Volume 10 Number 3/4 Mar/Apr 2009
Last year, i-Base funding was withdrawn by the London HIV Commissioners as part of their re-structuring of services for HIV-positive people. They have since refused to review the process or the final outcome, despite extensive letters of support from patients, doctors and other healthcare professionals, detailing the importance of the services we provide.
We have since learned, using the Freedom of Information Act, that the tender process failed to evaluate costs in the bidding process, despite many of the i-Base bids being significantly lower, and other evaluable aspects of the bids being comparable.
Given the importance of getting value for money from public funds, and the widespread discussions relating to the low level of funding available, this demands a review of the process and the current level of support for expert-patient produced and generated material and for smaller organization to receive appropriate levels of support for the services they produce.
We are still awaiting a formal response from our correspondence to Diane Middleditch, interim chair of Chelsea and Westminster PCT, printed below.
To: Diana Middleditch, Interim Chief Executive, Kensington and Chelsea Primary Care Trust
23 February 2009
Re: PAN-LONDON HIV PROGRAMME TIPI CONTRACTS
Thank you for your letter dated 9 May 2008 (attached) in which you briefly stated that you were satisfied with the evaluation of the TIPI tenders which took place earlier in the year.
As you are aware, we are an expert patient involvement organisation in NHS healthcare focused on HIV information services and training. The guide to HIV treatment we have produced since 2000, updated at least annually (2008 edition enclosed) was highly commended in the BMA Patient Awards this year and is used by hospitals across London when patients are newly diagnosed or starting treatment. In the tender process earlier this year, our bid priced provision of this guide across London at £5,000 (£0.90p a copy) but this bid was rejected. We fought for eight years to establish and maintain excellent resources that are a model recognised by WHO and many international and national experts, yet for some reason the largest purchaser of HIV patient services in the UK – who nonetheless continues to use all our products – refuses to provide any funding for them.
I am therefore now writing to ask you to clarify a number of points:
1. We have recently learned that the difference in financial considerations (including budgets, unit costs and value for money) between the two bids for the Treatment Information contract was not in fact evaluated at all. I would understand this if the two bids concerned were very similar, but this was not the case. I-Base bid for 80% of the total Treatment Information contract at a cost of around £70,000. The bid which won the contract bid for 100% of the contract but for a cost of £200,000. As you will appreciate, this is a considerable difference, which, given the cost pressure for this work, requires some explanation. The question therefore arises whether you and the other Commissioners were aware either that the financial aspect of the two bids was not evaluated in any meaningful way, or were aware of this fact but did not consider it be important. Were you aware that the bids with higher rather than lower costs won on nearly every stream? The results of the qualitative evaluation of the two bids for the treatment information workstream produced results that were very close indeed, so one would therefore expect financial considerations to take on a even greater determinative importance. This clearly was not the case.
2. The second concern relates the creation and distribution of the 15 more in depth booklets. Our tender was £15,000 for the development, design, printing and distribution of five booklets, that would cover all the subjects that would have been covered in 15 booklets. This is contrasted to the competitor tender of £52,195 for 15 booklets. We are concerned that the competitor bid was for the development and design of resources that already exist; prior to the award of the contract the organisation concerned already produced precisely 15 booklets which were funded from previous annual TIPI funding over the last 7 years. We do not understand the basis on which the Commissioners determined that the alternative tender constituted value for money, given that the development and design of their booklets has already been funded. Can you explain why this resource is effectively being funded twice? Was this cost consideration drawn to your attention by the Commissioners?
3. We also note that our costing for the 10 factsheets were significantly less than the competitor bid with our tender priced at £3,150, as contrasted to £14,035. Given this difference, what reasons did the Commissioners give you to prefer a tender for one particular resource which was nearly five times the price of the other? Given such a significant difference, their decision cannot have been based upon value for money.
4. A similar concern arises over the treatment workshops resource. I-Base has already run similar workshops, which have been a proven success. I-base tendered to provide this service at a cost of approximately £24 per person. The competitor bid tendered for this resource at a cost of £40 per person. Were you aware of this difference in cost? If so, what justified the decision to disregard such a considerable cost saving? If you were not aware of this difference in cost, why were you not aware of it?
5. The final point concerns the continued level of demand from London hospitals and patients for i-Base services. This demand has in fact increased since i-Base was defunded by you in April 2008, and the demand is coming directly from the end users in the London health care system that the TIPI contracts were intended to support. If these essential information services were being adequately provided by the organisation which won public funding to provide them then demand for i-Bases services in London should have fallen. It clearly has not. This means that we now have a situation where essential HIV information resources in London have lost their funding but continue to be used in preference to the resources to which the public funding has been transferred. I should point out that we have not been funded nationally for our work either – though we did apply, as suggested by the commissioners.
It becomes a matter of public interest when decisions about the award of public funding for what in health charity terms are considerable sums of money appear to have been taken with so little if any regard to cost. I should be grateful if you could therefore explain what you knew about the costing issues I raise above at the time that you and others ratified the contract award decision made by the Commissioners.
Ive enclosed a selection of letters of support for our services. I am obliged to point out that the likelihood of us being able to continue providing these services without any government support for the next three years is extremely poor. Given this, I wonder what suggestions you have for how we can ensure that this does not happen and that essential HIV information services in London are not lost.
I look forward to hearing your thoughts on the issues raised in this letter.
Simon Collins, HIV i-Base
cc by email: London HIV Commissioners
We received acknowledgement of our letter on 18 March with a promise for a detailled response within two weeks.
When HTB went to press on 9 April we had not received any formal response to these points.