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Appendix 5.4
MEETING:
Haringey Clinical Commissioning Group
Governing Body Meeting
DATE:
Wednesday, 26 March 2014
TITLE:
Contract Award Recommendation for NCL Direct Access
Diagnostics Service
LEAD DIRECTOR/
MANAGER:
Tim Deeprose/Leo Minnion
CLINICAL LEADS
Lyndon Wagman/ William Teh/ Neil Amin/Gillian Greenhough
AUTHORS:
Leo Minnion, QIPP Project Manager
Jeanetta Nelson, Clinical Procurement Manager
CONTACT DETAILS:
[email protected];
[email protected]
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:
[email protected]):

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 27th 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
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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.
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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.
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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
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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
MRI
Ultrasound
DEXA
X-Ray
Cardiac
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.
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PROCUREMENT PROCESS
Following approval Haringey CCG on 05/06/2013 a restricted tender was advertised on the
NHS Supply2Health on 18th 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
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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
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EVALUATION PANEL
An evaluation panel was established at the start of the process prior to the advertisement
being issued.
5.1
5.2
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
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.
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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 18th September 2013. The deadline for expressions of interest was
3rd 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
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4. Royal Free NHS Foundation Trust
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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 9th 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%
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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:





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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.
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.
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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.
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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.
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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.
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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.
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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.
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