Paper: 6.1
Date / Tuesday, 20th January 2015
Title of paper / NWL Wheelchairs Governance Structure
Presenter / Mona Hayat, Assistant Director of Service Redesign & Transformation CL CCG
Author / Mona Hayat, Assistant Director of Service Redesign & Transformation CL CCG
Responsible Director / Matthew Bazeley, Managing Director CL CCG
Clinical Lead / Dr Sheila Neogi, Clinical Lead for Planned Care, GP Member
Confidential / No
The Governing body is asked to:
The Governing Body is asked to approve the recommendations of the CWHHE Collaboration Board: Shared Support Services to:
- approve the recommended NWL wheelchairs governance structure
- disband the existing procurement and notify potential bidders
- commission hardware and maintenance services from the Shared Business Services (SBS) framework for the next 12 months as an interim solution
- give notice on the current contract for assessment and prescribing services and to seek for this to be less than 12 months’ notice if possible
- undertake a full service redesign of wheelchair services across NWL (the NWL Wheelchair Strategy Board will review the outputs of the service redesign, take a proposal to the CWHHE Collaboration Board: Shared Support Services, which will make a recommendation to the Governing Body).
Summary of purpose and scope of report
In January 2014 a project mandate to proceed with procuring a two-stage OJEU Wheelchair Hardware & Maintenance service across 9 CCGs (CWHHE, BHH and Barnet) was agreed at the CWHHE Investment Committee. The procurement commenced in March 2014 led by NWL CSU, with a PQQ advertised and issued 10 March 2014. Four PQQs were submitted and evaluated in April 2014.
The original timescale was to award the contract in December 2014 to allow a mobilisation period with the new Provider, and thus enable the effective delivery of services from 1 April 2015. In July 2014, Central London CCG took over the hosting arrangements for this procurement and undertook a review of the process thus far. A number of concerns were raised regarding due process which highlighted the potential for contestability. To this end, a recommendation has been made to disband the current procurement in its current form and undertake a full service redesign.
Quality & Safety/ Patient Engagement/ Impact on patient services:
The driver for revised consideration of an integrated wheelchairs service is based on significant lobbying from patients and key stakeholders.
Financial and resource implications
None. CL CCG is the host and NWL and BHH have a contractual arrangement with SBS to provide procurement services. This has been accounted for within the parameters of this budget.
Equality / Human Rights / Privacy impact analysis
This programme area is integrated into the IIA report being undertaken within Planned Care.
Risk
See paper.
Supporting documents
NWL Wheelchairs Brief
NWL Wheelchairs Governance Structure
NWL Wheelchairs Strategy Board Terms of Reference
Governance and reporting(list committees, groups, or other bodies that have discussed the paper)
Committee name / Date discussed / Outcome
NWL Wheelchairs Strategy Board / 1 October 2014 / Approved
Collaborative Performance Committee / 27 November 2014 / Approved
NWL Wheelchair Service Hardware & Maintenance Procurement Briefing
Background
In January 2014 a project mandate to proceed with procuring a two-stage OJEU Wheelchair Hardware & Maintenance service across 9 CCGs (CWHHE, BHH and Barnet) was agreed at the CWHHE Investment Committee. The procurement commenced in March 2014 led by NWL CSU, with a PQQ advertised and issued 10 March 2014. Four PQQs were submitted and evaluated in April 2014.
The original timescale was to award the contract in December 2014 to allow a mobilisation period with the new Provider, and thus enable the effective delivery of services from 1 April 2015. In July 2014, Central London CCG took over the hosting arrangements for this procurement and undertook a review of the process thus far. A number of concerns were raised regarding due process which highlighted the potential for contestability. To this end, the ITT was not issued to plan and potential bidders have been informed that there is a delay in the proceedings. Furthermore Harrow and Hillingdon CCGs have formally withdrawn from the procurement process and are undertaking their own wheelchairs procurement.
NWL CSU formerly developed a NWL Wheelchairs Steering Group. This was a task and finish working group set up to achieve representation from each CCG to deliver the end to end procurement. However, a mix of commissioners/providers attending, a lack of consistent representation from each CCG and a lack of seniority to make critical decisions was highlighted within the CL CCG review and it has since been reconstituted (to include lay representatives and exclude providers). Furthermore the CCG has formed a NWL Wheelchairs Strategy Board (NWL WSB) for the steering group to be accountable to. The NWL WSB is accountable to the Collaborative Operations Group.
Current Provision
Currently Wheelchair Service Approved Repairer (AR) services are provided by NRS Healthcare (providing hardware and maintenance services to the three wheelchair assessment services covering the CWHHE CCGs plus Brent and Barnet CCG).NRS Healthcare is currently operating out of contract having rejected a second formal contract extension proposal from March 2013. There are a number of outstanding issues that have been raised by the incumbent provider that include unpaid invoices, repair and spare pricing, parts to be charged at cost and planned preventive maintenance (PPMs- frequency of servicing of powered and non-powered wheelchairs). To date, NWL CSU had led the contract monitoring meetings on a quarterly basis. However, there had been a lack of robust performance and reporting mechanisms and internal CCG process inefficiencies have led to the incumbent provider accruing late payment interest of £43k in Q1-2 of 14/15 thus far.
Developments from July 2014
The Contract Monitoring meetings have now been moved across to Central London CCG (with input from each respective CCG). The outstanding service, quality and pricing issues cited by the incumbent provider are being addressed and CL will ensure all CCGs are provided with the appropriate updates.
The NWL Wheelchairs Strategy Board commenced on 1st October 2014 (see Appendix 2) and thus far two meetings have convened. Senior representatives from each CCG were tasked with some critical questions to address and further queries have arisen since both meetings. On the 27 November, this paper was presented to the Collaborative Performance Committee where the following information was discussed:
1)Has a Business Case been developed?
A Business Case was not written for this procurement presumably because the original mandate was to re-procure the existing model. However, there has been a general lack of legacy documentation being produced.
2)Was a review undertaken in order to present the recommendation to the Investment Committee to re-procure hardware and maintenance services only?
We are not aware of the approaches undertaken to achieve the proposed service model. There has not been:
- Data analysis to establish accurate levels of incidence and prevalence rates.
- Meaningful consultation and process-mapping with specialists and patient representative groups to inform the emerging service pathway.
- Consultation with expert external specialists in provision to identify best practice.
- Research on up-to-date guidance and publications to align and contextualise evidence to local NWL need and to strengthen performance and reporting mechanisms.
- Financial modelling
3)How was the affordability criteria set?
This is unknown. The finance lead from Ealing has been working on obtaining financial and BI information from each individual CCG. To date the principle issue has been a lack of data. He has received data relating to the first three years of the current NRS contract – 2010/11 to 2012/13 – and a different set of data for 2013/14 and the current year. The first provided overall expenditure, but not a detailed breakdown. The second provided a relatively detailed breakdown, without being clear whether the activity shown is the entirety of the contract. Merging these two data sources together suggests spend has increased from 2013 onwards, though the profile is not uniform across all of the CCGs and reliability of the data is questionable.
Ideally we require 2010-13 data set for the following two years, and the 2013-15 data set for the preceding three years in order to gain a realistic overview. As yet, the finance lead has yet to source anyone within the former CSU able to supply this information or that has the detailed knowledge that we require to proceed.
4)What is the forecast outturn for the current year?
The incumbent provider is stating that there is likely to be a year-end overspend. They are producing a paper to be circulated to commissioners on the 8 December which disaggregates the projected year-end overspend.
In addition, we know there are some invoices presently unpaid, but we don’t have information on the amounts of those invoices, the reasons for the non-payment (whether, for example, the invoices are incorrect) and therefore what impact they may have on outturn expenditure.
Some CCGs devolve their budget to the assessment and prescribing services. This is impacting financial controls.
5)Is there a draft service specification?
There is a draft service specification but it lacks the critical metrics required to measure future performance and reporting. SBS suggest it requires significant input to be fit for purpose.
There are a number of issues that have arisen as a consequence of proposing a single service specification across 7 CCGs. Hitherto, the seven CCGs have not operated in the same way. They appear to exhibit preferences for different types or makes of equipment, possibly different thresholds for prescribing and issue of equipment, and different rates of PPM. To this end, gaining consensus on a single service specification across all the CCGs is going to be a time-consuming. It may be that incorporating assessment and prescribing in the procurement, and consequentially restricting discussions to commissioning organisations, will make the process of producing a single service specification somewhat easier.
6)Due to a lack of due process do we reset the current process to PQQ stage or continue as is and absorb the risk of contestability further on in the process?
Procurement advice from SBS is clear; since there are now 7 rather than the original 9 CCGs participating, this presents a material change and therefore a legitimate reason to stop and re-start the procurement. If the material change means that there may be other suppliers in the market that could now bid for the business, there is a risk of challenge if we do not restart from PQQ. It would be prudent to start again and replace the OJEU notice for the 7 CCGs with wording that gives scope to increase the number should the others decide to join at a later date.
7)If we delay the Wheelchairs Procurement, would each CCG be open to contestability by the market on the basis of a further extension to the existing incumbent contract.
There is a residual risk with extending an implied contract and from governance and audit perspective certainly there is a case to ensure that spend is via an OJEU legally compliant framework. SBS can support this compliance by providing access to their Wheelchairs and Associated Products and Consumables framework as an interim measure whilst we assess the position. This would also introduce transparency for any variation required by the CCG’s and track changes via a Change Control Notice process. It can be for two (2) years with the option to extend for two further twelve (12) months.
The SBS wheelchair framework has a number of suppliers (24), one of which is the incumbent supplier. SBS can conduct a direct award or mini competition in supporting the 7 CCGs in providing continuity of service. Buy-in from all 7 CCG’s was sought at the NWL Wheelchairs Strategy Board on Monday 10th November. This was met with mixed reviews (Hounslow) as there was a lack of clarity regarding SBS and their representation across all CCG’s.
The outstanding issues that have yet to be addressed in the contract monitoring issues can be resolved by drafting a revised supplier performance and contract management set of metrics that will be easier to manage for CL on behalf of all the CCG’S.
8)How do we address the issue of governance across the 7 CCGs? Do we request a refresh of the mandate of the Investment Committee or extend the current timescale to incorporate all NWL governing timescales for sign off?
It was agreed at the NWL Wheelchairs Strategy Board that the Board will defer to each CCG Governing Body for business case approval (once it has been completed) and final sign off of agreed contract award. All other aspects of the procurement would be decided by the NWL Wheelchairs Strategy Board. Only with exception would matters be escalated to the CWHHE Collaborative Operations Group to make a recommendation on the Board’s behalf.
9)The current procurement is for wheelchairrepair and maintenance only. If we are in the process of reviewing do we reconsider inclusion of the assessment (and prescription) services too in order to commission a fully integrated service?
Patients, lay representatives and key stakeholders including Baroness Grey-Thompson are lobbying for NWL CCGs reconsider the decision to procure hardware and maintenance services only. They have expressed the need for the procurement to be combined with assessment and prescription services in order for services to be robust and seamless. This would mean the following components would be included:
- Powered and Non-Powered Wheelchairs
- Rehabilitation Engineering facilities (RE)
- Special Seating
- Wheelchair Cushions and Accessories
- Service and Maintenance Packages (AR)
Patient feedback suggests that by procuring the above, delays between the assessment and the issue of wheelchairs will be resolved as would the inconsistent communication between the assessment and maintenance services. Patients particularly cited the need for a resolution to waiting times for repairs. This view has been endorsed by experts in the field who have commented on the impact this has on quality as well as the delivery of efficiency savings based on economies of scale.
10)Do we require dedicated finance programme management to support this procurement?
Yes. There are a number of changes that can be introduced into the new contract to reduce costs.
11)Is there a reasonable existing market for this procurement on the basis that we only received 4 expressions of interest?
There have been an unprecedented number of current tenders for both Wheelchair and Integrated Community Equipment Services this year across the south east of England. There is a rationale for delaying the existing procurement into 2015/16 to plan for contract commencement later that year.
12)Would the NHS England Wheelchair Tariff Project align to our timescales?
Yes. This is due to be mandatory from 2017/8. If we incorporate this pilot into the NWL timescales, we will be joining the existing 19 current CCGs who have signed up. Of note, Ealing CCG is one of these.
The timescale is as follows:
Task / Deliver DateCommence work on datasets and start providing monthly data / November 2014
Analysis of first 6 months data and lessons learnt / May 2015
Benchmarking exercise / July 2015
Write up final analysis of data / August 2015
Sign off final currencies and issue guidance / December 2015
Implement non-mandatory tariffs / 2016/7
Implement mandatory tariffs / 2017/8
Specialised Commissioning/complex needs will be included in tariffs
Recommendations
The following recommendations were cited at the Collaborative Performance Committee:
- To disband the existing procurement and notify potential bidders
- To commission Hardware and Maintenance Services from the Framework for the next 12 months as an interim solution
- To undertake extensive service redesign
- To present the outcome of the redesign to the Collaboration Operations Group. Depending on the outcome:
a)To issue 6-months’ notice to the three incumbent Assessment and Prescribing Services
b)To reissue the wheelchairs procurement as an integrated model, inclusive of Assessment and Prescribing Services
c)Or to procure the Hardware & Maintenance service separately
d)To volunteer as a pilot for theNHS England Wheelchair Tariff project.
Points 1-4 were agreed by the Collaborative Performance Committee with an additional note that during the contracting round, providers should be informed that notice may be given to the assessment and prescribing services in 2015/6.
Next Steps
- Embed the new robust project structure and governance (see appendix 1).
- Identify clinical lead and patient representation.
- Seek feedback from Harrow and Hillingdon regarding decision to proceed with integrated procurement
- Undertake service redesign
The outcome of the above will determine how we will proceed. A report will be submitted to the Collaboration Operations Group and the Brent and Barnet Executive Committees to establish whether or not to commence with the procurement of an integrated or separate AR and Assessment & Prescribing service. From thereon in, the following will occur:
- Build and test robust financial and commercial model.
- Develop robust Business Case
- Engage fully across all 7 collaborative CCG’s to deliver an agreed specification.
- Pass through all necessary CCG governance structures
- Generate the procurement documentation ready for issue
- Draft Contract with robust quality, information and financial metrics
Proposed Overall Programme Timescales
Task / Timeframe / Delivery DateShort Term
Develop Contract Monitoring Framework / 4 months / December-March 2015
Develop consistent approach to performance management of assessment and prescribing services. / 3 months / January-March 2015
Mid Term
Service Redesign / 3 months / January March 2015
BC/Service Specification / 1 month / April 2015
Prepare procurement documentation / 1 month / May 2015
Draft Contract / 1 month / May 2015
Commence procurement / 2 months* / June – July 2015
Contract award & 10 day standstill / 2 weeks / August 2015
Mobilisation period / 3 months / September- November 2015
Service commencement / N/A / 1 December 2015
LongTerm
Transition to NHSE Tariff** / 4 months / December-March 2016
*Compressed Restricted Model