When I was enduring the procedure known as extracorporeal shock wave lithotripsy to break up my kidney stones some years ago, the experience felt like being slapped with a plastic ruler 100 times in quick succession.
Even without the pain distraction it would never have occurred to me to ask whether the KY Jelly liberally applied to my lower back cost the NHS £2.77 per 80mg tub − or a bargain £0.98.
With a very modest August fanfare − I spotted little media coverage ahead of Don (“openness and safety”) Berwick’s separate but more fashionable review on patient safety − Dr Dan unveiled plans to try yet again to raise the NHS England’s game on procurement. There will be a new Centre for Procurement Development, a new oversight board (chair: Dr Dan) and a “procurement champion” to promote awareness.
We must all be grateful that the champion is not − so far − being called the “rubber gloves tsar” or even the “KY Jelly tsar”. But there is an unavoidable sense of déjà vu here.
The National Audit Office and its parliamentary ally, the public accounts committee, have berated health managers for wasting anything between £500m and £1bn a year from the £20bn “non-pay expenditure” budget, which has been rising above the inflation rate and (because pay is being squeezed) as share of the total. In the wake of Sir Ian Carruthers’ review a zero inflation target to save £1.5bn by 2015-16 has been declared.
‘A “monopsony” − it means monopoly purchaser as distinct from provider’
A worthy ambition that pops up regularly across Whitehall; for the very good reason that civil servants who lecture local government and other public services on the need for efficiency don’t practice what they preach half as well. Thus former Tory health spokesman and medical equipment manufacturer, defence secretary Philip Hammond, is currently trying to tame our dreadful record on buying defence kit: dud aircraft cost more than KY Jelly. He could be the next chancellor.
Dr Poulter is telling MPs that the core issue is greater collaboration, one which involves greater involvement in procurement strategies and choices by trust boards and greater clinical engagement in which frontline health professionals say exactly which suture or venflon they prefer to use (preferably cheaper ones?).
All that and better skills among staff doing the buying. Small foundation trusts often appear to do a better job than big ones, the DH’s accompanying report notes.
Real money, old story
Though the media always loves demands for more transparency − part of the new regime − because it also loves the detail (the NHS pays 19 prices for pacemakers across a £750 range), not all the big ticket items are actually about kit.
The small print shows that drugs (£5.5bn) take the biggest single share of the £20bn total − surely a target of ministerial pressure on costs for decades? − ahead of medical supplies (£4.5bn). But premises (£3.3bn), often old and inefficient, are at number three, and contracted temporary staff (£2.4bn) not far behind.
‘I can’t help but note that in the devolved Lansley-Hunt model for the NHS central direction appears to live on’
South Tees Foundation Trust spends zilch on temps, whereas at Homerton hospital in high turnover east London it is around 10 per cent of its wage bill. That’s real money, but also an old story.
Still, there’s no harm in trying again. Ministers want to promote procurement partnerships to help iron out inconsistencies and inefficiencies and improve “procurement leverage”, which should assist such a big buyer as the NHS − a “monopsony” to use my favourite word you’ve never heard of. It means monopoly purchaser as distinct from provider.
All the same, I can’t help but note that in the devolved Lansley-Hunt model for the NHS central direction appears to live on.
Michael White writes about politics for The Guardian