Interoperability should not come at cost of “transparent” procurement

Interoperability will be a key driver of government plans to revamp the NHS but should not come at the cost of “open, transparent procurement”, it has been said.

David Hancock, healthcare executive advisor for tech supplier InterSystems, said integrated care systems (ICSs) will need to have interoperability embedded if true joined up health and care is to be achieved.

“It’s going to force some real digital transformation across health and care and they’re going to need interoperability to be able to support that,” he told Digital Health News.

“Hospitals are no longer going to be islands whose only way of measuring their success is whether they are in deficit or profit by the end of the year. It’s about how they perform as part of an integrated care system.

“For that they’re going to need to be able to collaborate and support patient journeys across the system and be able to share information in a way in which patient populations are managed across that system, which is all about interoperability.”

His comments come as government plans to overhaul the NHS revealed ICSs would be embedded in law, with every area in England expected to be covered by a system.

The plans aim to “modernise the legal framework” to make the health system “fit for the future”, according to a Department of Health and Social Care statement.

They follow health secretary Matt Hancock’s ‘bureaucracy-busting mission’, which aims to improve the use of data within the NHS and would see the health service capitalise on “good practice” responses during Covid-19.

Under the proposals, commissioners would no longer be required to put contracts out to tender and instead there would be a new policy which gives the NHS and local authorities greater flexibility over who would provide healthcare services.

It’s a move David Hancock said could cause “concern” among suppliers.

A relaxing of rules during the pandemic to allow faster procurement and better data sharing has seen the NHS to achieve “more digital transformation in three-to-five months that what we would have done in three- to-five years” but that shouldn’t always remain, he said.

“The procurement landscape and the way it’s been done has been good because they’ve had to be responsive, but obviously where they have done procurements where there is no transparency and no competition then it leads you to distrust a bit,” he told Digital Health News.

“If you have an emergency procurement the government typically goes to those people it trusts or thinks can respond and a new entrant onto the market is not somebody they know, that is clearly a problem.

“That is why we need open, transparent procurement to give everybody a chance.

“Where we need innovation, quite often that innovation needs to happen in very specialist or niche areas and quite often that specialist or niche innovation is coming from a small supplier. So we need to make sure we are able to give them that opportunity.”

Ian Crichton, chief executive of Servelec, said there were “pros and cons” to the proposed reforms.

“Removing the tender process would provide trusts with more flexibility around how they buy services. Often when a trust goes out to tender, they already know which supplier and solution they want, but lengthy and cumbersome tender processes can waste valuable time,” he told Digital Health News.

“Most importantly, the proposed changes could provide the opportunity to mandate data sharing and interoperability between suppliers. As we all know, joining up health and care is the single best way we can improve public services, as well as the patient experience.”

But he said “open engagement” with suppliers will still be necessary.

“The removal of formal tender requirements may actually offer an opportunity to improve engagement as fears of falling foul of formal tendering regulations diminish,” he added.

“We can’t go back to the days of awarding contracts based on individual bias, nor should supplier choice become a political question. It’s essential that selection and retention is based on the demand for the service and value for money.”

The white paper acknowledges some of those measures are “only appropriate as part of an emergency response” but that “removing bureaucracy could lead to better outcomes in more normal times”.

A ‘bonfire’ of procurement rules

Cori Crider, director of tech justice firm Foxglove Legal, fears changes to procurement rules could see large private firms get a ‘larger piece of the pie’.

“Despite the spin line that this is going to limit the private sector it looks to me like it’s actually carving out space to give larger contracts and larger pieces of the pie to private entities,” she told Digital Health News.

Crider said it appears the government were “seeking to lay the ground to make permanent systems that were rolled out under an emergency basis”.

“It’s almost as if, having used the pandemic to have a bonfire of the procurement rules, they’ve decided they don’t want to follow them when the pandemic is over either,” she added.

“I understand from people within the NHS that red tape is painful but actually having some laws and regulations around who gets the public contract are not just meant to protect the competition, they are mean to protect the public.”

Crider has campaigned for the government to be transparent about deals between the NHS and big tech firms following the appointment of global companies to run the NHS Covid-19 Data Store

The Data Store was set up to handle coronavirus data to inform the government’s response to the pandemic. A suite of tech firms including Palantir, Faculty AI, Google, Amazon and Microsoft were appointed to the Store in March 2020.

But the government was heavily criticised for failing to publish the contracts. Details of the contracts were eventually published in June.

The contracts were awarded under the Crown Commercial Services G-Cloud 11 Framework, which does not require a tender to be published.

Crider called for “real democratic debate” before any changes are made to NHS procurement rules.

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