We report in the News column yet another UK Government strategy to control the spiralling cost of procurement in the UK’s National Health Service. Well, good luck – they’ll need it.
I’m not exactly a greybeard (well, a bit badgerish if I’m honest, and I don’t use ‘product’, as my style-conscious daughters term it) but I really am getting a sense of déjà vu all over again.
Back when the world and I were both young, (October 1986 to be exact) my wife presented me with our first child, after a labour that was, to say the least, protracted. We went through four different foetal heart monitors – all different, all apparently homemade, and none repairable in any real sense, before the senior midwife ‘borrowed’ one from the emergency unit, which actually had a Hewlett Packard mark on it, and appeared to have been built in a factory rather than on a breadboard.
I wrote this experience up in ‘Manufacturing Matters’, a rag I was editing at the time, and was surprised and delighted some weeks later to get a letter from the Cabinet Office saying (I approximate, because sadly I have lost the original), that ‘The Prime Minister [Mrs Thatcher, no less] was very interested in my piece and wished to assure me that placing NHS procurement on a rational and cost effective footing was high on her Government’s agenda’. Possibly the highlight of what is laughingly known as my career.
But that was a quarter of a century ago. Since then, the Health Service has been reorganized more frequently than the old British Railways (for whom I once worked and which used under Nationalization to average a major reorganization every 18 months). ‘When you re-organize, you bleed’, some person of wisdom once said, except in the case of the NHS it may be that they reorganize, the patients bleed.
Procurement and logistics functions have been separated, recombined, regionalized, centralized and heaven knows what else. Currently, a lot of logistics, and a certain amount of procurement, is effectively outsourced to NHS Supply Chain, which is managed by DHL – I think we can assume the latter is applying the best of its, by no means insignificant, expertise to what must be one of its most prestigious contracts, but there is only so far an outsourced service provider can go. In an environment where, at least until recently, all clinicians were by definition saints, and health service managers by contrast the spawn of Satan, there is not much you can do to enforce rigour in sourcing and procurement. Maverick buying is of course common place across industry and commerce, but it is usually perpetrated by junior buyers with a cavalier attitude, not by Senior Consultant Surgeons!
And, unfortunately, if we are to judge by some of the comment in the new NHS proposals, central contracts even if adhered to haven’t been an unmitigated good. If sending a nursing auxiliary down to Boots in the High Street to buy a box of surgical gloves can save 40% over the cost of buying them through ‘the system’, well, why wouldn’t you? (I exaggerate, but you get the principle).
Nor has repeated reorganization helped. Whatever purchasing and supply chain expertize (and there has been a lot) has been built up in the NHS is dissipated every time a government introduces, abolishes, reintroduces, a ‘purchaser-provider’ split, or scraps a regional organisation, or creates a national ‘centre of excellence’.
I should in fairness point out that there have been significant improvements in the past quarter century. I recall, ‘back in the day’ some hospitals found Wards and Departments squirreling so much stuff away, because they couldn’t be sure if they ordered replenishment stocks whether they would be delivered in time, that the response was to make ward level stocking official, and effectively abolish Central Stores. Now, that could be a sensible supply chain strategy, for the right reasons, but not as an admission of defeat which this was. One can at least say these days that if clinicians or managers order stuff, it has a good chance of being delivered on time!
It used to be said, with what truth I know not, that the NHS was the world’s third largest employer, after the People’s Liberation Army and the Indian State Railways. I have no comparable performance figures about the latter two, but one has to wonder whether, despite the national commitment to a ‘National’ health service, the NHS in its present form isn’t just too big to manage.
And if a latter-day Cabinet Secretary should happen to comment on this column, I’ll be sure to let you know!
Sam Tulip
Editor
Supply Chain Europe
(0044) 1904 720081
samtulip@viacommsgroup.com
