Analysis

Effective, safe and affordable – the nurse’s dream shopping list

A team of nurses is being charged with the task of assessing equipment for cost and clinical effectiveness in a bid to improve NHS procurement.

The seven-person NHS clinical evaluation team was set up in April. It will aim to make it easier for directors of nursing and procurement specialist nurses to select the best products.

RCN executive nurse network lead Naomi Chapman will head up the team of clinical evaluators

Picture credit: Barney Newman

The team’s clinical lead and RCN executive nurse network lead Naomi Chapman told an audience at the college’s London headquarters last week it is important for nurses to be involved in procurement.

She said: ‘If the clinical products nurses use are not safe and high quality, they are not going to be able to do their jobs in the way they want to.

‘If a pair of gloves splits, you have got to deal with the clinical risk of that. That takes time and affects the relationship with the patient.’

A preliminary list of products to be assessed has been drawn up by selecting items that are used in high volumes across settings and have a direct effect on patients. These include syringes, gloves, electrodes and catheter tubing.

Each team member will be given responsibility for a group of around 15 to 20 products and Dr Chapman estimates the reviews will take about 18 weeks to complete.

Product reviews

The team has funding for six months from the Department of Health but this might be extended. It will report to Nottingham University Hospitals NHS Trust nursing director Mandie Sunderland. She chairs the NHS clinical reference board, which advises on procurement nationally.

The review process will include gathering information about each product and finding out what clinicians need the products to do.

Meet the clinical evaluators

Naomi Chapman – clinical lead RCN executive nurse network lead

Sian Fumarola University Hospitals of North Midlands NHS Trust senior clinical nurse specialist in tissue viability and continence

Simon Hall University Hospitals Bristol NHS Foundation Trust tissue viability lead nurse

Liam Horkan Colchester Hospital University NHS Foundation Trust clinical procurement nurse specialist

Clare Johnstone Central London Community Healthcare NHS Trust head of infection prevention and medical devices

Stephanie McCarthy Derby Teaching Hospitals NHS Foundation Trust clinical procurement nurse specialist

David Newton Nottingham University Hospitals NHS Trust matron of clinical procurement team

All the team members will be involved in assessing the products at a practical level, paying attention to ease of use and packaging.

Dr Chapman says she and fellow clinical evaluation team members will ask pragmatic questions such as:

Are the instructions clear?

Is the item easy to use?

Can I open it easily, in a sterile way?

Do the markings come off on my hands?

RCN head of standards, knowledge and innovation Rose Gallagher says it is important that procurement specialists do not simply choose the cheapest products without considering quality.

Speaking at the RCN networking event, Ms Gallagher said: ‘When you go for cheap first, it is detrimental in terms of patient care and doesn’t provide the savings you wanted to make in the first place.

‘When you go for cheap hand towels, you end up using five or six instead of one because they are not absorbent.’

The reviews will be published online and Dr Chapman hopes they will influence product development.

Extra expertise

The team’s work is co-ordinated by the NHS Business Services Authority, but Dr Chapman says it is forging links and will be sharing expertise UK-wide. And it will bring in extra expertise as required, she says.

Ms Gallagher emphasises how important it is for nurses’ voices to be heard when items of equipment are being selected for purchase.

This is especially the case as care models evolve, for example as services shift to the community. She wants to see nurses provide feedback on how products need to change too. The RCN has been running a campaign called Small Changes, Big Differences since last year, which aims to promote the idea of nurse leadership in procurement.

The college is calling on every local procurement team to have the clinical expertise to support decision making.

Ms Sunderland says purchasing in the NHS has often been dominated by non-clinical procurement departments, which has given financial considerations supremacy over clinical suitability and ease of use.

‘If clinical products are not safe and high quality, nurses cannot do their jobs as they would like’

The RCN says that if nurses are involved at all it is often too late in the procurement process. It has produced a booklet and online guidance urging nurses to establish clinical product review groups and to ensure staff know the cost of products. There is advice on building a case for having a specialist clinical procurement nurse in their organisation.

This increasingly common role sits between clinical teams and finance departments to influence buying decisions.

Ms Gallagher said: ‘If you haven’t got a clinical procurement specialist nurse, show the value such a role can bring.’

Although price will be part of the evaluation, it will be secondary, according to the NHS Business Services Authority. ‘The team’s primary focus is identifying the products that enable the highest quality of patient care,’ says a spokesperson.

NHS providers will be able to work together to get bulk discounts, according to Dr Chapman. Procurement staff will be able to assess a range of reviews for a product type, such as syringes, and decide if they could be buying a higher quality product at a cheaper price.

A purchasing price index, which was recommended in the Carter review of NHS spending discrepancies (see box), is due to be published this summer. This will allow trusts to compare their spending and consumption of staple products.

Close price gaps and save £700 million

The NHS will struggle to make £22 billion of planned savings by 2020, according to the Chartered Institute of Public Finance and Accountancy.

A review by Labour peer Lord Carter was intended to be part of the solution. Its February report identified ‘unwarranted variations’ in providers’ spending on staff, running costs and products. It said these discrepancies are costing the NHS billions of pounds.

The report highlighted the different prices providers pay for supplies, with the aim of standardising spend on everyday products such as bandages and needles.

The Carter review said few NHS trusts demonstrate control over their inventories and estimated £700 million could be saved on procurement.

Lord Carter recommended NHS Improvement hold trusts to account on their performance against the index.

Clinical evaluation team member Liam Horkan says the index and the team’s reviews could be used together.

He adds: ‘The question is whether any differences in price are for a clinical reason, or could that organisation use the lowest price product in the index?

‘To answer that, you need to have assessed the quality’.

The team will publish its reviews at www.nhsbsa.nhs.uk/CET

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