Improving data quality and getting systems to work together are more or less the first issues to arise whenever IT is discussed in the NHS. They apply as much to commercial systems as to clinical ones.
Yet the health service has tended not to take a common approach when it comes to developing the processes, coding and other standards that would encourage inter-operability in business areas, such as its purchasing and supply chain.
The result, says Kevin Pritchard, chair of the NHS procurement eEnablement delivery group (NPEDG), is that it has failed to achieve some of the cost, efficiency, and clinical benefits that it might have achieved.
The NHS is not using its purchasing power as effectively as it might. Many organisations within it have little information about what they are purchasing and what it costs – and how their purchasing patterns and costs compare with others.
And few trusts are tracking what they buy through to its final use in delivering healthcare, so they can analyse its safety and effectiveness.
“We have got some trusts that are exemplars in their field, who really understand the need for robust transactional processes, and who have put the infrastructure in place to track items through their procurement systems and into their patient systems,” says Mr Pritchard.
“But there are other trusts that are still very dependent on paper processes, or even worse, that are just working with invoices and payments that give them very, very little information.”
These frustrations are widely felt. “The fragmented nature of the NHS is a challenge,” says Janice Kite from the Association of British Healthcare Industries.
“Trusts have different processes, different information demands and different levels of IT usage.” All of which means higher costs, as suppliers have to employ people to understand how organisations work and to run catalogues and processes tailored to them.
A few years ago, the IT response to these issues might have been a national e-procurement system for the NHS; and, indeed, this idea was floated at the end of the 1990s.
Now, however, there is a tendency to at how common coding and standards could be used to drive inter-operability and more stream-lined processes.
This is the approach being taken by the NPEDG, a stakeholder group with members drawn from the NHS Purchasing and Supply Agency and trusts, primary care trusts and regional procurement hubs.
In June, it published a strategy whose objective “is not to replace existing systems, but to put in place the essential enablers [for] the NHS to effectively exploit eEnablement technologies” (see box).
In November, it followed this up with a work programme that will develop these “enablers” – such as common coding systems – along with best practice guidelines and demonstrators of what can be achieved (see box).
“We came together as a group to look at data and we decided we could fix that,” explains Mr Pritchard. “But that raised the question of whether trusts really understood their procurement processes and how to link into their clinical systems.
“The workstreams come out of that. We felt we needed a common data set for purchasing, some standards for interoperability, and an understanding of best practice so trusts can start to understand their patterns of purchasing and to ask questions about whether they are appropriate.”
The NHS Procurement eEnablement Strategy ties into other initiatives, such as Coding for Success, which mandated the use of GS1 codes to identify products in NHS commercial and clinical systems (see box).
This has been welcomed as an essential first step. “It gives a clear statement that this is the standard that should be adopted,” says Ms Kite. “There will be challenges for some suppliers to adopt it, but the statement is there that GS1 is the route to follow.”
The rest of the work programme is similarly practical. “We need initiatives that will make this easy to use,” says Rachel Hodson-Gibbons, head of e-procurement at NHS PASA.
“For example, [the business information company] Dun and Bradstreet is drawing up supplier codes for the NHS to use. These will be on the NHS PASA website.
“Our standard for supplier codes will be the D&B numbers, and they will be on the website so people can access them easily. We want to provide small, practical steps like this to move people along.”
Common reactions to the strategy and its workstreams tend to include words such as “realistic” and phrases such as “not overly ambitious.” There is widespread optimism that it is achievable.
“The thing that makes me feel this has real traction is the range of people interested and the size of the organisations saying that they want to support this,” says Mr Pritchard. “The advantages of better procurement are also more widely understood [for example by] finance directors and the government itself.”
IT has also moved on. “The technology is mature enough to do this now,” says Ms Hodson-Gibbons. “This is about creating common standards and building good systems around them. You no longer need to impose one system to get inter-operability and its benefits.”
Box [450 words]: The strategy:The aims of the NHS Procurement eEnablement strategy are summed up in its subtitle: using information to deliver better healthcare.
It says “the lack of shared information [across the NHS supply chain] has led to a fragmented and inefficient approach to commercial and procurement decision making and processes” and that its aim is to lay the “foundation” for overcoming this fragmentation.
The strategy says specifically that its vision is not one IT system for NHS commerce and procurement. Instead, it aims to “put the tools and processes in place that will enable better services, easier co-ordination, seamless sharing of information and better decision making throughout the NHS.”
These tools – or “enablers” - will include “coding, classification and content standards, and the widespread use of best practice.” It will be for trusts and suppliers to invest in implementing these. www.pasa.nhs.uk
The strategy and Coding for Success:The strategy is aligned with a number of other initiatives, including Coding for Success.
This was launched in February 2007, and provides guidance on the use of auto-identification and data capture technologies across the NHS. Specifically, it says the health service should use the GS1 system of codes when it adopts such technologies to support clinical or commercial processes.
GS1 is a global standards body. It issues unique numbers that can be attached to items and even people via bar codes, radio frequency identification tags and other devices. This means that items can be tracked across the supply chain and matched to each other. www.gs1uk.org.
The strategy and workstreams:The strategy will be taken forward by five work streams, the first of which is “standards and eEnablement technology adoption.”
This will produce data and business messaging standards and monitor their adoption. It will also create a model of the NHS supply chain, to understand where the standards need to be taken up, and demonstrators to show the benefits of using them.
The second workstream is “landscape, benefits realisation and good practice.” This will develop a “landscape tool” to determine how the NHS is using eEnablement technologies and “maturity analysis” tools help trusts and suppliers assess their processes and systems and decide where they need to invest.
The workstream also deliver an agreed methodology for assessing the benefits of eEnablement technologies and a best practice guide.
The next workstream is “environment scanning and stakeholder engagement”, which will identify stakeholders and run a website and newsletter, and the fourth is “once only opportunities”, which will evaluate initiatives and encourage their wider adoption.
The fifth workstream is “commissioning and payment by results”. This will identify how procurement data is being used in the commissioning process and set up demonstrators to show the benefits of aligning procurement, commissioning and financial initiatives.
Box [175 words]: Benefits:The NHS Procurement eEnablement strategy argues the entire NHS – and, indeed, the general public – will benefit from better procurement. It says that if the strategy is implemented effectively:
The public will get better value for money, while the Department of Health will be able to “unlock financial and human resources” to meet its public service agreements and other objectives.
Suppliers will see a more “consistent and shared approach” to purchasing by NHS organisations, resulting in “reduced frequency of requests for the same information, more accurate orders and faster information flows” and “a lower cost of sale.”
NHS trusts will benefit from more efficient commercial and procurement activities that generate fewer errors and better value for money, while their finance directors get “reliable information about the demand for and expenditure on goods and services” and “savings to invest in front-line services.”
Clinicians and patients will deliver and receive better, safer healthcare as goods are delivered in a timely manner and identified more consistently and accurately.
Box [400 words]: Shared systems in action:Northumbria Healthcare Foundation Trust hosts what is colloquially known as the “North East Patches [subs correct, no apostrophe] shared system group” (or NEP Consortium).
Head of supplies Bob Davidson stresses that this is not a shared services project. “We provide a common system that trusts and other organisations can work themselves,” he says. “It is an approach that works very well in the North East, where we probably don’t have some of the recruitment issues that make shared services attractive elsewhere.”
The project has supplied a common technology platform – based on the Oracle e-business suite – to more than 50 strategic health authorities, ambulance services and trusts of various kinds in the North East and, more recently, parts of Yorkshire and Manchester.
These organisations still manage their own procurement and financial systems, but get the benefit of common catalogues, information and reporting systems, plus advice and training.
“We went live in 2003 and the biggest benefit has been consistency of information,” says Mr Davidson. “All of our organisations use a single database [of suppliers and products] and we have a consistent chart of accounts.
“This makes it easier for organisations to compare their purchasing activity and costs. They can look at whether they are applying more or less resource to achieve a particular outcome. We have also developed ‘healthchecks’ around their purchasing activity and advise them on best practice.”
Mr Davidson sits on the NPEDG and has been involved in developing the new strategy. Like others, he feels the time is now right for it to work.
“There is a much harder focus on procurement now and a much clearer understanding of how it can deliver benefits for the service,” he says. “There is more professionalism in [purchasing and supply] and a clearer understanding of how to move forward.
“The [technology] market place has also simplified. We don’t have 30 dot.coms all trying to sell us e-services anymore. But the technology that is available is better and people right down to ward level are more used to using it.
“There is also a better understanding of the benefits of moving in this direction in the supplier community. With some notable exceptions, NHS suppliers have not been geared up for e-commerce. We now have a platform that will make it easier for them to invest in it.”