Dr Hamish Meldrum, outgoing chairman of the BMA, once famously said, the NHS should not be run like a supermarket. Over the years, I have often thought secretly that the NHS would be far more efficient if it adopted some of the business practices of the supermarkets.
So, when Sir David Nicholson wrote last month to all NHS trust CEOs, foundation trust CEOs , NHS trust board chairs, directors of finance, and procurement directors saying that they should adopt a standard coding system for procurement of more or less everything the NHS buys, called GS1, I applauded. Perhaps the NHS was, after all these years, making its procurement more like a supermarket.
Not only was Nicholson asking the sector to adopt a standard coding system, but to incorporate it in barcodes on pharma products, surgical instruments, hospital equipment, and artificial hips. I suddenly woke up. Barcodes became general on just about all retail goods in supermarkets way back in the 1980s. Hasn’t the NHS adopted them yet? Apparently, it has, to some extent, but not universally, and the standard codes in place tend to be “what works for each trust”. In other words, they are not standard at all.
This makes me rather angry, as I was involved 20 years ago in tracking an initiative to implement a technology called Electronic Data Interchange across the NHS. This was a paperless way of ordering and invoicing goods coming into hospitals, and demanded rigid product codes and tough data standards. The UK was ahead of the rest of Europe in implementing this technology – in supermarkets and other industries – and I hoped that if the NHS managed to do it too, the UK would lead the world.
But no, for a variety of reasons, the initiative fizzled, as top-down initiatives tend to do in the NHS. Most trusts were just too slow to adopt EDI, and the world moved on into the dot.com boom and bust. It seems to me that nothing much has happened since in NHS procurement. What on earth has everybody been doing for the last 20 years?
So, Nicholson’s endorsement of GS1 codes, as part of a more general initiative to “raise our game” in procurement, is about 20 years overdue. The trouble is, will his warm words just be ignored by the trusts and commissioning groups, like that old top-down EDI initiative? After all, in Andrew Lansley’s NHS, all decisions are supposed to be decided locally by clinicians, not dictated from a bureaucrat in the Department of Health.
Some signs are good. Roger Lamb, health manager at GS1 UK, the promoter of the GS1 standard in the UK, tells me that to his knowledge there are already dozens of sites using GS1, and the DH claims even higher figures. So GS1 is not starting in a green field.
GS1 UK has lined up a load of private sector implementers to market the technologies, and educate NHS staff in their use. Suppliers have agreed to put barcodes on their new products by the beginning of next year, and are aware that they could lose business if they do not play ball with the new standard. Roger Lamb says that NHS procurement executives are becoming quite assertive.
And the DH is pinning a lot of hope that trusts will realise, rather belatedly, that better procurement will save them a load of money, which is important right now. It looks as if the DH means business this time.
Most important is that GS1 codes, barcodes and its related technology, radio frequency identification (RFID), are, unlike EDI, not just used for dull things like stock control, but also for tracking folders of patient notes and for coding patient wristbands. Matching patients electronically to the right medication, the right bed, the right hip replacement kit, will stop many of the mismatches, which today cost patients’ lives. GS1 codes are a tool for patient safety.
Who knows, in the future, an RFID tag under the skin could contain a full patient record in GS1 code. But that’s science fiction, isn’t it? So, a technology, which started life in supermarkets, may take over the NHS.