Repairing stakeholder relationships has helped the health service transform from a cost cutting focus to one of time and resource management
One could argue that procurement and NHS clinicians have not been the closest of bedfellows. But this could become history as a new initiative to pivot procurement of clinical procedures within the NHS from a cost-driven to a value-driven model is helping to align and unify the two sides.
Spearheading this value-based procurement (VBP) transition is project lead Brian Mangan, who recalls one of his first meetings with a clinician after joining the NHS from Royal Mail as a hospital procurement manager in 2004. A neurosurgeon not-so-gently told him: “This isn’t Tesco, you know.”
“It was a totally different world,” Mangan says. “Very much an ‘us and them’ attitude. Their perception of procurement was very transactional.” Times have changed since then but, even now, a style of procurement that emphasises outcomes rather than price is likely to be high on many clinicians’ management-related wish lists. The challenge is more how to find commonalities and communication between the groups.
It wasn’t surprising, then, that when Mangan began to discuss this with multi-disciplinary clinical teams as part of an NHS Supply Chain VBP initiative in 2019, he found he was “pushing on an open door”.
“We had been getting a lot of suppliers talking about value. Procurement tended to be adversarial when it came to dealing with suppliers but, of course, there’s only so far you can go on price,” he recalls. “We needed to have better relationships with suppliers and we needed to do something differently.”
Carving out a joint strategy
As part of the pilot, NHS Supply Chain approached 20 top strategic suppliers and several SMEs to ask for their input on how to release capacity, resources and services. The aim was to view whole-life costs and build better relationships with suppliers that have developed an intimate knowledge of the NHS’s clinical needs.
“It’s not rocket science. The idea was the NHS might pay a bit more but use less of a supplier, might train a surgeon to do things differently, might move a procedure from an inpatient to a day case,” Mangan says. Procurement took the lead on the resourcing strategy for the 10 pilot projects that ensued. Eight of these delivered the results their advocates had foreseen.
Of course, shortly after the study began, the pandemic intervened. This limited the scope of some of the pilots and caused delays. It also placed an even greater emphasis on saving money and freeing up valuable capacity. One initiative at Oxford University Hospitals NHS Foundation Trust piloted the use of devices enabling selected patients to receive intravenous antibiotics at home. Eighty-six patients used the device, saving a total of 1,143 bed days, equating to cost savings of £360,410. Expanding use of the devices to 200 patients a year could generate savings of £630,640 by freeing up 2,000 bed days.
At Manchester University NHS Foundation Trust, the use of a specialist tissue glue instead of a post-operative drain to prevent blood clotting reduced inpatient stays for the surgical removal of the parotid gland from 2.5 nights to one day in hospital. The saving per patient is forecast at £805 and, if the procedure were adopted across Greater Manchester, it could release 575 bed days, avoiding costs of £185,150, according to estimates.
A pilot to use different urinary catheter systems saw the catheter-related urinary tract infection rate fall by 100% at one hospital at University Hospitals of North Midlands NHS Trust. Testing on just 12 patients a year brought savings of £47,162 per annum on consumables, £23,616 on costs associated with infections and £21,000 from patients not occupying hospital facilities. Expanding the pilot throughout a trust that carried out 200 of the procedures a year would release additional capacity of 1,200 bed days a year. That would deliver an estimated £415,200 of cost avoidance savings.
Meanwhile, an alternative method of treating a prostate condition reduced theatre time from an average of 75 to 20 minutes. It also cut the length of hospital stays from an average of 2.8 days to just four hours. And yet these figures only tell part of the story because it is hard to measure the full benefits to the patients who participated in the trials. Helping patients avoid painful infections thanks to new procedures or devices, enabling people to receive antibiotics in the comfort of their own homes, or to avoid the discomfort of having a drainage tube removed were all positive outcomes of procurement’s initiative, though harder to quantify.
Value on a global scale
The financial potential unearthed by the pilots is impressive. The use of glue rather than a post-operative drain, for example, led Manchester to explore whether the same techniques could be used for other neck or facial surgeries. Expanding its use to these procedures could support good experiences for patients and possibly avoid even more costly stays in ICU. And the idea of having such savings writ large across the NHS, not in only one hospital or one trust, is intriguing.
So where does this lead? The process is already being rolled out in 30 projects across the NHS. The pilot study has been used to produce a toolkit for NHS Supply Chain about how to use VBP, and training is under way among NHS Supply Chain buyers. “We’re hoping that within the next 12-18 months it will become business as usual,” says Mangan. He believes the pilots have seen lessons learned on both sides. Pre-pilot discussions with suppliers revealed a relationship gulf in some cases. Some suppliers failed to understand the concept of value at all.
“In one case a supplier told us they could save us three minutes per procedure in theatre time and this would generate £2m of savings. I told them: ‘That’s just not going to happen.’” Mangan says. On reflection, he believes if he had communicated better with the supplier, the outcome might have been different. “Perhaps if I’d told them we needed to release capacity of 30 minutes in the operating theatre, they could go away and determine whether they could do it or not.”
How large could VBP get? “It won’t work everywhere. You will see it in certain clinical areas but not necessarily all,” says Mangan. “Overall, it’s got potential to become a mainstream approach to procurement in the NHS.” Bear in mind that the trend is substantially bigger than this pilot.
On a recent trip, Mangan discussed the potential of VBP in healthcare for the UAE. And right now, lessons are being exchanged between teams from multiple countries in Europe and the US to touch more lives and enable procurement to bring greater value to healthcare on a global scale.