NHS Clinical Reference Board and NHS Clinical Evaluation Team

Mandie Sunderland, Chief Nurse, Nottingham University Hospitals NHS Trust

1. Mandie Sunde r l a nd, Chi e f Nur se , No tti ngha m Un i v e r si ty H o sp i ta l s NH S T r u st
NHS Clinical Reference Board and
NHS Clinical Evaluation Team
13 Apr i l 2016

2. NHS Clinical Reference Board and NHS
Clinical Evaluation Team
MandieSunderland
Chair, NHS Clinical Reference Board

3. Overview and national picture

4. Why do we need to make changes?
•The overspend in the NHS has increased from £822m in 2014/15 to an
expected £2bn in 2015/16*
•The NHS spends £4.5bn per year on clinical products in the acute sector
alone
•All trusts are under pressure to make savings, yet we must work together to
protect patient safety and the frontline as a priority. Every £30,000 saved
equates to one Band 5 nurse
•If we can buy products more efficiently across the NHS, then there is less
need to look for efficiencies at the bedside

5. Lord Carter’s Report: Operational productivity and performance in
English NHS acute hospitals: Unwarranted variations
•The challenge is to lift hospital efficiency to a consistently high
standard in every area of every NHS hospital
•15 detailed recommendations for tackling unwarranted variation in
the productivity and performance of trusts
•Savings: up to £5bn per annum can be saved by 2019/20 if there is
political and managerial commitment to take the necessary steps:
ØUp to £2bn by improving workflow and containing workforce
costs.
ØUp to £3bn from improved pharmacy, estates and
procurement management
•Proposes a single integrated performance framework for hospitals –one version of the truth –to help trusts set
baselines for improvement and provide them with the tools to manage their resources
•The ‘Adjusted Treatment Index’ (ATI ) will help hos pitals t o identif y where f urther invest igation is required, and where
efficiencies may be achievable
•Develop a model to define what an efficient NHS hospital looks like.
•A single national catalogue for hospitals to improve inventory management. Clinical involvement in defining the range the
NHS will purchase

6. Potential savings
Total = 776 Band 5 nurses
Save £1.3m
on Disposable
continence
Which could
equate to:
43
Band 5 nurses
Save £4m
on Infection control -
skin
Which could
equate to:
133
Save £18m
on Wound Care
Which could
equate to:
600
Band 5 nurses Band 5 nurses

7. NHS Customer Board structure
National Customer Board
Sir Ian
Carruthers
OBE
Chair
Mandie Sunderland
Chair
Chief Nurse, Nottingham
University Hospitals NHS
Trust
Clinical Reference Board
VACANT
Chair
London Customer Board
David Melbourne
Chair
Deputy Chief Executive and
Chief Finance Officer,
Birmingham Children’s Hospital
NHS Foundation Trust
Midlands Customer
Board
Suzanne Tracey
Chair
Director of Finance and
Business Development,
Royal Devon and
Exeter NHS Foundation
Trust
Southern Customer Board
Mick Guymer
Chair
Director, North West
Procurement
Development
Northern Customer Board
NHS Clinical Evaluation Team
Clinical Lead, D

8. Name Role & Trust Name Role & Trust
MandieSunderland
(Chair)
Chief Nurse
Nottingham University Hospitals
NHS Trust
Professor Suzanne
Hinchliffe
Chief Nurse/Deputy Chief Executive
Leeds Teaching Hospitals NHS Trust
Greg Dix
(Vice Chair)
Di recto rof Nursing
Plymouth Hospitals NHS Trust
Michelle NortonDi recto r o f N u rsi n g
Geo rge El i o t Ho s p i tal N HS Tru s t
Sandy Brown
Di recto r o f N u rsi n g an d Cl i n ical Qu al i ty
Eas t o f En gl an d Am b u l an ce Servi ce N HS Tru s t
Christine PerryDi recto r o f N u rsi n g
Weston Area Heal th N HS Trust
Dr Naomi Chapman
Execu ti ve N u rs e N etwo rk Lead
Royal College of Nursing
Mark Radford Chief Nursing Officer
Un i vers i ty Ho s p i tal s C o ven try an d Warwi cks h i re N HS
Tru s t
Geraldine Cunningham
Associate Director of Cultural Change
BartsHeal th N HS Tru s t
Dee Roach Execu ti ve Di recto r o f N u rs i n g an d Q u al i ty
Lancashire Care NHS Foundation Trust
Rose Gallagher
Nurse Adviser Infection Prevention and Control
Royal College of Nursing
Ray Walker Execu ti ve Di recto r o f N u rs i n g
Mersey Care NHS Trust
Gaynor Hales
Associate Nurse Director, North
NHS Improvement
NHS Clinical Reference Board members

9. Objectives of the Clinical Reference Board
•Raise awareness of the role clinicians play in
achieving best value from clinical products
•Identify areas for savings and standardisation,
linked to the NHS £300m savings challenge,
compare and save and core list
•Support and drive the existing good practice
in clinical engagement in procurement
•Publicise the work of the group and seek
opportunities to engage the wider clinical
workforce in the challenge
•Work collaboratively with all the Local Boards
to support clinical engagement across they
key priorities
“By facilitating interaction with
trusts through the Customer
Board at a local level we will be
able to help accelerate change
and the delivery of the
significant savings needed.”
Sir Ian Carruthers OBE,
Chair of National Customer Board Chair of
Portsmouth Hospitals NHS Trust

10. NHS Clinical Evaluation Team members
Name Role Name Role
DrNaomi Chapman
(Clinical Lead)
Executive Nurse Network Lead
Roy al College of Nursing
SimonHall Tissue Viability Lead Nurse, University Hospitals Bristol
Liam Horkan
Clinic al Proc urement Spec ialist, Colc hester H ospital Univ ersity
NHS Foundation Trust
Sian Fumarola
Senior Clinical Nurse Specialist Tissue Viability and Continence,
University Hospitals of North Midlands NHS Trust
David Newton
Matron-Clinic al Proc urement, Nottingham Univ ersity
Hospitals NHS Trust
Clare Johnstone Head of Infection Prevention and Medical Devices, Central London
Community H ealthc are NH S Trust
Stephanie McCarthy
Clinic al Proc urement Nurse, Roy al D erby H ospital

11. Remit of the NHS National Clinical Evaluation Team
•Established April 2016, reporting into the NHS Clinical
Reference Board
•For the NHS, by the NHS
•Reviews some of the clinical productscurrently available
through NHS Supply Chain to identify those that enable
high quality patient care
•As a secondary issue, considers products that could be
procured more effectively through combined NHS buying
power
•Work will inform the future development of national
clinical specifications across various product categories.
“Quality, safety and
value are at the heart
of our work and it’s
important that we use
our clinical experience
to deliver high
standards of care in
ways which also
reduce cost and waste
in the NHS.”
Mandie Sunderland
Chair of NHS Clinical Reference Board

12. Small changes, big differences

13. www.supplychain.nhs.uk
UK / NATIONAL
SCALE.
DIRECTLY
SUPPORTS
£58M
NURSE LED
SAVINGS
OPPORTUNITIES.
EXAM GLOVES †
DRESSI NG S†
CO NT I NENCE CARE†
POLYMER
WIPES†
INCLUDING
†PLUS CORE LIST
CO MPARE AND SAVE
AND PRICE RANKING.
SUPPORTED AND DRIVEN BY MANDIE SUNDERLAND,
CHI EF NURSE AT NUH AND CLI NI CAL REF ERENCE BO ARD CHAI R.
Acute and
Community
Hospitals, Prisons,
Mental Health
Trusts, GPs,
Care Homes.
Clinical supplies -quality, safety and value at the frontline.
ENCOURAGING AND EMPOWERING NURSES TO MAKE CHOICES
WHICH CONTRIBUTE TO PATIENT SAFETY, SUPPORT THE
FRONTLINE AND DELIVER SAVINGS FOR THEIR ORGANISATION.
LAUNCH
TUES 24
MARCH 2015
RCN HQ ,
LO NDO N.

14. www.supplychain.nhs.uk Clinical supplies -quality, safety and value at the frontline.
INFORMED BY OUR NURSING
TIMES PURCHASING SURVEY
(Jan 2015)
856
RESPONSES
NURSES TOLD US
THEY DO SEE
OPPORTUNITIES
TO SAVE, ALIGNED
TO KEY CATEGORIES,
AND THEYWANT
TO GET INVOLVED.
AND THEY WANT
CASE STUDIES
‘HOW TO’
GUIDES
TRAFFIC
LIGHT
SUPPORT
SYSTEM
(Identi fi ed as mos t
essential tool)
WEB

15. ‘small changes, big differences’ resources
Quick wins
Best practice
Practical ‘how to’
guides
Web presence

16. Improving patient safety and making savings
Case study: Nottingham University Hospitals NHS Trust
Issue: CAUTI (catheter associated urinary tract infection) is one of the most
common sorts of hospital acquired infections and results in severe illness
and high levels of hospital admissions
Project aim: to standardise urinary catheters across Nottingham University
Hospitals over 2 acute sites, where a number of different urinary catheters
were being used by clinicians with no consistent practice

19. Improving patient safety and making savings
Case study: Nottingham University Hospitals NHS Trust
55% reduction in CAUTIs from Jan –August 2015 (compared to
same period 2014)
Estimated savings of £111,000 per annum (30%)
Outcome: standard catheter pack and education implemented
which delivers best practice on recent health guidelines

20. Supporting change in wound care

21. Which products do nurses think we can make savings
on?
Disposable wipes
63%
Incontinence products
53%
Gloves
65%
D
74%

22. Key facts
•The NHS spends £302m on dressings and wound care annually
•43% is through NHS Supply Chain (95% in the acute market) £126M
•Some products are already generic ie. Cotton Wool
•High price differences exist between most and least expensive products
•Clinicians tell us someproducts are over specified for clinical usage
•Pricing is not always clear, with direct rebates in place with suppliers
•Developing national clinical specifications would support patient safety and effective
procurement
•There is an opportunity to improve quality of care and patient safety, whilst also
making £18m of savings for the NHS

23. Progress to date
A Team of nearly 30 experienced nurses across a range of specialisms including
tissue viability, burns management, infection control and clinical procurement
have reviewed specifications across seven categories of products.
Film
dressings
Super
absorbents
Barrier
cream and
ointments
Non woven
island
adhesive
dressings
Foam
dressings
Gelling
fibre
Wound
contact
layer

24. Breakdown of products reviewed
General wound care Ad van ced wound Care
Categ o ry
(Lotsin current
catal o g u e)
No. of sub-
categ o ri es
No .of
Nati o n al
product
co d es
Categ o ry
(Lotsin current catalogue)
No. of Sub-
categ o ri es
No .of
Nati o n al
product codes
Film dressings
Super absorbents
Barri er creams an d
ointments
No n-woven island
ad h esi ve d ressi n g s
4
3
3
3
374
61
57
144
Foamdressings
Wound contact layer
Gelling fibre
7
2
2
470
165
75
Total 13 636 Total 11 710

25. Wound care -next steps
•Establish NHS Clinical
Evaluation Team
•Review the outcomes and
recommendations from the
wound care clinical work
done so far
April
•Work with key stakeholders
including representative
bodies, the clinical team and
NHS Supply Chain to review
objectives and agree next
steps
April/May
•Undertake clinical
evaluation, ensuring patient
safety and quality of care
remain paramount
Summer

26. Beyond wound care….
•The NHS Clinical Evaluation Team have been seconded to this project from April 2016
for an initial 6 month period
•The Team are part of the NHS and will work with the NHS to conduct clinical
evaluations, focusing on providing the best opportunity to improve patient care and
deliver greater value for the NHS
•Working with procurement professionals at NHS Supply Chain and the NHS Business
Services Authority, the NHS Clinical Evaluation Team will use independent, robust and
transparent processes to do a range of clinical evaluation activity which may include:
–research on clinical outcomes and published data
–table top evaluations
–review of existing or proposed savings opportunities to ensure clinical viability
–creation of national clinical specifications which identify clinical standards, feeding into national
procurement processes