NHS procurement – File on Four radio programme review

I worried unnecessarily about how my interview (for last night's BBC Radio 4 File on Four programme on NHS procurement) came over because so little of it got used! In terms of the programme, it started well with the comparison between England and Scotland where there is apparently a much more centralised and structured approach to health procurement. Interesting and I'd like to see real comparisons between English and Scottish prices.

I thought the Health Minister interviewed didn't come over very well. "We are hoping this will happen.."  - didn't sound very convincing.

One point which I'm sure I made in the interview but unfortunately didn't seem to come through was the issue of commitment. A key problem with having so many different procurement providers is that none of them are  able to go to the market with real committed volume from the hospitals. Anyone in procurement knows that this is how you get the best value. So different bodies all claiming to "represent" Trusts leads to the market not offering the best deals to anyone. That point was missed really.

The programme also only skirted round the issue of private firms (procurement outsourced service providers) coming into the picture via joint ventures with "hubs" and other means. Interesting as they seemed very keen on that when I was interviewed. Perhaps that got cut to make room for the material on GP Commissioning which wasn't inititally going to be part of the agenda. But that issue of private sector involvement is a concern - not the principle, but the lack of oversight and underpinning strategy.

I also felt that introducing GP Commissioning in the last 6 minutes perhaps bit off more than the programme could chew - that's a huge issue in itself. Then the Minister, according to the interviewer, said that "the procurement spend that GP Commissioning Groups will be responsible for will be  modest".

WHAT???  Who is handling it then? Have I missed something? Perhaps he means that they won't be spending much through formal procurement processes but that seems really unclear at the moment. Or perhaps there was confusion and he was talking about GP groups spending money on health consumables and equipment - which isn't significant in the greater scheme of things. But they certainly will be spending money on health services which is what I was talking about.

It finishes with the Minister basically saying that Trusts are independent and they need to improve procurement without intervention from the "heavy hand" of the Department of Health. So let's see if that happens.

Anyway, I suppose it's worth contributing, even if I feel now it was more to help the producer and interviewer understand the issues, rather than get a lot of air time.  But I do end up wondering if its worth pretty close to a day of my life to get about 30 seconds of radio time.. but maybe that's just my ego talking. Or time to start the Spend Matters radio station perhaps.

You can listen to the programme via this link.

And in case you want more, here are my notes taken in real-time as I listened last night.


Real-time notes

Scotland – have common procurement system, common specification, same price, understanding prices, same price across country. (How do their prices compare to England?)

NAO report – very different in England.  Mark Davis, NAO,  652 different rubber gloves! £500m savings possible.

Simon Burns – Minister – agrees need to do better. Should Trusts have a target – “what we are hoping will happen...” (that is not a strong Ministerial argument). “It is easier in Scotland, they’re smaller” he says.

Zoe Greenwell (CPO Barts). “All sorts of gloves in the Supply Chain catalogue”.  She offers a limited selection to her clinicians.  Numerous regional organisations – collaborative procurement bodies. “We use supply chain, London supply chain, other collaborative bodies, national contracts....”

“Procurement landscape is a mess” (me).

Groups would work together when first set up – hubs, Supply Chain etc. But not happened, created confusion.  No co-ordinated approach.  US firms coming in. Detrimental effect on Supply Chain business. Supply Chain – “our prices are competitive if you take everything into account”.

Clinicians also want to get involved in the decisions.

NAO want more transparency on pricing.

East Midlands hub... one Trust found would cost hospital more working via hub. Hub didn’t match lowest price. Hub now folded.

New contracts overlap and duplicate. NAO hampered by lack of information. Hubs haven’t worked very well. Duplication, no consistent basis.

Small suppliers prefer to work with individual buyers (of course they do).  Interviewer asks about profit margin on an operating table. Supplier doesn’t answer but raises the cost of managing a purchase order for the NHS (totally not the issue – waste of time. Not sure what this bit added).

Mario Varela (I thought he was CPO at Barts? Has he moved – see Zoe G above). Procurement should be on the agenda for Monitor and needs more focus from Boards of Trusts.

NAO – nobody is responsible for procurement in Foundation Trusts. Minister says they’re independent organisations. But Monitor makes no mention of targets on procurement? Minister struggles. “They’re independent, driven from bottom up”.  But we’re providing help and advice, he says.

GP Commissioning gets introduced to the programme with 6 minutes left.

It’s Peter Smith... GP reforms add another layer of uncertainty. More fragmentation. Losing opportunity to get best deals. VFM risks, confusion. Lots of good news for lawyers - challenges etc .

Minister says (reported by interviewer) -  GP Commissioning group spend will be modest. WHAT THE HELL DOES HE MEAN??

Or is it he (or the interviewer) talking about GP’s spending on health goods and equipment – which will be modest - but of course they’re going to be spending a fortune on health SERVICES. Which is what I was talking about.

So a bit of a confusing end to the programme to be honest, which then seemed to finish fairly abruptly.  Like this.

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Voices (3)

  1. Zoe Greenwell:

    Like Peter, I too spent almost 3 hours with the BBC team and we covered a number of issues and our various strategies at Barts and The London NHS Trust (yes, Mario Varela is now Managing Director at The London Procurement Programme with membership across the whole of London) but the majority ended up on the cutting room floor!

    We had also talked about clinical preference and that we had controversially changed supplier following tender evaluations in a number of key product areas recently because the clinical evidence produced was insufficient to outweigh the additional cost. You need strong Board level support and a clinician led procurement group to challenge existing practice and to introduce ‘cost to treat’ methodology. The next phase will be to challenge specifications – not just to ensure they are generic but also to question automatic uplifts in technology.

    Like Simon, we also benchmark prices through LPP and The Advisory Board. Knowledge is key.

  2. Simon Walsh:

    Your comments were useful Peter in an otherwise disappointing programme.

    The comparison with Scotland (whose version of the NHS is vastly different) was ironic given that the Scottish NDC is relatively new and most of the English NHS developed RDCs in the mid to late 1980’s. Scotland declined to do so for reasons of geography and strategy.

    It was good to hear Mario and Zoe interviewed.Mario restated the need for the Board and monitor agenda to include procurement – The Board at our Trust are very interested in procurement and our Chairman especially so.

    The reality of the competitive landscape for NHS Procurement intermediaries was well illustrated though unless DH policy changes it is something we will have to get used to.

    The procurement function at Central Manchester NHS FT is embracing these change and working within the landscape to getthe best for our services whilst not disadvanting others.We have productive relationships with NHSSC ;NHS SBS and CPC – none are exclusive and all offer benefit. This is not similar to American Hospitals who will have multiple GPO relationships.

    We are also a member of The Advisory Board initiative.

  3. Chris Chapman:

    Rubber gloves and A4 paper – er, how original is that? I can’t believe they got down to just 2 types across an entire hospital, while cheap A4 paper is OK until the loose fibres damage the printers…

    Little focus was put on stock control – regularly topping up a store room is OK but has anyone checked if what’s in it is being used efficiently? Barcoding was briefly mentioned – again possibly a valuable lesson/tool to learn from other distribution industries?

    The section with the operating table maker was interesting and highlighted how Procurement should have technical skills so it can enter into, and contribute to, informed dialogue between users and suppliers to ensure that the best value products are bought to maximise life and ease of use – no point saving a few quid in buying equipment that soon falls apart and makes operations more difficult to perform successfully.

    One of the biggest bugbears in Procurement must be trying to stop suppliers’ reps visiting hospitals without its approval…

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