Cambs CCG gives £800m contract to NHS bidder. Should we all be cheering?

There seems to be general relief that the huge £800m contract which Cambridgeshire and Peterborough CCG have given for integrated care of the elderly hasn’t gone to the private sector. Two of the three final bidders were commercial organisations, but the contract has gone to an alliance between the local teaching hospital, Addenbrooke’s, and the local mental health trust. So should we all be rejoicing?

Well, maybe. The concern about the private sector was that it was out for commercial profit and that the NHS would fail to get value for money. The concern that people will have about the successful bidder (and the acute hospital partner in particular) is that it doesn’t have a strong track record of working with the community. Indeed in a conversation I had with a senior hospital manager a while ago, it was clear that old ladies who’d fallen and broken their hips were regarded as rather a distraction from the hospital being able to get on and provide top quality tertiary care (which it generally does very well despite only recently having come out of special measures with Monitor). Further evidence of how inward looking this hospital is comes from their recent purchase of a £200m electronic medical record system which doesn’t integrate with GP records – not a great start for a hospital which now says it’s going to be at the centre of providing fully integrated care.

So a lot is going to rest on how effectively the CCG can monitor the contract to provide integrated care for older people across acute, primary and community settings. The CCG has put into place an extremely challenging set of performance measures which will tax the new provider organisation. These include detailed patient experience checks across all sectors, measures of joined up working, putting in services to reduce hospital admissions, and providing services to support patients when they are discharged from hospital.

A lot will depend on how effectively the CCG can police the contract. Addenbrooke’s is financially stretched (financial viability was one of the reasons for it being in special measures until recently), and the CCG must make sure that this £800m isn’t simply used to shore up acute services. The goal, however, is a really exciting one. Many of the world’s best healthcare systems (e.g. Kaiser Permanente, Group Health) are vertically integrated (i.e. include both hospital and community care) and this has always been a challenge in the NHS with its purchaser-provider split. Cambridgeshire and Peterborough CCG has an ambitious vision to bring these sectors together, currently unmatched anywhere else in the English NHS. All eyes will be on how well they succeed.

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