Commissioning and procurement

Transcription

1 England Sustainable, Resilient, Healthy People & Places Module: Commissioning and procurement

2 Module: Commissioning and procurement Vision: Every pound spent enables positive health, social and environmental outcomes The measures of success by 2020 are: Commissioning of programmes and services realise wider environmental and social benefits A responsible, whole lifecycle approach is taken to procuring products Commissioning organisations are key partners in enhancing the environmental, social and economic wellbeing of local areas Assessment of business cases, option appraisals and models of care redesign include social and environmental impacts alongside financial impacts. Introduction In England over 88 billion of public money is spent on health and care services commissioned for local people. Delivering health and care services in turn involves the procurement of a large amount of goods, services and infrastructure, with the health and care system spending over 40 billion each year. This presents a significant opportunity to influence health and care providers, as well as suppliers of goods and services to develop more environmentally, financially and socially responsible practices. The sustainable clinical and care models module 1 highlights how these underpin high quality care. This module is divided into two parts that focus on: 1. Services: The specific role of social care, public health and NHS commissioners 2. Products: A whole lifecycle and responsible sourcing approach to procurement of goods 2 Sustainable Resilient Healthy People & Places

3 Turning Point Connected Care model Connected Care recruits and trains people from the local community to carry out in depth research of people s views and experiences of local services. This information allows commissioners to understand the changes needed in social care provision. Connected Care then works with commissioners to design bespoke services and provide support for integrated health, housing and social care. This approach has been successfully used across the country. Putting the voice of the community at the centre of service design results in a more integrated delivery covering a range of needs 2. The RCGP understands how essential it is to provide high quality care in ways that are sensitive to the environment. General Practice delivers around 90% of patient contacts each year and General Practitioners are also central to the process of commissioning further care for our population. GP led Clinical Commissioning presents an ideal opportunity to help us to move to more effective, less damaging ways of delivering health care" Maureen Baker - Chair of Council Royal College of General Practitioners Commissioning and procurement 3

4 1. Services: The role of social care, public health and NHS commissioners Commissioners across social care, public health and in the NHS have the power and responsibility to seek maximum economic, environmental and social value in the commissioning of services. The increasingly diverse range of providers of health and social care makes this more critical than ever. Sustainable commissioning takes a whole system approach to improving the health and wellbeing of the people it buys services for. It recognises that commissioning services in a way that utilises local assets, improves the local environment and empowers local people and communities, can achieve wider benefits from the same investment. Sustainability and social value can be optimised in the commissioning cycle when it is a core aim, built into the process from the outset and then embedded into all subsequent stages. At the planning/policy development stage - To help justify commissioning decisions, commissioning organisations could prepare and adopt a sustainability policy and management framework that covers a range of issues including carbon emissions, resource consumption, resilience, social gains and ethical supply chains. This may take the form of a Sustainable Development Management Plan (SDMP) 3. During the commissioning cycle - To enable a sustainable commissioning approach, the principles of sustainable development could be considered throughout the commissioning cycle and procurement process. For instance, as part of designing service specifications and invitation to tender documents, commissioners could use local benchmarking data to establish indicators against which providers can be judged. This might include data on emissions or energy usage at an estate or patient level. Additionally, working with local stakeholder groups, the social impacts of any service can be established and specified in measurable ways. This could include the use of existing community assets, focusing on local employment skills and resources and additional impacts beyond the immediate scope of the service being commissioned. In the monitoring and evaluating stage - Commissioning expectations can be used as the principal driver for improved sustainable development performance by provider organisations. The mechanisms provided through contracts could include social and environment indicators against which a provider is managed. These might include: Communicating organisational commitments to minimise environmental impacts Carbon management and monitoring Contribution to wider social value. Enhancing social value through the design and delivery of services Commissioners can seek to enhance social value by incorporating community assets and voluntary or third sector providers into the existing commissioning and delivery of health and care services. The Turning Point Connected Care model is just one example that illustrates the potential of shifting the commissioning and delivery culture from one designed to meet needs to one that utilises local assets to support health, care and wellbeing. The NHS Standard Contract - Service Conditions SC15 Services Environment and Equipment - requires all providers to: Take all reasonable steps to minimise their adverse impact on the environment Demonstrate their progress on climate change adaptation, mitigation and sustainable development, including performance against carbon reduction management plans, and must provide a summary of that progress in their annual report. 4 The headings against which providers might be assessed include: Reduced impact on carbon emissions and air quality Reduced resource use and less waste Positive impact through the supply chain Adaptation and resilience to environmental change Harnessing pro-environmental and social behaviour to benefit health. 4 Sustainable Resilient Healthy People & Places

5 2. Products: A whole lifecycle and responsible sourcing approach to procurement of goods Sustainable procurement requires the health and care system to work in partnership with suppliers and the supply chain to take into account the whole lifecycle, environmental, social and ethical impact of procured goods and services. It takes into account the carbon emissions released and resources used at all stages of the products life i.e. from extraction, processing, manufacture, distribution, use and disposal or recovery. The procurement of goods and services represents 72% of the NHS, public health and social care carbon footprint 5. Measuring and reducing the carbon footprint of procured goods and services can help demonstrate a more sustainable procurement approach across the system. A pragmatic approach for procurement professionals could be to identify goods and services with significant impact (for example by using a carbon footprint analysis tool) and then prioritise stages of the lifecycle that need addressing in more detail. The four steps in the Procuring for Carbon Reduction Hierarchy of Interventions 6 approach provides a useful framework for procurement professionals to take action in this area : 1. Reduce demand The most environmentally sustainable solution is to look for opportunities to reduce the need and demand for goods and services. A sustainable procurement approach constantly questions whether procured products are necessary, supports interventions that reduce demand for products or uses them more efficiently ensuring procured products are not wasted. 2. Efficiency in use Procurement approaches can aim to buy products, equipment or services that consume less and have a lower environmental impact throughout their in use life and at their disposal and recycling. 3. Substitute and innovate Understanding the environmental and social impact of procured goods in more detail can help identify opportunities to improve sustainability. Where appropriate, alternative products, materials or approaches can be used that have less impact on the global environment and are more sustainable. Commissioning and procurement 5

6 4. Supply chain management Improvements in the performance of suppliers and their supply chain can be achieved by setting clear expectations through the procurement process, and working closely with suppliers to find innovative solutions that deliver sustainability benefits for both parties. Enhancing social benefits through the supply chain The health and care system has an ethical duty to protect and promote health and wellbeing. It is important that suppliers of goods and services operate in a socially responsible way. Buying goods or services from suppliers which damage public health through poor environmental practices or promote social inequality through their employment practices is a breach of that duty. Equally the health co-benefits of buying goods or services from providers that take sustainability, staff health and wellbeing and environmental impact seriously will deliver savings and improve health outcomes through linked environmental, social and financial considerations. Public Services (Social Value) Act The NHS, public health and social care system should aim to use its buying power to generate social benefits. This duty is enshrined in the Public Services (Social Value) Act 2012, which brings a statutory requirement for public authorities to consider economic, social and environmental wellbeing, when negotiating public service contracts 8. The products and materials used in delivering health and care are procured from all over the world. An environmentally and socially responsible procurement approach provides an opportunity to enhance health and wellbeing globally as well as in the UK. Forward Commitment Procurement It is important that providers of goods and services demonstrate they have policies and procedures in their own work place that promote sustainable development and maintain a healthy working environment for their staff. Such an approach would have the effect of driving the understanding of sustainable development further into the wider community to positive benefit" Graham Jukes - Chief Executive The Chartered Institute of Environmental Health The Rotherham NHS Foundation Trust used an innovative approach when procuring new lighting systems using Forward Commitment Procurement (FCP). FCP is an approach where organisations engage with suppliers, specifying the outcome required and a commitment to work with the chosen supplier over a longer period of time. This provides suppliers with the incentive to work closely with the customer to develop more innovative solutions. The winning tender was a pod-style patient environment that combined efficiency with improved patient experience. Whole-life costing was used so while the cost of the pods was the same as a traditional refurbishment there were longer term benefits in terms of reduced maintenance, more efficient and effective lighting and a better patient environment. Forecast savings over a ten year period include a 30% reduction in energy and an 80% reduction in maintenance 9. 6 Sustainable Resilient Healthy People & Places

7 Local food procurement Nottingham University Hospitals NHS Trust sources more than 90% of its fresh red meat and all of its milk, vegetables, salad and fruit in season from within a 30 mile radius of the hospital. By switching to local suppliers and choosing different cuts of meat the bill for fresh meat fell while the producers still enjoyed a premium. Nottingham has made a concerted effort to localise the supply chain and had achieved savings of over 800,000 per year while also significantly reducing food miles and supporting the local economy 10. Responsible procurement at Cornwall Council Cornwall Council is driving socially, environmentally and economically responsible procurement through its Responsible Procurement Policy. In 2012/13 the Council spent around 464 million with over 7000 suppliers. To guide and influence the supply chain they have embedded responsible procurement into their systems including environmental sustainability, carbon management and ethical sourcing. A Selling to the Council Guide for suppliers has been produced and the policy is linked to the county s Clear about Carbon initiative. A whole life approach is taken where the cost and sustainability of a product or service are not just considered at the point of purchase but the on-going maintenance, service, energy and disposal are also taken into account 11. Commissioning and procurement 7

8 This document is one of a number of modules supporting the Sustainable, resilient, healthy people and places a sustainable development strategy ( For further information, guidance notes, tools and good practice to support the delivery of this module visit References 1 Sustainable Development Unit, Module: Sustainable clinical and care models [Online] Available at: [Accessed 06 January 2014] 2 Turning Point, Community Commissioning [Online] Available at: [Accessed 06 January 2014] 3 Sustainable Development Unit, Sustainable Development Management Plan (SDMP) Guidance. [Online] Available at: [Accessed 06 January 2014] 4 NHS England, /15 NHS standard contract [Online] Available at: [Accessed 06 January 2014] 5 Sustainable Development Unit, NHS, Public Health and Social Care Carbon Footprint [Online] Available at: [Accessed 06 January 2014] 6 Sustainable Development Unit, Procurement for Carbon Reduction (P4CR) [Online] Available at: [Accessed 06 January 2014] 7 HMSO, Public Services (Social Value) Act 2012 (c.3) [Online] Available at: [Accessed 06 January 2014] 8 Cabinet Office, Procurement Policy Note The Public Services (Social Value) Act 2012 advice for commissioners and procurers. Information Note 10/12 [Online] Available at: [Accessed 06 January 2014] 9 Sustainable Development Unit, Case Studies. Procurement. Rotherham NHS FT [Online] Available at: [Accessed 06 January 2014] 10 Sustainable Development Unit, Case Studies. Local responsible food procurement. Nottingham University Hospitals NHS Trust [Online] Available at: [Accessed 06 January 2014] 11 Cornwall Council, Responsible Procurement [Online] Available at: [Accessed 06 January 2014] Document produced by the Sustainable Development Unit (SDU) which is funded by, and accountable to, NHS England and Public Health England to work across the NHS, public health and social care system. The SDU supports the NHS, Public Health and Social Care system to be sustainable environmentally and socially. This is done by engaging across the system to identify the frameworks, networks and mechanisms that will encourage a healthier environment, better health and enable communities and services to be resilient to adverse weather events and climate change. Responsibility for the content of this document lies with the Sustainable Development Unit. The Sustainable Development Unit Victoria House, Capital Park, Fulbourn, Cambridge, CB21 5XB T: E: england.sdu@nhs.net Published January 2014 W: Follow us on Twitter Designed and produced by: MJWebb Associates Ltd This publication is printed on 100% recycled paper and is printed using vegetable-based inks and a water-based sealant.