Romy Hughes, director, Brightman, reflects on what can be different about NHS procurement after its experience of handling COVID-19.
Once the dust settles and we’ve all had a chance to deconstruct and analyse the government’s handling of the COVID-19 pandemic, one aspect that will undoubtedly come under the microscope was the procurement and distribution of necessary equipment, in particular PPE. As reports came out of doctors and nurses being forced to re-use or share masks, or in some instances relying on home-made donations from the public, the lack of capacity and flexibility in the supply chain will come as no surprise to anyone.
Yet on the other hand, NHS procurement should be immensely proud of how it handled the crisis. Many of the issues that will be addressed in this article are systemic to the way the NHS, and the broader public sector, has always procured its goods and services. But that doesn’t mean they can’t change now. After all, we mustn’t let a good crisis go to waste…
A tale of two strategies?
The NHS response to the pandemic appears to be a tale of two strategies; while we all read reports of PPE equipment being plentiful but failing to reach hospitals in time, or SMEs’ offers to supply equipment being left unanswered, on the other hand the NHS was rapidly adopting new technology solutions. In a recent Sky News article for example Tom Whicher, chief executive of booking software provider DrDoctor was quoted as saying: "It feels as if someone's taken the handbrake off the NHS, it's like it's been given permission to go fast."
The NHS has proven its capacity to ease procurement processes in times of crisis, but it will likely revert to its more bureaucratic ways once “normality” resumes. Could lessons be learned to bring more agility to procurement in the future? Clearly there is a middle ground to be struck between the cautious and officious approach the NHS has always taken with procurement, with its capacity to be more flexible during an international crisis.
Systemic challenges
There are a number of systemic challenges within public sector procurement which pre-date COVID-19. Many of these will have undoubtedly compounded or caused the problems we saw when the NHS’s supply chain came under strain. It is here where the NHS must focus its efforts after the crisis. This will only help to make the NHS more agile for the next crisis, but bring more efficiency during normal times too.
- Lack of change management when introducing the Digital Marketplace. The Digital Marketplace was supposed to be the answer to public sector IT procurement, lowering the cost of entry for smaller businesses and making the process simpler and faster for all involved. Yet public sector staff have often not been trained on how to use it, so it remains underutilised.
- Overwhelmed by too many suppliers. Lots of choice is a good thing, but procurement is simply not equipped to deal with the high number of smaller suppliers that the government has actively encouraged to pitch for government business. As a result, many contracts are still won by larger suppliers, despite there being far more SMEs on the procurement frameworks than ever before.
- Too slow to match supply with demand. British manufacturers were ready, willing and able to support the NHS but many were left unable to do so due to the inability to contact the right people and/or a lack of specifications on what exactly was needed. The pandemic proved there is simply no efficient mechanism for the government to communicate to the market what it needs, and for businesses to communicate how they can fulfil those needs.
- Inability or unwillingness to react to the situation. While there is evidence of some processes being expedited in the technology sector, was procurement willing to change its approach or relax its rules in other areas? This was the time for creative thinking and flexible approaches, but did the “by the numbers” culture of procurement stifle this?
What can be done to address these problems?
- Educate the NHS on the procurement frameworks available (the framework agreements already provide faster routes for procurement, but they need to be used);
- More standardisation of frameworks and working processes – this will make it easier to scale down/up more quickly and make it easier for suppliers;
- Move NHS away from primarily using/building its own e.g. NHS Trusts routinely build their own data centres. While some cloud contracts have been awarded to Google and Amazon most recently, the Cabinet Office’s own cloud provider, Crown Hosting, could be better utilised;
- Drive efficiency from the top by appointing a “minister of government efficiency” – someone who can review all public sector procurement practices and drive reform across the whole sector and in every department. This should be a cabinet role to ensure real change;
- More agile procurement, especially in times of crisis – the NHS demonstrated its ability to be flexible with tech start-ups during the crisis. It needs to replicate this in other areas, especially since stockpiling often isn’t feasible due to storage costs and the short lifespan of many items. A specific, streamlined procurement approach for crises needs to be in place ready to be activated whenever necessary. The willingness to change procurement procedures during a time of crisis must be part of all national business continuity planning
I appreciate that hindsight is always 20:20, so these recommendations are not intended to be a criticism of the NHS during this crisis. This was clearly was an unprecedented situation for which no amount of planning could have resulted in the perfect result. Every country was reacting to a virus for which they had very little knowledge, and the global supply of medical equipment was severely strained at a time when demand levels were unparalleled. As with any crisis, the NHS was working with imperfect knowledge, so we must acknowledge that the recommendations in this article are built entirely on the benefit of hindsight. But let’s not waste this hindsight. Churchill’s words ring as true today as they ever did; let’s not waste this crisis, but use it to bring about the much-needed change public sector procurement has been waiting for.
