Clinical Procurement – view from a Medical Director Dr Steve Ryan

1. Clinical Procurement – view from a Medical Director Dr Steve Ryan Medical Director, Barts Health NHS Trust

3. Barts Health – headline figures • History – from St Barts first opened in 1123 to new PFI at The Royal London Whitechapel • 5 large Acute central and North East London sites + community services • New PFI 900 bed build at Whitechapel £110m PFI cost pa • Major Trauma Centre, Cardiac, Stroke and Cancer services • Air Ambulance base – over 2,000 casualties per annum • 250,000 A&E attendances • 160,000 inpatient admissions • 15,750 staff • £1.4bn turnover • £480m non-pay influenceable spend

4. Barts Health - merger April 2012 • Full restructured organisation in October around eight Clinical Academic Groups: • Surgery • Emergency Care • Ambulatory • Cardiovascular • Clinical Support Services – diagnostics • Cancer • Children’s Health • Women’s Health • Procurement team to provide improved category management and support to the Clinical Academic Groups – but still a ‘lean’ team so need to collaborate with other trusts

5. Clinical Preference • Active challenges to clinical preference resulting in shift of business to alternative suppliers – no longer a ‘threat’ but a reality • Clinical Development, Innovation & Procurement Group – approval needed for: • All new clinical products • Trials • New clinical procedures • Standardisation • Developments and innovation • Delivered much greater savings • Decisions mandated across the trust

6. New Behaviours • Clinical engagement and communication • Getting benchmarking information • A more rigorous approach to the quality of evidence used to support decision making • Use of risk assessment and risk management to support decisions • Partnership working at every level • A different move on scoring methodologies with a focus on quality and cost – “value” • Equating cash released to WTE equivalents • We have to reduce costs by £250 million over next 4 years. • Procurement has to deliver in the same ballpark

7. Delivery of Value - ICD/Pacemakers • Working with the London Procurement Partnership we • have seen significant value delivered in two key • contracts • ICDs & Pacemakers delivered significantly in this year alone, on a spend of just over £6m • The market was dominated in Barts by three suppliers and our clinicians argued that this kept the market competitive and managed risks of failures of leads • Together with procurement the clinical group challenged this and in 2011 the Trust Board awarded to two suppliers only for major ICDs saving in that year. • The new LPP framework was scheduled – how could London improve on value?

8. Delivery of Value – ICD/Pacemakers • LPP set up a Stakeholder Group to review the way in which London • approached the market and the risks in the products • Supplier briefings were held to demonstrate solidarity between trusts • A clear message and determination that trusts would be willing to switch supplier • A challenge that the NHS should not shoulder the cost of • managing risks of technical failures through spreading awards • Barts held its nerve and awarded to just two suppliers and maximised its market share discounts • Through standardising our suppliers we have improved ability for remote monitoring thus enhancing patient care and outcomes • ICDs & Pacemakers contract started 1st October and will deliver over £1m savings in 12 months on a spend of just over £6m

9. Delivery of value – Hips & Knees • The Orthopaedic Prosthesis LPP framework awarded in Dec 12 will deliver us • over £0.75m savings on a spend of £2.63m in 12 months • As a newly merged trust we were paying very different prices for the same implants due to a fragmented market and the power of the global suppliers • Market share discounts played a large part in Whipps Cross Trust getting significantly better prices

10. Delivery of Value – Hips & Knees • The new LPP framework was run through the South West London Elective • Orthopaedic Centre and represents 16 trusts in London • Together we challenged the power of suppliers and price differentials we faced • At Barts, we brought together the three clinical units to form one cohesive evaluation team • We reviewed revision rates through NJR, Australian and Swedish registries • If suppliers could provide training, sufficient instrumentation and support, then our clinicians could and would switch supplier • Our award is to just one supplier across all three sites • It provides efficiency in use of instrumentation and reduces • the need for loan sets • We still have flexibility to use revisions and extremities • from other suppliers

11. In essence, LPP gives Barts Health the confidence to challenge the market and restores the power balance. It enables us to work together and challenge clinical preference with the knowledge that together we are getting value for money. • Any Questions? • Thank You • steve.ryan@bartshealth.nhs.uk • john.watts@bartshealth.nhs.uk