How do we define 'value' in the NHS?

Finding ways that procurement can maximise its contribution to supporting frontline care and creating sustainable savings opportunities requires a ‘re-think’ in the way we do things

Value can mean different things to individuals within an organisation. For some, it may be about reducing the amount of time people have to stay in hospital, accessing the best quality care, reducing pain and discomfort for patients, improving quality of life or doing more with less. For organisations that support the NHS, delivering value in a way that matters for staff, patients and carers remains a top priority

Finding ways that procurement can maximise its contribution to supporting frontline care and creating sustainable savings opportunities requires a ‘re-think’ in the way we do things. The application of value-based procurement (VBP) is one such alternative approach to current practices being considered by health systems across the world and being led in the NHS by NHS Supply Chain. Here, there is a shift in emphasis from looking solely at reducing product costs to working with industry to consider technologies that can provide a better outcome for patients at the same time as influencing a reduction in total costs within the patient pathway.

Value-based procurement

In May 2019, NHS Supply Chain started a project designed to review the potential benefits and practical application of VBP. The aim was to establish a series of pilot projects led by trusts that could be used to test the concept of VBP in practice. These could then be used to work on scalable models. In total 13 pilot projects took place.

Initial NHS Supply Chain pilot tests have shown potential benefits to the NHS in areas such as:

• reducing waste and the number of products used
• allowing patients to move from inpatient to day care
• reduction in length of stay in hospital
• reduction in infection rates, therefore, improving safety
• access to new or innovative high-quality products that provide better results for patients
• increasing operational productivity.

Working in the NHS

NHS Supply Chain has conducted several VBP pilots over the last two years which demonstrated clinical and efficiency benefits. One such pilot worked in partnership with Baxter Healthcare and Manchester NHS Foundation Trust, which were keen to explore how VBP could be applied in practice. Working with the clinical and procurement teams at Manchester NHS Foundation Trust, Baxter Healthcare successfully piloted a new standard of care within parotidectomy procedures which removes the need for a surgical drain, thereby reducing a patient's length of stay (LoS) in hospital from 2.5 days to just a single day. In addition to reducing the LoS, this pilot proved to reduce patient discomfort and allowed patients to return home swiftly without the challenges a surgical drain can create. 

Based on the Manchester NHS Foundation Trust experience and a throughput of 93-day case parotidectomy patients per annum the annual forecasted saving is £74,865. If we put this into context across the whole of the NHS, not only could the savings be huge, but the value added to the whole patient pathway and improving the quality of life are substantial too.

Taking the opportunity

We have a real opportunity as an NHS system now to focus less on individual aspects of care, and more on the whole patient pathway

VBP offers an opportunity for both buyers and suppliers to create change and drive increased savings and operational efficiencies throughout the NHS. Enabling an environment that supports the move from a traditional transactional relationship, where contribution is measured on the achievement of one-dimensional savings and sales targets to a progressive, collaborative and strategic partnership, based on the delivery of shared objectives aligned to the transformation of healthcare. To speed up the adoption of VBP, we need finance teams in trusts to embrace these opportunities, looking at cultures and processes that will make this possible. At a national system level, we need to create a standard approach to recognising and measuring these efficiency benefits.

With the move to integrated care system working and an increasing focus on collaboration, we have a real opportunity as an NHS system now to focus less on individual aspects of care, and more on the whole patient pathway and the value that can add. As the national provider of medical devices and clinical consumables to the NHS, NHS Supply Chain is committed to playing a leading role working with our NHS partners to deliver value in a way that really makes a difference.

Colin McCready is chief financial officer at NHS Supply Chain. You can follow NHS Supply Chain on Twitter @NHSSupplyChain