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

Event Management:Media Sponsor:

www.hcsaconference.org.uk

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CONFERENCE SLIDESDAY 1 – 13 November 2013

1

Slide 1 Session Chair:

ANDY HARRIS

Head of Procurement, University Hospital

Birmingham and Health Care Supply Association,

Council Member – West Midlands

Conference Welcome

SIMON WALSH

Chairman, Health Care Supply Association

Slide 1

Question TimeChair:

Professor Duncan

Eaton

Slide 1

2

NHS Procurement –Implementing the

new strategy

JOHN WARRINGTON

Deputy Director, Policy & Research Procurement,

Investment & Commercial Division,

Department of Health

John.Warrington@dh.gsi.gov.uk

November 2013 DH – Leading the nation’’’’s health and care

Update

HCSA Annual Conference

9

Last year…..

• “The time taken for the new system to bed down will lead to a delay in

reducing costs, increasing the size of what needs to be delivered…

• Should assume NHS will not be exempt from cuts post 2015, particularly with an election due that year….

• Political pressure to save money from any area they see as ‘pain free’will increase. Procurement is seen as ‘pain free’….

• So in summary, the storm clouds are building…..

• Whilst the procurement profession is in a better position than it was 3 years ago, if you didn’t lead on better procurement the system would

find someone who could…..”10

Size of the task HAS got bigger……• NHS SRsettlement 2013: 0.1% real terms growth in 2015-16 means no growth in

budget until end of 2015-16 (extending Nicholson £20bn challenge for another year)

• QIPP target not happening……… delays?

• Demand and inflation still rising, so estimate we need to find £1.5-2bn by end of

2015-16 to ensure £22bn non-pay budgets stay within settlement

DH – Leading the nation’s health and careDH – Leading the nation’s health and care

£bn

16%inc 9%

dec15%inc

18%inc

7%inc

11%inc

0%inc

46%inc

16%

inc 7%

dec

15%

inc

18%

inc

11%

inc

46%

inc

7%

inc

0%

inc

Total non-pay spend

2010-11 £18.56bn2011-12 £20.61bn 11% inc 2.9%2012-13 £22.67bn 10% inc 2.9%?

Activity% change

Non-clinical Pharma Clinical supplies/services Agency staff Healthcare Serv

£bn

11

Even if the NHS is subject to cuts…..

We know settlement flat-lines until 2015-16, but

what will election bring? Can we expect health to be continued to be protected? Even if we did, the reality is that trusts are finding it ever more difficult

DH – Leading the nation’s health and care

Trust Sector 1 FT Sector 2 NHS Providers

£m £m £m

2013-14 Net surplus/(deficit) -167 276 109

No. of organisations in deficit 31 16 47

% organisations in deficit 31% 11% 19%

No. of organisations in surplus 69 129 198

% organisations in surplus 69% 89% 81%

1. The source of NHS Trust figures is NTDA's Summer report - based on month 4 forecasts

2. The source of NHS FT figures is Monitor. Based on NHS FT plans

• 47 of 245 trusts are

predicting a deficit for 2013-14 (19%)

• 31 of 100 non-FTs predicting a deficit (31%)

• 16 of 145 FTs predicting a deficit (11%)

HEADLINES A significant shift in overall financial position of

the NHS non-FT sector

• 2012-13 aggregate position was a net £106m surplus. Forecast is now £167m deficit

• 2012-13, 5 out of 102 NHS Trusts reported a deficit. Forecast is now 31 out of 100

12

“Political pressure for the ‘pain free’ solution”DH – Leading the nation’s health and care

3

13

“If you don’t lead, the system will find

someone who can……”DH – Leading the nation’s health and care

?

14

“In a better position….”• No doubt things are improving

• Excellent work going on at local and regional levels

• More investment in benchmarking

• National organisations improving their capability, if not

obvious to the NHS yet

• More clinical and executive engagement

• HCSA upping their game

• But, the clock is ticking…….

15

Getting the balance right….

• BPBVBC is a combination of short & long term

• Long term

• Data

• Capability

• Leadership

• Short term?

Building a sustainable ‘world-class’procurement system will take time

16

4 priorities to deliver improvement

1. Deliver immediate efficiency gains

– Combat inflation, agency staff strategy, Common Goods & Services,

simple price-benchmarking

2. Improve data, information and transparency

– e-Procurement strategy, GS1 data pool, national ‘‘‘‘data warehouse’’’’and systems, transparency, NHS spend analysis & price benchmarking service, dashboard of procurement performance

metrics

3. Action to improve outcomes for patients at lower costs through clinical engagement

– Clinical Procurement Review Partnerships (e.g. orthopaedics)

4. Longer term programme to improve leadership/capability

– Centre of Procurement Development & Academy, support for NEDs

and FDs

DH – Leading the nation’s health and care

17

Long term – the enabling function

DH – Leading the nation’s health and care

LeadershipLearning &

Development (Academy)

Networking, Best Practice,

Standards, KM

Diagnostics, Data, Analytics,

Benchmarking, Performance

Centre of Procurement Development

70/20/10 learning

All NHS procurement staff to be registered

E-Procurement Strategy

Mandate transparency and GS1Data warehouse and benchmarking

Network & support NEDs

Support FDs

Standards of Excellence

Case studiesKnowledge sharingSingle Category Management Process

Hosted and owned

by the NHS

18

Short term: savings ambition

DH – Leading the nation’s health and care

Areas of expenditure 2012 / 13

expenditure

Savings

target

Clinical Supplies and Services £5.0bn £530m

Non-Clinical Supplies and Services (incl common goods and services) £2.6bn £227m

Property (Premises and Establishment and Rentals) £5.1bn £150m

Non-permanent staff (*including £1.4bn spent on interims, fixed-term

appointments and bank staff)£3.5bn £450m

Inventories Consumed (Pharma inc. £3.8bn PPRS) £6.5bn £400m

Total £22.7bn £1.757bn

Resources/partners

NHS Supply Chain £1.4bn (£1bn medical, £0.4bn non-medical)

Govt Procurement Service £1.5bn (non-medical)

Commercial Medicines Unit £1.8bn (pharma)

Collaboratives c£3.0bn

Total £7.7bn (45% of spend)

4

19

National proposition for immediate savings

DH – Leading the nation’s health and care

£ms

£5bn

£2.1bn

£2.6bn

£5.1bn £2.1bn

The opportunity (£1.9bn savings) How?

1. Key Supplier Programme (KSP)• Extend Crown Supplier Rep Scheme to NHS• Create Clinical KSP

The partners and their current level of influence

NHS Supply Chain £1.4bn (£1bn medical, £04bn non-medical)GPS £1.5bn (non-medical)CMU £1.8bn (pharma)Hubs c£3.0bn Total £7.7bn (45% of spend)

2. Non-permanent staff strategy• Improvements in local demand, processes and controls• Develop the category strategy• Engage Trust Management to drive change

3. Common Goods & Services•Identify opportunities and increase GPS penetration•Focus on ICT category•Explore ‘savings guarantee’4. Property• KSP for soft FM providers• Deep dive in 1/2 trusts to get better understanding of spend

5. NHS Supply Chain proposition•Work up a proposition that ‘guarantees’ individual savings to trusts for the last 3 years of the contract

6. High-spend national category strategies• Create strategies for orthopaedics and cardio• Change the business relationship with these suppliers• Engage clinicians at all levels to drive change

7. Pharma• CMU savings plan• Consider medicines management programme

20

National proposition – Key Supplier Programme

• Clinical suppliers

• Identified first wave of 10 suppliers

• Letter sent from Dan Poulter

• Briefing session organised for 19/11

1. Non-clinical suppliers

• Extension of Crown Reps Scheme (e.g. Oracle & Microsoft

• Meeting with Business Services Association on 18/11 to discuss

approach to KSM for Soft FM suppliers

DH – Leading the nation’s health and care

SUPPLIER CEO/MD Title

3M UNITED KINGDOM PLC Mark Dawson Business Director

BAXTER HEALTHCARE

LIMITED

Harry Keenan General Manager

BECTON DICKINSON UK

LTD

Johnny Lundgren ChairVP NW Europe

BOSTON SCIENTIFIC LTD Tim Coutts Vice President

COVIDIEN UK Mark Harvie VP - Med Supplies

EMEA

JOHNSON & JOHNSON LTD Sophie Dutilloy Regional VP UK &

Ireland

KEYMED LTD Nick Williams Group Managing

Director

MEDTRONIC LIMITED Jackie Ganley Regional VP UK & I

ROCHE DIAGNOSTICS LTD Christopher

Parker

Managing Director UK

& Ireland

MOLNLYCKE HEALTHCARE

LTD

Jamie Brannan General Manager UK &

Ireland

• CSR scheme has delivered c£1bn savings to central government

• No consolidated NHS data on key suppliers

• Health Logistics/Lord Wolfson project will provide better data early in 2014, but in meantime we are engaging with who we think are the

major suppliers

Accenture

Airwave Amazon

Amey Atkins Atos

Babcock Balfour Beatty

BT Capgemini

Capita Carillion

Cisco Cognizant

CSC Detica

Fujitsu G4S

HP IBM Infosys

Interserve Level 3

Lockheed Martin Logica

Microsoft MITIE

Oracle Royal Mail Group

SAP Serco

Sodexo Steria

TCS Telereal Trillium Thales

Vodafone Wipro

Xerox

Crown suppliers

NHS approach

21

National proposition – non-clinical

• Non-permanent staff

• Common Goods & Services

• GPS Proposition & Customer Engagement Plan

• Intention is to increase GPS footprint in travel, fleet, consultancy services, office solutions, and ICT

• Focus on ICT and software licences in particular

• Property

DH – Leading the nation’s health and care

* The ERIC collection is pay and

non-pay therefore 30% of the total

has been applied to generate an assumed non-pay spend

Contracted Out Services £2,098,507,894

Water & sewage £76,618,679

Energy £613,920,879

waste services £83,067,498

Hard / Soft FM services * £1,535,316,603

Building Engineering & maintenance * £216,784,113

Grounds, Gardens and Maintenance * £8,542,959

Laundry & Linen services * £51,536,777

Patient Services (transport) * £158,940,562

Cleaning services * £269,394,215

Total £5,112,630,181

22

National proposition - NHSSC

• Objective: guarantee £250m - £500m savings by end of 2015-16

• Proposition to include: reducing NHSSC costs,

improving NHSSC service, and accelerating

customer savings

• Series of initiatives, some untried, but purpose is to rethink relationship between NHSSC and NHS

trusts

• Meeting organised with Cabinet Office for 28th

November to discuss proposition

DH – Leading the nation’s health and care

23

National proposition – clinical engagement

• Orthopaedics Clinical Procurement Review Partnership (CPRP)

• Objective: to remove waste in the supply chain to drive down costs, whilst maintaining and improving clinical outcomes

• Key issues:

Variation

• Significant variation in prices paid (for the same item from the same

supplier, and between suppliers for similar systems)

• Clinical practice variation with debateable justifications

Inefficiency

• Inefficient procurement and supply chain methods and processes

• Disproportionately high ‘costs to serve’e.g. cost of consigned inventory, sales

and technical support, instrumentation –may represent as much as 40% of the price of a product

24

Why are costs to serve so high?

• Commission driven selling model =

keep clinicians happy

• Transfer pricing mentality

• Costs to serve not been an issue because no pressure on prices

• Keeping clinicians happy = stock everywhere, reps everywhere, and “don’t tell anyone but you have got the

best deal”

• All suppliers do it, despite economies

of scale, so variation adds cost

5

25

We already know clinical variation…..

But we don’t know the cost of

variation…but we are getting there….

• Database now contains c£29m spend in hips and knees across 35 hospitals with 5

suppliers

• Average cost of implants used in primary hip procedures is £1368 – but averages range from £800-£2150

• For knees average is £1395 with a range of £1000-£1950

• Prices paid do not have a significant relationship to the volumes used/purchased

• There is even variation in the average cost of implants used across surgeons in a hospital 26

Findings – Procedure Device Costs by Trust - HIPS

For example…..

27

How can we change this?

• Need data to for ‘intelligent’ discussion

• Supply chain efficiency starts with reducing variation…

• Reduced variation leads to better partnerships with industry

• Better partnerships with industry lead to joint approaches to

reducing costs to serve

• BUT, this requires trust and commitment from all parties,

and clinicians need to be driving and leading the change

28

National proposition: engagement with NHS

• Needs to be an ‘integrated programme’ – a national strategy

• Need a 'national game-changer' and catalyst

• Implementation needs to be 'NHS-led' - change from within will

be permanent and resilient

• No time to build new architecture; need to exploit limited

resources we have at pace and scale

• Model needs to address all in-scope spend

• Can Shelford Group be prime catalyst leading to wider adoption?

• Savings will not be delivered without NHS buy-in, so need CEOs

approval and appropriate incentives – potential underwrite?

DH – Leading the nation’s health and care

29

National Integrated Programme

DH – Leading the nation’s health and care

Centre for Procurement Development

CIPS

NHS Leadership Academy

Immediate efficiency

and productivity

gains

Key supplier programme

National category teams

GPS

NHSSC

Hub alignment

Customer boards

NHS Health Logistics

(Data Warehouse)

e-Procurement Strategy

Lord Young Recommenda

tionsNHS England

Data,

information and

transparency

Improve

leadership and

capability

Contribution to

economic

growth

Clinical savings

programme

Non-clinical

savings

programme

• Spend analytics

• Price benchmarking

• GS1 coding

• Capability diagnostic

• Support for NED's, FD's and

Senior Clinical Stakeholders

• Transparency

• Engagement

• Ease of access

• Complex clinical category

strategies e.g. Ortho, Cardio

• Key supplier management

• Common good & Services

• Agency Staffing strategy

• Property

30

How can we get to tipping point?

DH – Leading the nation’s health and care

£million £million

Guys & St Thomas* £383 Imperial* £377

UCLH* £302 Leeds £355

Newcastle* £276 Barts £318

Central Manchester* £250 Oxford* £296

Royal Free £245 Nottingham £266

Sheffield* £228 Leicester £237

Cambridge* £198 Brighton £234

Kings College* £191 St Georges £202

Birmingham* £172 Pennine £176

Heart of England £169 South London £172

East Kent £157 Portsmouth £171

South Tees £153 Hull & E Yorks £170

Chelsea & West £133 Cov & Warwick £170

Derby £143 Mid Yorks £156

Salford £132 Barking H & R £153

UH Bristol £128 Royal Liverpool £150

Norfolk & Norwich £136 North Bristol £149

County Durham £125 Plymouth £137

Total £3,521 North Staffs £133

North West London £130

United Lincs £130

Sandwell £120

Total £4,402

Foundation Trusts Non-Foundation Trusts

Top 40 FT and Non-FT Trusts = c£8bn spend (40%)

Top 10 FTs

= £2.4bn

Top 10 Non-FTs

= £2.6bn

Top 10 FT and Top 10 Non-FT Trusts = c£5bn spend (25%)

*Denotes Shelford Group members (£2.7bn = 13%)

Total Trusts by

Sector:

173 acute

16 Community

57 Mental Health

10 Ambulance

Estimate

breakdown of

spend by sector:

Acute 83%

Community 3%Mental Health 11%

Ambulance 3%

6

31

Delivery & Governance

DH – Leading the nation’s health and care

Ministerial Oversight Board

Delivery Board

(DH, CO, NHSE, TDA,

FTN/NHSConfed, HCSA)Shelford group Top 20 non-FTs/TDA

National Integrated Programme

Improve data, information & transparency

Improve leadership

and capability

Contribute to economic

growth

Clinical savings

programme

Non-clinical savings

programme

• e-Procurement strategy

• Spend

warehouse

• GS1 coding

• Benchmarking

• Dashboard

• Support for NEDs and FDs

• CPD

• Academy

• Networks

• Transparency

• Engagement

• Ease of access

• SMEs

• Innovation

• Combatting inflation

• NHSSC

proposition

• Key Supplier Programme

• Category

strategies

• GPS penetration

• Crown Suppliers

• Agency staffing strategy

• Property (FM CSR scheme)

• NHSSC proposition

32

So predictions for 2014-15

• Realisation that the scale of savings needed cannot be delivered by what we have been doing so far – has to be breakthough initiatives

• Unlikely health budget will be protected after 2015 election

• Political pressure to intervene is already happening, but could it get

more radical? Will the scale of the challenge trump health policy?

• NHS will be talking to its key suppliers very differently

• Competition between intermediaries will cease

• Procurement may collaborate at AHSN level and contribute to the

innovation agenda e.g. redesign of care pathways

• NHS procurement profession will unite to lead and meet the challenge

There is no other choice…….

Slide 1Session Chair:

MARK ROSCROW

Director of Shared Services –

Procurement Services,

NHS Wales Shared Services Partnership

Financial challengesfor NHS providers

TONY WHITFIELD

Executive Director of Finance/Deputy Chief

Executive, Salford Royal NHS Foundation Trust

and President, Healthcare Financial

Management Association HFMA)

Slide 1

7

Delivering care onthe front line

SUE LORD

President, Association for Perioperative Practice

(AfPP)

Delivering Care on the Frontline

Sue LordPresident of

The Association for Perioperative Practice

HCSA Conference November 2013

Aims of the session:

• Look briefly at the history of nursing

• How does that compare with delivery of todays care

• Discuss the current role of the modern matron and other health professionals

• External influences which impact on care delivery

• Major areas which are being addressed currently

Who is this?

Florence Nightingale said:

“The very first requirement in a

hospital is that it should do the sick no harm”.

(Notes on Hospitals, 1863)

Do You know who these other famous nurses are at the same time as Flo?

8

Other nurses who influenced delivery of care and helped to change from a medical model to

a nursing model:Dorothea OREM Virginia Henderson

Virginia Henderson famous definition of nursing is:

"The unique function of the nurse is to assist the individual, sick or well, in the

performance of those activities

contributing to health or its recovery (or

to peaceful death) that he would perform

unaided if he had the necessary strength,

will or knowledge".

Let’s see how it used to be – the role of the Matron:

http://www.youtube.com/watch?v=Lapa7-

42TN0&list=PLB896984519596408

How does this compare with todays health care delivery?

• All nursing profession until the 20th Century

• Nursing was an all female dominated profession till 20th

Century

• Very medical led model of delivery of care till late 20th Century

• Nurses were subservient to doctors

• Patients were respectful of nurses

• Authority of Matron and only 1 per hospital

• Cleanliness of the hospitals

• Good staffing levels

• Low Stress levels

• Non/Low expectations of nurses technical skills

What does the “thoroughly modern Matron” do?

The key focus of the modern matron role is to

ensure all patients receive quality care

Areas of importance are:

• Infection control

• Patient safety

• Pressure sore prevention

• Right skill mix and numbers of staff for

optimum care of patients

• Bed management

Matrons come in all shapes and sizes

9

Example roles of Modern Matrons

• Matron for Surgery and Musculoskeletal

• Emergency and Critical Care Matron

• Maternity Services Matron

• Matron for Medicine

• Cancer and Diagnostics Matron

Other Health Care Professionals

• Physiotherapists

• Occupational Therapists

• Radiographers

• Healthcare Scientists

• Operating Department Practitioners

• Surgical Care Practitioners

• Physicians Assistants

• Surgical First Assistants

Todays health care delivery?• Mixed professions healthcare team

• Mixed sex nursing profession

• Very nursing led model of delivery of care

• Nurses equal to doctors

• Loss of respect for nurses from patients

• Divided authority of Matron, several per hospital

• Cleanliness of the hospitals

• Staffing levels reduced to basic levels

• Stress levels very much more increased

• High expectations of nurses technical skills

External influences which have impacted on delivery of care recently

• Francis Report

• 6 Cs

• The NHS Constitution

• Economic Crisis

• Educational Reform

• Demographic changes

The Francis Report

Robert Francis QC

Stafford - The Hospital that didn’t Care –Patients left to die!

• http://www.youtube.com/watch?v=iHX

OFS9ec2Q

10

Francis Five:

1. To structure clearly understood fundamental standards and measures of compliance, accepted

and embraced by the public and healthcare professionals, with rigorous and clear means of

enforcement.

2. Openness, transparency and candour throughout

the system.

3. Improved support for compassionate caring and

committed nursing.

4. Strong and patient centred healthcare leadership.

5. Accurate, useful and relevant information.

Francis 1 – how will these be implemented and monitored in England?

• The National Institute for Clinical Excellence (NICE) will be charged to work with relevant professional and patient

organisations to produce the fundamental standards

• AfPP will be looking to work with NICE for them to utilise our

“Standards and Recommendations for Safe Perioperative Practice” (2011) for the UK and also our “Staffing for Patients in

the Perioperative Setting” (2008) – currently being up dated

• Monitored by the Care Quality Commission

• Monitored by public and practitioners - “whistle blowing” (Jackson et al 2010)

Francis 2 – Openness, transparency and candour:

• Openness - “enabling concerns and complaints to be raised freely and fearlessly, and questions to be

answered fully and truthfully”

• Transparency – “means making accurate and useful

information about performance and outcomes available to staff, patients, the public and regulators”

• Candour – “means informing any patient who has or may have been avoidably harmed by a healthcare

service of that fact and a remedy offered where appropriate, regardless of whether a complaint has been made or a question asked about it”

(Francis 2013 page 6)

Francis 3 – compassionate , caring and committed nurses (the 3 C’s):

• Need to ensure that all qualified nurses hold these qualities and are empowered to deliver them

• Recruitment of nurses to ensure these qualities

• Train nurses to ensure they hold these qualities

• Training and regulation of Healthcare Support

Workers

• Stronger nursing voice

• More emphasis on the importance of care of the

older person by creation of a registered old persons nurse

Francis 4 – Strong & Patient centred Leadership:

• Creation of a leadership staff college

• A common code of ethics, standards and conduct for

senior healthcare leaders and managers

• An effective appraisal scheme

Francis 5 – Accurate, useful and relevant information:

• “Patients, the public, employers, commissioners and regulators need to have access to accurate, timely

and comparable information” (Francis 2013)

• Need improved information systems to ensure this is

achievable

• Need to ensure accurate collection of data

• In England the Information Centre for Health &

Social Care will be key to attaining this

• Francis wants it to be a criminal offence to wilfully

impart false statements and data regarding safety or fundamental standards

11

Final thought from Francis:

“We need a patient centred culture, no tolerance of non compliance with fundamental standards, openness and transparency, candour to patients, strong cultural leadership and caring, compassionate nursing, and useful and accurate information about services”

Robert Francis QC 2013

The 6 C’sJane Cummings

Chief Nursing Officer (England)

'You need to have enough staff,

but you also need to have the right culture, the right

environment, the right training and education.'

Jane Cummings CNO England

"It was very clear that nursing was getting a bit

of a bad name and it felt like the profession

was being quite beleaguered and criticised,"

says Cummings. "Nurses felt frustrated about

that, but we also knew that we had evidence

from Mid Staffs, from the first report, that

actually care had been bad. Nobody in this

country can say that care is brilliant all of the

time."

How do we change that image and rebuild the public trust in nursing

The six Cs

• Care

• Compassion

• Competence

• Communication

• Courage

• Commitment

Short video on 6 Cs

• http://www.england.nhs.uk/nursingvision/

The NHS Constitution - England March 2013 – revised in the light of the Francis

reportFocus of main areas of improvement:

• patient involvement

• feedback

• duty of candour

• end of life care

• integrated care

• complaints

• patient information

• staff rights, responsibilities and commitments

• dignity, respect and compassion

http://www.youtube.com/watch?v=4Oc3gf9PeAg

12

Economic crisis

• Massive influence on

• How care is delivered – more with less

• How areas are staffed – numbers, roles, etc

• Your industries with regard to purchasing restrictions on cost from Healthcare provider

• Cost of technology is increasing

• Savings expected to be made

Educational Changes

• All graduate profession for nurses and midwives

• Moving towards all graduate professions for Allied Health Professionals e.g. Paramedics, ODP’s

• Takes longer to train the workforce

• Education of more non registered professionals e.g.

Associate Practitioners, Assistant Practitioners

• Recommendation for more practice placements for

healthcare professions before and during training

• Reduction of hours practitioners can work (EU directive)

• Extended roles for Health Care Professionals

Demographic changes

• Aging population

• Increased co-morbidities e.g. diabetes,

heart disease, dementia

• Aging workforce

• Decreasing qualified workforce

• Higher expectations from the public

• More care closer to home

Remember the most important thing is good quality patient care

Any Questions? References:• Department of Health 2013 The NHS Constitution:

the NHS belongs to us all 26th March 2013 London

DH

• Francis R QC 2013 The Mid Staffordshire NHS

Foundation Trust Public Enquiry: Executive Summary 6th February 2013 London The Stationery

Office

13

Slide 1Thank you for attending

Slide 1

Government Opportunities

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EVENTSdelivering procurement excellence and tendering success

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