A challenge often faced by technology providers is understanding how to go about working with, or ‘selling to’ the NHS. From the perspective of a supplier, the NHS, in its many guises, appears a confusing, impenetrable establishment where procurement of services is considered somewhat of a black art. This can be very frustrating, particularly when there is a clear mandate set by UK and Regional Government to focus on health and care-based Innovation.
This blog will outline how products and services are procured by the NHS, the mechanisms of support available to suppliers and suggest how best to gain procurement traction within the organisation.
The prevailing perception
A recent report from the DHI commissioned by UKRI as part of the MINDSET Programme highlighted the sense of confusion be companies when considering engaging with the NHS;
‘Companies are not clear what they need to do to be in a state of readiness e.g., level of evidence to meet innovation procurement requirements. They tend to engage directly with individual clinicians to raise awareness and undertake trials; however, this is unlikely to provide significant market traction as the clinicians/trials tend not to be linked to procurement routes.’
In addition, suppliers often express concern around the lack of a single ‘front door’ to the healthcare procurement environment. Decision making in relation to acquiring services into the NHS appears disjointed and inconsistent leading to confusion around the various innovation and funding support models available to suppliers and how these differ based on geographic region. Similarly, there is no single procurement model into the NHS, which is perhaps unsurprising bearing in mind the scale and complexity of the organisation.
Procurement within NHS
The procurement-related functions of public sector bodies including the NHS, can be divided into three main aspects:
- Funding Distribution – top level funding distribution/procurement, directly by government or through another public body such as a health board/trust.
- Commissioning – assessing needs, planning, and monitoring services.
- Procurement – directly acquiring goods and services.
Responsibility for these functions is typically divided between national, regional and local organisations.
The Current National and Regional Landscape
At the national level, commissioning and procurement are typically overseen by distinct entities. In the United Kingdom's healthcare system, the primary organisations responsible for procurement are NHS Supply Chain in England, NHS National Services Scotland in Scotland, NHS Wales Shared Services Partnership in Wales, and Procurement and Logistics Service in Northern Ireland.
At the regional level, there are 42 Integrated Care Systems (ICS) in England and 318 local councils; 14 territorial health boards in Scotland with 32 local councils; 7 local health boards in Wales with 22 local councils; and 5 Health and Social Care Trusts and Local Commissioning groups in Northern Ireland. These organisations tend to be responsible for both commissioning and procurement.
Innovation support depends on product maturity
Various mechanisms can provide support for different stages of innovation depending on the ‘readiness’ of the product or service. Support types are listed below in terms of increasing innovation maturity level (though clearly there will be a degree of overlap). Please note, that much of the content below has been extracted and abbreviated from the excellent DHI/UKRI report referenced above.
Signposting, engagement and trialling
If the product or service is at a very early stage, the NHS Innovation Service in England, Scotland Innovates, and Digital Health Wales offer online portals to guide innovators towards relevant assistance. These platforms have established connections with numerous organisations that can provide support. Applicants are required to complete a form describing their innovation, which is then used to direct, assess, and connect them with suitable opportunities for testing and development.
Evidence generation
When a solution is in its early stages of innovation, it becomes essential to generate evidence to demonstrate its potential value. During the initial stages, the focus of evidence gathering for such innovations may revolve around conducting trials and implementing them on a small-scale, local level. This can involve reaching out to individual clinicians or interested local services. This approach is crucial for gathering evidence and building confidence. In addition, there are other avenues to generate initial evidence, such as collaborating with academia to conduct research studies, carrying out feasibility studies funded by the Small Business Research Initiative (SBRI), or working directly with third sector organisations or local authorities.
Challenge Calls
An innovation challenge call refers to a situation where a procurer publicly announces a request for all suppliers operating within a specific field. These calls typically outline a particular area of demand and provide an estimated contract value. They specify whether they are seeking feasibility studies or more advanced research and development (R&D) projects. Suppliers submit their applications, detailing their proposed solution. These applications undergo evaluation, and the most promising innovations are selected for further support, often in the form of R&D funding and guidance. Innovation challenges often adopt the format of pre-commercial procurement, such as the Small Business Research Initiatives (SBRIs). Numerous organisations issue these calls to encourage innovation and collaboration.
Case Study – Infix
PRODUCT OR SERVICE
Cloud-based software, which automates the process of booking hospital operations.
The solution integrates in real-time with the NHS’s electronic patient records system, Trakcare, and automatically books operations based on the urgency of each case and how long each patient has been waiting. This was a process previously done manually by staff.
FUNDING / PROCUREMENT SUPPORT
Since raising an initial £300,000 in autumn 2020 from private investors and Innovate UK, the UK's innovation agency, Infix has announced further funding including angel investment of £125,000 last August and a £100,000 prize in the Scottish EDGE competition last month for businesses with high-growth potential.
Research and development (R&D)
R&D funding plays a crucial role in advancing innovations that have demonstrated feasibility. Such funding provides assistance across various stages, including planning, prototype development, regulatory approval, and testing. The innovation partnership procedure is specifically designed to support R&D in a dynamic lab environment, allowing for further refinement and development of the solution.
In addition, certain R&D funding is available through pre-commercial procurement approaches, such as the previously mentioned SBRI. This approach involves a competitive process where multiple suppliers simultaneously offer R&D services to public procurers. The competition unfolds in several phases, progressively narrowing down the number of suppliers. Throughout this process, suppliers maintain ownership of the intellectual property, while procurers seek innovative solutions to meet their specific needs.
Case Study – ScotCAP
PRODUCT OR SERVICE
SCOTCAP Service Evaluation was embedded within the CCE service, rolled out across three Health Board Regions, and was a multi-centre service evaluation of patients (presenting with GI symptoms to their GP and patients waiting for colonoscopy).
FUNDING / PROCUREMENT SUPPORT
Innovation Partnership Procurement Process
Bidding on contracts
Innovations that are ready for implementation and have substantial initial evidence can compete for public sector contracts, provided there is both demand and available funding. For innovations with limited evidence of impact or less developed business models, smaller-scale local or regional procurements may be more suitable. Innovations with robust evidence of large-scale implementation may be better suited for national procurements.
Solutions with limited evidence often undergo initial introduction and development within a single service or local organisation. This may involve unpaid trials through portals or individual contacts, as well as applications to funded innovation challenge calls. Solutions that have gathered sufficient small-scale evidence can be implemented across a broader range of organizations or at a regional level. This can be achieved through R&D procurements or innovation partnerships.
Who to contact
As outlined earlier, innovation and procurement support is available at various levels depending on region and service (or product) readiness. Details on specific Innovation Organisations for England, Scotland, Wales and NI can be found in Appendix 2 of the DHI report which also features the table below outlining UK wide innovation support.
Best practice
Until such time as a ‘standardised’ approach and ‘route map’ exists in relation to NHS procurement, a self-driven formula that appears to be effective based on the Case Studies mentioned above is the engagement and leveraging of combined innovation support available at national, regional and local levels. It is probably the case that some of these organisations are considerably underutilised bearing in mind the expertise and influence they offer, and effort spent establishing the right consortium of support, while time consuming, can have significant long-term benefits.
It’s fair to say the NHS and the associated support bodies are aware of the challenges faced by suppliers and the all-round benefits to be gained from addressing persistent issues, particularly those experienced across the range of medical services. Hopefully, in the next few years (and partly inspired by the innovation time warp that took place in response to Covid-19) new mechanisms and processes will be established to support more effective and efficient procurement. Based on a degree of experience working in the health and care innovation space, this could take several forms, including a publicly available ‘innovation procurement blueprint’ and designated points of contact with the responsibility of guiding companies through the process, saving time and money while inspiring and supporting product development.
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