4th April 2013 

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Born yesterday               
News and Comment from Roy Lilley

The incidence of twins born in England is included in a set of numbers called the Twinning Rate.  It's up; from 9 per 1000 maternities in 1980 to 16.1 in 2009.  Nowadays about one in 32 children born is a twin.


I wonder how many twins there are working in the NHS?  With a workforce of about 1.3m there should be a good few. It's funny, I don't know any twins.  Do you?  Although, having said that I think there is a twin.  Maybe a doppelganger?


I think there are two David Bennett's (the �200k boss of Monitor).


There is someone called David Bennett who told the Cass Business school; 'As a sector regulator, we should be guided by the evidence, and there is evidence which shows that choice and the competition between providers that goes with it can be a valuable tool, alongside other levers and incentives, driving up quality, efficiency and effectiveness, and encouraging innovation'.


Warming to his theme he went on to add; '...a study led by Carol Propper of Imperial College and Bristol University showed that greater competition results in better management, which in turn leads to improved clinical outcomes such as survival rates from emergency heart attack admissions'.


You might think that is enough of 'David Bennett'.  But no; I can authoritatively announce there is another 'David Bennett'.  This one told the HSJ's excellent CrispinDowler; "... (Monitor) would be "... mad" to enforce those rules in a way that left commissioners "spending all their time running competitive processes because they're terrified they're going to get in trouble if they don't".


Do we have two David Bennetts?  Or is there one David Bennett with two minds, or perhaps one David Bennett that thinks people working hard in the NHS are stupid, don't have memories, access to Google or a nose for a contradiction, recognise a whiff of ambiguity when they smell it  and the scent of a cheap eau-de-cologne called 'Contradiction'.


Yes, I accept, I have selectively quoted from the Bennett Twins.  That's why I've linked to their pronouncements.  See for yourself.  However, I can only do this because the Twins have left open room for question, concern and at the very least competence.


It seems to me neither the Twins, the Carbuncle nor LaLite seem to get it (or don't want to).  The law trumps guidance, letters of intent, billet-doux and wishes for the Tooth Fairy.  The Health and Social Care Act is clear and unambiguous:


Regulation 5 of the National Health Service (Procurement, Patent Choice and Competition) (No. 2) Regulations 2013 requires a CCG to put every arrangement that they make for delivering NHS services out to the market unless the CCG is satisfied that the services can only be delivered by a "single provider".  The "single provider" test is the only test in the Regulations which decides whether a competition must be held for a particular NHS service. The test is not whether the CCG 'thinks' that a procurement competition for the right to provide that service is in the interests of patients but whether 'there is' only a single provider who could deliver the service.


I know that, you know that and the Bennett Twins and the Carbuncle know that and unless LaLite wants to change the law - he knows that.


Let's spell it out; there are almost no circumstances, I can think of, in a town with two hospitals, where there will be only one provider.  FT boards have a fiduciary duty to maximise their income and acquisitive Boards will drive competition.  I can think of no circumstances where a private provider of services will not insist on competition.  How else

will the likes of Virgin and Circle expand their market share?


If a contract is let without competition the aggrieved party can complain.  To whom?  To the Bennett Twins and if a disappointed organisation is not sure how to do it the Twins have obligingly told them.  


If we are to take the word of one of the Bennett Twins, the other one should be at the forefront, insisting the Regulations are changed.  Or do they think we were all born yesterday.


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