Those of us working in the NHS are all too aware of the need to provide quality services within stretched budgets.
As public servants, the way we spend taxpayer money is subject to public and legal scrutiny, and we must ensure that we make the best use of resources for our patients and communities. But finance is only part of the story. Most decisions in the NHS are led by clinical considerations, and the public expectation for service quality is high. So, how can we make sure that people receive good quality health care, particularly when it comes to specialised commissioning, which may benefit only small numbers of people? Increasingly, strategic use of procurement techniques is helping to answer that question.
Procuring in a unique context
NHS England specialised services are usually for patients with rare, complex, and often life-threatening conditions requiring expert care. The number of patients is smaller compared with other services. The treatments and interventions are often new or just emerging from innovative research, and suitable providers may be limited. NHS England specialised commissioning undertakes regular reviews of its priorities and has a legal duty to fund certain new medicines and devices recommended by NICE. The procurement process traditionally begins after these priorities are established by decision-makers, relevant stakeholders have been engaged and consulted, and policies and service specifications have been adopted. However, learning from recent specialist projects has shown that there is much to be gained from involving procurement specialists at the embryonic stage, enabling a more holistic approach.
Pre-procurement—plan, research, and design
Procurement includes a number of different ways of obtaining services and supplies. In NHS England specialised commissioning, procuring cutting edge healthcare services can be associated with higher risks compared with procuring routine or already well established services—such as the inherent risks of complex and novel interventions like brain or in utero surgery. Designing and running a successful procurement process that is right for the service in question can be significantly enhanced by a more detailed approach to pre procurement activities.
Advance planning and thorough identification of needs are key stages in each procurement project. Realistic yet ambitious project plans allow the participants to engage with and commit to the project and spend enough time at each procurement step. The process of defining the needs and what is required to satisfy them is also critical, because it will set out the scope of the future procurement steps.
Research and engagement
Investment in pre-procurement research, market consultation, and testing pays dividends later. This is particularly true when commissioning a service for the first time or when seeking to solve a problem without a clear understanding of the options that might be available. For example, pre-procurement questionnaires and market engagement events provide the opportunity to interact with potential suppliers and test the art of the possible. In return, potential providers have an opportunity to feed back their suggestions, take part, and identify if the opportunity is right for them.
Design in collaboration
Within the flexibilities of the law for procuring healthcare services, processes are designed that consider the specifics of the service, including accessibility, continuity, and availability. When procuring a service for airborne high consequence infectious diseases for example, market engagement was crucial in informing the number of centres nationally, thus ensuring that there would be equitable access to HCID services across the country. Engagement also helps to determine the market size and to design an appropriate procurement process model. Setting clear organisational and project governance structures at the outset is beneficial, particularly for specialised commissioning.
From process design to effective execution
During the formal procurement phase, developing clear documentation is critical, drawing on all the learning from the previous phase. This allows potential providers to make an informed and timely choice about their suitability, and improves the quality of submissions received. Where possible, patient representatives are involved in scoring and moderation. This can include help with developing the questions as well as scoring and participating in discussions, as was the case in the ABI procurement. Patient representative involvement allowed for richer analysis and discussions, and ensured that the patient’s voice was heard in a complex procurement that affected a small number of people.
Reaping the benefits
Ideally, the benefits identified at the start of a project will eventually be matched or even exceeded by those realised as a consequence of the procurement process. In a typical procurement, the projected benefits are first captured in the initial reports and project initiation documents, which are then translated into the procurement documents, questionnaires, and moderation discussions. Clear benefits-realisation strategies need to be established as early as possible, and tracked to the end of the process through to contract management. In the NHS, a strong relationship between procurement and contracting should be the norm.
Procurement is much more than simply obtaining services and goods. It encompasses the steps leading to the design of the best process to obtain these services and the activities needed after the process is run and complete. It is a tool to meet an organisation’s strategic aims. When it comes to securing the best possible solution to a complex condition, a holistic approach to public procurement—with advance planning, strong governance, and multidisciplinary working—can deliver safe and high-quality specialised surgeries and interventions.
This is a summary of an article written for Specialised Commissioning Journal by Neli Garbuzanova, Senior Procurement Manager at NHS Arden & GEM Commissioning Support Unit. Read the full article here.