How reform of the tendering process will save the NHS millions

The cost of NHS competitive tendering is a scandalous waste of public money. So what can be done?

A flurry of freedom of information (FoI) requests from government departments requesting data about spending on NHS competitive tendering signals the start of political parties gearing up for their election campaigns.

While I am not a huge fan of FoI due to the additional burden they place on stretched resources, I welcome this sudden interest in a hugely costly exercise that is draining much-needed frontline resources at a time when we are all facing enormous financial challenges to make unprecedented savings.

Our response to these FoIs makes for salutary reading indeed: more than £1m a year is being spent on the competitive tendering process. Assuming that we are not unique, the overall cost to NHS providers is quite simply eye watering – a scandalous waste of public money.

Over the years there has been much talk about improving the bid process while retaining robust governance and intelligent commissioning. However, talk has not translated into change and costs continue to rise year on year. Now must surely be the time to take decisive and urgent action to streamline the process and save the NHS millions of pounds.

Even at the pre-qualification stage, there is no standard format meaning that each tender requires a new response. Some questions may be similar but either have a slightly different angle or require information that has not been requested before or is required in a different format. There is limited opportunity to use previous responses to streamline the process and reduce the cost of responding to each individually.

There are occasions when, having invested huge amounts of resources, the tendering process is stopped or suspended for various reasons. On other occasions, the process has been stopped and then restarted with a slightly different tendering requirement so bidders have to invest similar resources again if they want to stay in the running.

This is not just a burden on providers: commissioners are also investing resources in coming up with new tender documentation and rules of procurement – not to mention the considerable amount of time and money in administering the process itself. Many of these functions are outsourced, which can only add to the expense. Clinical commissioning groups have not learned the lessons of the past. If anything, the expectations placed on bidders have increased.

We need a wholesale review of this process so that the NHS can lead the field in sensible, efficient procurement that ensures the best bidder is selected while saving money at the front line. We already have a model that offers some potential to achieve this in the “any qualified provider” process. Its core features are:

Online submissions: reducing the costly and environmentally unfriendly requirements of paper submissions
Standardised questions: this means previous responses on issues such as organisational form, clinical governance, quality, financial management, patient engagement and feedback can simply be re-used
Service specific questions: this targets resources to providing information about how the particular service being commissioned would be delivered
Local questions: these enable commissioners to ask one or two additional, specific questions to deal with local challenges and demographics

We could go further and make better use of Monitor’s licensing regime and the Care Quality Commission’s inspection processes. Both are designed to provide assurance around viability and the quality of care, providing commissioners with assurance and reducing the requirements of individual procurement exercises.

Through the use of technology, we could develop a centralised procurement hub where organisations respond to a set of core questions which can be accessed by commissioners to supplement the more local and specific information needed for individual bids – all of which would be managed online. Information could be updated as required and would reduce the huge amount of resources needed to manage the process for both providers and commissioners alike.

I would love to see someone rise to the challenge of reviewing the procurement process as a political priority, so we can target our increasingly stretched resources to where they are most needed –at the front line, on high quality services for patients.

Source – Guardian