1. Six Countries Programme – Innovation and Procurement Wednesday 16 November 2005 Margaret Horton Head of Research and Innovation The UK Approach to Procurement and Innovation

2. What I am going to talk about…… UK Government policy The NHS and innovation The NHS supply network A little bit of theory…… Key NHS changes Barriers to Innovation

3. UK government taking strong interest Ex DTI SoS Patricia Hewitt met stakeholders Sept 2003 to discuss ways of opening up public procurement (PP) to encourage creativity from suppliers. Key issues emerged: –Better forward planning –Greater transparency –Increasing professionalism of those involved in PP –Building in scope to encourage innovation DTI Innovation Report December 2003 –Called for action across the public sector to boost innovation –Stressed the vital role PP can play as a lever for stimulating and enabling supplier innovation –Tasked OGC to develop guidance that identifies ways in which govt can stimulate innovation from suppliers through the procurement process Patricia Hewitt chairs the Innovation in the Knowledge Economy x-govt group to drive report forward. Immediate focus is on breaking down the £109bn spend to identify the opportunities

4. Capturing Innovation – nurturing suppliers ideas in the public sector OGC guidance 2004 Challenges govt procurers to think innovation and become intelligent procurers Innovation should be encouraged throughout but greatest potential arises from the earliest stages: –When policy is being formulated –When programmes and projects are being shaped –In the formulation of procurement strategy

5. Capturing Innovation – nurturing suppliers ideas in the public sector OGC guidance 2004 Why we dont capture innovation: –Inadequate warning –Risk aversion –Client capability shortfalls –Regulation What we can do to capture innovation: –Challenge (ESI, procurement strategy, SME involvement, output/outcome specifications, acceptance of variants, contract management) –Channel (communicate long-term plans to the market, unsolicited proposals, early design contests and IPR) –Reward (cost and value for money, incentives, risk and reward sharing, payment not the only reward, ownership of IP

6. WHAT HAPPENS IN THE NHS?

7. Extent of NHS use Innovation Basic research Applied research Targeted development First human use Clinical trials Early adoption Late adoption Accepted practice (or disuse) Basic research Applied R&D Clinical investigation and testing Diffusion DevelopmentDiffusion Innovators Early adopters Early majority Late majority Time Industry funded DH NEAT programme SBRI? DTI funding Research Councils Innovations pushed from industry Mainly reacting to push

8. Extent of NHS use Innovation Basic research Applied research Targeted development First human use Clinical trials Early adoption Late adoption Accepted practice (or disuse) Basic research Applied R&D Clinical investigation and testing Diffusion DevelopmentDiffusion Innovators Early adopters Early majority Late majority Time The adoption dilemma When is the best time to buy? When is the best time to evaluate? Requires a time series approach to evaluation and procurement

9. But how does the NHS respond? the UK is a late and slow adopter of new technology, compared with early and rapid adoption of technology in the US. Australia, Canada and France tend to be classified as late adopters of technology, but once they start to adopt, they do so rapidly Derek Wanless, 2002 new technologies currently present themselves to different parts of the NHS in seemingly random order and there is much scope for inconsistency, duplication and delay To negotiate such a system requires either a well-resourced commercial sponsor or a resolute innovator! Professor Kent Woods, 2002

10. How does the NHS respond? (Co-map report) OJEC driven tender process tends to enshrine yesterdays solution NHS purchasing decisions are perceived to be driven by lowest price tenders which results in bias towards old technology and a consequent reduction in longer term benefits to the NHS There are problems with health economic methodology used because of perceived focus on relative cost of like for like replacement products in current systems of practice rather than looking at benefits that may come from change of practice Multiple entry routes – central versus local: which is the appropriate entry point for sales effort? PASA, HAs, Acute Trusts, PCTs or social services? Budgetary silos appear to prevent purchasing decisions which are justifiable in terms of clinical and cost effectiveness and care pathways but cut across organisational boundaries Multiple entry routes – clinician versus accountant: what purchasing decisions are driven by clinicians and what by management? How do clinical preferences get incorporated into management purchasing policy?

11. WHY DOES IT RESPOND LIKE THIS?

12. The shape of the NHS supply network DH and its ALBs NICE PASA MHRA MANPSA 300 Acute Trusts (with own procurement depts 300 Primary Care Trusts 1.2 million staff 600+ organisations Other Govt policies e.g. OGC, Sustainability, SMEs 20,000 suppliers 28 Strategic Health Authorities R&D Healthcare Commission MPIG 12 NHS IP hubs 28 Supply Management Confederations £15 billion non-pay expenditure

13. How are purchasing decisions made? PASA 300 staff Specialist buyers National contracts, DH initiatives, geographical contracts, and specialist support for Trusts for bespoke contracts PASA 300 staff Specialist buyers National contracts, DH initiatives, geographical contracts, and specialist support for Trusts for bespoke contracts NHS Logistics 7 distribution centres 40,000 Commodity products Supply chain expertise Trusts Board leads Supplies teams Generalists Local contracts One-off purchases Supply Management Confederations Consortia within SHA boundary Mainly virtual Evolving structures – developing expertise Drug Tariff Levels of purchasing activity and contract workplans? NICE Not all purchasing is undertaken by supplies staff CAGs Product user groups Committees Clinical procurement specialists Clinical preference Demand MPIG

14. A perception of public procurement ………. Historical reactive end of the process role? More comfortable buying what has been bought in the past? Large procurement organisations can become remote Rigid adherence to EU procurement legislation – to point of using it to justify existence! Do procurement staff understand their own business and what really drives the NHS? Struggle to deal with uncertainty of innovations – risk averse We must deliver Value For Money – whatever that means……

15. Do procurement staff understand the value of new technology? Understanding the value in VFM

16. Two worlds of value Problem: how do you define value in healthcare? For medical devices and pharmaceuticals it should be clinical and cost-effectiveness?!? Clinical and cost effectiveness (HTA) HM Treasury VFM BUT………

17. Public procurement – the comfort zone EU regulations based on competition Public procurers only comfortable when they have competition and can test the market Public procurers therefore intent on commoditising Public procurers have little interest in innovation because public services do not rely on innovation to survive/compete Its the law to throw relationships up in the air every few years – therefore little prospect of developing supplier relationships based on innovation!

18. A BIT OF THEORY…..

19. Some of what I have said is backed up by research Public Technology Procurement (as opposed to regular procurement of existing products where only price/performance are considered) doesnt fit with auction theory of EU public procurement –Reason: EU believe it creates national champions who are not necessarily innovative –The result is perpetuation: public procurers repeat what they have bought before and create suppliers who become lazy & respond to public supply contracts and do not look to innovate Edquist et al, 2000) (Irony: EU single market set up to strengthen member states rate of innovation but in practice regime has followed a strictly economic & competition approach to public procurement)

20. Public technology procurement Key aspect of PTP is dimension of time versus buyer competence (Edquist et al, 2000) creates problems: –Early & sophisticated demand – procuring agency needs to monitor leading edge technology and needs to understand where innovation is needed –Being locked-in too early – into risky (uncertain) new technological trajectories. Solution is to use PTP to support multiple trajectories to allow choice and strategic alternation between them –Buyers develop bargaining power by selecting the right specifications at the right time (beware delays caused by bad organisation and poor coordination of the procurement process)

21. WHAT IS CHANGING?

22. Healthcare Industries Task Force Outcome 1: Device Evaluation Outcome 2: Innovation Outcome 3: Procurement Processes

23. 9 KEY OUTPUTS Development of new Device Evaluation Service (DES) Development of new NHS Innovation Centre Procurement Building R&D capacity Work towards the development of Healthcare Technology Co-operatives Regulatory issues Export strategy Communication on regulation & safety of devices Training & education

24. Device evaluation (1) inform procurement decisions, and encourage and support the uptake of useful, safe, innovative products and procedures used in health and social care: –Develop a new device evaluation service to integrate and strengthen horizon scanning, and the assessment of value and effective performance of new and enhanced healthcare technologies, devices and related procedures –Develop nationally accepted methodologies and toolkits for device evaluation that can be used locally to ensure consistency of approach whilst facilitating decision-making at the appropriate level –Consider how best to ensure speed of evaluation, a once-only approach and prompt sharing of outputs with stakeholders throughout the health/social care system and industry To help effect these changes existing DES will move to PASA w.e.f. 1.4.05

25. What will it be called and what will its mission be? NHS PASA - Centre for Evidence-based Purchasing Underpin purchasing decisions and provide objective evidence to support the uptake of useful, safe, innovative products and related procedures in health and social care

26. Innovation (2) Stimulate more innovation and encourage a more entrepreneurial culture in industry and the NHS: –Work towards the development of a new Innovation Centre in an appropriate organisation to promote and support the rapid development, dissemination and commercialisation of a pipeline of innovations coming from the NHS, academia or industry. The role would be to: Coordinate and develop the activity of the existing network of NHS Innovation Hubs Improve interactions and promote the exchange of knowledge between the NHS, industry, financiers and others, utilising online knowledge exchange/comms tools Play a brokerage role between industry, financiers and the NHS, fostering partnership and collaboration opportunities Promote successes and facilitate innovation uptake in the NHS Introduce an innovation fund to promote the development and exploitation by the NHS of innovative products and procedures Establish collaboration between Med Devices Faraday Partnership and others to deliver coordination, brokerage and routemap, and increase translational research

27. National Institute for Improvement & Innovation Lord Warner said the NHS Institute will: work closely with clinicians, NHS organisations, patients, the public, academia and industry in the UK and world-wide to identify best practice; Develop the NHS capability for service transformation, technology and product innovation, leadership development and learning; Support the rapid adoption and spread of new ideas by providing guidance on practical change ideas and ways to facilitate local, safe implementation; Promote a culture of innovation and life-long learning for all NHS staff

28. Procurement and Innovation Aim of combined strategies to provide over time: –single market entry point to NHS –clear pathway & support from early product development to ready for market –faster NHS uptake of innovation –informed purchasing decisions –stimulus for innovation –better outcomes for patients Outputs are interdependent!

29. Procurement processes (3) Embed modern approaches to procurement in the NHS to deliver better value for the service of patients through : –nationally agreed/accepted best practice models, including early communication with industry on workplans, to provide clarity on levels of market access and to ensure capture of innovative solutions –A focus for regional procurement with significant clinician involvement to provide the platform for an informed approach to procurement decision-making –Ensuring that the role of procurement in supporting the timely uptake of new technologies identified as providing benefit to patients is embraced –The above to be incorporated into the redesign of PASA, the CPH model, and continuing SMCs –Ensure training and education for devices are covered –Regular dialogue between NHS and industry to encourage input into policymaking (PbR, NSFs)

30. Collaborative Procurement Hubs Lifesource (Shropshire & Staffordshire) Healthcare Purchasing Consortium Greater Manchester Trent & Leicester Northampton, Rutland North Central London Hants & Isle of Wight Thames Valley Pathfinders & Group 1 Deliver £270 million by 2007 Improved support for clinicians and clinical networks by increasing their involvement in purchasing Reduced clinical risk and enhanced patient safety strategies Stronger partnerships with suppliers through commitment to contracts and a focused route into the health economy Encouragement for innovation and provision of support for R&D in emerging treatments and technologies Building a robust, sustainable environment for procurement specialists through improved career structure and enhanced recruitment and retention

31. So …… Barriers to Innovation? Organisational boundaries Lack of forward planning & existing financial frameworks Understanding Value Incentives and measures Attitudes, behaviours and capability Ethos of public procurement – competition = innovation? Regulation - One size fits all approach

32. Steps to overcome barriers? (1) Understand real business needs and match to procurement strategy Create effective networks and clear pathways for innovation which allow pull as well as push Create capability Create intelligent platforms for procurement Define and understand value & communicate value definition Develop procurement processes which encourage opportunities to harness innovation throughout procurement life-cycles

33. Steps to overcome barriers? (2) Develop procurement toolkits which provide options to avoid one size fits all approach Develop new measures for procurement which are focused on value and which incentivise them to seek innovations to support business needs Create body of knowledge to underpin procurement decisions Challenge organisational boundaries and financial systems which restrict opportunities for Innovation