I’d like to do a wee bit more of an interactive session guys. So we’re going to have a wee bit of fun with this, I hope. So first of all just to say thank you very much for inviting me here, to John and to Ruth and to the team. And it’s really nice for me to be here on the 10th anniversary. It’s also really nice to be here because it’s the Marshall Arena and one of my passions is playing the electric guitar. And I’m probably one of the few guys in here who’s actually met Jim Marshall who invented the Marshall amplifier. And I’ve got two things to thank Jim Marshall for. One is all the pleasure I’ve had over 40 years of playing the electric guitar and the second thing I have to thank him for is the fact that I now wear two hearing aids. Anyway, so I had to come up with a snazzy title of something a little bit different and I came up with does our opinion count?
So the way things worked in the old days, we’ll come to in a minute, but first of all, as part of this interaction, what I would like to do is I want you all to imagine that you are the House of Commons. So I already see a couple of folk who are actually asleep at the back there anyway. So wake them up please. So I’d like you all to act like a complete shambles. Now, what we’re going to do is we’re going to have an indicative vote here. I would like, you’re going to get three options here, and your options are, you’re going to tell me, are you busy, that’s your first option, and secondly are you very busy, which is your second option, and your third option is that you’re too busy to get involved with equipment procurement. So let’s have a show of hands on option one, who’s busy? OK, right. Who’s very busy? Oh that’s a bit more popular. And who’s too busy to get involved in equipment procurement? Oh you took your hand down awful quickly there, yes. So what that does tell us is that we’re all busy. We’re definitely all busy, but we should be getting involved in that and we’re going to talk a wee bit about why.
So we’re going to talk about the old days here, just to kind of set the scene, and that’s because there’s quite a lot of nostalgic people in here and they like to talk about the old days. Now Laura mentioned yesterday if you were here that she was actually pleased to see that there wasn’t too much grey hair in the audience. And I think that’s because it’s all disappeared, it’s now no hair. So what happened in the old days and did our opinion count back then? So in the old days what would happen is that your supplies department or your purchasing department before they became fancy like procurement, they would tell consultants oh we’ve got some money, and they would say oh great what do you want? Well I’ll tell you what the consultants they’d say we’ll have some patient monitors, just as an example. So the supplies department they would then say great OK we’ll get patient monitors, but what would be the best ones to buy? And the consultants they’d say actually we don’t really know but there are some guys that deal with medical equipment and if we let them out of the cellar for a day they might tell us. Because most of us were based down in a dungeon somewhere and we did seem to know about those things and they did recognise that. So they would ask us and they would say what should we buy? And we’d say well why don’t you buy these ones because these ones are the most reliable, these ones have got the best service back up or these ones have got the latest technology and they do far more than all the other ones. So they were bought.
Now I don’t even expect Dave Mulvey to recognise this because this is from goodness knows when, but things were a lot simpler back then. And that’s roughly how it worked. And did our opinion count? Yes it did. People knew who to go to. There wasn’t actually that much medical equipment about when you look at it in the terms of today, so it was easier. Everything was easier in the old days wasn’t it, Dave? I’m going to pick on Dave a wee bit here because Dave announced he’s retiring in June and at one time I actually thought there was only one technical trainer in the whole of the UK and it was Dave Mulvey. But it’s not like that now is it? And so what we’re going to do is we’re going to ask does our opinion still count?
So a lot has changed and a lot has been touched on as we’ve gone through the conference. So there’s laws and regulations on how you can procure goods in the public sector. So there’s things like the European Journal. And I hesitate to say this, but another thing that probably had an effect on procurement was the Bribery Act. Now I’m not casting any aspersions but it’s amazing how many surgeons used to get wee visits to Florida where they just happened to have a medical centre or surgical centre set up. Bribery Act is the formation of the NHS-wide procurement organisation which I’ve already mentioned, NHS Supply Chain. In Scotland, we’ve got National Procurement Scotland, which is a similar sort of organisation. Finances have become much tighter and are expected to go further. There’s far more medical equipment to be covered with any replacement programmes and the expectations are far higher.
We’re looking for more out of our medical equipment now. We’re looking for things like reduced bed days, we’re looking for improved patient outcomes, the expectations of what it can do and what technology can do have already been touched on, but they’re far higher than they were. We’ve got, our procurement have come up with some wonderful scoring mechanisms to look at tender processes, and some of these are very heavily weighted on cost and that might lead you to believe that cash is king and actually what you get is the cheapest. But is it? Oh did I mention this? No I think probably we won’t mention it because we’ve already pretended we’re Parliament and I think that is quite enough of that. Also other things, so most equipment families they will have multiple manufacturers, they’ve got the same equipment and that’s roughly the same thing and there’ll be slight variations on it. So it’s harder to separate out the differences between these, and that’s made it quite hard to write a spec. And we can write a spec and what we get is what I call the Ronseal effect: you just get exactly what it says on the tin, you don’t get anything more and you don’t get anything less.
So who in the audience, and you’ll notice there’s a few who’s up here. I tried to get a who to cover the bulk of the audience for each of the ones that they could relate to, but sorry Dave the one just after the war they’ve lost the publicity stills for, so who in the audience has drawn up a specification before? Yes, so quite a few people and quite a few that haven’t. So you and I are actually going to have a wee go at it, right. So we’ve heard a lot about going out into the community, a lot of our work’s going to be out in the community. So we’re going to write a spec for a vehicle and it’s a pool car. This was the best I could get for a pool car. There’s certain irony there I suppose. So let’s face it guys we’re all techy and we’re a wee bit geeky. So when someone asks us what we want we tend to go right in there for all the bells and whistles and that’s before we get to the basics. So look the spec in this pool car. We want the full electrics don’t we? We want windows, locks, satnav, cruise control, auto-park, and then we put our sensible head on and we think well we better have four wheels, because we don’t want any Reliant Robins do we? So four wheels and we need an engine. So we’d better have an engine and we want to be able to transport people about. And we want a way of stopping it as well, because once we get it going we need to be able to stop it.
So that’s what we get, well in our heads that’s what we get. But then procurement, they come along and they say wait a minute mate, your spec is anti-competitive. You can’t have that, it’s a pool car, this is public money, it’s public money, you can’t spend it on that and anyway it rules out a vehicle that can get you A to B without any of those bells and whistles and it’ll still do the job – going back to the Ronseal tin. So they tell us make it more generic. So we say oh yes. So the sharp eyed of you will notice that that’s a girl this time, the picture of the geek, that’s because I’ve been on equality and diversity training and I know that girls can be geeks too. So girl geek, girl geek says well OK I’ll make it more generic, it’s got to have four wheels, an engine, a way of stopping and it’s got to be able to transport people. And women are generally a wee bit more sensible in that. Men like gadgets and gizmos don’t they in their cars? Women just want to get about. And that’s what you get.
Does anybody know what that is? A Trabant, that’s it, a Trabant. Now the thing about a Trabant is it was actually a very successful car produced in East Germany from the ‘50s right up to the ‘90s. Have you any idea why you wouldn’t get a Trabant now and why that wouldn’t be considered? Well we’ll come to that in the next slide. They’re still not happy, procurement, it’s still too specific and there’s the reason there, we’ve green targets to make, a Trabant was actually a two stroke engine. They’ve got green targets. Anybody had that experience now when you’ve been drawing up a spec with green targets. They want to know the power consumption. They want to know how it can be ethically disposed. They want to know what type of batteries it takes and how those can be disposed. Green targets definitely didn’t exist when I started in this 36 years ago, it didn’t happen. And anyway you’re ruling out electric vehicles, you don’t actually need to have an engine do you? Not these days, so it can be an electric motor. So we need to make it more generic again.
So we say OK let’s take it right down to basics. It’s got to have four wheels, a means of propulsion. It’s got to be able to move people and most importantly you need a way of stopping and that’s what we get – the Ronseal effect. Anyway writing a spec has really become a bit of an art form and this is a Banksy, but does our opinion still count? I would suggest it still does. Now we’re going to play a wee bit more here, a bit of interaction, does anybody watch Catchphrase, you know the game? OK. What do you think that one says? Any guesses? It’s a fine line between a roller and a roller skate, yeah.
So what about the value to the procurement process? So this was by, this little quote was by Professor Randy Pausch who is a professor of computer and human interface in the States. And he said be good at something it makes you valuable and have something to bring to the table because that’ll make you more welcome. And what have we got? And what have we got in abundance? We’ve got information and we’ve got expertise and always remember that knowledge is power. If you’ve got that you can be quite powerful.
Now Albert Einstein he was up here yesterday again, so, Albert Einstein gets quoted a lot at these conferences and he was quite a clever guy, I believe. But he’s illustrated here one of those problems that I think is particular to us and it has been touched upon throughout the conference, we maybe don’t have the biggest egos and we maybe don’t put ourselves forward too much and we don’t beat our drum loudly enough. Albert Einstein says the more the knowledge the less of the ego, the less of the knowledge the more of the ego. We’ve got a lot of knowledge and we don’t have a big enough ego. So that means that someone is going to have to rewrite this equation so we get to be known for more knowledge and we beat that drum louder so that people know we’re here and what we can contribute to the process.
So before I go on to that I would just like to ask, those people that think that they’re very busy, do you feel that you’re under pressure in your job? Yes, so there’s quite a few nods in there. And my boss actually said to me just a couple of weeks ago when I was moaning about the workload that it would be interesting to see how it performed under pressure and I said to her, I don’t do that one actually, but my Bohemian Rhapsody’s quite good. I’ll have to think about that one. Anyway, my wife always said I should try and be funny. But usually I’ve taken her hearing aids out by that point. Anyway, so your medical equipment database, it’s really the most powerful tool and it gives you a lot of clout, what can we tell from that? We’ve got equipment age profiles. We have reliability data, you can do risk analysis from it. You can actually get a planned programme of replacement up and running. And you can tell your procurement what is needed and when it’s needed.
So the question today who else knows as much about medical equipment as we do? Caroline touched on that. And the answer to that is nobody does. We know about things, things outside of your equipment database. We know about the ergonomics of devices. We know about build quality. We recognise build quality when we see it. We know about supplier performance, no offence to any suppliers in here, but we do know about performance, including things like their after sales care, technical backup, how good they are at supplying spare parts when you need them. We know about things like outstanding safety alerts on particular bits of equipment and we know how to look these things up. And if we don’t know about it, we know a man that does. There’s a network of us across the country and I’ve yet to pick up the phone to ask someone, can you tell me about a piece of kit that we’re looking at and thinking about buying, for them not to tell me how they’re doing with it. We are quite free with our knowledge and our expertise and we’re quite willing to share it. And you only have to look at the 10,000 members that John was talking about yesterday who registered on EBMA website who often do that, exactly that, shared knowledge. So we have that community there already.
So a prioritisation process, we’re going to talk about this a little bit. I pinched this little, I don’t know what you’d call it, down at the bottom here from Public Health Wales because it was the only thing I could find that had things like evidence based prioritisation, rational decision making, cost. So these things are things that we really do need to consider. We know that budgets are tight. We’ve already discussed the fact that money is expected to go much further. So what we would like to see you all do is use that data that you have. If you don’t have a system already to get contributing to your health board or your trust’s prioritisation process, get yourself one. It’s not really that difficult and I’m going to illustrate it.
So here’s one that we use. It’s quite simple. We’ll look at, I’ll talk you through this, so we look at what’s the function of this device? Now I’m not saying this is perfect and they’ll be other ones out there, but you give each of those functions a weighting, and you can see I’ve put them in brackets there, whether it saves or supports life or whether it’s a patient treatment device, monitoring device, diagnostic device, you get the idea and you give that a score. Then you look at all those things that contribute on the maintenance side, whether it has got no technical support from the manufacturer, so it’s out of support, you can’t get parts, they won’t service it, whether it’s on a best effort support, whether it runs on a software platform that’s unsupported. I think that one’s actually probably going to have to go up a wee bit in terms of its score now though. It wasn’t so when I first wrote this.
Consequences, this is to the patient, whether the consequences of that not being replaced and malfunctioning might be death, injury, mistreatment, delayed that treatment diagnosis. And failure rate, so we’re back again to your database and look at what’s in your database. You can pull out failure rates for models. You can do all that; you’ve got all that power there. On top of that we look at the frequency used, how often is that device used, whether it’s daily, regularly, etc. Whether there’s any back up or redundancy to this, so it might be a single item in which case it’s a single point of failure, it might be one of multiples that you’ve got other ones there that you can tap into. And then lastly down in the left-hand side we’re looking at the corporate aspect here. So this is the impact on the organisation. We’ve already included impact on a patient. So things that your management might be interested in like loss of a major service or whether it’s a failure to meet waiting time targets, if it’s a big ticket thing like an MRI or something like that. So you give these all a score and you end up with what’s at the bottom which is a final risk score.
So that in itself is great, but it doesn’t tell you anything really because you’ve got nothing to benchmark it against. But if you do that for all the categories that you’re considering then what you end up with is something like this. So that last one was for the ventilators and you can see there that they came in at 55. Anaesthetic machines, they came in at 69. The reason they came in so high was because we had such a proliferation of them and they’re all about to go out of support over the next two years. We couldn’t wait to try and just replace those all in a year. Now you’ll notice some of these have got the same ranking, unfortunately when you do this that’s going to happen. What this does though is it does give your procurement department and your board who consider what they’re going to replace, it gives them as an objective a way of looking at replacing it and deciding on what’s to be replaced as possible, because you’re always going to have a little bun fight aren’t you if you leave it to consultants, they like this, they like being told, replace this, because then they have something to go back and say no this is what we’re going to do because here’s the risks.
You’ll notice also that I’ve put a replacement value in there as well. I stopped at £16m. This was for last year, so this was for ‘18/19. I stopped at £16m because we don’t get anything like £16m, and this also illustrates something neatly as well. We need roughly £15m every year in my health board to keep up with the equipment replacement. We get allocated £5m. That’s the challenge that we’ve got. And of that £5m it doesn’t all end up with that planned replacement I’m afraid, because in-between times we have emergency things that have to be replaced and we end up with closer to £2m. So you can see how short we are in actually being able to fund what we need to. And that creates a real problem and that’s why it’s so important that you target it where it needs to go. So remember bring something to the table, a fine wine’s actually a good thing to bring to the table, and actually buying wine could be a bit like buying medical equipment if you take it on a case by case basis. I know we ought to have a little drum sound up here.
So I was talking earlier about the weightings and how it’s heavily weighted towards the cost. So this was a recent example from Greater Glasgow and Clyde for a coronary care unit, and this is the weighting that was given out on the tender process to the companies who were to tender for this. And you can see there: commercial. So commercial is your capital cost, it’s your lifetime cost, all that. Commercial was given a weighting of 50%. We can’t really influence that too much. But if you look at those other things, the technical side, so we’re looking at performance and things like that, we’re looking at service support, there’s 30% in there. Functionality, also as well we know about ergonomics and things like that, it’s not all about the nursing staff being able to use it easily as well. So there’s a big chunk in there that we can actually tap into and we can comment on and contribute to.
So does our opinion still count? I think that it does and I think that if it doesn’t as we said earlier it’s up to you to make it count. Take that to your senior management, come up with your plan, come up with your way to do it, take that to them and show them where they can make that investment. You’ve got all the tools, they’re there, you just need to use them. However, it’s important to note, there’s two differing definitions of opinion. One of which is, a view or a judgement formed about something not necessarily based on fact or knowledge and also a statement of advice by an expert on a professional matter. And I think the last one is where we want to be with that. There is a third view on opinions, but I’m going to let you look it up yourself and that was Harry Callahan in Dirty Harry who had an opinion, no I’ll leave you, go and Google it, Harry Callahan opinions. Somebody knows what it is.
So thank you for listening. Before I sign completely off though, you’ll notice there was a wee theme in here. So we had a boy geek, we had a girl geek. We had Dr Who which is basically for geeks. We’ve got Spock, Trekkies, it’s a bit kind of geeky. So what I would like you to do is to consider this. It’s been scientifically proven that one in three people that works with medical equipment is a geek. So what I would like you to do is look at the two guys either side of you and if they’re all right it must be you.
Thank you very much.
Ted Mullen's presentation at the EBME Expo Procurement - Does our opinion count?