Is Service Commissioning the Solution for Cost-Effective Quality Public Services?

By Allan Watton on

DispatchesI am always on the lookout for mentions of service commissioning in the media, and at the end of last month I sat down to watch a Dispatches special, Getting Rich on the NHS. The programme highlighted Virgin’s involvement in public healthcare further to their purchase of Assura Medical a couple of years ago.

In the programme, Morland Sanders paints a dim view of Virgin’s performance to date, backed up by various interviews with patients along with evidence of apparent breaches of contract. One of the key focuses of the programme is the clash of a profit culture against what should be the overriding priority (quality healthcare) — something that has been debated ever since Virgin purchased Assura Medical in 2010.

Sanders leaves us with more questions than answers, but it would perhaps seem clear to any layman that the programme indicates Virgin’s involvement in healthcare is not in the best interests of patients. And by extension, the very concept of service commissioning as a viable solution to cutting costs and improving efficiency of service in the NHS is under attack. With that in mind, we are left with one big question: can service commissioning still succeed in healthcare?

Virgin’s Apparent Failure in Healthcare

VirginThere are few people in the UK who haven’t heard of Virgin. From music, to planes, to trains and mobile phones, Sir Richard Branson has built up one of the most well-known conglomerates in the world. It is far more associated with the allure of international travel and cutting-edge technology than it is with the rather unglamorous world of public healthcare.

It would be reasonable to state that as any business, it is profit-driven. That is generally not considered a bad thing, unless are you are against the very concept of capitalism. But many people (quite reasonably) feel rather uncomfortable with a profit-driven company taking responsibility for their health. The NHS is something that many people in the UK value highly, and many of us fear a transition to a healthcare system more resembling the American culture led by lobbyists and powerful pharmaceutical companies.

As previously alluded to, at the heart of the issue surrounding Virgin’s involvement in healthcare is the culture clash between a profit-driven business and a healthcare system that prides itself on quality patient care. This is highlighted at various points during the Dispatches special, in which Sanders interviews various patients who have suffered at the hand of Virgin’s apparent impotence. These interviews are backed up by various apparent breaches of contract, such as:

  • Original promises of service improvements (such as extended opening hours) not being fulfilled
  • Woeful understaffing issues and an overt reliance upon locum doctors
  • Misrepresentation of available staff

In one particularly memorable section of the programme, Sanders revealed that managers working for Virgin had apparently sought to artificially inflate chlamydia testing numbers (in order to avoid fines) by asking staff members to hand out test kits to their friends and family members.

Is Service Commissioning the Problem?

Although the programme presents what seems to be a fairly one-sided argument, it would be difficult to defend Virgin’s performance based on the evidence that the programme presented. It is highlighting what apparently amounts to a widespread failure to perform. Even if you strip away the somewhat subjective arguments of individual interviewees, we are left with various evidenced instances of material shortcomings in service delivery.

Is the NHS culpable for Virgin’s apparent failings?

But on the assumption that Virgin is failing to meet its promises, the issue is less with service commissioning per se, and more with the administration of the service commissioning contract. A well written and administered contract would have measures in place to combat blatant failures to meet quantifiable and measurable goals.

Whilst pointing fingers doesn’t help, one has to ask whether there is an element of responsibility that falls to the NHS side for inadequate measurement and management of the contract as there is with Virgin failing to provide strong healthcare services. As much as Virgin has a duty to perform as promised, the NHS has a duty to the taxpayer to ensure that services are commissioned and administered responsibly and effectively. Based upon the Dispatches special, there are clear questions on both fronts.

In Conclusion

A proportion of Virgin’s patients are clearly unhappy, and based upon the interviews I saw as part of the Dispatches special, you can see why. Having said that, Virgin claims that they are performing adequately (and perhaps even optimally).

Either way, Virgin’s performance doesn’t define service commissioning’s worth as a system of boosting service quality and cutting costs, as some would have you believe. The onus lies upon the expert provider (Virgin) to perform as promised — if they do not, the blame can be laid upon the commissioning party for failing to make desired outcomes clear, the provider for failing to deliver on its promises, or on both parties.

Competent tendering, procurement and contract administration can result in the fulfillment of Virgin’s original promises (and in fairness, they may well be delivering on those promises overall). There are culture clash issues in all forms of service commissioning, but they are not insurmountable. Cultures can be aligned, and private involvement in public services can result in all of the desired benefits, when executed ably.