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Buying into procurement: the RCN campaign to make better use of health service money

Rose Gallagher reflects on the RCN Small Changes Big Differences campaign and why every healthcare organisation needs a specialist procurement nurse

Rose Gallagher reflects on the RCN Small Changes Big Differences campaign and why every healthcare organisation needs a specialist procurement nurse


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Procurement of equipment and consumables to the NHS in England is complex and has historically centred on a broad catalogue of products, and on cost being a major driver to support the selection of items.

The engagement of nursing staff to support product selection has grown since 2011, when the RCN was approached to help support open and constructive communication between the NHS and NHS Supply Chain, with the ultimate aim of saving NHS money. 

The positive development of strategic engagement however was not matched locally as, for nurses at that time, the language of ‘procurement’ meant that many did not recognise the hidden value it could offer through the experience, insight and skills developed in their clinical roles.

It became evident that there was a wide division between strategic and front-line decisions and therefore opportunities to influence change in a way that could save money and make patients safer.

From this realisation, the RCN Small Changes Big Differences campaign was born. Originally a short-life campaign of four months, it is now celebrating its second anniversary and shows no signs of stopping as its potential growth is fed from the front line of care and delivery, our most precious resource.   

Outcome and impact

The sheer scale of NHS procurement, estimated at more than £4.5 billion a year in clinical supplies and services, offers untapped opportunities for change.

From its early days, the campaign has focused on supporting front-line staff to engage across all care settings. The sharing of a broad variety of case studies and experiences has been central in delivering achievable change, reducing duplication of effort and maintaining visibility of innovation and impact regardless of scale. 

With a website­­­ that provides how-to guides, quick guides and checklists to champion the value of specialist procurement nurses, the Small Changes campaign has something to offer every NHS and independent care provider.

Its language and approach, focusing on quality, not cost, and built bottom up to balance the top-down directives, have created meaningful messages and experiences that RCN members report to be of value at times of intense scrutiny and challenge in the NHS.

Likewise, as a resource that supports the strategic aims of the RCN, the campaign offers a unique platform to lobby for one specialist procurement nurse in every NHS trust in England to embed and drive procurement efficiencies and clinical engagement locally.

Unintended consequences

Two clear unintended benefits have emerged from the campaign and are now providing a new focus that will affect all NHS professionals and support staff.

First, although initiated by the RCN, participating organisations have taken the central themes of engagement to lead local campaigns demonstrating the value of small changes, applied more broadly across the whole organisation.

Championed by Colchester Hospital University NHS Foundation Trust, Essex, the benefits to patients and the trust are clear, but more importantly sharing success with staff has provided much needed recognition of the campaign at a time of continuing challenge to the NHS.

Second, aligned to procurement, the difference of small changes to the management of healthcare waste has been highlighted and championed by the RCN.  The variation in costs and segregation of bagged waste, for example, offers further opportunities to support nursing staff and reduce the burden of financial efficiencies at no cost to nursing posts.

The two years of the Small Changes campaign have taught us much, and in 2018 offers far more than financial savings, as important as these are. Clinical staff offer value in the field of procurement that the Small Changes campaign is likely to continue for many years to come, in order to champion the voice of clinical staff and provide a platform for its growth and attention.

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About the author

Rose Gallagher is RCN professional lead for infection prevention and control

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