Open letter to Nicola Sturgeon regarding outsourcing of patient experience 
programme surveys

[To view this as a pdf: http://www.health.ed.ac.uk/CIPHP/]

Nicola Sturgeon MSP
Cabinet Secretary for Health and Wellbeing
St. Andrew’s House
Regent Road
Edinburgh. EH1 3DG

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Dear Minister

We are concerned that the recent decision of the Scottish Government to 
outsource surveys on the patient experience programme to the private sector 
introduces serious commercial conflicts into NHS service planning and 
information and public research. The project was launched under the 
previous administration.
http://www.scotland.gov.uk/News/Releases/2007/03/01103247

According to the recent press announcement by the Scottish Government on 04 
February 2008, the Scottish Government has awarded £1.36 million to 
PricewaterhouseCoopers (PwC), a for-profit management consultancy firm, to 
act as a coordinating centre for the Scottish Patient Experience programme 
(PwC is the Technical Partner, contract number HCC/001/19 awarded 14 
December 2007).
http://www.scotland.gov.uk/News/Releases/2008/02/04094521

A further £2.16 million for social research services under the Contract for 
the Scottish Patient Experience Programme's Framework is currently out to 
commercial tender.
http://www.nhstenders.net/modules.php?
op=modload&name=News&file=article&sid=23569&newlang=eng&topic=193&catid=0

First, we are concerned that the contract award to PwC, which was signed by 
the Scottish Government on 14 December 2007 and the current commercial 
tender of social research services represents a major step in the 
commercialisation of core public health and  information functions and 
academic research. We are also concerned that the process places in 
jeopardy the principles of accountability and transparency to which the 
Scottish Government is committed.

Second, patient experience and survey work has traditionally been the 
responsibility of the Scottish Executive and departments of public health 
within health boards. Patient surveys allow service planners and providers 
to conduct needs assessment and rapid appraisal in order to address 
population needs for services. However surveys are vulnerable to political 
manipulation and bias and for this reason it is normal practice to involve 
academic departments in design and analysis.

However, according to National Procurement NHS Scotland, PwC has now been 
given the remit of:

'developing the guidance and instruments which NHS boards and their 
framework contractors will use to survey patients and carers; analysing and 
disseminating the results of surveys undertaken by health boards and 
general practices; and finally advising boards, general practices and 
framework contractors on using the information to improve services'

The Scottish Government has not specified what the requirements are for 
scholarly peer review and public consultation regarding these factors and 
it is therefore unclear to what extent the private sector will control the 
methods, instruments, standards, analysis and results of patient survey 
through the patient experience programme, as well as the dissemination and 
control of information into needs assessment and service planning and 
service reconfiguration.

Third, indicators of patient experience (satisfaction or responsiveness) 
are conceptually complex and require values to be determined by the 
investigator. We are concerned that the delegation of these matters to the 
private sector provides an opportunity for introducing methods and 
manipulating results for commercial ends rather than what is in the best 
interests of the needs of the public and the NHS. In England, millions of 
pounds of NHS funds are being outsourced to private sector companies under 
an equivalent programme called NHS Surveys.
http://www.nhssurveys.org/approvedcontractors

Although the Healthcare Commission (HCC), the organisation responsible for 
quality in England, has been unable to show that using the private sector 
provides better access, quality of care and value for money, there are 
concerns that patient experience surveys are being widely used to promote 
the privatisation of NHS care and reconfiguration of services.
http://tinyurl.com/2jdnzc

Finally, the full tender document and contract with PwC is not in the 
public domain, and key areas have been redacted. We have not yet been able 
to establish whether patients are aware that they will be giving their data 
to a private for-profit provider, or what uses the instruments, analysis 
and data may be put to. Nor do we know what will be subject to commercial 
confidentiality and covered by intellectual property. The whole programme 
lacks sufficient clarity and transparency and warrants proper scrutiny and 
an independent review.

The Scottish Patient Experience programme represents a significant threat 
to the academic integrity of survey design, to the vital independence of 
public health departments, and the integrity and reliability of public 
information organisations such as the Information Services Division. Public 
information is the lifeblood of any health care system. The 
commercialisation and privatisation of these functions represents a very 
considerable threat to public health care and research.

It is for this reason we call upon the Scottish Government to publish and 
review in full the tender and contract with PwC and to halt the current 
£2.16 million procurement of social research services under the Scottish 
Patient Experience Programme's Framework.

Yours sincerely

Prof Allyson Pollock, Director, Centre for International Public Health 
Policy, University of Edinburgh
Prof Gerry Fowkes, Director, Centre for Public Health and Primary Care 
Research, University of Edinburgh
Prof Harry Campbell, Professor of Genetic Epidemiology and Public Health, 
Department of Public Health Sciences, University of Edinburgh
Prof David McCrone, Co-Director of the Institute of Governance, University 
of Edinburgh
Dr Sarah Wild, Core Director, Epidemiology and Statistics, Wellcome Trust 
Clinical Research Facility / University of Edinburgh
Prof Graham Watt, Professor of General Practice/Head of Section, General 
Practice & Primary Care, University of Glasgow
Prof Phil Hanlon, Professor of Public Health, Department of Public Health & 
Health Policy, University of Glasgow
Dr Ian Harper, Senior Lecturer in Social Anthropology, School of Social & 
Political Studies, University of Edinburgh
Prof Patricia Jeffery, Professor of Sociology, School of Social and 
Political Studies, University of Edinburgh
Prof Roger Jeffery, Professor of Sociology of South Asia, School of Social 
and Political Studies, University of Edinburgh
Prof Kath Melia, Professor of Nursing Studies, School of Health & Social 
Science, University of Edinburgh
Prof Adrian Sinfield, Professor Emeritus of Social Policy, University of 
Edinburgh
Prof Janette Webb, Professor of Sociology of Organisations, School of 
Social and Political Studies, University of Edinburgh