Value Based Healthcare Experts

It was encouraging to see that the new Government had commissioned a review of the NHS within its first 100 days. The purpose of this article is to consider some of the key messages and findings from Lord Darzi’s report through the lens of a value based approach to procurement. Productivity The report states at length about the fact that staff are working harder than ever and still experiencing challenges increasing productivity across the system. The lack of capital funding and assets is cited as a major contributor to this inefficiency, coupled to the need to improve patient flow throughout the system. A reduction in length of stay, greater use of day case surgery and releasing bed capacity through the application of technologies that enable patients to be treated at home, are all cited as desirable ways of working for the NHS. Through the initial Value Based Procurement (VBP) pilot project undertaken by NHS Supply Chain, there are several case studies that have been written where these objectives have been achieved across different pathways 1. Given that there was limited investment in the resources to undertake the proof of concept pilot, it would appear that wider adoption and application of VBP across multiple strategic areas has the potential to make a significant impact to the productivity goals cited in the report. Sustainability Through focusing on pathway optimisation, it was also identified in the NHS Supply Chain project 2, that per procedure a VBP approach has the potential to reduce carbon emissions, for example through reduced theatre time with the use of minimally invasive technologies and reduction patient travel through remote monitoring and care provided in a patients home. Value creation Lord Dazi refers to “value creation” in the report. The challenge, as I know from experience of VBP, is the need for the NHS to be clear what value means and translate this into tangible and measurable objectives/outcomes. When explaining how to adopt a value based approach to procurement professionals, I have recommended they undertake and analysis of treatment pathways to identify what needs to change and by how much, a simple but effective approach. This exercise allows suppliers and healthcare stakeholders to focus in on the needs of the NHS and the patient, and enables them to explore and garner resources to create solutions that effectively address the challenges identified. Partnerships There is a line from the TV sitcom “The Office” from the late 1990’s that goes something like..”just when we thought we saw the light end the end of the tunnel, it was someone with a torch bringing us more work!” To think that our NHS staff without support, have either the enthusiasm or the capacity to deliver the changes at the scale and pace required is unrealistic. Through VBP we have the opportunity to move from competition to collaboration with industry partners and create win/win relationships that can draw upon suppliers’ knowledge, skills and resources to accelerate the pace of change necessary and reduce the burden on already overstretched front line staff. Continuing the theme of collaboration, I call upon suppliers both MedTech and pharma to consider working together across pathways where they do not compete on product sales to create a single solution. This could potentially increase efficiencies for participating suppliers and healthcare professionals, reduce project management/support teams and free up resource across the supply chain. Finance In my experience of the NHS, I have witnessed examples of where financially favourable solutions over the life of a 2 year + contract have been rejected in favour of alternatives that generated a larger in-year saving; this is deemed necessary in some quarters of the NHS as accepted practice to balance the books. I’m no finance expert but intuitively does this approach make sense? Surely a longer term view would have more positive impact on the overall NHS finance position. When considering the delivery of value across a patient pathway, there may be higher upfront costs in one part of the system EG the Acute sector, which then results in lower total treatment costs when taking into account expenditure on community care. It is encouraging to see the importance of Integrated Care Systems highlighted in the Lord Darzi’s report and the hope is that ICB’s fully embrace whole health economy approaches to financial flows. It’s my assertion that there needs to be a restructure and commercialisation of the NHS finance regime; one that transitions to multiyear budgets, bundled payments based on targets for specific deliverables, and allows flexibility to introduce commercial incentives for over performance. These moves I believe will provide the stimulus for the creation of value and mechanisms for Healthcare and industry to work together in the co-creation of solutions that reduce total pathway costs, increase efficiency, and improve patient care. Conclusion Having had recent first-hand experience of the NHS as a patient in both NHS Wales and England, I am eternally grateful to live in a country where we have access to skilled health professionals who genuinely care for patients’ health and their wellbeing. As someone that has worked in an around the NHS for 20 years, I’m also acutely aware that this desire to “make a difference” is very much in the DNA of healthcare procurement professionals in the UK and around the world, and one of the reasons why people are attracted and stay in profession. In this article my aim has been to highlight that by adopting a value based approach will maximise the potential of procurement in playing a vital role supporting the NHS to meet the challenges set out in Lord Darzi’s report. Brian Mangan FCIPS MSc  CEO Luach Consulting Group 1 VBP Case Studies » NHS Supply Chain 2 NHS Supply Chain Sustainability