Quizzical decision making

25 June 2017 by Petra Erving

I haven’t written my blog for sometime, due to huge changes that have taken place recently. My time has been somewhat taken up stressing about the future of my clinic. In mid April I received a telephone call from the service manager in an NHS clinic I was being referred patients from, informing me that in a mere 6 weeks, they would no longer be funding treatment for my NHS lymphoedema patients. As you might imagine I was shocked. Firstly, the short notice completely threw me as they had always promised at least 3 months notice. Secondly, I worried about the future treatment of my patients, for whom I had developed a high quality and effective service for over the past 2 years.

I contacted the CCG - the Clinical Commissioning Group - who are responsible for commissioning services, to see what the plan was going forward. Who would now supply the service? Would I continue to provide treatment to this group of patients and simply invoice the CCG directly? I told the Director of Strategy and Commissioning that I was putting a Service Specification and Business Case together to apply to be commissioned directly and would have it with them by mid May. This lady expressed absolutely no interest in my Business Case, nor did she request that I forward it for consideration. I believed that once you expressed an interest and and intention to supply a business case, that the CCG HAD to consider it. This is in NHS procurement rules. However, it seems that things in my local CCG’s don’t quite run the way we expect. I simply received an email saying that ‘we already commission a service in …… and would like that relationship to continue’ and that should prepare to transfer my caseload of 214 patients over to them. I rang the place where the CCG were intending the new service to be based and spoke to the Director of Nursing and Patient Care. She had no idea what I was talking about. She said the CCG had approached them to take over the care of a few patients from another service, but that there had been no mention of them taking a caseload of 214! Apart from anything else, they only have one therapist who already has a full caseload and they simply don’t have the capacity to take on my patients. However, when we met the following week, she did admit that she had been asked by the CCG to put a business case together with a view to taking over my patients. It became clear during our meeting that the CCG did not in fact, commission the service there. They are a charity and so any lymphoedema treatment that has been provided in the past, has been covered by the charity, not the NHS. Sneaky things were going on right under my nose.

I wrote to the Chairman of the 3 CCG’s in my area, who are covered by the same Director of Strategy and Commissioning, expressing my concern to the procurement process. There had in my eyes been no transparency, no equality. According to procurement regulations, if a service value is a certain amount i.e.: in excess of 80,000 Euros, then the contract should go out to tender. The CCG claim that the annual expenditure for the year 2016/2017 fell below that figure and so they could waiver the tender process. Well, I’m not sure where they got their figures from but it wasn’t me. My figures are well above the tender threshold - which warrants putting the service out to tender. Now, bear in mind the CCG were not interested in reviewing my business case. One of the regulations states that if the CCG intends commissioning a service that they should make a public notice of their intention. There was no notice given, because once again, they claimed that the annual income fell below the threshold and so they didn’t have to announce it. I wrote to the Director of Strategy and Commissioning asking her to clarify where she got the figures from and to what part of the regulations was she referring to, constituting a single tender waiver. In fact I wrote to her twice because the first time she didn’t respond. It took 2 weeks for her to reply. I wonder was she trying to find a loophole to prove that what she was doing was legal? It seemed extremely odd to me that she didn’t delay any communication when she was informing me of her decision, however when I asked her to qualify her decision and her reason for it, it took 2 weeks. Hmmmmm - the mind boggles. Oddly enough, when I did get a response, the rules she initially referred to and quoted had changed to different rules and suddenly there was a ‘grant fund’ which had never been mentioned before. It seems the hole was found to fit the peg, not the other way around.

Despite the fact I have been providing an effective service to this group of patients for nearly 2 years, and have achieved some excellent outcomes, I have documentation to prove my outcomes, both quantitative and qualitative, I have some fantastic testimonials from patients, I have the results of a survey saying 96% of patients would recommend my service to friends and family (this is a test the NHS do to rate the effectiveness of a service) the CCG have had no communication with me a to the level of service I am providing. They’ve shown no interest in how beneficial my service has been to patients. A number of patients have written to both the Chairman and this lady in the CCG expressing their concern and their wish to continue having their treatment with me, it has fallen on deaf ears. The CCG have gone ahead an commissioned a service that at this moment cannot provide a service to 214 patients. The ‘new service’ provider asked me if I would like to run their new service - how bonkers is that - because they recognise that I have been providing excellent care to these patients. They are currently advertising to recruit a Team Leader to run their service. It is worth mentioning that I was being referred all these patients by the first NHS clinic because they couldn’t replace their lymphoedema nurse who retired. That was 2 years ago. And until the end of August I am being sub-contracted the the current commissioned provider to ease the transition of patients over to them. So, it remains to be seen if they will be successful in recruiting a Team Leader to run this new service.

It seems extremely odd to me that the CCG would commission a service when the new service provider haven’t got anything valid in place and there is already an effective, high standard service already in place - me and my clinic, a service I have been providing the service for the past 2 years. The past 2 years have been an education on developing an effective and efficient service. The past 8 weeks have been an eye opener on how the NHS and CCG operate behind the scenes. I have been trampled over by a giant and because I am a small business I have no recourse. Even though my solicitor agrees with me, it would be too costly to do anything about it. And, as she says, in the long run is it going to benefit it to have my name blackened? So, I just have to sit tight and watch all my hard work with these patients go down the drain. However, after 6 weeks of being incredibly angry about it, panicking about the future of my clinic, and my income, I have to be positive and believe that everything happens for a reason. My initial intention was to set up an independent clinic and over the past 2 years I have become distracted my NHS work. I have to start at the beginning. Start promoting myself - again. So, letters have been written, beautiful new brochures printed and sent out. I now have to organise meetings - some are already arranged and keep thinking that everything will be ok. But, it’s very difficult to keep positive when in reality in September, I could have a minimal income. Thank god for the unending support of Jason and my mum, and my amazing new accountant Sarah. Sarah has been a godsend and is keeping me buoyed up with positivity and good ideas. In times like this, you really do need a good support circle.

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