An easy route to better patient safety

There is a huge government push to focus on delivering cost savings across the NHS – but it should not be to the detriment of patient safety. In this article I would like to advise trusts how to take stock and take control to realise the significant cost savings that can be achieved through better stock control.

Recent events
In the past few months the dangers of poor stock control have been underlined by a series of news stories. Medics at Bromley’s Princess Royal University Hospital complained that “crude” cuts led to items running out of date, including sealed chest drains, epidural packs and gynaecological and radiological disposables. In Scotland the Healthcare Environment Inspectorate (HEI) reported that Caithness General Hospital’s maternity unit held out of date sterile medical supplies, some of which expired in 2002.

During one recent NHS hospital stock review we filled two plastic sacks with out of date clinical supplies – some should have been binned in 2005. Far from being unusual, we have found out of date stock at five of the hospitals we’ve checked this year. The biggest worry is that one hectic day some of these items could have ended up being used on a patient undergoing surgery or in a medical ward, with a disastrous outcome. As the NHS is pressed ever-harder to deliver more for less there’s every possibility that these kinds of risks will grow.

There is evidence that NHS staff want to see changes and improvements in the handling of clinical supplies. A GS1 UK Healthcare survey found that 63 per cent of nurses and 56 per cent of doctors put real-time views of stock levels in the top three on their IT wish lists. But as an age of austerity spreads across the healthcare sector it’s possible that senior management will be reluctant to modernise their systems because they are too worried about costs. Yet, if this happens, the growing demands on hospitals and increasing complexity of treatments mean their supply chains will become less and less able to cope. That means we can look forward with some trepidation to an increasing number of news stories about operations being cancelled due to equipment shortages, or staff having to rush to other hospitals to get basic supplies.

Hospital managers will try to explain that they are doing their best, but there will be precious little sympathy when a mum and dad are saying that the drugs or equipment weren’t available to treat their child. Legal actions and large compensation payments will follow, and then we will naturally get into the territory of whether the UK government and devolved administrations are providing enough cash. However, much can be done to avoid this kind of scenario.

Evidence Based Savings assessment
When hospitals invite us in to do what we call an Evidence Based Savings assessment (EBSa) we look at what they have in stock and how it’s stored. At that point we sometimes have staff telling us that more space is needed and they are thinking about converting things like nurses’ areas for storage. Closer inspection often reveals that about 20 per cent of what’s on the shelves is stuff that for a variety of reasons – for example it’s a product they no longer use – can be got rid of. Then there are the items that have passed their use-by date.

What’s actually needed is a thorough clear-out. It can help with the space problem and, far more importantly, it improves patient safety. Some old stock can even be used for training, however, this has to be separated out so there’s no risk of it getting near patients.

Getting rid of clutter also helps address a frequent complaint that staff end up wasting time because they can’t track down what they need. But this is just the start. Once you have got a handle of what’s overstocked and, more crucially, what’s understocked, you can start making rapid gains that will pay for themselves.

Most of the problems come about because the stock control and distribution systems at hospitals are obsolete. They have not been at the top of the priority list for organisations having to focus on pushing down waiting times and meeting umpteen other targets. The relatively rosy financial times also meant it was a problem that could be lived with. It is not a problem of poor management – quite the opposite. Managers, clinicians and everybody else know full well that there is a real need to deal with supply chain management.

Finding a solution
Identifying the problem is one thing, finding and implementing the solution is quite another. An EBSa or equivalent in-house exercise, to look at exactly what’s being ordered and why, is a vital first step. All too often the purchasing process is unquestioning – regular orders go in and supplies turn up, but some remain unused and stock builds up. Alternatively, when something is used a replacement is ordered regardless of whether it’s actually needed.

This is not the fault of any individual; it’s simply that they are stuck with old-fashioned, often paper-based systems that belong to a past era. Healthcare is now so complex, demanding such an enormous variety of equipment and materials, that such systems are simply not fit for purpose. Rather than working in the hospital’s favour, the supply chain actually ends up being a liability, and soaking up money because unnecessary items are being bought. When we carry out an EBSa we can normally expect to identify savings of at least five times the cost of the assessment. We have never yet been to a hospital where worthwhile savings can’t be found.

If IT is good for anything it’s for stock control, telling you what’s in stock and where it is, following it through the system from storeroom to patient. This gives immediate control over ordering and distribution, driving down costs by cutting waste and raising efficiency by making sure that the surgeons and maternity ward staff have what they want when it’s needed.

Choosing supplier
I’m glad to say that Secretary of State for Health, Andrew Lansley, has emphasised that needs vary and has promised that the NHS can have the freedom to choose suppliers and solutions. But I would like to sound a note of caution. There have been cases where we have found that hospital management has tried to improve stock control, but found that the project has run into problems as the staff had raised valid and unforeseen challenges. This is partly because wide enough staff involvement and buy-in hadn’t always been sought from the outset.

It’s very easy to underestimate the extent to which supply chain issues affect working lives and the impact – or the fear of – change. The fear can be to do with worries about job losses, or about the impact on clinical services. A prime example of the latter is when surgical teams over-order seldom-used items for fear of one day being caught short by an unexpected demand. What they need to be sure of is that the process is about optimisation not just reduction – or the “crude” cuts of the Bromley example. A good supply chain management system only eliminates unnecessary stock.

It also means monitoring the situation and making sure that older stock gets used first. The objective is to ensure that the clinician has exactly what they need, when they need it, and that it can be found easily. This is one of the reasons why I would suggest that a full assessment of the existing system is carried out before anything else happens. Once staff are presented with firm evidence of the waste, and both asked and shown what can be done to make things better for them, then the enthusiasm for modernisation found in the GS1 UK Healthcare survey starts to kick in.

Supply chain optimisation
In fact, supply chain optimisation is probably one of the quickest and easiest changes that can be implemented. And it’s something which organisations can approach with confidence as there are people around with lots of experience who can help them get it right. As to the financial implications, we estimate that the NHS could save £300 million over three years – in the current climate that’s a pretty attractive sum.

What would be useful is to see the government push supply chain issues up the priority list. The current, very welcome, consultation on Liberating the NHS: An Information Revolution comments on how effective the retail sector is at recording items at point of sale then following them through the system in a way that generates an abundance of valuable information.

Quite reasonably the main focus of the paper is on the relationship between patients and healthcare providers. But I would argue that an information revolution needs to reach into every part of the health system, and that quality of care is directly linked to clinical supplies. My hope is that this recognition will be firmly embedded in any action that results from the consultation. If that happens, the NHS, and the Westminster government, could end up in the happy situation of being able to push forward together to save money and deliver better services.