Tendering For Care

A health summit took place in London which saw mental health charities and social inclusion experts encourage healthcare chiefs to utilise local services better by embracing 'time banking'.

'Time banking' is the name given to the practice where people are encouraged to pledge time to volunteer for a variety of initiatives, schemes and communities.These volunteers can provide a lifeline within all aspects of healthcare, but there is a particular market for the mental health sector.Dr Edgar Cahn, the inventor of time banking and founder of Time Banks USA, told the summit: "Mental Health professionals must learn to say 'I need what you can do as badly as you need what I can do' otherwise programmes will continue to fail if they cannot enlist service users as co-producers of the outcome."Executive director of Time Banks UK, Martin Simon, added: "Mental health professionals need to seek out such opportunities for their service users and value contributions from a wider range of local people rather than treat people as passive consumers of services."

Payment by Results  (PBR) is intended to support NHS modernisation by paying hospitals for the work they do, rewarding efficiency and quality. It also carries risks that need to be managed effectively both locally and nationally. It is essentially a way of paying providers a fixed price for each individual case treated. Each case, such as an admission to hospital, is grouped into a healthcare resource group according to the treatment carried out and the clinical condition of the patient. Then a fixed price or tariff will be assigned to each healthcare resource group, based on the national average cost of treatment in NHS trusts in England. This articel provides further information on the implementation of PBR.

The Department of Health has announced that it will be beginning piloting primary care commissioning of telecare in July, with pilot sites chosen by next month. Gary Belfield, the DH’s head of primary care announced that three PCTs will be chosen next month to deliver hardware, worth an estimated £5,000, to patients in their homes.

Belfield said it is necessary to find a way of dealing with the increasing burden of chronic diseases, which is set to increase rapidly by 2020 and self care by these patients could easily be used by 70 -80% of the long term conditions population.

Moving closer to self-care could save the NHS money, with the cost of a hospital admission being up to £1000 plus.

Three pilot sites will be chosen in May from a shortlist of PCT’s who apply and work will begin at the demonstrators in July. If successful, the scheme will be rolled out nationwide over the following two years. The telecare machines were likely to include equipment such as blood pressure gauges to cover four conditions: diabetes, chronic heart disease, the frail elderly, and chronic obstructive pulmonary disease. They would be monitored remotely by community nurses who will follow up any alarm recordings.

As part of PCT commissioning, boards will be required to first need to assess needs, review service provision and decide on their priorities. Once strategic planning is completed, they will begin to design their services and shape the structure of the supply they are given. GP’s will then be able to manage demand and make referrals based on an assessment criteria, offering the patient advice on their choices, treatments or activities they can participate in. Telecare participants should be asked for their views and opinions and quality performance and outcomes should be monitored.

Belfield said that it was vital that the DH worked with Connecting for Health to ensure that the systems will support a shared health and social care record. He outlined a skills set to ensure that communication between the health and social care bodies were strong and all partied involved were aware of the patient’s programmes. Partnerships were fundamental he said.

Report of a review by Dame Denise Platt on how the status of social care might be raised, as commissioned by the Secretary of State for Health, in her speech to the national Social Services Conference in October 2006.

The terms of reference for the review were:

• To review the current arrangements for promoting the contribution social care makes to the promotion of people’s independence, inclusion, health and well being
• To consider whether any action is required to improve the status of social care services and the social care workforce
• To propose recommendations and timetable on any next steps which will be required.

Health, Education and Social Care are "Part B" services under the Directive. Some purchasers believe that they can opt out of the advertising these services. The Commission recently won a case in the ECJ against Ireland whenit argued that to award a contract without competition is a breach of the Treaty principles.

The Court's case-law clearly holds that the Treaty provisions on the freedoms of establishment and service impose on member States in respect of the award of public contracts which fall outside the scope of the Directives. With this in mind the Commission has successfully submitted that Community Law requires an appropriate level of advertising despite a contract falling outside the scope of the Directive. Just because a contract whose value is above the financial threshold and falls under the Part B sevices provisions of the Directive this is not sufficient for the purchaser to fail to advertised.

In a further judgement against ireland over a similar but separate complaint by the Commission. The view in this case is that Ireland has failed to comply with its obligations under the Treaty through failure to advertise. As advertising did not take place, the contract was not subject to competition. This has led to a breach of Articles 43 and 49 of the Treaty in regard to the free movement rules, despite the service being a Part B service.

These judgements mean that purchasing Authorities must be careful to advertise contracts widely and to do all in their power to avoid discrimination in their procurement procedures.

ECJ case law now confirms that the treaty principle of non discrimination implies an obligation of transparency on contracting authorities. The ECJ has indicated a need to ensure that there is "a sufficient degree of advertising to enable the market to be opened up to competition and the impartiality of the procurement process to be be reviewed "