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Small changes, big differences

Securing a business case

Lancashire Care NHS Foundation Trust

Nicky Morton, Senior Nurse for Clinical Procurement and Dee Roach, Executive Director of Nursing and Quality Lancashire Care NHS Foundation Trust share their experiences of bringing nursing leadership into procurement. 

Lancashire Care NHS Foundation Trust (LCFT) provides health and wellbeing services for around 1.4 million people. Services provided include community services such as district nursing, health visiting, podiatry, dentistry and prison healthcare as well as inpatient and community mental health services.

The Trust covers the whole of the county and employs around 7,000 members of staff across more than 400 sites and extends to sites in St Helens and Liverpool.

Dee Roach, Executive Director of Nursing and Quality says: “As Executive Director of Nursing and Quality and the lead for Community and Mental Health Trusts on the National Clinical Reference Board, I feel passionate about nurses driving the efficiency agenda within LCFT.

“Within LCFT I knew that in spite of ongoing review by managers and procurement experts there were still efficiencies to be made by reviewing and sometimes changing clinical practice and nursing staff are vital to this process.”

Dee felt that senior clinical leadership and questioning would: lead further engagement with clinicians in these important procurement decisions; secure value for money in the procurement of clinical products; increase standardisation of products and equipment; and improve both patient safety and staff safety.

Making the case

Dee made the case for a Senior Nurse for Clinical Procurement post and the post was agreed as a pilot for 2.5 days per week from September 2015 to February 2016 in order to scope the business case. Nicky Morton was seconded to the role.

Nicky Morton, Senior Nurse for Clinical Procurement says: “There was a nursing voice in procurement previously but it relied on personal relationships between clinicians and procurement colleagues – there was no oversight.

“Different areas of the Trust tended to do their own clinical procurement but there was no clinical overview trust-wide. Dee’s vision for this role has ensured Executive Nursing leadership which gives me a lot of credibility with nursing staff.”

Achievements so far

Nicky’s role was set a target to find approx. £85,000 of savings during the five month pilot, but it was acknowledged that potential savings were likely to be much more if a full time post was funded. From March 2016, a full time secondment for up to 2 years was agreed.

Within the first three to four months of the post, there were over £135,000 worth of efficiencies identified by Nicky from key projects. Some of these projects have already been implemented, others are still in the design phase and further projects will emerge throughout the year.

Key projects to date have included:

  • standardisation of advanced wound dressings
  • review of the use of continence products in the inpatient setting to ensure that the right patient has the right product at the right time
  • bandages and tubular bandage reviews
  • standardisation of single use sterile instruments
  • direct product switches eg. sterile saline
  • enteral feeding and suction consumables review
  • evaluation and implementation of safer sharps legislation
  • clinical evaluation of products

Dee says: “I get amazing feedback about Nicky’s interventions – these projects are really exciting our workforce. Nicky’s role and engagement with colleagues is fantastic and builds confidence in the decisions we are making and the products we are selecting.

“Colleagues trust that we aren’t choosing cheapest product but the right product.”

Engagement with colleagues

LCFT services are divided into four networks: specialist services (e.g. secure mental health and secure offender health); adult community services (e.g. physical health services and older adult mental health services); children and families; and adult mental health services.

Nicky has worked closely with each network and has been supported by colleagues in Procurement and Finance to understand the cost pressures and clinical practice issues which need to be addressed through her work.

Improved engagement with clinicians

Nicky says: “Clinicians feel optimistic when they feel their views are being listened to. Everyone wants the best and safest patient care. We are evaluating products through this process and making sure the decisions we make are right for each area of services as we know standardisation may not work for all areas.

“We factor in evaluation days and invite nursing staff to attend – practitioners feel involved, know their views are being listened to and have a voice in decision making.”

Clinicians from across the service now approach Nicky with ideas for new projects when they see opportunities to reduce waste or improve efficiencies and value for money.

Nicky has also joined the National Clinical Procurement Specialist Nurse Network which allows LCFT to share their successes and learn from other Trusts.

Sharing success

The success of this role has been attributed to a number of factors. As the post is a secondment, it will allow all nursing staff within the organisation to have the opportunity to make their voices heard in procurement decisions. Additionally, as the role sits within the Nursing and Quality Directorate it has visibility with nursing staff.

“Nicky also works collaboratively with colleagues in Networks and Corporate Services to set and achieve shared objectives whilst ensuring senior clinical leadership in decision making.

Dee concludes: “Nicky regularly reviews projects and shares these learnings widely with those staff who have contributed to the successful projects. This builds on the engagement and collaboration with nursing staff within the Trust and nationally to drive the quality and efficiency agenda.

“Ultimately nursing leadership within this work has been instrumental in getting staff engagement – they see the work as clinically led and want to support it.”