Journal of Perioperative Practice PROCUREMENT GUIDE July 2012

Journal of Perioperative Practice

PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

01423 881300 www.afpp.org.uk

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

02

?????????

03

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

Contents

Welcome to your July Procurement Guide 05

Preventing surgical site infections

07

National Institute for Health and Clinical Excellence: Infection control (CG139)

08

Constrained procurement across Europe

11

New strategy for NHS procurement: Manchester Conference Centre, 17 April 2012

14

Guidance aims to improve procurement across healthcare system

15

Procurement decisions packed full of efficiency

Journal of Perioperative Practice Procurement Guide information In print within the AfPP Journal of Perioperative Practice covering national AfPP members, but also with a dedicated print and e-distribution to supplies and purchasing managers.

Key Sectors: NHS Supply Chain, Independent Hospitals, Higher Education. Medical Device Companies.

Published 6 times a year we will focus on procurement issues in every edition as well as specialist subjects which for the following year include:

July 2012 Infection Control / Prevention / Wound Management. Procurement.

September 2012 Consumables & Accessories.

Innovation. Procurement.

November 2012 Urological surgery based items.

Renal surgery based items.

Safety. Wound Management.

Procurement.

January 2013 Recovery / Patient Warming.

Procurement.

Contact Information: Advertising, Sponsorship & Partner Packages.

Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: francesmurphy60@yahoo.com Editorial Chris Wiles Head of Publishing / Editorial AfPP T: 01423 882950 E: chris.wiles@afpp.org.uk

PR & press material.

All press releases welcome and we will feature as many as we can in each issue, all press releases need to be submitted to: Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: francesmurphy60@yahoo.com

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

04

?????????

05

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

Infection Control

Preventing surgical site infections In less enlightened times, the risk and impact of infection made surgical intervention virtually a last resort option. If the patient survived the operation, infection and death usually followed. In the late 19th century, Joseph Lister applied Pasteur’s theories to surgical sterility, and the breakthrough in our understanding of infection prevention and control in the surgical setting had begun.

Great advancements in knowledge and innovations in surgical practice through the 20th century made the use of prophylactic antibiotic drugs, heat sterilisation of instruments and microbial barriers, universal.

Yet the incidence of surgical site infection (SSI) remains a pressing healthcare concern.

These advances in knowledge and innovations have resulted in an aging population who often require complicated procedures such as hip replacements where an SSI could prove disastrous. Many elderly patients requiring surgical intervention have conditions that predispose the risk of SSI. This situation demands meticulous surgical practice to prevent any additional risk to these compromised patients.

According to the National Institute for Health and Clinical Excellence (NICE 2008), surgical site infections account for up to 20% of all healthcare associated infections (HCAIs). At least 5% of patients undergoing surgery develop a surgical site infection.

The impact on patients of contracting an SSI is considerable. In 2009 the World Health Organisation (WHO) found SSIs increase the time patients have to stay in hospital; they push up mortality rates and result in higher rates of re-admission to hospital, post discharge.

Good infection prevention and control are vital to ensure that

people who use health and social care services receive safe and effective care. To be effective, prevention and control of infection must be part of everyday practice and applied consistently by everyone.

Perioperative practitioners have a professional duty of care to their patients to minimise the risk of them acquiring an infection and are arguably at the frontline of policy procedures set out for practitioners.

All four countries in the United Kingdom adhere to the requirements set down by their own Code of Practice. These can be accessed at: www.wales.nhs.uk www.infectioncontrolmanual.co.ni www.hps.scot.nhs.uk In England the prevention and control of infections and related guidance (DH 2008) applies to registered providers of health and adult social care. It sets out 10 criteria against which a registered provider will be judged on how it complies with the registration requirement for cleanliness and infection control. The registered provider needs to demonstrate: 1. Systems to manage and monitor the prevention and control of infection.

These systems use risk assessments and consider how susceptible service users are and any risks that their environment and other users may pose to them.

2. Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.

3. Provide suitable accurate information on infections to service users and their visitors.

4. Provide suitable accurate information on infections to any person concerned with providing further support for nursing/ medical care in a timely fashion.

5. Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people.

6. Ensure that all staff and those employed to provide care in all settings are fully involved in the process of preventing and controlling infection.

7. Provide or secure adequate isolation facilities.

8. Secure adequate access to laboratory support as appropriate 9. Have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and control infections.

10. Ensure, so far as is reasonably practicable, that care workers are free of and are protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care.

Providing a safe environment for the patient is best achieved by maintaining asepsis and limiting the risk of contamination.

Measures to prevent surgical site infection include the provision of medical devices, supplies and equipment which are free of microbial contamination at the time of use. The highest level of assurance that an object is devoid of viable microbes are in single use items. There is some value in sterilisation, particularly where single use is not possible, however this may damage the product.

The basic principles of aseptic technique prevent contamination of the open wound, isolating the operative site from the surrounding non–sterile physical environment, and create, maintain and promote a sterile field so that surgery can be performed safely.

The majority of wound infections are associated with the patient’s own skin flora. The skin cannot be sterilised and therefore has to be correctly prepared to reduce the risk of surgical site infection.

The purpose of skin preparation is to remove dirt and debris from the patient’s skin, reducing the number of microbes present.

Pre-operative cleansing of the skin also inhibits the re-growth of further micro-organisms and reduces the number of organisms entering the wound site, thus reducing the potential of surgical site infection. Also there is a programme of preoperative screening for MRSA (DH 2006).

A study by Darouiche et al (2010), published in the New England Journal of Medicine found pre-operative cleansing of the patient’s skin using chlorhexidine-alcohol was more effective in preventing surgical site infection than povidone-iodine, following clean contaminated surgery. A sterile field is created by providing a barrier between sterile and nonsterile areas, thereby reducing the risk of surgical site infection.

Ultimately, the outcome of a patient’s surgical experience is influenced by the competence, knowledge and skill of application for aseptic technique

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

06

Protection ????????? from Surgical Smoke Awareness of the health risks arising from exposure to surgical smoke is growing although the only guidance for infection control staff comes from the MHRA (Device Bulletin, 2008) and British Occupational Hygiene Society (2006) where some form of smoke removal system is recommended.

Electro and laser surgery produce particulates ranging in size from 0.07 micron. Particles from ultrasonic devices, high speed saws and drills are from 0.35 micron but because of their biological make-up – tissue, blood and blood by-products - pose a greater risk of cross-infection to surgical staff. Particulates of these sizes can easily penetrate deep into the lung and several studies reported on the presence of viral DNA, such as human papillomavirus (HPV), and HPV lesions in surgical staff.

In Laparoscopy patients risk carbon monoxide build-up in the abdomen which can be absorbed through the peritoneal membrane causing a reduction in the capacity of red blood cells to carry oxygen resulting in a falsely elevated pulse oximeter reading potentially leading to unrecognised patient hypoxia.

Frequent removal of smoke during laparoscopy reduces the risk to patients and improves visibility for surgical staff. However, whether released during or at the end of surgery the ultra-fine particles can travel up to 3 metres away from the site posing a risk to both scrubbed and unscrubbed staff.

Removal of contaminant as close to the source of its generation is the rule of thumb when developing air filtration devices. Air Safety’s Laparo Clear Smoke Filtration Kits consisting of ULPA and activated carbon media meet this requirement along with a capability to remove particles down to 0.027 micron.

E: webenquiries@airsafetymedical.com T: 01524 388696

07

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

The majority of wound infections are associated with the patient’s own skin flora. The skin cannot be sterilised and therefore has to be correctly prepared to reduce the risk of surgical site infection.

The purpose of skin preparation is to remove dirt and debris from the patient’s skin, reducing the number of microbes present.

Cleansing also inhibits the regrowth of further micro-organisms

Infection Control by perioperative staff. Therefore everyone in the team involved in the preparation and performance of surgical procedures is responsible for providing a safe environment for the patient.

The Association for Perioperative Practice, Quest PR and Anne Choyce References: Darouiche RO, Wall MJ, Itani KMF, et al 2010 Chlorhexidinealcohol versus povidone-Iodine for surgical-site antisepsis New England Journal of Medicine 362 18-26 Department of Health 2006 Screening for Meticillin-resistant Staphylococcus aureus (MRSA) colonisation: a strategy for NHS trusts - a summary of best practice London, DH Available from: www.dh.gov. uk/en/Publicationsandstatistics/ Publications/ PublicationsPolicyAndGuidance/ DH_063188 [Accessed June 2012]

Department of Health 2008 The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance London, DH Available from: www.dh.gov. uk/en/Publicationsandstatistics/ Publications/ PublicationsPolicyAndGuidance/ DH_122604 [Accessed June 2012]

National Institute for Health and Clinical Excellence 2008 Clinical Guideline 74- Surgical Site Infection: Prevention and treatment of surgical site infection London, NICE Available from: www.nice.org.uk/CG74 [Accessed June 2012] World Health Organisation 2009 Surgical Safety Checklist Available from: www.who. int/patientsafety/safesurgery/ tools_resources/en/index.html [Accessed June 2012]

National Institute for Health and Clinical Excellence

Infection control (CG139) This clinical guideline (published March 2012) updates and replaces NICE clinical guideline 2 (published June 2003). It offers evidence-based advice on the prevention and control of healthcare-associated infections in primary and community care.

New and updated recommendations address areas in which clinical practice for preventing healthcare-associated infections in primary and community care has changed, where the risk of healthcare-associated infections is greatest, and where the evidence has changed.

For further information and the full guidance go to: http://guidance.nice.org.uk/CG139

08

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

Procurement

Constrained procurement across Europe Most of us are aware that the financial climate across Europe at the moment is inevitably going to impact upon our way of working. This is particularly so in the area of procurement. Our surgeon ´Gods´ can no longer demand whatever they wish, and we as the new generation of ‘Florences’ cannot rub our lamps and produce the genies with their endless pots of gold.

It is only after we visit other countries or exchange discussions at various European or International congresses and meetings that as theatre nurses we come to realise that problems we experience in our day-to- day work are not confined to the UK alone, but are often present to a greater or lesser degree in the lives of operating room (OR) nurses everywhere. Like it or not, OR nurses have had to utilise our housekeeping skills and develop new approaches to maintaining our supplies of equipment and staff to respond to the controlled budgets within which we work.

For some European countries this has always been the situation whereas others have suddenly found themselves having to think carefully and to review working practices across the whole sphere of OR nursing.

Negotiation skills have been brought to the fore and in some parts of the continent this has even led to the belated building of new exchanges and working protocols between nurses and surgeons as they recognise everything is not simply available on demand.

Some countries are still in the early stages of considering IT as a possible way forward. Many are still dealing in a ´paper´ world with requisitions either directly to companies or through central hospital systems.

Some eastern European countries continue to work within limited budgets as has always been their situation. The cost cutting exercise on required levels presents mega challenges.

In discussions with representatives of various European countries recently I focused upon aspects of budget holding, stock ordering and inventories, company deliveries and hospital linking and sharing practices.

Although there did not appear to be specific nurses assigned to the position of procurement responsibilities, all senior nurses appeared to have access to the control systems and could argue for their department needs.

The major striking difference was the use of IT systems to support stock controls. For example, in the north of Portugal they have developed a fully comprehensive programme where quantities are managed through a Kanban system. A LEAN management system was introduced in 2006 in the hospital central warehouse. Departments agree with administration and central warehouse what stock of medical devices they require and this is topped up to that level twice daily.

This system has reduced the overall stock within the hospital by 50%. In the OR their stock was also reduced by 50% in the first stage and as staff became more confident of the system a further 25% reduction of stocks was achieved. This resulted in a lowering of budget needs as well as a release of space which became an invaluable equipment room. Automatic stock controls negate the need for separate inventories thus further saving time. An annual budget setting and review meeting between administrators (budget holders), department staff and warehouse personnel agrees levels of supplies. An outline projected budget for the year will also include major equipment and staffing requirements etc.

Other countries, however, are still in the early stages of considering IT as a possible way forward. Many are still dealing in a ´paper´ world with requisitions either directly to companies (fewer now) or through central hospital systems. Some eastern European countries continue to work within limited budgets as

has always been their situation.

For them the cost cutting exercise on required levels presents mega challenges. I found few where OR staff had total control of the budget for their area.

The further development of IT systems will lead to direct company links and they too will automatically replace items where a reduction of agreed hospital stocks is flagged up on their system.

With reference to deliveries by companies there were surprisingly few problems identified. One or two stated that although the ‘anytime´ delivery system did not function as previously, they did not have many problems due to delayed receipt of equipment. For some it was more a problem of wrong equipment being delivered.

Various agreements had been established independently with hospitals. Out of date stocks

09

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

are returned to companies, and expensive materials are placed in the unit by companies, and if used an order will be raised. There were a limited number of sale or return agreements reported.

It is always interesting to note that within the core group of companies serving all countries, there are often major variations in service - even allowing for the individual country situations.

Units which did not have an IT system developed still did an annual inventory of stocks manually, this was done by OR managers, local hospital supplies personnel and sometimes included companies.

The establishing of hospital links for stock control varied from country to country and hospital to hospital within a country. As in the UK several countries have already united local hospitals into a group with one overall management system. Consequently they

Procurement The establishing of hospital links for stock control varied from country to country and hospital to hospital within a country.

As in the UK several countries have already united local hospitals into a group with one overall system. They share supplies through a central system thus gaining the maximum discount on purchasing larger quantities

share supplies through a central system thus gaining the maximum discount on purchasing larger quantities. In other parts individual staff have negotiated with neighbouring units in areas of drugs and general equipment in an effort to reduce both costs and stocks. There did not seem to be any major hiccups in the process, although it was stressed that it only included a small category of items.

became part of the system, whereas individual hospitals found themselves under constant scrutiny of staff numbers with a need to regularly justify staffing budgets – not an unfamiliar story to us all. For private hospitals this has always been an issue.

It was interesting to hear how some countries are standing firm on nurses only within ORs, but again the argument for alternative grades regularly raised its head.

Nobody I spoke to seemed to have considered joint purchasing of major equipment; many claiming that frequency of use or transport would prohibit.

This would obviously need full surgeon cooperation but might be worthy of consideration, particularly if it means access to additional equipment which would otherwise not be available in some areas.

So in spite of the large areas of land and sea that separate the individual countries across Europe, many ORs share common dilemmas and difficulties in managing their day to day work. Some of us are still in the early stages of responding to the influence of the financial crisis pervading, whilst others have surged forward in a dynamic way which has actually brought unexpected benefits to individual departments.

Within the larger groups staff sharing and movement also

I would like to offer my thanks to OR nurses from Belgium, Portugal, Greece, Italy and Norway who were prepared to spare me a few moments of their time to share information on the situation in their country.

We are not out of the woods yet, but if we can, as Portugal demonstrates, bring benefits to our patients and ourselves within the OR environment, perhaps it´s not all bad news. Sometimes we need that extra pressure to remember the ongoing need to stop, assess and review practice from a number of different perspectives.

Margaret Brett Retired OR Nurse, Manager, Educator & Chairman of NHS Trust

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

10

?????????

11

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

Procurement

New strategy for NHS procurement Manchester Conference Centre, 17 April 2012 Through the QIPP agenda, the NHS is expected to deliver procurement savings of £1.2bn by 2014/15. The question at the conference was – is that enough?

The NHS as a whole is expected to deliver efficiencies of some £20bn, which implies that, if procurement was to take its fair share, savings of some £3bn-3.5bn would be needed.

The aim of this conference was to address the key issues, with a summary of the vision, the role of leadership in ensuring delivery, addressing clinical technology and how different approaches can deliver substantial savings without risk to patients. Finance directors have a key role in delivering savings and this approach was examined along with questions of accountability and how one can ensure it is appropriately applied.

The Health Care Supply Association, representing the procurement professionals, is also critical to delivery.

The procurement profession must be able to engage more effectively with the other professions, but that in turn requires greater willingness from all parties.

The conference was generally aimed at people working within the NHS and how they could achieve the savings without reducing quality and service, a massive challenge for any organisation.

It also touched on how organisations can measure procurement savings and how a concentrated effort across all disciplines was needed if organisations are to maximise the use of purchasing agreements and agencies to ensure the scale of NHS spend can be leveraged effectively.

The event was a platform to launch the new vision for NHS procurement, with a view to promoting discussion about the implications and in particular, how it can be implemented and savings achieved.

Speakers at the event:

Colin Cram, Chair, who has held senior positions within the Public Sector including central and local government, Beth Loudon, Programme Manager for the DH’s response to the Quality, Innovation, Productivity and Prevention (QUIPP) requirement to gain efficiencies through procurement across healthcare, Lord Hunt of Kings Heath, Chairman of the Heart of England NHS Foundation Trust, Catherine Beardshaw, CEO of Aintree University Hospital, NHS Foundation Trust since 2011, John Neilson, CEO of NHS Shared Business Services since 2009, Edward Green, Head of Domestic Procurement Policy in the Cabinet Office’s Efficiency and Reform Group, Andrew Coulcher, Director of Business Solutions for the Chartered Institute of Purchasing and Supply (CIPS), Chris Tulloch, Consultant Orthopaedic Surgeon Clinical Director for Orthopaedic Surgery and Associate Medical Director at North Tees & Hartlepool NHS Foundation Trust, John Vinuesa, Trading Director of Consumables NHSSC.

The Health Care Supply Association is also critical to delivery. The procurement profession must be able to engage more effectively with the other professions, but that in turn requires greater willingness from all parties. The conference was generally aimed at people working within the NHS and how they could achieve the savings without reducing quality and service

Overview of the messages gained from the presentations:

• The DH has written four strategies for procurement and they are currently working on their fifth following ratification of the White Paper.

The last strategy (4th) was based on: - NHS Trust Internal Environment NHS Standards of Procurement Governance and metrics Maximising procurement technology Leadership and capability - NHS Trust External Environment Working with industry Introducing and adopting innovation Collaboration and using procurement partnerships Procurement in commissioning • 10% of spending i.e. £500m a year, on consumables within NHS Trusts could be saved if Trusts bought in a more collaborative way • NHS CEOs should consider procurement as a strategic priority • QUIPP savings target for NHS procurement = £1.2bn • Procurement is viewed as critical in managing innovation in trusts and is considered by government to be a key driver for economic growth • Procurement is a driver in delivering not just savings but improved patient care and outcomes • Transforming procurement within the NHS will require a combination of evolutionary/ revolutionary approaches, local/regional/national actions and process/cultural changes.

NHS Trusts will have to become collaborative clients to bring commitment to the procurement process • Initial publication in May leading to an NHS owned procurement strategy by end of 2012 • There will be wider consultation regarding the strategy prior to publication • The DH will continue to work with NHSSC to ensure value for money

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

12

?????????

13

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

• The National Audit Office (NAO) Report on Procurement. The report states that currently hospital trusts have the freedom to manage their operations with minimal intervention or direction for central government. Under this model the DH provides a framework and incentives for trusts to improve efficiency but does not mandate particular actions • Responsibility to demonstrate value for money in procurement currently falls upon the management of individual trusts • Trust CEOs need to consider procurement as a strategic priority – consider how key stakeholders such as clinicians can be involved more effectively in the procurement strategy • NHS Trusts and other NHS organisations need to: - Improve organisation capability

Procurement

The pressure on costs within the NHS is only going to increase over the next few years and procurement has a huge role to play, but not many trusts recognise this. A more ‘all round’ view of costs and value would seem to be a key area of potential i.e. ‘whole life costs’ in the case of major equipment, services etc

- Improve commercial procurement skills - Build collaborative relationships - Engage with peers - Improve data to provide good management information - Develop innovative and efficient solutions • Clinicians understand the challenge and have a major contribution to make • Building blocks for improved procurement are not in place in some trusts • Protection of funds for front line patient care is essential • To achieve strong, sustainable and balanced growth, efficiency and reform are essential • The Government are making it 40% faster to do business with them i.e. completing procurement processes within 120 days using LEAN sourcing techniques.

Conclusion

It would appear from the presentations that the health procurement landscape is still in disarray with hubs, privatised hubs, supply chain, GPs and local collaboration, which doesn’t help with a good approach to collaboration between organisations and procurement professionals. There was a lot of talk about working with clinicians to ensure a feasible way of progressing procurement.

The pressure on costs within the NHS is only going to increase over the next few years and procurement has a huge role to play, but not many trusts recognise this. A more ‘all round’ view of costs and value would seem to be a key area of potential i.e. ‘whole life costs’ in the case of major equipment, services etc.

Dawn Stott , CEO, AfPP

14

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

Procurement

Guidance aims to improve procurement across healthcare system

Guidance aimed at improving procurement across the healthcare system has been published by the Department of Health.

NHS procurement: raising our game sets out proposed actions for NHS trusts and the Department and focuses on taking immediate action to start tackling six key areas for improvements: • levers for change • transparency and data management • NHS standards of procurement • leadership, clinical engagement and reducing variation • collaboration and use of procurement partners

• suppliers, innovation and growth This guidance is launched in advance of a procurement strategy planned for later in 2012 that will be developed following a wider call for evidence. It aims to start the journey to world class procurement by identifying those issues and actions that require immediate attention in order to lay the foundations for a fuller and further-reaching strategy later in the year.

Procurement call for evidence A call for evidence on how procurement in the NHS can be transformed has been issued. Views and contributions are being sought from the NHS, industry, other government departments, the academic, scientific and third sectors and social care.

This could include actions for the Department of Health, wider government, industry, the NHS Commissioning Board, other national bodies, the NHS, or other sectors.

Sir Ian Carruthers, who is leading the work, said: ‘Whilst some improvements in NHS procurement are evident, the pace of change is not sufficient to meet the financial challenge facing the NHS. We need more innovative procurement processes and more widespread procurement of innovation. By harnessing relationships with suppliers, the NHS can adopt existing innovations and stimulate new innovation to deliver quality and value, for both NHS patients and taxpayers’.

To read the call for evidence and ideas document and the letter from Sir Ian Carruthers go to: www.dh.gov.uk/en/Publicationsandstatistics/ Lettersandcirculars/Dearcolleagueletters/DH_134371 To contribute to the call for evidence please go to the online form at: www.dh.gov.uk/health/procurement-review

In support, NHS Standards of Procurement, is also published which will support trusts in understanding what good procurement looks like and in planning their improvements at a local level.

NHS procurement: raising our game is available from: www.dh.gov.uk/en/ Publicationsandstatistics/ Publications/ PublicationsPolicyAndGuidance/ DH_134376

The standards can be used to identify what a trust’s areas of strengths and weakness are in their procurement and suggest ways in which they can start to monitor and measure improvements.

NHS Standards of Procurement is available from: www.dh.gov. uk/en/Publicationsandstatistics/ Publications/ PublicationsPolicyAndGuidance/ DH_134377

15

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

Product News

Procurement decisions packed full of efficiency Procurement decisions cannot only impact upon cost savings for a hospital, but also the quality of care a patient receives.

We take a look at how the procurement of surgical procedure packs has addressed efficiencies in the theatre environment, and what the ultimate impact is for patients being cared for in the NHS. Quality and productivity

Quality and productivity are the two buzz words that all NHS trusts aim to excel in. Since The White Paper, Equity and Excellence: Liberating the NHS was published in July 2010 it has been made explicit that quality cannot be delivered through top down targets.

Instead, attention has shifted dramatically to outcomes to ensure that patients have more power and the frontline has by far the majority of power and accountability. QIPP (Quality, Innovation, Productivity and Prevention) and its work streams have been created to address this as the NHS Institute for Innovation and Improvement explain; “At a critical time when the NHS is facing the biggest challenge in its history - to find £15-20bn in efficiency savings, the need to improve quality and deliver care more efficiently has never been greater. Now more than ever NHS teams need to work together to meet the challenges and opportunities that face us all.

The QIPP agenda requires organisations to achieve value for money and deliver the best possible quality care for patients. Theatre teams can play their part in delivering QIPP by implementing The Productive Operating Theatre programme.

The Productive Operating Theatre helps theatre teams to work more effectively together

to improve the quality of patient experience, the safety and outcomes of surgical services, the effective use of theatre time and staff experience.

This focus on quality and safety helps theatres run more productively and efficiently, which subsequently can lead to significant financial savings.”

NHS Institute for Innovation and Improvement web extract 2012 Following a statement in 2010

by Andrew Lansley, QIPP has been on the tip of many a manager’s tongue.

“All those who work on the frontline should be thinking carefully, and imaginatively, about how we can do things differently.

The QIPP process is a home for this in the NHS and the way that we can implement the best and brightest ideas across the service. As the Prime Minister said: ‘Don’t hold back – be innovative, be radical, challenge the way things are done’.”

Andrew Lansley, Secretary of State for Health – 2 July 2010 But not an easy feat you may say! So how can changes in procurement methodology really help to achieve such a target?

A changing landscape?

For many years hospitals have been purchasing the components needed for surgical procedures from different suppliers and as separate items. Traditionally, the laborious task of ordering each item, signing for each delivery,

preparing each item, transferring stock of each item, replacing each item, paying for each item, and so on was just considered to be normal practice.

The landscape is seeing an evolutionary change that now provides a range of operative components in one sterile pack.

A number of different suppliers now provide packs to the discerning trust looking to drive forward efficiency savings and government targets.

Perhaps it could be suggested that QIPP has spurred such a change. Whatever the reason, there has certainly been a sea change in procurement choice for such items, although some trust’s continue to purchase separate componentry.

Efficiencies packed into one neat procedure pack

Procedure pack company Full Support Healthcare Ltd (FSH) take the strong viewpoint that their range of essential Easipacks designed for different medical and surgical procedures will help to standardise session start up and clinical practice, enabling a smooth and quick transition of patients. This transition should then allow a quicker turnaround, allowing the hospital to increase list capacity and ultimately shorten waiting lists.

Sarah Stoute, CEO for FSH said; “By reducing lengthy preparation time and the administrative burden of co-ordinating separate

items, there will inevitably be more time to care for patients. Clinical time will not be compromised. In fact, by standardising practice it should only be better. Coming from an NHS background myself I know how hard it can be to juggle patient care and all the management issues that come with running such a complex and incredible service.

Not only will the patient receive more one to one care but the hospital will be able to significantly reduce hidden costs. It is easy to lose sight of all the costs associated with buying separate components.

We have tried to create a product in collaboration with hospitals and their staff who both procure and use the packs, to ensure we meet their needs in a way that supports their own efficiency agenda.”

And it seems that such a simple change in procurement can have an enormous impact, as the South West London NHS Elective Orthopaedic Centre explains; “We looked to use Full Support Healthcare’s essential procedure packs to further enhance our efforts to improve efficiencies and quality of service at the South West London Elective Orthopaedic Centre (EOC).

The EOC based at Epsom Hospital is the largest hip and knee arthroplasty centre in the UK and is recognised as a centre of excellence for its model of care and clinical outcomes. The EOC has a philosophy that is quality driven and quality focused, and since our conception I have worked closely with the surgeons and wider team to ensure the right processes were in place and the right products available.

Procedure packs have enabled us as a specialist centre to improve patient transition and theatre set up time allowing us to complete additional procedures in a day without any compromise or reduction in clinical time spent with patients. This has been evidenced by a decrease in waiting lists.

16

Journal of Perioperative Practice PROCUREMENT GUIDE July 2012 Volume 01 Issue 03 www.afpp.org.uk

There are so many elements involved in the procedures we carry out, and procedure packs have played a key part in creating further efficiencies through standardising processes and items used. We have also been able to reduce hidden costs which ultimately go back into patient care.

In addition to this, Full Support has taken time to understand our processes and look to see how they can best assist us; in my experience this would seem to be its company philosophy.”

Steve Thomas, Director. South West London NHS Elective Orthopaedic Centre

Custom or essential?

The procedure pack market offers both ‘custom packs’ designed to suit the wants of particular surgeons and teams, and ‘essential packs’

Product News which are not designed for just one customer, but have been created collectively by a number of different hospitals, medical professionals and procurement managers throughout the UK, enabling supply and reliability that cannot be beaten.

FSH are taking a bold step and going the essential pack route - a harder sell you may think but worth every ounce of effort to see smooth and effective procurement in the NHS. There has been some debate in the market about whether custom packs are the most desirable route in procurement, or whether they provide potential issues for supply and reliability, in particular for harder to predict emergency procedures.

There is also a fair amount of discussion as to whether custom packs create unnecessary cost implications.

Naturally the decision making process with custom packs can create lengthy lead times for each customer, adding further delays to potential cost savings and efficiencies.

FSH believes that ‘essential packs’ which are provided to numerous hospitals will stamp out this problem. As they are provided to multiple sites, stock is always readily available, even for emergency procedures where the usage is hard to predict.

As ‘essential packs’ are most likely to be supplied to a range of hospitals already, it means that the correct and essential components are packed and ready to go. No delay necessary and efficiencies at your fingertips you could say. There is no need to deliberate about the niggly necessities that characterise a ‘custom’ pack. The simplicity of ‘essential’ Easipacks and the range of efficiencies they deliver make the conversion to procedure packs straightforward and hassle free.

Either way, it is hard to find fault in such an evolutionary change in procurement. Certainly food for thought. Pack that into your lunchtime thinking! www.fullsupporthealthcare.com 01933 672 180

The Association for Perioperative Practice is a registered charity (number 1118444) and a company limited by guarantee, registered in England (number 6035633). AfPP Ltd is its wholly owned subsidiary company, registered in England (number 3102102).

The registered office for both companies is Daisy Ayris House, 42 Freemans Way, Harrogate, HG3 1DH.