NHS Contracts and Foundation Hospitals: Who has the Legal Expertise?
Is it actually the contracting out to private (or indeed social enterprise) suppliers for some NHS services which should be of most concern? Or is it the exact nature of the contracts agreed between NHS Trust Boards etc and their suppliers which requires the most scrutiny? There may be details here which make all the difference to what happens in the future….
Foundation Hospitals present us with a bewildering array of issues, on which much time and energy has been expended. There is one aspect of this development, and of the ‘contracting out’ of services in other NHS Trusts (to private suppliers, or indeed to social enterprises) which apparently perplexes me more than it does many others.
I don’t necessarily have a problem with ‘buying in’ at least some services, which for whatever reason an NHS Trust may not be able to provide; but there could be a problem if control of the service somehow thereafter eluded the Management of that Trust. Is this a medical or, rather, a legal matter?
How much training and expertise do public sector managers have in developing contracts with private companies? Is this a field in which most public sector staff could – or indeed until till now should? – have significant experience?
If a private contractor provides satisfactorily exactly the service which has been agreed, in the way and for the price agreed, perhaps there is no real problem; but is there a risk that sometimes this may not occur and either
(a) there will be no legal redress, or
(b) there could be loopholes which might enable the private contractor to have a hold on service provision which is greater than that envisaged?
In either of these cases there is the risk of compromise of the basic tenets of the NHS. Perhaps therefore it would be more useful to examine precisely what NHS Trusts and private suppliers agree, than to make a big thing of the idea of contracting out for specialist (or whatever) services as such. Some have suggested that these details were at base the ‘real’ problems with PFI. It is to be hoped, if so, that they are not repeated in the implementation of current proposals.
The devil, I suggest, is in the detail rather than in the ideas themselves. It will be interesting to see what specific expertise NHS managers acquire (or have already acquired) in these legal matters, as we move ahead. There is no doubt a tale or two as yet to be told about these complex propositions.