A parable of procurementBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7397.1043 (Published 10 May 2003) Cite this as: BMJ 2003;326:1043
Some say that the NHS is unnecessarily bureaucratic, its decision making slowed down by committees and procedures. This, however, is an essential response to the avarice of clinicians, who if left unchecked will spend an entire annual budget on equipment and will treat far more patients much more expensively than is agreed in the contracts so carefully drawn up at the start of each financial year.
I believe in incorporating the best of NHS practices into my domestic situation
I believe in incorporating the best of NHS practices into my domestic situation. Let me take a recent example.
Last April, soon after the start of our financial year, my wife, whom I shall call Mrs B to protect her anonymity, went on a short break to Paris and fell in love with a watercolour landscape on sale at a gallery there. Back home she could hardly contain her enthusiasm, saying how well it would go in our living room and what a long term investment it would prove. I was quickly convinced, but as family treasurer I had to be mindful of all the other demands on our budget.
We first had to establish whether the painting was to be a new item or a replacement, as we have an agreed moratorium on new purchases.
“I thought we could get rid of the old still life over the mantelpiece and hang it there,” said Mrs B. I wondered what grounds there were for taking out of service an apparently adequate print of a vase of flowers, but here my experience as clinical director came to my aid. The glass was not shatterproof and did not meet safety standards, so clearly the picture had to go. We took it down at once, leaving a pale rectangular area on the wallpaper.
Mrs B would then cheerfully have phoned the gallery, but I had to remind her of the steps we had agreed to take before buying anything over £1000. First we had to establish a case of need. That was clear: the old picture had been thrown out on legitimate health grounds, and there was a clear duty to cover the bare wall. Together we wrote out our “case of need.” We estimated the total purchase price and added in delivery, customs charges, and insurance. We estimated the revenue consequences—only a marginal increase in the annual premium for our contents insurance.
At this point I confessed that I was ready to sanction the deal, but something made me run the proposal past my friendly directorate manager. After deliberating for several weeks his reply was: “You cannot let that go through. Where are the competitive quotations? Is the artist on your approved list of suppliers? Presumably you have a written purchasing policy at home, so does it meet your criteria?” All of these were such obvious and essential questions that I was embarrassed at having neglected them.
Mrs B was less pleased, however. She said, “The painting is unique and can only be bought from the one gallery, so there can be no other quotations. We can go through one of our ‘approved suppliers,’ who can arrange for it to be authorised, but it will of course cost more. Anyway,” she continued truculently, “it is not even your money. I am going to use Aunt Hilda's legacy.” Calmly, I explained that the money's origin was not relevant, as once installed the picture would be entered on the household asset register.
And so, one by one, we negotiated all the steps that are so necessary if one is to keep proper budgetary control. At last the paperwork was completed, and it joined the other files on my desk. There is always a delay at this stage, because what with my duties as consultant and all the other “unpaid” time spent on administration of one sort or another at home I cannot keep up with rechecking all the applications.
The process had started in April. By the following March we had become used to looking at the bare wall. Then one evening, on inspecting the household accounts, I suddenly realised that unless something were done our annual budget would be underspent. We had agreed at the outset that we would not carry forward any surplus, so there was no time to lose.
“Look here,” I said with undisguised urgency, “we are heading for an underspend of nearly £2000. How can we avoid this?”
Mrs B is good in a tight situation like this. Quick as a flash she reminded me that she had seen a particularly striking watercolour in Paris. The next day I phoned the gallery. They told me that the artist was now much more sought after and his works were commanding higher prices but that the picture could be ours for £2000, including delivery. Without delay I phoned the order through.
The painting was delivered and installed by 1 April—which just goes to show how even in the most difficult domestic situations the NHS procurement system is second to none.
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