Flawed Business Models

As regular readers will know, occasionally I'm tempted to go a little 'off piste' and this story caught my eye as a perfect illustration of how many similarities there are between our own shambolic situation with that of other areas of privatisation of public services. Despite the political rhetoric, we are all sleep-walking into a stealthy privatised world, including the NHS, and created for us by 'dodgy Dave'. (Thanks for that moniker Denis Skinner.) From the Guardian:-

Ambulance privatisation descends into 'total shambles'

Hundreds of patients including people with cancer and kidney failure have missed important appointments for treatment because ambulances did not arrive to take them to hospital, after privatisation of NHS non-urgent transport services in Sussex this month.

Some elderly patients have had to wait more than five hours for ambulances and been stuck at hospital for long periods after their appointments because the transport service, now run by the private firm Coperforma, has proved so unreliable.

Patients, relatives, NHS bodies and local MPs have severely criticised the service’s performance, and a trade union representing ambulance crews said it was an “absolute shambles”. The NHS organisations that awarded the four-year, £63.5m contract have now launched an investigation.

A host of problems have arisen since Coperforma replaced the NHS’s South East Coast ambulance service (Secamb) as the provider of non-emergency patient transport services on 1 April. 

• Cancer patients have missed oncology appointments after ambulances failed to turn up to collect them.
• Patients with kidney failure have not been able to receive scheduled sessions of kidney dialysis for the same reason, with some missing two of their three treatments in a week.
• So many patients have become stuck at the Royal Sussex County hospital in Brighton because their transport has not arrived that it has paid for taxis and other private vehicle suppliers to take them home.
• Staff there have had to stay until midnight to ensure kidney patients arriving hours after their scheduled start time have received vital dialysis.
• Coperforma crews have been left doing nothing, despite patients’ need to get to hospital, because poor mobile phone reception in parts of Sussex has meant they did not receive details of calls to attend via an app the firm saw as pivotal to the service’s smooth running.
• Patients, relatives and NHS staff have faced waits of 45 minutes and more to get through to the firm’s phone lines, which have been unable to cope with demand.
• Coperforma vehicles have turned up to collect patients who have already died.

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So, who the hell are 'Coperforma?  This from their website:-

Coperforma specialises in running comprehensive patient and other hospital transport services in the UK. As this is our core business we have focused 100% of our time and energy on getting it right. We are now the leading provider of patient transport consulting and managed services to the NHS and currently arrange more than 1,500 patient journeys every working day – though we have the capacity to handle tens of thousands more.

Michael Clayton is the Managing Director. Prior to founding Coperforma, Michael Clayton was Group Services Director for AssetCo Plc, a £124m company responsible for UK public sector clients including the London Fire and Emergency Planning Authority, University Hospitals Leicester and the Metropolitan Police.

Who the hell are AssetCo? Why, they bought all the Fire Engines that used to be owned by the London Fire Brigade. This from the Telegraph in 2012:-

AssetCo sells UK fire engine fleet to equity firm for £2

The troubled Aim-listed company has off-loaded its UK business to private equity firm AB&A Investments. The move means that AssetCo, which was the subject of a shareholder revolt in 2011, has shed ties to both the Lincoln and London fire brigades amid mounting losses.

The company said the decision to exit its historic UK business was because the management team believed that operations were “based on a flawed business structure”, which was at the heart of why shareholders had lost so much money. The UK division made a loss of £16.5m on revenues of £33.5m for the audited 18-month period that ended Sep 30 2011.

Overall, the parent company, which also operates in the Middle East, had assets of £5.6m, with sales of £5.2m and profits of £470,000, for the six months to March 2012.

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Back to Coperforma. This from their website FAQ's:-

SECAmb calculated it would cost them £30m pa to deliver the contractual services required by the CCG from 1 April 2016, how can Coperforma do it for £12m pa? 

As we do not know the basis of the assertion from SECamb who did not tender for the work, it would be wrong to comment in the first instance and in the second instance we would never comment on another company. Coperforma will ensure we provide the service we are contracted to deliver with a continual emphasis on continuous improvement and efficiency.

Will Coperforma recognise Unite, Unison and GMB for transferring employees? 

This is still being considered. Coperforma does not recognise any trade unions at present and will consider whether to recognise any or all the currently recognised trade unions. There is no legal obligation to recognise the trade unions after the transfer.

Do you feel assured that Coperforma and its sub-contractors will be able to deliver the required service, despite their lack of experience of PTS on this scale? 

Coperforma has been awarded the contract by the CCG as it has a proven track record in the delivery of high quality, consistent, flexible and Award winning patient transport services that meet the needs of patients and the NHS and improve the experience of patients, carers and NHS staff. Coperforma won the Health Service Journal (HSJ) Efficiency Award for Transport & Logistics in 2012 and the HSJ Value in Healthcare Awards for transport and logistics for their Efficiency Review Service in 2014. Coperforma was also independently recognised as providing the best performing patient transport service in the UK by Clock Tower Consulting in October 2015. 

Patient safety is the CCGs' number one priority, and we are assured that Coperforma will provide a safe and high quality service for patients. CoperformaÕs performance will be managed and monitored by the CCG in the same way as any other NHS contract; using a clear contract monitoring process and Key Performance Indicators (KPIs) covering performance, quality and safety. The CCGs will hold Coperforma to account for maintaining these standards across the entire Sussex PTS, and for every element of the service, whether this is delivered by Coperforma itself or one of its qualified sub-contractors.

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Who awarded this contract? This from the Guardian again:-

Sussex Clinical Commissioning Groups, a group of seven GP-led CCGs in the county, which handed Coperforma the contract, said: “We recognise that the first few days of the new non-emergency Sussex patient transport service provided by Coperforma were not acceptable and apologise to all patients who were affected by this.

“A combination of initial technical hitches and problems with some of the patient data and journey information transferred from the previous service have created delays. These triggered a significant volume of calls to the call centres, which in turn created further issues; including some patients spending a regrettably long time waiting for transport.”

An explanation can be found on the nhsccc website:-

Clinical Commissioning Groups (CCGs) were created following the Health and Social CareAct in 2012, and replaced Primary Care Trusts on 1 April 2013. CCGs are clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area.

Commissioning is about getting the best possible health outcomes for the local population, by assessing local needs, deciding priorities and strategies, and then buying services on behalf of the population from providers such as hospitals, clinics, community health bodies, etc. It is an ongoing process, and CCGs must constantly respond and adapt to changing local circumstances. CCGs are responsible for the health of their entire population, and are measured by how much they improve outcomes. CCGs are:

• Membership bodies, with local GP practices as the members;
• Led by an elected Governing Body made up of GPs, other clinicians including a nurse and a secondary care consultant, and lay members;
• Responsible for about 60% of the NHS budget; or £60 billion per year;
• Responsible for healthcare commissioning such as mental health services, urgent and emergency care, elective hospital services, and community care;
• Independent, and accountable to the Secretary of State for Health through NHS England;
• Responsible for the health of populations ranging from under 100,000 to 900,000, although the average population covered by a CCG is about a quarter of a million people.

No mention of community involvement or oversight and of course GP's are private contractors to the NHS and have been since the beginning. Being a private contractor, Coperforma are not subject of FOI requests. 

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I'll end with the Guardian article:-

Coperforma refused to say how many patients had so far been caught up in the problems, though the CCGs said at least several hundred were involved. The firm, which claims to be “transforming hospital transport”, also works for the NHS in Hampshire and London.

Gary Palmer, an official with the GMB trade union, which represents many of the Coperforma personnel involved, said: “Regularly patients are missing their appointments at hospital because they are just not being collected or are so late in being collected that they miss them. We know that hundreds and hundreds of patients have been affected. But given that Coperforma are carrying out 300,000 journeys a year, or about 1,000 every weekday, it could easily be 2,000 or 3,000. It’s been and still is an absolute shambles – chaos.”

Michael Clayton, Coperforma’s chief executive, has apologised for the failings and blamed Secamb, the previous provider, for not supplying it with enough information in advance about the patients it would be transporting, and for asking thousands of patients to contact it on the first day of the change, overloading the company’s system.

In a statement, the company said: “Coperforma apologises unreservedly to all patients who have and are still experiencing delays in patient transport services. We investigate all out-of-line situations and report back to any patients or NHS staff affected.

“Our total focus is in improving the service we are able to provide in partnership with our transport providers and are working through core issues such as validation of patient data. We are currently in receipt of 19 formal complaints, three of which related to patients who had sadly passed away more than a year ago, information that should have been passed on to us prior to the start of our service.”