Chris Whitehouse, a political consultant and expert on medical technology policy and regulation at Whitehouse Communications, calls for urgent clarification on the approach of England’s NHS supply giant to value-based procurement and warns that government ministers may be being misled.
A recent, successful workshop on the adoption of value-based procurement (VBP) hosted by the Department of Health and Social Care, saw much of the breaktime discussion focus on confusion caused by a recent article in HSJ by NHS Supply Chain Commercial Director, Richard Evans.
Restating an enthusiastic welcome for a proper VBP approach, industry representatives expressed concern and confusion that the article claimed that NHS Supply Chain is “making VBP the backbone of all our future procurement” and citing its recent cardiology and vascular procurement tender as, to date, “the most extensive application of the DHSC methodology” for assessing value. A tender in which more than 95% of the Lots are evaluated with a 70% weighting on price and, perhaps more concerningly, a tender at odds with the published DHSC methodology in that it introduced a maximum price “threshold” in the Lots where value is supposed to have a higher weighting than price.
The introduction of such a threshold means that a bidder could score full marks on all the value assessment questions, but could still see their tender rejected completely if their price did not come in under a maximum level – regardless of whether they had demonstrated great value in terms of patient outcomes and financial savings.
As one published comment on Evans’ article put it: “Several of the examples the article cites may have asked value based questions, but regardless of a supplier’s score for those questions, they would be ruled out if they didn’t undercut a threshold price – making a mockery of the claim to be putting value first. Sadly, this is par for the course with NHS SC, and they shouldn’t be using HSJ to mislead readers.”
Another commentator went on to ask: “Has the HSJ fact checked this article?”
That interpretation was confirmed in the written answers given by NHS Supply Chain to bidders raising queries, saying: “Any tenderer submitting a price in excess of the stipulated Threshold Price shall be deemed non-compliant, and such submission shall be excluded from further consideration without exception”.
All this despite the Government’s NHS 10-year plan which itself states “The NHS has mixed up its priorities when it comes to buying things. It has bought goods and services as if everything were a basic, interchangeable item, where only price matters. This means the NHS has focused too much on lowest cost, rather than best value and outcomes.”
Industry experts also explained that the way in which the performance of products was calculated would lead to potentially worse patient outcomes being achieved by giving high weighting to evidence over a longer period of time, regardless of what the patient outcomes were – the weighting favouring length of evidence period, not actual quality of outcomes.
Again, a written answer by NHS Supply Chain to suppliers states “The scoring is based on the type and robustness of the study rather than the specific percentage outcomes. While your results may be stronger than others, the framework assesses evidence level rather than comparative performance”.
In cardiology, such an ignoring of patient outcome data could cost patient lives.
Other procurement processes also highlighted by Evans in the article as examples of VBP were met with a high level of scepticism, particularly those on disposable and washable continence care, and wound therapy.
The new VBP methodology is due to be launched in June for roll-out across the NHS in England, and clarification of these confusing assertions by NHS Supply Chain is now urgently needed, as is a correction of the public record in HSJ, which is a leading national publication focusing on NHS policy and practice.
What is more, a whole series of Ministerial statements in the form of Written Answers to parliamentary questions have confirmed a commitment by NHS Supply Chain to adoption of the DHSC VBP methodology, which is inconsistent with the cardiology and vascular tender, and other tenders highlighted in the HSJ article. If Ministers are being misled by NHS Supply Chain, whether intentionally or otherwise, then this is a serious issue that needs to be investigated.
Industry representatives at the DHSC workshop were clear: adoption of VBP is long-overdue and will deliver a welcome paradigm-shift from an emphasis on item price, to an emphasis on patient outcomes and overall system costs. That opportunity must not be squandered by a covert reluctance by some procurers fully to embrace the principles of VBP.
The Author used AI in preparing this article. Comments upon or questions about this article can be addressed to chris.whitehouse@whitehousecomms.com.
