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Mandie Sunderland, Chief Nurse, Nottingham University Hospitals NHS Trust
NHS Clinical Reference Board and NHS Clinical Evaluation Team
13 April 2016
NHS Clinical Reference Board and NHS Clinical Evaluation TeamMandie SunderlandChair, NHS Clinical Reference Board
Why do we need to make changes?• The overspend in the NHS has increased from £822m in 2014/15 to an
expected £2bn in 2015/16*• The NHS spends £4.5bn per year on clinical products in the acute sector
alone• All trusts are under pressure to make savings, yet we must work together to
protect patient safety and the frontline as a priority. Every £30,000 saved equates to one Band 5 nurse
• If we can buy products more efficiently across the NHS, then there is less need to look for efficiencies at the bedside
Lord Carter’s Report: Operational productivity and performance in English NHS acute hospitals: Unwarranted variations
• The challenge is to lift hospital efficiency to a consistently high standard in every area of every NHS hospital
• 15 detailed recommendations for tackling unwarranted variation in the productivity and performance of trusts
• Savings: up to £5bn per annum can be saved by 2019/20 if there is political and managerial commitment to take the necessary steps:
Ø Up to £2bn by improving workflow and containing workforce costs.
Ø Up to £3bn from improved pharmacy, estates and procurement management
• Proposes a single integrated performance framework for hospitals – one version of the truth – to help trusts set baselines for improvement and provide them with the tools to manage their resources
• The ‘Adjusted Treatment Index’ (ATI) will help hospitals to identify where further investigation is required, and where efficiencies may be achievable
• Develop a model to define what an efficient NHS hospital looks like.• A single national catalogue for hospitals to improve inventory management. Clinical involvement in defining the range the
NHS will purchase
Potential savings
Total = 776 Band 5 nurses
Save £1.3mon Disposablecontinence
Which could equate to:
43Band 5 nurses
Save £4mon Infection control -skin
Which could equate to:
133
Save £18mon Wound Care
Which could equate to:
600Band 5 nurses Band 5 nurses
NHS Customer Board structureNational Customer Board
Sir Ian Carruthers OBEChair
Mandie Sunderland Chair
Chief Nurse, Nottingham University Hospitals NHS Trust
Clinical Reference Board
VACANTChair
London Customer Board
David MelbourneChair
Deputy Chief Executive and Chief Finance Officer, Birmingham Children’s Hospital NHS Foundation Trust
Midlands Customer Board
Suzanne TraceyChair
Director of Finance and Business Development, Royal Devon and Exeter NHS Foundation Trust
Southern Customer Board
Mick GuymerChair
Director, North West Procurement Development
Northern Customer Board
NHS Clinical Evaluation TeamClinical Lead, Dr Naomi Chapman
Name Role&Trust Name Role&Trust
Mandie Sunderland(Chair)
ChiefNurseNottinghamUniversityHospitalsNHSTrust
ProfessorSuzanneHinchliffe
ChiefNurse/DeputyChiefExecutiveLeedsTeaching HospitalsNHSTrust
GregDix(ViceChair)
Director ofNursingPlymouthHospitalsNHSTrust
MichelleNorton Director ofNursingGeorge EliotHospitalNHSTrust
SandyBrownDirector ofNursingandClinicalQualityEast ofEnglandAmbulanceServiceNHSTrust
ChristinePerry Director ofNursingWestonArea Health NHSTrust
DrNaomiChapman Executive NurseNetworkLeadRoyalCollegeofNursing
MarkRadford ChiefNursingOfficerUniversity HospitalsCoventryandWarwickshireNHSTrust
GeraldineCunninghamAssociateDirector ofCulturalChangeBarts Health NHSTrust
DeeRoach Executive Director ofNursingandQualityLancashireCare NHSFoundationTrust
RoseGallagherNurseAdviserInfectionPreventionandControlRoyalCollegeofNursing
RayWalker Executive Director ofNursingMersey Care NHSTrust
GaynorHalesAssociateNurseDirector,NorthNHSImprovement
NHS Clinical Reference Board members
Objectives of the Clinical Reference Board• Raise awareness of the role clinicians play in
achieving best value from clinical products• Identify areas for savings and standardisation,
linked to the NHS £300m savings challenge, compare and save and core list
• Support and drive the existing good practice in clinical engagement in procurement
• Publicise the work of the group and seek opportunities to engage the wider clinical workforce in the challenge
• Work collaboratively with all the Local Boards to support clinical engagement across they key priorities
“By facilitating interaction with trusts through the Customer Board at a local level we will be able to help accelerate change and the delivery of the significant savings needed.”Sir Ian Carruthers OBE, Chair of National Customer Board Chair of Portsmouth Hospitals NHS Trust
NHS Clinical Evaluation Team members
Name Role Name Role
Dr Naomi Chapman(Clinical Lead)
ExecutiveNurseNetworkLeadRoyalCollegeofNursing
Simon Hall TissueViabilityLeadNurse,UniversityHospitalsBristol
LiamHorkan ClinicalProcurementSpecialist,ColchesterHospitalUniversityNHSFoundationTrust
Sian FumarolaSeniorClinicalNurseSpecialistTissueViabilityandContinence,UniversityHospitalsofNorthMidlandsNHSTrust
David NewtonMatron-ClinicalProcurement,NottinghamUniversityHospitalsNHSTrust
Clare Johnstone HeadofInfectionPreventionandMedicalDevices,CentralLondonCommunityHealthcareNHSTrust
Stephanie McCarthy ClinicalProcurementNurse,RoyalDerbyHospital
Remit of the NHS National Clinical Evaluation Team• Established April 2016, reporting into the NHS Clinical
Reference Board• For the NHS, by the NHS• Reviews some of the clinical products currently available
through NHS Supply Chain to identify those that enable high quality patient care
• As a secondary issue, considers products that could be procured more effectively through combined NHS buying power
• Work will inform the future development of national clinical specifications across various product categories.
“Quality, safety and value are at the heart of our work and it’s important that we use our clinical experience to deliver high standards of care in ways which also reduce cost and waste in the NHS.”Mandie SunderlandChair of NHS Clinical Reference Board
www.supplychain.nhs.uk
UK / NATIONAL SCALE.
DIRECTLY SUPPORTS
£58MNURSE LED
SAVINGSOPPORTUNITIES.
EXAM GLOVES†DRESSINGS†
CONTINENCE CARE†POLYMER
WIPES†
INCLUDING
† PLUS CORE LIST COMPARE AND SAVE
AND PRICE RANKING.
SUPPORTED AND DRIVEN BY MANDIE SUNDERLAND, CHIEF NURSE AT NUH AND CLINICAL REFERENCE BOARD CHAIR.
Acute and Community Hospitals, Prisons, Mental Health Trusts, GPs, Care Homes.
Clinical supplies - quality, safety and value at the frontline.
ENCOURAGING AND EMPOWERING NURSES TO MAKE CHOICES WHICH CONTRIBUTE TO PATIENT SAFETY, SUPPORT THE FRONTLINE AND DELIVER SAVINGS FOR THEIR ORGANISATION.
LAUNCHTUES 24
MARCH 2015 RCN HQ, LONDON.
www.supplychain.nhs.ukClinical supplies - quality, safety and value at the frontline.
INFORMED BY OUR NURSING TIMES PURCHASING SURVEY
(Jan 2015)
856RESPONSES
NURSES TOLD US THEY DO SEE
OPPORTUNITIES TO SAVE, ALIGNED
TO KEY CATEGORIES,AND THEY WANT
TO GET INVOLVED.
AND THEY WANT
CASE STUDIES
‘HOW TO’GUIDES
TRAFFIC LIGHT
SUPPORT SYSTEM
(Identified as most essential tool)
WEB
‘small changes, big differences’ resources
Quick wins
Best practice
Practical ‘how to’guides
Web presence
Improving patient safety and making savings Case study: Nottingham University Hospitals NHS Trust
Issue: CAUTI (catheter associated urinary tract infection) is one of the most common sorts of hospital acquired infections and results in severe illness
and high levels of hospital admissions
Project aim: to standardise urinary catheters across Nottingham University Hospitals over 2 acute sites, where a number of different urinary catheters
were being used by clinicians with no consistent practice
Improving patient safety and making savings Case study: Nottingham University Hospitals NHS Trust
55% reduction in CAUTIs from Jan – August 2015 (compared to same period 2014)
Estimated savings of £111,000 per annum (30%)
Outcome: standard catheter pack and education implemented which delivers best practice on recent health guidelines
Which products do nurses think we can make savings on?
Disposable wipes63%
Incontinence products53%
Gloves65%Dressings74%
Key facts• The NHS spends £302m on dressings and wound care annually
• 43% is through NHS Supply Chain (95% in the acute market) £126M
• Some products are already generic ie. Cotton Wool
• High price differences exist between most and least expensive products
• Clinicians tell us some products are over specified for clinical usage
• Pricing is not always clear, with direct rebates in place with suppliers
• Developing national clinical specifications would support patient safety and effective procurement
• There is an opportunity to improve quality of care and patient safety, whilst also making £18m of savings for the NHS
Progress to dateA Team of nearly 30 experienced nurses across a range of specialisms including tissue viability, burns management, infection control and clinical procurement have reviewed specifications across seven categories of products.
Film dressings
Super absorbents
Barrier cream and ointments
Non woven island
adhesive dressings
Foam dressings
Gelling fibre
Wound contact
layer
Breakdown of products reviewedGeneral wound care Advanced wound Care
Category (Lots in current catalogue)
No. of sub-categories
No. of National product codes
Category (Lots in current catalogue)
No. of Sub-categories
No. of National product codes
Film dressings
Super absorbents
Barrier creams and ointments
Non-woven island adhesive dressings
4
3
3
3
374
61
57
144
Foam dressings
Wound contact layer
Gelling fibre
7
2
2
470
165
75
Total 13 636 Total 11 710
Wound care - next steps
• EstablishNHSClinicalEvaluationTeam
• Reviewtheoutcomesandrecommendationsfromthewoundcareclinicalworkdonesofar
April
• Workwithkeystakeholdersincludingrepresentativebodies,theclinicalteamandNHSSupplyChaintoreviewobjectivesandagreenextsteps
April/May • Undertakeclinicalevaluation,ensuringpatientsafetyandqualityofcareremainparamount
Summer
Beyond wound care….• The NHS Clinical Evaluation Team have been seconded to this project from April 2016
for an initial 6 month period• The Team are part of the NHS and will work with the NHS to conduct clinical
evaluations, focusing on providing the best opportunity to improve patient care and deliver greater value for the NHS
• Working with procurement professionals at NHS Supply Chain and the NHS Business Services Authority, the NHS Clinical Evaluation Team will use independent, robust and transparent processes to do a range of clinical evaluation activity which may include:
– research on clinical outcomes and published data– table top evaluations– review of existing or proposed savings opportunities to ensure clinical viability– creation of national clinical specifications which identify clinical standards, feeding into national
procurement processes