Over the last week I've been writing bits and pieces about what might happen as a result of the process. Of course much of that is conjecture - it could make things better - but it has been based on evidence, firstly of the actual levels of veterinary activity in some of the areas, and on experiences in other parts of the world (i.e. New Zealand).
The final thing to do here is to distill all that down into a couple of key things to worry about and watch out for:
1. The impact will vary
It was interesting to hear Dilwyn (thanks again) describe the kinds of people/companies interested in putting together tenders at a meeting about OV procurement.
@GarethEnticott Plenty of co's lining up to put tenders in eg FSS, ?E&J, Co's dealing with MHS. Some very good with public procurement
Dilwyn Evans
whelfordian
Dilwyn Evanswhelfordian
What's clear from the data is that already the nature of the disease influences the way vets are organised around it. In some parts of the country, veterinary practices have come to rely on it so much that taking away the income could have a serious impact on veterinary capacity in those areas. In effect, TB testing income has been subsidising the availability of vets and farmers' access to them in these areas. Perhaps given the state of farming in these areas, that is no bad thing. Others would say that we should let the market decide. Ultimately it depends on what your intervention logic is: if policy makers want vets to have good links with farmers, then maybe TB testing isnt the right model, maybe there are better ways?
Whatever, in these areas - the TB heartlands - there's no way I can foresee any of those big 5 practices I mentioned losing out on a contract. This doesnt mean that they wont be financially worse off. But, I just can't see how the consequences would be accepted - unless some other form of compensation was delivered. Besides which, the lessons of competitive tendering is that the incumbent provider usually wins the contract because of various advantages, such as knowledge and resources they have.
But, in other areas, like the "Norfolk Super Area" as I'm calling it, I think the result will be different. Here, the advantages of the incumbent are much lower and there is less consistency between practices. It might even be likely that practices won't even want to be part of TB testing for fear of having their business model distorted.
The data backs this up. In the Norfolk Super Area so many of the testing practices are either one man bands dedicated to testing, or they are practices with only 1 or 2 vets actually testing. How many other vets they have I'd like to know, but I can't tell because the data is anonymised. For these practices, the income per vet is way higher than the TB heartlands, but I think these vets are most vulnerable. I can see a big company - one of the suppliers to the MHS for example and sucking up all that work. What's more interesting to me is what will happen to those vets and practices.
2. Testing will be cheaper in some areas
This is more complicated, but I think speaking to people, vets are prepared to take a bit of hit financially to stay involved in testing. Some of them feel responsible and don't want to step away. I think they should - that their skills are better suited to other aspects of disease control, such as case management and investigation. But their stake in local farming and reliance on TB income will mean that they will adapt rather than adopt a new business model. This will mean that prices will appear to have come down.
But again, as in point 1 above, where vets feel they have less emotional stake in managing TB, then the cost of TB testing may in fact rise. I think it will certainly be higher than in the high risk areas. Maybe there will be more competition for these areas amongst the corporates? Perhaps the point Im trying to make is that the intensity of competition is going to vary between lots, and so will the nature of the competitors.
Overall? It depends on what you include on the balance sheet, such as the auditing costs of each testing company. I'd be surprised if things came out cheaper overall, but it wouldn't be the first time competitive tendering hasn't delivered lower costs either.
3. Audit won't resolve quality concerns
If AHVLA think that having better quality assurance procedures in place will result in better quality tests, then I think they'll be disappointed. I can't see how this addresses the structural problems facing quality assurance. I also dont think its a great idea having a range of different standards across all the of the lots, or asking contractors to define their own QA procedure. AHVLA should be specifying that, or what is the basis by which they are going to make comparisons between testing organisations once contracts are under way.
Those are three things I'll stick my neck out on. I may add some other predictions. I could be proved right, I could be wrong. But what do you think?
No comments:
Post a Comment