The challenges arising from procuring long term social services
Interview with Niels Uenk, part-time Researcher at the Public Procurement Research Centre a joint interdisciplinary research centre of the universities of Utrecht and Twente. Before joining academia Niels worked 5 years as international consultant in supply chain and logistics optimization. He specialises in public procurement of long term / social health care services.
Hello Niels, welcome to the programme.
Good morning Pedro, thank you for providing me the opportunity to talk about my research.
My pleasure, so Niels you have a mixed background because you’re working in academia but you’re still connected to practice, so can you give us a little bit of a flavour of what’s your actual background?
Yes, so after graduating my Masters in industrial engineering and management I worked five year in a private company called ORTEC like you mentioned in supply chain and logistics optimisation, and after five years I was ready for a new experience and I joined the Public Procurement Research Centre which has quite a unique position for me. Half of the time I get to work on my PhD research and the other half of the time I do paid work, so research and advisory work for other institutions, and basically to finance my PhD and that allows me to do my scientific research. Most of the other work I do is actually in the same area, so focusing on the procurement of social care services.
And have you been doing that for long?
I’ve been doing that since, well late 2013, starting my research around early 2014 actually.
Moving onto the actual research that you’re doing, can you provide us with a little bit more detail what are you actually doing your work on?
Yeah, and I’ll pay a bit attention to the context in the Netherlands as well, so my research focuses on the procurement of social care services, and in healthcare procurement we distinguish between two types: you have procurement for healthcare which actually boils down to buying anything from rubber gloves to equipment that is necessary in the process of providing healthcare, for example a buyer in a hospital, that is on the one hand, and on the other hand we identify procurement of healthcare, so actually buying the healthcare services often from healthcare insurer point of view, or from a public body’s point of view, buying or commissioning healthcare services. I strictly focus on the last part, and it’s a very relevant topic, I focus on the long-term care services, for example home care and a lot of care services that are not medical in nature, so it’s not fixing broken bones, or doing surgery, but it’s rather the type of care services that allow people with a disability or people that come of age to keep living on their own, to participate in our society, so it’s for example mental therapy for people with anxiety disorders, or also sometimes pretty straightforward assisting elderly with doing their tasks around the house, cleaning their house, and in doing so it prevents those people from having to move to an institutional home for the elderly. Especially in developed nations, the expenditure on these kind of services is rapidly growing and it’s one of the main concerns and challenges in healthcare for a lot of developed nations as well that the expenses and the expenditure is quickly growing because of for example the greying society. So in the Netherlands for example we spend about 15 billion euros a year on these kind of services, both for adults and for youth and it’s actually growing at a rate of 5% or 6% a year, much faster than our economy is growing, so that provides a challenge.A lot of other countries, the UK, I think the most countries in the OECD face similar challenges.
That is true and it’s certainly the case here in UK.
Yeah, in my research context what is very interesting is that in 2015 in order to do something against these rising costs and also to improve the quality, in the Netherlands we underwent a massive system reform where these services were previously centrally coordinated and centrally arranged (and procured), responsibilities switched, moved to local governments, so the municipalities, we have about 400 in the Netherlands, from 2015 became responsible for arranging and thereby also procuring these social care services. It was one of the biggest system reforms in the last I think 60 or 70 years, the budget involved like I mentioned is about 15 billion euros and the municipalities got a lot of freedom to actually manage these services to their best insight. That creates a very interesting situation where a lot of municipalities are choosing different ways of commissioning these services, choosing different ways of paying for these services, they are designing their own system of how people should apply for these services and a lot of different approaches are visible right now which for me as a researcher is obviously a very interesting position because I actually get to, on the one hand investigate how municipalities are approaching the procurement and the commissioning of these services, and then see if the difference between those approaches actually results in better or worse care for the citizens. So that is basically the main topic of my research, how are there municipalities contracting this care and does a different approach need to improve quality, reduce costs, etc.
It’s interesting because my impression here in the UK is that long-term care services are procured by local authorities separately from healthcare, so and one of the discussions that I’ve seen over the years popping up time and time again is actually merging long-term care or social care with healthcare procurement, because at least in UK there’s the view that by keeping them separate each one of those two systems tries to shift patients to the other system so that they don’t have the cost.
So what’s the experience in the Netherlands if it’s possible to find any kind of information about it right now?
One of the reasons for decentralising long-term care to municipalities is in fact to try and bundle a lot of responsibility within this social care sector with the same organisation, so that the municipalities have a very wide responsibility right now for any kind of support, social support, social services that may be necessary within the situation of a client, so before for example the social care for youth was very fragmented in the Netherlands, where provinces had responsibility for one part, regional offices of healthcare insurance agencies were responsible for a different part, and the local government and the central government was responsible for a third part and all these different parts have now been combined and made the responsibility of the municipality. Indeed there is still a distinction between the private, the curative healthcare procurement, so the procurement of hospital care and basically any type of care that actually involves medical care, (and the social health care procurement, red.) there’s still a division, and there is still also debate on whether certain types of care will be decentralised in the future as well, in order to optimise and be able to manage as integrative care system as possible. But for now these types of social and home care, as they are quite different from the medical care you receive in the hospital, the municipality already have quite a lot of responsibilities as they have right now.
Moving onto the research that you have actually done so far within your PhD, as far as I know you’re doing it in a similar way to one of my previous guests, Suvi Taponen, you’re basically doing your PhD by publications, am I correct?
Yeah, that’s correct.
So what have you been doing so far and what have you concluded in terms of research?
One of the first things I started to do, I started right in the year 2014 when all the municipalities have had to contract these homecare services, and what I did was, well I wanted to find out to what extent these municipalities took different approaches with respect to procurement. They all came from the same situation: before 2015, the procurement was standardised for the entire country, the same products, the same tariff structure, the same procurement procedures were applied. The first thing I did when I started was to collect the procurement documents and tender procedures and any kind of information on how municipalities actually procured these services, for as many municipalities as possible. So I started making a database with all the tender documents, all the contracts I could find, and most of the municipalities actually published these services, or these contracts which in 2014, was not actually required from public procurement regulations because these services are actually back then part of appendix 2B-services (EU regulations on public procurement, red.) that were exempt from most of the public procurement regulations. The municipalities, most of them, published their contracts anyway and I made a database of that and the database I have has about 95% coverage of all these tender documents of all the municipalities, so there are approximately 400 municipalities, I have the tender documents about 385.
That’s a big dataset.
That’s quite a big dataset, I have to say thank god for me most of the municipalities actually also collaborated, so it actually boiled down to 90 different tenders, still it’s quite a big dataset because most tenders, well if you have seen public tenders before you know they can contain quite a lot of different documents and quite a lot of extensive documents.
The next thing I did was, well to actually build the database with analysis of these tender documents, of well about 20 different factors ranging from aspects of the procurement process: did the municipality collaborate with the procurements, how big was the collaboration in size, how many different municipalities joined, what kind of procedure did they follow and then there was a lot of negotiation going on and a lot of dialogue in those procedures, was the procedure open for any kind of care supplier or did the municipality invite a selection. I also analysed the content of the contracts: what kind of products did they procure, did they simply copy paste the product lists that was used before 2015 or did they create new products, what kind of reimbursement method did they apply. So I analysed all those tenders based on all these factors, also what kind of tariffs did they pay and I created one quite big database based on the procurement approach, each individual municipality or collaboration took, and it is actuallynow my starting point to also write scientific papers based on this dataset. So I have the first paper out, it was just yesterday accepted at the IPSERA conference, so I’m very pleased with that as a competitive paper, where I will present the results. In the paper I first do an analysis on what kind of aspects are relevant to study based on literature (on service triads, red.) and I then present the approaches of the Dutch municipalities, how they went about with respect to the relevant aspects.
You’re still working in practice so you’re just doing the research part-time and working at the Public Procurement Research Centre in a part-time basis, so from your perspective what are the challenges of managing this joint or dual track kind of life, managing research and practice side-by-side?
Let me highlight first the good things about it and then the challenges, obviously or what I really like about the joint work is I get to apply the knowledge that I find from the research and I get to directly put that in practice, or make use of that in practice, so more and more municipalities are inviting me to come and talk about my research, they want to know how do other municipalities tackle certain problems, they want to have an overview of different approaches that may be possible and well because I analysed that for my research I have a nice overview and I can directly put that into practice. Also, sometimes municipalities or also care providers, well they have like quite practical problems or issues they deal with, and it also keeps my research relevant to practice, because I’m not just doing some very theoretical research, because I know what kind of issues the practitioners face, I can also know what kind of relevant research questions I should focus on to actually be able to do research that is directly relevant not only for the scientific community and for our knowledge, but also for practice. Now that’s what I very much like about my position, one of the main challenges and I think every part-time researcher will provide the same answer is that for my work related activities there’s always something, there’s always a deadline and there’s always something waiting for an answer. And for my PhD that may also be the case, but the deadline is always a bit more soft, or if I don’t do the work this week well nobody is going to shout on the phone to me that I haven’t... so one of the big challenges is actually to on a weekly basis make sure that I also spend enough time on research, and yeah, I don’t have a very strict planning that the university keeps me to from when I should finish this article and when I should finish that article or that paper, but that actually increases the risk of not doing enough research and letting your agenda be dominated by the work related activities.
It’s interesting that you’re highlighting that because I felt exactly the same thing when I was doing my Masters, maybe 12 13 years ago, and I was working as a lawyer at the time and I just could not pull it off, exactly because what you’ve said, because if you have work related commitments they tend to have very tight turnaround timescales attached to them and certainly as a lawyer that was the case, there’s always stuff that needed to be done in that day, so you keep on pushing out for later and later those deadlines that are not as strict, and it’s almost like an adult version of the marshmallow test that it’s done with kids, so that if we delay gratification and actually work on those softer deadlines we’re going to be better off on the long-term instead of just fighting fires every day. But I could not pull it off so I ended up actually once my decision was made to do a PhD in actually moving full-time and I never considered even the possibility of doing it part-time as you’re doing so I have a huge respect for the researchers that are able to do those two different jobs and roles at exactly the same time because I find that incredibly incredibly challenging. Now one of the things that I really liked when I was a PhD student is that my supervisor was very, I wouldn’t say strict, but very assertive with deadlines, and that is something that over the years once I became PhD supervisor myself as well I found to appreciate more and more, which is it’s important to give PhD candidates a certain structure and a certain timetable that builds on them a certain rota or a certain way of doing work so that they can expect to submit a piece of work, be it a paper, be it a chapter, half a chapter, 5,000 words, whatever, with the certain cadance, i.e., a certain number of words, a certain number of pages every four weeks or every six weeks because that creates the habit of producing work constantly. And that worked really well for me as a student and it works well for most of my PhD students as well, so sometimes I think, and I have these discussions with colleagues, that we sometimes leave PhD students to their own devices and say, okay, they’re doing a PhD so they’re supposed to be autonomous, it’s up for them to manage their own time. And that is sometimes very hard and especially I would say it’s doubly hard for people like yourself when you have other competing interests, in this case actually a part-time job elsewhere.
Yeah, it is for me one of the main challenges, and having worked in a consultancy firm five years before starting my PhD I think actually helps me to have the, to make sure…
Yeah, the discipline, that’s what I was going, to have the discipline to make these deadlines for myself, although yeah like I just mentioned it remains being challenging, I don’t have a supervisor that’s strict with me and if I would have it probably would help, would help as well.
Okay, I’ll send him an email saying that!
Yeah, but I try to do this, I’m collaborating also on a few papers from time-to-time with others and I try to make deadlines on myself if I have agreed to work on something and to have it finished with a colleague it helps me because I hate to be late or to not manage that deadline. So I I visit a lot of writing workshops through my contacts at IPSERA, I get invited to writing workshops and I tend to use those workshops and those days as deadlines to just make sure that I have something done, have a new version or concept version of a working paper done, and working from conference to workshop to, well those are actually the deadlines that make sure that I, well writing enough. But to be honest right now for me it becomes much more important than in the first year because in the first year I did the collection of that data and it was both for the PhD but also for some external projects it was relevant, so up till now I’ve been able to combine a lot of the research activities with my activities in practice, but the writing of scientific journal articles, well that’s purely for my PhD, so I’m much more in the phase where I have to produce those papers where a lot of the data is already collected, so it actually becomes much more important in this stage of my research to keep those deadlines and to keep in what we mentioned, a certain cadance of producing scientific articles for book chapters, compared to 2015 and early 2016.
What do you see yourself doing after you finish your Ph.D, do you want to stay connected with academia, do you want to go back full-time to practice?
To be honest I don’t know yet, I very much like the position that we are in to be able to do really scientific research from university point of view producing to sometimes discuss about a research and the methods used with colleagues and to be able to, well improve the quality of research compared to some of the reports written by other firms, sometimes consultancy firms that sometimes just need to quickly produce something with maybe a more commercial motivation, so I really like the scientific base where we come from. But yeah of course if I want to stay in science and in academia writing and producing there’s much more emphasis on that (getting published) after the PhD maybe, so to be honest I'm not sure yet.
Very well, I think it’s a great way to finish the interview. Niels, thank you very much for coming.
Yeah, it was a pleasure, I feel like I haven’t discussed a lot in detail of some of the stuff I’m doing but maybe that’s also not for the greater audience, a bit less relevant, but I thank you for the opportunity and well I think it’s a very interesting way of sharing research with the world, so thank you and very interesting project you have.