The Procurement Act 2024 is due to go live in October 2024, the Act after Brexit, is aimed to simplify the procurement process and support SMEs. There is also a drive to be more transparent across public sector procurement.
There is increased emphasis on social value and policy goals, for example sustainability, climate change and social inclusion – otherwise, addressing inequality.
For using procurement to address inequality, it is imperative that buyers, and end users of goods and services should shape their procurements with people in mind.
In order to this, people need to inform their needs by using data models obtained by asking people directly, and this means consulting with people who are not usually consulted.
So, why has this not been happening?
In general, it’s historically a reflection of who is doing the role within organisations and them not understanding differences in culture.
Additionally, bad experiences cause a breakdown in trust. Where patients think it’s pointless as when they may have engaged or been involved in the past with healthcare services or feedback, their needs may have been ignored.
There are barriers because people don’t understand, but increasingly there are tools to help manage and involve people in these processes.
The key to reducing economic health inequality is through engagement, information and co design of the requirement. Procurers have not in the past listened to people, and the power of people is within their stories.
This has an impact on patient flow and recovery and quality of life. However, there is a need for people to take responsibility on themselves and be part of the NHS and there is a strong argument for encouraging the patient voice, and patients (and the public) need to embrace this better. There are a variety of conflicting priorities in NHS, and the relationship between people and the NHS needs to be symbiotic. What works in different demographics need to be considered. This is a challenge even if it’s the same service. The perception is that the NHS makes 1 decision and it flows down. Everyone has to consider that this is not the case, and due to this, there is lots of collaboration required which extends the time to make the changes which will impact this issue.
How can the economic side of the NHS be more inclusive?
This is through co-production of policy. With a view of “Not doing it to people but with people”. Data needs to be sought which can tell us the gaps in what people are accessing, and the different outcomes in different age/ gender/ locations.
Procurers need to focus on consultation with specific communities.
We want to make the NHS as local as possible, to benefit local people, so is there a shift in attitude?
Not really, there needs to be strong local leadership, which isn’t reinventing the wheel, but with a real drive to make sure that we don’t always do the same thing.
Funding is an issue.
Digital exclusion is an issue for certain communities, for example the homeless, the elderly and the young.
We shouldn’t expect people to offer input, as they may not be aware of what they need or what is available. Procurers need to adopt the attitude to learn from everyone and use people’s experiences to base the design of the procurement on. The focal point should always be patient first – if you start from financial point of view, the solution provides economic VFM but is not good for the patient. The procurement process should demonstrate the best outcome for the patient and then fund / cost it appropriately instead of matching the service with the money. The increased focus on supplier requirements for social value is a key opportunity to deliver above the subject matter if the contract. Suppliers could try to deal with health inequalities in this area of tenders, but procurers have to improve their supplier engagement activities.
Also, there needs to be increased occurrence of place-based procurement – this is vitally important for reducing health inequalities, diagnosis and care closer to the patient. Procuring for the local community encourages the use of services and gives people confidence, control and choice. It builds relationships and provides a pool of knowledge to continue improvement.
This needs to work closely with national programmes, and collaboration between local and national teams is important for best practice and trust. Good experiences should be shared to areas with inequality to help increase confidence.
The earlier that this interaction from suppliers and procurers with those with lived experiences, then the public pressure or appropriateness can be used to do develop procurement plans to address local needs.
There are health inequalities in provision of services but looking at this through procurement offers opportunities that local understanding will deliver better outcomes.
The sector needs to identify what the optimum local/ national/ regional level for our sector is and how we can evidence value so that the ICS is enabled to go beyond the direct requirement for the goods and services offered at a fiscal level.
If you have case studies or data that supports improving the economic inequality through diagnostics – please contact helen.dent@bivda.org.uk
