Wednesday, 24 April 2013

Jeremy Hunt's recommendations for procurement improvement

On the 26 March the Heath Secretary outlined his response to the Francis Report; the investigation into healthcare failings at Mid Staffs. I have been watching some of the NHS discussions and, in parallel, following the Public Administration Select Committee (PASC) Inquiry into Public Procurement. As I listened to the discussions on the Francis Report I had a vision of Bernard Jenkin (Chair of PASC) having had coffee with the Health Secretary and each accidentally leaving with the others papers. Just to clarify, I wondered what would have happened had suggested improvements for the health service been transferred across as recommendations for public procurement improvement.

First a caveat, I am not in any way trying to undermine or trivialise the significance of the horrors experienced by patients and their families at Mid Staffs, but merely exploring transferability of the proposed NHS improvements to public procurement. PASC will need to come up with something significant in the light of the conflicting evidence their Inquiry uncovered and decades of inertia, while CIPS has long argued that the procurement profession should be viewed as an equal of other professions. Now I pose the question: "Is what's good for the goose, good for the gander?".

Let's consider the Health Secretary's rationale for a response as an example of what I mean:
"Actions that must ensure [public procurement] is what every [procurement] professional and [citizen] wants - a service that is true to [government] values, that puts [citizens] first, and treats [it's users and the market] with dignity, respect and [professionalism]." 
Hopefully the above provides a feel for this blog, so let's see what you think?

It is recognised there is a need for culture change in the NHS. It is also inconceivable that PASC will not agree there is a need for culture change in the light of the evidence they considered. While the NHS needs to ensure a culture of 'patients first' is embedded, public procurement, I would suggest, needs to get on top of implementing policy, reducing costs, managing risk, working more strategically and collectively across silos, and with perhaps a little more honesty and humility.

I applaud the government for recognising mistakes happen in healthcare and there is a need to learn from those mistakes while fostering a culture of managed risk. Is it not true that public sector has too high a level of risk aversion embedded within its culture. Public procurement needs to also accept that mistakes happen and yet proactively encourage more innovation through prototype procurements. I think the current NHS system of explaining risks to patients prior to an operation is good but I have very, very rarely seen anything remotely similar applied in public procurement - why is that acceptable?

The NHS needs to protect patients against the risks of harm and inhumane treatment - public procurement needs to protect the public purse from the risks of money wasted and unreasonable treatment of the market. Like the NHS, a review of the implied public procurement complaints procedures needs stress tested. I have met so many bidders who lack confidence in the current processes and have demonstrable evidence of what appear to be systemic cover-ups, public procurement clearly needs to do better. Yet we heard public procurement leaders praising the very systems which many simply neither trust nor use.

The NHS has been too focused on compliance with regulation. Equally, public procurement appears to have been too focused on compliance with regulation, even to the extent of not sharing information across silos, and an excessive risk aversion to EU procurement regulation compliance. I'm not suggesting ignoring the Regulations and breaking the law but more intelligent working within the Regs. To make this happen procurement and legal professionals need a culture change to 'can do' and bravery. Some will have other more colourful descriptions.

The NHS will see a super inspector introduced and challenging peer-reviews. Strange thing is procurement capability reviews and IDeA Fitness Checks have been stood down - perhaps they were set aside too early, or was it because there was insufficient attention paid to implementation of their recommendations?
"[In the NHS] in order to expose failure, recognise excellence and incentivise improvement, the Chief Inspector will produce a single aggregated rating for every NHS Trust. Because the patient experience will be central to the inspection, it will not be possible for hospital to get a good inspection result without the highest standards of patient care."
I don't think there is any doubt, even though it contradicts the decentralised government agenda, that the aggregated ranking approach could be applied to public procurement with the substitution of 'procurement' for 'patient care'. However, I do doubt that would be applied as, if it were, it is likely to highlight that central government procurement has frequently been the laggard in public procurement performance while it has often presented itself as the innovator. Wouldn't it be interesting if, at the time of the next inquiry into public procurement, some local authorities were explaining how they had effectively and innovatively developed and embedded best practice - certainly my review of the GO Awards entries suggests superior public procurement performance is in place within the wider UK public sector.

I have long sat in the camp which holds that if someone is paid well to lead procurement initiatives in the public sector then they should also accept personal accountability. Therefore, if their performance is less than would have been expected, they should not be rewarded for failure and should carry their legacy of failure with them so that their potential risk to other employers and stakeholders is clear. So, I personally have no problem with the NHS having personal accountability and similarly that being applied in public procurement.

The media have picked up on the proposed new NHS statutory duty of candour. If public procurement is to progress I would suggest it also requires a statutory duty of candour - candour on who are 'the blockers' to the implementation of procurement policy and change management initiatives, candour on when errors in bid evaluations have been discovered but not admitted, candour when fraud or corruption is suspected, and candour when incompetence is present. Who would fear such candour? Surely only those who have stood in the way of procurement improvement for decades!

Then we have the need for prospective nurses to have a year of healthcare assistant experience. The nursing profession say "nurses are not too posh to wash". Would it make sense for prospective public sector CPOs to have had a year's experience of delivering basic purchasing. Yes, I mean basic buying. As a profession are we too posh to buy? My own view is that it has helped me to periodically take on basic purchasing roles as it has kept my feet on the ground and been a really useful, if at times more difficult than I expected refresh. So while I would not necessarily copy the 'one of' year's experience I think there may be merit is say, six months every six years.

I started by hypothesising what would be the impact if the proposals for healthcare improvement had inadvertently been mixed up with those for procurement improvement and we ended up with Jeremy Hunt's recommendations for public procurement improvement. Now I conclude there may well be a good case for directly copying the proposals for healthcare improvement to public procurement. I wonder is Bernard Jenkin thinking something similar?

NB This blog was previously published as a two part guest blog on Spendmatters 10 April  and 11 April

No comments:

Post a Comment