Feedback on patient services is helping to develop best practice ©NHS
Feedback on patient services is helping to develop best practice ©NHS

Case study: How Arden & GEM CSU fixed a fragmented service

A project to redesign community health in Nottinghamshire brings radical transformation

It’s a challenge familiar to many a procurement team in the public sector: a multitude of contracts, a vast number of stakeholders and the need to deliver efficiencies. In Nottinghamshire, the challenge was to fix a fragmented healthcare service with an inconsistent standard of care due to a lack of co-ordination between providers.

The solution was a £247.38m project to tie together the many public bodies delivering health services, namely six clinical commissioning groups (CCGs), Nottinghamshire County Council, Nottinghamshire Healthcare NHS Foundation Trust and Nottinghamshire Hospice, to form NHS Arden & GEM CSU and Nottinghamshire CCG.

“There were multiple contracts and some services were being delivered without a contract,” explains Neli Garbuzanova, procurement manager at the CSU and procurement lead for the project.

The partnership delivers services including community nursing and healthcare for young people. In total there are more than 70 stakeholders.

“Our vision was to work with the CCGs to change the way community services are delivered across Nottinghamshire,” says Garbuzanova. “The key was to put the patient at the heart of delivery.”

Among the first tasks was to establish a decision-making structure that took into account the number of organisations involved. This includes a commissioning board to make high-level decisions; a steering group for practicalities; and task and finish groups to set KPIs and monitor contracts.

A two-stage procurement process was designed comprising a pre-qualification questionnaire followed by bidder presentations and real-life scenario questioning. “We have to see if they can deliver complex contracts,” says Garbuzanova.

The tender evaluation panel includes patient representatives, parents and carers. The process has been managed with an electronic tool (pictured left), with training provided to assist those unfamiliar with procurement software.

To develop best practice, feedback surveys have been completed, showing an average satisfaction rate of 70%, and unsuccessful bidders receive debrief sessions to improve future submissions.

The procurement overhaul, which began in 2015, has taken 17 months. Over the life of the seven-year project, savings of over £12m are expected. The length of stay in short-term rehabilitation beds – a key measure of how efficiently a health system is operating – has already dropped from around 32 days in 2015-16 to 17 days.

The project was recognised when it won the 2017 CIPS Supply Management award for Best public procurement project. Garbuzanova believes working together has been key to its success: “We should be fearless in promoting collaboration,” she says.

Outcomes first

Among the key aims of the project was to join up health and social services and introduce outcomes-based commissioning.

Contracts are structured so payment is directly related to achieving clear objectives, such as reducing length of stay in rehab beds.

An Outcomes and Performance Monitoring Group reviews contract outputs and provides data assurance before the relevant contract monitoring group assesses outcomes.

The CSU said successful providers “have become partners committed to delivering integrated service and collaboration”.

Garbuzanova says: “We are moving towards outcomes-based commissioning where a proportion of the contract value is dependent on achieving outcomes. Successful bidders have to deliver quality services if they want to get paid.”

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