their overall working hours.
But the British Medical Association rejects the claims of the Health Secretary, and instead states that the rally in Westminster is a “wake-up call for ministers”.
Aside from the March in London, thousands of junior doctors also attended rallies in Belfast and Nottingham.
Critics of the government scheme believe that it will be extremely detrimental to the living of junior doctors, and may even lead to a ‘brain drain’ of talented individuals to health services overseas.
The British Medical Association asserts that the new contract will involve pay cuts of up to 30 per cent, with the change in normal hours central to this.
Hunt intends to extend this period to 07:00 to 22:00 every day except Sunday.
Speaking to the BBC, the Health Secretary claimed that the motivation for the new contracts was to ensure that hospitals no longer have to incur financial penalties for rostering staff on at weekends.
He was also keen to emphasise that the government would be willing to negotiate over safeguards that will enable doctors to work less hours.
However, the suggestion that removing financial penalties that force hospitals to roster less at weekends is the motivation for this contractual system does appear to be a rather self-defeating argument.
If healthcare services are able to save money under the new contractual scheme, it is hard to see how this could possibly be achieved without paying junior doctors less.
By definition, this is precisely what junior doctors are striking about, so the comments of Hunt will undoubtedly be considered extremely disingenuous by many.
Nonetheless, Hunt called for the British Medical Association to return to the negotiating table, claiming that the contracts represent a good deal for doctors.
In particular, the Health Secretary stated that the maximum hours a doctor can be asked to work for will be reduced from 91 to 72 hours per week.
Weather a 72-hour week can really be considered acceptable, considering that the European Working Hours Directive states that no one should work for longer than 48 hours per week, is debatable.
Naturally this still means that doctors can experience a working week that is 50 per cent more than the supposed European maximum.
Doctors speaking at the protest indicated that the new contractual proposals would represent an unprecedented pay cut for them.
One individual who spoke to the BBC indicated that after diligently assessing the government’s proposals, it had become clear to him that he would experience a 15 per cent reduction in salary.
This was an individual with 11 years of experience dealing with casualty patients on a daily basis.
The issue is set to rumble on, but it certainly appears that the government has an extremely difficult position to defend.
The Health Secretary, Jeremy Hunt, has given some indication that he may be willing to back down over the junior doctor contract dispute.
It seems that Hunt could compromise with union leaders in order to establish a process of dialogue.
According to media reports, Hunt has already engaged in a meeting with the British Medical Association (BMA).
The BMA had announced that it will be balloting members in England on the subject of strike action.
This dispute has been widely publicised in the mainstream press, and relates to a dispute over contracts that are due to be introduced in August next year.
The contracts in question are extremely controversial, and many junior doctors, and indeed analysts of the industrial niche, have suggested that the new contractual provisions are unfair.
But despite the fact that the government has continually defended its plans related to junior doctors, it seems now that Hunt is at least willing to talk with the unions representing healthcare professionals.
In particular, it seems that the Health Secretary could be willing to change plans related to unsociable hours payments.
Hunt has apparently written to the BMA suggesting this particular compromise.
Critics of the government’s plans have suggested that the deal could mean 15 per cent pay cuts for many doctors.
This significant reduction in pay is due to the government’s plans to reclassifying normal hours as being from 7am to 10pm from Monday to Saturday.
Extra payments for unsociable working hours will only be allocated outside of these times, as opposed to the existing arrangement which was from 7am to 7pm Monday to Friday.
But according to a letter that has been seen by BBC journalists, Hunt is apparently “pleased to discuss” a compromise on the definition of normal hours on a Saturday.
Hunt also suggested in the letter that the contract is not a “cost-cutting exercise”, and that the “great majority” of doctors would retain their current level of pay.
It must be said that this seems to be a completely disingenuous argument, considering that the reduction in unsociable hours will almost inevitably lead to many doctors being paid less.
And in terms of motivation, it is hard to think of any possible justification other than simply reducing the amount of money paid to doctors overall.
So the comments of Hunt in the letter will certainly be subjected to scepticism from critics of the plan, and the Conservative government in general.
However, Hunt maintains that the current contracts are “outdated” and “unfair”, pointing out they were introduced in the 1990s.
Commenting on the issue, Dr Johann Malawana, chairman of the BMA’s junior doctor committee, was cautiously encouraged by the letter, but also stated that “questions still remain and we are urgently seeking clarification on the points raised in the letter.”
Both Scotland and Wales have already indicated that they have no intention of introducing the changes, and Northern Ireland is yet to make a decision on the subject.