UK Public Procurement – could health ideas inform procurement thinking?

(We're delighted to feature another guest post - in two parts - from Dr Gordon Murray, procurement practitioner, academic and commentator).

On the 26 March the UK Health Minister outlined his response to the Francis Report; the investigation into healthcare failings at Mid Staffs hospitals. I have been watching some of the NHS discussions and, in parallel, following the Public Administration Select Committee (PASC) Inquiry into Public Procurement. As I listened to the discussions on the Francis Report I had a vision of Bernard Jenkin (Chair of PASC) having coffee with the Health Secretary and each accidentally leaving with the others papers. Just to clarify, I wondered what would have happened had suggested improvements for the health service been transferred across as recommendations for public procurement improvement.

First a caveat. I am not in any way trying to undermine or trivialise the significance of the horrors experienced by patients and their families at Mid Staffs, but merely exploring transferability of the proposed NHS improvements to public procurement. PASC will need to come up with something significant in the light of the conflicting evidence their Inquiry uncovered and decades of inertia, while CIPS has long argued that the procurement profession should be viewed as an equal of other professions. Now I pose the question: "Is what's good for the goose, good for the gander?".

Let's consider the Health Secretary's rationale for a response as an example of what I mean:

"Actions that must ensure [public procurement] is what every [procurement] professional and [citizen] wants - a service that is true to [government] values, that puts [citizens] first, and treats [it's users and the market] with dignity, respect and [professionalism]."

Hopefully the above provides a feel for this blog, so let's see what you think.

It is recognised there is a need for culture change in the NHS. It is also inconceivable that PASC will not agree there is a need for culture change in procurement in the light of the evidence they considered. While the NHS needs to ensure a culture of 'patients first' is embedded, public procurement, I would suggest, needs to get on top of implementing policy, reducing costs, managing risk, working more strategically and collectively across silos, and with perhaps a little more honesty and humility. Just like the health sector.

I applaud the government for recognising mistakes happen in healthcare and there is a need to learn from those mistakes while fostering a culture of managed risk. Is it not true that public sector has too high a level of risk aversion embedded within its culture. Public procurement needs to also accept that mistakes happen and yet proactively encourage more innovation through prototype procurements. I think the current NHS system of explaining risks to patients prior to an operation is good but I have very, very rarely seen anything remotely similar applied in public procurement - why is that acceptable?

The NHS needs to protect patients against the risks of harm and inhumane treatment - public procurement needs to protect the public purse from the risks of money wasted and unreasonable treatment of the market. Like the NHS, a review of the implied public procurement complaints procedures needs stress testing. I have met so many bidders who lack confidence in the current processes and have demonstrable evidence of what appear to be systemic cover-ups, so public procurement clearly needs to do better. Yet we heard public procurement leaders praising the very systems which many simply neither trust nor use.

The NHS has been too focused on compliance with regulation. Equally, public procurement appears to have been too focused on compliance with regulation, even to the extent of not sharing information across silos, and an excessive risk aversion to EU procurement regulation compliance. I'm not suggesting ignoring the Regulations and breaking the law but more intelligent working within the Regs. To make this happen procurement and legal professionals need a culture change to 'can do' and bravery. Some will have other more colourful descriptions.

(To be continued…)

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Voices (2)

  1. Gordon Murray:

    Thanks Dave, I was not arguing for the NHS reforms, of which I am very cynical, but instead asking would procurement could benefit from some of the approaches being applied to procurement. Sorry for the confusion.


  2. Dave Orr:

    Quoting the US-style Powerpoint slide cliche of a culture of “can do” is a sound bite, rather than serious debate, on the pros and cons of a market economy in NHS procurement for medical services.

    And, if culture change is needed, then how will the best bits of public service culture be identified, nurtured and sustained?

    The key to an effective NHS is to deal with elderly social care and join that up with health & community care, if our NHS hospitals are not fill up with an elderly populatiion as it ages and suffers multiple chronic conditions.

    How will existing joined up services avoid fragmentation and the inevitable cherry picking from private contractors who may remain unaccountable and where risk is transferred directly to the patient of harmed or they die?

    How will any emerging health market stay competitive and avoid large suppliers creating a future cartel as in energy?

    What makes a good hospital good and what makes a bad hospital bad? Could part of the answer be accountable Leadership ?

    How will complex contracts for possibly 10 or more years be written that can cope with change, that will inevitably have to deal with the unforeseen and unexpected e.g. new medical technology, new chronic disease treatments etc.

    Anyone brave want to “own” the disastrous NHS IT project (NPfIT) that wasted something like £14bn for little discernible benefit?

    “Everybody lost in the NHS IT debacle. We can only hope everybody learned from the experience.”

    When some £40bn of NHS funding is at stake and lives may be at risk if “bravery” is not tempered with a full business case and awareness of the risks, then does another NHS fiasco beckon?

    Here is what happens when “brave thinking” is not informed by evidence and underpinned by rigorous process (as in good medical practice):

    “Paramedics slam new 111 non-emergency phone service”

    In follow-up articles, I hope that the author also deals with issues of public accountability, information access and governance, as well as the above please.

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