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Small changes, big differences

Changing attitudes

Plymouth Hospitals NHS Trust

When Chief Procurement Officer Andy McMinn arrived at Plymouth Hospitals NHS Trust, it was clear there was a lot of work to be done.

‘Procurement in the NHS lacked maturity when compared to fast-moving sectors such as consumer goods or manufacturing’, says Andy. ‘When I started, the procurement team sat on the periphery of the Trust, both literally and metaphorically.’

The vision

Andy’s aims were clear: to give staff more time to care for patients by making nursing processes more efficient; and to deliver the supplies that nursing staff needed as close to the point of care as possible, creating extra space on the wards and minimising time spent searching for the correct product.

Andy and his team understood the challenges of introducing change into a busy trust, and they initially experienced problems in finding time to meet with clinical staff:

‘Where we could, we went directly to frontline staff at their place of work and simply listened to their concerns. By building rapport we soon understood the best way to improve their processes.’

Andy set about making a series of changes which allowed his team to work in partnership with clinical colleagues. For example, they created a cross-functional team within the Surgery Directorate that included colleagues from nursing, IT, finance and surgeons, supported by procurement specialists. The group had a mandate to increase quality, efficiency and productivity in surgery. 

Andy adds: ‘These simple changes have helped make the work of staff, in all disciplines, much easier. It has fuelled a sense of excitement across the organisation.’

‘For all NHS trusts, there needs to be a shift in thinking so that the whole organisation is geared towards meeting the needs of the staff caring for patients on the frontline.’

Clinical Procurement Manager

Senior Theatre Sister Chelley Winfield has worked within the Trust for 30 years. She recently began her role as a Clinical Procurement Manager.

‘I’ve been running clinical theatres for much of my time at the Trust’, says Chelley. ‘I’ve always kept my budget in the black, in part because of my strong relationship with our procurement team.’

‘When I was asked to begin this specialist procurement role, the surgeons and anaesthetists were pleased because I already knew what they needed and what our patients needed. We were confident that we could all work together to identify the best supplies for our department, at the best price.’

Chelley admits it hasn’t been completely smooth sailing: ‘Colleagues can be resistant to change and some staff have complained. I always encourage them to give feedback through a clinical perspective – why is a new product not working for them or their patients?’

Chelley adds: “Colleagues are very engaged and doing amazingly well at adapting to the changes. We recently identified a brand of surgical quill which is more effective so will save the surgical team both time and money (10p per unit compared to 15p). Although the saving is relatively small, making a change to a frequently used product has saved the Trust thousands of pounds.’

Significant cost savings and improved patient care

When it became apparent that nursing staff from across the Trust were running out of the same items (toothbrushes, hair brushes and sponge socks), and spending time searching for this stock, a new "patient pack" was proposed which was given to patients when they arrived for an overnight stay, and included one of each item.

Andy says: ‘Our existing supplier created the "patient pack", and they thought it was such a great idea that they have rolled these out nationally across the NHS.

‘This initiative has saved us £9,000 per year, in addition to savings to staff time and space on the ward. We now stock additional packs in our vending machines which have become an additional income stream. Most importantly, these packs were extremely well received by our patients.’

The Trust has recently made a combined saving of £400,000, simply by changing its brand of sutures and surgery gloves.

Andy says: ‘If you were to ask any procurement team what product would be most difficult to change in a surgery setting, surgeons’ gloves and sutures would be top of the list and consequently suppliers rely on this to maintain high prices.

‘Surgery is a very difficult area to change and we would have faced resistance without having a clinical procurement specialist, such as Chelley, in post.

‘If all NHS Trusts evaluated their procurement of surgeons’ gloves and sutures, I think this would save the NHS tens of millions of pounds per year.

The Trust regard the Clinical Procurement Manager as an investment in nursing because the role is financed by the Director of Nursing, Greg Dix, through the nursing budget, and nursing colleagues can see its value. Andy and his team plan to introduce a combination of permanent and secondment procurement roles in the near future, in order to develop good practice across the organisation.

‘Cost savings mean that clinical procurement specialists pay for themselves,’ says Andy.

‘If six people are trained to think about effective procurement and in turn tell six of their colleagues, eventually we will change the culture of the entire workforce; the quality of patient care is improved and we enjoy significant cost savings.

‘Nursing staff are in the best position to influence their colleagues.’

Project benefits

Overall, the project has created significant savings, released staff time and freed up an estimated 70% of storage space across the Trust.

By adopting a leaner approach to clinical supplies, the maternity department now includes an extra room for triaging pregnant women, a High Dependency Room and three additional beds, all of which hugely benefit patient care.

Andy says: ‘Through our Southern Procurement Partnership (a collective of eight major acute trusts in the South of England), we have standardised our ordering of simple clinical supplies and achieved remarkable savings.

‘We’ve reduced the cost of DVT stockings by 53%, simply by agreeing a standardised range from a single manufacturer. Seven out of the eight trusts were already using this type of stocking anyway, so there was no change for the vast majority of staff and patients.’

“This kind of partnership working isn’t common across the NHS, but when it works it means that suppliers can trust that there is a commitment to order and can offer savings accordingly. We’re already looking to standardise other items such as alcohol gel, wipes and gowns.’

Good communication

Chelley emphasises the importance of good communication with colleagues throughout the procurement process: ‘Thinking about productivity and procurement should be a part of everyone’s role, so it is important that staff feel empowered to come forward with suggestions and then receive feedback on the impact of their suggestions.

‘We’ve been recording our savings on a "totaliser" and explaining how staff-led ideas have created value. It’s all geared towards helping staff to understand how they have made a difference.’

The team share good practice with others trusts in the South West and meet regularly with procurement specialists to hear about the work taking place.

‘If we think the idea would work in our Trust, we propose it to our Board’, says Chelley.

‘We’ve also been invited to University Hospitals Birmingham NHS Foundation Trust to share our experiences and to discuss ways in which we can work together.’

Clear vision

The team admit that to achieve effective procurement processes across an organisation, you need people in post who are innovative and have a clear vision.

Greg says: ‘Plymouth Hospitals NHS Trust approach to procurement isn’t just an isolated project, it is integrated across the entire Trust.

‘You need to engage colleagues to buy into this approach; share the vision for the future and want to deliver the best possible outcome every time.

‘You also need a clinical procurement specialist. This sent a clear message that the whole nursing team is behind the process.’