Adult Community Services

Caroline Dinenage Excerpts

Wednesday 26th June 2019 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your stewardship, Mr Gapes. I thank the hon. Member for Bristol South (Karin Smyth) for securing this debate. She spoke passionately on behalf of her constituents. It is right to bring such concerns to this forum. She asked the questions that any good MP should ask, and she has the right concerns. She spoke strongly about valued local services that no one wants to see lost, such as her Healthier Together service, and said that she fears for their future. I hope that some of the things I shall say will allay her fears, but if I do not cover anything she mentioned, we shall write to her to give her as comprehensive a response as possible.

Community services play a vital role, but we have perhaps not emphasised them as much as we should have done in recent years and decades, so we must put that right. Effective community services mean that patients are treated where they are most comfortable—often their own home—and supported to manage their conditions and live independently. More widely, they are key to improving the patient experience. They provide preventative care and prevent people’s illnesses and ailments from getting worse. Crucially, they prevent reliance on the big acute hospitals.

The NHS long-term plan sets out our vision for community services. It highlights the need to move away from small, narrowly defined and often poorly co-ordinated community services to those which are more joined-up and operate over a larger footprint. It also encourages much longer commissioning times, to enable us to build the relationships that we want to continue to establish. Importantly, it will make it easier for patients to navigate the system without having to repeat their story multiple times, and will ensure that their care is delivered in a smoother, more timely manner. To help to deliver on that vision, as part of the extra investment in the NHS long-term plan, an extra £4.5 billion per year will be spent on primary medical and community health services by 2023-24.

That is why ideas such as this, from local areas such as Bristol, North Somerset and South Gloucestershire, which embed community services as a central component of their plan in a way that mirrors the vision of the NHS long-term plan, appear very attractive. By awarding all its adult community services in a single contract, we can see that the CCG is aiming to promote a cohesive, integrated approach, which will improve consistency and efficiency across its entire geography.

The CCG’s 10-year funding approach also reflects the NHS long-term plan and will enable transformative change, through the kind of long-term relationships we need, based around strong, collaborative partnerships across not only the health and care system, but also the third sector, which the hon. Lady mentioned and which plays such a crucial part in the delivery of some of our most vital community services. We think that the length of the contract will allow the local area to design its services not only for the current need, but to address the future needs of its population, while also giving greater certainty to the workforce.

Additionally, the plans contain key commitments on community services set out in the NHS long-term plan. These include delivering care through multidisciplinary teams, the deployment of rapid response teams and providing services in central hubs located in people’s communities, where they can get the holistic support that will enable them to stay healthy and well.

We think that all those things will ensure that patients receive timely, integrated and holistic care in their community, with a greater focus on treating the whole person rather than merely their condition. This approach will join everything together, so that people no longer slip through the gaps or get pushed from pillar to post or from A to B, and it will provide a one-stop shop where people have a named contact and a real integration of community, mental health and adult social care services and the third sector.

The hon. Lady spoke with great passion and knowledge about the importance of transparency and engagement when deciding service provision, something that of course I entirely agree with. At the same time, it is right that these decisions are made by local areas, such as CCGs, local authorities, sustainability and transformation partnerships or integrated care systems, because those people decide how services should be configured to meet the needs of their local area. When they do so, we have clear expectations of them: they must involve patients, carers and the public in decisions about the services they commission, and be clear and transparent about their decisions.

That could be where we appear to have a difference of opinion between how the hon. Lady feels that her CCG has communicated and the way the CCG feels that it has. I have spoken at length to the director of commissioning and the chief executive, who say that in this particular case they have made considerable efforts to meet those expectations. They report that they engaged with 500 local people, including health and care professionals and representatives from the third sector, and that patients and carers have been supported to engage with the process through a public reference group, which I know she mentioned.

Additionally, the CCG says that it has engaged with a range of organisations and partners from across the local system, including hospital and mental health trusts as well as local authorities, to better inform the contract process. Those organisations have met bidders for the contract to discuss service provision. The CCG says that that collaborative process will help the contract holders to build relationships and allow patients to receive integrated services, which is what we all want.

The CCG also says that it has taken steps to ensure a transparent process, including press releases, letters to stakeholders, engagement events and making key information available online. Additionally, the CCG reports that the procurement is being overseen by a programme board that includes patient and carer representatives.

The hon. Lady made the point that it might be premature to go out for tender while the NHS long-term plan’s proposals for amending procurement requirements are being considered. That is a very good point, but unfortunately considerations around legislative changes do not change the CCG’s duty to comply with current procurement law, nor do they change its duty to use its resources as efficiently and effectively as it can.

The CCG has agreed that if the legislation changes during the procurement process it will review and evaluate that process, but more widely, by law it must ensure that there is no gap in access to services. Its contracts for adult community services will expire in the coming years, and by law cannot be extended. The CCG has informed me that if the procurement was halted, it would create the risk that when the current contracts expired, local people would be left without vital community services, which the hon. Lady knows they rely on. Of course, that simply cannot happen.

The hon. Lady also rightly noted that we must ensure that contracts are given the necessary external support and scrutiny. To that end, NHS England’s and NHS Improvement’s integrated support and assurance process—for which we use another of those attractive acronyms, ISAP—provides a co-ordinated, consistent approach to reviewing complex contracts, which is intended to ensure that complex contracts are cost-effective, robust and in the interests of patients.

On 17 October, NHS England and NHS Improvement held an early engagement meeting with the CCG, where they discussed this contract under ISAP. Following that meeting, NHS England and NHS Improvement were assured of the need to have a single contract that runs for 10 years. A full ISAP process is triggered when a procurement is found to be sufficiently novel and complex. NHS England and NHS Improvement found that in this case these requirements were not met, meaning that the full ISAP process was not required. Instead, NHS England and NHS Improvement regional teams will provide assurance that is informed by ISAP principles, which will include ensuring that the contract provides value for money, that it is centred around patient care and, crucially, that some of the key parts of patient care that the hon. Lady spoke about are not lost. The regional teams must also jointly ensure that the correct processes are followed, and that any chosen provider has the capacity and capability to deliver the services set out in the contract. Importantly, the regional teams must then give further formal, joint approval before the CCG can award a contract.

With that in mind, scrutiny of how we award contracts for delivery of health services is clearly vital. We must be assured that due care is taken so that patient outcomes are absolutely first and foremost, and that services are organised and delivered with prudent financial planning. To that end, NHS England and NHS Improvement will continue to closely monitor this contracting process. I welcome the close attention that the hon. Lady has paid to this contract; I know she has looked at it very thoroughly and I am grateful that she has raised her concerns. We believe that the CCG’s approach in this case is right, but we will continue to engage in every way possible with all parties to help ensure its successful delivery.

Question put and agreed to.