Select the very best tools for the job
The NHS faces enormous efficiency challenges if it is to make the 22 billion in savings by 2020 outlined by NHS England chief executive Simon Stevens last October in his Five Year Forward View.
No staff group will be exempt from this challenge, so it is no surprise that efficiency is a key theme at the chief nursing officer (CNO) for Englands summit, Leading Change and Creating Value, which concluded today (December 2).
One of the speakers at the summit is Lord Carter, whose interim report on efficiency in the NHS, published in June, highlighted how the NHS could save 1 billion a year through better procurement (see box , page 20).What is the carter report all about?
Respected Labour peer Lord Carter of Coles was asked by the government to review the efficiency of NHS providers. His interim report, published in June, highlighted...
No staff group will be exempt from this challenge, so it is no surprise that efficiency is a key theme at the chief nursing officer (CNO) for England’s summit, ‘Leading Change and Creating Value’, which concluded today (December 2).
One of the speakers at the summit is Lord Carter, whose interim report on efficiency in the NHS, published in June, highlighted how the NHS could save £1 billion a year through better procurement (see
With political and managerial commitment, and funding to help achieve efficiencies, Lord Carter suggested that savings of £5bn a year could be made by 2019/20. Up to £2bn could be delivered by improving workflow and containing workforce costs. Savings on pharmacy, estates and procurement management could release another £3bn, with £1bn from each. This would be important in helping the NHS make the £22bn savings it needs to continue delivering the same level of care to a changing population.
Lord Carter and his team have also been working closely with 22 hospitals to identify opportunities for productivity improvement, and to find a way of comparing the performance of different hospitals. So far this work has only covered acute hospitals and has not looked at the different challenges in the community sector or in primary care.
While a £5bn savings grabs the attention, Lord Carter has pointed out some challenges to achieving it, such as the lack of data and performance metrics which would enable comparisons between organisations. He suggested, and has developed, an adjusted treatment index that would take into account the complexity of care provided.
However, many in the NHS would say that a critical part of his report – the need for funding to help organisations achieve efficiencies – has been overlooked.
Lord Carter and his team have been working with chief nurses and the RCN to see if the current array of products available through the NHS Supply Chain could be radically reduced. At present, around 500,000 products are available, with similar items frequently varying in price.
Making savings on everyday consumables, such as dressing and syringes, requires nurse involvement, in advising on which products to buy and ensuring the right products are used for the right job.
Getting involved in procurement ‘may sound a tad boring’, as one nursing director says, but it can bring benefits for NHS trusts and patients – and often for nurses too – rather than leaving it to the men in grey suits, more hospitals are involving front line staff in the decisions on what to buy.
Ruth May, nurse director at health sector regulator Monitor, says that much has already been done to increase nurses’ involvement in procurement, with initiatives led by senior nurses.
‘This has yielded some great ideas and significant early wins from dressings, gloves, blood devices, ECG electrodes and other consumable savings,’ says Ms May, who was part of a panel looking at some of these issues at the CNO summit.
‘I have heard of good procurement activity being carried out by nurses that has resulted in multi-million pounds worth of savings. But it is vital that we engage with and encourage the wider nursing workforce to become more involved in procurement, as they can influence it in a good way.’
RCN professional lead for infection prevention and control Rose Gallagher, who has led the college’s work on procurement, says everyone on the nursing team – from healthcare assistant to director of nursing – has a part to play, whether in providing feedback on products being used, or in selecting them.
‘Procurement is not something nurses recognise as being a core part of clinical practice, but the types of products we use can have an effect on patients if they are not up to the required standard,’ she says.
Ms Gallagher says the possibility of improvements to quality and safety, and therefore patient care and outcomes, means nurses are more likely to take part in procurement. Although cost savings will not always be delivered immediately, she says that standardising some consumables across trusts, for example, can release savings very quickly.
His job is to bridge the gap between procurement departments and front line staff. This involves identifying innovations the trust may want to adopt, scanning the horizon for new developments, and ensuring people on the front line are getting what they want.
‘Traditionally, someone from the procurement department would say: “I have this item” and someone else would say: “I don’t like it”. There was no means to have a conversation,’ he says. ‘So this role is about bringing those two people together.’
Mr Horkan says that nurses often feel a particular product would be useful, but they do not know how to go about getting it into practice. One of his successes has been to move from two types of examination gloves to only one across the trust. This has resulted in savings and has also been acceptable to staff.
The trust was also buying mattresses that typically came with an eight-year warranty, but tended to be replaced after a year, making the warranty rather redundant. By changing mattress supplier, the trust has saved £60,000.
Mr Horkan is adamant that good procurement is not just about choosing what is cheapest, but about drawing together quality, safety and value. He has now started working with the trust’s orthopaedic doctors on some of the tricky decisions in surgery.
‘As clinicians, we are taught the ABC approach – to look at symptoms and come to a diagnosis,’ he says. ‘I am able to translate the commercial language into clinically understandable language to provide information, rather than just telling people we are moving from product A to product B.’
To help inform staff about the costs of what they are using, Mr Horkan uses a traffic light system: red indicates something is costly for what it is; yellow raises the question of whether something is appropriate for use – the trust uses two types of urinary catheters, for example, one of which is intended for longer-term use and is more expensive; and green indicates a standardised product seen as a good choice.
She believes that the Carter review is important in encouraging organisations to involve nurses in procurement. ‘The variation out there means there is a real role for specialist procurement nurses,’ she says.
As suppliers tend to have a scattergun approach, and often try to talk to many different people in an organisation, a specialist procurement nurse would give a supplier a single point of contact and stop them taking up other clinicians’ time.
Nurse Michelle Winfield moved from a senior role in theatres to a clinical procurement manager role, with responsibility for 34 theatres at Plymouth Hospitals NHS Trust. She found that consultants were willing to consider changing clinical materials, but they liked to see things first and sometimes try them out.
By working with trust staff, she has changed the gloves and sutures used – historically two of the hardest areas in which to bring about change.
‘We also have a warehouse and are able to bulk-buy,’ says Ms Winfield. ‘A lot of people were ordering independently of each other, so we were spending a lot on postage and packaging.’
Better procurement in theatres at the trust has yielded at least £400,000 in savings so far. Ms Winfield has also worked with the intensive care unit on a business case for new equipment which, although it has an initial cost, offers substantial savings through reducing the length of patient stay and better recovery. The trust also has its own decontamination facilities, which helps to keep costs low. Sending equipment away to be decontaminated can be expensive and alter the balance of cost between single use and reusable instruments.
Buying the right products is just the start of the process. Controlling waste is another big issue. Over-ordering products and ‘hoarding’ them in one area can mean they go out of date and have to be discarded.
To address waste at her trust, Ms Winfield is starting an initiative known as Operation Womble. She says that reducing what goes into clinical waste bags can lead to substantial savings, while better stock control can save staff time spent looking for items.
But whatever the benefits, will involving nurses in procurement contribute much to the £1bn yearly savings Lord Carter says are achievable? Imperial College Healthcare Trust director of nursing Janice Sigsworth, another contributor to the CNO summit, says some areas of procurement require a multidisciplinary approach. ‘Nurses need to be identifying where these areas are, and bringing other professionals into the discussion,’ she says.
Potential savings from procurement will vary from trust to trust. In Plymouth, many of the ‘quick wins’ on a list of 400 items have already been tackled by the likes of Ms Winfield. Other trusts at an earlier stage in the process could see some significant savings delivered quickly.
Buying products that staff are happy to use, which make their lives easier and improve care, is always going to make sense.
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