The past two years have highlighted the importance of effective procurement to the NHS, changing perceptions of the function – and, in some instances, its practice.
Covid pressures have brought a new understanding of the link between effective procurement and effective services
As a mental health and community trust, there had never been any real need for Leicestershire Partnership Trust to have an inventory and supply function. The care provided by the organisation meant it wasn’t necessary, for instance, to have a significant stock of personal protective equipment. Items were simply ordered as needed, just-in-time fashion, from over 150 different requisition points in the organisation. Then covid hit and everything changed.
“We had to implement a supply function within the space of about a week in order to distribute PPE [personal protective equipment] across the trust,” remembers Sarah Holliehead, the organisation’s head of procurement.
In the two years since, the focus of that supply work has gone from insourcing and providing PPE to helping provide vaccinations, uniforms, and a whole host of other items.
“Our remit has quadrupled because we’ve now recognised that need for that function, which has been invaluable,” says Ms Holliehead. There is even talk of the trust investing in IT solutions to support staff in better managing this newly expanded role.
It’s an example of how the pandemic has altered both the practice and the perception of those working in local NHS procurement. As Michael Pace puts it: “We’ve always been there, but we’re now suddenly recognised by our finance colleagues, by our nursing colleagues, by other colleagues, and they’re starting to understand what we do.”
Evolving understanding Mr Pace, managing director of the London Procurement Partnership – one of the NHS’s four procurement regional hubs – says he’s spoken to numerous trust chief executives who during the pandemic have experienced “no end of times where they were sitting there knowing that they were about to run out of product and then got a call from the head of procurement saying: ‘I’ve managed to find some, I’ve got somebody going in the car to go and get it.’
“I think that really changed everybody’s perception of who we are as a function.”
It’s a theme echoed by Alan Turrell, who had worked in NHS procurement for 40 years before his recent retirement. “I think it’s shown that procurement, certainly at local levels, is not just a bureaucratic processing of placing orders.”
This evolving understanding comes after a decade in which it was frequently suggested the NHS was perhaps not achieving best value in its purchasing. In the early 2010s, a National Audit Office report suggested trusts’ procurement of consumables represented “poor” value for money due to “a combination of inadequate information and fragmented purchasing”.
We’ve always been there, but we’re now suddenly recognised by our colleagues and they’re starting to understand what we do
It was followed a few years later by the launch of a review by Lord Carter which urged the removal of unwarranted variation in healthcare procurement.
It seems that, in the supreme pressures of the pandemic, some of the factors that might previously led to such variation have fallen away. The idea of trusts collaborating when procuring might have felt alien in an environment where competition had sometimes been emphasised and cost improvement programmes been all-consuming. But with covid, and particularly the initial scrabble for PPE, there has sometimes been more of a recognition of everyone being in the same boat.
“There’s definitely been a tonne more collaboration taking place,” suggests Keith Rowley, managing director of the North of England Commercial Procurement Collaborative and the current chief officer of the Health Care Supply Association.
“Barriers between trusts have broken down,” he continues. “People were sharing stuff, and supporting each other. And still that’s going on now – it went on over Christmas  with lateral flow devices. In some ways, it’s given a bit of strength to the ICS agenda.”
One of the most memorable findings of the NAO report was that one trust bought 177 different types of glove – those hundreds of different purchases, it was suggested, making it impossible to gain economies of scale. In some instances, such variation was caused by individual clinician preference: it having become accepted that different surgeons should be able to use their preferred brand of a product, for instance.
According to Mr Rowley, that too has in some ways been changed by the pandemic and, specifically, the initial issues with PPE. “People worried less about the brand of a particular product when what they needed was that product,” says Mr Rowley.
“Previously they were materially concerned about the quality of that product, and some of that got a little lost in the early phases because there simply wasn’t the quantity and the time available. However, it was surprising that once that was resolved we were all more brand agnostic about PPE.
Whether it will return remains to be seen. “We may change back and people will say, well, that glove that you gave me was OK for the job that it did when I was facing the pandemic and it was a crisis and I just needed a glove, but it isn’t the best product to do what I need to do.”
Yet there is optimism among procurement specialists that, even if those conversations do materialise, it will be with colleagues who have a new-found understanding of the role of procurement – forged during an incredibly difficult period.
“From a personal level, I’m absolutely exhausted, it’s been really challenging,” says Ms Holliehead in summing up the past couple of years. “But I’m a positive person, and I think the pandemic has really put procurement on the map, and we’re being seen as more than just a process function – [there’s been a] much more proactive look at the way we work, much more strategic. I think that’s really positive.”
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Date: 6 April