When buying things, the NHS has focused too much on lowest price, rather than best value. Ministers must not miss the opportunity to put this right, writes HCSA Patron Lord Philip Hunt in HSJ.
After three years’ development, a new approach to how the NHS procures medical devices was launched in September by the minister for medtech, Zubir Ahmed MP, with a promised rollout across the NHS in June this year.
Yet, if remaining hurdles to delivery are not urgently addressed, all this hard work risks falling short of ministers’ ambitions for a genuine shift from a focus on item “price” towards a recognition of “value”, as set out in the 10-Year Health Plan.
The new system is designed to reduce the emphasis on cost and place greater weight on improved patient pathways, experiences and outcomes, alongside social value factors such as environmental impact, and the ability of a device to deliver on its intended purpose.
The intention is to improve patient care, decrease avoidable treatment episodes and adverse impacts, reduce clinical staff time commitment, deliver significant whole system cost savings, and reduce waiting lists. But major hurdles need to be removed if this change is to be delivered.
First, clinical involvement in the procurement process has been limited. Too often, procurement managers determine which consumable products, devices and equipment are purchased, responding to pressures from more senior directors by choosing the cheapest, often less effective options.
The new methodology provides a real opportunity to involve clinicians from the outset, enabling them to determine the improvements procurement should deliver in terms of patient pathways, experience and outcomes.
Yet many integrated care boards and NHS trusts have barely heard of the coming shift – a change which should ideally be adopted for all NHS procurement, not just medical devices – and nothing of substance has been done to adapt processes and structures to ensure that clinicians are fully involved in determining the specific aspects of value to be assessed.
Second, the patient voice has so far been conspicuously absent from the discussion. Those with lived experience should be standing alongside clinicians to help them better understand the reality of the patient experience – which still receives too little attention despite it supposedly lying at the heart of the whole ICB approach.
Third, NHS Supply Chain (NHSSC), which manages much of the NHS’s purchasing in the acute sector and will be stepping up its drive to take more of a share of the community supply, is failing to adopt the new methodology. Why NHSSC is pursuing a range of different methodologies, not only in its current framework tenders but also in its planned future ones, remains a mystery and risks creating confusion and missed opportunity.
For example, back in 2023, it was the failure by NHSSC to adopt a proper value-based procurement (VBP) approach to its framework tender for urology and bowel management products (catheters and stoma products) that first led me to raise concerns with ministers.
Date: 30 March