More model contractual AI clauses -- some comments on the SCL AI Clauses

Following the launch of the final version of the model contractual AI clauses sponsored by the European Commission earlier this month, the topic of how to develop and how to use contractual model clauses for AI procurement is getting hotter. As part of its AI Action Plan, New York City has announced that it is starting work to develop its own model clauses for AI procurement (to be completed in 2025). We can expect to see a proliferation of model AI clauses as more ‘AI legislation’ imposes constraints on contractual freedom and compliance obligations, and as different model clauses are revised to (hopefully) capture the learning from current experimentation in AI procurement.

Although not (closely) focused on procurement, a new set of interesting AI contractual clauses has been released by the Society for Computers & Law (SCL) AI Group (thanks to Gisele Waters for bringing them to my attention on LinkedIn!). In this post, I reflect on some aspects of the SCL AI clauses and try to answer Gisele’s question/challenge (below).

SCL AI Clauses

The SCL AI clauses have a clear commercial orientation and are meant as a starting point for supplier-customer negotiations, which is reflected on the fact that the proposed clauses contain two options: (1) a ‘pro-supplier’ drafting based on off-the-shelf provision, and (2) a ‘pro-customer’ drafting based on a bespoke arrangement. Following that commercial logic, most of the SCL AI clauses focus on an allocation of obligations (and thus costs and liability) between the parties (eg in relation to compliance with legal requirements).

The clauses include a few substantive requirements implicit in the allocation of the respective obligations (eg on data or third party licences) but mostly refer to detailed schedules of which there is no default proposal, or to industry standards (and thus have this limitation in common with eg the EU’s model AI clauses). The SCL AI clauses do contain some drafting notes that would help identify issues needing specific regulation in the relevant schedules, although this guidance necessarily remains rather abstract or generic.

This pro-supplier/pro-customer orientation prompted Gisele’s question/challenge, which is whether ‘there is EVER an opportunity for government (customer-buyer) to be better able to negotiate the final language with clauses like these in order to weigh the trade offs between interests?’, especially bearing in mind that the outcome of the negotiations could be strongly pro-supplier, strongly pro-customer, or balanced (and something in between those). I think that answering this question requires exploring what pro-supplier or pro-customer may mean in this specific context.

From a substantive regulation perspective, the SCL AI clauses include a few interesting elements, such as an obligation to establish a circuit-breaker capable of stopping the AI (aka an ‘off button’) and a roll-back obligation (to an earlier, non-faulty version of the AI solution) where the AI is malfunctioning or this is necessary to comply with applicable law. However, most of the substantive obligations are established by reference to ‘Good Industry Practice’, which requires some further unpacking.

SCL AI Clauses and ‘Good Industry Practice’

Most of crucial proposed clauses refer to the benchmark of ‘Good Industry Practice’ as a primary qualifier for the relevant obligations. The proposed clause on explainability is a good example. The SCL AI clause (C1.15) reads as follows:

C1.15 The Supplier will ensure that the AI System is designed, developed and tested in a way which ensures that its operation is sufficiently transparent to enable the Customer to understand and use the AI System appropriately. In particular, the Supplier will produce to the Customer, on request, information which allows the Customer to understand:

C1.15.1 the logic behind an individual output from the AI System; and

C1.15.2 in respect of the AI System or any specific part thereof, which features contributed most to the output of the AI System, in each case, in accordance with Good Industry Practice.

A first observation is that the SCL AI clauses seem to presume that off-the-shelf AI solutions would not be (necessarily) explainable, as they include no clause under the ‘pro-supplier’ version.

Second, the ‘pro-customer’ version both limits the types of explanation that would be contractually owed (to a model-level or global explanation under C1.15.2 and a limited decision-level or local explanation under C1.15.1 — which leaves out eg a counterfactual explanation, as well as not setting any specific requirements on how the explanation needs to be produced, eg is a ‘post hoc’ explanation acceptable and if so how should it be produced?) and qualifies it in two important ways: (1) the overall requirement is that the AI system’s operation should be ‘sufficiently transparent’, with ‘sufficient’ creating a lot of potential issues here; and, (2) the reference to ‘Good Industry Practice’ [more on this below].

The issue of transparency is similarly problematic in its more general treatment under another specific clause (C4.6), which also only has a ‘pro-customer’ version:

C4.6 The Supplier warrants that, so far as is possible [to achieve the intended use of the AI System / comply with the Specification], the AI System is transparent and interpretable [such that its output can be traced back to the input data] .

The qualifier ‘so far as is possible’ is again potentially quite problematic here, as are the open-ended references to transparency and interpretability of the system (with a potential conflict between interpretability for the purposes of this clause and explainability under C1.15).

What I find interesting about this clause is that the drafting notes explain that:

… the purpose of this provision is to ensure that the Supplier has not used an overly-complex algorithm if this is unnecessary for the intended use of the AI System or to comply with its Specification. That said, effectiveness and accuracy are often trade-offs for transparency in AI models.

From this perspective, I think the clause should be retitled and entirely redrafted to make explicit that the purpose is to establish a principle of ‘AI minimisation’ in the sense of the supplier guaranteeing that the AI system is the least complex that can provide the desired functionality — which, of course, has the tricky issue of trade-off and the establishment of the desired functionality in itself to work around. (and which in a procurement context would have been dealt with pre-contract, eg in the context of technical specifications and/or tender evaluation). Interestingly, this issue is another one where reference could be made to ‘Good Industry Practice’ if one accepted that it should be best practice to always use the most explainable/interpretable and most simple model available for a given task.

As mentioned, reference to ‘Good Industry Practice’ is used extensively in the SCL AI clauses, including crucial issues such as: explainability (above), user manual/user training, preventing unlawful discrimination, security (which is inclusive of cyber secturity and some aspects of data protection/privacy), or quality standards. The drafting notes are clear that

… while parties often refer to ‘best practice’ or ‘good industry practice’, these standards can be difficult to apply in developing industry. Accordingly a clear Specification is required, …

Which is the reason why the SCL AI clauses foresee that ‘Good Industry Practice’ will be a defined contract term, whereby the parties will specify the relevant requirements and obligations. And here lies the catch.

Defining ‘Good Industry Practice’?

In the SCL AI clauses, all references to ‘Good Industry Practice’ are used as qualifiers in the pro-customer version of the clauses. It is possible that the same term would be of relevance to establishing whether the supplier had discharged its reasonable duties/best efforts under the pro-supplier version (where the term would be defined but not explicitly used). In both cases, the need to define ‘Good Industry Practice’ is the Achilles heel of the model clauses, as well as a potential Trojan horse for customers seeking a seemingly pro-customer contractual design,

The fact is that the extent of the substantive obligations arising from the contract will entirely depend on how the concept of ‘Good Industry Practice’ is defined and specified. This leaves even seemingly strongly ‘pro-customer’ contracts exposed to weak substantive protections. The biggest challenge for buyers/procurers of AI will be that (1) it will be hard to know how to define the term and what standards to refer to, and (2) it will be difficult to monitor compliance with the standards, especially where those establish eg mechanisms of self-asessment by the tech supplier as the primary or sole quality control mechanims.

So, my answer to Gisele’s question/challenge would be that the SCL AI clauses, much like the EU’s, do not (and cannot?) go far enough in ensuring that the contract for the procurement/purchase of AI embeds adequate substantive requirements. The model clauses are helpful in understanding who needs to do what when, and thus who shoulders the relevant cost and risk. But they do not address the all-important question of how it needs to be done. And that is the crucial issue that will determine whether the contract (and the AI solution) really is in the public buyer’s interest and, ultimately in the public interest.

In a context where tech providers (almost always) have the upper hand in negotiations, this foundational weakness is all important, as suppliers could well ‘agree to pro-customer drafting’ and then immediately deactivate it through the more challenging and technical definition (and implementation) of ‘Good Industry Practices’.

That is why I think we need to cover this regulatory tunnelling risk and this foundational shortcoming of ‘AI regulation by contract’ by creating clear and binding requirements on the how (ie the ‘good (industry) practice’ or technical standards). The emergence of model AI contract clauses to me makes it clear that the most efficient contract design is such that it needs to refer to external benchmarks. Establishing adequarte protections and an adequate balance of risks and benefits (from a social perspective) hinges on this. The contract can then deal with an apportionment of the burdens, obligations, costs and risks stemming from the already set requirements.

So I would suggest that the focus needs to be squarely on developing the regulatory architecture that will lead us to the development of such mandatory requirements and standards for the procurement and use of AI by the public sector — which may then become adequate good industry practice for strictly commercial or private contracts. My proposal in that regard is sketched out here.

Public consultation on procurement planning by the Spanish Competition Authority now open (until 20/12)

The Spanish Competition Authority (Comisión Nacional de los Mercados y la Competencia, CNMC) is in the process of revising its 2011 Guide on public procurement and competition to reflect recent developments and the change of regulatory framework derived from the transposition of the 2014 EU Public Procurement Package [for a critical assessment of the original guide, in Spanish, see A Sanchez-Graells, ‘Una Visión Crítica de la 'Guía Sobre Contratación Pública y Competencia' Publicada por la CNC’ (2011) 21 Gaceta Jurídica de la Unión Europea y de la Competencia 15-31].

The CNMC plans to update their guidance in steps, and has started the process by focusing on procurement planning. In order to gather input into the formulation of guidance on procurement planning from a competition perspective, the CNMC has published a short preliminary working paper (in Spanish), is holding a public conference on 3 December (in which I am honoured to participate), and has also opened a public consultation (closes 20 Dec 2019).

Even thought, unfortunately, this is a process mainly conducted in Spanish, I am sure the CNMC would welcome any contributions on best procurement planning practices and on the impact of planning on competition via email: dp.ayudaseinformesnormativos@cnmc.es (subject: “Consulta pública Planificación de la contratación pública", indicating whether your contribution can be published or should remain confidential). In case of interest, below is my own contribution to the public consultation (in Spanish).

Is Circular Economy a move towards or away from sustainability? A short piece on the (ab)use of the concept of circularity [guest post by Dr Lela Mélon]

With business sustainability in mind and in search of sustainable governmental behaviour, especially in terms of public purchasing practices, circularity seems like a fitting concept for fulfilling public needs in a sustainable manner (see eg Geissdoerfer et al: 2016). Given the hurdles with the implementation of green public procurement practices across the EU, and the struggles in furthering sustainable public procurement (going beyond environmental to also add social concerns), I expected that circular public procurement would be an exception and applicable only to a handful of cases. And indeed, it did not take much research to verify that the application of circularity across European public procurement is scarce at its best: while listed under green public procurement, circular public procurement exhibits few best practices across the EU that mostly arose at the local level (see eg this 2018 best practice report).

While it might be argued that circularity by definition requires local action, that does not prevent the development of practices at a regional, national or even supra-national level in specific sectors with potential to become circular, e.g. energy sector, construction sector and waste management. Yet, whether we speak about circularity in the framework of private markets or public procurement, it is absolutely indispensable to embed circular practices in the framework of sustainability and not simply formulate it under the framework of waste management.

Much has been said on recycling, less on the cycle. Seeing circularity as an exercise of recycling and bringing materials back into the loop has been widespread, leading to even higher production and consumption and straying away from true sustainability. That being said, the underpinning reasons for such developments do not lie solely in private market practices, but also stem from the lack of knowledge on circularity and policy incoherence on the national and EU level in general.

What is (true) circularity?

Applying to both private and public markets, the notion of circularity should be clear. Recycling comes last. The whole purchasing procedure needs to be rethought and redesigned to accommodate more sustainable decisions and close the loop of linear practices as in ‘buy, use, dispose.’ Already at the stage of making the purchase decision, circularity demands us to rethink: do we need the product, service or works in question? Could we upcycle a product that we already own to fulfil that need? Could the need be filled by buying a service instead of the product or conversely leasing or renting the product? If the answer to those questions is no, then we need to purchase the product, service or work in question demanding a long life-time evaluation model.

Here the companies engaging in circular production need to provide a life-long guarantee, user manual, strategic design that facilitates reparability, minimal use of raw materials and energy (and its responsible sourcing, accounting for the social aspect of sustainability), use of renewable energy and efficient service and maintenance in case of a product fault. Spare part guarantee, service agreements, small repairs, standard components and easy disassembly are the must-haves under a truly sustainable circular economy.

Reuse and sometimes upcycling are the key. Recycling under a circular model is truly the last resort and its success in extracting useful materials for further production actually depends on the way the product was designed: the absence of hazardous materials, the possibility to disassemble the product into different materials with ease, the possibility of downcycling and upcycling of the materials. These notions all run counter to the current linear economy: and the implications of such systemic change on business models and private markets as we know them will be significant, causing significant policy spill over effects and demanding the elimination of existing policy incoherences inhibiting such a transition. This piece aims to provide further food for thought on the system as it is regarding private and public markets; discussing the current state of affairs, the impediments to a higher uptake of circular practices and the policy spill over effects of a successful implementation of circularity as a general exercise.

Where are we at? – the European Commission’s Action Plan

In terms of EU policy on circular economy in general, the European Commission has issued an ambitious circular economy package—which surprisingly focuses on waste management and bringing resources back in the loop—coupled with two subsequent implementation reports in 2017 and 2019. While the package recognises that the value of circular economy lies also in job creation, savings for businesses and the reduction of EU carbon emissions; the action plan on the matter focuses heavily on reforming the waste management legislation, albeit briefly reflecting also on the broader aspects of circular economy such as job creation, innovative design, business models, research, re-manufacturing, product development and food waste. The wrong signal is therefore sent to the private and public market: the focus on getting scarce materials back into the loop instead of a systemic change of production processes themselves. This influences private and public markets and reinforces the idea that the only issue with traditional linear production and consumption processes is the scarcity of (raw) materials.

Further reinforcing this idea, the EU study on Accelerating the transition to the circular economy focuses on public funds employed to that effect, omitting the fact that this represents only a fraction of the funds needed for a true systemic change. The study has been seen as an accelerator for the deployment of the circular economy, discussed in the framework of new circular business models and in the framework of waste management (id at 10). While the need for extensive financing has been repeatedly highlighted (eg in this 2017 report’s estimate of EUR 320 billion by 2025) for a systemic transition to circular economy (with estimated combined benefits of such shift of EUR 500 billion), the focus of the report has been on providing such finance in the current ‘business as usual’ framework, advocating for higher investment in such transition by the EU, without a comparative assessment of the current private financial market frameworks and its indispensable role in such transition (cfr this call for integrating externalities in the existing risk assessment frameworks).

Arguing for a systemic approach and a stronger focus on private finance offerings, especially with regards to small and medium-size enterprises (see here and here), points to the insufficiency of public funds for the transition to a more circular economy. To boost the private finance offerings, there is a need for a systemic change of financial systems to account for the inherent risks of the current linear business models, thereby eliminating persistent unfair competitive advantage for linear business models in the access-to-finance scenario. Not incorporating the change of linear risk assessment practices in greater detail into the EU action plan is a pitfall that needs to be remedied, qualifying change that needs to occur regarding the traditional access-to-funding setting in order to accommodate circular business and the changes it entails for ‘business-as-usual’ also in terms of the access-to-finance.

The structural flaw of underestimating the risks of linear projects and overestimating the risks of circular economy projects will not be remedied simply by taxonomy and EU funds: the financial systems on their own need to ‘circularise’ their finance offerings: the world as we know it, business as usual, is about to change and it could cost them more than just their reputation. Asset backed loans will need to change into ‘relationship’ backed loans, which presupposes also changes and ameliorations to contract laws to ensure monetised value to relationships as steering wheels of the new circular economy.

The lack of circularity in finance influences the offerings of the private market and the innovation necessary for circular solutions, which will in turn influence also the success of circular public procurement: the public funds and practices in innovation procurement cannot produce a sufficient amount of circular procurement to create a strong movement on the private market.

What are the impediments to a higher uptake of circular practices and what are their implications?

Aside from these two broader policy concerns, there are some specific impediments to circularity in public procurement: the first is the low uptake of green public procurement (GPP) across the EU,[1] impeding the insertion of circularity as the next step of GPP and the second the lack of regional, national and supranational best practices to that effect.

The integration between public procurement and circular economy itself is at its early stages at the EU level, where the incorporation of social, environmental and economic specifications into public procurement is not at a sufficiently high level to produce an indirect effect on products and consumers themselves and thereby stimulating circular economy. Furthermore, as majority of circular innovation stems from small and medium sized enterprises, it is crucial to further facilitate their access to public procurement systems, aside from general efforts to support the implementation of sustainable public procurement.

While the Eco-design Directive 2009/125/EC incentivises Member States to implement waste-preventing public procurement strategies according to information about the products’ technical durability, simultaneously suggesting the recycling requirements to be designed accounting for corresponding requirements for waste treatment in the waste legislation related to product, significantly supporting the circular flow of substances and materials, it is still strongly focused on waste management. Once again, here the notion of circularity supports more the linear production models than it does true circularity: while waste management and preservation of materials is important, determining the initial need for production and the potential for lease, reuse and upcycle is more important in terms of circularity.

The second supporting tool for circular public procurement, the Environmental Footprint Initiative of the European Commission, aims at providing a harmonisation process for the development of a scientific and consensus-based method, trying to inform and direct consumer choices with clear and comparable environmental information. Again, while reliable information is an indispensable steppingstone for determining sustainability hotspots, it is a truly preliminary and indirect step towards circular procurement. It does not provide for a true move from linearity to circularity.

Aside from the general concerns introduced above, the private sector further encounters impediments to circularity in current legislation on plastics recycling, competition law and the general corporate law favouring and prioritising linear business practices, lacking clear guidance on circularity. These are all examples of policy incoherence, some representing a direct example of incoherence (the silence of corporate legal frameworks on the social norm of shareholder primacy,[2] the plastic packaging requirements preventing the use of recycled plastics), others an indirect example (competition law).

Coupled with the abovementioned issues of financial law, these impediments are sufficient to significantly reduce the development of new circular solutions beyond pure recycling efforts. Additionally, the indirect policy incoherence in terms of competition policy as it stands, needs to be revised simultaneously to other sustainable changes to EU legal frameworks, and we have not accounted yet for those changes to a significant extent. If circularity is to be a tool towards achieving true sustainability, the traditional notions of ‘separating’ competitors and keeping them from cooperating will need to be revised. Circular systems have a need to be interconnected, cooperating and sharing, especially as reuse, repair and upcycling are the building blocks of circular economy. This calls for a systemic change of competition laws in themselves.

Furthermore, to aid the financing of this transition, traditional property and contract law will need to develop additional institutions to account for a different economy, one not based on assets as in material assets but rather relationships as assets. The road towards true circularity is still long, but these policy spill over considerations need to be resolved simultaneously with other sustainable changes to areas directly connected with sustainability in order to achieve a timely change towards truly sustainable circularity.

Where to now?

To conclude, a systemic change requires efforts of policymakers, private and public market actors as well as consumers. The above presented reflections represent just a fraction of what we will have to deal with in terms of transition towards sustainability and I would love to hear about any additional concerns and/or solutions to the policy issue that you have encountered in your professional field. I would gratefully any feedback or suggestions at lela.melon@upf.edu.

Dr Lela Mélon

Lela Mélon is a lawyer and an economist, specialised in sustainable corporate law. Lela started her sustainability career in 2014 with her research on shareholder primacy in corporate law. She is currently charge of the Marie Curie Sklodowska funded project ‘Sustainable Company’ at the Pompeu Fabra University in Barcelona. She has co-authored and authored monographs, published several scientific articles in the field of sustainable corporate lawand sustainable public procurement and presented her work at conferences across Europe, as well as introduced sustainable corporate law curricula in several universities in Europe.

[1] Mélon, L. ‘More than a nudge? Arguments and tools for mandating green public procurement in the EU.’ Working Paper, Conference Corporate Sustainability Reforms Oslo 2019.

[2] Mélon, L. Shareholder Primacy and Global Business (Routledge 2018); Sjafjell, B. (2015) Shareholder Primacy: The Main Barrier to Sustainable Companies, University of Oslo Faculty of Law Research Paper No. 2015-37.

Spanish competition watchdog CNMC issues report on health care outsourcing procurement

The Spanish Competition Authority has recently published a report on the application of its Guide on Public Procurement and Competition to public health care provision-related procurement in Spain (only available in Spanish: Aplicación de la Guía de Contratación y Competencia a los procesos de licitación para la provisión de la sanidad pública en España). 

The report is interesting to read and it identifies some common trends in competition-reductive procurement practices (if not fully suppressive of meaningful competition) and areas for massive improvement in Spanish health care-related procurement. 

Some of them may offer valuable insights for other countries that also organise their health care provision around a national health system. These are some of the aspects of the report that I find more interesting:

1. The report is mainly concerned with outsourcing processes, whereby the competent (regional) public authorities tender contracts for the construction and management, or only the management, of health care facilities (mainly hospitals). This is an area that will remain lightly regulated in the future EU Directive on concessions (Art 17) and in the new version of the Directive on public sector procurement (Arts 74 to 76a). Consequently, the recommendations and best practices identified in the CNMC report may help in the construction of a fuller set of (binding and non-binding) guidelines for health care management outsourcing.

2. The report offers a radiography of the hospital sector in Spain, which shows that it is rather large and that there is a very relevant presence of private investment in the sector. Overall, there are 789 hospitals in Spain (162,070 beds), which means that each hospital serves an average of roughly 59,300 inhabitants (290 inh/bed). 

However, there are significant regional differences in availability of total hospital services, ranging from Andalusia at 378 inh/bed to Catalonia at 218 inh/bed. Furthermore, it is also interesting that only 325 of the 789 hospitals are public (41%), but they accumulate almost 67% of available beds--which means that the availability of public hospital services actually ranges between Catalonia at 523 inh/bed and Aragon at 308 inh/bed. All regions have schemes of arrangement with private hospitals, so that they extend 'public' coverage through private hospitals (49% of private hospitals are included in such schemes, again with large variations ranging from 100% of private hospitals being included in the 'extended public network' in La Rioja to only 22% of private hospitals in Catalonia). 

The big discrepancies between the availability of total and public hospital services shows large regional differences in private investment and alternative (ie non-public) health care management strategies. This also seems to show that private hospitals tend to be smaller than public hospitals (116 v 334 beds on average)--and, probably, easier (but more expensive) to manage, at least in terms of general costs if economies of scale are properly exploited in the public system (a big if, I think, although the report offers no data to test this). It may also be worth stressing that 21% of private hospital capacity (by number of beds) is controlled and run by the Catholic church and religious organisations. The next larger private (or non-public) player only reaches 4%.

The distribution by areas of activity is also relevant, and it is worth noting that generalist, geriatric and psichiatric hospitals accumulate almost 90% of the available beds--which seems to indicate that there is room for further specialisation in the sector.

The report also offers more detailed analysis of the regions where there has already been some outsourcing of public health care management: Catalonia, Madrid, Valencia, La Rioja and Navarra.

3. The main body of the report focusses on the 5 aspects of health care management outsourcing that are more susceptible to create distortions of competition: (i) the design of the tender procedure and the setting up of the technical specifications, (ii) the setting up of selection criteria, (iii) the choice and weighting of award criteria, particularly those related to (non-measurable) qualitative elements, and (iv) issues related to contract modification.

It is remarkable that, in all of these areas, the CNMC has identified specific examples of very clear distortions of competition. It is worth noting, for instance, that:

a) There has been an excessive degree of bundling of specialist and general services in hospital outsourcing (sometimes forcing the hospital concessionaire to enter into existing public services contracts with third party providers of specialist services, such as image diagnostics or laboratory analysis).

b) Regional authorities have not availed themselves of proper strategic division of tenders into lots and the dominant strategy (one lot, one hospital) may have facilitated collusion.

c) Initial contract duration may have been excessive, with a median of 30+ years for works concessions (building + managing hospitals) and 10 years for service concessions/public service contracts (management only of an existing hospital). Some of them also include relatively generous extension/renewal provisions.

d) Of the 19 contracts that included health management (others were limited to the management of the premises, but included no sanitary provision), 15 were awarded to the only tenderer submitting an offer. In the other 4 instances, only 2 offers were received. This seems to indicate that participation requirements were exceedingly restrictive (or, in an alternative and very personal view, that there was no expectation of effective competition, either due to the existence of a market sharing agreement or widespread corruption, particularly in the case of Valencia and Madrid, where criminal investigations are underway).

e) The setting of very demanding selection criteria (particularly in terms of financial standing and previous experience) have limited dramatically the number of potential offerors and been particularly alienating for temporary unions of undertakings, as a relevant part of the tender documents required that each of the undertakings individually considered met all of the requirements. This is a stark breach of procurement law and, as such, should have been the object of legal challenges.

f) There was an insufficient publicity and advertisement of the tendering for public service concessions worth Eur 4,000 mn in the Madrid region (advertised only in the region itself). This indicates that, in reality, there may be some need for the extension of publicity requirements to concession contracts as the future Directive aims to do. However, this may also have been a breach of EU law requirements, given that the contracts seem to have (at least potential) cross border interest.

g) There was an insufficient disclosure of information with relevant financial implications, such as the personnel costs to be assumed by concessionaires of existing hospitals, or the system of mutual invoicing between public hospitals (which made it difficult to calculate the cost and revenue structure of the concession, particularly for relatively unexperienced tenderers). The information asymmetries were even higher when it came to disclosure of health planning and other requirements.

h) There was widespread misuse of the price criterion as one of the key elements to award the contract. Price assessment formulae based on average prices, or that gave a very low weight to prices (of 30% in construction concessions), or that included irrelevant criteria (such as giving 30% of weight to the establishment of a stock-option scheme by the concessionaire) might have limited the ability of regional authorities to obtain value for money in the outsourcing of hospital management.

i) There were several instances of double-count of elements as both selection and award criteria, particularly as previous experience is concerned. This is another blatant breach of procurement law and, as such, should have been the object of legal challenges.

j) Insufficient or too basic quality control mechanisms and penalties for breaches thereof were included in a significant number of concession schemes. Also, remuneration was always calculated on a per capita basis, so that concessionaires and public service providers would always be remunerated almost regardless of the level of quality or actual provision of services (80% of the per capita support working as a common floor or minimum remuneration).

k) Most tender documentation either imposed or facilitated subcontracting of up to 50-60% of the contract and no proper oversight mechanisms were in place, so that concessionaires were basically free to subcontract very significant parts of their contracts as they saw fit.

l) Excessive resort to contractual modifications: "Of the 38 contracts for which information is available, there have been changes in 24 of them (64%). In 7 of the 24 contracts modified there have been two changes to the contract."

4. In its conclusions (a bit too mild in my opinion, particularly in view of the major irregularities documented in the report), the CNMC recommends, among others, the following measures (see press release in English):

• When designing tender processes, the open procedure must be used whenever possible, as that procedure is the most conducive to competition and precludes contracts that cannot be justified on account of the pay-back times for investments.
• As regards access to tenders for participants, publication should be more widespread in order to open up access to the highest number of potential bidders possible.
• With respect to the weighting of criteria and the procedure for the award of contracts, a suitable weighting should be attached to the variables to avoid leaving excessive discretion to the award body. In the case of healthcare services, the overarching goal is to ensure quality in the provision of services to patients, so that a balance must be struck between competition in the price variable and the quality of the service.
• Lastly, as regards the implementation of contracts, it is proposed, among other recommendations, that the specifications should describe the elements that define the quality of contract performance and should contain credible and robust mechanisms for monitoring and penalising failures to meet the requirements of those elements. The specifications should also lay down remuneration and transparency mechanisms that encourage the awardee to provide high quality services (emphasis added).

In my view, this Report brings to light a very serious problem and a massive challenge in the modernisation and reform of health care management in Spain. I started wondering if a sectoral regulator would not be necessary, as the ones existing in England (Monitor) or The Netherlands (NZa), as this sector seems to really be crying for some close scrutiny...