6 CONTRACTING OUT COMMISSIONING
IN OXFORDSHIRE
182. In a further recent development, in October
2005 Thames Valley SHA decided to put forward a proposal to the
Department of Health to contract out the management of its proposed
Oxfordshire-wide PCT, including the commissioning function. In
an interview with the Health Service Journal, the SHA Chief
Executive Nick Relph said it would be "fantastic" if
an NHS team proved they were up to the challenges of Commissioning
a Patient-Led NHS, but added that "the skills and capability
required for the new PCTs are quite different from the current
PCTs. That is not to diminish those running the current organisations,
but the skill set for commissioning needs to be different".
[148]
183. We invited Nick Relph to give oral evidence
to us on this subject, but he declined. However, we received a
frank and compelling analysis of the proposals from Dr Helen Groom,
a member of Oxford City PCT PEC. Dr Groom told us that while she
supported the need to have the best possible management for the
future PCT, she felt that it was very important to question whether
the NHS should be tendering out to a private sector company the
commissioning of services for Oxfordshire:
We are saying that a private sector company would
actually come and hold the purse strings for the £600 million
of money that is spent on healthcare services in Oxfordshire,
and whilst I think we can debate whether private sector involvement
in the way we run our buildings might be appropriate, and private
sector involvement in the provision of hip operations, cataracts,
of MRI scans may be appropriate, this is a much, much bigger step
that has actually been taken with no discussion and no consultation[149]
184. According to Dr Groom, the SHA's rationale for
putting the management out to tender was that the proposed single
PCT would be a very large organisation needing "unusual management
expertise". However, she pointed out that the proposed new
PCT would in fact be the same size as the former Oxfordshire Health
Authority.[150] She
went on to tell us that staff had received very little notice
of these proposals, and the SHA have been very clear that they
did not propose to consult on the tendering out process, because
it did not constitute a service change. [151]
185. Dr Groom also argued, crucially, that if SHA
plans to the tender advertisement out in November 2005 went ahead,
there would effectively be no Board level involvement in or accountability
for this process, as the new PCT Board would not be appointed
until March 2006.[152]
When we put this to Lord Warner and his official, he reassured
us that this would not be allowed to happen, and we are relieved
to see that Thames Valley SHA has now reconsidered its plans.
186. However, we have further concerns surrounding
commercial confidentiality, which may limit the amount of information
on health spending that is made publicly available. This issue
is already raising concerns in respect of private sector providers;
if private sector companies could potentially be charged with
spending public money as well, than transparency will be even
more crucial. Although the issues surrounding the contracting
out of the NHS commissioning function are too complex and numerous
for us to take an informed view on at this stage, it is crucial
that they are properly debated and consulted upon if and when
the Government decides to proceed with this policy.
187. We were extremely concerned at evidence we
received about proposals to tender out the commissioning function
in Oxfordshire before the new PCT Board has even been appointed.
When we put this to Lord Warner he reassured us that this would
not be allowed to happen, and we are relieved to see that Thames
Valley SHA has now reconsidered its plans. However, we believe
that the idea of outsourcing commissioning represents a significant
departure from current policy, which has the potential of reducing
transparency about the disposal of public funds. Further consultation
and discussion is absolutely crucial before the Government allows
any PCT to proceed down this route.
148 Health Service Journal, 20 October 2005 Back
149
Q 78 Back
150
Appendix 39 Back
151
Q 78 Back
152
ibid. Back
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