NAO probing Capita's sickly £700m GP support gig Capita Business Services' shambolic £700m Primary Care Support contract with NHS England will at last be scrutinised by the National Audit Office amid “ongoing issues” with service delivery. The seven-year arrangement kicked off in September 2015 - with an option to extend it for three more years. Capita committed to provide …
Are they awarded such contracts because they have ex public service people among the execs or something?
Looking at their board, it appears not to any greater extent than any other large listed company. So we're seeking another reason why they keep on being awarded public sector work despite their excremental track record. Corruption would be the next most obvious line of enquiry, but I think that hugely unlikely - there might be the odd bad apples (as with any large company) but there's too much risk, penalties too great relative to the rewards for the directors.
Personally, I think it comes down to a mendacious sales effort, processes fully geared up to crap-headed public sector procurement bureaucracy, and the fact that Crapita will take on any public sector work, no matter how poorly specified, woefully defined, chaotically overseen. Any sane company would put a value on its own reputation and walk away from a lot of these deals, Crapita see these deals as simply an opportunity to gouge the client, because reputation doesn't count in future public sector procurement.
Correct.
In fact "poorly specified, woefully defined, chaotically overseen."
is perfect for their "business model."
Government, NHS, Police and Fire services will continue to be fertile ground for them to ply their trade until senior PHB develop much better procurement and PM skills, or hire permanent staff in house to do this.
Governments (in general but this one more than most) will prioritise cost over anything else. If Capita bid lower than anyone else, Capita wins. Simple as that. Factors such as "successful delivery of similar projects" will be in the mix, but not to the extent that a poor rating on that front trumps a low cost.
What you also have to consider is that as far as Capita is concerned, this might well be a hugely successful project. Sure the client is moaning but so what - if you're spending less delivering whatever service you are providing than you are earning from it, then you're in profit.
> So we're seeking another reason why they keep on being awarded public sector work despite their excremental track record.
It's simple: the 'r' in Crapita is both the service and what they promise to soak up. You never, ever hear of Capita executives complaining about the Government or ministers. And that's why they're successful again and again: ministers (and civil servants) know that, whatever happens, the crap stops with Capita.
Commissioning group (government) :
Specifies requirements
Pays bill
Expects to get hounds off their back and someone else to blame for problems.
Benefiting group (GPs, us)
Able to evaluate service against specifications
No input into specifications
No input into payment by results
Contracting group (Crapita, or any other commercial agency) :
Sells service to specifier
Attempts to satisfy payer's needs.
Intermediates (civil service) :
Accountable at a mass level to government (but in practice cannot be criticised)
Commissions contracting group for goverment but are not required to be transparent
So what's the problem ? No realtime feedback to close the loop. Failures have no consequences for the elements in power : the public will blame Crapita, who can ignore it because it doesn't affect their future performance. Same for the government. Civil service had the ability to choose a better contractor and monitor the results, but don't because failure has no consequence. Public suffer because they are powerless.
Those are requirements for an outsourcer like Crapita to make a profit. All those lovely change requests and consequent fees.
The initial tender is always low because they know they can pick up the profit on the CRs.
A "successful" Capita project depends upon which MP you have to con report to. So the Met Police pay and pensions contract is a roaring success, if you are the junior minister responsible for this. Otherwise the polite term "total cluster*ck" readily comes to mind.
Most outsourced contracts are regarded as a major success if over an extended period (usually well into the next administration's period of office) they have saved at least 1p below the original projected saving.
Apology to heroic Italians as far back as Horatius who held the bridge
Slight nitpick - he was *Roman*, not Italian. And would have been very, very offended if you had managed to speak ancient Latin and called him an Italian..
"Italy" was the part of the peninsula that contained non-Romans and other assorted rif-raf (Etruscans, Samnites, Sabines and Celts to name but a few) and were beneath the notice of a well-brought up Roman (unless he was pillaging them of course).
Tories want to break the NHS
I doubt that. The NHS is the nearest thing this country has to an official religion. The problem they have, like the preceding Labour administrations is that the concept of the NHS as free, universal health care is unaffordable given the increases in population, life expectancy, and treatment options. No matter how much the NHS is given, there's always new expensive drug treatments, new diagnostic capabilities, new therapies that cost even more. And if they work, they often compound the problem of rising life expectancy.
If you go back to the roots of the NHS, the socialists who devised it never saw it as some universal, all-providing, all-consuming health service, it was a safety net for those who couldn't afford to pay for access to health care, back in the days of very limited treatment options, and when life expectancy of men was 66.
Anyway, enough of trying to use logic, you shuffle back to the Socialist Worker comment forums, you'll feel at home there.
We manage it just fine here in Scotland where our NHS is the best performing in the UK despite our older, sicker population. How come? by not privatising, not outsourcing and not wasting money on unnecessary been counters with an internal market. Yup, not even an internal market.
The last was the doings of a decent Labour man Mr Malcolm Chisholm, possibly the last decent Scottish Labour cabinet office holder. The rest are thanks to the SNP which removed the small scale privatisations put in by the last Lib/Lab coalition which was booted out in 2007. That included buying back the day surgery hospital Stracathro outside Brechin in Angus.
IF you ever wonder how a party which has been in power in Scotland for 10 years continues to have doubled digit leads over its nearest rival in the opinion polls their stewardship of the Scottish NHS is a large part of it. For a lot of that time a certain Nicola Sturgeon was Health Minister.
I'm too healthy to need to very often but I can usually get a Dr's appointment same day if needed though you have to start phoning at 08:00 and be in genuine need. Ongoing appointments can be booked at the desk after your initial appointment if so directed. They will take blood, do ECGs, handle wounds etc down there.
Interesting. And it does prod me to wonder how much of the drive to outsource to the likes of Crapita, or PFI contracts and so forth is really about a lobby group who think that everything ought to be a business opportunity, rather than a public service. So our schools must be run by academy "chains", not the elected local authority. Our libraries have to be closed, because they let people read books for free, instead of getting them off Amazon. Our forensic labs outsourced to private laboratories and our hospitals should, if not owned by PFI holders, at least outsource as much as possible to private catering and cleaning companies and even clinics.
The problem is that social ownership means that there is normally some degree of commitment to the users. School cooks and cleaners will, more often that not (nothing is guaranteed) do the extra bits that need doing out of a sense of belonging (especially if there's half decent management) and caring. A contract cleaner or caterer just delivers what's in the contract. And often has such tight working schedules and low pay ( think care workers who don't get paid for the time between clients) that they can't do more than the basic minimum even if they have the will to.
"We manage it just fine here in Scotland where our NHS is the best performing in the UK"
And the population of Scotland vs the rest of the UK is what 5 million people? Certain things work at different scales. Plus, the NHS has been mis-managed for a very long time by both main parties. As has been said elsewhere, what is needed is a grown up, non political free ranging discussion on exactly what the NHS should be doing vs how we are going to pay for it. Certain treatments may not be viable long term or will require patient contribution.
The NHS is the nearest thing this country has to an official religion
The real problem is the expectation that the NHS provides everything for free! Things that were never envisioned in the original setup such as sex changes, IVF and non-emergency plastic surgery. Yet these are expected to be free, although I note IVF treatment is free only under certain conditions and is limited to 3 cycles LINK .
Health should never be treated as a cash cow and a, supposedly, first world country like the UK should be able to provide properly for it's citizens. National Insurance contributions were supposed to do this but this seems either to be insufficient or is not being used for the intended target.
Whilst keeping the basic stuff free necessary drugs, surgeries etc., we should look to charge for everything else. Other countries seem to have found a way to have a functioning system so perhaps we should look at their methods and see what might work here.
Perhaps the government should start with this article: How European nations run national health service
1) Crapita was misserving the NHS under a Labour government when I was working for the NHS. Was Labour trying to kill the NHS?
The biggest problem that the NHS has is that it's a political football where people are convinced to say "this is only a problem because party $A is in power! If party $B was in power then they'd fix our NHS!11!. Both parties do this equally.
If either party had the balls, they'd admit that:-
1) This is not the case
and;
2) Neither parties are capable of sensibly having the required discussions about the future of the NHS.
That discussion should go something like this:-
Funding per is a problem, but perhaps not THE problem. The percentage of government spending spent on the NHS in 1955 was 11%. This year, it's 30%. If you doubled that percentage to 60% of government spending, then the problem would vanish for a few years, and only to reappear with a vengence.
This is because truthfully, more and more people who are chronicly ill survive on the basis of increasingly expensive ongoing medical interventions. Meanwhile, more and more people go to uni, then start a career, buy a house, find a partner later in life and then discover that they aren't very fertile in their late 30's, requiring services such as IVF on the NHS, and basically we can't afford to do everything on the NHS.
IMO: Realistically the NHS needs three budgets. One for emergency treatment (ie, ambulances, A&E etc), another for quality of life enhancements (IVF, etc) and another for end of life extensions on medication, and treatments in each area need to be limited to our ability to afford them.
At the moment there is a situation where we say "a treatment is available and therefore it is available on the NHS". In the long term, this is unviable. Allowing this simply means that spending limitation is applied arbitarily by one area overspending and another having spending limited in response. ie; end of life medication and quality of life enhancements overspend relative to their fair share of the budget, and as a result A&E can't afford enough staff to adequately staff A&E and so people die there instead.
Of course, the first political party to point this out will get torn apart by the other for political gain, so the existing system will continue until it completely collapses.
IMO.
Whilst a lot of what you say is fair, "a treatment is available and therefore it is available on the NHS" - is not the case. While the National Institute for Health and Care Excellence (NICE) do approve a lot of treatments, there are many that don't make the cut. The main purpose of this body is to ration treatments according to it's cost effectiveness. Sounds blunt when applied to human lives but we have to accept that we do not have limitless resources.
The way I see it is if we all took more responsibility for ourselves, it would ease a huge burden on the NHS. Preventable disease takes a huge chunk of the NHS budget each year.
>if we all took more responsibility for ourselves, it would ease a huge burden on the NHS<
Most healthcare is a luxury not a money saver. If we recognised this we could have a sensible conversation about funding. Instead we remainl caught in the delusion at the outset of the NHS in 1948 - that it would get cheaper after a few years because everyone would be cured, fitter and economically productive.
Consider it was cheaper for the TaxPayer/Government when more people smoked like troopers, paid National Insurance and tobacco duty all their lives and then obligingly croaked with heart attacks or lung cancer before drawing their state pensions.
What's killing the NHS (other than rising expectations and more expensive treatment options) is people surviving longer with treatments for long term conditions - which (now) take a very long time to finish you off. I'd argue that's a great thing. However it's not saving money. It's a luxury - and we can choose how much of it we spend on it.
If great healthcare saved money you'd find some of the best healthcare systems in the poorest countries.
Consider we could cure or eliminate all cancers and heart disease - that would leave most everyone surviving to acquire senile dementias - which is the greatest social and economic health burden of all.
Preventable disease takes a huge chunk of the NHS budget each year.
This is true. However, there a plenty of people like me who have T2 diabetes[1] despite being reasonably active and having a BMI[2] smack dead in the middle of the ideal zone. In my case, it's the result of having the bad sense to have a mother who comes from a family with a long history of early-onset T2 diabetes and the additional bad sense to have had a very, very stressful job that finally tipped me over the brink.
Sadly though, I get classified in the same bucket as people who eat 10,000 KCal a day and never, never exercise and them complaim when they get diabetes. One nurse, on being told that I was T2 didn't believe it on the basis of "you are not fat". And if the medical professionals are not taught that other things can cause it, what hope do the lay public have.
Rant over..
[1] To be fair, the BBC now prepend a "usually" on their linking of diabetes to lifestyle..
[2] For all the use that measure is. About as much use as a ruler that only measures to the closest 10cm..
Bid low to provide a service that is only the surface of what is really going on. Provide the service as specified for the lowest cost they can get away with. Then claim that they've done their job- which they have within the letter of the contract. And since they don't care about the public/tax payers/patients/vulnerable people, only their bottom line, they're perfectly correct.
The big problem isn’t anyone taking backhanders it’s the crap procurement rules that we in the public service have to abide by.
‘Oh they gave you a crap service on a previous contract?’ Sorry you can’t take that into account when scoring the tender.... no prior knowledge allowed.
Capita help government bodies "save" on pension commitments to Civil Servants. Capita then try to run the service using staff who've been motivated by abandonment, with leadership from process driven management. Along the line Capita extracts a profit for their shareholders on a service priced lower than the original service.
You end up with the lowest cost workforce with no loyalty to the "customer" whose motivation is meeting short term internal Capita targets. To plaster over the cracks in service Capita wheel out Relationship Managers whose task is to reduce client complaint to an acceptable level.
Small wonder that the GP private partnerships are discovering a few service gaps.
Into what part of current politicians' brains enables them to believe that Capita can provide adequate IT systems despite a long track record of failure because they're the cheapest bids, but at the same time doesn't enable them to believe that walking off a tall building will enable them to fly.
Fix that and we'll save a lot of money, one way or the other.
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