Case Study – Complex Multi Stakeholder Alignment

Situation

Cheshire and Merseyside NHS Trusts (C&M) have held a consortium contract for clinical waste with HealthTrust Europe (HTE) for approximately 9 years. In 2017, HTE commenced discussions with the consortium members to embark on a mini-competition procurement process for the renewal of their clinical waste contract.

HTE project managed and ran the procurement process over 10 months. Initially the requirement was for a sole supplier to provide clinical waste services to 13 NHS Authorities in the region for Acute, Mental Health Specialist and Community healthcare. Due to new hospitals being built in the region there was an additional requirement for Authorities to join the contract at varying times when services were needed. The awarded contract secured a further 3 years of supply at a cost neutral position for each member. The members retained the same pricing for an 8-year term and Key Performance Indicators were introduced which were fully aligned with all member requirements.

Challenge

In recent years there has been an increase in the volume of clinical waste being produced. During the last 18 to 24 months, unforeseen issues in the supplier market, coupled with the effects of Brexit and the pandemic have resulted in:

  • An increase in waste (in particular incinerated waste)
  • A lack of infrastructure investment
  • Intense competition for drivers due to decreased availability
  • Missed collections leading to the build-up of waste at hospital sites

To address these challenges, the Chief Executives of the Trusts within the Cluster required a market review of the contract, so invited HTE to submit a proposal.

Solution

HTE recommended introducing a new contract offering 2 separate solutions – Lot 1 for Acute Trusts and Lot 2 for Mental Health and Community Trusts. This allowed the service requirements of each group to be catered for and removed the restrictions of the current framework agreement in relation to award structure and awarded suppliers. All suitable potential suppliers in the market, including new entrants, could then bid for the two contracts. We recognised that, whilst each Authority had specific, individual requirements, there is a strong open relationship between them all, and a requirement to be treated as one organisation.

HTE advertised the opportunity to potential suppliers through a Prior Interest Notification (PIN) as part of the pre-market engagement exercise prior to releasing a tender. This provided visibility of the requirements and timescales to suppliers, enabling them to make informed recommendations and propose possible solutions prior to final requirements being set. This approach ensured the consortium received proposals from the most suitable suppliers and reduced clarification requests during the process. HTE and stakeholders from the Cluster presented to several suppliers who had expressed interest, inviting their feedback on the tender structure.

Result

Following a Pre-Market Engagement meeting with suppliers, HTE representatives engaged in regular dialogue with the nominated stakeholder group for the Cluster. Tender documentation was drafted and provided to stakeholders for review, ensuring it represented their requirements. As part of our commitment to driving better services through Corporate Social Responsibility (CSR) and SME strategies, the C&M Social Value requirements were adopted within the tender requirements.

HTE managed the tender process and evaluated the commercial elements of the bids. The Trust Members evaluated the technical elements and moderation sessions were held to conclude the scoring. The awarded suppliers from this process are Stericycle for Lot 1 and Sharpsmart for Lot 2. Implementation will take place during Q2, 2022. HTE will support the Trusts and awarded suppliers to ensure a smooth transition to the new contract. This includes the agreement of new KPIs, onboarding the new supplier (Sharpsmart) and refreshing the service offering provided by the incumbent supplier (Stericycle) to align with the new contract.

 

For more information, contact our Customer Care Team on 0845 887 5000 or email customercare@htepg.com

Case Study – Collaborating to Reduce Locum Costs

Situation

A working group of thirteen like-minded NHS organisations in the West Midlands wanted to work together to develop regional controls and to drive their locum staffing costs down. The healthcare providers had established relationships with HealthTrust Europe (HTE) as a framework partner that had helped them source local temporary staffing solutions with high quality patient care at the heart. In connection with the project, the healthcare providers set out to secure a reduction in agency spend whilst delivering a range of successful outcomes to reduce cost, support patient services and enhance safe staffing.

Challenge

The West Midlands had a high vacancy rate for medical roles and a high spend on medical locums through agency suppliers. Wider workforce strategies were needed to improve the reduction in vacancies. There was a clear need for robust contracting and enhanced management of agency suppliers to control spend and for stakeholders to work more collaboratively to improve data visibility, quality and price.

Each Trust individually managed their own medical agency expenditure as a silo, engaging suppliers with different commercial terms and approaches to releasing shifts. Agency suppliers had an advantage in being able to engage Trusts in silo with limited controls on commissions and no controls on performance management.

A wider set of drivers (workforce planning issues, high vacancy rates, access to rostering and bank uptake) led to an environment where Trusts had less influence and paid an increased rate and commission in the process of engaging medical locums.. The competition for talent within the silos drove rates up, with Trusts less likely to engage collaboratively with regional peers to discuss local pressures or concerns.

HTE had previously worked closely with the regional Trusts and recommended a collaborative approach that would benefit the Trusts by controlling commissions, targeting market rate adherence, unifying contract terms and setting up more regular performance management to hold the supply chain to account.

Solution

HTE’s Total Workforce Solutions (TWS) team held talks with the healthcare providers and facilitated the collaborative working to tackle the problem. The group had an annualised spend of more than £42m on medical agency covering a total of 513,014 hours of supply. Organisational commitment from all parties was vital to ensure the project’s success and due to sheer geographical size, it took focus to establish the collaboration. The executive project sponsorship from HR and the commitment of steering group members were instrumental in promoting the approach.

The basis of the collaboration was to encourage the healthcare providers to develop a temporary workforce strategy which would see them combining their spend, using the same preferred supplier list (PSL), and working together to reduce costs across the region through effective performance management of suppliers. The TWS team liaised with the healthcare providers through the steering group to work together on an agency spend reduction plan. On a regular basis the healthcare providers shared their data, experience and knowledge to promote good practice between NHS organisations and target key deliverables that drive best value (quality, safety, service and price) outcomes.

This regular data sharing enabled HTE to conduct in-depth analysis and produce a balanced scorecard detailing information which highlighted the best performing supplier, average rate profiles, average rate per Trust and fill rate per provider to create a level playing field. This enabled providers and HTE to see where the healthcare providers were spending their budget and which areas were hard to fill, such as grade of doctor, specific shifts, and the percentage of shifts being filled by suppliers so that actions could be focused on specific target metrics.

 

 

The scope of the project was further widened from 6 members with circa £42m spend to 13 members with circa £95m spend, enhancing the leverage available. Collaboration and consistency eliminated the competition between NHS organisations which had previously been advantaging the suppliers and agency workers, giving healthcare providers access to key data and performance metrics to make effective sourcing decisions.

During the first three to four months the new strategy and rate card were adopted, and all relevant staff were made aware of the key contract terms and conditions. The healthcare providers had consistent access to HTE which offered hands on support and encouraged transparent working (including short term focused support for healthcare providers experiencing supply chain difficulties in adopting new practices). HTE arranged monthly ‘project health checks’ to mediate any issues and provide support to align to the new contract terms and process. Operating as a bridge between healthcare providers and suppliers, HTE had direct access to account managers and senior board stakeholders within the supply chain to support with any urgent issues the healthcare providers had and to ensure focus on the project deliverables.

Quality was enhanced by the provision of on-going monitoring of supplier performance which continually collected spend data from healthcare providers, direct engagement providers and the suppliers to capture a true, evidence-based reflection of performance across the region. This data was collected, monitored and fed back to healthcare providers regularly in the form of the balanced scorecard which was built to include all relevant metrics as requested by the participating Trusts.

Pricing was developed using an evidence based commercial strategy to drive reductions and savings, measuring key metrics effectively to allow operational and executive stakeholders to monitor project progress and successes. Where needed, healthcare providers used the collaboration to help fill shifts they found difficult to meet. HTE was able to, and continues to, act as a mediator to assist with rate negotiation, ensuring best value, and also as an ad hoc recruiter, assisting healthcare providers from time to time with hard to fill shifts.

 

 

Result

With support from HTE for the West Midlands medical agency project, the NHS has succeeded in its move towards collaborative working throughout the UK to help improve spend leverage, communication and create greater consistency within the temporary staffing market.

As a result of the collaboration between the healthcare providers, stakeholder cooperation and the partnership of HTE’s supplier community, cost reductions of more than £675,000 a year (during the NHS financial year of 2018-2019) were achieved by the healthcare providers including a 24% reduction in supplier commission rates and a marked reduction in average Total Charge Rates across key specialties and grades of medical locums.

Senior stakeholders were engaged through HR networks to expand the group to thirteen providers in November 2019, further strengthening the leverage of the healthcare providers and scope of the agreement to deliver benefits to the Acute Sector of the NHS across the Midlands.

The success of the NHS collaboration with HTE is on-going; HTE will be working on a renewal project in the 2022/23 financial year to support healthcare providers with navigating the latest market conditions and challenges.

For more information, contact our Customer Care Team on 0845 887 5000 or email customercare@htepg.com

Case Study – OPD Outsourcing

CASE STUDY

Imperial College Healthcare OPD Outsourcing

Client Overview

Imperial College Healthcare NHS Trust is a large acute and specialist Trust in London consisting of 5 hospitals: St Marys, Hammersmith, Charing Cross, Western Eye and Queen Charlottes and Chelsea.

The Challenge 

Imperial College Healthcare were seeking an external organisation to provide outpatients dispensing and retail pharmacy services for the Trust which would enable patient experience to be improved and efficiency savings to be realised.  In addition, the Trust saw the opportunity to assist the Pharmacy staff in focusing on specialist inpatient medicines and discharge, and to improve the service quality of outpatients dispensing.

Imperial expressed their interest in implementing a fully outsourced patient dispensing service for the Trust and as a result they asked HealthTrust Europe to run this project for them.

The Process/Approach

Sanjeev Narwal worked with Imperial and facilitated a full OJEU compliant Competitive Dialogue process to ensure that a partnership could be established which delivered an outstanding service for a leading hospital with the most cost effective and competent supplier.

Results

Through a robust tender process, a contract was awarded to provide an outpatient dispensing service and retail pharmacy services across three sites for Imperial implementing four Pharmacy Outpatient Dispensing sites.  This was to begin firstly in March 2013 where HIV dispensing was to be implemented, followed by the whole service in May 2013.  This project realised a saving of £2.3m for the Trust with multiple savings generated during the course of the agreement through the partnership working, as well as significant improvements in the quality of service provision.

For more information, contact our Customer Care Team on 0845 887 5000 or email customercare@htepg.com

Case Study – Payroll Services

CASE STUDY

South Warwickshire NHS Foundation Trust Payroll Services

The Challenge 

South Warwickshire NHS Foundation Trust’s (“SWFT”) existing Payroll Service was managed through Electronic Staff Records (“ESR”) as part of the Arden Cluster arrangement on an outsourced model. Due to NHS organisational changes within the cluster the Trust made a business decision to review the provision of their Payroll Service. Mark Higgitt, Head of Procurement at SWFT contacted Gary Snart, Category Specialist at HealthTrust Europe (“HTE”) to ascertain whether the new ESR Compatible Payroll Management Service Framework could be utilised to provide an alternative supplier.

The Process/Approach

Following initial engagement, it was agreed that HTE would assist the Trust’s project lead, Peter Dillon in managing a competitive process on behalf of the Trust and their collaborative partner George Eliot Hospital NHS Trust (“GEH”), who had similar requirements. A Project Group and Evaluation Panel representing both Trust’s and the incumbent service provider was formed with a view to awarding on a consensus basis.

The Project Group initially reviewed the four awarded suppliers on the HTE Framework to ascertain solutions available and to consider award criteria to achieve a successful outcome. An output based specification and a selection process outlining the Trusts requirements, with quality and price criteria for award was agreed and formalised by HTE in the form of an ITT. The Selection Process was then managed remotely by HTE through the Bravo eTendering Portal with relative support from the Project Group where required for bidder clarifications.

Three of the Four Framework Suppliers submitted offers, all of which generated savings, and each bid was evaluated by the Project Group, two of the bidders were subsequently invited to interview to clarify technical responses and finalise scoring. Following sign off of a Recommendation Report prepared by HTE outlining the evaluation process, a consensus award decision was made to award McKesson Information Solutions the Contract. HTE supported the finalisation of Contract Documents which were signed off by both parties before handing over implementation requirements to McKesson with a projected start date of 1st July.

Results

By engaging with HTE and accessing the Framework the Trust created a savings opportunity of £187,017.80 (exc VAT), subject to strategic changes in-house and repatriation of services, the actual saving realised against their Cost Improvement Programme was reduced. Overall, the Trust achieved good value whilst also delivering a fundamental service provision with appropriate market testing.

For more information, contact our Customer Care Team on 0845 887 5000 or email customercare@htepg.com

Case Study – Clinical Waste

Merseyside and Cheshire Clinical Waste Consortium

The Challenge 

A number of our Members within the North West region were participants in a previously negotiated agreement for clinical waste which was expiring in March 2013. As an active Member of HealthTrust Europe, Warrington and Halton Hospitals NHS Foundation Trust played an integral part in encouraging interest across the region for participation in a collaborative exercise to renew the current arrangement.

Brian Burge who represented the Trust confirmed the need to do this by saying

“The previous Clinical Waste Framework had expired and HTE agreed to facilitate access to their Framework Agreement for both member and non-member Trusts in the Cheshire and Merseyside area via a mini-competition. Warrington & Halton were happy to organise and host some of the meetings”.

 

The Process/Approach

Following an initial presentation to a collective group of Facilities and Procurement colleagues in late November 2012, a programme and timetable of activities was proposed and 13 neighbouring Trusts were divided into 2 specific Lots which were designated as Acute and Community sites, a decision which was based upon the forecasted market response to the procurement process.

Due to the Framework currently in place within the contract portfolio of HealthTrust Europe, timescales for the programme were significantly reduced and a Mini-Competition process was adopted by Harpreet Rupal, the lead responsible for this category.

Harpreet explained the benefits of this methodology by confirming

“The overall Framework acts a facility to complete a bespoke process which is compliant with EU Legislation but removing the timescales of a full exercise. Defined lists of providers who have been accepted onto the Framework were automatically included in the Mini-Competition, also saving them time and effort by adopting this process”.                                                                                               

 

Results

Input from each of the Trusts was paramount to the development of the specification and other subsidiary documents for the tender process. Both Andy Johnson from The Royal Liverpool and Broadgreen University Hospitals NHS Trust and John Foley representing Liverpool Women’s NHS Foundation Trust and Alder Hey Children’s NHS Foundation Trust were integral to the continuity of the programme timetable and their extensive knowledge of this category proved invaluable throughout the period of award. In recognition of the number of participants and as an aid for effective communication, a bespoke page and ‘log in’ was established on the Salesforce platform managed by HealthTrust Europe to improve communication. Tracking of all developments within the programme were live and visible for multiple contribution which was acknowledged by John who confirmed the necessity of customer input as being integral to the programme “Some stakeholders could not attend and we wanted to ensure those not present could see latest versions of tender documents, plus the changing waste and procurement landscape had driven changes that needed to be encompassed”. Invariably whilst ensuring compliance with the legislation surrounding the award of this category, the collaborative membership was cognisant in these times of financial challenge within the NHS of cost improvement. In recognition of this a challenging savings target of 15% was established for the overall amalgamated expenditure, this was surpassed when the final contract award was made to SRCL with an average saving across all members being reported as a 31% reduction on current spend.

 

Member Testimonial

Andy Johnson representing The Royal Liverpool and Broadgreen University Hospitals NHS Trust summarised the overall benefit of participating in the process as

“Considering the varied service requirements of the Acute and PCT Trusts I found, with the help of HealthTrust Europe, the consortium’s collective collaboration was essential and also commendable that the tendering process was completed within the tight time frame. It was ideal that each Trust could benefit from the competitive waste market to make savings and an excellent opportunity for us to investigate the additional services being offered and source a company who could process our waste with the minimum environmental impact”. 

For more information, contact our Customer Care Team on 0845 887 5000 or email customercare@htepg.com