conference slides - bip solutions

ANNUAL CONFERENCE& EXHIBITION 201313-14 November 2013Hilton Manchester Deansgate

Event Management:Media Sponsor:

www.hcsaconference.org.uk

MAIN EVENT SPONSORS:

CONFERENCE SLIDESDAY 2 – 14 November 2013

http://www.hcsaconference.org.uk

1

Slide 1Session Chair:

JIM MILLER

Strategy Sourcing Director,

National Procurement

NHS National Services Scotland,

Health Care Supply Association Council Member -

Scotland

The new health procurement

Strategy – a commentator

and supplier view

PETER SMITH

Editor, Spend Matters UK and CIPS Past President

The new health procurement strategy – and other procurement thoughts!

A commentator and supplier view – from Spend Matters and Pentax

Peter Smith

HCSA Manchester, November 2013

A quick 15 minutes sprint through:

• An overview of health procurement

• The new health procurement strategy

• What should procurement practically focus on?

• Insight from a major provider to the NHS (Pentax)

• Q & A

Peter Smith

• 30 years in procurement (how did that happen)?

• Started with the Mars Group, buying raw materials, then packaging

• After a stint running a potato factory, became CPO for the DSS, Dun &

Bradstreet Europe and the NatWest Group.

• CIPS Council and Board, President in 2003. 10 years of consulting,

speaking, writing...

• “Buying Professional Services” (Czerniawska and Smith) published in

2010 by the Economist Books

• Previously Commissioner for Legal Services commission, non-exec

for Remploy, now non-exec for private sector firm

• Editor of Spend Matters UK / Europe

October 2013 Page 6

2

Health procurement – an overview

• Progress continuing in terms of procurement capability and

performance – but still slow?

• Uptake of technology is increasing but still uncoordinated

• Relationship (in procurement terms) between health and central

government – an uncertain future

• The new health strategy – a promising document, but still just a

document at the moment

• Does the sector have the skills, resources and money to implement it?

• A new head for NHS England – what impact will that have? A strong

believer in the market by all accounts

• The NHS desperately needs procurement t(and commissioning) to be

top class given the huge cost / performance challenges ahead

October 2013 Page 7

The new health strategy

• Well written and presented, very accessible.

• More a roadmap than a strategy maybe – still some major issues

unaddressed (see final point).

• Much to be admired – a balance between short /long term, pragmatic

but aspirational. Good stuff on clinical partnerships, data, skills etc.

• Looking back, PASA going was a great shame. The need for a central

lead is clear, and strategy is good on that. Not going to come from CCS.

• But whole network will have to play a part if opportunities are to be

realised in area such as sharing information, capability building.

• The competition / collaboration dichotomy is still a puzzle and challenge

– as is the “landscape” of procurement organisations.

October 2013 Page 8

Practical actions for procurement

• Engaging with clinicians – defining the appropriate roles, being

confident and working effectively as a team

• A considered view of collaboration

• Balanced evaluation processes – upfront cost, ongoing costs, quality,

support and service, training and usability, etc.

• Focus on whole-life costs and outcome based value

• Using technology – spend analysis; product coding, catalogues etc;

eSourcing; invoice automation and supply chain finance ...

• Communication is key, be outward looking (internally and externally)

• Skills development, knowledge sharing and networking

October 2013 Page 9

The Pentax view: A whole-life, value-based approach

Generally matters are improving in terms of procurement ... Some good

case studies of very effective procurement

• See clinicians and procurement working together more often, and

procurement getting more assertive (countering the “can’t use” argument)

• Getting the balance of evaluation factors right, whole-life costs, and

objectivity in the process is key

• Early engagement – e.g. use suppliers to help with the business case

• Commitment still drives best value and best terms from suppliers

• And need to move beyond cost to value – try and consider clinical

outcomes and overall cost of patient care rather than just basic costs

• This can run into issues around how Trusts are rewarded – may even

be perverse incentives around savings for taxpayer, not for Trusts

Page 10

PENTAX UK Ltd.

PENTAX House, Heron

Drive, Langley, Slough,

SL3 8PN

Thank you!

Jamie Grimshaw PENTAX U.K. Limited

Pentax House, Heron Drive, Langley, Slough, SL3 8PNMobile: +44(0)7973 154486 [email protected]

Peter Smith http://spendmatters.co.uk/Tel. 07717 734601 / 01276 691770 [email protected]

Slide 1

mailto:[email protected]

http://spendmatters.co.uk/


3

Transforming procurement

at Trust level

JOHN WATTS

Director of Procurement and E-Commerce,

Barts Health NHS Trust

Procurement at Procurement at BartsBarts Health NHS Health NHS

TrustTrust

John Watts

Director of Procurement

Barts Health NHS Trust

Talk will cover Talk will cover

�� World class procurement in the NHS or not?World class procurement in the NHS or not?

�� BartshealthBartshealth the challengesthe challenges

�� Recent changes in decision making at Recent changes in decision making at BartsBarts

�� Some recent wins at Some recent wins at BartsBarts

�� What is World class?What is World class?

�� Where are Where are BartsBarts currentlycurrently??

Barts Health –

headline figures

� History - St Barts first opened in 1123 to new PFI at The Royal London

Whitechapel

� 5 large Acute central and North East London sites + community services

� New PFI 900 bed build at Whitechapel £110m PFI cost pa

� Major Trauma Centre, Cardiac, Stroke and Cancer services

� Air Ambulance base – over 2,000 casualties per annum

� Cared for 420,000 emergency patients, saw 1.3m outpatients

� Performed over 53,000 operations (and delivered 15,000 babies)

� 15,000 staff

� £1.25bn turnover

� £480m non-pay spend

� Full restructured organisation in October around six Clinical

Academic Groups;� Surgery

� Emergency Care

� Community Health Services

� Cancer and Cardiovascular

� Clinical Support Services – diagnostics

� Womens and Children’s Health

� procurement team provides commercial support to the Clinical

Academic Groups (business partner model). Small team so need

to collaborate with partners

Barts Health -

merger April 2012

4

� Challenges to Barts Health Trust…We are in turn round mode

� £250m cost reduction over next 3 years (£77m this year)

� 6.5% budget take out this year

� Aiming for FT status by 2016 (that’s now not a realistic target)

� Merger of 3 Trusts into 1 with additional community health

services with legacy systems and cultural differences.

� Standardisation and rationalisation

� Change Agenda

� Appointed a turn round Director

Clinical Preference

� Active challenges to clinical preference resulting in shift of business

to alternative suppliers – no longer a ‘threat’ but a reality

� Clinical Development, Innovation & Procurement Group – approval

needed for:

� All new clinical products

� Trials

� New clinical procedures

� Standardisation

� Developments and innovation

� Delivered much greater savings

� Decisions mandated across the trust

� Chaired by Medical Director, Dr Steve Ryan

New behaviours

� Clinical engagement and communication

� Getting benchmarking information

� A more rigorous approach to the quality of evidence used to

support decision making

� Use of risk assessment and risk management to support decisions

� Partnership working at every level (Business Partners)

� A different move on scoring methodologies with a focus on quality

and cost – “value”

� Equating cash released to WTE equivalents

� Joint ownership of work plan to deliver savings.

� Procurement has to facilitate the delivery on behalf of

CAGS/Corporate

Delivery of value – ICD/Pacemakers

Working with the London Procurement Partnership

we have seen significant value delivered in two key

contracts

�ICDs & Pacemakers has delivered significantly in

this year alone, on a spend of just over £6m

�The market was dominated in Barts by three

suppliers and our clinicians argued that this kept the

market competitive and managed risks of failures of

leads

�Together with procurement the clinical group

challenged this and in 2011 the Trust Board awarded

to two suppliers only for major ICDs saving in that

year.

�The new LPP framework was scheduled – how

could London improve on value?

Delivery of value – ICD/Pacemakers

LPP set up a Stakeholder Group to review the way in which London

approached the market and the risks in the products

�Supplier briefings were held to demonstrate solidarity between

trusts

�A clear message and determination that trusts would be willing to

switch supplier

�A challenge that the NHS should not shoulder the cost of

managing risks of technical failures through spreading awards

�Barts held its nerve and awarded to just two suppliers and

maximised its market share discounts

� Through standardising our suppliers we have improved ability for

remote monitoring thus enhancing patient care and outcomes

�ICDs & Pacemakers contract started on 1st October and will deliver

over £1.3m savings in 12 months on a spend of just over £6m

Delivery of value – Hips & Knees

The Orthopaedic Prosthesis LPP framework awarded in Dec 12 will deliver us

over £0.75m savings on a spend of £2.63m in 12 months

�As a newly merged trust we were paying very different prices for the same

implants due to a fragmented market and the power of the global suppliers

�Market share discounts played a large part in Whipps Cross Trust getting

significantly better prices

5

Delivery of value – Hips & Knees

The new LPP framework was run through the South West London Elective Orthopaedic Centre

and represents 16 trusts in London

�Together we were able to challenge the power of the suppliers and price differentials we

faced

�At Barts, we brought together the three clinical units to form one cohesive evaluation team

�We reviewed revision rates through NJR, Australian and Swedish registries

�If suppliers could provide training, sufficient instrumentation and support, then our clinicians

could and would switch supplier

�Our award is to just one supplier across all three sites

�It provides efficiency in use of instrumentation and reduces the need for loan sets

�We still have flexibility to use revisions and extremities from other suppliers

What is ‘World’ class (best in

class) procurement?

� People….

� Communication….

� Information & Measurement….

� Processes….

� Sourcing and Contracting….

� Supply Chain Management….

I

Any Questions?

Thank [email protected]

Slide 1

Beyond collaboration –

leveraging the value of scale

from shared commitment

STEVE ELLESMERE

Senior Project Manager NHS London Procurement Partnership

Beyond collaboration:

leveraging the value of

scale from shared

commitment

Steve Ellesmere

HCSA Conference

14th November, 2013


6

Calls to action

• NHS in England’s devolved structure

• Response to papers

• Response to pressure

…everyone agrees on the key issues and the need for change

A demand aggregation proof of

concept

Concept:

To test whether aggregating the demand for goods and services across a group of trusts and contracting with committed volume results in improved value for money over current arrangements.

Leadership:

• NHS Trust Development Authority

• Department of Health

• NHS England

• Trust Chief Executives

A demand aggregation proof of

concept

Objectives:

• To prove new process delivers cost savings

• To develop the approach for technology

• To develop a sustainable new operating model

Scope:

• 27 trusts

• Excludes pharmacy spend and CapEx

• Combined remaining non-pay spend c. £3 billion

Factors for success/1

• Build the right pipeline

• Market tension

• Quality data

• Demand side alignment

• Shared category sourcing teams

Factors for success/2

• Trust sponsorship

• Decision gated process

• Trust level commitment charter

• Aim for lowest cost to serve and manage supply chain risk

Demand aggregation and the future

• Aligning demand and supply – AHSNs to put procurement transformation on their agenda now?

• A move to key supplier management at a national level?

• Agree new procurement models at national, regional and local levels and get compliance – is there a carrot and stick?

• Demand aggregation in search of a good home!

7

Thank you

Steve Ellesmere

Demand Aggregation Pilot Project Manager

NHS London Procurement Partnership

[email protected]

WORKSHOP 1

Commissioning support –

making sense of the

landscape and competition law

ALAN HOSKINS

Director of Procurement and Commercial Services, NHS South of England Procurement

Services and Health Care Supply Association

Council Member – South Central Region

Making Sense of the CommissioningLandscape and Competition Law

Chair: Alan Hoskins, MCIPSDirector of Procurement & Commercial Services

The Panel

• Elaine Wyllie - Director of Operations & Delivery West Yorkshire

• Mary Mundy - Associate, Commercial Health DAC Beachcroft

• Giles Peel - Head of Health Advisory Practice, DAC Beachcroft

Healthcare Supply Association

14 November 2013

Elaine Wyllie

Director of Operations

& Delivery

West Yorkshire

A commissioner’s perspective

Opportunities

& Challenges

in the new system

� 42


8

A commissioner’s perspective

� Contract or market management

� Conflict of interest

� Timescales

� Alliance/lead provider arrangements

� Integration vs competition

� 43

Contract or market management?

� Contract clauses and levers used?

� Provider market – is this known, understood and

evidenced?

� Has a market intervention failed or succeeded elsewhere –

what are the lessons and have these been considered?

� Is the contract sufficiently detailed to allow contract levers

to be applied?

� Are all providers within the market locally operating to the

same terms and conditions?

� Is the contract monitoring and management resource

capable and does it have capacity to operate effectively?

� 44

Conflict of interest

� Is there any?

� What contract or market management options have been

considered – where is the evidence?

� What learning can be evidenced from other cases, e.g.

CCP/Monitor website?

� What evidence would be acceptable to demonstrate

sound governance?

� Have you passed the ‘3 why’s’?

� Does the case pass ‘the Sunday paper test’?

� 45

Timescales

� It was always thus!!

� Plan, plan and then plan a bit more?

� Think strategically and deliver operationally

� How will patient care and service quality be affected by

the plans?

� Do impact assessments that are real and can be

evidenced?

� How can a transformational change be delivered through

transactional management?

� 46

Alliance/lead provider arrangements

� Is the contract sufficiently robust to give assurance to the

commissioner throughout the supply chain?

� What benefit will this arrangement bring to patients?

� How will penalties, incentives and contract levers be

applied?

� Are shared commissioning arrangements clear in the

contract, e.g. governance and accountability?

� How is transactional resource shared and managed

between commissioners?

� 47

Integration vs competition

� What national and international models have been

considered?

� What benefit will this arrangement bring to patients?

� Does this support or limit plurality and choice to patients

accessing the service pathway?

� How does the plan deliver the strategy?

� What alignment is there in the financial, clinical and

information flows?

� How many hand-offs are there in the supply chain and are

service efficiencies reflected in the costs?

� 48

9

The Legal Perspective - NHS (Procurement, Patient

Choice and Competition) (No.2) Regulations 2013

(“NHS Regulations”)

Mary Mundy, Associate, Commercial Health DAC Beachcroft

Giles Peel, Head of Health Advisory Practice, DAC Beachcroft

NHS Regulations - overview� Made under s75 Health and Social Care Act 2012 and in force 1

April 2013

�Apply to arrangements for NHS health care services only

�Apply to NHS England, CCGs or any organisation assisting NHS

England or CCGs with commissioning health care services

�Replace the Procurement Guide for Commissioners of NHS

Funded Services and the Principles and Rules of Cooperation and

Competition but substance of both is preserved

�Run in parallel to the Public Contracts Regulations 2006 (the

“2006 Regulations”) but there is some overlap

Procurement rules in NHS commissioning

PCR (2006) S.75 Regulations (2013)

Coverage NHS England, CCGs and NHS

Trusts

NHS England and CCGs,

healthcare only

Thresholds >£113,057/>£173,934 No minimum

Services

covered

Procurement of goods, services

and works

Only procurement of healthcare

services

Obligations OJEU notice must be published,

unless it’s a “Part B service”

(e.g. healthcare services)

Publish notices on

Supply2Health

Enforcement Claims for breach enforced in

High Court

Monitor investigates, unless

already brought under PCR

Remedies Damages and declaration of

ineffectiveness in specific

circumstances

Declaration of ineffectiveness,

(damages)

Regulation 2 - Objectives

� Commissioners must act with a view to:

� securing the needs of health care service users

� improving the quality of services

� improving the efficiency with which services are

provided

Regulation 3 - General requirements

� Commissioners must:

� Act in a transparent, proportionate and non-discriminatory way and treat all providers equally

� Procure services from the provider that is most capable of delivering the objectives and provides value for money

� Consider appropriate means of improving quality and efficiency of services by:

� Providing services in a more integrated way

� Enabling providers to compete to provide services

� Allowing patients a choice of provider

Regulations 4 and 5 –

Advertising and competition

� Publish advert on Supply2Health (where there is an

intention to seek offers from providers) including:

� description of the service(s)

� evaluation criteria

� No need for advert where commissioner satisfied

that the services are capable of being provided by one

provider.

10

Regulation 10 – Anti-competitive

behavior• Commissioners cannot engage in anti-competitive behavior

unless it will be in patients’ best interests, including:

� services being provided in an integrated way

� co-operation by service providers to improve the

quality of the services

• Arrangements restricting competition are not permitted

unless they lead to a beneficial outcome for patients or are

required for achieving the objectives in Regulation 2.

Achieving objectives and

getting the evidence (1)

� Identify and evaluate health care needs e.g. through public consultation, engagement with clinicians, reference to clinical guidelines, etc.

� Consider availability of and impact of commissioning decision on related services

� Take steps to ensure equitable access e.g. elderly, the disabled, socially excluded groups

Achieving objectives and

getting the evidence (2)

� Identify need for patients to receive services in a particular setting

� Monitor quality and efficiency of existing services and identify areas for improvement

� Consider whether the quality and efficiency can be improved through

� the way services are procured e.g. competitive tender

� the service specification

� the contract e.g. quality indicators

� providing services alongside other services

Conflicts of Interest

Conflicts of Interests

• Statutory duty on CCG to;

�Make arrangements for managing conflicts and

potential conflicts of interest in such a way as to

ensure that they do not, and do not appear to, affect

the integrity of the CCG's decision making processes

• To discharge this, the CCG should ensure conflicts are:

� Identified;

� Disclosed; and

� Managed.

Disclosure

• Statutory duty on CCG to:

�Maintain one or more publically accessible registers of the interests of members of the CCG; its employees; members of the Governing Body; and members of committees or sub-committees of the CCG or the Governing Body; and

�Make arrangements relevant to conflicts or potential conflicts of interests and ensure these are declared and included in the registers.

11

Procurement and

Decision Making

A suggested approach• Backdrop

� CCGs bedding down

� Issue of conflicts for GPs

� Monitor approach – current consultation

• CCG sovereignty

• Consider using a decision matrix

• Evidence Grid to support thinking

A suggested approach

• Decision matrix – key elements� Is only one provider capable?

� Is only one provider assessed as being most capable?

� Are the benefits of competitive tendering outweighed by the costs of running it or any other VFM issues?

• If you answer “No” to all these then you must compete!!

• Consideration of suitable networks/collaborations rather than individual organisations

Evidence Grid

• A series of pointers and suggestions

• Will not be exhaustive

• The CCG needs to identify resources

• Remember to involve Governing Body in

contentious decisions and especially lay

members and nursing/consultant members

Monitor’s powers

� Co-operation and Competition panel now part of Monitor

� Limited to ensuring commissioners have operated within legal framework

� Investigate complaints it receives or initiate its own investigations

� Can declare a contract “ineffective”

� Can direct a commissioner to put in place measures to prevent further failures to comply

� Can direct a commissioner to vary a contract or an ITT

� Cannot direct a commissioner to carry out a competition

12

Slide 1

WORKSHOP 2

Procurement for innovation

HELEN LISLE

FCIPS CMGR FCMI, BA HONS

Head of Procurement and Commercial Services,

Northumbria Healthcare NHS Foundation Trust

www.nwcahsn.nhs.ukPhilip Dylak

Director of Innovation, Nursing and AHPs

Procurement for Innovation A New Landscape 2013

� Health & Social Care Act 2012 comes into force

� GP led Clinical Commissioning Groups set up

� Health and Well Being Boards established

� Public Health moves out of NHS and into Local Authorities

� Patient choice agenda e.g. Any Qualified Provider (AQP) can choose to goto the Provider of their choice – over 100 non - NHS organisations haveAQP status – compete on quality, not price (fixed price for service)

� NHS England (formerly the NHS Commissioning Board)starts to overseeday to day running of health services

A New Landscape

� “De clutter” the landscape – several hundred bodies scrapped, merged orreformed (e.g. PCTs, SHAs, HIECs)

� Role of Monitor (FT regulator) moves towards being the system regulatorfor all NHS funded services

� Health Education England and LETBs

� NICE responsibilities extended to social care

� CQC no longer assesses the performance of commissioner organisations

� New patient and public bodies established – known as Healthwatch

A New Landscape

� Continued development of “Innovation, Health & Wealth” and roll out of 15Academic Health Science Networks

� “Better Procurement, Better Value, Better Care” - A Procurement

Development Programme for the NHS

http://www.nwcahsn.nhs.uk

13

AHSNs –

Four National Areas of Focus

� Focus on the needs of patients and local populations: work inpartnership with commissioners and public health bodies to identify andaddress unmet medical needs, whilst promoting health equality and bestpractice

� Build a culture of partnership and collaboration: promote inclusivity,partnership and collaboration to consider and address local, regional andnational priorities

� Speed up adoption of innovation into practice to improve clinicaloutcomes and patient experience - support the identification and more rapidspread of research and innovation at pace and scale to improve patient careand local population health - that way we all win

� Create wealth through co-development, testing, evaluation and earlyadoption and spread of new products and services

Leading areas

Each AHSN also has

� Clinical priorities

� Cross cutting projects

� System wide leadership across England

The next slide summarises these for each AHSN

Procurement Matters

� NWC AHSN leads on Procurement

� North West Procurement Development (NWPD)

� “Procurement for Innovation” – source the technology earlier in the serviceplanning process , and other things

Procurement for Innovation

Different definitions, but we think its about:-

� Involving procurement specialists from the start when a service is beingdeveloped

� Seeing procurement as “everybody’s business”

� Building procurement expertise in staff who are not procurement specialists

� Improving the quality and flow of information to enable decision support –connected to the “innovation pipeline”

� Improving data systems

Why is it so difficult? Industry says …

� NHS budget silos - savings made in one area don’t transfer to another -disincentive

� Approach to implementing a NICE recommendation is unclear – should bea pathway

� Suppliers referred from one body to another – who is responsible forfunding the innovation?

� How to get “procurement” to understand the “value” a new innovation offerswhen the focus is on price per unit

14


� Need better ways to properly engage suppliers and reduce risk - e.g. “reverse” procurement

� Difficult for SMEs to understand how to penetrate what looks like a random set of market conditions.

� Rules about “where the bar is set” seem to vary – what proof of efficacy is needed?

� Numerous procurement systems/routes to market currently being adopted by many trusts? How do suppliers cater t them all?


� Different rules perceived to apply within and outside the NHS

� Lots of products that have been in the NHS for a long time seem to slip under the fence

� Making a convincing business case on cost effectiveness grounds is hard without inside knowledge – how do you ever get it?

Case Study

“Cardiospec” is a point of care test which identifies raised cardiacenzymes in the patient’s sweat.

The enzymes it detects rise when the patient has suffered cardiacdamage – e.g. following heart attack.

A positive result obviates the need for further extensive bloodtesting and observation, and a smart phone based algorithmassists the clinician to select the next test, or none.

Mid Counties NHS Trust and CCG implement a new rapid chestpain service due to rising numbers of admissions

Case Study

The new service involves

� A succession of invasive blood test

� External monitoring

� An additional cardiologist

� A cardiac specialist nurse

� A capital build

But not Cardiospec – why ?

Procurement and AHSNs – working

together

� The NWC AHSN’s contacts with industry, academia and its NHS partners all

point to the need to simplify, unify and streamline the systems and processesfor engagement with industry.

� AHSNs will act as a single point of entry between its partners, gatheringtogether the skills and knowledge needed to do this in the most effective way

� NWC AHSN’s “Innovation Express” will be about removing needless barriersand obstructions – so that innovation can happen more quickly, or we canstop businesses wasting time and money on things the NHS doesn’t want

Innovation Express – how can

procurement get involved?

� Web - based portal - help individuals, companies, innovation scouts,

etc. to decide where to go next with their product or idea, and what to

do to get there

� “Innovation expos” linking local SMEs with the academic and health

sectors - “speed dating”

� Regular SME “clinics” – you learn what the NHS wants, and what its

standards are, we learn about what industry is making available to us,

and what you see as the barriers to engaging with the NHS

15

Innovation Express

� Facilitated access to EU funding via the LEPs – essential forinward investment and sustainability

� A clear pathway from idea to implementation – it is in everyone’sinterests to get new technologies into practice as soon as

reasonably possible but not waste time on things we don’t want or

need

� Research or earlier stage testing – how to get to it

� Innovation improvement schemes including incentivising grantsand joint appointments with industry.

North West Industry Forum

� Jointly established with GM AHSN

� Representation from ABHI, ABPI, BIVDA, Medilink, LEPs, TrustTech andothers – with professional procurement advice

� Part of our objective to promote easy access to the NHS in the leastnumber of steps

Case study 2 – Plac8

“Plac8” is a matchbox sized monitor which measures 8 physical parameterswhich change in response to stress.

Using a complex algorithm, it can work out the degree of stress beingexperienced by the wearer and initiate preventive actions – at its most basic,alerting the wearer to the fact that they may be stressed, through to setting upa relaxation session via integral earphones, through to advice to seek urgentmedical help

It is worn in the pocket, has a small HD screen, and is fully compatible with allcurrent smart phone, tablet and PC product ranges

It has been identified by the International Council on Occupational Health andWell Being as a key technology to reduce work place stress and associatedabsenteeism

Case study 2

Why might Plac8 still be on the shelf 17 years from now?

� Invention phase – does it meet a need or is it just clever technology?

� What did the evaluation in practice really say about what it could do?

� What is the evidence of efficacy?

� Has its introduction been modelled up

� How has it been presented to CCGs or Boards?

� How can we help the product into practice

Board skills approach?

� “Pitches” sometimes fail because we cannot believe the claims made

� But we cannot ignore approaches from suppliers – we may inadvertently miss something very significant

� One approach to advocate is the “Board Skills” approach

� Rather than the supplier telling us how good the product s from their point of view, they need to pitch it from the point of view of a Board

Here’s what the Board might want to know


CEO – are there risks to the effective and efficient operation of the Trust, and

its reputation? Will introducing this mean a change in our relationship with anycolleague organisations?

Medical Director – does it work? How many people are affected by whatever itdiagnoses ? Who interprets the results – what if there is an extreme result ?Which doctor will be responsible ? What do we do now, and how and why is

this better?

Finance Director – contrary to stereotype will not think only about unit cost, but

also the wider financial implications – e.g need for capital build, newequipment, effect on tariff, write off of existing assets

16


HR Director – does the organisation need to lose staff to reap the benefit? Will

we need to commission different staff in the future, are they out there? Will weneed to retrain existing staff?

Nursing Director – is it safe to use? what are the risks to its introduction atclinical level? Will it deliver a financial saving, but use more nursing time?What will the patients think of it?

So …

� We are in a new landscape with lots of challenges but also lots of

opportunities

� New structures have been set up with the express purpose of accelerating

innovation

� Procurement and supply are key to delivering this seismic change

� Find out what is happening locally, and get involved

(nb the products and tests referred to in this presentation are fictitious and used for illustrative purposes only)

North West Coast AHSN

www.nwcahsn.nh

s.uk

Slide 1

WORKSHOP 3

Good procurement

management information –

myth reality?

ANDY McMINN

Head of Procurement and Logistics,Plymouth Hospitals NHS Trust and

Health Care Supply Association Council Member

– South West Region

Slide 1

http://www.nwcahsn.nh

17


JOHN EFFINGHAM

Executive Director,

Health Care Supply Association

DAVID PIERPOINT

Managing Director Customer Engagement,

NHS Supply Chain

www.supplychain.nhs.uk

NHS Supply ChainThe presentation with no name…….

David Pierpoint, MCIPS

Managing Director, Customer Engagement

14th November 2013

www.supplychain.nhs.uk 101 www.supplychain.nhs.uk

Imagine for a moment….

Director of Procurement

http://www.supplychain.nhs.uk



18


Less is more……do the right things well

More price competitive

Support commitment

Service Improvement

More responsive


A race against time to save £2.0bn

Savings on time and on target

Creative ways bypass OJEU to save time

Secure engagement from time poor

clinicians

Acceleration on savings through

commitment &

aggregation

Educating clinicians on best value

Inability to tackle in-trust supply chains

www.supplychain.nhs.uk 105

Strength of relationship

CommunicationsQuality

RelevanceFormat

Audience

Relationship

managementAccount management

Product availability

Service levelsMore customers More

commoditiesMore critical lines

Stock outsContinue to reduce

stock outsImproved contract

launch

InformationIntelligent ordering

Value for money

Achievable savingsPricing

OpportunitiesCustomer focus

InnovationVisibility and

communication

Range Category approach

Unit of issue

Service experience

DeliveryRight product

Right placeRight time

Service promiseManage expectations

Consistent approach

Tailored approachCatering for different customer types and

needs

Addressing the issues

www.supplychain.nhs.uk 106

Closer engagement is critical

Value/Compliance

Collaboration/Partnership

Fully

integrated supply chain

partnershipAdvanced

service solutions

Supply chain review

Committed & aggregated

spend

Joint savings plan

Standardisation

Benefits of greater engagement

Ad hoc use of frameworks

Assurance in procurement with robust compliant processes

Back office efficiencies

Outstanding service reliability and dependability can help minimise procedure cancellations

Internal supply chain efficiencies through better cost control

Additional resource, freeing up internal staff for other added

value activities

Improved effectiveness of internal supply chains

Accelerated savings


Responding to the challenge….. North West Collaboration and London

107

£1.3m savings forecast* (+18%) through volume commitment discounts

• Share the good ideas

• Secure buy in across trusts

• Need trust commitment

• Strong governance critical

• Avoid timelines slipping at all costs

24% savings forecast on £5.4m Audiology through standardisationand volume commitment


Responding to the challenge…..Department of Health Capital Equipment Fund

108

£14.6m savings achieved through the Fund

• MR / CT scans trebled

• Inability to share data for some

• Procurement trumps planning

• Financial constraints on capital







19


Responding to the challenge….. Managing consignment stock and supply chain

optimisation

109

74% time saving on stock management

9% saved on managed spend through reduced obsolescence

• Agree well defined requirements

• Ensure usability of product data

• Management information valuable

• Poor governance = Poor returns

£200k savings from rationalisation and improved stock control along with £100k of efficiency savings


Responding to the future challenge….. 2013-2016

110

£500m over 3 years£350m cash releasing

£100m

£150m

£200m

2013/14 2014/15 2015/16

£250m


AgendaThank you for your time

David Pierpoint, MCIPS

Managing Director, Customer Engagement

Email: [email protected]

Slide 1

65 years on –the NHS as we know it?

CLAIRE PERRY OBE

King’s Fund

65 years on –

the NHS as we know it?

Claire Perry

Health Care Supply Association

14th November 2014





20

65 years on – the NHS as we know it?

› Looking back

› Time to think differently – future trends

› Personal reflections

› The Wisdom of the Crowd – 65 views of the NHS at 65

› Wider perspectives

› Context for challenges in world class procurement

Timeline of some major inquiries

› Stanley Royd

› Wessex Information System

› Bristol babies heart surgery

› Alder Hey retained organs

› Pathology misreporting, radiological protection

› Mental health: Christopher Clunis

› Professional self regulation: Ledwood, Neil, Shipman

› Child protection: Victoria Climbié, Baby P

› Financial overspends 2003/4

› Maidstone and Tunbridge Wells infection control

› Mid Staffordshire Foundation Trust Learning Difficulties Winterbourne View

› Morecombe Bay maternity

› Keogh outcomes review

Future trends

1. Demography

2. Healthy behaviour

3. Disease and disability

4. Workforce

5. Public attitudes

6. Broader determinants of health

7. Medical Advances

8. Information technology

9. Sustainable services

10.Economic pressures

1. Demography

› Population size

› Ethnicity

› Migration

› Changing families

› Births

› Life expectancy

› Aging populations

› Deaths

Rising life expectancy

21

Rising numbers of older people2. Healthy behaviour

› Obesity

› Alcohol

› Smoking

› Drug Misuse

› Sexual behaviour

› Clustering of unhealthy behaviours

› Attitudes to health

Population lifestyles present significant risks to

their health

Obesity is associated with an increased risk of

diseases including diabetes, heart disease,

osteoarthritis and cancer

Behaviour change is not easy

3. Disease and disability

› Long term conditions and multi morbidity

› Care demands and dementia

› Mental health

› Child health

› Non communicable diseases

› Communicable diseases

22

Growing numbers of people with long term conditions and multiple conditions Stroke - rising numbers reducing mortality

• The number of people having a stroke is predicted

to rise from 1.06 million

people in 2010 to 1.25 million in 2020

• Mortality rates from stroke

halved from 1993 to 2010, and this trend is expected to

continue as a result of

continued improvements in

treatment

Rising Care Needs

More people living on their own Mental health and long term conditions

› Long term conditions

› Care demands and dementia

› Mental health

› Child health

› Non communicable diseases

› Communicable diseases

23

4. Workforce

› Wider workforce

› Health and social care workforce

› Social care workforce

› Informal workforce

› International flows

› Opportunities and new roles

Changing relationship between professional and work

› More information and power in the hands of patients

› More protocols for care for professionals

› Traditional connection between one profession and one particular type of

work loosening

› Team working - critical

5. Public Attitudes

› Public expectations and experiences of services

› Attitudes to NHS and social care funding

› Generational differences

6. Broader determinants of health

› Economic context

› Education

› Early childhood development

› Work environment

› Housing

› Parks and green spaces

› Social relationships

› Climate change

7. Medical advances

› Pharmaceutical advances

› Devices and diagnostics

› Assistive technologies

› Surgical innovation and regenerative medicine

Growing capacity to treat

› A “cure” or “vaccine” for certain cancers

› An increase in the number of lifestyle

drugs available

› Devices that have the capacity to replace

or integrate with human tissue

› Biosensors that allow continuous monitoring

of a patient

› Pharmacogenetics support more effective

treatments

› In the longer term stem cells provide

capacity to replace or repair organs

24

Genomics – could deliver significant gains in quality

Costs of genetic coding

falling dramatically

Many potential benefits

Many ethical issues

8. Information technology

› Internet use

› Computing power and access

› Digital technologies

› Applications in home and health care settings

› Digital privacy

Evidence based decision making and treatment regimes – improving outcomes

Apps in healthcare

› Providing information about services

› Providing information about conditions and treatments

› Supporting self diagnosis, management and monitoring

› Offering professional support and education

› Supporting clinical networks and sharing

clinical opinion and advice

› Enabling the remote monitoring of patients

› Sharing diagnostic images and information

Virtual visits – remove geographical barriers to access

Health care can be done at

a distance with video conferencing and remote monitoring of blood sugar,

blood pressure, heart rate, and other health data

9. Sustainable services

› Low carbon healthcare

› Adapting health services to a changing climate

25

10. Economic pressures

› Current economic context

› Historic trends

› Long term projections

Unprecedented financial pressures

0

1

2

3

4

5

6

7

8

9

10

19

60

19

63

19

66

19

69

19

72

19

75

19

78

19

81

19

84

19

87

19

90

19

93

19

96

19

99

20

02

20

05

20

08

20

11

20

14

20

17

20

20

20

23

20

26

20

29

20

32

Pe

rce

nt

GD

P

4% real: £170 bn

0% real: £84 bn

Match GDP: £132 bn

OBR 2012: £136 bn

Actual

UK NHS spend

2014/15:

£132 bn

% Increase last 20 years

0-64

65-84

85+

1989/90-2009/10

An ageing and more demanding population

NHS

Spend

Source: DH - Departmental Report 2006

133% by 2035

The home as the locus of care

The Wisdom of the Crowd

› Crucial - free at the point of use regardless of ability to pay

› NHS remarkable given 3 years of financial constraint

› Fragmented, complex and fragile

› Competition v cooperation

› Future funding scenarios

› Integrated care

› Impact on hospitals and public response

› Consistent objective quality measurement

› Openness and transparency, listening and responding

26

System complexity – a reality going forward

› Competition v cooperation

› Democracy in the NHS

› Health and social care, Health and Wellbeing Boards

› Academic Health Science Centres/Networks: research to practice

› System and organisational regulation

› Education, training and development

› Joined up care closer to home, future role of the hospital, specialist services

› Commissioning – driving change or an unnecessary overhead?

Developing and leading world class people and systems

› Organisational culture

› Lessons from mental health transformation of 1980/90s

› Simple vision, engaging line managers and employees, integrity

› Learning organisations Prof Richard Bohmer

› International networks and learning – USA Veterans

› Leadership styles – Kings Fund Commission – system leadership


EUGENE COOKE

Treasurer, Health Care Supply Association

Leading through change

NICK GRIMSHAW

Director of HR Services, Law by Design

©2013 Law By Design Limited

Hard on the Facts -Kind to the People

Nick GrimshawDirector of HR, Law By Design Limited

27

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.

Charles Dickens, A tale of two cities

©2013 Law By Design Limited ©2013 Law By Design Limited


TQM BAth and BrisTol LEAN CharterMark StAnley

RoYd LeiTch PledGe IiP IWL STBOP korner RAWP

McLeod QUIPP Alderhey MaiDstone and TonbridGe Wells Mid StaFfs

WhitLey AFC KSF DHSC RHA PCG PCT

CliniCal GradiNg 18 WeEks Southern Cross ShipMan etc etc


“Secretaries of State 4“Secretaries of State 4--44--2”2”

Hewitt Hewitt

WaldegraveWaldegrave BottomleyBottomley Newton Newton Clarke Clarke

Dobson Milburn Reid Dobson Milburn Reid DorrellDorrell

Burnham LansleyBurnham Lansley


28


Christine?Mary Pulleyn

Janet Williams

Pauline Fox

Jeremy Pease

Christine Atkinson

Tim Gilpin

Clive WarbrickElaine Leaver

John Sergeant

Christine Green

Julian Hartley

Aidan Kehoe


“Life is Fair”


“I am a Perfectionist”


“I want everyone to like me”


29




30



“Only connect”



31



“For God's sake, look after our

people”



Nick Grimshaw, Director of HR ServicesLaw By Design Limited

Email address: [email protected]

Slide 1


32

ConferenceClosing Address

SIMON WALSH

Chairman, Health Care Supply Association

Slide 1

Thank you for attendingSlide 1

Government Opportunities

www.govopps.co.uk

EVENTSdelivering procurement excellence and tendering success

Supported by: Organised by:

SCOTLAND • ALL ISLAND • NORTH • SOUTH

Discover > Learn > NetworkYour Passport to Procurement Excellence

For exhibition and delegate enquiries, please visit www.procurexlive.co.uk

29 April 2014Manchester Central

Exhibition Centre

www.procurexnorth.co.uk

21 October 2014Scottish Exhibition &

Conference Centre, Glasgow

www.procurexscotland.co.uk

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and Conference Centre

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Conference Centre, Dublin

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