- The Urology Trade Association is the leading urology membership organisation, representing 95% of urology manufacturers and suppliers.
- We are keen to see that public procurement policy, including skills and capabilities, looks beyond short-term approaches when procuring medical devices such as catheters, and considers the long-term impact of decisions made.
- Short-term approaches are likely to result in increased demands by patients on the health service – including unnecessary emergency admissions – if cheaper, but less appropriate, medical devices are procured for patients.
- The Government must engender a culture of long-term planning amongst procurement staff, in which staff look at the long-term implications of procurement and are fully aware of the differences between products available.
Background to the Urology Trade Association and vision of procurement
The Urology Trade Association (UTA) welcomes the opportunity to comment on the Public Administration Select Committee’s inquiry on public procurement, particularly in regards to the procurement of urology appliances within the health system. In our response, we particularly focus on the following two questions:
- What should be the strategic aim of the Government’s public procurement policy?
- Does the Government have the right skills and capabilities to procure effectively?
The UTA is the leading urology membership organisation representing 95% of urology product manufacturers and suppliers to the urology appliance market.
While we are aware that this inquiry will focus on central government procurement, we do have some concerns about NHS procurement which have implications for overall government finances. In addition, some of the principles which we advocate would be beneficial if applied across government.
In particular, we are concerned about the arrangements made by some Primary Care Trusts (some of which look likely to be continued by Clinical Commissioning Groups) which restrict patient and prescriber choice of urology appliances. Such arrangements have significant impacts on patients, the NHS, and public funds. Not only are urology devices hugely important to many people in ensuring their quality of life and independence are maintained and their dignity is preserved but patients who receive less suitable products may have costly adverse reactions. The result can be greater wastage of products, an increased tendency towards infection, and increased reliance on health and social care services rather than independence and self-care – all with increased costs to health and social care services. It is worth noting that the average cost for the admission of emergency urethral catheterisation resulting from infection is estimated in the region of £1,500 per patient, per visit.
In the UK, an estimated six million people are affected by continence problems and many rely on urology appliances on a daily basis. High quality urology appliances allow uses to manage their conditions, and avoid repeated medical consultations, to the benefit of both the individual and the wider NHS.
The new arrangements under Part IX of the Drug Tariff for the provision of stoma and urology appliances – and related services – in primary care were published in April 2009 and came into force in April 2010. These provide a list of all the products for stoma care and urology and determine the prices that the NHS should pay for each of the products. This list provides a reference for safe, clinical effective, and fairly priced products for patients, clinicians and NHS staff to refer to.
These arrangements have a number of benefits. For instance, when properly implemented they prevent the formation of a postcode lottery by ensuring that any patient in any part of the country is able to access any product prescribed by their GP, Nurse Independent Prescriber or Pharmacist Independent Prescriber. By setting out an agreed and fair price for each product, the arrangements also have benefits in terms of providing transparency in pricing across the NHS and reducing price variation.
Procurement staff and “silo budgeting”
The UTA believes that procurement staff working in the health field should be encouraged to consider the overall impact of their work on health outcomes, and of the health and social care budget, rather than simply the immediate impact on their own area or budget. This principle of looking beyond immediate money-saving concerns is one which would work well across the entirety of government procurement.
In addition, we recommend that procurement staff are well informed about the different kinds of products they buy and the differences between them. For example, it is important for staff to be informed regarding the differences between medical products such as catheters. Two different forms of catheter may appear to be very similar, and indeed substitutable, to non-medical procurement staff, or indeed to a non-specialist clinician, but small differences can make a real difference to patients and their ability to use the product. The impact of procurement officials’ work on patients, and on overall budgets, is significant and they should be aware of this.
It is widely recognised that reforms to the NHS over many years have failed to address so-called “silo budgeting”, where staff look at the impact in their own small area or budget, without fully considering what wider impacts this can have. We welcome a high-level political focus on more integrated commissioning and procurement but this must be followed through and implemented by those who carry out the procurement process.
As an example of silo budgeting, there is often a tendency in urology to steer patients towards cheaper products through the use of tenders or formularies, which fail to take into account the wider costs and implications that inappropriately short-term and narrow procurement will have. Ultimately, this will work against the necessary commitment to save sums of money in the NHS, if patients receive less suitable products. As previously mentioned, the costs of these are not only borne by the patient in discomfort and loss of dignity, but also by the health and social care systems due to increased reliance on the health and social care service, including unnecessary emergency admissions.
Conclusion and recommendations
The UTA has several recommendations regarding public procurement which will be of benefit to urology manufacturers. We recommend that procurement staff are well informed about the different kinds of products they buy and the differences between them. Similarly, procurement staff working in the health field should be encouraged to consider the overall impact of their work on health outcomes and the entire health and social care budget, not simply their immediate area.
Specific to urology care, we believe that the Drug Tariff system needs to remain in place and to be respected by local NHS organisations. This system supports innovation by providing a straightforward route to market for new products while ensuring, for the health service and for patients, that products are both of a high quality and good value for money, and that pricing is transparent and consistent. We also believe that arrangements made by some PCTs that restrict patient and prescriber choice should be ended, given their negative impact on patients, the NHS and the Exchequer through the increased likelihood of costly adverse reactions.