Category Archives: procurement

Are officials pressing GPs to switch IT supplier to SystmOne?

By Tony Collins

There’s concern in the NHS that Primary Care Trusts, which are due to be abolished next year, are putting GP practices under pressure to switch their IT systems to TPP SystmOne, a patient record system that is supplied by CSC under the National Programme for IT.

The conversions are being subsidised by taxpayers under unpublished NPfIT local service provider contracts. The concern of at least one aspiring Clinical Commissioning Group – which is one of the CCGs being formed under Andrew Lansley’s health reforms –  is that GP system conversions to TPP SystemOne under local service provider NPfIT contracts could leave CCGs a legacy of financial commitments that are as yet unknown.

One CCG contacted Campaign4Change to express concern that it may have uncertain financial commitments when it begins to take on SystmOne commitments next year. On 1 April 2013 PCTs and strategic health authorities are due to be abolished and their responsibilities passed to authorised CCGs.

Aspiring CCGs are now taking a close interest in PCT financial commitments because the Groups are due to inherit any of their local PCT deficits incurred from 1 April 2011 to 31 March 2013.

At present, GP practices receive PCT funding whether they take replacement SystmOne patient record technology from CSC  under the NPfIT or acquire new IT under a scheme known as GP Systems of Choice.

But the Group’s spokeswoman said that PCTs are putting pressure on GP practices to replace their systems with SystmOne. She said it’s because it can cost PCTs less – or nothing – for a GP switch to SystmOne under NPfIT-funded local service provider contracts. In comparison PCTs may have to pay costs such as hardware maintenance when GPs acquire systems under GPSoC.

Incentives for GPs to switch IT supplier

Our inquiries show that at least one PCT has received what it called “incentives” from its strategic health authority for GP practices to change computer systems, according to the PCT’s response to an FOI inquiry. The FOI response said: “The PCT can confirm that the incentives passed to [GP] practices to change computer systems as follows”.

It went on to say that its strategic health authority gave the PCT a £10,000 implementation fee [for each GP practice that changed its systems]. The PCT passed £3,000 of the £10,000 to the GP practice to part fund its implementation costs.

The PCT’s preferred GP system supplier was SystmOne, as supplied by CSC.

What happens when CSC’s NPfIT contract expires in 2015?

At that time Clinical Commissioning Groups may have to pay whatever costs are levied because GP practices with SystmOne could be reluctant to switch systems again, said the CCG spokesperson.

The Department of Health’s Informatics Directorate, which has subsumed NHS Connecting for Health, has confirmed that the prices it pays CSC for TPP installations are confidential.

Said a DH spokesperson “While prices within the LSP [Local Service Provider] contracts are commercially confidential we are in partnership with Intellect, the Technology Trade Association, to develop an open and transparent approach to costs and quality, as part of working to create a vibrant marketplace.”

A spokesperson for CSC said  “Because we are in active negotiations with the government, we are not able to comment in depth on the programme until those negotiations have concluded.”

The spokesperson said the comments applied to TPP as it is “a supplier to us working on the National Programme”.

Department of Health response

When asked if GP practices are taking on non-transparent NPfIT commitments for TPP systems, the DH spokesperson said “If a GP practice chooses to take a system under an LSP contract they are made fully aware of the product they are taking and the length of the contract.

“We are committed to ensuring transparent and trusting working relationships between suppliers and their NHS customers.”

Asked whether GP practices that choose GPSoC systems cost the PCT more than TPP acquired through the LSP contracts, the DH spokesperson said “ It is up to the GP practice as to whether they choose a system through GPSoC or through the LSP contracts.

“The GPSoC PCT/ Practice agreement provides a mechanism for GPs to raise and resolve any concerns they may have.”

Comment

Centrally-funded incentives to PCTs to encourage GPs to switch to SystmOne as supplied by CSC under the NPfIT keep alive one of the original objectives of the national programme, which was to have health IT dominated by a few suppliers that would be under firm central control.

But that strategy creates an imbalance in the health IT market, inhibits open competition and leaves the NHS with unquantifiable future costs given that SystmOne is being supplied under NPfIT contracts that are secret.

Favouring central control, Labour created the NPfIT. In contrast the coalition favours decentralisation so it makes sense for GPs to have a genuine choice of suppliers, with the funding PCTs remaining neutral on the decision.

TPP SystmOne is good enough to compete freely in the open market. It does not need a leg up from the PCT or the Department of Health – just for the sake of keeping a part of the original NPfIT alive.

 

CSC to change hands in 2012?

By Tony Collins

Techmarketview analyst Tola Sargeant who has followed the NPfIT closely, and particularly the ups and downs of CSC, says the implications for CSC of the government’s tough stance against the company are “dire”. She adds:

“Indeed, we wouldn’t be at all surprised to see CSC change hands in 2012 as a result”.

Maude gets tough 

Within the Department of Health and CSC in May last year executives were confident a new memorandum of understanding under the NPfIT would be signed.

Now the Government, in the form of the Cabinet Office minister Francis Maude, has declined so far to sign any new deal with CSC. This is the way CSC put it in a filing to the SEC, the US regulators, on 27 December 2011:

“… Since mid-November 2011, the parties [Department of Health, Cabinet Office and CSC) have been engaged in further discussions relating to the MOU [Memorandum of Understanding], which have included discussions regarding a proposed contract amendment with different scope modifications and contract value reductions than those contemplated by the MOU.

“However, CSC recently was informed that neither the MOU nor the contract amendment then under discussion would be approved by the government.

“Notwithstanding the failure to reach agreement, CSC anticipates that the parties will continue discussions in January 2012 regarding proposals advanced by both parties reflecting scope modifications and contract value reductions that differ materially from those contemplated by the MOU.

“As a result of the circumstances described above, CSC has concluded, as of the date of this filing, that it will be required to recognize a material impairment of its net investment in the contract in the third quarter of fiscal year 2012.

“Until CSC and NHS conclude their on-going discussions concerning a possible contract amendment, including any scope modifications and contract value reductions that might be part of any such amendment, the Company is unable to estimate the amount of such impairment.

“However, depending on the terms of such an amendment or if no amendment is concluded, such impairment could be equal to the Company’s net investment in the contract, which, as of November 30, 2011, was approximately £943m ($1.5bn).

“Additional costs could be incurred by CSC depending on the nature of such an amendment, or if no amendment is concluded. The Company is unable to estimate the amount of such additional costs; however, such costs could be material.”

Why the Cabinet Office has left draft MoU unsigned?

The non-signing of a new deal with CSC is the firmest indication so far that the Cabinet Office is prepared to bring a rigorous, independent scrutiny to big IT projects and contracts.

Though the DH had wanted to sign a new deal with CSC, at least to assure continued support and upgrades to the few NHS trusts that have installed CSC and iSoft’s “Lorenzo” patient records system,  Maude is said to have seen a new deal with CSC as rewarding the company for failings in the past.

Also Cabinet Office officials regarded the terms of a new deal with CSC as unattractive. One Cabinet Office official wrote in a memo dated March 2011 that CSC’s proposals would mean a reduction in Trusts using CSC IT from the original number of 220 Trusts to 80.

 “My view is that, on the face of it, while the additional savings are appealing, the offer is unattractive. This is because the unit price of deployment (per Trust) under offer roughly doubles the cost of each deployment from the original contract.

“Ultimately, we [Cabinet Office] are not convinced the [Department of] Health commercial team are approaching this in the best way.”

It is possible that a new deal for signing was put before Maude – and went unsigned. Had any appeal gone to the Prime Minister David Cameron it is highly likely he would have given his full backing to Maude.

David Cameron’s view?

Cameron may be delighted that at least £2bn remains uncommitted to the NPfIT and could be saved by not signing a new deal with CSC.

Conservative MP Richard Bacon, a member of the Public Accounts Committee who has become an authority on the NPfIT, said of CSC’s warning of write-offs on the Programme:

“It was always a worry that the Department of Health was initially keen to sign a new deal with CSC that would have been poor value. Now it seems the Cabinet Office has done its job as an independent scrutineer and has made sure the interests of taxpayers are protected.

“This shows how important it is for the Cabinet Office to have the final say on big Government IT-based projects.”

What does CSC’s plight mean for the NHS?

NHS trusts have long wanted open competitive tendering and now, to a large extent, they have it. More than a dozen acute trusts are likely to tender for major systems replacements this year which is a big increase on the annual rate for past years.

Some iSoft and Cerner sites may also seek to renew contracts or find replacement systems. CSC, which may be lifted of the burden of meeting high-priced NPfIT commitments, may be a strong competitor in the UK health market.

One problem for NHS trusts will be finding enough strong candidates for their shortlists. They may look to the US market – but end up with products that need anglicising, which will be risky process.

Techmarketview says that what is doom and gloom for CSC is an opportunity for others. Rival suppliers “will be cheered by the prospect of more NHS Trusts procuring systems that CSC should have delivered by now”.

School report on Govt ICT Strategy – a good start

By Tony Collins

In a review of progress on the Government’s ICT Strategy after six months, the National Audit Office says that the Cabinet Office has made a “positive and productive start to implementing the Strategy”.

The NAO says that at least 70 people from the public sector have worked on the Strategy in the first six months though the public sector will need “at least another 84 people to deliver projects in the Plan”.

The UK Government’s ICT Strategy is more ambitious than the strategies in the US, Australia, Netherlands and Denmark, because it sets out three main aims:

– reducing waste and project failure

– building a common ICT infrastructure

– using ICT to enable and deliver change

The US Government’s ICT Strategy, in contrast, encompasses plans for a common infrastructure only – and these plans have not produced the expected savings, says the NAO.

In a paragraph that may be little noticed in the report, the NAO says that senior managers in central government have plans to award new ICT contracts (perhaps along the pre-coalition lines) in case the common solutions developed for the ICT Strategy are “not available in time”.

The NAO report also says that “suppliers were cautious about investing in new products and services because of government’s poor progress in implementing previous strategies”.

Of 17 actions in the Strategy that were due by September 2011, seven were delivered on time. Work on most of the other actions is underway and a “small number” are still behind schedule says the NAO.

The NAO calls on government to “broaden the focus to driving business change”.

Some successes of the UK’s ICT Strategy as identified by the NAO:

* The Cabinet Office has set up a small CIO Delivery Board led by the Government CIO Joe Harley to implement the ICT Strategy. The Board’s members include the Corporate IT Director at the DWP, CIOs at the Home Office, MoD, HMRC, Ministry of Justice and Department for Health, together with key officials at the Cabinet Office. The departmental CIOs on the Board are responsible directly to Francis Maude, Minister for the Cabinet Office, for implementing the ICT Strategy in their departments and are accountable to their own minister. No conflicts have arisen

* Senior managers in central government and the ICT industry are willing to align their strategies for ICT with new cross-government solutions and standards but need more detail.

*  Some suppliers have offered help to government to develop its thinking and help accelerate the pace of change in ICT in government.

* The Cabinet Office intended that delivering the Strategy would be resourced from existing budgets. Staff have been redirected from other tasks to work on implementing the Strategy. “We have found collaborative working across departmental boundaries. For example HMRC and the MoD have combined resources to develop a strategy for greener ICT. Teams producing the strategies for cloud computing and common desktops and mobile devices have worked together to reduce the risk of overlap and gaps.

* The BBC has shown the way in managing dozens of suppliers rather than relying on one big company. For BBC’s digital media initiative, the Corporation manages 47 separate suppliers, says the NAO.

* The Cabinet Office intends that departments will buy components of ICT infrastructure from a range of suppliers rather than signing a small number of long-term contracts; and to make sure different systems share data the Cabinet Office is agreeing a set of open technical standards.

* Some of the larger departments have already started to consolidate data centres, though the NAO said that the programme as a whole is moving slowly and no robust business case is yet in place.

* The Cabinet Office is starting to involve SMEs. It has established a baseline of current procurement spending with SMEs – 6.5% of total government spend – and hopes that the amount of work awarded to SMEs will increase to 25%. Government has started talking “directly to SMEs”, says the NAO.

Some problems identified in the NAO report:

* Cloud computing and agile skills are lacking. “Government also lacks key business skills. Although it has ouitsourced ICT systems development and services for many years, our reports have often stated that government is not good at managing commercial relationships and contracts or procurement.”

* Suppliers doubt real change will happen. The NAO says that suppliers doubted whether “government had the appropriate skills to move from using one major supplier to deliver ICT solutions and services, to managing many suppliers of different sizes providing different services”.

* The Government CIO Joe Harley, who promoted collaboration, is leaving in early 2012, as is his deputy Bill McCluggage. The NAO suggests their departures may “adversely affect” new ways of working.

* The NAO interviewed people from departments, agencies and ICT suppliers whose concern was that “short-term financial pressure conflicted with the need for the longer-term reform of public services”.

* The culture change required to implement the Strategy “may be a significant barrier”.

* The Cabinet Office acknowledges that the government does not have a definitive record of ICT spend in central government (which would make it difficult to have a baseline against which cuts could be shown).

* The Cabinet Office has not yet defined how reform and improved efficiency in public services will be measured across central government, as business outcomes against an agreed baseline.

**

Amyas Morse, head of the National Audit Office, said today: ” ICT is going to play an increasingly important role in changing how government works and how services are provided.

“The Government’s ICT Strategy is in its early days and initial signs are good. However, new ways of working are as dependent on developing the skills of people in the public sector as they are on changes to technology and processes; the big challenge is to ensure that the Strategy delivers value in each of these areas.”

NAO report:  Implementing the Government ICT Strategy: six-month review of progress.

Public sector procurement change likely to spur outlook for social enterprises and mutuals

There is a good piece by Colin Cram on the Guardian Public Leaders Network which sums up a mood of change in public sector procurement towards social enterprise and the future of mutuals.

Cram argues that  “the public sector procurement spend of £236bn is the biggest lever the government has to generate economic growth. It could be argued that the focus on price or an overly narrow interpretation of cost has damaged UK businesses and UK economic growth. This, more than anything else, might explain the relative success of German industry and business compared to that of the UK.”

He suggests that MP Chris White’s public services social value bill, which has passed its third reading and report stage in the House of Commons,  seeks to strengthen the social enterprise business sector and make the concept of ‘social value’ more relevant and important in the procurement and provision of public services.

Its key elements, says Cram, include:

• A duty on the secretary of state for communities and local government to publish a national social enterprise strategy to encourage engagement in social enterprise.

• Local authorities, when entering into public procurement contracts, to give greater consideration to economic, social or environmental wellbeing.

There is already work in this area being done by Coventry City Council, which is helping social enterprises secure more business by supporting the creation of a consortium, which will be in a much better position to win business, and by the London Borough of Lambeth.

These procurement developments are likely to be  important for the take-off and future well-being of public service mutuals. It will be interesting to see whether further mutuals can take off inspired by the example set by the London Borough of Hammersmith & Fulham which is set to launch in early 2012.

iESE efficiency mutual set up to help English councils save money

By David Bicknell

An improvement and efficiency local authority-owned  mutual has been set up to help England’s councils save money.

Created from the South East region’s improvement and efficiency partnership, iESE is now setting out to help councils and other local public services that are struggling to cope with the public sector financial squeeze.

Although some services will be free, the bulk of the new company’s income will be generated by fees charged to councils levied from efficiency savings. Surpluses generated will be reinvested back into iESE ‘to further improve the sector’.

Neil Blake, who is Aylesbury Vale District Council’s representative on iESE’s board, said: “Councils can no longer rely on existing ways to meet their tough savings targets. That’s why we were the first council to sign up to iESE Limited’s shared procurement service as a fresh way of helping to deliver our savings. Only by exploring new avenues like those offered by iESE Limited will councils achieve the scale of savings required.”

iESE, which works with local authorities and other public sector organisations in the South East and beyond, believes it has built knowledge and expertise in complex service areas such as Waste and Resource Management; Social Care; Procurement and Construction. It argues that rather than creating unnecessary additional bureaucracy or process, it provides a fresh perspective to challenges to release savings and improve services for citizens.

Joint-venture mutuals again mooted as solution to local authority procurement hurdle

By David Bicknell

Stepping Out  managing director Craig Dearden-Philips has again  mooted the possibility of joint-venture mutuals i.e. new ventures which bring together public sector staff with an external partner to set up a new company on a 50/50 basis.

This, he suggests, can run a procurement – though not the contract to provide – as an external partner for the staff-led mutual, which will itself become the provider.

In an article for the Guardian Policy Hub, he suggests this gets round the procurement problem where in public services a tender process is run for virtually any service. For the nascent mutual, he argues, ‘this can feel like climbing Everest. With no trading history or commercial skills, being pitted against experienced competition is a deterrent. Why go to all the trouble of forming a mutual only to get knocked out in round one?’

Mutuals: asking the right questions to pick mutual winners in local government

By David Bicknell

Francis Maude’s recent pronouncements on mutuals, the launch of the Mutual Pathfinders report and the availability of the mutuals information service offer the prospect of greater activity around public sector mutuals, though the MoD’s decision not to consider a mutual option for its Defence Equipment & Supplies arm doesn’t say much for joined-up government.

With local government in the throes of reorganisation, this article perhaps provides some insight that could help councils measure the suitability of a service to operate as a mutual, and how they can determine if that service could run as a successful, stand-alone business.

The work that the London Borough of Hammersmith & Fulham has done in setting up its mutual might serve as a good benchmark.

Hammersmith & Fulham mutual Pathfinder on track

CSC criticised again in The Times

By Tony Collins

The Times has followed up its three pages of coverage of the NPfIT yesterday with an article in which the chair of the Public Accounts Committee, Labour MP Margaret Hodge, criticises one of the programme’s main suppliers CSC.

Hodge tells The Times she was surprised to learn that CSC was hoping for a revised NHS deal – worth about £2bn – after it failed to deliver fully functional software to any of 166 NHS trusts in England.

CSC has said in a filing to the US Securities and Exchange Commission that, based on events to date, it does not does not anticipate that the NHS will terminate its contract.

CSC gave a series of reasons in its SEC filing why the UK Government may retain CSC and its NPfIT contracts, though it conceded that the outcome of its talks with the Department of Health, is uncertain.

CSC also said it has cured or is in the process of curing the alleged events of default. It asserted that failures and breaches of contract on the part of NHS have caused delays and issues; and it said that if the NHS wrongfully terminated the contract on the basis of alleged material breach, CSC could recover substantial damages.

Hodge told The Times:

“Any private sector company that cares so little about the public interest that they are prepared to extract this kind of money from the public purse should not be given the right to work for the Government again.

“If they are going to take such a private sector attitude to it that they don’t give a toss about the public interest they should be treated like a cowboy builder.”

CSC says it has made a significant investment in developing systems for the NHS and has demonstrated a strong and continuing commitment to improving the quality of healthcare in England. It says it has a demonstrable track record of successful and widescale delivery to NHS within the National Programme and beyond.

The Times also reported that Christine Connelly, the Department of Health’s former CIO,  was bought a £416 first-class train ticket for a visit to a hospital at Morecambe, and was flown to San Francisco and Seattle at a business-class rate costing £8,278.80.

American “cowboys” blamed for NHS fiasco – The Times

CSC confident on £2bn deal says The Times

CSC confident on £2bn NPfIT deal says The Times

The Times reports today that CSC is confident that the Department of Health will not terminate the supplier’s contracts despite the Government’s pledge to dismantle the national programme.

The paper says that “taxpayers will foot the bill for a further £2bn on a failed NHS IT project even though the Government has already pulled the plug on it”.

It adds that the “American technology company Computer Sciences Corporation (CSC) has boasted to Wall Street that it expects an extension of its contract to provide electronic patient records despite failing to deliver a fully functional version of its software”.

In a series of articles on the NPfIT, The Times suggests that the Government is locked into CSC, at least until 2017.

“The Government’s pledge to dismantle the failed NHS programme to computerise patient records is in tatters because it cannot afford to break its contractual commitments and start a search for alternative suppliers”.

The Times quotes a CSC filing to the US Securities and Exchange Commission in November which says: “Based upon events to date, the Company does not anticipate that the NHS will terminate the contract.”

CSC, the Department of Health and the Cabinet Office are still discussing a memorandum of understanding which may end with the supplier’s cutting £764m from its NPfIT contracts, leaving about £2.1bn in place.

CSC discloses in its SEC filing that the Memorandum of Understanding anticipates that the contract term will be extended one year to June 2017 and that CSC anticipates revenue of £1.5bn to £2bn over the remaining term.

With certain amendments “ the contract remains profitable and the Company would recover its investment,” says CSC in its filing.

But MP Richard Bacon, a member of the Public Accounts Committee, has received Parliamentary replies to his questions on the costs of NPfIT deployments at University Hospitals of Morecambe Bay NHS Foundation Trust and North Bristol NHS Trust which show that the costs of installing and maintaining a system under national programme contracts are more than twice that of systems bought by trusts outside of the NPfIT.

Health Minister Simon Burns said in a reply to Bacon that the costs of a Cerner Millennium deployment at the North Bristol NHS Trust are £15.2m for deployment and an annual service charge of £2m. This brings the total cost of the Cerner system over seven years to about £29m, which is more than three times the £8.2m price of a similar deployment outside of the NPfIT at University Hospitals Bristol Foundation Trust.

At Morecambe Bay, the trust’s costs of being involved with the NPfIT (including the deployment of CSC’s Lorenzo 1.9 system) are £6.2m, according to Burns in his reply to Bacon, whereas the typical internal trust costs of deploying of a non-NPfIT system, excluding the cost of the system itself but including training, project management and additional corporate reporting tools, are about £1m-£2m.

Is the Department of Health locked into CSC?

CSC in its filing to the SEC says that the NHS, when considering its options of maintaining or terminating the contract, will “consider costs and risks that NHS may incur over and above those related to termination fees”.

These include:

– damages and costs that may be payable to CSC

– the cost of initiating and managing a public tender, procedure or procedures to obtain one or more suitable replacement suppliers

– the operational risk of switching suppliers at this stage in the contract with CSC

– the cost of alternative suppliers

– the cost of obtaining exit management services from CSC to ensure an orderly transition to one or more replacement suppliers.

In addition, said CSC in its filing, if the NHS terminated the contract for convenience, possible claims that the Company has against NHS include “claims for compensation due to delays and excess costs caused by NHS or for contractual deployment delay remedies or for costs associated with change.

If the NHS had terminated the entire contract for convenience with immediate effect at September 30, 2011, the termination fee would have been capped at approximately £430m.

CSC would also be entitled by way of termination fee to a sum to compensate for the profit that CSC would have earned over the following 12 months had the contract not been terminated.

CSC recognised in the filing, however, that the signing of a new NPfIT deal was uncertain.

Lorenzo “not right yet”

The Times quotes Dr Simon Eccles, the medical director of Connecting for Health, as saying “Lorenzo has had an extremely painful gestation. Lorenzo may yet be a great success because it is a brilliant bit of software but they haven’t got it right yet.”

In an editorial on its NPfIT investigations, The Times said that government IT failures have in common the fact that “we don’t really know who was to blame”. It says:

“Nobody took responsibility and nobody apologised. It is perhaps too much to hope that there will not be more disasters. But if there are, someone must carry the can.”

NPfIT to be dismantled – brick by brick

Maude unveils Mutual Pathfinder progress report and launch of mutuals information service

By David Bicknell

The government has announced that it will provide new support to help staff-led mutual organisations set up and spin out from the public sector.

The government wants public sector staff, tax payers and service users to benefit from the increased innovation, higher productivity and better customer satisfaction mutuals often create.

To help encourage and foster the development of mutuals, the government has launched  a new £10million programme Mutual Support Programme (MSP) to provide business and professional services to groups of staff or existing mutual organisations. 

A consortium of experts in employee ownership will manage the programme to purchase HR, legal, financial, tax and business planning services to develop the most promising new mutuals.

Public sector staff who want to take control of the services they run can access a new Mutuals Information Service.

Cabinet Office minister Francis Maude said, “The Government is getting support in place, developing a pipeline of innovative new mutual ‘spin outs’ where employees have real power. The evidence is clear – mutuals can provide better, more efficient public services.

“It’s time for politicians and public sector bosses to cut the apron strings and trust frontline staff to make decisions. They are the real experts, they know what’s important to the people who use the service and they know how things can be done better.”

The Mutuals Support Programme will also fund support to help organisations tackle common barriers and share information so that many others benefit from the work.

The Government has also published the first progress report from the Government’s Mutual Pathfinder programme which highlights barriers that staff have faced, including a tendency for contract tenders to make requirements beyond what is legally necessary such as demanding an organisation has a multi-million pound bond before taking the contract.

Maude was critical of such requirements, saying, “Too often tender processes go way beyond what’s necessary, asking for massive bonds up front and insisting that the organisations have existed for years. Iron cladding contracts bars all but a few big companies from winning them. It is a fundamental barrier to creating the vibrant, innovative and competitive public services this country needs.

“Through our Mystery Shopper exercise mutuals and other small businesses can tell us about discriminatory practice. We will intervene when problems are exposed. I do understand that Commissioners may feel stuck in the middle. Where they feel they are forced to over complicate things they can let us know through the Tell us How website and we will address the problem.”

Professor Julian Le Grand, Chair of the Mutuals Taskforce, said: “The Mutuals Taskforce has gathered evidence for why employee-led mutuals make sense in public services. The next phase of our work will be focused on making the case across the public sector and stimulating demand.”

Maude and Le Grand made the announcements while visiting the largest Pathfinder mutual, Anglian Community Enterprise, which provides over 40 community health services and a range of learning disability, GP and dental services for the population of North and North-East Essex.

MoD rules out mutual option