Procurement has become a political and environmental priority under ongoing NHS reforms, and nurses could be key to driving change.
Michelle Johnson, national clinical executive director at NHS Supply Chain, spoke to Nursing Times about the growing focus on procurement in government plans to transform the health service, and how nurses are leading the shift toward more sustainable and patient-focused choices.
“I think there is responsibility for nurses to really open their eyes to the procurement that’s happening around them”
Michelle Johnson
NHS Supply Chain sources and supplies over 35 million products a year to the NHS in England and Wales, across a variety of categories.
“We procure, on behalf of the NHS, everything from toilet rolls, staff uniforms… right through to supporting NHS trusts to buy [magnetic resonance imaging] scanners and robotic arms,” Ms Johnson said.
“I don’t believe there’s any trust in the country that doesn’t procure at some point through NHS Supply Chain.
“The value of that is you’re doing it once for the whole of the NHS, so, therefore, you can negotiate with suppliers and manufacturers the best possible quality market product at the best possible price.”
Ms Johnson, a registered adult and children’s nurse, joined NHS Supply Chain 18 months ago to lead its clinical arm.
She brought with her four decades of experience, having held several senior nurse leadership roles across London NHS organisations.
She now oversees the safety and effectiveness of NHS Supply Chain’s product catalogue from a clinical perspective.
“I make sure that all the products we have on our catalogue are safe, they’re effective and they give the patient and the healthcare professional the best possible experience,” she said.
Procurement is moving higher up the political agenda, in the wake of major NHS reforms that have given it renewed prominence.
As part of a structural shake-up, prime minister Sir Keir Starmer announced plans earlier this year to abolish NHS England, bringing oversight of the health service back into central government.
As its functions are absorbed back into the Department of Health and Social Care, local integrated care boards are expected to gain greater autonomy in procurement decisions.
Alongside this, the government’s new 10-year plan for the NHS, Fit for the Future: 10 Year Health Plan for England, published in July, has committed to delivering a “clear national scheme for procurement”.
The document, which has set out ambitions around technology and innovation, warned that the NHS had long been “behind the technological curve” and too focused on lowest-cost purchases “rather than best value and outcomes”.
This approach, Ms Johnson noted, is a core challenge for her organisation. “We adopt things very slowly in the NHS,” she explained.
“There can be some of the most amazing innovations… and the way that the NHS is structured, it can be quite slow and cumbersome to get them implemented in a trust, or all of the trusts across the country.”
To counter this issue, the new plan has promised to centralise certain procurement decisions.
Products designed to boost clinical productivity, for example, will be procured once nationally and then made available through an internal marketplace.
This approach is set to unlock “the extraordinary potential” of the health and medical technology sectors, the document said.
Gone are the days where individual trusts would pilot the latest technology, if another trust has already successfully embedded it in their organisation, noted Ms Johnson.
“We have to have a lot more [of a] robust [approach] in terms of adoption at scale… and nurses and midwives are brilliant at doing that and are enablers,” she said.
Ensuring that nurses and midwives are supported to become “decision makers” in the procurement process was essential, she highlighted.
“We’ve got a big ambition around how we partner with the NHS to do exactly that, to support them to adopt at scale more products that might give better outcomes,” she added.
Overall, Ms Johnson praised the 10-year plan’s direction, describing it as a “north star” for NHS organisations to follow.
“We have to have somewhere in the NHS [where] we are all going in the same direction,” she said.
“It’s aspirational, but you wouldn’t expect anything less than [that in] a 10-year plan.”
“I think there is a lot more we can do as nurses to really challenge ourselves about reducing use”
Michelle Johnson
Ms Johnson also argued that the three central tenets of the plan – moving care from hospital to community, sickness to prevention, and analogue to digital – all “apply to NHS Supply Chain”.
“It feels as if we’re lining everything up and NHS Supply Chain plays a role in that,” she said.
“We’re absolutely on board with it, we’re part of it, and I can see things starting to shift already. There is a sense of ‘let’s get on and do it’.”
One of the plan’s obvious omissions was any reference to delivery or costings to underpin the reforms.
With NHS trusts currently under pressure to make savings, the supply chain will inevitably feel the impact, acknowledged Ms Johnson.
“There have always been cost pressures in the NHS, but it is particularly challenging 1754459572,” she said. “I know the pressure is on and I would never underestimate the impact of that.”
At trust level, procurement teams were already “making tough decisions day in, day out”, she said, adding that NHS Supply Chain, as an arm’s length government body, faced similar financial constraints.
“It makes it even more important, then, that what we do is the right thing at the right time, minimise any waste, implement systems that support us to minimise waste,” she said.
Sustainability is one of NHS Supply Chain’s more complex obstacles. The NHS has committed to reaching net-zero carbon emissions by 2045, with an ambition to achieve an 80% reduction between 2036 and 2039.
Nurses and midwives – as the largest NHS workforce and the biggest consumers – will “play a leading role” in achieving this target, according to Ms Johnson.
During her career, Ms Johnson said she had seen a “complete shift” from reusable products and instruments – cleaned, autoclaved and sterilised in-house – to single-use alternatives.
She said: “I’m not compromising on the safety aspect, that still remains in place, but I think there is a lot more we can do as nurses to really challenge ourselves about reducing use, making better use of what we do have, and that circular economy of just reusing where we can, where it’s safe to do so.”
Ms Johnson pointed to “amazing examples” of nurses and clinical procurement teams already driving greener practices, such as cutting back on unnecessary glove usage and minimising the use of couch roll.
The latter, while needed for privacy in some situations, “does not offer any clinical benefit to your care”, she argued.
Similarly, clinicians are also looking to reintroduce reusable tourniquets. Ms Johnson said: “We have to make sure that we’re doing things from an infection control perspective in the right way, but there is a need to clinically evaluate whether every trust needs to use single-use tourniquets.”
Clinical input into procurement by nurses has grown and must continue to do so, Ms Johnson said.
She argued that “everyone has a responsibility around it”, whether from a sustainability, efficiency or patient care point of view.
“Every nurse has a responsibility about ensuring that the products that they use, the consumables, the medical devices, the equipment, is of the best quality, and it’s going to be safe to use,” she said.
For nurse leaders, Ms Johnson argued that there was an “added layer of responsibility around procurement”.
Those overseeing services can ensure not only that they have the right equipment on the ground, she said, but can work with procurement teams “to make sure that they’re procuring what the wards need”.
“When you’re in a leadership role across the NHS or the wider health and care system, I think there is responsibility for nurses to really open their eyes to the procurement that’s happening around them,” Ms Johnson told Nursing Times.
Reflecting on her own experience as a chief nurse, she added: “You’re responsible for a big budget, and a significant amount of that budget is non-pay, which is all the things that you need to buy through procurement.
“We have to pay attention to that and realise that we can influence what’s used in a hospital.”
With procurement increasingly seen as a foundation for delivering wider NHS goals – from digital transformation to climate targets – Ms Johnson said she was excited about the future role NHS Supply Chain will play.
Going forwards, her goal is to “bridge that gap” between her organisation’s work and what the NHS needs.
What gave her the most satisfaction, she suggested, was the chance to help the NHS achieve its net-zero goals.
“If I can make any difference [to] the climate crisis, from a net-zero achievement through what NHS Supply Chain does from a clinical perspective, that’s the bit I’ll be proudest of doing,” she said.
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