NHS Procurement Atlas – useful benchmarking or completely flawed data? (Turn left at Copier Paper Junction for Toilet Roll Avenue …)

The National Health Service today published their first spend ”Atlas”, available here. It is trailed in the Daily Telegraph by an article from Dr Dan Poulter, the junior Health Minister.

"With an eye-watering £14 billion spent on hospital goods and services, better procurement practices represent a tremendous opportunity to improve efficiency and free up money for patient care... So, today we have launched a new website that begins the process of comparing the prices hospitals pay for over 100 different healthcare product lines – the NHS Procurement Atlas of Variation".

These variations, as we might have expected, are pretty large and will appear shocking,

"Hospitals will be ranked on how they spend money on a range of popular goods, helping them identify where they need to do better. For example, some hospitals are spending under £4 for every 100 blunt needles, while others are spending more than £30. This is scandalous". 

Hang on, aren't those medical items – thought you said this is non-medical supplies? I’m not clear what the precise definition is for these items. There is also separate Telegraph article announcing the initiative which gives some actual comparisons, and has drawn all the “comments” you would expect around why there isn’t a single national contract, how terrible this all is and so on.

We applaud the desire for transparency and the opportunity for trusts to benchmark prices and indeed other performance metrics. But after some initial excitement, my heart sank when I saw the detail. And that was for three reasons.

Firstly, we're back to the Philip Green world of A4 copier paper and toilet rolls, which of course is the heartland of procurement. That's what gets us up in the morning, isn't it?

Hospitals getting the best value are spending between £32.78 and £35.78 on 100 toilet paper units … Hospitals getting the worst value are spending between £50.15 and £66.72 on toilet paper units”.

What about the more strategic medical items, devices and equipment - and why not link the data to medical outcomes (see our article here)?  No, we're getting toilet rolls.

Secondly, and related to that general dismay, there does not appear to have been any attempt to look at issues such as specifications, order quantities or other factors that might make valid differences to prices. Was the £30 for the needles quoted above an emergency short notice delivery? What are the annual volumes for each of the Trusts? How many sheets in a roll of toilet paper? (Remember that long after the Green report was published, PC Pro and others finally established that the figures quoted there for various items were nonsense as they did not compare like with like).

So it will be fascinating to see the push-back on this from hospitals who have been accused of literally throwing money down the toilet. We understand that Trusts have not had a chance to look at the data prior to today's announcement, and that much of the data has come from NHS Supply Chain figures – “completely flawed”, I have already been told by an insider.

I predict some very robust responses from Trusts explaining why they pay what they pay (or arguing that this isn’t what they pay at all)! My local, Frimley Park, comes out of this badly, yet in wider terms is one of the best rated hospitals in the country. That seems odd. And actually, it is hard to understand some of the data in the Atlas - I don't know whether the figure quoted for Frimley Park's potential savings is a percentage, an absolute or what.  (And I wonder what David Lawson makes of the huge savings opportunities Guy's and St. Thomas's appear to have)?

Finally, it highlights the lack of progress on many of the more strategic initiatives that were proposed in last year's NHS procurement strategy. Where have we got to on the Centre for Procurement Development and other genuinely interesting ideas that could help drive real long term improvement in NHS procurement? What has happened to the Procurement Strategy Development Board, full of top people, which appears to have met once and been disbanded?

Let’s see what comes next – maybe this will start a wider and more useful approach to data. We live in hope. And let’s hope we see real progress on all the other procurement improvement work that is needed too in the NHS.

 

Voices (20)

  1. Stephen Heard:

    This is what Roy Lilley has to say on the matter:

    “I can’t believe I’m doing it but I am. I promised myself I wouldn’t but I’m going to have to. Once again I have been drawn into writing about the price the NHS pays for a bog-roll. Even the BBC’s new health-editor, Hugh Pym, has been drawn in to believing the NHS is so stupid it can’t buy a bog-roll.

    Let me tell you about bog-rolls. As the former chairman of the standing committee on supplies and purchasing in the NHS, this is a topic I think I do know something about. Yes, I know, I was in the chair when we were still buying starch for Florence Nightingale’s bonnet but the principles are the same.

    A bog-roll is not a bog-roll. How many wipes are there on the roll? How many leaves on the roll? How easy is it t tear off one leaf at a time… to avoid waste. More important; is it a plumpcious, comfy bog-roll, that caresses the rectal area, absorbent and responsive to the touch, that will be accepted by the CQC and pass the Chief Nurse’s personal test for test of caring and compassion. Or, is it a sandpaper bog-roll that scrapes and drags leading to Pruritus Ani.

    Trauma and scratching, in the presence of moisture can lead to inflammation, itching and makes the sit-upon, impossible to sit-upon… leading to patient complaints, disastrous F&F test results or workplace acquired injury, days off work, loss of productivity, tribunal hearings and compensation claims.

    To prevent theft and unauthorised use (theft of bog-rolls is a common occurrence in hospitals), is the bog-roll to be printed with a logo, or perhaps; ‘This toilet tissue is the property of Jeremy Hunt. Please use it sparingly, on both sides where possible’. It could include his picture to remind us we are wiping our backside in his time and we should hurry up.

    It might be the bog-roll has been bought as part of a janitorial package and is of such dimensions it only fits into a certain type of dispenser and is replaced by cleaning staff as part of a domestic cleaning contract. It may not be a roll at all; it might be interleaved in flat packs. The bog-roll might come bar coded to facilitate stock control.

    What is the make-up of the paper in the bog-roll? Pulp paper is air-dried and can contain northern bleached softwood kraft, the bog-roll maker’s benchmark grade of pulp or blended with the product of chemi-mechanical pulp containing wood chips or other plant material like straw with sodium carbonate, sodium hydroxide, sodium sulphite.

    Then, there is the all-important strength of the bog-roll. To get the right roll is to take into account compression, peel, friction, tear, tensile strength and puncture. The bog-roll has to dissolve, quickly, in the bowl but be strong enough to do its job. Dry tensile strength, measured using TAPPI T 576, should be 420-2700 measured in gf/3in.

    Anything outside that range can lead to sticky disaster and more use of the soap dispenser thus rendering savings in bog-roll wiped out (so to speak) by the use of more soap, hand towels, or electricity to turn hand-washing residue into a toxic, wash-room aerosol by the use of the looky-likey Dyson jet blower.

    Buying bog-rolls is not easy and there will be variations in cost.

    Hugh Pym, no doubt hoping for the Pulitzer Prize for writing bog-roll stuff, also informs us there is a huge variation in the costs, to the NHS , of clinical waste bags. He doesn’t discuss tensile strength, capacity, volumes, or fittings to accommodate dispensers. He also concerns us over the variations in the cost of a pack of A4 paper. I thought the NHS was paper free?

    Yes, there are variations and frankly, who cares? Buying all the bog-rolls centrally will, by the time they reach the Trusts, cost more. The no little matter of breaking bulk, distribution, warehousing and on-costs will make them 11% more expensive – you can bet the farm.

    There are all kinds of variation in procurement, often for good reason. Answer? It’s easy; just say to Trusts you can spend what you like on non-medical consumables but it must never exceed x% of your turnover… decide what x% is and tighten it every year. Then butt out.
    ———-
    Contact Roy – please use this e-address
    roy.lilley@nhsmanagers.net

  2. Simon Walsh:

    HCSA response issued at 7.30am Tuesday 22nd July,2014
    The HCSA did not receive advance notification of the Atlas publication, unlike all previous national initiatives and publications.

    The ‘Atlas’ illustrates the range of brand/product/price available from NHS Supply Chain along with the local decision making process that exists, as opposed to the accusation that Trusts are acting profligately.

    It identifies the need for NHS Supply Chain to improve pricing and better manage category choice along with the challenge to Trusts to support a more managed approach to core common lines.

    Sadly, the above will be lost in the discussion, as an approach has been taken that gains short term headlines but not long term gain.

    I am immensely disappointed on behalf of all NHS Procurement staff especially those who will read headlines this morning suggesting they will be ‘shamed’ into action.

    The vital work we are all doing to effect real improvement in NHS procurement will continue both at individual Trust level and in partnership with the Department of Health.

    Simon Walsh MCIPS
    HCSA Chairman

    1. Eugene Cooke FCIPS:

      From a personal perspective, I can only reiterate what Simon has said here. As immediate past Chair of the Association, I can only say I spent two years trying to understand why DH would say and take such actions. Unfortunately, if they (DH) decide to publish without involving the profession then we all have to suffer the consequences.

      It is easy to say that HCSA are a waste of space and as a Council Member, I am always happy to have a conversation with anyone about the work we try to do. But again, as Simon points out, these cooments don’t help towards better partnership working.

      For me the timing is another thing, it is almost one year since the publication of Better Procurement, Better Value, Better Care….ask yourselves what has happened in developing procurement in the NHS?

  3. Stephen Heard:

    I would like to know where the Health Care Supply Association are on this as the professional organisation for NHS procurement teams!

    1. Bill:

      I’m told that the HCSA is a complete waste of space, but its individual Committee Members and Chairman are all procurement leaders, and, importantly, are passionate about procurement in the NHS. Its President is Lord Hunt.

      1. Simon Walsh:

        Bill….never believe everything that people tell you!
        Simon Walsh Chairman and HCSA Council Members
        Contact me for a chat- I may be a waste of space but I am human so a chat would be great.

        1. HoP to it:

          I’ve met Simon and can safely say he’s defintely not a waste of space. He stuck me as a person with a real passion for the job he does, for his trust, the HCSA and the NHS generally.

          I’m sure he’ll agree that there’s always masses of opportunity for procurement teams around the country and they’re working their socks off for what are likely to be their own local hospitals. Shame politicians don’t think things through!

          I wonder if politicians, when invested, get the link between thier brains and their mouths removed?

        2. Bill:

          Simon, I never said that you were a waste of space. Rumour has it (as I tried to write previously, but clearly in haste) that you and your fellow ‘Commitee Members’ are procurement leaders and are passionate about procurement. I’ve been sent copies of your recent communications that were sent out to your fellow professionals, and it is clear that you give a damn.

  4. Tony White:

    Delighted to see some sense in the comments here. Yesterday was my most demotivating day in 14 years NHS service. We all know NHS Procurement in England is a complete mess, and the lack of a coherent national approach is entirely down to politicians and civil servants, NOT individual Trust Procurement teams. Presumably Dr Poulter would have blamed the stokers in the engine room for the sinking of the Titanic.

    1. Robert Beveridge:

      I wrote to Dan Poulter to explain why he was wrong to issue this data in the way he did. I will let you know if I get a response.

      1. Bill:

        IYes please. Let us all know the details of his response.

        We all want to know why:
        – there were no advanced comms – not to anyone;
        – product choice was so fundamentally flawed (bog rolls!?);
        – data was so fundamentally flawed;
        – process was so fundamentally flawed;
        – the name of Patrick Carter – the ‘Procurement Champion’ – was strangely absent from ANY articles or comms

  5. Bill:

    This is a spectacular balls-up. Policy teams are supposed to advise and protect their Ministers, not make them look like complete arses. Everything about this initiative is flawed – not just the data. As one Procurement Director explained to me (after a national phone call yesterday which took place 30 minutes AFTER this data was put in the Atlas): “regardless of ‘what’ is imposed by a Minister, it’s up to the DH policy team to determine ‘how'”. All they heard on the call was a long drawn out excuse that it was all the Minister’s fault. So, did the Minister say that no advanced warning was to be given to any NHS trust?. Appalling lack of change management, and an absence of any basic courtesy. If Dan Poulter was on the call yesterday, I imagine he would have been quite surprised at being singled-out for this debacle.

  6. David Lawson:

    “This is not what we pay” The analysis is based on the average price paid during 2013/14 FY rather than latest price. Significant direct rebates in return for commitment/ standardisation are not included. Scrutiny of the quoted examples is now showing the products and unit of measure are not always like-for-like and reflects the lack of validation before the analysis was published.

    As commented previously the current focus on unit price in isolation although important ignores broader efficiency/ waste opportunities that deserve greater attention.

  7. PublicPound:

    I know what David Lawson will have done ….. laughed. Luckily he’s one of the more intelligent Procurement Directors and doesn’t let drivel like this detract him from the job of the doing the best he can for his Trust.

    The DH don’t do themselves any favours producing analysis like this. They’d be better dishing out the £30m they’re sat on to Trusts to do some real work.

    Having said all this, I do like the Atlas website. If only it were created for human beings (what the hell is Metadata?!)

    1. Secret Squirrel:

      The Metadata is actually quite revealing. Metadata is data about data. So in this case, it tells you the basis for the comparisons. You get to see that the comparisons are between some common and some specialist products for example.

      In other words, the metadata actually demonstrates the analysis is hogwash.

  8. Sam Unkim:

    The £30 needles contain a tiny filter which prevents tiny particles being drawn up into a syringe.

    http://my.supplychain.nhs.uk/catalogue/product/ftr436

    Blunt filter needles are used to remove undissolved crystals prior to solution administration to patients. They are rarely needed, but of course we can’t see that from the Atlas

  9. PCZZZ:

    Indeed – this simply highlights the variations at play with one Supplier who as I understood things were appointed to work as a partner to the NHS and operate ‘inside the NHS tent and aggretate demand’. It seems the very contract designed to get rid of price variation has indeed completely exploited the NHS on the issue.
    Why are we being told this 7 years into their contract – it’s a little late. But that said I’m interested to learn what the ‘so whats’ are?
    Will NHS Supply Chain now remove these variations, who will take what action to get to the waste now its been highlighted – albeit a only a fragment of the big picture?

    1. Secret Squirrel:

      If the analysis is what it says it is and the data only comes from NHS Supply Chain then it’s showing two things:

      1) NHS Supply Chain’s catalogue has a range of items and preference come into play
      2) The goods are offered with break points

      Insightful stuff…..

  10. Publicservzzzz:

    Let me get this right… the DH complete some analysis on the products NHS SC (a 50% government owned business) supply into the NHS. They inadvertently blame themselves (or 50% of themselves) for not standardising products during the 8 years of the contract.

    Typical DH analysis. Politically motivate, pointing the finger at everyone but themselves, then run for the hills once Dan Poulter has spread the muck all over the public domain.

    The telegraphs’ headline “At last we can track how the NHS spends our cash is laughable. They should tell the public that the spend analysed accounts for less than 1% of total revenue. If you made that claim in the private sector you’d be out of a job by noon!

  11. Robert Beveridge:

    This data is based on trust purchases from one supplier, the DofH controlled NHS Supply Chain. On average across the country trusts spend only £1.1m each with this supplier. This is because they are largely uncompetitive versus alternatives. In this data it is highlighted that there is on average a potential to save 0.03% of costs, so about £30,000 per trust, enough to pay for one procurement person to deliver it.
    The real opportunity here is to renegotiate a sensible contract with the provider of the NHS Supply Chain services to provide a better quality wholesale supply to the NHS.

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