Appendix 5.4 MEETING: Haringey Clinical Commissioning Group Governing Body Meeting DATE: Wednesday, 26 March 2014 TITLE: LEAD DIRECTOR/ MANAGER: CLINICAL LEADS AUTHORS: CONTACT DETAILS: Contract Award Recommendation for NCL Direct Access Diagnostics Service Tim Deeprose/Leo Minnion Lyndon Wagman/ William Teh/ Neil Amin/Gillian Greenhough Leo Minnion, QIPP Project Manager Jeanetta Nelson, Clinical Procurement Manager Leo.minnion@haringeyccg.nhs.uk; Jeanetta.nelson@nelcsu.nhs.uk SUMMARY: The contract for the current London Diagnostics Service, which provides direct access diagnostics to Haringey GPs, ends on 31 March 2014. In response to this, a procurement process, led by NEL CSU, has taken place to secure provision of the service from 1 April 2014 for the five North Central London boroughs: Barnet, Camden, Enfield, Haringey and Islington. The process, outlined in this paper, has led to a recommendation for the contract to be awarded to In Health (the current provider). The panel, which included representation from all North Central London boroughs, all agreed that, of the bids received, In Health offered the highest quality and best value service. SUPPORTING PAPERS: The following supporting papers are available on request (please contact: Jeanetta.nelson@nelcsu.nhs.uk): Briefing note outlining the rationale for the procurement process Supply2Health advert Expressions of Interest summary Restricted Tender Pre-Qualification Questionnaire (PQQ) and Invitation To Tender (ITT) documentations Service Specification 1
RECOMMENDED ACTION: The Governing Body is asked to: RATIFY Chair s Action on behalf of the Governing Body to approve the contract award recommendation Objective(s) / Plans supported by this paper: This paper seeks ratification of Chair s Action, taken by Sherry Tang on 27 th February 2014 on behalf of the Governing Body to approve the award of a three-year contract to In Health to supply direct access diagnostics services. This has been a joint procurement process, coordinated by NEL CSU, with Camden CCG acting as the lead commissioner. Papers have also been sent to the relevant Governing Bodies in Barnet, Camden, Enfield and Islington CCGs with the same recommendation. Audit Trail: The recommendations were supported by the Haringey CCG Senior Management Team (SMT) on 12 February 2014 and the QIPP Delivery Group on 18 February 2014. John Rohan approved the award recommendation by Chair s Action on behalf of the Finance and Performance Committee on 26 February 2014. Chair s Action was taken by Sherry Tang on 27 February 2014 on behalf of the Governing Body to approve the award of a three-year contract to In Health to supply direct access diagnostics services. Patient & Public Involvement (PPI): A patient representative appointed by NEL CUS was involved in the development of the service specification and on the panel for the PQQ, ITT and final interview stages of the procurement process. Equality Analysis: Equality issues were discussed with a patient representative appointed by NEL CSU before the Pre-qualifying Questionnaire (PQQ), Invitation to Tender (ITT) and final interview stages of the procurement process. This ensured that equality issues were discussed and evaluated and the outcome used to inform the questions asked of bidders at each stage. RISKS Of the original risks considered at the start of the procurement, one is still active: Provider does not meet quality expectations Assurance: the winning bidder is the current provider of diagnostic service. This means that protocols and cross-provider working relationships have already been established and there will be minimal disruption to service once the new service starts. Mitigation: Service specification contains KPIs with trigger points to ensure that action is taken if quality measures fall below expectations. HCCG commissioners will continue to work with the provider to continually improve the service once it commences. RESOURCE IMPLICATIONS None 2
1 SUMMARY REPORT Haringey CCG is procuring a cost effective model of service based on: 1.1 Approved Business Case for NCL Direct Access Diagnostics The business case approved by Haringey CCG on 05/06/2013 demonstrates the service has been designed using evidence including: (i) activity types and volumes, (ii) what our patients have told us, and (iii) what needs to be taken into account for the future. The business case is based on activity Haringey CCG is responsible for, i.e. Haringey patients/residents presenting to Haringey GPs. The successful bidder will be required to provide a service to all Haringey GPs, for their registered patients, with an expectation that costs will be recovered from Haringey CCG commissioners. The proposed service will link with the integrated care programme. The service specification clearly defines expectations for a supplier to work within an integrated system In drawing up the business case and analysing historical activity, lead clinicians have taken the view that there can be a better pathway of care for patients that improves access for them and ensures they are treated by the right clinician in the right place. 2 STRATEGIC CONTEXT 2.1 Briefing Notes 3rd June and 20th November 2013 The current LDS contract ends on 31 March 2014. This contract is a pan London diagnostic services contract between NHS England (previously DH) and InHealth Ltd. The diagnostic services provided are MRI, Ultrasound scanning, Cardiac services (Blood Pressure monitoring and ECG scanning), Endoscopy, Audiology services, DEXA scanning and X-Rays. When the contract ends, General Practitioners in London will no longer be able to refer patients to InHealth under the contract. To continue to use these diagnostic services, the NCL CCGs will need to establish a new contractual arrangement with a provider before the end of March. Coordinating and aligning tendering processes between CCGs will maximise economies of scale, increase bargaining power with potential providers and make the tender processes easier to manage. The NCL CCGs made a joint decision, which was agreed at a Chief Operating Officers meeting on Friday 5 July 2013 that they would procure a single provider for a direct access diagnostics service delivered and accessible across the geography in NCL. The contract which is held by NHS England with the current incumbent service provider, InHealth, terminates on the 31 March 2014 and NHS England has stated that there is no provision to extend this. Chief Finance Officers were asked to give a view on the pricing and scoring mechanism for the pricing elements of the procurement. 3 MODALITIES At the QIPP Delivery Group on 20 September 2013, it was agreed that Haringey CCG should commit to MRI and Ultrasound with only options available on other modalities. This was reflected in the service specification. Although all boroughs chose not to procure 3
endoscopy and audiology services under the new contract, Haringey CCG is the only borough that will not procure DEXA, X-Ray or Cardiac Diagnostics (see table 1). Table 2: Modalities indicated for each borough in the service specification Cardiac MRI Ultrasound DEXA X-Ray Diagnostics Endoscopy Audiology Barnet Yes Yes Yes Yes Yes No No Camden Yes Yes Yes Yes Yes No No Enfield Yes Yes Yes Yes Yes No No Haringey Yes Yes No No No No No Islington Yes Yes Yes Yes Yes No No 3.1 Inclusion of DEXA and Cardiac Diagnostic Services DEXA scans account for approximately 3% of current In Health activity (approximately 200 episodes p/a) and there is concern that stopping this service could lead to an increase in GP referrals to hospital rheumatology services. Cardiac services account for about 10% of current In Health activity (approximately 700 episodes p/a) and redirecting this service to secondary care providers may lead to unintended consequences such as an increase in cardiology outpatient activity. 4 PROCUREMENT PROCESS Following approval Haringey CCG on 05/06/2013 a restricted tender was advertised on the NHS Supply2Health on 18 th September 2013. Initially 13 (thirteen) organisations expressed an interest in delivering this service however only 9 (nine) organisations submitted Pre-Qualification Questionnaires (PQQs) by the deadline of 28 October 2013. A Restricted Procedure route (Pre-Qualification Questionnaire [PQQ] and Invitation to Tender [ITT] was chosen to procure the service, with the process commencing in September 2013. Table 2 outlines the procurement process timetable: Table 2: The Procurement Process Activity Date Business Case approved by Haringey CCG 5 June 2013 Advert Placed on Supply2health 18 September 2013 MOI, Information & Guidance issued 18 September 2 October 2013 PQQ issued 3 October 2013 Deadline for clarification questions 21 October 2013 Deadline for PQQ submission 28 October 2013 PQQ Evaluations 29 October 8 November 2013 ITT Issued to successful bidders 6 December 2013 Tender submission deadline 9 January 2014 4
Tender Evaluations 10 January 21 January 2014 Presentation/interview 23 January 2014 Contract Award Approval by CCG Board February 2014 Successful and unsuccessful bidder notification February / March 2014 Standstill Period March 2014 Contract Signature March 2014 Commence mobilisation March 2014 Expiry of current provider(s) 31 March 2014 5 EVALUATION PANEL An evaluation panel was established at the start of the process prior to the advertisement being issued. 5.1 PQQ Evaluation Panel: Keith Spratt, Commissioning Lead, Enfield CCG Dr Lyndon Wagman, Clinical Lead, Barnet CCG Nim Johnson, Patient Representative Sarah Morgan, Clinical Lead, Camden CCG Sharon Barrington, Commissioning Lead, Camden CCG Thanos Loli, IG Lead, CSU Leo Minnion, QIPP Project Manager, Haringey CCG 5.2 ITT Evaluation Panel: Keith Spratt, Commissioning Lead, Enfield CCG Dr Lyndon Wagman, Clinical Lead, Barnet CCG Teresa Callum, Commissioning Lead, Barnet CCG Nim Johnson, Patient Representative Gillian Greenhough, Clinical Lead, Islington CCG Sharon Barrington, Commissioning Lead, Camden CCG Leo Minnion, Commissioning Lead, Haringey CCG Thanos Loli, IG Lead, CSU Eleanor Davies, HR Lead, NELCSU In addition, Clare Kapoor, Commissioning, Enfield CCG undertook an overall assessment of the bids. The following Finance Leads were issued with the financial submissions for their assessment: Rael Gamsu, Antoinette Jones and Stephen Carruthers. 5
5.3 Presentation Evaluation Panel: Keith Spratt, Commissioning Lead, Enfield CCG Teresa Callum, Commissioning Lead, Barnet CCG Nim Johnson, Patient Representative Gillian Greenhough, Clinical Lead, Islington CCG Leo Minnion, Commissioning Lead, Haringey CCG Dr Neil Amin, Clinical Lead, Enfield CCG Evaluation of the PQQs and ITTs were undertaken independently by each member of the panel. Moderation meetings were held after each stage in order to discuss the differences in views on the bidders responses and to arrive at an agreed view for each stage. Both moderation meetings were facilitated by the Procurement Lead to ensure a robust process. The evaluation panel received procurement advice and support from North and East London Commissioning Support Unit s clinical procurement team throughout the process. 6 PRE-QUALIFICATION STAGE Following approval by all 5 CCGs the restricted tender was advertised on the NHS Supply2Health portal on 18 th September 2013. The deadline for expressions of interest was 3 rd October 2013 and the deadline for PQQ submission was 28 October 2013. 6.1 Expressions of interest and PQQ submissions Initially 13 (thirteen) organisations expressed an interest in delivering this service. However only the following nine (9) organisations submitted Pre-Qualification Questionnaires (PQQs) by the deadline stated above: 1. Barnet & Chase Farm Hospitals 2. Lyca Healthcare 3. North Middlesex University Hospitals Trust 4. Alliance Medical Ltd 5. Royal Free London NHS Foundation Trust 6. InHealth 7. Global Diagnostics Ltd 6.2 PQQ Evaluation These PQQs were then evaluated by the subject matter experts. There were two stages in the PQQ evaluation a Pass/Fail section and then a section where scoring was involved. Bidders who failed any of the Pass/Fail questions were excluded from the process and their scoring questions were not evaluated. The remaining PQQ submissions were evaluated in full and the following four (4) bidders who achieved the highest points and met the minimum score thresholds were shortlisted to the Invitation To Tender stage of this procurement and were issued the Invitation to Tender documents. The bidders shortlisted to the Invitation to Tender stage were: 1. Alliance Medical; 2. Global Diagnostics; 3. InHealth, and 6
4. Royal Free NHS Foundation Trust 7 INVITATION TO TENDER (ITT) STAGE Invitations to Tender (ITTs) were issued on 6 December to all shortlisted bidders. Bidders were given opportunities to ask clarification questions. The deadline for submitting tenders was set as 5pm on 9 th January 2014 and the CCG received tenders from all the 4 above mentioned organisations: Tender responses were received as sealed bids. The procurement lead removed the seal, verified the submissions and released them to the evaluators for scoring. There were three stages in the tender evaluation process 1) Pass / Fail stage Financial submissions 2) Scoring stage ITT submissions 3) Bidder presentation and interview stage. 7.1 ITT Evaluation and Weighting As was set out in the briefing note and the advert, NHS Barnet, Enfield, Haringey, Camden and Islington had set maximum prices to be paid for the modalities to be included in the tendered service (see Appendix A). The tender documentation therefore stated that bids above the maximum prices would not be evaluated. As a result, all bid submissions were equal to or below the maximum prices. The bidders submissions were assessed on the following weightings: Qualitative: 80% weighting; Presentation: 20% Financial cost per point scoring As stated in the ITT, this involved a weighting for each price submitted, based on estimated usage. The bidders price was divided by their quality and presentation score and then multiplied by the relevant weighting to give a cost per point. As was set out in the tender documentation tender submissions were assessed on the following evaluation criteria and weights: Table 3: Weighting Evaluation Criteria Weights Qualitative elements 80% Service Delivery (30%) Clinical Governance, Performance and Quality (30%) Workforce (10%) Patient Focus (10%) Information (5%) Information Governance (10%) Mobilisation and Contingency (5%) Bidder Presentation/Interview 20% 7
Bidders were required to demonstrate in detail how they would deliver the service as described in the service specification through their responses to a number of questions. In considering and scoring these responses, the panel assessed the capability, capacity and quality of each bidder s proposals. 7.2 ITT Scoring Process The sections of the ITTs were scored by panel members. The process was as follows: Evaluations were issued with panel scorecards to complete their evaluation and scoring. Responses to each question were evaluated independently by the respective panel members with scores and rationale for their score recorded on an individual scorecard. The individual evaluator applied a marking score of 0-4 depending on the material and information provided. The Procurement Lead was responsible for collating the scores and identifying where there was 2 or more points difference in scoring for moderation. This allowed direct comparison of scores and, at the moderation meeting, for discussion between panel members on their reasons for the scores that they gave. Panel members were free to moderate their scores as a result of discussion or to maintain them as originally scored. A moderation meeting was held on Thursday 23 January 2014 to moderate any scores where there were two or more points difference in score between evaluators. Following the moderation meeting, the Procurement Lead updated the final score card with the moderated score and the rationale for any revisions to the initial score. A duly completed moderation spreadsheet was issued to all the evaluators, including the finance leads to leave a proper audit trail of the moderation process. 8 BIDDER PRESENTATIONS AND INTERVIEWS After the moderation meeting, based on a minimum threshold of 55% for the ITT stage, two bidders were invited to the presentation day on 30 January 2014. 8.1 Panel Presentation Bidders were advised in advance of the presentation question, and advised of the evaluation criteria. They were asked to deliver a 15 minute presentation on the following topic: How would you address the current issue of providers repeating radiological and cardiological investigations when referred? 8.2 Panel Interview All bidders were asked, during the presentation, to provide responses to 5 unseen questions to the evaluation panel. These consisted of referral processes, reporting standards, consistency and quality of service to all sites, managing imaging serious incidents / root cause analysis, requirements for new sites. 8.3 Scoring 20% of the overall marks were reserved for this stage. As before, presentations were marked individually and moderated after all bidders had presented. The session was facilitated by the Clinical Procurement Lead who took no part in the scoring. A discussion on the overall ranking of the panel presentations was undertaken with panel members. 8
Subsequent to the Presentation meeting, the Clinical Procurement Lead provided these scores to the Finance Lead to add to the ITT scores and pricing information for consolidation to arrive at the final cost per point scores. Following a review of the final overall scores, the panel agreed that the contract for the NCL Direct Access Diagnostics contract should be awarded to InHealth. Detailed feedback will be provided to the unsuccessful bidders. 9 FINANCIAL POSITION This procurement has been developed as part of the QIPP Programme in Haringey CCG. Notice has been given to the current direct access diagnostics providers (In Health) and it is proposed that the new service be re-provided on a local tariff basis from 01/04/2014. A full financial analysis has been undertaken by the Senior Financial projects officer for the CCG. This analysis includes sensitivity testing against a range of scenarios. Scenarios tested included the flexing of activity between tariff bands and variations in activity being streamed into and away from the UCC. In all cases the outcome of the financial evaluation was consistent in that the preferred bidder retained the highest score. The outcome of the ITT process has resulted in a bid that will represent savings against the do nothing scenario. 10 MOBILISATION PROCESS The bidders have been notified of the outcome of this process and the 10 days standstill period ended on 25 March 2014. The CCG will now initiate contract negotiations with InHealth and proceed to signing of the NHS Standard Contract. This will be followed by operational mobilisation which will be overseen by the QIPP Director for the CCG. 11 CONCLUSION In light of the above, the Governing Body is asked to ratify Chair s Action to approve proceeding to contract discussions on successful completion of the standstill period and the award of contract within the terms of the tender as outlined above. 12 NEXT STEPS AND RECOMMENDATIONS Contract signing will take place following the end of the 10 day standstill period Service mobilisation will commence Haringey CCG will arrange for DEXA and Cardiology Diagnostics to be included in the service specification, in addition to MRI and Ultrasound. Planned service commencement from 1 April 2014. 9