E-procurement/GS1 standards
came up with a different name to ‘demonstrators’ – ‘Scan4Safety’. Accelerate to the current day,” Glen Hodgson explained, “and we have had very clear support from the DH, with the Department’s commercial director, Pat Mills, confirming at our conference that the Department was now planning for the next phase of implementation throughout the estate.” While Pat Mills had not gone into detail on this, Glen Hodgson believes the Department’s medium-term intentions are clear. He expanded: “It’s all about the ability to identify people, product, and places; delivering patient safety, regulatory compliance, and operational efficiencies. Our day two conference keynote speaker, Lord Prior, Parliamentary Under Secretary of State for NHS Productivity, felt the benefits of GS1 standards around procurement and patient safety were already clear; the sector should also, he said, be focusing on clinical productivity.” Glen Hodgson explained that wider implementation of GS1 standards should enable improvements to clinical practice via a number of routes. He said: “For instance, at one demonstrator site, the Royal Derby Hospital (run by Derby Teaching Hospitals NHS Foundation Trust), in 30 of 35 operating theatres no item or person goes into a theatre without a GS1 barcode.” In fact, using its own licence, the Derby Teaching Hospitals NHS Foundation Trust has developed barcodes for numerous items, including standard kits – for gowns, drapes and gloves, for standard packs for general anaesthetics, and for standard kits for standard operations.
Clinical variations
Glen Hodgson explained that the GS1 UK conference also saw Lord Prior highlight the example of maxillofacial surgery, and the clinical variation apparent between the maxillofacial surgeons at the Derby Trust. He said: “These variations might, for example, be around the different amount each spends on consumables, or it may be that one surgeon can complete a particular procedure in 90 minutes, and another in 60. It may be that the consultant completing the procedure in an hour has nine people in theatre, and the one taking 90 minutes, seven. The question is: ‘Should we have two healthcare assistants in the theatre to get the operation completed quicker?’” Following this work, Glen Hodgson said the intention was to use GS1 standards to look at what difference different practices could make to clinical outcomes. He explained that, at Derby, every patient, healthcare assistant, chief nurse, the theatre or ward staff, the consultant going into the operating room, plus every instrument used, would have its own GS1 number. “In fact,” he added, “clinical variation is slightly beyond the scope of the original demonstrator sites. Nevertheless, the points that Lord Prior made about GS1 adoption’s benefits to clinical productivity were echoed at our conference by Professor Sir Terence Stephenson, chair of the General Medical Council, who wholeheartedly supports the programme, and sees great opportunities for doctors to get involved. At the heart of all this is patient care and safety.”
Good sources of data Entering the discussions, Leeds Teaching Hospitals NHS Trust’s associate director, Commercial and Procurement, Chris Slater said: “In fact, surgeons are very interested in costs, and if we can clearly show we have sound data sources, they become engaged.” The Leeds Trust is currently England’s third largest, with a £1.2 bn turnover. Chris Slater said: “Like all NHS organisations, we have challenges around quality, performance, and costs, and have been looking to meet these in various ways. My key focus is cost. However, when we start looking at efficient procurement, we begin to recognise that it can also improve the quality and performance of the organisation.”
Day two conference keynote speaker, Lord Prior, felt the benefits of GS1 standards around procurement and patient safety were already clear; the sector should also, he argued, be focusing on clinical productivity.
26 Health Estate Journal September 2016
‘Unsophisticated and manual’ Chris Slater explained that on joining the NHS in 2004 from a manufacturing and IT background, he rapidly realised that, ‘outside of the retail operations’, the way stock control and inventory were handled in a ‘typical’ hospital was ‘fairly unsophisticated and manual’. He said: “It very much involved clinical staff replenishing, stocking, and stacking; so a lot of high-cost time was taken up
An RFID tag of the type used in healthcare applications.
on supply chain activity. We embarked on a programme to bring this work under the control of our supplies and procurement function, and put some automation around the process, using stock and inventory management. This entailed setting the data standards within a software package, and then overlaying that into an inventory system.” He continued: “The first GS1 barcode was used in 1974 in retail on Wrigley’s chewing gum. You came into healthcare, and actually GS1 standards were not being applied. We found different manufacturers using different barcode standards, so the same product, from the same manufacturer, would feature different barcodes, depending on the point of manufacture.
“Using a retail analogy,” he said, “you could have a checkout not recognising a product. So we have had to cope with different standards of barcodes and keep our systems working. It was clinical staff, however, who we were asking to monitor barcodes and book product out with patients on the operating table. They are not going to take time and correct a barcode error; they will simply take the product. Replenishment then doesn’t happen, and you run out of stock, so the next patient doesn’t get the product.”
Critical mass
While GS1 standards were by no means new to suppliers, a barrier to wider adoption had, he explained, been lack of critical mass. Chris Slater elaborated: “Some of our suppliers have told us historically that, while acknowledging that we are a big customer, until the NHS adopts GS1 standards, changing their standards and packaging is quite costly. They have said: ‘We are not really prepared to do it just for one Trust; we will wait for an NHS imperative.’ Hence the need for DH to say: ‘This is something that all Trusts must comply with’. Thus, for the first time, we are getting a powerful
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