Tackling the care backlog created by the COVID-19 pandemic has led to a need for service innovation on an unprecedented scale.
Throughout the NHS we have had to adapt our ways of working and procurement is no exception. But in the face of this challenge, we are unlocking innovative, flexible approaches to buying services that are fit for a post-pandemic health service and seeing procurement shift from being a necessary process to a strategic enabler of quality patient care.
Frameworks have never been the bread and butter of the healthcare commissioning world, yet there are now two high-value national framework agreements in place to help tackle the aftermath of the pandemic; the Increasing Capacity Framework (ICF) for acute elective care and the Community Diagnostic Centre (CDC) framework for validated diagnostics providers. Traditionally, commissioners have gone to market for a specific service with the intention of finding a single provider or handful of providers to meet the requirements. Post pandemic, however, we have had to think differently. The sizeable backlog caused by COVID-19 has significantly increased the scale and complexity of finding solutions. And with the pandemic far from over, we need fast, flexible solutions that can be dialled up or down in response to changing demand.
Accessible, agile solutions
Working on behalf of and in close partnership with NHS England and NHS Improvement we have adopted zero-value framework contracts for the ICF and CDC, with call-off arrangements giving commissioners faster access to approved providers.
The ICF contract involves 90 providers of services, of which the majority are small and medium sized enterprises (SMEs), between them offering the equivalent additional capacity of another two or three multinationals. This extra capacity is vital to give the NHS the best chance to reduce backlogs, with a more traditional approach might well have overlooked these smaller providers.
The past two years have certainly taught us to expect the unexpected, which is why agility is key. Although the need for fast solutions can limit the initial market response, both frameworks have built in flexibility to allow NHS England and NHS Improvement to refresh the frameworks when needed to capture any available capacity. This opens up access for new entrants within the lifespan of the agreements and gives previously unsuccessful providers the opportunity to address any gaps in their capabilities. This is essential in ensuring these frameworks provide both scale and value long term.
Regardless of the scale of any contract, success is in delivering something which is simple and effective to use. By building advanced search functionality into the provider database, we have seen commissioners successfully use these frameworks to commission validated services in as little as three days – far quicker than would traditionally be the case.
Procurement done well not only provides vital due diligence, but also enables the health service to deliver better services whilst protecting the public purse.
Market engagement is a key part of the commissioning model. Talking to potential providers allows us to understand the art of the possible and help commercial organisations see opportunities through an NHS lens. We need to move towards a more dynamic way of buying services and not be afraid to tackle the potential challenges that arise when trying to bridge commercial and public sector priorities. This is best achieved by focusing on what we have in common – putting patient outcomes at the heart of everything we do. A key element of developing the ICF was moving all providers onto the National Tariff (or less). For some this was a significant drop in their traditional rates but, through effective engagement, we were able to build a desire to be part of the post-pandemic solution – while satisfying the providers’ commercial needs by giving access to a much larger pool of patients.
COVID-19 has undoubtedly given rise to more complex problems which require a different approach. The learning point here isn’t that we need to start moving to framework contracts on a regular basis – it’s that we need to be open to the full range of procurement tools available to us and choose the right one to achieve the best solution.
Even before the pandemic, we were starting to see a shift in how some services were being procured, largely in response to their complexity. Achieving this, however, is reliant on commissioners involving procurement colleagues ‘downstream’. As the holder of the metaphorical cheque, commissioners have the potential to shape the market response. Our job as procurement professionals is to interrogate the ask, so we can identify a commissioner’s ideal outcome and work with them to achieve it. For example, when East Kent CCG wanted to commission urgent treatment centres across its locality, their ‘utopia’ was a solution where all providers would work together. There was an assumption that this may not be achievable but, by working in partnership, we were able to work through the technical, legal, commercial and operational elements to set up a successful joint venture across all providers, giving the commissioner the optimal solution.
As commissioning becomes more complex – both in tackling the pandemic legacy and in moving towards more integrated, system-wide working – procurement specialists and commissioners working together earlier in the buying process will be crucial in identifying the ideal procurement solution to achieve the quality outcomes our communities deserve.
This feature was originally published in the May/June 2022 edition of National Health Executive which is available here.