Below: my original questions to Warwickshire County Council (sent July 31st 2019) and WCC reply (August 15th, replies in italics).
As you will see, there are no direct replies to my questions as to scoring and why Compass was awarded the contract, and not South Warwickshire Foundation Trust. I am referred to 4 documents, none of which answer my questions.
Ms Anna Pollert
South Warwickshire Keep our NHS Public
Telephone 01926 418633
Please ask for Jonathan Sheward
Our ref: 4750552 Your ref: Date: 15 August 2019
Dear Ms Pollert,
Freedom of Information Act 2000
Your request for information has been considered by Warwickshire County Council under the Freedom of Information Act 2000.
You asked us:
I would like to make a Freedom of Information Request to Public Health,
Warwickshire County Council, regarding the tendering of the Warwickshire
School Health Service, and the awarding of the contract to Compass.
Please could you provide information on:
The scoring for:
a) Digital capability and how this is measured
b) Access to nursing services by children
c) Integration of school nursing services with other services, e.g. health visitors and social services.
d) Health outcomes of services
e) Competence (and how this is assessed)
Please see answer to q3 below.
Please could you provide me with information on the weighting of the score
Please see answer to q3 below.
Please could you provide me with information on how the scoring criteria were
In answer to questions 1,2 and 3, please see the following documents attached to our covering e-mail:
i) Invitation to tender
ii) Service specification
iii) Heath Needs Assessment of School Aged Children in Warwickshire and School
Health & Wellbeing Service Review (Update 2018)
iv) 2017/18 Compass Annual Report
4.Please could you provide me with the performance targets provided to Compass in its contract, whether these were achieved, and the score (% or whatever method WCC Public Health assessment was used).
A detailed service evaluation and audit against the Healthy Child Programme was undertaken as part of the Needs Assessment provided in response to Q1. Appendices 1 and 2 demonstrate the overall performance, including the associated targets.
Please could you provide me with information on the length of the contract to Compass.
The Initial contract term is 3 years with further options to extend for periods up to 3 years (up to 31st October 2025) and further option to extend for up to 3 years (up to 31st October 2028) being the maximum available extension periods at the discretion of the Council based on the contract performance of the successful applicant.
Please could you provide me with the value of the contract in £s.
Total contract value is £20,721,645 over 9 years.
Please could you explain why the evaluation team was not keen to integrate school nursing services with SWFT’s wider hospital and community pediatric service portfolio, especially health visiting. This question is based on SWFT’s CE’S report, which states, from formal feedback, that ‘Our bid focussed quite heavily on the potential to closer integrate the service with our existing Health Visiting service across the County as well as our wider hospital and community paediatric service portfolio. But it became clear that this approach reduced the attractiveness of our bid as the evaluation team were keen not to integrate this service, particularly with health visiting’.
This is not an accurate reflection of the feedback provided following the contract award, therefore we are unable to respond to this question.
Please could you explain whether SWFT’s contract for school nursing in Coventry and Solihull was considered in its bid to WCC, and if so, whether its performance was assessed and how.
Bidders were invited to use examples from existing contracts within their tender
response (see the Invitation to Tender). Please contact SWFT if you wish to request
further information from their response.
If you are dissatisfied with the handling of your request, you have the right to ask for an internal review. Internal review requests should be submitted within 40 days of the date of receipt of the response to your original letter and should be addressed to:
Insider tales and must-read analysis on how integration is reshaping health and care systems, NHS providers, primary care, and commissioning. This week by mental health correspondent Rebecca Thomas.
This month we had the return of the integrated care provider contract.
In theory, this should be a big deal for NHS policy, but with just one area likely to be using the contract in the near future, the relevance of it is somewhat hypothetical.
Regardless, there are a few things worthy of note in the most recent iteration.
First is the omission of a previous rule that prevented an integrated care provider from holding more than one ICP contract at a time. This omission means, in theory, that a provider could hold an ICP contract across two sustainability and transformation partnerships, if it had GP partners in both areas.
In reality, this is unlikely to happen now the contract cannot be handed to a private provider.
The integration specific requirements for fledgling ICPs are also interesting.
Any provider, for example, will have to have information systems and data sharing agreements that allow it to understand and analyse the health needs of its population, and identify, for instance, which members of its population are at risk of developing certain diseases. The providers must also “use all reasonable endeavours” to offer patients alternatives to face-to-face contact, creating opportunities for the likes of Babylon.
Some areas are already on their way to achieving both these requirements, but having it within a contract would be an additional push.
The big question on everyone’s lips when NHS England first revealed its ambitions for this contract was whether it would end the purchaser/provider split.
The answer appears to be ‘not really’, as there’s nothing within the final version of the contract which suggests commissioners will be able to completely transfer their statutory roles.
For example, before subcontracting a service, an ICP would still need to gain commissioner permission.
Although the contract will give providers a greater say in commissioning decisions and budgeting, those hoping the final version would spell the undoing of the Lansley reforms will be disappointed.
If they do get off the ground, ICPs will be handed big budget multiyear contracts.
The contract size will vary depending on how many GP practices agree to include their contracts and the extent to which social care is involved.
The details around how the non-core GP elements of the contract should be costed are vague and non-prescriptive. The baseline calculations are a mixture of historical activity, demographic modelling, benchmarking activity trends etc, but will need to allow for future flexibility.
Those thinking about either commissioning or providing will want to weigh up where the financial risk sits.
Clinical commissioning groups will bear the risk of changes in population size and demographic, although this is, in theory, addressed by their yearly allocations.
The ICP, on the other hand, will bear the risk of:
activity changing – patients using services more or less frequently;
variation in patient usage patterns;
efficiency savings not realised; and
changes which impact the quality of care.
Is this contract required?
The likelihood of this contract becoming a mainstream vehicle for integrated care systems in the near future is low. While some areas are now starting to look into its use – Barking, for example – Dudley CCG is the only commissioner to have started a procurement process to use this contract.
As a reminder, these plans would effectively split the Dudley Group FT in two, with a new trust being formed around its community division. This new legal entity would then hold the ICP contract, allowing GPs to sit on the board.
Two thirds of GP partners believe primary care networks (PCNs) will fail to achieve key targets set by NHS England, which include stabilising the GP partnership model and easing pressure on the workforce, a GPonline survey shows.
Meanwhile, over half (55%) of all GPs who responded to the survey – 440 in total – said the networks would be unable to deliver on their core aims, which should be achieved by 2023/24.
Several survey respondents told GPonline they believed PCNs, which came into force in July, would dissuade GPs from becoming partners and create additional workload for GPs rather than reduce it.
The networks, which group neighbouring practices across populations of between 30,000-50,000 people, are intended to strengthen primary care services by encouraging practices to work together and share staff.
In June, NHS England’s national director for strategy and innovation Ian Dodge outlined five key ambitions he hoped PCNs would achieve:
stabilise the GP partnership model
dissolve the divide between primary and community care
help solve the capacity gap and improve skill-mix by growing the wider workforce by over 20,000 wholly additional staff
become a proven platform for further local NHS investment, including in premises
achieve clear quantified impact for patients and the wider NHS
However, a majority of GP partners in England – and a majority of GPs of all types – said PCNs would fail to achieve these targets, casting doubt over the impact of the latest NHS restructure.
Above all, partners believed PCNs would struggle to stabilise the GP partner model, with only one in 10 saying the new measures would be successful.
One GP partner said PCNs would ‘actively discourage’ young GPs from becoming partners; a sentiment echoed by a fellow partner, who labeled the changes ‘very disappointing’.
‘Initially when this was announced I was excited that it may lead to improved patient care. [But] already I feel that it is a mechanism to destabilise partnerships, increase the risk carried by GP partners and prevent new GPs from wishing to undertake partnerships,’ the partner said.
GPs were also not convinced that PCNs would help to solve the workforce gap and improve skill-mix by growing a wider workforce – another of NHS England’s core aims.
PCNs are intended to increase the primary care workforce by 20,000 staff including physios, social prescribers, pharmacists and others by 2023/24. But just shy of a quarter (23%) of GPs in England said the networks would achieve this target. Partners were less convinced than GPs overall, with just 14% indicating that the networks would help to reduce capacity and skill deficiencies within practices.
Many respondents said the recruitment of additional primary care professionals was merely a ‘sticking plaster’ solution to the wider issue of GP retention.
One GP said: ‘PCNs are not the solution to the GP recruitment and retention crisis. The directed enhanced service is unlikely to be adequately funded and way more resources will be needed to achieve targets.’
BMA GP committee chair Dr Richard Vautrey said it was unsurprising that some GPs were sceptical about future developments following countless NHS organisational changes in the past.
However, he said the speed at which PCNs had been set up across England underlined GPs’ commitment to ‘seize the opportunities’ and make a success of the five-year contract that took effect from April.
‘GPC England has been clear from the outset that the £20bn commitment to the NHS to fund the long-term plan and the £4.5bn contract agreement, which includes the development of PCNs, cannot solve all the problems we face… but they are a step in the right direction.
‘We are very aware that too many people believe PCNs will somehow be able to solve almost every problem the NHS faces but they don’t have the capacity or capability to do that and we must manage expectations, giving these new groups time, space and support to develop.’
A decision not to award a new contract to provide school nurses in Warwickshire to the South Warwickshire NHS Foundation Trust (SWFT) has been greeted with disappointment by its chief executive.
Earlier this month the chief executive’s report revealed that SWFT had lost out on the contract to an independent provider called Compass.
Giving his reaction to the news, Glen Burley, chief executive at SWFT, said: “We were disappointed that our bid to bring the Warwickshire School Health and Wellbeing Service back into the Trust had been unsuccessful. Following the success of our similar contracts in Coventry and Solihull we feel like this is a real missed opportunity for our local health system.
“Preventing illness is a key element of our strategy so we will seek to work collaboratively with Compass, the independent sector provider of the service, to ensure that there is an increase in health promotion and prevention interventions in this really important part of our community.”
The report explained that SWFT may have lost out because its ‘digital maturity’ needed improvement.
It added that SWFT hoped to bid again for the contract in the future.
Compass is the current provider of the School Health and Wellbeing Service in Warwickshire which delivers preventative and universal public health programmes in schools across the county, as well as in youth centres, children’s centres, homes and elsewhere.
It also provides advice on a wide range of health topics from healthy eating; friendships and bullying; to parenting, fussy eating, anxiety and sleep.
The service is delivered by nurses and healthcare support workers and is freely available to all school-aged children and young people from 5 to 19 years old (up to 25 years old for people with special educational needs) and their families and carers.
Rachel Bundock, Compass chief executive and executive director said: “Compass is delighted to have this opportunity to continue delivering this very important and much valued service. We have established some fantastic partnerships over the last four years which contributed significantly to the service’s success. We are very much looking forward to working with our partners over the coming months to implement the next phase of the service.”
The new contract will run from 1 November 2019 – 31 October 2022, following the end of the current contract on the 31 October 2019.
Warwickshire County Council declined to comment on how much the new contract was worth.
Stephen Fry narrates a video comparing the UK and US healthcare systems. It shows the startling number of unnecessary procedures, a seriously injured woman begging bystanders not to call an ambulance, and the illusions that cover it all up.
For the first time in 100 years, Britons are dying earlier. The UK now has the worst health trends in western Europe – and doctors and experts believe that the impact of austerity is a major factor.
In a few days, a team of researchers, statisticians and geographers will gather at University College London to tackle an issue of increasing concern for doctors and health experts. They will investigate why many UK citizens are now living shorter, less healthy lives compared with the recent past.
The emergence of faltering life expectancy in Britain has caused particular alarm because it reverses a trend that has continued, almost unbroken, for close to 100 years. Over this period, lives have lengthened continuously, blessing more and more British people with the gift of old age.
But now that increase has come to a halt, statisticians have discovered. Indeed, among many sections of the UK population, declines have set in. Hence the meeting, organised by the British Society for Population Studies, which has been organised so delegates can use data – to be released this week by the Office for National Statistics – to update their life expectancy projections.
“It is a perfect storm,” says Danny Dorling, professor of social geography at Oxford University, who has organised the London meeting. “Our faltering life expectancy rates show we have now got the worst trend in health anywhere in western Europe since the second world war. To achieve that, we must have made a lot of bad decisions,” he said.
Statisticians first noticed in 2013 that rises in life expectancy in the UK had begun to slow down. Gradually, the graph – which been rising for decades – flattened out until, a few years ago, it started to decline forincreasing numbers of people. The elderly, the poor and the newborn were worst affected. For example, life expectancies for those over 65 have dropped by more than six months.
The trend now causes considerable concern among doctors who view life expectancy figures as barometers of the health of Britain. From this perspective, the nation is sickening – and a host of different factors have been put forward as explanations.
One frequently made claim is that humans have simply reached the peak of longevity. “Life expectancy cannot be expected to increase forever,” Robert Courts, a Tory MP, told the Commons recently.
Many statisticians point out, however, that life expectancy has continued to rise – well above UK levels – in many other places, including Hong Kong, mainland China, Japan and Scandinavia. Other factors must be involved, they state.
For its part, the Department of Health initially claimed that flu epidemics, triggered by harsh winters, were killing the weak and elderly, raising mortality rates and reducing life expectancies. But this idea is dismissed by Dr Lucinda Hiam, an honorary research fellow at the London School of Hygiene and Tropical Medicine.
“I was working as a GP during this time and didn’t notice a dramatic increase in flu among patients coming into my practice,” she said. In fact, it has been shown that five of the seven winters between 2011 and 2017 had above-average temperatures, making them unlikely triggers of flu epidemics.
Nevertheless, the Department of Health persisted with the idea for some time. “When my colleagues and I first questioned the strength of impact that flu was having in increasing deaths, and suggested the role of the cuts should be explored, we were dismissed by health officials,” Hiam said. “But since then the evidence of flu being solely responsible has largely evaporated.”
And once imposed, they triggered dramatic reductions in funding for social care, meals on wheels, rural bus services, NHS spending, numbers of health visitors and many other services. These in turn contributed to increased numbers of early deaths of vulnerable people, it is argued.
“Life expectancies started to stall just after the austerity cuts were introduced,” said Hiam. “That alone does not prove the latter was the trigger for the former. However, no other plausible suggestion has since survived scrutiny, so it is hard not to conclude austerity cuts are involved.”
In the case of care for the elderly, the link looks especially persuasive. “Funding for social care for the elderly had already been at breaking point for decades and recent austerity cuts only compounded the crisis,” says Tom Gentry, senior health and care policy manager for Age UK.
Previously the only individuals who had contact with many lonely, isolated old people were social and community care workers. Then came the cuts, which led to a dramatic reduction in this last line in defence of the elderly.
“Today, there is often no one who is talking to those elderly folk or spotting when they have stopped eating or noticed that are not moving around or are having balance problems. Then they fall over, lie there for days before being found and are then readmitted to hospital where they have to be given more serious interventions than would otherwise have been the case. Inevitably that will mean shortened lives.”
Earlier this year, the Institute and Faculty of Actuaries said it now expects men aged 65 to die at 86.9 years, down from its previous estimate of 87.4 years, while women who reach 65 are likely to die at 89.2 years, down from 89.7 years. In other words, the life expectancy of people entering pension age has been cut by six months.
This has implications not just for our health services but for our pensions industry. “The recent lowering of improvements in life expectancies has already had consequences,” said Cobus Daneel, of the actuarial body, the Continuous Mortality Investigation. “Insurance companies have been releasing money because it is realised they may not have to pay out as much to pay future pensions as previously expected. Of course, life expectancies still have room to get better in future”
At the same time, the government has plans to put up the state pension age to 68 and has floated the idea of increasing it to 70. Now it may be forced to backtrack as increases in life expectances stall. “The increase to age 68 is only scheduled to come in between 2037 and 2039 and I would expect there will now have to be a further review before they are implemented,” added Daneel.
Last week the former health secretary, Jeremy Hunt, admitted that some cuts in social care funding imposed by the Conservative government “did go too far”. However, the Department of Health continues to reject any link between those cuts and drops in life expectancies. “We are taking action to help people live longer and healthier lives,” said a spokesman. “Cancer survival is at a record high, while smoking rates and teenage pregnancies are at an all-time low.”
Nevertheless, the connection between austerity and dwindling life expectancy is hard to shake off, says David Walsh, of the Glasgow Centre for Population Health. The city once had some of the worst life expectancy rates in the western world – for example in the central area of Calton, a place blighted by poor housing, illness, high smoking rates, and violence.
Inhabitants suffered high death rates linked to drug and alcohol abuse and suicides. As a result, at the beginning of the 21st century, the male life expectancy in Calton at birth was 54, one of the worst figures in the UK. Glasgow subsequently made major efforts to improve death rates in Calton but is now watching life expectancies slide back towards their old levels.
“I think it is pretty clear that austerity is to blame,” says Walsh. “We have taken away these people’s safety nets.”
The grim future facing these young adults was summed up by Sir Michael Marmot, professor of epidemiology at University College London. “If you were to go to a young man growing up in Calton who is doing drugs and alcohol and smoking and is unemployed and is unemployable and say to him: ‘Look, you really shouldn’t smoke.’ Well, you wouldn’t get far with him and, in any case, he might be quite rational for not making long-term plans because he does not have a long-term future.”
On top of the health impacts on the elderly and the deprived, there has also been a worrying change in infant mortality rates – as was acknowledged last week by the Office for National Statistics. It reported that in 2017, there were 3.9 deaths per 1,000 live births in the UK. In 2016, there were 3.8.
“Infant mortality had been reducing since the 1980s and reached an all-time low in 2014. But since then the rate has increased every year,” said Vasita Patel, a senior research officer at the ONS. “The one in 2017 is significantly higher than the one in 2014.”
To explain this alarming increase in infant mortality, Dorling blames a host of factors: “Fewer midwives, an overstrained ambulance service, general deterioration of hospitals, greater poverty among pregnant women and cuts that mean there are fewer health visitors for patients in need – all these factors are involved.”
The crucial point is that health statistics tells us something fundamental about how well a society is doing, says Marmot. “When you see significant differences in life expectancy rates, that is telling us something particularly important about how well society is distributing its benefits.” According to Marmot, a former president of the World Medical Association, a person with a university degree in Britain has a longer life expectancy than a school leaver with A-levels who in turn will do better than someone who did not sit A-levels. “The higher your income the longer you live,” he states. “Similarly, the higher the status of your occupation, the longer your life expectancy.”
Equally, the lower the step on the socio-economic ladder that a person stands on, the more dependent they are likely to be on help or support from local authorities. As a result, these individuals are disproportionately affected when cuts are made to services.
“Two years ago, I went out of my way not to blame austerity measures for faltering life expectancy rates,” said Marmot. “Now I am much closer to blaming them for the ills we are witnessing.”
While Marmot remains cautious, Dorling and Hiam are more certain of a causal link between austerity cuts and lowering life expectancy rates. However, all agree on one issue: that there is now an urgent need for a full-scale inquiry into the issue, a move that is also supported by Professor Martin McKee, of the London School of Hygiene and Tropical Medicine.
McKee said: “Health authorities cannot continue to dismiss the possibility of a link between cuts and lowered life expectancies. We need to find precise answers and we need them urgently. The only way to do that is to set up a proper public inquiry – as a matter of urgency.”
Of course, in coming years, mortality rates may halt their decline and begin to show renewed growth. But to rejoice at these would be a mistake, says Dorling.
“Life expectancy in the UK is a long way from what it should be for a country as rich as ours. The argument should not be about weeks of life lost or regained but how many years are being lost to life expectancies because we chose not to do what a normal European country would do and that is to invest properly in social care.”
The real fear is that Britain is falling into a pattern that has emerged in the US where taxes – and social care budgets – are low and where much of the healthcare system is privately run. In the US, life expectancy started falling significantly years ago. Causes of soaring mortality rates there include spiralling rates of drug overdose deaths and suicides. However, care of the elderly and the very young is also under stress in many states.
“I am worried that we are heading along the same route as the US,” says Marmot. “We shouldn’t be. We should be investing significantly in health and social care like the rest of Europe. Its social policies are better for health and long life than American social policies.”
There is a lot going wrong in the world today and big tech is driving much of it in its indomitable thirst for ever greater global influence and markets to profit from. In the meantime, the British government is already making many moves to ‘Americanise’ society and continues towards its unpopular privatisation model in healthcare. These are not the musings of TruePublica’s editor. Professionals at the heart of the artificial intelligence community, privacy, civil liberty and healthcare are alarmed the NHS has teamed up with certain tech firms with scant care for patient outcomes especially with the latest announcement of American behemoth Amazon giving health advice.
The voice-activated assistant is now automatically searching NHS web pages to find answers to medical questions. And the government is selling it on the hope it will reduce the demand on human doctors. But there is more to this than meets the eye and the move has split opinion among artificial intelligence experts and data ethicists.
“The sensitive data holdings of a national healthcare provider like the NHS are a form of ‘critical social infrastructure’, Yet they’ve been handed to a foreign company that’s both a defence contractor and targeted advertiser.”
Responding to news that the NHS has partnered with Amazon to encourage people to seek health advice from Amazon Echo devices, big Brother Watch director Silkie Carlo said:
“Encouraging the public to give their private health details to one of the most aggressive corporate data guzzlers is astonishingly misguided. Amazon’s Alexa records what people say, stores recordings in data centres we know nothing about, and exploits our data for profit. This scheme will likely result in people being profiled and targeted by data brokers based on their deeply personal health concerns. These home surveillance devices are controversial and not widely used. Any public money spent on this awful plan rather than frontline services would be a breathtaking waste. Healthcare is made inaccessible when trust and privacy is stripped away, and that’s what this terrible plan would do. It’s a data protection disaster waiting to happen.”
Amazon is known to have major ambitions in the healthcare industry and is now targeting Britain. With the impending UK/US trade deal getting closer every day, Amazon is simply getting its brand name and collecting valuable data in front of what it plans next. A small example of this is that in 2018, Amazon paired up with Omron Healthcare to allow a blood pressure monitor to be controlled via Alexa – and announced its software could automatically analyse electronic health records for information that could be useful to doctors.
It is clear that Amazon is training its algorithms on NHS patients queries. Data privacy campaigner Phil Booth makes this point exactly with a tweet that asks that question and also “who’ll be responsible for patient safety.”
And this new partnership is not really new. The government has form. The NHS has increasingly partnered with private companies to offer access to its services. Notably, Babylon Health, Push Doctor and Now GP all allow video appointments with GPs to be made remotely.
A partnership with the aforementioned healthtech firm Babylon, for example, which offers patient consultations via a smartphone app, has been criticized for gaming the UK’s healthcare system. Doctors say the app mainly attracts young, low-maintenance patients while pushing harder and more expensive cases back to regular GPs.
Following several complaints from doctors, the Medicines and Healthcare products Regulatory Agency (MHRA) has reviewed the Babylon Health app which powers the NHS GP-at-hand service, according to a report in the Financial Times.
According to the paper, the MHRA asked questions about the app after one doctor complained that it had failed to identify symptoms of a heart attack or deep vein thrombosis and other doctors telling the paper that they had complained about wording on the website that could confuse patients. The Advertising Standards Authority has also received five complaints about the app.
HealthTech could, of course, be very beneficial to the healthcare industry but equally be seen as just another privatisation deception, especially when it involves global exploitative corporations such as Amazon.