Can one written question deliver a paradigm shift in NHS purchasing?

Chris Whitehouse, a political consultant and expert on medical technology policy and regulation at Whitehouse Communications, chair of the Urology Trade Association, updates readers on key recent announcements impacting the medtech sector in the UK and EU.

Hundreds, if not thousands, of written parliamentary questions are put down every sitting week in both the House of Commons and the House of Lords. The equivalent of throwing confetti at weddings, there’s a danger that the answers they receive are all too often little more than a brush-off, and they have little impact.

Once in a while, however, there’s a question so drafted and timely, that it elicits a real answer of substance that commits ministers to policies and targets for the delivery of which they can be held to account. Such a written answer emerged recently in the House of Lords, committing government ministers to the delivery of “value based procurement” across the NHS.

The question was put down by Lord Hunt of Kings Heath, somewhat of an expert on health policy having served as a health minister in Tony Blair’s government and prior to that as the first chief executive of the NHS Confederation. He has also served as chair of an NHS Foundation Trust and president of the Royal Society for Public Health, so he knew what he was asking about when he put down this question:

To ask His Majesty's Government what is meant by the term "value-based procurement" in the context of NHS Supply Chain; whether it is their policy that such a value-based procurement approach applies to medical devices and similar product procurements by the NHS; and what steps they are taking to promote the widespread adoption of this approach to procurement of medical devices and similar products.

Normally, such a question risks receiving only a brief, possibly terse, and not particularly informative response; but to many policy watchers there was a surprisingly detailed answer which committed government ministers to a policy approach talked about for some time, but which to date had delivered little more than warm words, saying:

“Value-based procurement (VBP) is a procurement approach that delivers a reduction in the whole life costs of healthcare where value can be created from financial, efficiency, patient, and environmental benefits.

“In May 2019, NHS Supply Chain launched a project to consider the potential benefits and practical application of VBP. This involved a series of pilot projects to test the concept of VBP in practice, with a view to producing a scalable model for potential wider deployment.

“An internal toolkit for the use of Category Tower Service Providers was produced as an output of the VBP project. It is designed to be flexibly applied to the varying product ranges procured through NHS Supply Chain. Central to the guide has been the creation of two models: one can be applied to the renewal of existing frameworks/contracts for product ranges, the other for the procurement of innovation. Activity will be delivered across a wide range of categories including cardiology, orthopaedics, sterile intervention equipment and ward-based consumables.

“The Government's new Medical Technology Strategy, published in February 2023, commits to developing an environment that supports the understanding and delivery of value for money and affordability across the whole patient pathway, using high quality data to ensure that prices are both reasonable for the health system and sustainable for suppliers. The application and adoption of VBP in the National Health Service is a key priority under the strategy to realise the potential of medical technology to improve patient outcomes and support the NHS workforce. The Department’s Medical Technology Directorate is working closely with NHS Supply Chain and NHS England to build on the work already undertaken to ensure that a consistent methodology is now developed and adopted at both a national and local level.”

Those who work at the interface between the NHS and those supplying the products, whether devices or consumables, know from experience that the purpose of negotiations is to get down the unit cost of purchasing, whilst, at best, paying only lip-service to patient quality of life and outcomes, and impact upon the wider health and care system.

That the concept of value-based procurement has been so long talked about, but has not been delivered, has been a frustration across the medtech sector and more widely among many different categories of product provider. This commitment by government that it should underpin purchasing decisions across the new ecology of the NHS, at least in England and Wales, is very timely.

The new ICB/ICS structure is supposed to focus on the patient experience and outcomes. VBP, if properly taken up, could, for the first time, create an environment in which whole system costs are identified and reductions in them could deliver huge savings.

If a purchasing manager goes for a cheaper product, it might not be as effective, it might be associated with a higher level of complication, a slower recovery, and more treatment incidents than a more expensive but more appropriate product. But a purchasing manager is typically incentivised only to get purchase cost down, not to consider, frankly, a patient’s quality of life or the cost implications for the wider system.

Could one written question help deliver a paradigm shift in NHS procurement? As David Lawson, head of the government’s MedTech Directorate recently asked an audience of members of both Houses of Parliament, “if not now, then when?”.

Questions about or comments upon this article can be addressed to the author at chris.whitehouse@whitehousecomms.com.