NHSPN's response to NHS Standard Contract for 2014/15: Discussion paper for stakeholders

Transcription

1 NHSPN's response to NHS Standard Contract for 2014/15: Discussion paper for stakeholders Comments from the NHS Partners Network (NHSPN) The NHS Partners Network, (NHSPN) which represents independent sector providers ( for profit and not for profit ) of NHS care across all sectors except mental health, is a self-governing network of the NHS Confederation, working with the other members of the Confederation and fully committed to the values of the NHS Constitution. More information about the network can be found on our website at We are grateful for the opportunity to comment on this discussion paper from NHS England and appreciate the fact that NHS England officials have taken the time to hold a more "in depth" meeting with a cross-section of NHSPN members which allowed for a fuller dialogue. This paper therefore seeks to summarise the main points from that meeting under the headings of each of the specific questions in the discussion paper for stakeholders. Answers to questions P.4 - Key issue 1: Maintaining the current contract structure Question 1: Do you support our intention to retain the current three-part structure for the Contract for 2014/15? A1. Yes. Although there is a case for some restructuring of the contract, the timescales are now such that any attempt to make major changes for would almost certainly delay and jeopardise contracts being in place on time and add unjustifiably to the huge burdens already being impose by the reorganisation of the NHS in its first year. It needs to be borne in mind that whilst public sector provider have traditionally been willing to maintain services (on trust) even if there are delays in completing formal contract documentation, this approach is really not open to independent providers for legal compliance and risk related reasons. In terms of the sort of changes that should be considered, these could include, for example, moving the Schedules into "Service Conditions" and keeping the "Particulars" shorter and clearer. P.5 - Key issue 2: Allowing recent changes to bed in Question 2: Do you support our intention not to make material changes for 2014/15 to the clauses of the Contract dealing with contract management processes? A2. Yes, for the reasons set out in A1.

2 P.6 - Key issue 3: Greater flexibility on contract duration Question 3: Do you support our intention to provide a Contract with greater flexibility in terms of duration, as outlined above, and do you have any comments on the specific details of the approach? A3. Independent sectors support the principle of moving to longer term contracts. The standard one year model makes sensible planning and continuity of service to patients more difficult and the extreme short-termism of the approach is a major problem for investors. However, there are some important secondary issues that need to be fully addressed as part of a move to longer-term contracting: Where longer term contracting is being contemplated it is vital that these are usually only awarded after full, non-discriminatory procurement processes. As a general principle, the longer the contract, the stronger the case for full scale procurement to secure the best provider(s) for patients and for taxpayers. It is essential that within longer term contracts the rights of patients to "choice" are fully respected, including when contracts are let for multi-service "integrated" pathways and care. A risk of longer-term contracts is that they either engender complacency on the part of incumbents or fail to adapt to respond to changed requirements, conditions or service innovations. However, there is a delicate balance to be struck between excessive contract variations which destabilise the provider and the need to be able to make necessary adjustments - for example to accommodate service reconfiguration. More work is needed on this, drawing on experience in other industries where longer term contracts and supply chain relationships are more established. Variations need to take a responsible and realistic view of the impact on provider costs. There is also an issue that needs to be addressed about alignment of AQP status with the period of contracts. P.6 - Key issue 4: Innovative approaches to contracting Question 4: Do you agree that the current Contract can support innovative commissioning models such as the prime contractor approach? If not, what changes do you think are needed? A4. Yes, it can, as evidenced for example in Torbay and Cambridgeshire. The reasons why the current model is sometimes seen as an inhibitor are primarily down to lack of commissioner expertise and experience, and excessive caution, rather than the contracting model itself. This needs to be rectified by upskilling commissioners. Even so, the changes we are suggesting would, we believe, make innovative commissioning easier. P.7 - Key issue 5: Balance between acute and other services

3 Question 5: Can you suggest additional quality or service standards for community, mental health and other non-acute services which could be reflected in, and possibly incentivised through, the Contract in 2014/15? A5. The development of essential quality data for non-acute services remains an area of weakness and this is especially true of services which have traditionally been delivered in acute settings but will increasingly be delivered in the community. However, it is not necessary to start from scratch: some of the innovative contracts with independent providers already have robust quality data standards which could be used as a basis for further development. It is however important that: data requirements are relevant and tailored to the sector and services concerned. Simply adding new requirements to a list originally put together for totally different services just serves to add to the bureaucracy that other initiatives are trying to reduce; the application of incentives is not done piecemeal, adding to an already confused and incoherent approach to incentivisation (see response to separate consultation). P.7 - Key issue 6: Guidance on collaborative contracting Question 6: Is the current guidance on collaborative contracting sufficiently comprehensive, detailed and clear? If not, which specific areas and issues require further clarification? A6. Yes. See A4 above. P.8 - Key issue 7: Electronic Contract Question 7: If an improved, more reliable and responsive e-contract system is made available for 2014/15, will your organisation plan to make use of it for the majority of its contracts? A7. In principle, yes. But experience of the sector to date is that the structure of the e-contract and the reluctance of commissioners to use it means that the task of reshaping it and bringing it into more widespread use may involve more preparation than this timescale recognises. Even where the e-contract is being used, commissioners are doing so too late and inflexibly which negates the purpose of the e-contract. P.8 - Key issue 8: A contract for all shapes and sizes of provider? Question 8: Are there types of contract or provider for which use of the NHS Standard Contract is proving particularly problematic? How can these problems best be overcome? A8. In a number of respects the standardisation of the current model and structure of contract is problematic. Many community service providers, for example, found the old sector-specific community services contract more relevant and easier for both providers and commissioners to use. The problems are partly due to the irrelevance

4 of requirements for one to sector to another (see A5 above); and partly due to the way the three part structure works (see A1 above). A further problem is the extent to which there are differences, which may on occasion amount to discrimination, in the way in which some commissioners have in the past applied the contract as between different types of provider. This is a "fair playing field" issue. P.9 - Key issue 9: Payment reconciliation processes Question 9: Do you agree that it would be appropriate to amend the Payment Terms clause, so that providers issue monthly reconciliation accounts, which each commissioner can then accept or contest? A9. Yes, but this area is largely driven by PbR requirements which need to align with local practice. P.10 - Key issue 10: Reporting requirements Question 10: Do you have suggestions for specific changes to the Reporting Requirements schedule of the Contract, with a view to safely reducing the information collection burden? A10. This relates to the need already referred to of ensuring that reporting requirements are both necessary and genuinely relevant to the sector concerned. Commissioners/NHSE need to form a clear view about what is really needed, including the balance between national core requirements and justifiable local requirements. P.10 - Key issue 11: Making the Contract simple to complete and use Question 11: In terms of practical completion of the Contract documentation, can you suggest ways in which this could be streamlined, eliminating any current requirements which are not seen as adding value locally? And do you have suggestions for the type of support you would like in understanding and using the Contract? A11. Providers need early warning of changes or new requirements. Giving commissioners the ability to derogate where doing so is not inconsistent with law or specific policy (see below) would be sensible. P.11 - Key issue 12: Compliance with the law and specific policy guidance Question 12: Do you think that the Contract gets the balance right, in terms of the extent to which existing guidance on specific policy areas is re-stated within it? Should specific content be removed, or additional areas added? A12.Contracts are not the right place to make policy statements. They are essentially the working documents for a relationship and the clearer and more precise they are the better. It would be preferable to include a blanket clause about the need to comply with all relevant statutory and NHS Constitutional requirements and to have

5 regard to such policy statements as may already be extant or may be issues from time to time. NHSPN August 2013