While there is little sign of any activity in the public domain, the establishment of Integrated Care Systems is likely to result in significant changes being pushed through behind the scenes, due to new funding arrangements and the pressure to increase spending on private sector management consultants, data and digital providers.

The new funding system which will run to the end of the financial year allocates funds at “system” level, and requires providers and clinical commissioning groups (CCGs) to “achieve financial balance within their ICS/STP envelope.” However individual organisations within each system may record a deficit “dependent on mutual agreement within their systems”.

The pressure to bring in more private contractors and consultants is linked to the ‘Health Systems Support Framework’ (HSSF) established by NHS England, which facilitates swifter and wider use of the private sector to help steer ICSs, and direct them in how to spend the funding allocated.

Some elements of the HSSF were re-tendered last year by NHS England as a 4-year £700 million framework contract, which was explained as a means to help establish ICSs:

“The Health Systems Support Framework (HSSF) was established to provide a mechanism for ICS and other health and social care organisations to access the support and services they need to transform how they deliver care. It focuses on specialist solutions that enable the digitisation of services and the use of data to drive proactive population health management approaches across Primary Care Networks (PCNs) and integrated provider teams.”

The HSSF is around 80 firms, around two dozen of which are US based and follows on from the management consultancy framework contract, put in place by NHS Shared Business Services back in 2018. It involved 107 companies and included the “Big Four” (PwC, Deloitte, EY and KPMG) along with the top three strategy firms (McKinsey, Bain and Boston Consulting Company) as well as “a number of boutique firms”. The framework selected companies that were pre-approved for work on ten different “lots.” Consultancy.uk reported:

“As well as reducing costs, these frameworks can also streamline and harmonise the hiring processes across NHS bodies – as lengthy tender processes are reduced by having a list of preferred suppliers in place – and across the full spectrum of operations, covering everything from audit services and construction consultancy to catering, facilities and management consulting.”

On September 8 NHS England published a Contract Notice advertising an additional contract worth up to £30million for ‘Health Systems Support Framework — Workforce Deployment Solutions as part of the HSSF’, noting that:

“NHS England and Improvement have determined a requirement to expand the scope of the HSSF in order to provide access to workforce and HR solutions which can help to deliver the NHS Long Term Plan and NHS People Plan. As such we are developing a new workforce service category and, under this procurement, are opening up the HSSF to bids from suppliers of eRostering, job planning and temporary staffing software solutions.”

One ICS which clearly displays the extent to which it is being taken over by costly management consultants is Bedfordshire, Luton and Milton Keynes (BLMK), where the lucky winners of seemingly endless consultancy work are Carnall Farrar,

The BLMK ICS Partnership Board papers from September show their determination to press through with the merger of CCGs into a single CCG covering the ICS area, despite (as reported in Lowdown last month) the clearly stated opposition of three of the four local authorities at the July meeting.

Carnall Farrar are determined that the merger should forge ahead regardless and the September papers include a shameless “BLMK CCG Merger – Update” which makes clear that not only is the bid being submitted at the end of September, but before NHS England rubber stamps  the plan, Carnall Farrar will begin working on the next stage:

“Our OD programme is designed to start work developing the BLMK CCG values in September/October…

“…Next steps on this work will be progressed with support from Carnall Farrar Sept-Oct 2020.”

So frequent are the references to Carnall Farrar that it’s unclear what role if any is being played by senior NHS management in the emerging BLMK ICS:

“As part of the Carnall Farrar work starting on 14 September we will work with ICS partners to identify commissioning activities and the associated resources that could transfer to partner organisations in the ICPs (tactical commissioning) as we implement strategic commissioning in due course. It is expected therefore that the BLMK CCG will reduce in size over time as we implement the co-designed Target Operating Model for the strategic commissioner.”

Expanding frameworks

In addition to an ever-increasing variety of “framework contracts” spanning ICSs, others are being set up by individual trusts.

In April this year consultancy.uk reported that over 50 consulting firms had “won a spot on a £200 million consultancy and advisory framework from the University Hospitals of Coventry and Warwickshire” – a trust with an annual income of around £600m.

“Over 70 consulting firms signed up for the competitive tender process, and following a due diligence on firm credentials and their bids, 57 consulting firms were appointed to the scheme across seven lots spanning management consulting, human resources, supply chain, finance, audit, digital transformation and property development.”

Another example is the NHS London Procurement Partnership (LPP) which set up a framework for contracting out Total Facilities Management, including fifteen different contract companies. North West Anglia Foundation Trust appears to have made use of the shortlist of approved contractors to conduct a mini competition for outsourcing catering and support services at Hinchingbrooke Hospital.

In August the private hospital sector was offered an unprecedented bonanza when NHS England published a new “open opportunity contract notice”, aimed at establishing a £10 billion framework agreement running up to December 2022 “for service providers capable of helping NHS trusts and services reduce waiting times”.

Meanwhile the government is lining up “hundreds of consultants” to help salvage its desperately poor and failing £10 billion privatised test and trace system – headed by Tory peer and ex McKinsey consultant Dido Harding.

Consultancy.uk reports: “The cost of the consulting services to the public purse are unclear at present, but any expense at all on such contracts is likely to come under fierce scrutiny, as the country’s biggest consulting firms have already picked up pay-cheques for work on many aspects of the UK’s Covid-19 response – including test-and-trace itself.”

It also points out that the expansion of NHS contracts is offering a lifeline to the consultancy business which has suffered a sharp drop of up to 18% in its income from other businesses during the Covid-19 crisis: “public sector consulting is one of the few areas where revenues continue to boom”.

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