Collaboration’s working across trust boundaries, multiple agency initiatives, private sector partnership and patient involvement in procurement decision’s signals the way forward for public procurement in the health sector as a joined up, networked activity Christine Harland.
This year’s Health Care Supplies Association conference (London, 3-4 November) featured high level speakers, not just from the procurement community, but also from the broader NHS and public procurement arena. Despite the diverse range of topics some common themes emerged most strikingly that of collaboration and joined-up activity.
As Christine Beasley, Chief Nursing Officer, highlighted, this new way of working involves discussion and facilitation, rather than individual authoritative decision making. She referred to patients as senior partner’s not passive recipients. Duncan Eaton, chief executive of the NHS Purchasing and Supply Agency (PASA) urged the procurement community to fully involve patients in decisions on how NHS money is spent to provide their care.
One speaker (not from the NHS, I hasten to add) painted a picture of patients as simple folk who, if given a choice of provider, will base their decisions on food and car parking. In my experience this is absolutely not the case. Carers and patient’s particularly those with long term and serious health problem’s can become highly educated about their condition and possible treatments. In the last few weeks we have seen patients use media coverage of the prescription of Herceptin by other primary care trusts (PCTs) to reverse decisions made about their own treatment. In our research on collaborative supply networks in healthcare, patient involvement in prosthetics and wheelchair design has had a profound impact on procurement decisions that improve quality of life. Attempts to include patients in decision-making must be genuine and afford them respect.
However, this strategic, holistic approach to procurement necessitates highly qualified, thinking practitioner’s and it is generally accepted that these are not in plentiful supply. Joe Gibson, chief executive of the Lifesource collaborative procurement hub, offered a sensible short-term solution’s surround your best procurement people with resources which allow them to focus on their core competence. John Oughton, chief executive of the Office of Government Commerce (OGC), described how the OGC draws in procurement people from outside the public sector, in addition to growing its own through investment in undergraduate placements.
I empathise with both views. In my research centre at the University of Bath I surround research staff with administrative and technological support. Researchers research 100% of their time instead of doing tasks that others can do better and more cost-efficiently. I am frequently required to defend this approach against proponents of so-called lean organisation’s; I argue that it is lean. I also like the grow your own approach. Public procurement, particularly in the complex confederal NHS with its many, sometimes conflicting, issues takes a long time for people to get their heads around.
Collecting evidence and measuring outcomes is imperative for procurement. If the only measures we have are savings-based, this is what will drive us. We need to implement measures that provide evidence of other benefits of public procurement such as social, economic and environmental benefits, now termed sustainable procurement.
And it is around this last point that the main dichotomy of this conference appeared. I had a sense of left hand and right hand that troubled me and it came down to the policy and ethos of a public sector health service. One speaker promoted increased commercialisation of services; while a practical reality, patients are none too happy at being refused a MRI scan because the scanners are booked for private use for six months. In my own presentation I emphasised that if the NHS is to afford the increasing costs of drugs and technologies required to deliver leading edge healthcare, plurality of provision and partnerships with the private sector are essential. However, I expressed concern about unintended consequences of decisions that impact acutely on supply markets. There is particular concern over the limited involvement of procurement professionals in sourcing decisions for large areas of spend such as treatment centres, outsourced services and new hospitals. Duncan Eaton expressed the view that if the outsourcing of NHS Logistics went ahead the NHS must retain strategic responsibility for clinical equipment. Not to do so would be madness. And I agree wholeheartedly babies and bathwater spring to mind. Dimitrios Hatzis of the Commercial Directorate of the Department of Health said that anything can be outsourced if it’s specified and managed professionally and to a certain extent I agree with this as well. But managing the ethos of a unique public sector healthcare service being performed by a private sector, possibly culturally different, organisation requires sensitive service level agreements. There is plenty of evidence of unintended consequences when we have failed to recognise broader forms of value in service level agreements. Hospital cleaners used to chat with them, help them eat their lunch and offer a cheery face; outsourced cleaning contractors must adhere to the most efficient rota of tasks to be performed. Private sector catering providers increased patient satisfaction and reduced costs but in some cases provided inappropriate nutrition, leading to increased clinical malnutrition. So, I sincerely hope that the DH can pull this off successfully, becoming a beacon for other government departments to follow. Let’s hope next year’s conference has shining examples of these successes.