Can a 7 year old solve the paradoxes of NHS privatisation?
This week for the first time, my 7 year old daughter has co-written the blog with me in the shape of a recent letter to a local Clinical Commissioning Group about the Guardian front page NHS story last week. I hope it will be clear why......
Dear High Weald Lewes and Havens Clinical Commissioning Group,
My daughter Anna and I write to offer you some advice with your recent commissioning trauma. As you are aware, the national press have picked up on the host of problems that have arisen since you replaced South East Coast Ambulance with the private firm Coperforma as the provider of non-emergency patient transport services. Hundreds of patients, including people with cancer and kidney failure, have missed important appointments for treatment because ambulances did not arrive to take them to hospital.
I was with the kids when I read about it so I told them about it in language that they could understand. Anna is 7 and Andrew is 4 years old. Andrew responded by saying he wanted a cake which I took to be unrelated to your predicament. Anna, however, asked why people were not being taken to hospital? I said I'd read on to try to understand more and provide an answer.
So I was reading out loud about the four-year, £63.5m contract. Anna said that 4 years was a long time. She asked why they didn't they just let them do it for a day and if they couldn't do it then give it to someone else. To translate her query into more technocratic terms, she was suggesting piloting potential bidders as part of the procurement process and prior to contract award. Anyway this gave me an idea.
So I undertook a little test.
I read on. “It has been suggested that Coperforma crews have been left doing nothing, despite patients’ need to get to hospital, because poor mobile phone reception in parts of Sussex has meant they did not receive details of calls to attend via an app the firm saw as pivotal to the service’s smooth running”.
I asked Anna what she thought the problem might be if an ambulance driver used mobile phones in the countryside to talk to patients. She said that when she was in Devon she noted that Daddy couldn't get a signal often so the patient might and ambulance man might not be able to contact each other.
You see what she did there?
I read some more. “The previous provider, SECAmb had satisfaction survey results regularly above 90%”. I told Anna this and that the CCGs were “taking this situation very seriously and have launched a formal investigation into the start of the new service”. Anna said that they don't have to worry because they can just give it back to the ambulances who used to do it because they were good at it.
Anna seemed to be on a roll by now.
“Coperforma had announced that from the commencement on 1st April they were to implement cuts to or to re-define eligibility criteria for the current transportation of renal patients to hospital for dialysis.” That took a bit of rewording.
“Daddy is that why they were cheaper than that other ambulances?”
Bouyed by this I asked her what she thought would be the outcome of a cut-price bidding war- if you invited different people to bid to do a job and you chose the one who said they could so it for the cheapest price rather than the one who everyone thought did it well. She thought for a while, not once looking up from the farm picture she was colouring in, and said, “You'd have more money to spend but maybe you'd be worried because their phones wouldn't be very good.”
I finished off my line of inquiry. Andrew, my four year old was throwing his toy ambulance against the wall, possibly unaware of his own metaphorical link to your CCG commissioning process. Whose fault do you think this whole thing was Anna?
'The people who swapped the ambulances weren't very good.'
She said that this reminded her of Jake from her school. Apparently Jake always thinks he has good ideas but they never are and he ends up getting in trouble. So the bad news is your commissioning strategy to outsource a previously reliable patient transport service to an ill-equipped private provider is reminiscent of Jake from the local Primary School.
However don't feel too down. In this new post 2012 NHS dystopia, commissioners being unable to select suitable providers, and bidders not knowing how to meet bid specifications, really isn't new. But as you are struggling with this particular area I was struck by an idea that might interest you.
It sounds to me like my 7 year daughter has a skillset that you might find useful- the capacity to foresee the blindingly obvious impediments to botched attempts to sell off parts of the NHS. In the interests of avoiding this in future I've asked Anna if she would be interested in joining your CCG and she said she's not averse to the idea as long as it's not too boring and she can watch Scooby Doo if your meetings get too boring. Anyway those are her terms should you be interested.
Carl and Anna Walker
Carl Walker has started a patient transport petition
Please sign and share with friends, colleagues and campaigners across the South East.