Talking on Radio Devon this morning I spoke about why Clinical Commissioning Groups do have the power to support local caring charities. Below is a transcript of the conversation that took place when Dr David Bennett, Chairman and Chief Executive of Monitor, gave evidence to the Select Committee and was questioned by me about the situation facing locally based charities like Dartmouth Caring.
The official recording of the Health Select Committee Evidence Session is available here
Dr Wollaston: There is no significant change yet, so it is too early to say. Can I ask about a specific point? A complaint and fear I am often hearing if I visit small local charitybased providers-for example, organisations in my areas such as Dartmouth Caring and Brixham Does Care, which are very locally focused and often have great community buyin-is that they are not being allowed a foot in the door. If things go out to competitive tender, they do not have the resources to put in a tender and they fear that they may lose out to big countywide providers that do not have a local focus. We could end up losing that important resource, the really good service that they can provide on a very small amount of money. What is your view there? Will you be encouraging commissioners to engage directly with locally focused groups and make allowances for the fact they do not have the resources to put in fancy bids?
Dr Bennett: First, my overall view is that charitable organisations play an extraordinarily valuable role, both the very big ones and the small ones, across the whole country. Whatever we do, it should not be making that more difficult. Indeed, they will complain that it was already-under the old rules, the old behaviours-less easy than they would like. In fact, we have just published a big report looking at this very issue called "A fair playing field for the benefit of NHS patients," a review which identified that one of the biggest problems in terms of providers being treated fairly is the fact that many of them feel they could be providing a better service than the incumbent provider and do not get an opportunity to do that. That was a complaint we heard from charitable organisations from lots of foundation trusts that would like to be providing services outside their current area but are finding it very difficult. It is a complaint, too, that the independent sector will make. Our recommendations were basically to say that we must do more to help commissioners give everybody a fair opportunity to provide services, including the small charities. When you talk to the commissioners, it is not fundamentally a lack of willingness that is the problem. They just find it very difficult. They do not know how to do it. This tendency to go through very bureaucratic, costly competitive tendering processes is not necessary. They need some help to understand that there are other ways of doing it.
Dr Wollaston: But it is often because they are fearful that, if they don't follow very rigid procedures, they cannot accept bids from organisations that do not have the resources maybe to do it strictly in the way that a bigger organisation could do it. Could you reassure me that where they are bringing in locally based-particularly charity-providers without those resources, they will not be expected to produce the kind of bids that you would expect from a commercial organisation?
Dr Bennett: I have to make the general statement that we need to work to make it possible for these small charities to continue to participate. Dr Wollaston: What does that mean? Does that mean them having to federate with other charities to produce-
Dr Bennett: It might do.
Dr Wollaston: The reality is that this takes up a huge amount of time, and if you are a volunteer organisation, with the best will in the world, and you may be providing a fantastic service, you do not have the people on the ground that can put that kind of thing together.
Dr Bennett: I can only tell you that I am extremely sympathetic to that, but I should not let you draw me into making some blanket statement that may not always be right. There may be situations where it is not appropriate to give it to your local small charity and not consider other providers or not to run some sort of process to select the best provider.
Dr Wollaston: Could I perhaps ask that an organisation like Monitor directly goes and visits some local charities-for example, Dartmouth Care-to see what the issues are on the ground?
Dr Bennett: I would be very happy to. We did talk enormously to them during the course of this "A fair playing field" review and we absolutely recognise the problem. The starting point is to get commissioners to understand that, even where they want to choose between different providers, they do not have to go through this hugely bureaucratic process they often run. It is a general problem in the public sector and I do not understand it.
Dr Wollaston: It is a fear rather than a reality on the ground. Here you cannot provide them with any guidelines.
Dr Bennett: No, we are working with the Commissioning Board to give the commissioners better guidance about how to do these sorts of things