Howard Croft column:NHS: the big focus on saga of rubber gloves

Health Secretary, Jeremy Hunt
Health Secretary, Jeremy Hunt

Speaking at a conference of NHS Providers last week the Health Secretary, Jeremy Hunt (so beloved of junior doctors) announced another (yes, another!) league table that might help us to judge the quality of our local hospitals. The financial crisis in the NHS, he advised, is not a matter of under-funding; it is all down to rubber gloves.

He has discovered an astonishing variation in the prices paid by NHS trusts for such consumables as rubber gloves, boring but vital in the unceasing battle to control the spread of infections in clinical settings.

This is of course old news and I am sorry to say that good old Jerry is way behind the curve on this. I have known about it for years and I’m not really paying attention.

An example: one trust is paying £16.47 on a pack of twelve gloves (pairs, I suppose), whereas another manages to get them for just 35p, a 47-fold difference.

A number of questions beg to be asked. Are hospitals really buying gloves in packs of twelve? There are roughly 150,000 doctors in the UK, some working part-time and some, not in contact with patients, whose need for gloves is confined to a spot of gardening perhaps.

If every doctor used gloves once a day – and of course those who do use them change them frequently – that’s thirty million pairs of gloves. Add to that nurses and you get a very big number.

Another question is, why is good old Jerry raising this issue with providers, even going so far as to thank them for “your efforts to clamp down on unnecessary waste”, not with NHS buyers? It is the duty of NHS providers to work diligently in the interests of their company, that is to maximise profits; it is not to clamp down on NHS waste. That is the duty of those NHS employees who work in the purchasing departments of hospital trusts.

It is here that the problem lies. Public sector employees are on the whole very poor negotiators but tend to see themselves as having sharp business minds. Some of them obviously do – the person who paid 35p, when a colleague down the road is spending sixteen quid for the same product is a case in point.

Those who do business with government at all levels, as I have done, are aware of all this and the unscrupulous among them (not me obviously) use flattery to encourage this delusion. Everyone is happy – except the tax payer.

When this situation – the huge discrepancy in prices paid – came up years ago trusts were told to share information among themselves, but this they refused to do so on the grounds of “commercial confidentiality”. This of course is nonsense. A clause to that effect might well be in purchasing contracts, put there by suppliers for obvious reasons, but such contracts should not be signed and do not need to be. I suspect that some purchasers use “commercial confidentiality” as a beard behind which to hide their professional incompetence.

You may be interested in other examples. A stethoscope bought by one trust for £90 cost another £26.78 for the exact same model, although the quantities may have differed. In another case, one trust paid £21.76 for a box of adhesive for which cost another only £1.68. And so it goes on.

So, what to do? Central negotiation of prices, especially for high volume items, would do the trick, but only if a senior Whitehall mandarin is not put in charge.

A small group of poachers who, if paid enough and given access to all the data, were prepared to turn gamekeepers might be an idea. Link that to an incentive scheme for Mr Hunt – a ten thousand pound annual salary reduction for every ten million wasted would certainly focus his mind and encourage him to seek a different government portfolio. And make a lot of junior doctors very happy.