Commissioning: further issues - Health Committee Contents

Written evidence from Mary E Hoult (CFI 05)

I am submitting this from a carer perspective. The Personalisation Agenda for social care has put the control over commissioning care with the service users themselves in order to put the patient at the heart of everything, Health & Care through the eyes of the patient.

Following on from my previous papers on the subject of Commissioning.

Working from paragraph 118 page 36 in the Committee's Third Report:

The committee regards the principle that there should be greater accountability by commissioners for their commission decisions. To highlight the importance of this principle, I wish to show a recent example of how decisions were made that resulted in the following headlines:

Shock Decision by Leeds City Council—CohearentVision left out in the cold as Birmingham based organisation awarded "Leeds Deaf Services" contract, and "Action for Blind People" lead successful consortium bid to provide "Leeds Blind Services", value £1 million.

The previous contract was held by CohearentVision better known as the Leeds Society for the Deaf & Blind who claim to have provided a high level service with reducing contract costs by over £200,000 per annum over a three years period. They also offered to deliver the new contract on a service specification for 26% less but failed in the tender process.

Currently the new contract starts 1 April 2011 and it is yet unclear what the handover process to ensure a smooth transition will be.

Charities bidding against each other seems to the lay person a sad state of affairs. Awarding Leeds services to Birmingham control, is contradiction to the concept of localism. How does this help "The Big Society"? This seems to have been overlooked in this instance, leaving only accountability. How all this will pan out does leave patient/service users very worried indeed.

In my years of attending NHS meetings I have been struck by many examples of how accountability can be a moveable feast. Two examples come quickly to mind:

—  although meetings are held in public, the practice of having certain agenda items in private session continues and even increases. Surely decisions which inevitably impact on public expenditure should at least be heard in public?

—  Questions I raise, as a result of meetings attended, often go unanswered despite lukewarm promises. This can apply to both written and verbal requests. The impression is that engaging with the public is not a priority more an inconvenience. Where is the spirit of openness and accountability?

Whatever changes your Committee recommends, we need to be sure that structures, reporting arrangements etc. fully support accountability and good governance. In the past, whatever the architecture, health bodies have had a tendency to function as much for their own benefit, as for the purpose for which they were created. The role of the non executive is key to this. Legitimate challenge should be welcomed and encouraged. Only then can the public begin to believe that the patient is at the heart of the NHS.

Can the Select Committee look into the governance of all and how this contract links into the Health and Social care agenda to provide clarity and accountability for service users who are still in the dark about these changes?

January 2011

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Prepared 5 April 2011