Thank you, let’s get on with spending it well.by Graham Flynn, January 31, 2018
Writing for The Observer, Andrew Rawnsley’s article (24.06.18) examined the Theresa May’s spending pledge for the health service.
It is of course right to consider the question of where the £20bn funding boost will come from, but the extensive, largely negative commentary in the wider press seems a little strange to me. The reality is that we have now received, what the majority collectively branded the politicians as too inept to provide, and yet we continue to complain.
I applaud the funding increase.
And while those who called so vigorously for funding increases appear to be knocking £20bn as not enough or too late, perhaps we should instead be saying: "Thank you, let’s get on with spending it well."
Throughout my career I have focussed on creating mechanisms for the NHS to be more efficient with the money it has, without impacting negatively on, and indeed to protect critical front line services. The question which is most pressing now is perhaps not where the funding will come from but how does the NHS stop wasting money so that the £20bn can go directly to the front line. In his 2016 report, Lord Carter noted that NHS trusts spend around £9bn every year buying goods and services. Operating costs, the report indicated, ranged from £100 to almost £1,000 per square metre. With such variation between sites and the operating practices of NHS trusts themselves, Lord Carter estimated a saving of £1bn solely on running costs every year, if each NHS trust performed as well as the best.
First-hand experience has done nothing to suggest this is not the case. Indeed, it has made me acutely aware of the significant wastage within the NHS created through inappropriate procurement practices and a lack of tangible data.
Across the NHS there are multiple procurement departments, all of which procure predominantly the same consumable items, facilities management services, medical equipment or waste disposal services. Each department decides on the mechanism under which they make these purchases, therefore all pay a different price for the purchase.
Some NHS entities join forces to leverage their joint buying power, however none of the stakeholders fully agree with the specifications that are issued. This leads to a great deal of frustration, the wrong product or service being purchased and thus the circle continues.
Unfortunately, even when an NHS organisation has made a good purchase, typically with services, there remains a significant lack of control over the contracts. This leads to the contractor potentially overcharging for services not delivered while the NHS continues to pay the invoices. One of the solutions is better data management.
Having data in a structured format that is easily analysed helps the NHS (the customer) understand the levels of service, compliance against the contract terms and importantly validate line items on the submitted invoices.
The reality now is that the NHS could save tens of millions quickly, simply through more effective procurement and wherever possible, by reusing equipment such as walking aides.
Over £300m of unused medicines are disposed of every year at a cost to the NHS. Why is there so much wastage in this area? Quite simply, because of unclear guidelines and operating standards and consequently over prescribing.
I applaud the £20bn additional funding, but how will this money be utilised and how will the NHS monitor it to determine whether they are spending it well, considering the significant issues that are already in play?