Tails wagging dogs

When contracts and procurement dictate how you do business rather than support you to do the kind of business you want to do, you know something is wrong.

I read Nigel Edwards and Robert Breedon’s piece in the HSJ last week and strongly support their argument. Yes we need a range of contract types and lengths. We need to select the right ones for the right circumstances to get the right results.

The article raises the issue of the disconnect between strategy and implementation. In health and social care we are pretty good at partnerships and strategic joint working. Purchaser provider splits, competition and procurement are recent developments compared with other sectors. So we are well used to getting round the table and sharing ideas. We have had urgent care networks, cancer collaboratives, joint health and care strategies to name but a few. Sometimes these are strategic, sometimes improvement and development, occasionally operational.

The problem has been that these mostly carry on in a completely different universe to the contracts and finance discussions. Mention these two words and people either switch off or say we need to ask the contract and finance teams. Or the collaborative discussions are all going fine until January to March when they have to go on hold while heated debates with thumping of tables has to be enacted for the obligatory ‘contract round’.

Shouldn’t we be making contracts and procurement support what we are trying to do strategically? Of course there are important rules and guidelines that you need expert advice about and need to adhere to. But quite often, people imagine constraints that are not actually there.

The simple point is that if you want to have integrated care, with providers and professionals collaborating with each other, then you have to procure and contract in a way that promotes this. No point saying you want collaboration and then setting up adversarial, micro managed contracts with different objectives and funding arrangements for different parties. That is a perfect design for the table thumping and finger pointing, not for collaboration.

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