Master presentation from the Excel in Health: Understanding the NHS workshop on Thursday 31 October at the Radisson Blu Hotel, Liverpool

1. Excel in Health
Understanding the NHS

2. 1. Understanding the NHS
2. Relevant knowledge and skills
for success
3. Applying your learning and
pitching your innovation
Three day programme overview:
@innovationnwc

3. Find someone you’ve never met:
Spend TWO MINUTES (each) sharing:
What challenges do you bring with you today?
What are you hoping to get from this experience?
Repeat with another new contact…
@innovationnwc

4. Today’s outcomes
By the end of our session today, you will be able
to:
Identify characteristics of NHS structure and system
Recognise processes for working with the procurement
system
Identify relevant elements of NHS culture that may
impact your work
Respond to Reflection #1 in your workbook
@innovationnwc

5. NHS landscape

6. NHS landscape: topics
NHS history overview
NHS structures
National context
STP/ICS priorities
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7. NHS history and context
• Created in 1948
• Free at point of care to all
• £125B = 7% of GDP
• 1M patients every 36 hours
• 1.2 million staff
• 135 acute non-specialist trusts
• 17 acute specialist trusts
• 54 mental health trusts
• 35 community providers
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8. NHS core principles
1. Meeting the needs of everyone
2. Free at the point of delivery
3. Based on clinical need, not ability to pay
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9. NHS structure
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10. @innovationnwc
https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-england-work

11. • Clinical commissioning groups (CCGs)
replaced primary care trusts (PCTs) 2013.
• CCGs can commission any service provider
- NHS trust, social enterprises, charities or
private sector providers.
• 220 CCGs grouped into 44 STPs
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12. • NHS England/NHS Improvement – single entity
regional teams
• 1948 - £437M (£15 billion at today’s value)
• 2017/18 - £125B
• Budget increase by 1.2% between 09/10 and 20/21
• Cost increase of 4%, cash reduction, activity rising
at 4% annum
• L/T average of 4% £ increase not keeping pace
with demand
@innovationnwc

13. National health and care challenges
30% of people in
Liverpool live with one
or more long term
conditions
The difference in life
expectancy
between areas
across LCR can vary
by more than 10
years
By 2021 there will
be 9% (5700) MORE
people living beyond
65 years with the
biggest growth in
those aged 70-75
and 85+
Over half of
adults are
overweight or
obese
@innovationnwc

14. • Shift the emphasis from disease and distress to
prevention and promotion (prevent the fires)
• Passive patient becomes more discerning and
responsible for their health and wellbeing –
choices and consequences
• Technology
• Resource optimisation
• Reducing duplication
• Greater standardisation and reliability
@innovationnwc

15. The Accelerated Access Review
“Seventeen years ago, I performed the
first operation in the UK using a surgical
robot. As it happens, that is the average
time it takes for an innovation to spread
around the NHS”
“But 17 years? It is far too slow. That is
why the joint government-industry
group, the Accelerated Access
Collaborative was launched to identify
the most transformative medical
innovations and ensure they are
available on the NHS up to four years
earlier than at present”
Professor the Lord Darzi of Denham Chair
of the Accelerated Access Collaborative &
Chair of surgery at Imperial College
@innovationnwc

16. Clinical priorities
• Early diagnosis
• Measures enabling rapid diagnosisCancer
• Prevention
• FH; Cardiac Arrest; Stroke servicesCVD
• Prevention
• Monitors; self care; choices and consequencesDiabetes
• Prevention
• Rehab; Meds Opimisation; Risk ScoringRespiratory
• Children and young people (25% prevalence)
• Crisis; suicide preventionMental Health
@innovationnwc

17. Service delivery priorities
• Primary Care Networks
• To integrate teams and digital servicesPrimary Care
• Urgent treatment centres, NHS 111
• To reduce pressure on A&EUrgent Care
• Digital transformation
• To reduce wait times and delayed transfersAcute Care
• IAPT expansion
• Crisis; suicide preventionMental Health
@innovationnwc

18. • 60% of Trusts are in the red
• We pay for activity not outcomes
• Annual budgetsFinance
• More patients, less staff
• 100k workforce gap
• Retention and skill developmentWorkforce
• Digitalising the system for patients and clinicians
• Interoperability of digital systems
• Patient information and record sharingDigital
Resource challenges
@innovationnwc

19. Integrated Care System
Currently a shadow integrated care
system called Healthier Lancashire and
South Cumbria:
• five integrated care partnerships
• 1.7m population
• 8 CCGs
• 5 Trusts
• 4 upper tier Local Authorities
• NHS England and NHS Improvement
• Wider partners such as voluntary,
charity, hospices and education
Morecambe
Bay
Pennine
Lancashire
Central LancashireWest
Lancashire
Fylde Coast
Lancashire and South Cumbria
@innovationnwc

20. Healthier Lancashire
Out of Hospital Acute and
Specialised
Mental Health Prevention and
Population Health
• Regulated Care
• Primary Care
• Stroke
• Cancer Alliance
• Better Births
• Head and neck
• Vascular
• Diagnostics
• Pathology
• Children and
Young People
• Suicide Prevention
• Preventing
Diabetes
• Public Health
• Population Health
• Personalised care
Commissioning Urgent and
Emergency
Workforce Digital
• Commissioning
development
• Clinical policy
reviews
• Respiratory
• Falls
• UTIs
Careers
Clinician Passport
It's Your Move
Well at Work
Our digital future
@innovationnwc

21. Cheshire and Merseyside
Healthcare Partnership
• 12 CCGs
• 9 Local Authorities
• 20 Provider Trusts
Focussed on:
• Collaboration and
partnership
• Joined up care
• Targeting localised
priorities
• Implementing a place
based care matrix
@innovationnwc

22. Cheshire and Merseyside Healthcare
Partnership
Health Inequalities Focus
• Mental wellbeing
• Zero suicide
• Cardiovascular disease – zero strokes
• No harm from alcohol
• Every child immunised
• Reducing falls
• No violent crime
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23. Where does your innovation match
system needs?
Respond to Reflection #2 in your workbook
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24. Procurement and Commissioning

25. • Where is the funding?
• Procurement towers
• Procurement frameworks
• Other avenues…
• Hot topics
Procurement: our topics
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26. Procurement: landscape
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27. https://www.kingsfund.org.uk/sites/default/files/2017-10/NHS_structure_2017.pdf
Commissioning and regulation

28. @innovationnwc

29. NHS
England
GP practice
GMS / PMS contract
Local authority
Social care
Domiciliary care
Care homes
Other providers
CCG
NHS Acute Trust
NHS Mental Health Trust
NHS Community Trust
Payment by results
Block contracts
Contracts for services
Self
funders
@innovationnwc

30. What does this mean for you?
• Providers procure products, Commissioners commission
services
• STPs may have some funds. Integrated Care Systems
aren’t real world (yet!)
• The org that uses a product may not be the organisation
that reaps the benefit
• Operational efficiencies vs cost savings
• 70% NHS costs are in staff. Incremental changes are not
cash releasing for commissioners.
• What will your product replace or improve?
• The tariff for PbR is available publically. Use it.
https://improvement.nhs.uk/resources/national-tariff-1719/
@innovationnwc

31. • More with less
• Reduce variation
• Increase efficiency
• Reduce cost without clinical
compromise
Repeat….
Procurement seen as
key solution to these
problems
@innovationnwc

32. DH – Leading the nation’s health and care
Procurement towers
A Category Tower is a public or private sector organisation that is
responsible for the sourcing of a pre-determined specific logical group of
products on behalf of the NHS.
Non Medical
Tower 11
NHS Hotel Services
Tower 4
Orthopaedics, Trauma &
Spine, Ophthalmology
Medical
Tower 3
Infection Control
And Wound Care
Tower 5
Rehabilitation, Disable
Services, Women’s
Health & Associated
Consumables
Tower 2
Sterile Intervention
Equipment And
Associated
Consumables
Tower 10
Food
Tower 9
Office Environment
Capital
Tower 7
Large Diagnostic
Capital Devices incl.
Mobile &
Consumables
Tower 8
Diagnostic
Equipment and
Associated
Consumables
Tower 1
Ward Based
Consumables
Tower 6
Cardio-Vascular,
Radiology, Audiology &
Pain Management
@innovationnwc

33. @innovationnwc

37. • Register on the NHSSC supplier
portal
• Consider partnering with a larger
supplier
• Consider forming a consortia
• Use your AHSN as conduit
@innovationnwc

38. Health systems support framework
• About the framework
• Scope of Framework Lots 1 – 10
• Who can use the framework
• Lot 0 NHSE to create ‘innovation greenhouse’ to
accelerate uptake of technology
• G-Cloud 11 - CCS
You can compete!

39. What is a framework agreement?
Definition: an agreement between a Contracting Authority (e.g. NHS
SBS, an NHS Trust, or a local council) and one or more suppliers, the
purpose of which is to establish the terms governing contracts to be
awarded during a given period, in particular with regard to price and,
where appropriate, the quantity.
• 6-9 month procurement process
• Awarded following a fully OJEU compliant process under the 2015 Public
Contracts Regulations
• Usually awarded for a period of 4 years
• *Legal requirement for public sector procurements over the value of
£118K
• Approx. cost of £25,000 per tender process for a Contracting Authority
@innovationnwc

40. Healthcare
Contrast Media Cardiology,
interventional
radiology and
vascular grafts
Ophthalmolog
y Equipment
and
consumable
Respiratory
therapy
Insourcing
Orthopaedic
Products
including power
tools,
arthroscopy
products and
long bone
healing
Clinical
Managed
Services
Community
Equipment
Products and
Services
Orthotics and
Prosthetics
Products and
Services
Medical
Imaging and
Radiotherapy
Advanced
Woundcare /
Advanced
Woundcare
Delivery
Patient
Connected
Support and
Therapy
Equipment
Point of Care
Testing: Drugs
of Abuse
@innovationnwc

41. Opportunities - if no…what alternatives?
• AHSN’s links in to Procurement Teams
• Support with Insight, Apsiz
• Countess of Chester Hospital work with Leanvation

42. Making NHS SBS procurement easy
AI Enabled Framework Agreement Portal
• Phase 1 – customers can search, find and sign up to agreements
on-line
• Phase 2 – customers can navigate category detail and create
bespoke contracts online
Increased Implementation Support Resource
• Supporting customers in navigating and using our Framework
Agreements
Customer Engagement – Geographical
Expansion of Team
• Creating a national engagement strategy
• Growth of the Commercial and Clinical Engagement Team in 2018
/19 to cover NHS
@innovationnwc

43. Trust procurement policy – an NHS
example
@innovationnwc

44. Definition: a contract that is awarded to a Framework supplier without further
competition.
1. The supplier must already be awarded to the Lot relevant to the work being
procured.
2. Make initial contact with the preferred supplier through the Capability
Assessment or;
3. Contact the preferred supplier directly via the details provided within the
Buying Guide whilst quoting the Framework reference number.
4. Notify the supplier of the requirements, time frames and scope of the work.
5. Agree upon a contracted rate – where possible this should relate back to the
indicative Framework rates provided.
6. Place the order directly with the chosen supplier using framework reference
number
7. Where appropriate, Sign SLA with the supplier and return to NHS SBS to
complete the process.
Direct Award
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45. Where to look for NHS Opportunities
NHS Opportunities MUST be published online - you need to put the work in, you
have to search!
Essential Sites:
Above OJEU >£118k DoH, NHS Trusts / £181k NHS England, CCGs & NHS
Foundation Trusts
• TED Europa http://www.ted-Europa.eu
Below OJEU >£10k to £118k / £181k
• Contracts Finder http://online.contractsfinder.businesslink.gov.uk
Contracts Finder pulls from all sites where possible (One Place – Full
Transparency)
Other Useful Sites:
• Public Contracts Scotland – www.publiccontractsscotland.gov.uk
• Sell2Wales – www.sell2wales.gov.uk
• eSourcing Northern Ireland – www.e-sourcingni.bravosolutions.co.uk
@innovationnwc

46. How to look for NHS opportunities
• Registering is essential
• Register for all or as many as possible
• Searching for Opportunities is critical
• CPV Codes, NUTS codes and / or Key Words
• CPV Codes – define what is being sourced (e.g. 3314000 Medical
Consumables)
• NUTS codes define the location (e.g. Essex – UKH3)
• Use Alerts
• Regularly review sites and evaluate opportunities
@innovationnwc

47. Procurement Hot Topics
@innovationnwc

48. Why is it hot?
• Restructure of NHS Supply Chain
• NHS Procurement Target Operating Model tender – Deloittes work is
underway
Impact
• Uncertainty at all levels – local, regional, national
• Costs increasing in some cases as long term deals cannot be secured
• Targets increasing for Procurement teams at Trusts as the top slicing
starts to impact
• More scrutiny on structures and landscape
• Procurement resource getting more difficult to attract and retain,
salaries being pushed. Great for the profession, not so great for the
discussion with HR!
Hot topic 1: the changing NHS
procurement landscape
@innovationnwc

49. Why?
• Uncertainty – D1ND
• High profile
Impact
• Pressure on Procurement teams to understand and measure the risk
• DH central co-ordination
• Stock piling
• Increasing supply chain issues emerging i.e. cold storage
• Prices increasing
• Post Brexit Law: Government publishes draft Public Procurement
Regulations Amendment for EU Exit which will be of relevance to all
public sector bodies and potential suppliers in the UK.
Hot topic 2: Brexit
@innovationnwc

50. Why?
• Limited Capital Fund for equipment replacement
• Increased demand in some health areas e.g. endoscopy
• VAT Recovery opportunities
• Growth in digital/tech services and markets
• Development and growth of innovative solutions in response to NHS challenges
• Shift from product to service based contracts
Impact
• Growth in demand for Clinical Managed Equipment Services
• Increase in complex and innovative commercial models that are scalable
• Suppliers getting innovative with commercial models e.g. driving outcome based
solutions
• Category expertise is often limited in these areas
• NHS Standard Terms and Conditions are not always appropriate
Hot topic 3: changing NHS spend
profile
@innovationnwc

51. @innovationnwc

52. Understanding NHS culture

53. Culture describes the rich
pattern of social behaviour
present in an organisation over
time, including all spoken and
unspoken rules, symbols,
routines and stories. Culture
binds together an organisation’s
different parts, giving identity to
the whole.’
This includes:
• Values
• Assumptions
• Artefacts

54. @innovationnwc

56. Old power values New power values
Formal (representative) governance,
managerialism, institutionalism
Informal (networked) governance,
opt-in decision-making, self-
organisation
Competition, exclusivity, resource
consolidation
Collaboration, crowd wisdom,
sharing, open-sourcing
Confidentiality, discretion, separation
between private and public spheres
Radical transparency
Expertise, professionalism,
specialisation
Maker-culture, “do it ourselves” ethic
Long-term affiliation and loyalty, less
overall participation
Short-terms conditional affiliation,
more overall participation
@innovationnwc

58. • Learning culture
• Listening culture
• Open and transparent culture
• Just culture

59. • Vision and values
• Goals and performance
• Support and compassion
• Learning and innovation
• Teamwork
@innovationnwc

60. Value The way we do things
Constant commitment to
quality of care
Everyone taking
responsibility in their work for
living a shared vision and
embodying shared values
@innovationnwc

61. Value The way we do things
Effective, efficient, high
quality performance
Everyone ensuring that there
are clear priorities and
objectives at every level and
intelligent data constantly
informing all about
performance.
@innovationnwc

62. Value The way we do things
Support, compassion, and
inclusion for all patients and
staff
Everyone making sure all
interactions involve careful
attention, empathy, and
intent to take intelligent
helping action.
@innovationnwc

63. Value The way we do things
Continuous learning, quality
improvement, and
innovation
Everyone taking
responsibility for improving
quality, learning, and
developing better ways of
doing things.
@innovationnwc

65. Value The way we do things
Enthusiastic cooperation,
team working, and support
within and across
organisations
Everyone taking
responsibility for effective
team-based working,
interconnectedness with
and across organisations,
systems thinking and
acting.
@innovationnwc

66. Vision and
Values
Goals and
Performance
Support and
Compassion
Learning and
Innovation
Teamwork

67. Resistance to change
Shock
Frustration
Resistance Exploration
Commitment
Integration
Valley of Despair
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68. Overcoming fixed mindsets
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69. Respond to Reflection #3 in your workbook
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70. Excel in Health
Understanding the NHS