The must-read stories and debate in health policy and leadership.

Outside help

Procurement teams across NHS trusts are bracing themselves for more change.

HSJ revealed NHS Improvement is bringing in management consultants to help design a new procurement operating “model” for trusts in a fresh bid to deliver on Lord Carter’s £5bn efficiency challenge.

The news that consultants are being drafted in was met with scepticism by the Health Care Supply Association, which pondered why NHSI couldn’t use the health service’s existing procurement expertise.

However, NHSI said the consultants, in addition to drawing up at least three options for the new model, will advise on “private sector expertise and best practice”.

The model is set to become the second big national procurement programme running in the NHS. It follows the new NHS Supply Chain model (also known as the future operating model), which aims to deliver savings from the annual £6bn NHS expenditure on common consumables, devices, and equipment.

NHSI says this accounts for 40 per cent of spending on goods and services by trusts. With its new model, NHSI is going after the remaining 60 per cent of expenditure.

Precisely which categories of non-pay spend this relates to is not yet decided, but it does not include medicines or agency staff. Other areas of non-pay spend include estates and facilities services, transport, consultancy, administration and training.

No savings target has been set yet, but it is likely to be in the billions of pounds.

Under pressure

In the early years of austerity, there was lots of scope for NHS accountants to shake the magic money tree and deliver helpful one off adjustments to boost their organisation’s reported financial position.

Many of these adjustments will have been perfectly legitimate, such as removing excessive prudence from income assumptions or more accurately expressing the value of an asset.

But, in the second half of the decade, the opportunities have started to run thinner, leading to greater temptation and pressure to make adjustments where the case is not so clear.

Survey responses collected by the Chartered Institute of Public Finance and Accountancy suggest a significant number of NHS staff have carried out “professionally unethical” tasks after feeling pressured to do so.

Although the sample size was small, Margaret Pratt, chair of CIPFA’s ethics working group and former interim chief finance officer at St George’s University Hospitals Foundation Trust, told HSJ: “The main thrust of the survey results is very clear. People feel under pressure to act unethically, and more worryingly, people know what they’re being asked to do is wrong and yet they are still doing it.

“It reflects my own experience and that of colleagues. I’ve had a 25 year career working in or for the NHS and absolutely recognise those pressures, while colleagues continue to raise these concerns with me.

“We need to support members to do the right thing and to raise a red flag when that needs to be done. The regulators need to respect professional integrity; in the long run it doesn’t help them if they are relying on reporting that is economical with the truth.”

There are clearly varying levels of concern about the ethics, however, as many in the NHS finance world, rightly or wrongly, see it as a relatively minor and contained issue.