NHS Pricing on labels

Jeremy Hunt, the health secretary, is leading an initiative to put indicative prices on all NHS medicines over £20.  Though I have been negative about some government initiatives, this is one I support - though before you swoon in surprise I have to point out that I think the strapline "paid for by the taxpayer" is cheesy and unnecessary.  (I am though quite in favour of the proposal of a chap on BBC Question Time that MPs should have to wear the same line on a badge on their suits - but maybe it doesn't go far enough and we should insist they all wear HM Parliament boiler suits branded with that as a logo.  But I digress)

People are very unaware of the costs of the NHS.  A prescription costs £8.20.  I am not sure how much of that is actually administration costs (and I cannot find it - perhaps you know?) but given that a private prescription from a doctor may cost £15, and according to CIPS a Purchase Order typically costs £50, I believe that in fact ALL that charge is administration cost (and probably does not cover all of those costs).  So we literally do not pay for the pharmaceutical at all - just contribute to the administration of the process.

Which of course leads to the usual complaints that is is cheaper to buy Asprin over the counter than to get it through prescription.  People do not realise what they are actually paying for.

Let's do some back of a fag packet assessments.  (now that few people smoke, what can we use instead of fag packets?  Just asking)

Nearly 20 years ago my wife was taken ill in the USA.  Though we had medical insurance the bills we received (and had to pay before claiming back the money) where a real eye-opener.  The initial 5 minute consultation with a doctor was $50 - he said "go to hospital".  Kerching.  We went to hospital, where my wife had a 5 minute consultation ($150), and got a prescription for antibiotics, which cost us $80 at a nearby pharmacy.  Total cost $280 plus a bit of driving around.

Recently my son broke his ankle here in the UK.  A NHS doctor's consultation (she said "go to hospital"), a 5 minute consultation with a nurse, an x-ray, 5 minutes with a doctor, plaster clinic, and loan of crutches cost us £2.50 in car parking fees.  Subsequent new rubber ferrules for the crutches, x-ray, removal of cast, 5 minutes consultation with doctor cost us a further £2.50 in car parking fees.  A total of £5 and a bit of driving.

Looking on the internet the cost to the NHS might be £4 for the ferrules alone.  (Ferrules was a new word for me, so I am getting maximum mileage from it)  Based on salary cost of £50/hour that is £25 of staff time at minimum.  We haven't even considered overheads, infrastructure etc.

Based on my US experience I would expect that the cost might have been say twice what we paid 20 years ago, so $560 or £350.  According to this website that might be the lower end of a range that could run from $520 to $1000, or even $2500.


If you get something free you tend not to value it, but to take it for granted.  The NHS is free at the point of use, which is great because I did not need to consider the cost or call my insurance before taking my son to the doctor.  However I then did not actually value the service accordingly.

Incidentally my kids were born by emergency Caesarian section back in 2002.  The average bill for that in the USA according to a 2011 study by Truven Health Analytics was $50 000.  For that operation, and a month in Intensive Care Baby unit we paid just some car parking fees.   I call that a bargain.  How much of a bargain, I only realised by doing some research.

If I had been presented with an indicative bill for that service, then perhaps it would put the complaining about the price of parking into a bit of perspective.

The illustration incidentally is for a US bill for treating a snake bite.  Ouch and ouch again.

Tender Evaluation and moderation

Stephen Ashcroft of AECOM, and Spend Matters have highlighted a recent case between Bristol Missing Link (BMLL) and Bristol City Council.  They have fuller details but in short BMLL are the incumbents and have challenged the award of a contract to a new supplier after a tender process.  The decision was close, and the court has suspended the implementation of the contract until a full hearing of the challenge.

It will be interesting to hear what the verdict is in the full case, but in the meantime there are a couple of points to remind ourselves about when evaluating tendering.

The case hinges on the scoring process, and the subsequent moderation of those scores.  Bristol's case appears to be hampered by the lack of evidence (either written at the time or subsequently to the court) about those processes. 

The names of most of the individual evaluators have been redacted, as I would expect (at least in initial stages of the case).  Their initial scores have been significantly changed during the moderation stage because they were initially not in compliance with the published scoring regime - these changes were significant enough to change the award of the contract.

So the key points I take from this are;
- firstly, the (external) chair of the moderating panel should have emphasised before marking began that the published scoring regime must be used.  If they (she) did then the panel did not listen. 
- second, that instruction could/should have been documented to demonstrate compliance to process
- third, those scoring sheets are a matter of public record and available under the Freedom of Information Act for precisely this sort of situation
- fourth, moderation of scores is allowed and this was stated by the court
- fifth, they were correct to moderate rather than take a simple average
- sixth, they were correct to re-score at moderation to ensure the correct scoring process was adhered to, but
- seven, they should have documented that process including the instructions to evaluators, the process followed, and the consequences.  I am surprised that when the consequence of the re-scoring was a change in the successful bidder that this was not checked, re-checked, documented and reported in detail.  That is what I would have done.
- eight, there seems to have been no report on the tender process, which should be a matter of routine but particularly so when the decision is close or is in any way subject to re-evaluation
- nine, the evaluation panel are either unwilling to give evidence or have been instructed not to give evidence to the court, which does not help their claim to be acting in an open, honest and transparent manner (regardless of whether they actually are doing so, which I expect they are).

What do I take from this?  Well as chair of the panel, do instruct your evaluators and make a note of doing so.  Document the moderation process.  When bids have to be re-scored, then ensure that all bids are scored using the same regime and all the individual evaluators are fully committed to their scores for each bid.  When bids are close, get evaluators to double check their scoring and document the responses.  Do write a tender report detailing the process, the scores, any issues, and comment on the overall result.  Do create an evidence trail, and do expect that trail to be public knowledge (though in practice most times it will not, or will not matter).  Be prepared to defend your process and your decision.

This is at the heart of the tendering process.  If bidders do not trust you to evaluate their proposals fairly and in line with what you have published, then there is no point in bidding.

Eliminating PQQs - the consquences

I know I keep wittering on about this, but I believe that the elimination of PQQs will have the opposite result to that intended - increased participation by SMEs in public contracts.  Philip Prince of Constructionline takes a similar view in Supply Management Magazine.


http://www.supplymanagement.com/blog/2015/06/new-public-contracts-regulations-risk-increasing-the-burden-on-buyers-and-sme-suppliers