Mandie Sunderland, Chief Nurse, Nottingham University Hospitals NHS Trust

NHS Clinical Reference Board and NHS Clinical Evaluation Team

13 April 2016

NHS Clinical Reference Board and NHS Clinical Evaluation TeamMandie SunderlandChair, NHS Clinical Reference Board

Overview and national picture

Why do we need to make changes?• The overspend in the NHS has increased from £822m in 2014/15 to an

expected £2bn in 2015/16*• The NHS spends £4.5bn per year on clinical products in the acute sector

alone• All trusts are under pressure to make savings, yet we must work together to

protect patient safety and the frontline as a priority. Every £30,000 saved equates to one Band 5 nurse

• If we can buy products more efficiently across the NHS, then there is less need to look for efficiencies at the bedside

Lord Carter’s Report: Operational productivity and performance in English NHS acute hospitals: Unwarranted variations

• The challenge is to lift hospital efficiency to a consistently high standard in every area of every NHS hospital

• 15 detailed recommendations for tackling unwarranted variation in the productivity and performance of trusts

• Savings: up to £5bn per annum can be saved by 2019/20 if there is political and managerial commitment to take the necessary steps:

Ø Up to £2bn by improving workflow and containing workforce costs.

Ø Up to £3bn from improved pharmacy, estates and procurement management

• Proposes a single integrated performance framework for hospitals – one version of the truth – to help trusts set baselines for improvement and provide them with the tools to manage their resources

• The ‘Adjusted Treatment Index’ (ATI) will help hospitals to identify where further investigation is required, and where efficiencies may be achievable

• Develop a model to define what an efficient NHS hospital looks like.• A single national catalogue for hospitals to improve inventory management. Clinical involvement in defining the range the

NHS will purchase

Potential savings

Total = 776 Band 5 nurses

Save £1.3mon Disposablecontinence

Which could equate to:

43Band 5 nurses

Save £4mon Infection control -skin

Which could equate to:

133

Save £18mon Wound Care

Which could equate to:

600Band 5 nurses Band 5 nurses

NHS Customer Board structureNational Customer Board

Sir Ian Carruthers OBEChair

Mandie Sunderland Chair

Chief Nurse, Nottingham University Hospitals NHS Trust

Clinical Reference Board

VACANTChair

London Customer Board

David MelbourneChair

Deputy Chief Executive and Chief Finance Officer, Birmingham Children’s Hospital NHS Foundation Trust

Midlands Customer Board

Suzanne TraceyChair

Director of Finance and Business Development, Royal Devon and Exeter NHS Foundation Trust

Southern Customer Board

Mick GuymerChair

Director, North West Procurement Development

Northern Customer Board

NHS Clinical Evaluation TeamClinical Lead, Dr Naomi Chapman

Name Role&Trust Name Role&Trust

Mandie Sunderland(Chair)

ChiefNurseNottinghamUniversityHospitalsNHSTrust

ProfessorSuzanneHinchliffe

ChiefNurse/DeputyChiefExecutiveLeedsTeaching HospitalsNHSTrust

GregDix(ViceChair)

Director ofNursingPlymouthHospitalsNHSTrust

MichelleNorton Director ofNursingGeorge EliotHospitalNHSTrust

SandyBrownDirector ofNursingandClinicalQualityEast ofEnglandAmbulanceServiceNHSTrust

ChristinePerry Director ofNursingWestonArea Health NHSTrust

DrNaomiChapman Executive NurseNetworkLeadRoyalCollegeofNursing

MarkRadford ChiefNursingOfficerUniversity HospitalsCoventryandWarwickshireNHSTrust

GeraldineCunninghamAssociateDirector ofCulturalChangeBarts Health NHSTrust

DeeRoach Executive Director ofNursingandQualityLancashireCare NHSFoundationTrust

RoseGallagherNurseAdviserInfectionPreventionandControlRoyalCollegeofNursing

RayWalker Executive Director ofNursingMersey Care NHSTrust

GaynorHalesAssociateNurseDirector,NorthNHSImprovement

NHS Clinical Reference Board members

Objectives of the Clinical Reference Board• Raise awareness of the role clinicians play in

achieving best value from clinical products• Identify areas for savings and standardisation,

linked to the NHS £300m savings challenge, compare and save and core list

• Support and drive the existing good practice in clinical engagement in procurement

• Publicise the work of the group and seek opportunities to engage the wider clinical workforce in the challenge

• Work collaboratively with all the Local Boards to support clinical engagement across they key priorities

“By facilitating interaction with trusts through the Customer Board at a local level we will be able to help accelerate change and the delivery of the significant savings needed.”Sir Ian Carruthers OBE, Chair of National Customer Board Chair of Portsmouth Hospitals NHS Trust

NHS Clinical Evaluation Team members

Name Role Name Role

Dr Naomi Chapman(Clinical Lead)

ExecutiveNurseNetworkLeadRoyalCollegeofNursing

Simon Hall TissueViabilityLeadNurse,UniversityHospitalsBristol

LiamHorkan ClinicalProcurementSpecialist,ColchesterHospitalUniversityNHSFoundationTrust

Sian FumarolaSeniorClinicalNurseSpecialistTissueViabilityandContinence,UniversityHospitalsofNorthMidlandsNHSTrust

David NewtonMatron-ClinicalProcurement,NottinghamUniversityHospitalsNHSTrust

Clare Johnstone HeadofInfectionPreventionandMedicalDevices,CentralLondonCommunityHealthcareNHSTrust

Stephanie McCarthy ClinicalProcurementNurse,RoyalDerbyHospital

Remit of the NHS National Clinical Evaluation Team• Established April 2016, reporting into the NHS Clinical

Reference Board• For the NHS, by the NHS• Reviews some of the clinical products currently available

through NHS Supply Chain to identify those that enable high quality patient care

• As a secondary issue, considers products that could be procured more effectively through combined NHS buying power

• Work will inform the future development of national clinical specifications across various product categories.

“Quality, safety and value are at the heart of our work and it’s important that we use our clinical experience to deliver high standards of care in ways which also reduce cost and waste in the NHS.”Mandie SunderlandChair of NHS Clinical Reference Board

Small changes, big differences

www.supplychain.nhs.uk

UK / NATIONAL SCALE.

DIRECTLY SUPPORTS

£58MNURSE LED

SAVINGSOPPORTUNITIES.

EXAM GLOVES†DRESSINGS†

CONTINENCE CARE†POLYMER

WIPES†

INCLUDING

† PLUS CORE LIST COMPARE AND SAVE

AND PRICE RANKING.

SUPPORTED AND DRIVEN BY MANDIE SUNDERLAND, CHIEF NURSE AT NUH AND CLINICAL REFERENCE BOARD CHAIR.

Acute and Community Hospitals, Prisons, Mental Health Trusts, GPs, Care Homes.

Clinical supplies - quality, safety and value at the frontline.

ENCOURAGING AND EMPOWERING NURSES TO MAKE CHOICES WHICH CONTRIBUTE TO PATIENT SAFETY, SUPPORT THE FRONTLINE AND DELIVER SAVINGS FOR THEIR ORGANISATION.

LAUNCHTUES 24

MARCH 2015 RCN HQ, LONDON.

www.supplychain.nhs.ukClinical supplies - quality, safety and value at the frontline.

INFORMED BY OUR NURSING TIMES PURCHASING SURVEY

(Jan 2015)

856RESPONSES

NURSES TOLD US THEY DO SEE

OPPORTUNITIES TO SAVE, ALIGNED

TO KEY CATEGORIES,AND THEY WANT

TO GET INVOLVED.

AND THEY WANT

CASE STUDIES

‘HOW TO’GUIDES

TRAFFIC LIGHT

SUPPORT SYSTEM

(Identified as most essential tool)

WEB

‘small changes, big differences’ resources

Quick wins

Best practice

Practical ‘how to’guides

Web presence

Improving patient safety and making savings Case study: Nottingham University Hospitals NHS Trust

Issue: CAUTI (catheter associated urinary tract infection) is one of the most common sorts of hospital acquired infections and results in severe illness

and high levels of hospital admissions

Project aim: to standardise urinary catheters across Nottingham University Hospitals over 2 acute sites, where a number of different urinary catheters

were being used by clinicians with no consistent practice

Improving patient safety and making savings Case study: Nottingham University Hospitals NHS Trust

55% reduction in CAUTIs from Jan – August 2015 (compared to same period 2014)

Estimated savings of £111,000 per annum (30%)

Outcome: standard catheter pack and education implemented which delivers best practice on recent health guidelines

Supporting change in wound care

Which products do nurses think we can make savings on?

Disposable wipes63%

Incontinence products53%

Gloves65%Dressings74%

Key facts• The NHS spends £302m on dressings and wound care annually

• 43% is through NHS Supply Chain (95% in the acute market) £126M

• Some products are already generic ie. Cotton Wool

• High price differences exist between most and least expensive products

• Clinicians tell us some products are over specified for clinical usage

• Pricing is not always clear, with direct rebates in place with suppliers

• Developing national clinical specifications would support patient safety and effective procurement

• There is an opportunity to improve quality of care and patient safety, whilst also making £18m of savings for the NHS

Progress to dateA Team of nearly 30 experienced nurses across a range of specialisms including tissue viability, burns management, infection control and clinical procurement have reviewed specifications across seven categories of products.

Film dressings

Super absorbents

Barrier cream and ointments

Non woven island

adhesive dressings

Foam dressings

Gelling fibre

Wound contact

layer

Breakdown of products reviewedGeneral wound care Advanced wound Care

Category (Lots in current catalogue)

No. of sub-categories

No. of National product codes

Category (Lots in current catalogue)

No. of Sub-categories

No. of National product codes

Film dressings

Super absorbents

Barrier creams and ointments

Non-woven island adhesive dressings

4

3

3

3

374

61

57

144

Foam dressings

Wound contact layer

Gelling fibre

7

2

2

470

165

75

Total 13 636 Total 11 710

Wound care - next steps

• EstablishNHSClinicalEvaluationTeam

• Reviewtheoutcomesandrecommendationsfromthewoundcareclinicalworkdonesofar

April

• Workwithkeystakeholdersincludingrepresentativebodies,theclinicalteamandNHSSupplyChaintoreviewobjectivesandagreenextsteps

April/May • Undertakeclinicalevaluation,ensuringpatientsafetyandqualityofcareremainparamount

Summer

Beyond wound care….• The NHS Clinical Evaluation Team have been seconded to this project from April 2016

for an initial 6 month period• The Team are part of the NHS and will work with the NHS to conduct clinical

evaluations, focusing on providing the best opportunity to improve patient care and deliver greater value for the NHS

• Working with procurement professionals at NHS Supply Chain and the NHS Business Services Authority, the NHS Clinical Evaluation Team will use independent, robust and transparent processes to do a range of clinical evaluation activity which may include:

– research on clinical outcomes and published data– table top evaluations– review of existing or proposed savings opportunities to ensure clinical viability– creation of national clinical specifications which identify clinical standards, feeding into national

procurement processes