In June, it was two years since Lord Carter published his interim report on operational productivity in NHS providers, and it’s now over 18 months since his final report. Programmes that support Lord Carter’s recommendations, particularly the procurement aspects, have been publishing progress over the summer, so we’ve summarised some of the discussion under three key themes – collaboration, data and small steps.
It’s been widely recognised that Lord Carter’s report helped hospitals achieve some major initial efficiencies. Lord Carter, speaking at Health+Care in June said, “I think people have done incredibly well. If I had said to providers five years ago ‘you’ll be taking £3bn a year out’, I’d be laughed out of the room” (cited by NHE, June 2017).
Of course, many trusts had already been focusing on reducing unwarranted variation and improving operational efficiency, however Lord Carter’s report increased focus on this work (and the challenges faced by procurement teams), as well as stimulating new programmes of activity, such as the ‘model hospital’ and GIRFT.
Although a lot has been achieved so far, further work on procurement efficiency is still very much a priority. The HFMA’s ‘temperature check’, published in July, revealed that 81% of FDs said procurement savings were one of the key mechanisms they are using to effect savings in 2017-18 (Knowles et al, 2017). Indeed, our own survey amongst senior finance and procurement staff confirmed that 70% of budgets were still impacted by unsanctioned product purchases and pricing disparity.
Here’s a selection of some of the recent commentary and debate, which we’ve collated around three areas – collaboration, data and small steps.
Collaborative procurement approaches had already brought many efficiencies and improvements in care before Lord Carter’s report. However, the report’s recommendations have often supported ongoing work, as well as starting new work streams.
Over the past few months, procurement hubs and clusters have continued to receive focus and recognition. Lord Carter visited the Lancashire Procurement Cluster in July to learn about the innovative work being done by both the procurement and cardiac teams, observing, “…the rest of the country can learn from the things that are going on here” (BFWH.co.uk, 2017). Also, the East of England NHS Collaborative Procurement Hub announced £10.48m savings 2016-17, 11% higher than last year.
There are also many examples of strong clinical and procurement relationships. For example, after the Carter report, Chelsea and Westminster Hospital decided that any changes to existing products should be managed through procurement. New suppliers and clinical innovations are now managed initially by the Trust’s procurement team, then reviewed with clinical colleagues on the Clinical Product Innovation Group (CPIG). As well as generating efficiencies, this has also helped the hospital eliminate unsolicited commercial visits, reducing commercial visits to theatres by 60% (case study, June 2017).
As well as many examples of successful collaboration, there has also been debate around a more ‘enforcement’ approach. At Health+Care in June, there was discussion around at what point NHSI should be able to tell, not ask. “The pressure we’ll face all the time is, when do we ask and when do we tell? That’s the thing we’re going to need guidance on,” Lord Carter told delegates. “Because sometimes, the greater good requires people to give things up, which instinctively they would not do unless there was some pressure applied” (cited in NHE, June 2017).
In September, Rob Knott, former National Director of NHS Procurement, provided his perspective on emerging developments affecting the NHS procurement landscape; first on his list being the ‘Healthcare Data Supply Chain’. In his article for the HCSA, Rob wrote that data was going to play a ‘pivotal role in transforming the procurement and supply chain landscape across the NHS’, and that ‘In the last 12 months, the Purchase Price Index and Benchmarking (PPIB) tool has illustrated the importance of exploiting data to deliver price parity’ (Knott, 2017).
The PPIB was launched last year after being highlighted as a key vehicle for making some of the efficiencies outlined in the Carter report. However, HSJ reported in mid-August that trusts were going to be asked to part-fund the tool, a move opposed by the HCSA, with Chair Alan Hoskins cited as saying that the HCSA “remains strongly of the view” that the tool should be funded centrally (cited by Carding, N. 2017).
NHS Improvement’s ‘model hospital’ programme was also in the news in August, with the announcement that it would be expanded across the health service over the next two years. NHSI launched a £1.1m procurement exercise to identify digital experts to work alongside its team to expand the tool, migrate data from the prototype and integrate financial information (Coggan, 2017).
Another continuing theme is that taking smaller incremental steps adds up. Roy Lilley, former chair of the NHS Trust and a commentator on healthcare policy, interviewed Lord Carter in June, observing, “when we first heard of the Carter programme, it was like a big national programme…but when it comes down to it, it’s the little things that really matter”. Lord Carter agreed, saying “There are no silver bullets…it’s £100,000 here, it’s £50,000 there”. “As I’ve gone round trusts”, Lord Carter said, “…people are drawing on the data we’re giving them, and they’re using the information to improve performance of their hospitals…it’s on a line-by-line basis” (Lilley, 2017).
With so much in the news about the continual work by trusts to improve care and increase efficiency, we’ve only been able to take a snapshot here. And, with Lord Carter reflecting in June that there were 120 weeks left to deliver, the coming months are likely to reveal further progress across a wide range of areas.
BFWH.co.uk (2017) Blackpool hospital praised for innovative working. Retrieved from www.bfwh.nhs.uk
Carding, N. (2017) Regulator shifts costs of ‘hugely successful’ efficiency tool to trusts. Retrieved from www.hsj.co.uk
Clinton, N. (2017) Rob Knott on The Future of NHS Procurement. Retrieved from www.spendmatters.com
Coggan, A. (2017) Revealed: Major expansion of ‘model hospital’ to STPs and CCGs. Retrieved from www.hsj.co.uk
EOECPH.co.uk (2017) Hub’s Annual Savings Figures Announced. Retrieved from www.eoecph.co.uk
Knott, R. (2017, Sept) The future of NHS Procurement? Look into your procurement strategy, not a crystal ball. Retrieved from www.nhsprocurement.org.uk/news/
Knowles, E., Robertson, L. and Watson, D. (2017) NHS financial temperature check – briefing July 2017. Retrieved from www.hfma.org.uk
Lilley, R (2017) Lord Carter of Coles discusses the Carter Report with Roy Lilley [VIDEO]. Retrieved from www.fabstuff.net
NHE.co.uk (2017) NHSI ‘should be able to tell, not ask’ providers to comply. Retrieved from www.nhe.co.uk