Can governments be trusted with commissioning?

The fiasco over West Coast Main Line rail franchise raises questions of whether ministers or civil servants can be trusted with commissioning projects in the future. Alasdair Palmer writing in the Daily Telegraph described it as ‘the latest in a long line of blunders in the way the state awards contracts to private companies.’

The Department of Health is not immune from this, remember the project to modernise the NHS computer systems, abandoned after £12 billion had been spent and wasted. Yet commissioning remains the cornerstone to provision of healthcare across the NHS including dentistry.

Indeed in its response to the recent Office of Fair Trading report, the government once again committed itself the principle of commissioning NHS primary dental care, with all such decisions being vested in a central mammoth NHS Commissioning Board.

Locally decisions will guided by advice from professional networks, with the added possibility of ‘jobs for friends’, maybe even brown envelopes stuffed with cash.

The rail franchise was initially awarded on the (inaccurate) basis of the winner being cheapest, not on whether it could provide a better service for passengers. The experience in dentistry over the past six years is that dental contracts are awarded to the cheapest, not those that will deliver the best patient experience.

What will happen when Sir Richard Branson in the form of Virgin Healthcare challenges a decision of the NHS Commissioning Board in the courts? Will it expose the flimsy basis on which NHS commissioning is based?

Of course until 2006 patients could choose which dentist to attend and what treatment to have. They were at the centre, but this, of course, robs the bureaucrats of their power and cannot be tolerated in the new world of the NHS.

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