Involve NHS staff in procurement

Mandie Sunderland, chief nurse for Nottingham University Hospitals Trust, has a rare gift: a knack for engaging nurses in procurement.

It is a knack she has learned through being part of NHS Supply Chain’s national Customer Board, where she has put her mind and energy into addressing the inescapable fact that it is clinicians who use supplies and therefore clinicians who must be involved in procurement decisions to deliver savings.

“Being involved with the Customer Board has been a real eye opener,” she says. “If we can make savings somewhere other than the front line, I will do it. If we can buy products more efficiently and use standards so that we can buy in bulk and reduce waste, then these are all savings that we can make without looking to staff.”

‘All my senior nurses were on a mission. We made £800,000 of nurse led procurement savings in a year’

Her eureka moment on procurement came during a cost improvement programme at a previous employer. “I asked the director of finance if savings made other than through the nursing budget would count towards the programme. He said yes. That’s when I realised that procurement could contribute and suddenly all my senior nurses were on a mission. We made £800,000 of nurse led procurement savings in a year.”

She keeps a number close at hand: every £30,000 saved is a band 5 nurse’s job.

Winning over nurses involves more than just citing savings numbers, though: much of her work to convince them focuses on safety. Take an everyday item such as a syringe driver. Standardising across several providers not only drives down cost through bulk buying the kit and disposables, but also means the equipment will be familiar to all nurses, and therefore safer.

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It also improves quality of care. “We had an incident with a patient who was at the end of their life and was admitted to hospital,” says Ms Sunderland. “The patient wanted to go home to die and a quick transfer was needed. It was difficult because the community used a different syringe driver to the hospital.

“As a result of that incident, we got together with the community nursing trust and standardised the syringe drivers, the disposables and the training. The nurses totally loved it.”

That experience and her work with the NHS Supply Chain Customer Board led to joint work with the Royal College of Nursing called Small Changes, Big Differences. It is all about why and, just as importantly, how to involve nurses in procurement.

Stakeholder voices

Crucial to getting frontline NHS clinicians and managers involved in procurement is the Customer Board, set up “to engage with our senior stakeholder community”. The board was refocused last autumn to bring the organisation closer to its customers and to help it deliver £150m of cash releasing savings with the NHS by March next year. As of the end of this August it had achieved just over £100m.

The board involves clinicians, finance and procurement directors, chief executives, the NHS Business Services Authority and the Department of Health - and is chaired by Sir Ian Carruthers. It links to Lord Carter’s work on productivity and efficiency in the NHS.

Beneath the national board are local boards and a clinical reference board, which also involve procurement, finance and clinical leads. These are the link between the national board and individual trusts, providing a vital mechanism for feedback between NHS Supply Chain and the front line, and an opportunity to share learning and benchmark progress against savings targets.

Sir Ian has had a long involvement in improving NHS procurement and, like Ms Sunderland, identifies two drivers. The first is to deliver good value for money for tax payers by maximising the buying power of the NHS pound.

‘Trust boards must get behind efforts to improve procurement’

“But more important is the direct impact that procurement has on the safety and quality of patient care,” he says.

One focus of NHS Supply Chain’s work has been the NHS Core List which commits the NHS to larger volumes of a smaller range of products selected for quality and price with the help of clinicians. The commitment allows NHS Supply Chain to leverage good prices. Another is Compare and Save, which encourages trusts to look at what they are paying for items such as wound care and to compare them with lower cost alternatives without compromising on quality.

Suzanne Tracey is director of finance and business development for Royal Devon and Exeter Foundation Trust and chairs NHS Supply Chain’s Southern region customer board. “Our role is to deliver the national programme and to make sure we are really communicating with trusts so that everyone knows what’s available,” she says. “We are really pushing organisations to engage so that they can reap the benefits.”

She regards herself as a “critical friend” to NHS Supply Chain - someone who was convinced that the national contract could and should be improved and has now been called on to act.

“What’s been really good about getting involved is that I can see the enthusiasm and commitment from NHS Supply Chain to get things right,” she says. “They are really making sure that they are focusing on the right places. The national and local customer boards give them access to procurement leads, directors of nursing and directors of finance that they did not have before.”

More clinicians and finance directors are getting involved with procurement colleagues to deliver savings.

NHS Supply Chain is closer than ever to its customers. Now trust boards must get behind efforts to improve procurement, says Sir Ian.

He explains: “Quite often procurement is not really addressed in many [trust] boards in the way it should be. Can we collectively, and in the interests of the whole system, really start working on this and start putting procurement high on the agenda? That is going to be the key to getting the greatest benefit and the greatest savings.”