A single NHS contract to supply orthopaedic hip and knee replacements would save money and secure quality. Photograph: Rex FeaturesIf we pooled all of the expertise within the NHS, we would have one of the best-equipped and most capable procurement teams in the world. It would hold all the cards to find cost savings while improving services for patients. The problem is that we don't pool expertise.
The government's NHS procurement strategy is dividing rather than uniting us. Bringing competition into the healthcare market is considered vital to ensure services are delivered a high standard. But, in many situations, this is contrary to procurement best practice, where pooling resources, knowledge and buying power delivers real savings.
NHS procurement needs more than a makeover. It requires fundamental changes in attitude to cope with the conflicting priorities of competition and collaboration.
The entire clinical strategy is geared up to seek best value services in a competitive market, but the national procurement strategy says we should be collaborating. Why should trusts seek to collaborate with each other when they are increasingly in competition on the provision of health services?
It is common knowledge that the competitiveness of your supply chain has a direct impact on the competitiveness of your products and services. That relates both to price and quality.
Try applying that logic to the health sector: as trusts, we're expected to share price information in order to drive best value, but that's tantamount to putting our competitive information directly into the hands of our rivals. And yet we should be seeking to consolidate nationally price and quality from suppliers. Take orthopaedics as an example. One national hip and knee contract for the whole of the NHS, rather than an undulating standard of price and quality, would hardly be a revolutionary idea. But it's sadly lacking today.
We should be pooling information and working together to drive best value and standardised quality through supplier contracts. This would give the entire NHS a quality baseline in terms of the services they deliver. Competition then comes into the equation in terms of service and specialisation in different trusts, but not in terms of price and not at the cost of squandering quality standards.
My personal approach to NHS procurement would be to split the strategy on an 80:20 basis between single national contracts and areas that remain open to competition.
Where the priority is best value and standardised quality, and in areas of little impact to health provision such as utilities, catering and office supplies, we should seek to collaborate on the widest scale possible. This would probably represent 20% of all NHS expenditure. The other 80% of spend, perhaps where local supply or specific products and services are priorities and there is less opportunity for consolidation, could remain competitive. As soon as the concept has been proven, inroads could then begin on the remaining 80%.
One challenge lies at the heart of the NHS procurement issue: a lack of joined-up information. Because we're all using different systems and processes for managing procurement and spending, there is no single picture of what the healthcare sector spends.
Until the NHS as a whole has a level of visibility through its systems and software it will be difficult to build a strategy that delivers simply because could be founded on inaccurate information. As a sector, we need a change of culture to affect a strategy led first by quality standards and second by selective competition. Until that happens, the NHS procurement makeover will prove little more than skin deep.
Malcolm Preston is associate director of procurement at County Durham and Darlington NHS Foundation Trust.
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.
