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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.

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.

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.

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.

Your 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