Source · Select Committees · Public Accounts Committee
Recommendation 23
23
Accepted
Free' specialised devices create perverse financial incentives, conflicting with clinical judgement.
Recommendation
NHSE described how it has established an evidence base for which specialised products are best to use (formerly known as high cost tariff excluded devices and now known as the Specialised Services Devices Programme). NHSE explained in written evidence that products purchased through this route are effectively free to trusts, with any consequent savings being available for spending elsewhere in the NHS. The resulting financial incentive for the trust is to purchase the ‘free’ device, creating the potentially perverse incentive of local financial incentives being in tension with local clinical preference or clinical judgement and not therefore always in the best interests of patients.40
Government Response Summary
The government agrees and claims the recommendation is implemented, stating NHS Supply Chain will redesign its Commercial Service Proposition by November 2024, led by a new Clinical Executive Director, to enhance clinical engagement in sourcing decisions. This aims to ensure procurement considers a broad range of value drivers, including patient outcomes and clinical efficiency, to counter the identified perverse financial incentives.
Government Response
Accepted
HM Government
Accepted
6.1 The government agrees with the Committee’s recommendation. Recommendation implemented 6.2 NHS SC engages clinicians in all sourcing decisions. Lead trusts are used to ensure the voice of the clinical workforce is at the forefront of understanding needs that should be fulfilled by commercial activity. 6.3 To create the opportunity to enhance the voice of the clinical teams in future decision making, NHS SC will re-design the Commercial Service Proposition by November 2024 and be clearer in the opportunities for representative clinical groups to engage in future commercial activity. This work is being led by the newly appointed Clinical Executive Director of NHS SC. 6.4 NHS SC will continue to work with NHS Trusts to identify when they will implement the current schedule of Value Based Procurement initiatives and continue to focus selection criteria for supplies across the broad range of value drivers in the NHS (including sustainability, patient outcome and clinical efficiency alongside unit cost). 6.5 These steps will help reduce the current catalogue of around 600,000 individual items where the intention is to ensure that any product that an individual clinician might want is available for them to purchase to one where there is a smaller list of products based on clinical input and best practice. 6.6 NHS England will provide clinical support to NHS SC where necessary to support the delivery of the savings programmes.