back to article Brit spending watchdog brands GP Primary Support Care a 'complete mess'

NHS England must re-evaluate the way it outsources work to the private sector in the wake of "continued squabbles" with Capita over the mismanaged £700m Primary Support Care (PSC) contract. The seven-year agreement that began in September 2015, which includes an option to extend it for three years, was to provide support …

  1. shifty_powers

    "When outsourcing goes bad!"

    What do you mean, when?

    1. Arthur the cat Silver badge

      Re: "When outsourcing goes bad!"

      What do you mean, when?

      As in when, not if.

    2. theblackhand

      Re: "When outsourcing goes bad!"

      Normally, you expect outsourcing to be a gold-plated turd or maybe a competently delivered shit sandwich that vaguely provides what someone hoped the business or customers would want.

      However, in the hands of the NHS and Crapita, you can really get the worst of all worlds.

      Managed end of contract service handovers? who would need that? CHECK

      Arbitrary cuts to budgets without anyone understanding the effects for years to come? Maybe even requiring a third party to come in and tell you how to do YOUR job? CHECK

      Reassuringly expensive for both the initial failed delivery and subsequent attempts to try and deliver the original requirements? CHECK

      Making thousands of peoples lives miserable? CHECK

      Those responsible walk away with their Teflon shoulders in tact? CHECK

      PR people making bland apologies in-spite of nothing improving? CHECK

      (Note: NHS managers considering using this as a requirements document should contact me first...)

      1. Anonymous Coward
        Anonymous Coward

        Re: "When outsourcing goes bad!"

        If you did not want the outcomes described above, why would you get Capita involved. Their 100% failure rate is _almost_ unbeatable. (If rumours are true: defence procurement is aiming to beat their own 110% failure rate).

  2. Denarius Silver badge

    consider those affected

    why ? we are government.

    I note the Antipodean clones of Whitehall drones are busily doing their fail study in Oz.

  3. Salestard

    and to think...

    we used to mock the Soviet/Communist system for its ability to squander vast sums of money on achieving massive inefficiency...

    1. Teiwaz Silver badge

      Re: and to think...

      we used to mock the Soviet/Communist system for its ability to squander vast sums of money on achieving massive inefficiency...

      That was staid big government inefficiency, this time it's the worst dysfunctional marriage of Private and Public sectors.

      I'm beginning to think that mismatch-up works about as well as National-Socialism - i.e. looks like it might weil be popular on paper but doesn't work as advertised in reality, but applied with dogged determination no matter the consequences.

      1. codejunky Silver badge

        Re: and to think...

        @ Teiwaz

        I dont know why your getting downvoted for that unless you upset some national socialists. I dont see much difference between a nationalised inefficient system (like the communists) and the private but exist as a government department off the books that we have now. Either way its big government and both enjoying the fruits of our labour.

        1. Teiwaz Silver badge

          Re: and to think...

          unless you upset some national socialists

          Could be, what with nationalism seemingly on the rise again along with the US becoming more isolationist, seems we may well be on track to repeat the mistakes of the early-mid 20th century all over again.

          1. Doctor Syntax Silver badge

            Re: and to think...

            "seems we may well be on track to repeat the mistakes of the early-mid 20th century all over again."

            Those who do not learn their history...

        2. CrazyOldCatMan Silver badge

          Re: and to think...

          Either way its big government and both enjoying the fruits of our labour

          AKA "privatising the profits and socialising the costs".

      2. RedCardinal

        Re: and to think...

        Or as well as our obesession with handing public services over to private companies so that they can make their shareholders large amounts of cash...

        1. iansn

          Re: and to think...

          Where is there any talent to do this in the NHS, or local government, they are all bag carriers and watchers, reporting something when it breaks, no experience n big projects other than as observers and no interest in being involved in case it goes wrong and they're careers upward trajectory is damaged. No risk taking, challenging authority or even common sense judgement. That's the reason the contracts are badly written, there is no talent there either. IT just has to mop up later.

      3. Anonymous Coward
        Anonymous Coward

        Re: and to think...

        @Teiwaz

        National-Socialism was Hitlers mob, is that what you mean?

        1. Teiwaz Silver badge

          Re: and to think...

          @Teiwaz

          National-Socialism was Hitlers mob, is that what you mean?

          Yes, well done A/C, you can press the reward button now.

          Modern equivalent in political terms is parties promising both lower taxes and better public services, only the stupid and greedy should be taken in by such promises, but it seems to work decade after decade and the corporate driven right wing gets in more elections than not.

        2. Anonymous Coward
          Anonymous Coward

          Re: and to think...

          National-Socialism was Hitlers mob, is that what you mean?

          It pays to enquire. The same term can of course be applied to the Scottish National Party.

    2. TheMeerkat

      Re: and to think...

      The State is inefficient. And NHS proves it, it does not matter if they outsource or not, the result is going to be the same.

      The difference with the USSR was that they had the State everywhere resulting in inefficiencies everywhere, not just in health system.

      1. Mark Dempster

        Re: and to think...

        >The State is inefficient. And NHS proves it, it does not matter if they outsource or not, the result is going to be the same.<

        No, it's not. That's just an argument that neoliberals use to justify cuts.

        The NHS is (or was) the most efficient healthcare service in the world. Despite always being a rationed service it delivered excellent outcomes for low cost (compared to other systems). The problems come from politicians trying to run it as a business. For example they see 80% bed occupancy as inefficient, so they cut the number of beds available to give 95% occupancy. That might work for a hotel, but not a hospital! That 20% 'spare' figure was in order to cope with sudden emergency demand, or natural increases such as happen during the winter. So now, in the 'newly-efficient' service, we can no longer cope with bad weather & hospitals grind to a halt - including, this year, non-emergency surgery being cancelled for 2 months! Just think what kind of backlog that causes, quite apart from increased suffering.

        These organisations had specialised knowledge & experience that is lost when bringing in outsourcing. Politicians with none of these skills should leave them alone, beyond ensuring that they have the resources required.

        Outsourcing never works as advertised - and I'm ex-Capita myself.

        1. codejunky Silver badge

          Re: and to think...

          @ Mark Dempster

          "The NHS is (or was) the most efficient healthcare service in the world."

          Not really. On pretty much any scale it doesnt perform well except free at the point of delivery. A fairly good reason being-

          http://www.continentaltelegraph.com/healthcare/to-pinpoint-why-the-nhs-doesnt-work/

          Our system is so wonderful and amazing nobody will copy it.

          "The problems come from politicians trying to run it as a business. For example they see 80% bed occupancy as inefficient, so they cut the number of beds available to give 95% occupancy. That might work for a hotel, but not a hospital!"

          That is a pretty good example.Governments love opening a new hospital or performing some grand gesture and yet when it comes to maintenance they fail. In the governments hands things quickly fall into disrepair. A politician wants to make a mark, as the above link with the NHS or in education changing things regularly and increasing pressure on those who actually do the work.

          It isnt running things like a business, its running things like an elected representative.

          "Outsourcing never works as advertised - and I'm ex-Capita myself."

          Not quite. The small production company I worked for couldnt have delivered the items themselves. Even when we expanded to new products we couldnt produce but we had the technology to sell, and a manufacturer of the new products could make them but had no technology for selling it. Obviously not private sector but that business is still in existence, employing people and growing purely on the ability to work well with others.

        2. rskurat

          Re: and to think...

          Efficiency is not the goal of any (good) healthcare system, good health is. Staffing for peak load for a time slot means you don't have gurneys in the corridors.

          1. codejunky Silver badge

            Re: and to think...

            @ rskurat

            "Efficiency is not the goal of any (good) healthcare system, good health is."

            I agree in the terms you seem to mean (just enough beds/nurses/etc if I understand correctly) would be bad. But efficiency of (correct) diagnosis, treatment and discharging patients is important to a good healthcare system.

            I dont think anyone can claim that of the NHS.

  4. Chris G Silver badge

    Crapita! A bit like cockroaches but much harder to kill, compared to them cockroaches are cuddly and don't make you feel so bad.

    NHS management are little better, my sister worked in a path' lab for years. She told me so many things about managers and their lack of interest in actual medicine, one occasion they had a surplus to spend before the year's end so the money went on furnishings and a new coffee machine in the top office.

    1. Juillen 1

      That would be the insane way that Hospitals are forced to work.

      Each year, you get an allocated budget. In most years, you'll really need more than your budget, so you scrimp and save all year to try and make sure you can cover emergencies.

      Come the end of the year, if you have money left in your budget, you don't get a hearty round of applause for being efficient. The accountants turn round and say you didn't need as much money as you claimed, so they cut that money from next year's budget (plus, they _also_ remove the 3% per year 'efficiency savings' that every department needs to make).

      If you don't spend the money, it can cripple you the next year (on capital spend). Unlike businesses, there is no concept of saving money in the bank to build up a war chest that'll let you get the really natty things you'd really like in the long run; you simply make a capital bid in the year to see if someone will fund you that year.

      It's a bit better with Foundation Trusts, but not much.

      1. Chris G Silver badge

        I fully understand how budgets work, my point is that these morons put their comfort first in a health service that is always complaining it needs more money to treat patients well. I have seen piles of wheelchairs and other stuff that they say they can't afford to have repaired because that is outsourced and too expensive.

        Few NHS managers can manage.

      2. Nezumi
        Facepalm

        Regional Govt is just as bad

        I remember doing a fixed-term contract at a regional govt campus. I was told quite plainly by my Line Manager as I approached the end of my employment, that the reason why the dept had so many contractors is because central govt capped the amount of permies they were allowed.

        Of course, pissing money up against the wall for contractors who cost more and took all their knowledge with them when they left was fine.

      3. Doctor Syntax Silver badge

        "Unlike businesses, there is no concept of saving money in the bank to build up a war chest"

        OTOH, if you're running a lab and are actually hands-on, unlike the management of Chris G's sister's lab, you use the end-of year surplus to buy routine consumables that aren't going to have a limited shelf-life; microscope slides and cover-slips were examples in may case. Some of the money you might otherwise have spent on those next year then becomes your contingency fund.

  5. m0rt Silver badge

    "Capita is committed to delivering this contract and its vital purpose: digital transformation for NHS support services that were previously paper-based, fragmented and without national standards."

    Oh that's alright then.

    1. Prst. V.Jeltz Silver badge

      If they are busy buying a shitload of scanners , bad news , that bits already been done. Glad they know their mission.

      I see no mention of finishing on time / budget in that commitment

  6. Primus Secundus Tertius Silver badge

    Who else is available

    Another poor performance from Capita.

    But who else is there? Our arts graduate civil service? The old defence contractors, trying to diversify out of a contracting market?

    The NHS would do better to just hire a few capable sandwich students.

    1. Lyndon Hills 1

      Re: Who else is available

      The NHS would do better to just hire a few capable sandwich students.

      People who study sandwiches? Where do you sign up?

    2. This post has been deleted by its author

  7. Anonymous Coward
    Anonymous Coward

    The problem with NHS or any large organization was never Government but "old boys" hiring practices which leads to incompetence and eventually demoralizes competent, effective employees. As with anything else there needs to be real oversight at all levels. Outsourcing can destroy an organizations ability to run its own affairs (much like Cloud) and that leads to companies like Crapita being able to say we can do it for a particular price while knowing that they can't but then having that organization by the [insert your own word(s) here] and that they'll be able to charge whatever they want. Sadly, this will never happen as the powers that be like to be able to put their useless children somewhere like middle or upper management or into political roles and lying about cost to swindle more later seems to be an excellent income earner for both organized crime and large Corporations.

    1. annodomini2

      Which is the entire aim of the policy from a political perspective.

  8. Crisp Silver badge

    For its part, Capita has apologised

    Oh that's all right then. Because whenever I can't get the medical care that I need an apology is always just as good.

  9. PipV
    Holmes

    "Brit spending watchdog brands GP Primary Support Care a 'complete mess'"

    No S*** Sherlock

  10. Destroy All Monsters Silver badge

    Is it time for another Adam Curtis movie about the failure the Management Dream?

    Yes, yes it is.

  11. Prst. V.Jeltz Silver badge

    shouldnt NHS England be doing this themselves? Isnt that their job?

    1. Anonymous Coward
      Anonymous Coward

      shouldnt NHS England be doing this themselves? Isnt that their job?

      Before this Crapita deal, they probably did. But inefficiently. Now its outsourced inefficiently.

      The way the NHS manages primary care has been crap since the NHS was created, largely because the Labour party architects of the service left GPs as private contractors. GPs should be salaried NHS employees (and incidentally the NHS should undertake workforce planning and commission GP training from universities) and the current service "commissioning" arrangements should be remade to dissolve the unaccountable and incompetent CCGs (with extreme prejudice).

      The overly powerful BMA will never support this; All mainstream political parties have neither the moral fibre, nor the intellectual capacity to come up with a proper operationally effective and affordable architecture for healthcare. They'd also run a mile from the idea that those of us able to pay should make some contribution at point of use for using the service (eg "hotel services" in hospitals, £20 to see the GP or NHS dentist). And I don't think they've got the balls to unwind the vast PFI albatross that Gordon Brown put round the neck of the NHS.

  12. Anonymous Coward
    Anonymous Coward

    From what ive seen any given practice , or group of practices will buy whatever hardware and software they want . Currently Emis and un networked Brother printers

  13. adam payne Silver badge

    "The dismal fallout here, with NHS England and Capita squabbling over details that should have been agreed in 2015, tells its own sorry tale," said Hillier.

    Sounds like important things that should have been discussed and ironed out in the initial specing up stage never happen.

    Why does this keep happening time and time again?!?

    1. Mike Pellatt

      Why does this keep happening time and time again?!?

      Because there are no/insufficient people capable of framing contracts properly and then managing them within uk.gov.

      AKA client-side capability. The cost of which is clearly never properly factored into this sort of thing.

      DafT are just the same. It's the root cause of the current rail fiasco - and first became blindingly obvious after Virgin's successful challenge of the ECML franchise award. Which, of course, is still to be re-tendered.

      Then, of course, there's the Home Office. G4S tagging fiasco. Probation service fiasco. etc. etc.

      And the G4S Olympics security fiasco.

      Let's not mention DWP and the WCA.

      All, every single one, symptomatic of ineffective client-side contract management. And the constant forgetting of the maxim that the Government can (maybe) transfer (some) financial risk, but the risk of service delivery failure can never be transferred. After all, that's the job of the government.....

      1. DonL

        "Because there are no/insufficient people capable of framing contracts properly"

        I doubt it can be done for anything remotely complex, everyone has their own view and even the users sometimes don't know what they actually want/need or their individual needs differ. When doing things in-house you can often just be flexible, with outsourcing it suddenly needs to be 100% specified which leads to new contract negotiations for the changed requirements. Since there already is a contract in place you're left to mercy of the outsourcer, this often doesn't work out very well at that stage.

        1. Mike Pellatt

          everyone has their own view and even the users sometimes don't know what they actually want/need or their individual needs differ

          "T-Government" (Transformational Government - yes, really) which was going to be the successor to E-Government was going to fix all that.

          What people needed would be defined by the IT spec, not the other way round. Yes, really. I remember sitting through this crap whilst a minister talked about it.

  14. RedCardinal

    Gosh! Who would have thought something involving Capita could have gone wrong....

  15. Lee Zwager

    "wake of "continued squabbles" with Capita over the mismanaged £700m Primary Support Care (PSC) contract"...

    " 'short-sighted rush' to cut around 35 per cent of the £90m it costs annually to deliver these services"...

    So to save 35%, they immediately signed up to spend 12% more for 7 years?

    Some time soon people will realise that career managers (if you can't do it, teach it, if you can't teach it, manage it) are the problem that causes every other problem.

    1. Aristotles slow and dimwitted horse Silver badge

      Hmmm...

      Yes, it's that bizarre spreadsheet bean-counter accounting logic that is totally detached from day to day reality that states that we're going to spend £700m over 7 years, to save £31m or so per year - over 20-25 years. When in reality that business case is flawed from the outset because it doesn't take into account any form of external factors such as... reality.

      1. Juillen 1

        Re: Hmmm...

        Ahh, but you assume all hospitals are spherical and exist in a vacuum. Makes perfect sense from then on. :)

  16. Anonymous Coward
    Anonymous Coward

    I wonder if it's as shit as NHS Mail

    Now that is a POS...

  17. Fruit and Nutcase Silver badge
    Alert

    Have an App

    Just what the DoctorHealth Minister ordered

    https://www.bbc.co.uk/news/newsbeat-44945062

    Don't worry, nothing will go wrongright

  18. Richard 12 Silver badge

    So why are Capita still an approved supplier?

    They have never, ever, managed to deliver anything on time or on budget.

    And yes, much of the blame lies with the client, because they still haven't learned that you cannot believe anything Capita tell you about time, capabilities or money.

  19. Anonymous Coward
    Anonymous Coward

    I was once an IT worker in the 'lazy wicked no good public sector' - job was privatised. Utter shambles ensued, private company couldn't make it work, got fined, handed back contract.

    Neoliberalism has brainwashed the masses into the thinking that contracting out is the only option. It isn't - IT can be run well in the public sector but only if its properly funded and resourced. However we live under a government that has put the needs of capital to earn an undeserved rental first above all else. The result is private profit over safety, quality and delivery.

    1. Anonymous Coward
      Anonymous Coward

      IT can be run well in the public sector but only if its properly funded and resourced.

      Having worked in public sector IT, I don't recognise any examples of great success. You could argue that's down to the resourcing, but in what universe will that change?

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