journal of perioperative practice procurement guide november 2013

Journal of Perioperative Practice

PROCUREMENT GUIDENovember 2013 Volume 02 Issue 05

01423 881300 www.afpp.org.uk

01423 881300www.afpp.org.uk

02Journal of Perioperative Practice PROCUREMENT GUIDE

November 2013Volume 02 Issue 05www.afpp.org.uk ?????????


November 2013Volume 02 Issue 05www.afpp.org.uk Contents

Journal of Perioperative Practice Procurement Guide informationIn print within the AfPP Journal of Perioperative Practice covering national AfPP members, but also with a dedicated print and e-distribution to supplies and purchasing managers.

Key Sectors: NHS Supply Chain, Independent Hospitals, Higher Education. Medical Device Companies.

Published 6 times a year we will focus on procurement issues in every edition as well as specialist subjects which for the following year include:

05Procurement, power, predicaments and patient safety

09Health and Safety – complicated or common sense?

January 2014Recovery

March 2014Instruments

May 2014Infection Prevention

July 2014Day Surgery

Contact Information:

Advertising, Sponsorship & Partner Packages.Frances MurphyMedia ManagerOpen Box M&CT: 0121 200 7820E: [email protected]

EditorialChris WilesHead of Publishing / Editorial AfPPT: 01423 882950E: [email protected]

PR & press material.All press releases welcome and we will feature as many as we can in each issue, all press releases need to be submitted to:Frances MurphyMedia ManagerOpen Box M&CT: 0121 200 7820E: [email protected]

Welcome to your November 2013 Guide

11Kimberly-Clark announces the winners of the 2013 HAI Watchdog Awards

12X-ray protection

15Minister launches radical new procurement strategy to save the NHS £1.5 billion


November 2013Volume 02 Issue 05www.afpp.org.uk Xxxxxx


November 2013Volume 02 Issue 05www.afpp.org.uk Safety

Procurement, power, predicaments and patient safety

With all the competing priorities that present themselves to perioperative teams, the recently published Better Procurement, Better Value, Better Care (DH 2013) should be essential reading to enable an understanding of the past, and present and future of the impact on patient safety that our partners in industry and NHS procurement processes have through their economic and development interactions. It recognises the pressures that both disciplines experience as they strive to deliver a quality service for the NHS.

quality at a higher cost, he said, because any other decision can be seen by some overseers as an unjustified expense”.

There is a parallel to be struck here on this perceived safety culture, which in the wider healthcare environment is the subject of daily scrutiny in the media. This is a challenge to us all as we move forward in the changing healthcare landscape.

Fortunately, the report recognises that a long term strategy is required in addition to the immediate cost savings. Significantly, it acknowledges that industry has traditionally found it hard to engage with the NHS. Many seasoned industry partners will reflect on the changes and the inconsistencies that have faced them over the years within this relationship. There is recognition that suppliers need to be more involved within the NHS procurement process and a culture of early engagement and open dialogue about strategic direction of the challenges faced. There needs to be transparencies about future procurements to allow suppliers to develop their

Another key point in the report is that the NHS needs to be more responsive to innovations from industry as a knowledge tester and a testing ground for these innovations as this has been an issue in the past.

The primary theme of the report is inevitably around immediate savings, citing the reduction of non permanent staff and supplies, naming many items in perioperative and surgical daily use. Delivering this substantial cost reduction, will affect clinicians delivering care as well as partners of industry supplying the essential and innovative products that are required to give patients safe, high quality care.

A US congressional hearing in Feb 2103 addressing a national IT strategy (and I recognise the similarity in this situation) says procurement reform must address the human factor. It gives some grounding remarks about national strategy reform and the pursuit of rapid cost savings. “Sometimes, people are looking at best price, not necessarily looking at quality,” said the committee’s ranking member. “And sometimes the price is nice, but in the long run, you’re not really saving because you’re not purchasing wisely and looking at the long run.” It further adds that procurement staff “fear mistakes and blame, even the potential for what may be viewed as waste. They choose the lowest price over better



business models and products and to support future NHS needs before procurements are actually undertaken.

Another key point in the report is that the NHS needs to be more responsive to innovations from industry as a knowledge tester and a testing ground for these innovations as this has been an issue in the past. It needs to support the complex processes to secure research and support funding for industry to engage with the NHS on these important aspects of future technology and development.

Frances, Keogh and Berwick have assured that all aspects of healthcare delivery will be affected by the fundamentals of a culture change for the benefit of patient safety .This recognition of true collaboration within diverse teams that are delivering healthcare wherever it is in the patient’s pathway is so important. Openness and resolve, as quoted in the report, is particularly encouraging to individuals like me working in improving patient safety. Team communications and interactions, performance strategy and product development (and consequently human factors recognition) which ultimately makes the patients care and interventions safer, is a key driver for us all and I hope the report and the consequential consultations that will be produced from it will further engage us to be involved and respond. This should then support the development and the delivery of the vision it foresees and its subsequent effects on patient safety. Tracy Coates Past President AfPP (Oct 2012 to Jan 2013)Independent Healthcare Consultant (Patient Safety)www.tracycoatesconsult.com

Reference Department of Health 2013 Better Procurement, Better Value, Better Care: A Procurement Development Programme for the NHS (online) https://www.gov.uk/government/publications/improving-procurement-in-the-nhs [Accessed October 2013]

There is a parallel to be struck here on this perceived safety culture, which in the wider healthcare environment is the subject of daily scrutiny in the media. This is a challenge to us all as we move forward in the changing healthcare landscape. Fortunately, the report recognises that a long term strategy is required in addition to the immediate cost savings. Significantly, it acknowledges that industry has traditionally found it hard to engage with the NHS.


November 2013Volume 02 Issue 05www.afpp.org.uk Airways



The investigation which followed this incident resulted in what we all recognise as the Health and Safety at Work Act 1974. It was described at the time as “a bold and far reaching piece of legislation”, (John Locke HSE director-general), and marked a departure from the framework of prescribed and detailed regulation which was in place at the time.

The topic of health and safety frequently receives some bad press, some blank looks and some eye rolling. It is often seen as an imposition on progress and innovation, viewed as complicated and difficult to manage.

UK safety in the workplace dates back to the 1800s, with the first factory inspectors appointed under the provisions of the Factories Act 1833.

Initially, their main duty was to prevent injury and exploitation over children working in the textile industry. Thankfully, we have progressed since then.

Some 20 years later, in the mid 1850s, an investigation into the mining industry told shocking tales of workplace accidents, brutality, lung disease, long hours and highly dangerous and adverse working conditions which were found to be the norm within the industry.

It took another 50 years before a controversial but ground breaking appointment of the first woman as a factory inspector. There was much opposition to this, and the Chief Inspector of Factories at the time, is reported to have stated “I doubt very much whether the office of factory inspector is one suitable for women…The general and multifarious duties of an inspector would really be incompatible with the gentle home loving character of a woman…” (Alexander Redgrave Annual Report 1879).

After much campaigning the first two ‘lady inspectors’, May Abraham and Mary Patterson were appointed in 1893. They were based in London and Glasgow and earned an annual

healthcare is the introduction of the 1988 Control of Substances Hazardous to Health (COSHH) Regulations, to protect the health of people arising from work activities. Under the regulation, employers must carry out risk assessments to ensure that employees are not exposed to substances which would be hazardous to their health.

Where exposure to such substances cannot be prevented, employers must provide suitable protective equipment (PPE) and control measures. All equipment must be adequately maintained and tested and records kept evidencing this having been done. There is also a requirement for health surveillance and medical surveillance, together with providing employees with relevant information, instruction and training.

One of Britain’s worst sporting disasters occurred on 15 April 1986 at the Hillsborough football stadium during the FA Cup semi final match between Nottingham and Liverpool. Many of us will recall those shocking images on TV and in the newspapers at the time. Ninety-six people were killed and 170 injured. Football fans were caught up in a massive crush as a result of too many people being allowed access to the ground, leading to the fans already inside been pushed against wire safety fences and crushed. As a result of this disaster many new safety measures were introduced for sporting stadiums.

1992 saw the introduction of the ‘six-pack’ regulations’(The Workplace (Health, Safety and Welfare) Regulations 1992) which came into force on 1 January 2003 regulating many workplace issues, such as maintenance of workplace and equipment; devices and systems; ventilators; indoor workplace temperatures;

Health and Safety – complicated or common sense?

salary of £200. Much of their work involved investigating women’s hours of employment and enforcing health and safety within laundries.

The 1900s saw the introduction of further legislation in areas of agriculture, and nuclear installations. A massive chemical explosion on Saturday 1 June 1974 destroyed a large part of the NYPRO (UK) plant at Flixborough near Scunthorpe. In this major incident 28 people were killed and 36 people suffered injuries. There would potentially have been significantly more casualties if this had happened on a weekday.

The investigation which followed this incident resulted in what we all recognise as the Health and Safety at Work Act 1974. It was described at the time as “a bold and far reaching piece of legislation”, (John Locke HSE director-general), and marked a departure from the framework of prescribed and detailed regulation which was in place at the time.

The new legislation introduced a less prescriptive and more broad-based regulations, supported by guidance and codes of practice. For the first time employers and employees were to be consulted and engaged in the process of designing a moderate health and safety system. The health and safety executive (HSE) which is still in place today was created to enforce health and safety law, a duty shared with local authorities.

The 1970s also saw the introduction of safety representatives and committees which were supported through legislation to investigate potential hazards in workplaces and make representations to the employer on matters considered to affect the health, safety and welfare of the employees of the workplace.Of specific interest to us in



lighting; cleanliness; waste materials; room dimensions and space; windows; ventilators; sanitary and washing facilities; drinking water; facilities and accommodation for clothing; changing clothing; resting and eating meals. All pretty basic common sense approaches to providing a suitable and safe environment for staff, visitors, patients etc.

Human error is commonly blamed for accidents in the air, on the railways, in complex surgery and in healthcare generally. Immediately after an incident people make quick judgements and, all too often, blame the person most obviously associated with the disaster. The pilot of the plane, the doctor or nurse who administers the drug or the train driver who passes a red light is singled out. However, these quick judgements and assignment of blame prevents us uncovering the secondary story. This is the true story in its richness and complexity, which only emerges after thoughtful and careful inquiry (Vincent 2010). While a particular action or omission may be the immediate cause of an incident, closer analysis usually reveals a series of events, errors and departures from safe practice and system failures, each influenced by the working environment and the wider organisational context

Surgical environments and interventions by their nature are accompanied by an increased degree of risk and hence it is imperative for us as practitioners to pay heed to the small cumulative events which individually may pass unnoticed, but are most likely to lead to a risky and potentially unsafe situation. Patient safety is the foundation of quality patient care. “There is something horrifying about being harmed or indeed causing harm, in an environment of care and trust” (Vincent 2010).

Common sense, instinct, leadership and attention to detail together with an understanding of the environment and the potential for error and adverse events are the foundation for safe practice in perioperative settings.

The identification and management of these risks is the key to enabling safe surgery for our patients and a safe environment for us and individuals and our colleagues and visitors and it is all of our responsibility.

There is nothing new about health and safety and it certainly cannot be viewed in isolation as it is fundamental to safer patient care. All the events alluded to here, (and this is not a full or comprehensive list), have an impact on healthcare facilities and perioperative environments. The human cost of adverse events is one of life’s great tragedies from which none of us have immunity.

Mona Guckian FisherRGN, LLM, BsC (Hons), OHND, CMIOSH, Dip. Operating Theatre Nursing, Dip Counselling

Independent Healthcare Consultant and Vice President/ Trustee AfPP

References and further readingHealth and Safety Executive http://www.hse.gov.uk

Vincent C 2001 Clinical Risk Management: Enhancing patient safety 2nd edition London, BMJ Books

Vincent C 2010 Patient Safety 2nd edition Chichester, Wiley-Blackwell


November 2013Volume 02 Issue 05www.afpp.org.uk News

Kimberly-Clark Health Care has announced the winners of the 2013 HAI Watchdog Awards to reward individuals and teams who are championing infection prevention in UK hospitals.

The category winners of the panel-judged entries are Peterborough and Stamford Hospitals NHS Foundation Trust, University Hospital Coventry and Warwickshire NHS Trust, The Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust and The Royal Liverpool and Broadgreen University Hospitals NHS Trust. The Clinicians’ Award was won by the FIT4Safety project team represented by NHS Midlands and East, Barnet, Enfield and Haringey Mental Health NHS Trust and the Somerset Partnership NHS Foundation Trust.

The HAI WATCHDOG Awards programme recognises the work and dedication of doctors and nurses who are making a difference in reducing and preventing healthcare associated infections (HAIs) in wards and departments throughout the country. The winning hospitals receive a £1000 educational grant and a commemorative plaque.

The entries were scrutinized by an expert panel of judges comprising Andrea Berry from the Critical Care Network, Ruth Collins from the Association of Perioperative Practice and Derek Butler from MRSA Action UK.

The judges said they were delighted that so many hospitals were doing such worthwhile and effective work and they wanted to share it with others.

The winner of the category for Operating Theatre Infection

Taking the top accolade in the Clinicians’ Choice Award was a joint entry from NHS Midlands and East, Barnet, Enfield and Haringey Mental Health Trust and Somerset Partnership NHS Foundation Trust for the FIT4Safety Group. The goal of the group was to reduce the number of needlestick injuries to nurses whilst administering diabetes injections.

Jonathan Price, General Manager for Kimberly-Clark Health Care in Europe, Middle East and Africa (EMEA) said: “Despite significant improvements in infection prevention in hospitals in recent years there is still much work to do and the winners of the HAI Watchdog Awards show how individuals and teams can take the initiative and deliver effective campaigns that benefit patients and staff.

“Kimberly-Clark is committed to working in partnership with hospitals to play our part in helping to deliver the best possible care to patients and we’re delighted to be able to highlight the efforts and success of the winners.”

Central to the scheme is a website – www.haiwatchdog.com – where hospitals can view the details of this year’s and last year’s winning entries.

In addition, a dedicated Facebook page is active so that clinicians can discuss and share their experiences and, in so doing, facilitate the exchange of best practice.

The awards also ran simultaneously in the United States and Canada as well as Australia and New Zealand with the aim that the HAI WATCHDOG website can become a central point for the sharing of international HAI prevention best practice.

The General Critical Care Unit at University Hospital Coventry and Warwickshire NHS Trust showed how they reduced the risk of patients developing Clostridium Difficile (C Diff) by introducing initiatives they dubbed the ‘Big Two’ to help them increase compliance cleanliness on the ward.

The winner of the Staff Infection Prevention category was the Royal Liverpool and Broadgreen University Hospitals NHS Trust for its programme to encourage more staff to have the influenza vaccine. As the highest performing trust in the UK, the hospital achieved an uptake of 86.3%.

Prevention Initiative was The Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust for its project to prevent contamination of operating theatre equipment utilising the residual antimicrobial effect of chlorhexidine.

In the ICU Infection Prevention Initiative category the judges were unable to decide between the high standard of two entrants and so awarded a joint first prize. At Peterborough and Stamford Hospitals NHS Foundation Trust, a team of intensive care consultants showed how new interventions in the ventilator care bundle had driven down infection rates and saved the Trust money.

Kimberly-Clark announces the winners of the 2013 HAI Watchdog Awards

The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, Operating Theatre Infection Prevention Initiative Intensive Care Consultant Dr Mark Blunt, Senior Sister Critical Care Carol Underwood, OR Sister Liz Baker Sister, Jason Donohue Sales Manager in the Surgical and Infection Prevention team for Kimberly-Clark Health Care, Intensive Care Consultant Dr Peter Young, Senior Theatre Practitioner Raji Abbura.


November 2013Volume 02 Issue 05www.afpp.org.uk Product News

Wardray Premise Ltd has made x-ray protective clothing in the UK for 40 years. Aprons are one of the company’s flagship products. They epitomize everything customers expect from Wardray in terms of product quality and longevity.

Wardray’s protective clothing range includes traditional aprons and top & kilts. Garments are offered in a range of lead equivalents, come in a wide range of sizes and lengths to ensure a comfortable fit.

A Wardray garment is suited for

of the apron to be carried and supported at the waist.

To discuss your requirements or to arrange a sample for trial please contact Noreen Connolly, phone 0208 3989911 ext 237 email: [email protected]

Full details of Wardray’s products and services are available at www.wardray-premise.com.

X-ray protection

Customers may be seduced by the marketing of lead free aprons, but Wardray believe that the surcharge for the material and the minimal weight saving don’t offer good value for money.

Wardray would challenge customers to try wearing one of their garments before selecting an alternative product.

Their design allows the weight

use in theatres as the double shoulder clips allow easy / quick garment removal.

An optional labeling service, allows departments or individuals to ensure that their inventory of aprons is properly identified and accounted for.


November 2013Volume 02 Issue 05www.afpp.org.uk XXXXXXXX


November 2013Volume 02 Issue 05www.afpp.org.uk Product News


November 2013Volume 02 Issue 05www.afpp.org.uk Procurement

A radical new blueprint for how our NHS buys everything - from rubber gloves and stitches to new hips, building work, bed pans and temporary staff - has been unveiled by health minister Dr Dan Poulter.

Dr Poulter’s new strategy for NHS procurement is set to radically change what our NHS does with its money by cutting wasteful spending - so cash can be ploughed back into the front line for patient care. It details ambitious plans to save £1.5 billion by getting our NHS to use its money more smartly and more efficiently.

The government’s NHS reforms are already making £1.5 billion of back office savings each and every year for our NHS by reducing unnecessary bureaucracy, but Monday’s document will show how our NHS can save much more, and support economic growth, by changing the way it buys supplies and does business.

Health Minister Dr Dan Poulter said: “The Government is putting an extra £12.7 billion into our NHS but that money needs to be spent much more wisely by local hospitals. When our NHS is the single biggest organisation in the UK, hospitals must wake up to the potential to make big savings and radically change the way they buy supplies, goods, services and how they manage their estates.

“We must end the scandalous situation where one hospital spends hundreds of thousands more than another hospital just down the road on something as simple as rubber gloves or

Minister launches radical new procurement strategy to save the NHS £1.5 billion

syringes, simply because they haven’t got the right systems in place to ensure value for money for local patients. This kind of poor resource management cannot go on, and this radical new strategy will help our NHS get a grip on wasteful spending to drive real change and improved procurement practices so that more of our NHS’s resources can be spent on frontline patient care.

“The money saved though our plans to cut wasteful NHS spending can be spent instead

on the things that really matter – such as more operations or revolutionary new treatments.”

Dr Poulter’s new strategy, launched ‘Better Procurement, Better Value, Better Care: A Procurement Development Programme for the NHS’, which takes an open and frank look at the procurement inefficiencies that currently exist in our NHS. Findings show there is little consistency in the way our NHS spends money, and that very few senior people in NHS hospitals

know what good procurement looks like.

It also finds an over reliance on ‘framework agreements’ at the expense of the NHS striking radical money-saving deals, like hospitals getting together to bulk-buy equipment for a discount. Dr Poulter set out a number of specific actions to tackle these problems. They include:

• The recruitment of a new NHS procurement champion with private sector expertise who will have the authority to drive better procurement practices across the whole of the NHS; recruitment will start immediately.

The Association for Perioperative Practice is a registered charity (number 1118444) and a company limited by guarantee, registered in England (number 6035633). AfPP Ltd is its wholly owned subsidiary company, registered in England (number 3102102).

The registered office for both companies is Daisy Ayris House, 42 Freemans Way, Harrogate, HG3 1DH.


November 2013Volume 02 Issue 05www.afpp.org.uk Procurement

Journal of Perioperative Practice P R O C U R E M E N T G U I D E

A V A I L A B L E O N L I N E N O W !

• Dr Dan Poulter to lead a special top-level team, drawn from Government, the NHS and business to work with the new procurement champion to provide on-going scrutiny and guidance to the NHS in driving improvements in NHS procurement and productivity gains.

• Mandating hospitals to publish for the first time what they pay for goods and services and setting up a brand new ‘price index’ especially for hospitals, through which they will be able to see how much they are spending on different products compared to other hospitals. This will drive improvements because for the first time ever, hospitals will have to publish what they pay for supplies and services, and be held accountable to patients and the public for what they spend. Hospitals and their boards will be able to see where they are lagging behind and could do better;

• Cutting the temporary staff bill by 25 per cent by the end of 2016 (temporary staffing currently costs the NHS an eye-watering £2.4 billion every year), by helping the NHS learn from the best hospitals and use more efficient staffing arrangements;

• A plan for the Department of

Health to make the most of the market by working with top NHS suppliers directly to strike new, bulk deals for cutting-edge medical equipment like radiotherapy machines and MRI scanners;

• Growing the UK economy by making the NHS more agile and better at working with small and medium-sized businesses; including implementing Lord Young’s recommendations on pre-qualification questionnaires, including simplifying them across the NHS, or even abolishing them for low value procurements;

• Exposing poor value for money and bad contracts by making more data about the deals the local NHS is signing publicly available; and

• Improving support to help senior NHS staff better understand procurement.

The new procurement strategy for the NHS is part of a wider government drive to save taxpayers’ money by being more efficient and make every taxpayer pound count.

Better Procurement, Better Value, Better Care: A Procurement Development Programme for the NHS is available from: https://www.gov.uk/government/publications/improving-procurement-in-the-nhs

Have you any ‘New Products’ to launch or ‘Established Products’ you wish to push to the forefront of the ‘NHS Supply Chain & Private Sector’?

Call our sales contact, Frances, to discuss including them in our upcoming editions

Frances Murphy +44 (0)121 200 7820

journal of perioperative practice procurement guide november 2013

Documents

better procurement

procurement issues

nhs procurement processes

perioperative teams

patient safety

safety complicated

nhs supply chain

perceived safety culture