NHS Clinical Reference Board and NHS Clinical Evaluation Team

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1 NHS Clinical Reference Board and NHS Clinical Evaluation Team Mandie Sunderland, Chief Nurse, Nottingham University Hospitals NHS Trust 13 April 2016

2 NHS Clinical Reference Board and NHS Clinical Evaluation Team Mandie Sunderland Chair, NHS Clinical Reference Board

3 Overview and national picture

4 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

5 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

6 Potential savings Save 1.3m on Disposable continence Which could equate to: 43 Band 5 nurses Save 4m on Infection control - skin Which could equate to: 133 Band 5 nurses Save 18m on Wound Care Which could equate to: 600 Band 5 nurses Total = 776 Band 5 nurses

7 NHS Customer Board structure London Customer Board VACANT Chair Midlands Customer Board David Melbourne Chair Deputy Chief Executive and Chief Finance Officer, Birmingham Children s Hospital NHS Foundation Trust National Customer Board Sir Ian Carruthers OBE Chair Clinical Reference Board Mandie Sunderland Chair Chief Nurse, Nottingham University Hospitals NHS Trust NHS Clinical Evaluation Team Clinical Lead, Dr Naomi Chapman Northern Customer Board Mick Guymer Chair Director, North West Procurement Development Southern Customer Board Suzanne Tracey Chair Director of Finance and Business Development, Royal Devon and Exeter NHS Foundation Trust

8 NHS Clinical Reference Board members Name Role & Trust Name Role & Trust Mandie Sunderland (Chair) Greg Dix (Vice Chair) Sandy Brown Dr Naomi Chapman Geraldine Cunningham Rose Gallagher Chief Nurse Nottingham University Hospitals NHS Trust Director of Nursing Plymouth Hospitals NHS Trust Director of Nursing and Clinical Quality East of England Ambulance Service NHS Trust Executive Nurse Network Lead Royal College of Nursing Associate Director of Cultural Change Barts Health NHS Trust Nurse Adviser Infection Prevention and Control Royal College of Nursing Professor Suzanne Hinchliffe Michelle Norton Christine Perry Mark Radford Dee Roach Ray Walker Chief Nurse/Deputy Chief Executive Leeds Teaching Hospitals NHS Trust Director of Nursing George Eliot Hospital NHS Trust Director of Nursing Weston Area Health NHS Trust Chief Nursing Officer University Hospitals Coventry and Warwickshire NHS Trust Executive Director of Nursing and Quality Lancashire Care NHS Foundation Trust Executive Director of Nursing Mersey Care NHS Trust Gaynor Hales Associate Nurse Director, North NHS Improvement

9 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

10 NHS Clinical Evaluation Team members Name Role Name Role Dr Naomi Chapman (Clinical Lead) Executive Nurse Network Lead Royal College of Nursing Simon Hall Tissue Viability Lead Nurse, University Hospitals Bristol Liam Horkan Clinical Procurement Specialist, Colchester Hospital University Sian Fumarola NHS Foundation Trust Senior Clinical Nurse Specialist Tissue Viability and Continence, University Hospitals of North Midlands NHS Trust David Newton Matron-Clinical Procurement, Nottingham University Hospitals NHS Trust Clare Johnstone Head of Infection Prevention and Medical Devices, Central London Community Healthcare NHS Trust Stephanie McCarthy Clinical Procurement Nurse, Royal Derby Hospital

11 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 Sunderland Chair of NHS Clinical Reference Board

12 Small changes, big differences

13 UK / NATIONAL SCALE. Acute and Community Hospitals, Prisons, Mental Health Trusts, GPs, Care Homes. ENCOURAGING AND EMPOWERING NURSES TO MAKE CHOICES WHICH CONTRIBUTE TO PATIENT SAFETY, SUPPORT THE FRONTLINE AND DELIVER SAVINGS FOR THEIR ORGANISATION. INCLUDING EXAM GLOVES DRESSINGS CONTINENCE CARE POLYMER WIPES PLUS CORE LIST COMPARE AND SAVE AND PRICE RANKING. LAUNCH TUES 24 MARCH 2015 RCN HQ, LONDON. DIRECTLY SUPPORTS 58M NURSE LED SAVINGS OPPORTUNITIES. SUPPORTED AND DRIVEN BY MANDIE SUNDERLAND, CHIEF NURSE AT NUH AND CLINICAL REFERENCE BOARD CHAIR. Clinical supplies - quality, safety and value at the frontline.

14 INFORMED BY OUR NURSING TIMES PURCHASING SURVEY (Jan 2015) AND THEY WANT HOW TO GUIDES 856 RESPONSES NURSES TOLD US THEY DO SEE OPPORTUNITIES TO SAVE, ALIGNED TO KEY CATEGORIES, AND THEY WANT TO GET INVOLVED. TRAFFIC LIGHT SUPPORT SYSTEM (Identified as most essential tool) WEB CASE STUDIES Clinical supplies - quality, safety and value at the frontline.

15 small changes, big differences resources Quick wins Best practice Practical how to guides Web presence

16 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

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19 Improving patient safety and making savings Case study: Nottingham University Hospitals NHS Trust Outcome: standard catheter pack and education implemented which delivers best practice on recent health guidelines 55% reduction in CAUTIs from Jan August 2015 (compared to same period 2014) Estimated savings of 111,000 per annum (30%)

20 Supporting change in wound care

21 Which products do nurses think we can make savings on? 74% Dressings 65% Gloves 63% Disposable wipes 53% Incontinence products

22 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

23 Progress to date A 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 Foam dressings Non woven island adhesive dressings Super absorbents Wound contact layer Gelling fibre Barrier cream and ointments

24 Breakdown of products reviewed General wound care Advanced wound Care Category (Lots in current catalogue) No. of subcategories No. of National product codes Category (Lots in current catalogue) No. of Subcategories No. of National product codes Film dressings Foam dressings Super absorbents 3 61 Wound contact layer Barrier creams and ointments 3 57 Gelling fibre 2 75 Non-woven island adhesive dressings Total Total

25 Wound care - next steps Establish NHS Clinical Evaluation Team Review the outcomes and recommendations from the wound care clinical work done so far April April/May Undertake clinical Work with key stakeholders including representative bodies, the clinical team and NHS Supply Chain to review objectives and agree next steps evaluation, ensuring patient safety and quality of care remain paramount Summer

26 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