Back To The Future (of NHS Procurement) – A Lesson in Time With Help from Mr H G Wells 

Today (June 18) at the HCSA’s Summer Conference at Whittlebury Hall, Towcester, about 300 senior procurement professionals, national policy makers, commissioners, professional and technical experts from the UK health sector have come together to listen to speakers, meet exhibitors, learn about new innovations and to share best practice. Attendees include NHS procurement professionals, Heads of Procurement and Clinical Procurement Specialists.

The topics for the day include a keynote about the Future Operating Model (FOM), an introduction to CaPA (the Clinical and Product Assurance function in NHS Supply Chain, which sits within the Supply Chain Coordination Limited), The Category Towers, PTOM, and Market Insights from AdviseInc with its Purchase Price Index and Benchmarking (PPIB) solution. There will also be some ‘good practice’ stories from Trusts.

If you were to take a look inside the conference brochure (available at the event and online on the HCSA website) you would find a central article supporting the many ‘future of procurement’ themes running through the agenda, called ‘Back to the Future.’ It’s written by Spend Matters’ friend and long-time public sector, NHS and procurement aficionado, Rob Knott, former National Director of NHS Procurement at the Department of Health, and Procurement Director of Hampshire Hospitals NHS Foundation Trust.

It’s an interesting reflection on NHS Procurement through time. Rob, travelling in the NHS Time Machine, takes us through the changes in NHS Procurement over the decades, from Hospital Management Committees in the ‘50s, to the creation in the ‘60s of the National Association of Hospital Supplies Officers (the forerunner of the HCSA today) which publicised the importance of Procurement and Supply Management across the NHS and promoted a formal career path within the function. But everything he sees from his H G Wells’ invention isn’t necessarily as rosy as it could have been:

“They were ahead of their time,” – he said – “But they might be a little saddened to hear how, over the next 60 years, the NHS Procurement and Supply Management function would experience another 32 ‘centre-led’ reviews. They might be tempted to ask you what went wrong so many times to result in so many reviews failing to address the same recurring problems so often with the same solutions.”

Rob exposes some of the reviews’ most common themes and shows how they became more sophisticated over the years, incorporating increasingly advanced recommendations, while attempting to reflect the prevailing dynamics and complexities of the NHS and its supply markets and relevant technology advancements. He concludes that every one of those themes would resonate with Procurement leaders across the NHS today.

He takes us through development after development (from appointing national, executive leadership in commercial, procurement and supply management, to delivering hundreds of millions of £s [billions cumulatively] in measurable benefits and efficiencies) of the centre-led reviews that have tried to take the NHS on a new journey and have failed.

If we could go back and reset one thing, he hypothesises, to make sure just one of the major recommendations proposed in the reviews over the past 60 years was fully implemented, and had become a permanent feature in the current landscape, what would five years of continuous professional development, practice and improvement across every NHS organisation look like by now? Take the initial PTOM blueprint, he says, “let’s imagine we reversed the catastrophic decision taken on the NHS Centre for Procurement Development (NHSCPD), and, instead of losing its funding, it was successfully launched in 2014, as planned … Many of the initiatives and activities proposed in the PTOM blueprint wouldn’t be necessary – we would already proudly own these capabilities. And yet, here we are again, reluctantly accepting that we will need to start from scratch.”

But we can’t go back and change the past, we can only learn from it, he assents.

“The NHS Procurement leadership community, with all of its know-how, knowledge and experience, is more than capable of driving the design and implementation of a modern procurement and supply management organisation, and one of the most advanced in global healthcare. It’s about time they were given the opportunity to get it right first time.”

Do read the whole (very substantial) article here on the HCSA website.

We will have some roundup commentary and key takeaways from the event in the coming days. And don’t forget that the Winter HCSA event takes place in November.

 

Voices (4)

  1. NHS HOP:

    Very interesting and pertinent comments Michael.

    Beyond doubt, NHS trust procurement leadership iwould favour a much more focused and sustained attempt at ‘centre-led’ sourcing and supply management. Any HOP who says they’re not is deluded and in the wrong job. Whether, as you indicate, they would favour centralisation – where typically the majority of products and services are sourced and supplied by a single, central team – is debatable. And for the reasons you have outlined.

    IF (note the caps) we had experienced significant success over many years where centralisation was enabling the NHS “to exploit its leverage” then we would be pushing this agenda hard. (Note the quotation marks – this phrase appears so often in the reports and reviews of external consultants where they make themselves believe that they are some kind of economic plumbers who suggest that you simply need to turn the leverage tap and the value just flows out.) But this hasn’t been our experience. What we are seeing is Jin Sahota feature in various publications, telling everyone how well it’s all going and the savings he’s achieving, when, on the ground in the NHS, we are seeing cost pressures due to increases in prices, often on some very basic commodities. In fact, here we are, coming up to four months in the new finnacial year, and we’re not even in possession of any detailed savings plans from SCCL.

    Do we have any faith in centralisation? No.
    Do we have faith in a centre-led approach where that ‘centre’ might be a regional/local concentration of capacity built on expertise and experience? Yes.

    One of the major problems in all of this is leadership. And it isn’t just about Jin.
    Michael is being very subtle with his expression “Head of Procurement, NHSI” because we all regard this person to be relatively junior and inexperienced (though, clearly, she is not lacking in ambition). And it’s blindingly obvious to all of us that Deloitte is driving this initiative, and to their own agenda.

    This is the first time, for a long time, that I have seen members of the NHS procurement leadership speak up and push back at the HCSA Conference. We need to keep it up. Or be happy to stay asleep at the wheel.

    1. Michael Angel:

      I do hope you all keep pushing back. I still find it amazing that no-one at national or policy level are really listening to the local NHS procurement leaders. They are just unfairly portrayed as blocking or adverse to change.

      As for Jin. As you say can’t keep out of publications stating how great SCCL. No verifiable savings delivered yet and he then suggested they could procure Health Services nationally for the NHS. Can imagine every Commissioner in the land reading that had shivers sent down their spines.

      One supplier who shall not be named has been saying for years now on LinkedIn how procurement keeps pushing back year on year on price and questioning not just the sustainability of said approach, but questioning the expertise of NHS procurement which again just unfair.

      External consultants will come in and try using blunt force to apply the centralisation model on to NHS procurement with no real understanding whatsoever how the NHS works as a system. The fall back position when it doesn’t work “too much bureaucracy”. Sadly you can’t change law, so if that isn’t something that is considered or is simply disregarded by consultants, then it begs the question their role in such an exercise.

      My advice to national and policy makers is simply listen! Listen to the people on the ground actually facing these challenges daily. That way proper factual analysis can be gathered and used more wisely.

      1. NHS HOP:

        If you recall, SCCL was originally called ‘the intelligent client coordinator’ (ICC). Literally, this means the ‘coordinator of intelligent clients’ which doesn’t make the slightest bit of sense. And then you recall the person who came up with this name and you recall that they were clueless about procurement in the NHS.
        What they actually meant was ‘intelligent client’ – the strategic function which coordinates key activities across the NHS procurement and supply management landscape, specific to ensuring the delivery of the in-scope categories of the former NHS Supply Chain contract and service.
        But this illustrates how easy it is for just one clueless but empowered person in the centre to make us all look utterly clueless to our peers in other industries and other healthcare economies, and our suppliers. In the latter stakeholder group (suppliers), we often hear that they are laughing their heads off, but it is at the expense of our reputations.
        Once the self-declared experts in the centre, their consultants, and sponsoring Ministers have moved on – like bored children who’ve given up half-way through building a complex jigsaw – it’ll be left to us to pick up the pieces. This has forever been the one constant in an ever-changing (procurement) landscape.

  2. Michael Angel:

    Former colleagues of mine found the most highlighting part of the conference was NHSSC reluctance to confidently state they are able to deliver the savings they’ve set out to deliver.

    What was interesting was the Head of Procurement of NHSi stating that there is scope for a centralised and nationalised procurement service. Not sure they are going to garner much support for it given lack of confidence and lack of evidence the SCCL model is a working one. As one of my favourite film quotes says “Don’t build a bed in a burning house” which is opt for the notion of centralising procurement within the NHS.

    Many leaders in procurement across the NHS haven’t been against centralisation, if anything they are looking for a compelling argument that supports the notion that this could be successfully implemented. One of the ongoing arguments is NHS Procurement shouldn’t be driven by law or compliance but by economics and many commentators have also stated buy in is required.

    Just imagine demand management for a moment which is the biggest challenge the NHS would face with centralisation. The budget is derived from a central pot. The NHS doesn’t generate the levels of income as other major organisations. Imagine for example a supplier who providers cardiac consumables signs up to an agreement with a nationalised agreement. Told for example there will be volumes of say 2.5 million consumables provided to each hospital. 12 months on and the NHS budget is further slashed. Demand has grown for the consumables, however the supplier is expected to absorb the cost. The demand can’t be reduced (because of patient safety) and then the procurement team will no doubt be left with no choice but to attack the supplier margins (which has underpinned many CIP’s in the NHS).

    If that is happening at local level, then how on earth can centralisation be seen to eradicate that problem?

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