The Northwest Development Agency manages all operations from its Headquarters at: PO Box 37 Renaissance House Centre Park Warrington WA1 1XB Tel: +44 (0)1925 400 100 Fax: +44 (0)1925 400 400 e-mail: Information@nwda.co.uk
In addition, there are five area offices for the implementation of local activities as follows: Greater Manchester Giants Basin Potato Wharf Castlefield Manchester M3 4NB Tel: +44 (0)161 817 7400 Fax: +44 (0)161 831 7051
Cumbria Gillan Way Penrith 40 Business Park Penrith Cumbria CA11 9BP Tel: +44 (0)1768 867 294 Fax: +44 (0)1768 895 477
Merseyside Station House Mercury Court Tithebarn Street Liverpool L2 2QP Tel: +44 (0)1925 400 100 Fax: +44 (0)151 236 3731
Lancashire 13 Winckley Street Preston Lancashire PR1 2AA Tel: +44 (0)1772 206 000 Fax: +44 (0)1772 200 049
Cheshire Brew House Wilderspool Park Greenalls Avenue Warrington WA4 6HL Tel: +44 (0)1925 644 220 Fax: +44 (0)1925 644 222 Visit: www.nwda.co.uk & www.englandsnorthwest.com
NWDA KADM 03/04 18018
Health and Social Care Industries Study Report to the Northwest Development Agency by SQW Ltd. February 2004
Contents Section
Page
Executive summary 1
Introduction
1
2
Strategic framework
4
3
Approach and report structure
6
4
Health and Social Care sector in the Northwest
8
5
Goods and services purchased by the NHS
12
6
Suppliers to the NHS in the Northwest
16
7
NHS procurement and supply chain development
19
8
NHS and capital projects in the Northwest
27
9
Employment and workforce development in the NHS
35
10
Developing the Health and Social Care industries in the Northwest
46
11
Summary of conclusions and recommendations
52
Appendices A
Scope and roles of health and social care issues and stakeholders in regional development
56
B
Summary of the priorities and proposed actions in the Investment for Health plan for the Northwest
58
C
Health and social care "system" in the Northwest
60
D
The company base
63
E
NHS procurement processes for goods and services
64
F
Summary of NHS employment-related initiatives in the Northwest
71
G
Summary descriptions of some Northwest clusters relevant to the health and social care sector
80
H
Research-base in the Northwest
97
I
Provision of education and training in health and social care by the Higher and Further education sectors
105
J
Sources of primary research information and advice
110
Executive summary The aim of this study is to understand more fully the sustainable development opportunities in England's Northwest region that are arising from the major investments being made in the health and social care sector. It set out to determine the nature of the economic “footprint” of the NHS in the Northwest. Its purpose is to inform the actions of the Northwest Development Agency (NWDA) and its partners in harnessing the full potential of health and social care expenditure and investment in the Region. The emphasis by the Department of Health and the NHS on local empowerment to meet what are often quite localised needs and opportunities introduces challenges for the practical design and delivery of interventions in the context of the Northwest’s Regional Economic Strategy. These challenges are a recurring theme in the study. A second recurring theme is the pervasive and cross-cutting nature of the health and social care sector – specifically, NHS influence, expenditure and investments - with respect to sustainable development objectives. Strategic objectives as diverse as those concerned with the growth of businesses; social enterprise development; delivery of urban and rural renaissance; enhancing and protecting the environment; securing economic inclusion; labour market development and strategic communications infrastructure (specifically broadband) can all be associated with action areas in which the NHS as a ‘corporate citizen’ can make significant contributions. Conclusions and recommendations from this study focus around three key areas of NHS activity - purchasing of goods and services; workforce development; and capital /infrastructure projects. Recommendations are also made for the further development of the health and social care industry in the context of NWDA's support for cluster development and NHS contributions to the Region's knowledge-base. Key issues raised concerning NHS procurement include: ●
the likely significance of purchasing confederations (NHS Supply Management Confederations) in the Northwest on local and within-region sourcing of goods and services
●
ensuring full appreciation of the feasibility and benefits of local or within-region purchasing among NHS Supplies Managers
●
the nature and use of NHS purchasing data in the context of proactive identification of opportunities for local or withinRegion businesses to substitute for goods and services presently purchased from outside the area
●
the evaluation and mainstreaming of bureau and passport initiatives for SMEs supplying the NHS which takes account of the NHS’ own supply-chain initiatives.
It is proposed that NWDA and partners develop not new intermediary organisations but rather implement a framework programme –Northwest Businesses into Health – to promote collaborative activity between stakeholders in the NHS, Business Link network, existing business/cluster networks and individual firms, with objectives to facilitate the flow of information; co-ordinate the provision of advice and guidance; encourage and support alliancing and product/service trials; and convene “meeting NHS end user/purchaser” events. Key issues raised concerning NHS capital projects in the Region include: ●
enhancing links between the NHS and all business sectors that could contribute to capital projects, not only the construction sector - the development of links with firms and research groups in the environmental technology sector appear to offer valuable opportunities ■
including exploring the feasibility of developing pilot sites to demonstrate the use of innovative environmental technology in the NHS estate
●
the importance of NHS LIFT project teams gaining knowledge and understanding of the wider regeneration process and priorities in the area at an early stage in their process if the wider development opportunities offered by these projects are to be realised ■
and specifically, the need for a deeper exploration of the wider opportunities presented by the SHIFT project in Salford to be progressed speedily if it is to fit the tendering timeline
●
the need for one public agency to lead on the integration between an NHS LIFT project and wider regeneration needs and opportunities.
On NHS workforce development, a mapping of the various employment and basic skills development initiatives in the Northwest presents a ‘busy’ picture at regional and local levels. It is widely recognised that there is a plethora of initiatives and too little knowledge among the professionals involved of what is working best, where and for what reasons. There is a need to identify the initiatives that are underway and organise information and learning relating to them on a thematic basis. There is a need to bring people together to review, share, promote and help mainstream what is being done and what is working best. Local initiative is necessary and to be welcomed but that alone is unlikely to gain optimum benefits as learn curves can be long and mainstreaming uncertain. To make the challenge more tractable, it is proposed that NWDA, NHS and partners develop not new intermediary organisations but rather implement a framework programme – Northwest people into health work –with objectives to facilitate the flow of information; co-ordinate the provision of advice and guidance; encourage and support collaborative ventures; appraise and evaluate pilots; and convene “getting to know you” events between practitioners. It is proposed that steering of this programme should be done at a sub-regional levels linked to the Workforce Development Confederation nodes within the NHS and linked to the NHS University. On the way ahead more broadly for sector development, because of the diversity of the goods/services purchased and capital investments made, the NHS is relevant to and sits in the supply chain of a very diverse range of industry sectors and cluster groups in the Northwest. One health and social care clustering initiative is difficult to envisage addressing all aspects of the sector’s needs and opportunities. A “one size fits all” regional initiative would be less effective than encouraging a higher profile for the NHS amongst existing Northwest cluster networks and business organisations. The high growth business potential lies in niche markets. There appears to be a generic need for improved dissemination of the new product and process development needs and opportunities arising in the NHS. NWDA should work with the NHS Trusts to facilitate the dissemination of medium term "foresighting" in terms of technology needs and opportunities. Fora which help to link researchers and innovative businesses with the clinical governance mechanisms in Trusts, with end users and Supplies Managers, appropriate to different niche sectors, would be beneficial. Working with and though existing industry and cluster bodies should be adopted wherever possible. The priorities for action and allocation of resources within Strategic Health Authorities (SHAs) are emerging in the Northwest, as elsewhere in England, following the formation of the SHAs in late 2002. The SHAs are already involved in assisting with the integration of skills and capacity issues through Workforce Development Confederations. Given their role in creating a coherent strategic framework for health improvement in their area and their commitment to facilitative and developmental approaches across the health and social care "system", the SHAs would seem to be well positioned to work strategically in partnership with the NWDA and others in engaging with Trusts on the wider role the NHS can play in sustainable regional development.
1 Introduction 1.1
The aim of this study is to understand more fully the sustainable development opportunities in England's Northwest region arising from the major investments being made in the health and social care sector. It is concerned with determining the economic “footprint” of the NHS in the Northwest.
1.2
Its purpose is to inform the actions of the Northwest Development Agency (NWDA) and its partners in harnessing the full potential of health and social care expenditure and investment in the Region.
1.3
The study has been conducted at a time when an important, emerging policy agenda is linking health and social care with regional economic and social development (cf. the recent conference convened jointly by Regional Development Agencies, the Department of Health and NHS, London1). This is driving policy convergence and is demanding new alliances and collaborative programmes - between different public bodies and between these and private and third sector organisations. It is also demanding joint working and new kinds of dialogue between different groups of professionals. Claiming the health dividend
1.4
The actual and potential impact of the NHS on sustainable development has been underestimated to date. The NHS is a major organisation capable of making very significant contributions to the achievement of wider social, economic and environmental policy objectives and through these to the health of the population.
1.5
Recently, there has been a significant change in perspective on the linkages between health and sustainable development. A report by the King’s Fund published in 20022 identified the nature and scale of NHS activity nationally and provided examples of NHS contributions in areas such as: ●
Employment: the NHS employs over 1 million people nationally and is the major employer in many deprived communities
●
Purchasing: the NHS spends £11billion a year on buying goods and services - and could use its huge purchasing power more effectively for wider economic and social ends
●
Buying Childcare: the NHS invests heavily in childcare to help recruit and retain its workforce
●
Buying Food: the NHS is the largest single purchaser of goods in the country, spending £500m a year to feed patients, employees and visitors. Its food strategy could save money, reduce environmental damage and create jobs
●
Waste: the NHS produces 600,000 tonnes of waste a year and spends £42m disposing of it. By reducing waste or changing disposal methods, it could save energy consumption and safeguard natural resources, save on other resources, minimise costs and/or minimise health hazards
●
Travel: the NHS is a major cause of road travel, as employees, visitors, patients and suppliers travel to and from NHS sites. This contributes to ill health through accidents and air pollution
●
Energy: NHS hospitals produce around 7.5 million tonnes of CO2 a year. Reducing energy consumption could help reduce risks to health, environmental damage and the operating costs of health services
●
Building: there is a substantial capital programme in the NHS, with a focus on primary care facilities in deprived and under served areas. Measures could be designed that are health enhancing and sustainable. There is also the opportunity to ensure links to the local economy, and to produce social benefits and environmental improvements.
1.6
To this list can be added NHS contributions to intellectual capital development through investments in training and research.
1 Healthy Economies, Healthy People - how the NHS and RDAs can work together to achieve their targets - London, November 2003. 2 King's Fund (2002) Claiming the Health Dividend: Unlocking the Benefits of NHS Spending
Page 1
National Healthcare Industries Task Force 1.7
The Department of Health (DoH) established the Healthcare Industries Task Force (HITF3) in late 2003 to identify steps to stimulate the growth of the UK healthcare industry and to maximise the benefits to patients from healthcare products. The Task Force has working groups which address (1) market access, including trends in the use of new technology by the NHS; (2) the R&D and industrial base, including strengths and weaknesses with respect to promoting R&D partnerships between the NHS, academia and industry; (3) regulatory issues, including those posed by emerging technologies and advances in information technology; and (4) international and export business, including mechanisms to enhance penetration of priority overseas markets. The conclusions of the Task Force and its working groups, expected in late 2004, are likely to provide important additional insights for the development of the healthcare industries and related research-base in the Northwest. Linking national policy to local action
1.8
The potential to claim the health dividend by actions suited to regional and local needs and opportunities is influenced significantly by the DoH's Shifting the Balance of Power strategy. Part of the NHS Plan, this national change programme aims to deliver local empowerment – to frontline staff in the NHS and to local communities.
1.9
A key feature has been to give locally based Primary Care Trusts (PCTs) the role of running the NHS and improving health in their areas. In addition, the recently formed Strategic Health Authorities have the role of brokering solutions to local problems and encouraging greater local autonomy for NHS Trusts and PCTs. The proposed Foundation Hospitals will also advance the progress towards local autonomy.
1.10 The aspiration of the DoH to see the radical concept of Shifting the Balance of Power be “radical in reality”, should offer encouragement and opportunity for innovation in partnership working and action within the Northwest. 1.11 The emphasis on local empowerment to meet what are often quite localised needs and opportunities (e.g. skills and employment issues that face disadvantaged communities in specific Local Authority wards) introduces challenges for the practical design and delivery of interventions in the context of the Northwest’s Regional Economic Strategy. This is a recurring theme within this Report - namely the challenge of facilitating appropriate, effective and efficient local action and delivery within the strategic regional framework set for sustainable development. 1.12 Action to reduce health inequalities is also a key element of national policy that is relevant to the delivery locally of health and social care: it is now also a key policy area framing the work of Regional Development Agencies (RDAs) as they address the challenges of sustainable development. The DoH report on reducing health inequalities4 emphasises the importance of local services to meet a diversity of local needs - "one size doesn't fit all" - and the need for improved co-ordination across traditional boundaries at local and regional levels. 1.13 In setting out a vision for 2010, the DoH argues that action to address successfully underlying determinants of health could result in: ●
the opportunity of a decent home for all
●
neighbourhood services accessed from a single point
●
strong social networks and high levels of volunteering
●
end of fuel poverty for vulnerable groups
3 see www.doh.gov.uk/hitf/maingroup.htm 4 Department of Health (2003) Tackling Health Inequalities - a programme for action.
Page 2
●
cleaner, safer, greener environments for local communities
●
abolition of adult literacy with basic skills universal
●
a narrower gap in school performance
●
improved rates of benefit uptake among vulnerable groups, and
●
better public transport and better access to services.
1.14 The RDAs were identified in the DoH report (op. cit.) as playing key delivery roles in the following areas: ●
the development of consistent transport and land use planning policies that improve people's ability to access work and key services, and encourage greater exercise - working together with Local Authorities
●
the continued development and implementation of an integrated and sustainable approach to regional economic development which takes into account the needs of disadvantaged areas and communities
●
providing leadership and practical support in promoting economic regeneration sustained by developing social infrastructure - for example, in areas such as skills development
●
ensuring the sharing of experience between different sectors - notably in promoting a wider "corporate citizen" approach.
●
Page 3
work with the NHS to link into local skills development and local procurement initiatives.
2 Strategic framework 2.1
The purpose of this Chapter is to set out briefly key issues in the regional strategy arena within the Northwest which provide the context for this study. The context reflects the strengthening of the investment in health theme in the work of the RDAs, with health now being seen as "everybody's business"5 Regional Economic Strategy for the Northwest
2.2
The Regional Economic Strategy 2003 (RES) for the Northwest provides the economic and social development framework within which the findings and recommendations from this study must be placed. It is concerned with the achievement of sustainable development through economic growth, environmental protection and enhancement, and social inclusion.
2.3
2.4
The RES focuses on five priority areas: ●
business development
●
regeneration
●
skills and employment
●
infrastructure, and
●
image of the region.
Each priority has a set of objectives and associated actions. A review of these provides a useful insight into the place health and social care has already been accorded. In addition to identifying health and NHS investment as a major “opportunity”, the RES Action Plan makes a number of other specific references to the health and social care sector (see Appendix A for further information).
2.5
Objectives concerned with growth of business sectors, the competitiveness of businesses; delivery of urban and rural renaissance; securing economic inclusion; labour market development and strategic communications infrastructure (specifically broadband) are all associated with major actions in which health and social care issues and/or stakeholders are involved.
2.6
This introduces a second recurring theme in this study, namely the pervasive and cross-cutting nature of the health and social care sector – specifically NHS influence, expenditure and investments - with respect to sustainable development objectives.
2.7
In the remainder of this Chapter, the landscape most directly associated with strategies for health and social care is examined. Investment for Health plan for the Northwest
2.8
This study has been conducted against a background strongly influenced by the report Investment for Health – a plan for Northwest England (2003)6, with its vision, priorities, objectives, and recommendations on key actions required.
2.9
In its vision for the health of the Northwest’s population, the Plan emphasises the link between reducing inequalities and supporting regeneration. It sets as an objective: “to achieve significant reductions in health inequalities between groups and areas in the North West, within a framework of sustainable development which supports economic, social, and environmental regeneration”.
5 Department of Health, op cit (p. 47) 6 Investment for Health - a plan for Northwest England 2003, Government Office for the North West
Page 4
2 Strategic framework (continued) 2.10 Regional partnerships are highlighted as crucial to successful implementation. The organisational vision looks to: “build upon the development of regional partnerships to ensure that the improvement of the health of the population, and the reduction in inequalities, are at the heart of regional strategies and local policies and programmes”. 2.11 Priorities for action to improve the health of the Region’s population and reduce inequalities in health are identified in the Plan, together with recommendations for the integration of activity to address these priorities, specific objectives and actions. These are summarised in Appendix B. The present study links most closely to the priority concerning regeneration and sustainability. NHS contribution to regeneration and sustainability 2.12 For this priority, the objective in the Investment for Health Plan is to develop the role of the NHS. The Plan recognises that as a major organisation and by acting as a good corporate citizen, the NHS could use its employment, procurement, capital spend and other activities to achieve social and economic development objectives and reduce health inequalities. 2.13 In the associated Action Plan, a number of specific proposals are made (also summarised in Appendix B). These include proposals in areas as diverse as workforce development and human resources policy; purchasing of goods and services; skills and employment; assessing the impact of major capital projects on local communities; and environmental strategy and impacts of transport, energy and waste management policies. 2.14 Those priorities in the Plan that directly link to the NHS and its contribution to regeneration and sustainability, i.e. to the NHS as a corporate citizen, can be grouped into four key areas, namely purchasing, employment, capital /infrastructure and contributions to the Region’s knowledge-base. The first three are addressed as distinct topics in the present study. The latter is considered within a wider examination of the links between the NHS and the sectors and clusters supported by the NWDA and the Region’s research-base.
Page 5
3 Approach and report structure 3.1
The overall approach to the organisation of this study is illustrated by Figure 3.1. Figure 3.2 illustrates the conceptual framework which has guided research on the characterisation of the health and social care sector and its interactions with other business sectors and clusters supported by the NWDA.
3.2
The remainder of this report is structured as follows: ●
Chapter 4 describes the basic characteristics of the health and social care sector in the Northwest
●
Chapters 5, 6 and 7 discuss NHS procurement – examining the demand-side, the supply-side and the significance of NHS purchasing procedures
●
Chapter 8 considers the significance of major capital projects in the NHS
●
Chapter 9 addresses issues of worksforce development and employment
●
Chapter 10 examines the position of the NHS in business clusters already active and supported by the NWDA, examining “system” elements shown in Figure 3.2, including R&D
●
Chapter 11 summarises conclusions and recommendations
●
a substantial body of supporting information is provided in a series of Appendices (A to J).
Figure 3.1: Approach to the research
Page 6
3 Approach and report structure (cont.) Figure 3.2: Framework for the health and social care industries study
Page 7
4 Health and social care sector in the Northwest 4.1
The organisational structure of public sector health and social care provision in the Northwest is summarised in Appendix C. It is within this “system” that opportunities and initiatives to claim the health dividend must be taken forward. It is from the scale of investment and expenditure within this “system” that the scale of importance and opportunity for the Region can be appreciated. Scale and impact on the economy of the Northwest
4.2
The Centre for Public Services (CPS) produced an analysis of the health and social care economy in 2003 commissioned by the North West Regional Assembly7. This identified a large number of reasons why health and social care expenditure and investment are important to the Northwest's economy: ●
●
the level of direct employment and of indirect and induced employment ■
the income profile associated with the direct employment
■
the quality of this employment in setting labour market standards
the sector’s expenditure on goods and services ■
importance to manufacturing and related industries in the Region
■
capital investment and its importance for the construction industry
■
the potential opportunities offered for SMEs and ethnic minority businesses
●
its commitment to training and skills development
●
its investment in research and development
●
contributions to public health and impacts on regional productivity - reducing sickness absences and improving community well-being
●
contributions to reducing social and economic inequalities – for example though targeting of employment and increasing regional share of expenditure on goods and services
●
4.3
increasing regional identity.
The scale of the health and social care sector in the Region in terms of employment and expenditure is summarised in Table 4.1. Support for employment is treated in more depth in Chapter 9 of this report.
4.4
7
Total annual expenditure in the Northwest of £8.2bn (2000-1) is expected to grow 52% in real terms by 2007-8.
Centre for Public Services (2003) The Health and Social Care Economy in the North West
Page 8
4 Health and social care sector in the Northwest (cont.) Table 4.1: Scale of expenditure and employment associated with health and social care provision in the Northwest Region Total health and social care expenditure
£8.2 bn
(capital and revenue) 2000-1
(third highest spend among English regions, behind London and the South East)
Expected total expenditure 2007-8
£12.5 bn (52% growth in real terms)
Contribution to Region’s GDP
6.7%
Revenue expenditure 2000-1
£6 bn per annum
labour
£4 bn per annum
goods and services
£2 bn
clinical supplies and services
£678m
general supplies
£114m
office-related
£144m
utilities, maintenance and cleaning
£282m
Total health and social care employment
192,000 direct = 6.8% of regional employment 418,000 indirect and induced = 14.8% of regional employment
NHS employment
121,600 FTE
medical and dental
9,120 (7.5%)
nursing, midwifery and health visitors
58,003 (47.7%)
scientific, therapeutic and technical
16,780 (13.8%)
administration and estates
26,387 (21.7%)
other
11,430 (9.4%)
Sources: Centre for Public Services (2003) Health and Social Care in the North West – North West Regional Assembly’s Contribution to the North West Health Investment Plan; ONS (2002) Table 7.18 Regional Trends 37
4.5
Table 4.2 provides comparisons between various parts of the health and social care and related industry sectors in the Northwest in terms of employment (based on Annual Employment Survey figures for 1997).
4.6
The North West Strategy Review: Economic Report8 estimated that c. 0.5% of VAT-based enterprises in the Northwest are in the health sector, this amounts to c. 780 firms. The distribution of Northwest businesses in the health sector by turnover in 2001 is shown in Table 4.3. Close to 50% of health sector firms have annual turnovers in the range £100k to £499k. Biotechnology and pharmaceutical companies in the Northwest accounted for 7.7% of the Region’s exports to the rest of the world in 2000-2001, c. 25% of the equivalent figure for the chemicals sector. Healthcare and medical equipment accounted for 0.7% of exports in the same period, comparable to the environment sector.
8 Pion (2002) North West Strategy Review: Economic Report
Page 9
Table 4.2: Employment in health and social care and related industry sectors (1997 figures)
Manufacture of
Cheshire/ Warrington
Cumbria
Greater Manchester
Lancashire
Merseyside/ Total Halton
40
0
4
135
73
252
1,087
1,250
1,342
1,610
1,238
6,527
285
37
1,077
922
678
2,999
1,084
47
1,038
1,184
487
3,840
162
0
59
35
165
421
56,877
35,377
33,408
152,360
pharmaceutical products Manufacture of pharmaceutical preparations Manufacture of medical and surgical equipment Wholesale of pharmaceutical goods Retail sale of orthopaedic goods Hospital activities
16,637
9,640
Medical practice activities
2,135
2,694
6,660
3,455
3,563
18,507
Dental practices
783
454
2,389
1,115
1,126
5,867
Other human health activities
1,754
665
12,529
1,590
3,843
20,381
Total for health
23,967
14,787
81,975
45,423
44,581
210,733
6,382
4,417
14,990
12,510
14,665
52,964
accommodation
5,886
3,818
24,428
8,177
13,497
55,806
Total for social work
12,268
8,235
39,418
20,687
28,162
108,770
Total
36,235
23,022
121,393
66,110
72,743
319,503
Total employees in Region
393,441
193,877
1,063,926
562,710
516,330
2,730,284
% in health and social care
9.2
11.9
11.4
11.7
14.1
11.7
Social work activities with accommodation Social work activities without
Source: Annual Employment Survey 1997
Page 10
4 Health and social care sector in the Northwest (cont.) 4.7
The UK’s second largest pharmaceutical company (AstraZenica) houses its largest global R&D operation in Cheshire and employs c. 8,000 people. This significantly influences the Northwest’s position in the UK league table of private sector R&D investment, third out of twelve according to PION's 2002 Economic Report (op. cit.).
4.8
The CPS report (op. cit.) predicts that the health and social care sector is likely to remain among the top third of sectors in the Region in terms of contributions to GDP.
Table 4.3 : Distribution (%) of Northwest VAT-based businesses in the health sector by turnover value, 2001 Turnover band
£K-£49k
£50k-£99k
£100k-£249k
£250k-£449k
£500k-£999k
£1m-£5m
£5m+
12.7
16.9
27.1
20.5
12.7
7.8
2.4
20.1
26.7
25.5
11.6
7.0
6.8
2.3
Health sector firms Total – all VAT based firms
Page 11
5 Goods and services purchased by the NHS 5.1
One key element in developing understanding and action to win the health dividend in the Northwest relates to what the NHS purchases in terms of goods and services, at what scale, from what sources and using what procedures. The purpose of this and the next two Chapters is to describe each of these factors in turn, to the extent that data and commercial-in-confidence constraints permit. This is an important element in determining the “economic footprint” of the NHS.
5.2
The data and information provided here contribute to two strands of this study, namely: ●
the significance of the NHS as a purchaser of goods and services from other business sectors and clusters in the Region, and
●
the potential for enhanced local procurement, in particular from SMEs within the Region.
Spending pattern 5.3
Spending by the NHS on goods and services (including capital spend on new buildings and equipment) impacts a diverse range of business sectors, including: ●
pharmaceuticals
●
manufacturing of medical devices (hospital equipment and aids for patients)
●
manufacturing of medical and surgical supplies
●
textile, including clothing, manufacturers
●
information and communications technology (ICT) hardware, software and training
●
management and technical consultancy
●
catering supplies
●
office supplies and printing
●
transport vehicles and maintenance
●
construction, building repair and maintenance and other estates-related services.
Levels of revenue expenditure by the NHS in the Northwest 5.4
Obtaining detailed information on NHS revenue expenditure has proved challenging. Sources secured relate to patterns of expenditure by: ●
all NHS and Primary Care Trusts in the Northwest (providing data on expenditure - total and type)
●
the Royal Liverpool Children's NHS Trust (data on expenditure – total and supplier location)
●
the Wirral Hospitals NHS Trust together with the Aintree Hospitals NHS Trust (data on expenditure – total, type and supplier location).
5.5
Analysis of this information is outlined in the following sections. All Trusts in the Northwest
5.6
A profile of expenditure on goods and services for all NHS and Primary Care Trusts in the financial year 2001/2002 was provided by the NHS Purchasing and Supply Agency (PaSA). Expenditure ranged from around £0.5 million for Bebbington and West Wirral Primary Care Trust to £97,184,724 in the case of the Central Manchester and Manchester Children's University NHS Trust. Average expenditures vary significantly between types of Trust: NHS Trusts spent an average of £25.5million per annum and Primary Care Trusts an average of £8.5million. Table 5.1 shows this expenditure for each of the three Strategic Health Authority areas. Health and Social Care Industries Study Report to the Northwest Development Agency.
Page 12
5 Goods and services purchased by the NHS (cont.) 5.7
The profile of expenditures was mapped to standard PaSA product codes in order to identify the largest items of revenue spend across the Region. Table 5.1 shows the expenditure for each of the three Strategic Health Authority areas.
Table 5.1 Summary of total expenditure on goods and services by the NHS by Strategic Health Authority in the NW region, 2002/03 (Source PaSA) Expenditure item
Cumbria and Lancashire
Greater Manchester
Cheshire and Merseyside
Total
% of TOTAL
Construction
£21,824,768
£26,639,802
£21,901,159
£70,365,728
5%
Diagnostic medical equipment
£17,660,185
£26,745,360
£19,275,272
£63,680,817
4%
Facilities management
£35,184,898
£60,270,082
£50,177,639
£145,632,619
9%
£5,464,421
£10,952,369
£10,858,921
£27,275,711
2%
Medical
£51,744,369
£111,839,710
£92,437,032
£256,021,111
17%
Non medical consumables
£58,443,193
£76,108,538
£76,057,185
£210,608,915
14%
Outsourcing (incl. laundry)
£32,903,042
£73,017,232
£61,515,426
£167,435,700
11%
Pharmaceuticals
£45,177,992
£92,903,838
£77,665,764
£215,747,594
14%
£1,174,039
£6,144,070
£3,065,332
£10,383,441
1%
Rehabilitation services
£10,396,556
£20,609,266
£13,081,306
£44,087,128
3%
Expenditure on all other goods and services
£96,141,469
£153,388,925
£88,190,365
£337,720,759
22%
£376,114,933
£658,619,191
£514,225,399
£1,548,959,524
100%
IT
Professional Services
TOTAL
5.8
Total expenditure on goods and services by NHS and Primary Care Trusts in the Northwest in 2001/02 was £1.5billion. The largest proportion of spend was by Trusts in Greater Manchester, followed by Cheshire and Merseyside. The largest proportion of spend by Trusts in the Region by type of expenditure was on: ●
medical supplies (17% of total expenditure) – this includes a wide range of purchases from vaccination products, feeding tubes, bandages etc
●
non-medical consumables (14%) – this includes food, office and domestic consumables, workwear
●
pharmaceuticals (14%).
Royal Liverpool Children's NHS Trust 5.9
As an illustration of Trust expenditure, a breakdown of the spend of the Royal Liverpool Children's NHS Trust for 2002/03 is shown in Table 5.2. Just over one third of this expenditure was made directly with Northwest suppliers through direct contracts (£7,657,196). Data were not available to the study however on what was purchased. In addition, over £1 million was spent on goods and services provided through PaSA and NHS Logistics.
Page 13
5.10 Some of the items purchased by the Royal Liverpool through PaSA may have been supplied by Northwest companies holding contracts with PaSA. Data were not available the study to confirm this but the proportion purchased from Northwest firms can be estimate by applying the proportion of total PaSA national contract value across the NHS that is presently awarded to Northwest companies, namely 12%. Total expenditure with regional suppliers by the Royal Liverpool is estimated on this basis to be c. £7,804,800, representing 36% of the total revenue expenditure of the Trust.
Table 5.2 Breakdown of the Royal Liverpool Children's NHS Trust expenditure 2002/03 by supplier location Expenditure
% of TOTAL
£21,950,334
100%
£7,657,196
35%
TOTAL expenditure by the Trust Expenditure directly with NW suppliers Expenditure (estimated) with NW suppliers through national NHS Supplies contracts (at 12% of £1.23m) Total expenditure with NW suppliers
£147,623
12%
£7,804,818
36%
Wirral and Aintree Trusts 5.11 Additional information on patterns of Trust expenditure is provided by a recent study9 conducted in the Wirral area. The study analysed expenditure to identify patterns of spend with respect to local suppliers. The analysis focussed on suppliers in immediate post-code areas, as distinct from all within-Region suppliers. It found that: ●
Wirral Hospitals NHS Trust spent £23,600,978 in 2001/02, of which 32% (£7,552,312) was spent with local suppliers
●
Aintree Hospitals NHS Trust spent £64, 600,680, of which 29% (£1,8734,197) was spent locally.
5.12 The Wirral study developed its own typology to describe expenditure on different kinds of goods and services. This typology has been translated into PaSA’s product typology to provide a comparable picture of expenditure with local suppliers (see Table 5.3). Information on the nature of the suppliers was not available for analysis.
Table 5.3 Expenditure on goods and services locally by a sample of NHS Trusts in the NW Region, using PaSA typology Wirral Trust Expenditure Item
Total
Aintree Trust
% of TOTAL
Total
% of TOTAL
Construction
£0
0%
£0
0%
Diagnostic medical equipment
£0
0%
£0
0%
£2,750,205
36%
£2,206,352
12%
£31,138
0%
£17,631
0%
Facilities management and utilities IT Medical
£282,235
4%
£1,395,368
7%
Non Medical consumables
£1,258,137
16%
£3,786,694
20%
Outsourcing
£1,116,274
15%
£1,960,831
10%
£214,716
3%
£80,634
0%
£1,827,504
24%
£9,240,655
49%
£0 0%
£0
0%
£147,144
2%
£89,722
0%
£7,627,353
100%
£18,777,887
100%
Pharmaceuticals Professional services Rehabilitation services Other TOTAL
9
Anne Sleigh. Wirral Hospital NHS Trust & Groundwork Wirral EBS. (2002) Claiming the Health Dividend – unlocking the benefits of NHS spending and using NHS procurement policy to contribute to the regeneration of Merseyside.
Page 14
5 Goods and services purchased by the NHS (cont.) 5.13 The largest areas of local expenditure by these Trusts are: â—?
professional services (49%)
â—?
non medical consumables (20%)
â—?
facilities management and utilities (12%).
5.14 This kind of analysis of spending patterns both on type of goods/services and location of suppliers provides the basis for pro-active market development by the NHS and its regional partners. It could provide valuable information on Northwest firms with the capacity to supply at national, regional and local levels. It identifies the size of market niches in the Northwest that firms within the Region should be encouraged to exploit. However, as shown in subsequent sections of the report, the process of procurement differs significantly in the different market segments.
Page 15
6 Suppliers to the NHS in the Northwest 6.1
To complement the findings in Chapter 5 on what the NHS purchases and how much it spends with suppliers in the Region, in this Chapter the number of companies in the Region presently supplying this market is assessed (see also Appendix D). This is a key step in characterising the industry in the Northwest.
6.2
Information on the company base engaged in supplying directly to Trusts is available to this study from only a small sample of Trusts. Information on Northwest companies presently holding national NHS/PaSA contracts is probably comprehensive. Company information is available in the form of postal addresses. In some cases this may only be the invoicing address and may not be where the added value activity (manufacture, servicing, employment) occurs.
6.3
A list of all businesses holding national contracts to supply the NHS with goods and services can be obtained from the PaSA website (www.PaSA.doh.gov.uk). The name and address for each business is listed. An analysis of the list of businesses by location shows how many suppliers are based in the Northwest. The results are presented in Table 6.1. Around 12% of firms supplying the NHS through national contracts are located in the Northwest.
Table 6.1: Northwest based businesses supplying to the NHS through national contracts Number of companies in the Northwest Number of companies outside the Northwest Total number of companies in PaSA database
219 (12%) 1536 (88%) 1755 (100%)
Suppliers to the NHS through local Trusts 6.4
Businesses can also supply to the NHS through local purchasing arrangements made at the Trust level. To understand this pattern of supply, discussions were held with Supplies Managers from three NHS trusts in the Region. As a result, it has been possible to examine supplier details, together with information on expenditure by supplier, from one Trust. Royal Liverpool Children's Hospital
6.5
Supplier information was provided by the Royal Liverpool Children's NHS Trust for the financial year 2002-03. The information provides details of the amount spent with the supplier and the contact address for each business. In total, 2393 different suppliers provided goods and services under contract directly with the Trust. In order to establish how many suppliers to the Trust were based in the Northwest, the list of businesses by location has been analysed. The results of the analysis are presented in Table 6.2. Around 40% of businesses supplying the Royal Liverpool are based in the Northwest. However, information on what is being purchased from each company was not available for analysis.
Table 6.2: Supplier information on the Royal Liverpool Children's NHS Trust Number of companies in the Northwest
922 (39%)
Number of companies out with the North West
1471 (61%)
Total number of companies in supplier database
2393 (100%)
Page 16
6 Suppliers to the NHS in the Northwest (cont.) 6.6
Given the incomplete nature of the available company data, it is not possible to characterise the NHS supplies base in the Northwest at this time, into firms of a low, medium or high technology nature, far less into more or less innovative firms. The company base, intuitively, will be highly variable in these terms. Based on an understanding of the diverse nature of what the NHS requires, Figures 6.1 and 6.2 illustrate conceptual frameworks that could be used to provide a better characterisation of the supplies base. Information to populate the frameworks is not yet available.
6.7
Different segments will have different levels of contribution to make to economic development – high tech, high growth firms with leading edge technology and a national or international market potential will have a different impact than a firm providing standard goods and services to local markets. For the NWDA and its partners, the identification of these differences will be important in assessing the business development support that is needed (and the support that it is appropriate for the public sector to provide). This kind of characterisation will be important for the further development of the health and social care business sector in the Region.
Figure 6.1: Characterising market players and transactions in the context of demand and capability for innovation
Page 17
Figure 6.2: Towards a characterisation of the NW company base in terms of market opportunities and processes in NHS purchasing
Page 18
7 NHS procurement and supply chain development 7.1
The procurement processes of the NHS are described in detail in Appendix E. Potential suppliers must identify the appropriate procurement procedure and the key decision-makers. Broadly this means: ●
to supply to meet an existing, broadly based demand for higher volume products – NHS Procurement and Supply Agency (PaSA)
●
to supply to meet emerging/potential demand for higher volume products – local endusers and Trust Supplies Managers
●
7.2
to meet existing or emerging demand for low volume, high value products – local endusers and Supplies Managers
Inevitably suppliers will have to become more sophisticated in their ability to handle the procurement process where contract values are high (see Figure 7.1), notably where contract values exceed £100k and Official Journal of the European Community (OJEC) procedures are applied.
Figure 7.1: Supply characteristics and procurement processes
NHS supply chain development 7.3
Driven by PaSA at a national level, but with significance for businesses in the Northwest, there are a number of supply chain development and innovation-related initiatives currently being pursued by the NHS. These include both generic and technology/product specific initiatives.
7.4
One major area of activity concerns the development and implementation of an environmental management system (EMS) certified to ISO 14001 standards. This is of relevance not only to NHS operations but also to firms in the NHS supply chain. With respect to the latter, the rationale is that “the environmental performance of an organisation’s supply chain is increasingly considered to reflect the environmental performance of the organisation itself.”
7.5
Page 19
Five working groups concerned with progressing the EMS have been established for the NHS: ●
Waste Strategy Implementation Group
●
Environmental Supply Chain Working Group
●
Environmental Purchasing Working Group
7.6
●
NHS Environmental Purchasing and Supply Working Group
●
Travel Plan Steering Group – developing measures to minimise impact of travel on the environment
In facilities management and the purchase of utilities, there is a comprehensive review underway on waste management within the NHS – clinical and domestic waste plus waste electrical/electronic equipment. This is examining the role and activity of PaSA in the waste management market and has a remit to address both strategic and practical, operational issues.
7.7
The Waste Strategy Implementation Group (WSIG) was formed in 2000. This Group commissioned a strategic study to address legislative issues, provision of a market overview, options for waste disposal procurement practices and strategic options for the future. This could provide the basis of an innovation roadmap for Northwest companies in the environmental technology and services sector. This PaSA working group is also exploring the attractiveness and feasibility of consortium contracts for waste management in the NHS. The work is being pursued in conjunction with NHS Estates.
7.8
The Environmental Supply Chain Steering Group addresses the environmental performance of the NHS supply chain. An environmental survey of over 1,400 suppliers has already been undertaken. There are plans to identify and implement initiatives with selected key sets of suppliers aimed at reducing costs and benefiting the environment.
7.9
The results of the environmental survey are reported as indicating scope for the NHS to take greater advantage of opportunities to add value and reduce costs in its supply chain by taking greater account of environmental factors in procurement decisions.
7.10 Also in the environmental area, the NHS Sustainable Development and Environmental Purchasing and Supply Forum (NHS SDEPSF) is drawn from each region. Its remit is concerned with interpreting environmental policies in terms of purchasing and supply issues in the NHS; developing the environmental purchasing and supply agenda within the NHS; and sharing knowledge and best practice. The work of the Group will provide insights into the needs and demands of future NHS purchasing with respect to environmental standards. 7.11 Another area of importance to the NHS supply chain is the NHS e-commerce strategy, identified as having the potential to bring very significant savings and efficiency to the organisation. PaSA has the goal that all transactions between suppliers and the NHS will be in electronic form, from demand through payment. The strategy is being implemented from 2003 onwards. The pharmaceuticals and energy markets for the NHS already utilise ecommerce solutions. This will have implications for building up the capabilities of Northwest firms in e-business practices. 7.12 Additionally, PaSA has produced a Supplier Information Database (NHS-sid) allowing once only supplier registration to avoid duplication of information when approaching several Trusts. 7.13 PaSA reports that a large part of its business is transacted with SMEs. It provides a range of advice and support specifically for small and new suppliers, including: ●
a purchasing help desk
●
a guide for those interested in selling to the NHS (describing contracts, Trust contacts, NHS quality standards, procurement procedures etc)
●
customer consultation groups e.g. on theatre products, prosthetics, at which suppliers can demonstrate products and receive feedback from specialist buyers
●
product trials
Page 20
7 NHS procurement and supply chain development (cont.) ●
seminars in conjunction with trade associations and chambers of commerce
●
contract debriefings to unsuccessful bidders.
7.14 As part of its support for suppliers, the NHS convened a conference on Selling to the NHS in London in October, 2003. In its marketing of the event, the diversity of products purchased – “from MRI scanners to baked beans” – was emphasised. The agenda included: ●
working with EU procurement directives
●
Trust and Confederation purchasing
●
The role of PaSA and NHS Logistics
●
NHS-sid – the online supplier database
●
understanding PFIs, and
●
e-catalogues.
Initiatives to support SMEs in the Northwest 7.15 There is a growing awareness within the NHS concerning the potential influence of NHS purchasing on the local economy. There are also many perceived obstacles. 7.16 A significant local initiative is the pilot project 'Health and Safety @ Work in Wirral'. The aim of the pilot was to develop a model for integrating health and safety into the procurement process for the NHS. The project focussed on the ‘health community’ of Wirral comprising NHS Hospital Trust purchasers in order to examine their pattern of procurement from local companies. The project involved: ●
a health and safety audit of 21 local suppliers to assess their health and safety practices in the workplace
●
a report and action plan identifying areas where support improves standards.
●
support for 19 companies with a contract value of between £200,000 and £3000 per year.
7.17 The recommendation from this pilot was that purchasers set minimum standards for health and safety within the supply chain. However, they would also need to provide support systems to help achieve these standards within local companies. One suggestion was for a subsidy based on the size of the company 7.18 The project led to a number of benefits for the participants, including: ●
18 companies experiencing improvements in Health and Safety.
●
several companies highlighting business development opportunities as a result of the pilot, including: ■
a health and safety policy in place which demonstrates the quality of the company to customers other than the
■
networking opportunities
■
‘meet the buyer’ events increased
■
turnover and access to bigger contracts.
NHS
7.19 In addition, the pilot project has led to a number of further actions, including: ●
a study into the patterns of procurement of two large NHS Trusts on Merseyside for circulation to Government Office North West, NWDA and other regional partners. The results of the study were presented at a seminar for all nonExecutive Chairs and Directors of NHS Primary Care, Hospital and Ambulance Trusts in Cheshire and Merseyside in November 200210. The outcome was support, in principle (at NHS board level), for local procurement linked to regeneration within the NHS.
10
Page 21
Chairs and Non Executive Director's Development Event, 12 November 2002, Aintree Racecourse, Summary report
7.20 The Merseyside Business Environment Network (MERBEN) successfully attracted a package of funding (including EU Objective 1 funding) to provide health and safety advice to SMEs within the Developing Business programme. In addition to the obvious health benefits, this brings suppliers up to statutory requirements and thus enables them to attract sub-contracts from larger companies. 7.21 Another relevant initiative is under consideration by NWDA. This involves the proposal for a bureau and passport scheme led by Groundwork EBS (lead organisation for MERBEN): ■
the bureau would provide support for SMEs to access NHS market opportunities. It would create a once only system of accreditation to reduce duplication of effort created by the current NHS contracting system
■
the passport scheme would provide evidence that the contractor's staff are trained in health and safety, environmental standards, appropriate behaviour and confidentiality awareness for the NHS.
Food procurement 7.22 Sustainable food procurement in the NHS has received a considerable amount of national attention. The Sustainable Development Commission has already published a report11 on this subject. The Commission has set out fourteen recommendations for Government and the NHS at national level and six for NHS Trusts. 7.23 The recommendations to local Trusts concerned: ■
awareness raising among procurement professionals of sustainability issues
■
encouraging a more pro-active approach to looking for opportunities to pursue sustainable options
■
waste reduction through waste prevention
■
ending subsidies on unhealthy food served to staff
■
the avoidance of contract specifications that encourage unnecessarily long distance transport and the disadvantaging of smaller suppliers
■
working proactively with local suppliers to improve their understanding of the tendering processes
■
the establishment of a network of procurement professionals to share information and experience regarding sustainable procurement.
7.24 Public sector food procurement linked to better diets and sustainability is not well developed in the UK apart from a few notable pilot projects, including for example: ●
schemes at Llanidloes and Machynlleth hospitals12
●
fruit and vegetable co-operatives and box schemes linked to primary care13 .
7.25 European legislation is often cited as a reason not to favour local procurement, however consultees point to Italy, France, Denmark, Sweden, Finland, Austria and Germany all having long-running organic and local food public procurement programmes for schools, local government and some hospitals. Although 'local' may not be used as the criterion for awarding contracts, the explicit use of other criteria such as 'freshness', 'seasonality' and 'organic' are permitted and can favour local suppliers. 7.26 Opportunities may also arise from procurement activity in other areas of the public sector. For example, the regional School Fruit scheme, providing a daily item of fresh fruit (including carrots and tomatoes) to 300,000 primary school children is a potential opportunity for local procurement. The Merseyside pilot for this scheme used a local transport company, which distributed fruit from local markets. This has been promoted as a national good practice model and it is understood that the Government Office North West (GONW) is pursuing future local procurement initiatives of this kind through links with the NWDA. 11
Sustainable Development Commission (2003) Healthy futures: sustainable development opportunities for the NHS 12 BBC Radio 4 transcript 'Changing Places' programme 5 ‘from farm to fork’ - 25/04/03; www.bbc.co.uk/education/beyond/factsheet/changing5_prog5.shtml 13 Jochelson K Food Procurement, Health Service Journal 13 March 2003, p24,25
Page 22
7 NHS procurement and supply chain development (cont.) 7.27 Links to the local food industry have also been made through the Food Industries Forum convened by Liverpool John Moores University. Observations on local procurement initiatives and opportunities 7.28 Awareness of the links between NHS procurement, sustainability and the local economy is at a relatively early stage. At NHS board level there is growing support, in principle, particularly from non-executive directors of Trusts with their links to the wider sustainable development context for the Northwest. 7.29 Given the volume of NHS purchasing, a relatively small percentage shift to more local purchasing could benefit local companies, particularly SMEs. Mainstreaming bureau- and passport- type schemes would provide practical support and encouragement for NHS Supplies Managers and help to overcome obstacles for local SMEs. However, local initiatives should be informed by and aligned with the considerable effort that the NHS and PaSA are already investing to improve the supply chain. 7.30 In addition, some specific changes in NHS activity present further opportunities, for example: ●
the change in NHS non-emergency transport services - this will be purchased by PCTs14 and could create opportunities for local transport providers. It will also help raise awareness of the scale of NHS-related journeys. The NHS will have a transport access target, which is likely to engage interest and incentivise local action by NHS Hospital Trusts
●
access to healthy affordable food for communities is another new target for PCTs due to the 40% decline in small independent shops. This opens access to a package of support for retail SMEs in deprived areas and also potential for links to farmers markets
●
more generally, the “outsourcing” of services to social enterprises is a growing trend across the public sector15. Much of the focus has been on the role of these enterprises in social care but other opportunities will arise at local level – for example, engaging social enterprises in composting schemes for certain kinds of non-toxic hospital waste.
Conclusions and recommendations 7.31 In this section we offer conclusions and recommendations on the role of NHS purchasing in sustainable development. 7.32 There can be considerable barriers facing SMEs, especially those wishing to enter the market for the first time or expand their share of the NHS market, locally or nationally. The complexity of the NHS purchasing procedures stems in part from the diversity of what it buys, its organisational structure and the varied conditions and regulations associated with its tendering and specification processes. Despite the fact that a large number of Northwest companies already deal with these complexities more or less successfully, more information and support is likely to be required if Northwest companies’ share of the NHS market is to be increased significantly.
14 Making the Connections - Transport and Social Exclusion SEU 2003 15 DTI (2003) Public procurement: a toolkit for social enterprises
Page 23
Procurement nodes 7.33 A key early step is to confirm the nature and role of any aggregation into purchasing confederations (Supply Management Confederations) in the Northwest – where are the key nodes of purchasing capability and activity going to be and what parts of the Region’s NHS will they encompass? There is an opportunity here to reduce complexity by the NHS purchasing function, improving consistency in the way its business is conducted. 7.34 It is understood that the nature and role of Supply Management Confederations is likely to be determined by Trusts themselves i.e. a bottom-up approach. Confederation work plans may prove to be wide ranging in scope, embracing some or all of the following issues - procurement processes; distribution; supplier base rationalisation; key supplier relations; stockholding efficiencies; product and equipment standardisation or rationalisation; information provision; performance management and reporting arrangements; expenditure analysis and resource planning. It is important that any Regional initiatives in support of Northwest companies engages with these Confederations as they develop. Demand-side awareness and capacity 7.35 It is recommended that action is taken on both the demand- and supply-side. On the demand side, the NWDA should work with the NHS to ensure full appreciation among procurement practitioners of the feasibility and benefits of local or within-region purchasing. Any barriers to pursuing this agenda should be identified and addressed at an early stage. Engagement with Supplies Managers in Trusts will be essential. 7.36 Information and resource issues should be explored to enable a significant increase in local procurement – including new procurement opportunities for social enterprises. The means of sharing experience and leading practices on sustainable procurement and on local/withinregion purchasing should be enhanced. It is likely also to mean a review of how purchasing data are maintained and used if Supplies Managers are to be more pro-active in identifying opportunities for local or within-Region businesses to substitute for goods and services presently purchased from outside the area. 7.37 A clearly understood and broadly acceptable approach to strategic sourcing needs to be developed. This must address the profile of the products/services to be sourced and the niche markets of particular relevance to the Northwest company-base if there is to be an alignment between demand and supply to the benefit of all the relevant parties in the Northwest. Effective, efficient exchange of market-relevant information is key, as are opportunities for buyers to meet prospective suppliers. Information to companies 7.38 A large number of companies in the Region already sell to the NHS. However, opportunities do exist for new entrants to replace suppliers from outside the Northwest and for some Northwest firms, alone or in collaboration, to gain higher value and/or higher volume contracts with Northwest Trusts or with the wider NHS. For all groups, information on new opportunities and on how to handle NHS procurement procedures will be necessary.
Page 24
7 NHS procurement and supply chain development (cont.) 7.39 NWDA with the NHS should ensure that information and advice on purchasing opportunities and procurement practices are well known by firms in the Region. Regional and local events on selling to the NHS should be tailored for different audiences - for large scale contractors and smaller, local contractors; and for firms in different niche sectors. Information and knowhow are key to an effectively functioning market. Sources of generic business information and support in the Northwest should establish signposts to information on specific business opportunities with the NHS. Sources of sector-specific information and support such as cluster networks in the Northwest should consider similar signposts where appropriate. Business support 7.40 Having promoted the opportunities presented by the NHS market, the NWDA needs to ensure with its sub-regional partners such as Business Link that business support provision for SMEs in the Region is primed to follow-up with businesses as required. 7.41 Bureau and passport initiatives for SMEs supplying the NHS should be evaluated as soon as practicable. However, in designing for the mainstreaming of support, consideration should be given to what is happening in the Northwest with respect to the implementation of the NHS’ own supply-chain initiatives. We would caution against too much “intermediation� between supplier and purchaser. We would recommend designing sub-regional initiatives which closely involve the appropriate procurement nodes of the NHS and take due account of the benefits of being connected to Business Link support services. 7.42 Given the number of supply chain related initiatives being undertaken by the NHS and PaSA nationally, it is important that purchasing managers in Northwest Trusts are fully aware and involved to ensure that the significance of these initiatives for the Northwest are fully understood and disseminated, including to firms and to business support practitioners. Future needs and opportunities 7.43 For the more innovative products and services, knowledge of emerging end-user interests and requirements are necessary if firms are to be encouraged into new product development and trialling. We recommend that NWDA facilitates communication towards Northwest businesses of NHS' medium term "foresighting" on needs and opportunities for innovative products and services. Linking wherever possible with existing cluster networks and business organisations is recommended to access and engage their business members and the research-base in the Region. 7.44 Companies within the Region, notably SMEs, may benefit from the transfer of NHS inventions facilitated by the Regional NHS innovation "hub", Trustech, formed by a consortium of NHS Trusts in the Northwest to enhance the exploitation of NHS intellectual property. The innovations offered for commercial exploitation are often derived from clinical practice rather than research and may be relatively near to market.
Page 25
Northwest businesses into the health market 7.45 In any actions to increase the scale of Northwest business success in selling to the NHS, an organisational challenge for the NWDA is recognised in designing interventions on such a multi-faceted, complex set of needs and opportunities. Local initiative on procurement is necessary and to be welcomed but this alone is unlikely to gain optimum benefits as learn curves can be long, experience dissipated and mainstreaming uncertain. To make the challenge more tractable, it is proposed that NWDA and its partners develop not new intermediary organisations but rather implement a framework programme of partnering activity between stakeholders – Northwest Businesses into Health – with objectives to facilitate the flow of information; co-ordinate the provision of advice and guidance, encourage and support collaborative ventures, product/service trials and “meeting NHS end user/purchaser” events. 7.46 It is suggested that steering of this programme should be done at a sub-regional level or at levels linked to the key purchasing nodes within the NHS, if significant aggregation of purchasing activity emerges. Working with and through existing cluster and business networks in the Northwest to address thematic issues and product/technology niches is proposed. 7.47 In looking to develop and enhance local and within-region purchasing, it is important however to note that Trusts are legal entities that decide for themselves to whom business should be awarded. It is the individual Trusts that enter into commercial contracts. NHS Trusts expected to become Foundation Trusts are likely to be accorded greater freedom in the conduct of their business affairs.
Page 26
8 NHS and capital projects in the Northwest 8.1
The purpose of this Chapter is to examine the nature of capital projects associated with the NHS in the Northwest and the potential they offer for sustainable development. Construction and facilities management
8.2
All of the NHS organisations in the Northwest trade with the construction and maintenance sector to varying degrees, depending on the nature of their activities and estate. Each NHS body will have some basic maintenance requirements and the larger acute hospital Trusts may have major redevelopment projects with a capital value of several £ms. In between these extremes are numerous minor/medium sized projects involving the private sector.
8.3
It is not practical to identify the precise number of private sector firms working with the NHS in the Northwest, in particular the SMEs and sole traders, but due to the wide range of activity there is clearly a significant presence. Whilst most Trusts are likely to undertake their basic estate maintenance “in house”, specialised work will almost invariably be given to a subcontractor, who may or may not be locally based. Materials will be sourced from suppliers who may or may not be locally based, but who will have successfully tendered or otherwise quoted for the appropriate supply.
8.4
Major construction projects are undertaken by large national construction companies, many of which will have local bases and employ local people. Inevitably, much of the work on large projects will be sub-contracted, thus presenting opportunities for local contractors, subject to an appropriate supply being available.
8.5
Estimates of the value of construction work in the health sector for the UK as a whole are given in Table 8.1.
Table 8.1: Value of construction work in the UK health sector (£m at current prices) Sector
1997
1998
1999
2000
2001
2002
Public
822
764
879
928
1,083
1,330
Private
307
389
474
622
545
604
Total
1,129
1,153
1,353
1,550
1,628
1,934
% Total new work
3.8%
3.6%
3.8%
4.1%
4.1%
4.3%
8.6
The Construction Industry Training Board recently estimated that the Northwest has an average annual demand for 6,600 new recruits into the industry in the period 2002-616. Skill shortages are anticipated in craft occupations such as carpenters and joiners, brick layers, plumbers, painters and plasterers. Employment in health sector related construction in the Region is c. 6,900 (CPS op. cit.).
8.7
Most major NHS construction projects are now procured under the Private Finance Initiative (PFI). In these situations, the NHS procurer enters into a long term agreement, normally of 30 years’ duration, with a consortium of private sector organisations to build, maintain ("hard" Facilities Management) and provide a range of non-clinical services ("soft" Facilities Management), such as portering, catering, etc. Whilst some of these consortia may be dominated by national, or even international organisations, there still remains a significant opportunity for local contractors or locally based divisions/subsidiaries to be involved.
8.8
In addition to the normal opportunities available for technical and professional service providers and advisors such as architects, the complex nature of the PFI process requires significant input from both legal and financial advisors. In terms of legal advice for PFI schemes, the Manchester-based firm of Addleshaw Goddard has been particularly
16
Page 27
Construction Industry Training Board (2002) Construction Regional Skills Foresight Report - North West
successful in this market. In terms of financial advice, large national firms will utilise staff from local offices, if they have the requisite skills and experience. National firms with a regional presence have significant market share in project management and contract procurement aspects of PFI projects. 8.9
The condition of the primary care estate is poor, with 80% of the premises being below the current recommended size and only 5% co-located with a pharmacy or with social services. The most deprived areas tend to have the poorest primary care facilities. Private finance under the NHS LIFT (Local Improvement Finance Trust) initiative aims to renew or replace two thirds of the primary care estate by 2006. The LIFT process is described in more detail below. It is a Public Private Partnership (PPP) venture which, as with PFI, also offers business opportunity for legal and financial advisors.
8.10 For all other capital projects in excess of £1m, the NHS has introduced a process called ProCure 21 which enables NHS procurers to select from a schedule of relevant firms who have pre-qualified. The most recently available information reveals that out of 101 firms registered in the North of England, some 61 are based in the Northwest. Under ProCure21, Trusts are actively encouraged to recommend SMEs that "have provided an excellent local service over the years". Scale of the challenge and the private sector opportunity 8.11 In July 2000, the Government launched the NHS Plan which included a major investment in new buildings over the next 10 years. Headline items were 100 new hospitals, 20 new Diagnostic and Treatment Centres, 500 new one-stop primary care centres and up to 3000 family doctors’ premises substantially refurbished or replaced. Whilst these are national figures, it is clear that there is currently a substantial NHS capital investment programme being undertaken in the Northwest, as well as the rest of the country. 8.12 The current capital programmes for the three Northwest Strategic Health Authorities in respect of the 5 years ending 2007/8 are summarised below (Table 8.2). They project a total capital investment of some £4.5bn which can be broadly distributed as shown.
Table 8.2: Capital expenditure programmes for the five years ending 2000-8 DoH Modernisation £m
SHA Strategic £m
Trust/PCT Operation £m
Private Finance £m
PPP (LIFT) £m
Total £m
Cheshire & Merseyside
435
245
260
280
100
1,320
Greater Manchester
435
245
260
1,000
150
2,090
Lancashire & Cumbria
348
158
155
325
76
1,062
1,218
648
675
1,605
326
4,472
Total
8.13 Due to the nature of this type of expenditure, there will inevitably be some changes/slippage in the timing and incidence of the above projections, but nevertheless it is a good indication of the scale of the opportunity that exists for relevant private sector firms in the Northwest.
Page 28
8 NHS and capital projects in the Northwest (cont.) 8.14 The categories of planned expenditure analysed in the Table above can be detailed as follows: ●
DoH Modernisation – this is a national allocation to each SHA which is used to meet modernisation priorities, such as the development of cardiac services, as set by the DoH Modernisation Board. It is allocated to Trusts on the basis of bids
●
SHA Strategic – allocated to each SHA to enable capital projects to be undertaken which are not appropriate for PFI funding or to meet specific priorities
●
Trust/PCT Operational – annual allocations to Trusts (based upon depreciation) to be used at their discretion for equipment/minor capital projects
●
Private Finance – major hospital developments in Manchester, Salford, Tameside, Stockport, St Helens & Knowsley
●
NHS LIFT – for example, a number of schemes will provide refurbished and new GP, primary and community care facilities in St Helens, Knowsley, Halton, Warrington, Liverpool and Sefton.
NHS LIFT 8.15 NHS LIFT schemes are aimed at helping to improve the health of the population by providing modern services, in appropriate buildings, situated in accessible locations. They are designed to develop and encourage a new market for investment in primary care and community-based facilities and services. The projects result in a Public Private Partnership (the LIFT Company) being created, which will invest in and maintain local primary care premises. If investment is made in new premises, then the freehold will be vested in the LIFT Company, with the result that over time PCTs’ ownership of premises will diminish. 8.16 A LIFT Company’s Strategic Partnering Board will consist of representatives of the LIFT partner plus appropriate local NHS representation. Unlike PFI schemes, where the funding is raised externally, LIFT projects are funded by Partnership for Health alongside the local stakeholders. Partnership for Health has been established by the Government and is jointly owned by the DoH and Partnerships UK (PUK), which replaced The Treasury Task Force. 8.17 Partnerships UK is itself a Public Private Partnership (PPP), jointly owned by The Treasury, the Scottish Executive and a range of private sector interests. It is the Government’s focal point for PPPs across the whole public sector. Because of their size, LIFT projects will be subject to the EU’s procurement processes that require compliance with the appropriate legislation and the invitation of bids from interested parties through the Official Journal of the European Communities (OJEC). SHIFT, Salford 8.18 The SHIFT project (Salford's Health Investment for Tomorrow) is an example of an NHS LIFT initiative. It provides a useful insight into the challenges of integrating development planning and procurement for capital and other LIFT project elements with the various aspects of local regeneration. 8.19 For the SHIFT project, there is a senior management team consisting of Project Director, Director of Service Design, Director of Capital Investment, Director of Finance, Director of HR. Each has a Project Working Group - presently the Workforce Development Group is probably the most advanced. The Project Team has an established relationship with the Local Authority.
Page 29
8.20 The redevelopment of Hope Hospital, Salford is a key part of the SHIFT project. It is expected to create over 300 new jobs. Although the higher education sector will be concerned with the provision of doctors and specialist staff, currently there is no direct path for providing the remaining skills. In the main, these are expected be drawn from the local area. This is the particular focus for the Local Authority presently in its work with the SHIFT Project Team. 8.21 Although there is support for the idea of integrating SHIFT with other regeneration activity in Salford, to date little has been done with respect to other potential areas of collaborative activity. 8.22 The main area of innovation being considered within the SHIFT project is around home care and patient support in the community. A key area of development is ‘Guided Self Management’ – patient care outside the hospital environment – either in the community or at home. 8.23 New investment in IT is an essential part of the Hope Hospital redevelopment: it is directed however at the sharing of information between the Hospital and dispersed community care centres, GPs and specialists, rather than specifically towards innovative applications in telemedicine linked to patients' homes. 8.24 The Hope Hospital redevelopment faces significant challenges with respect to transportation and vehicle movements. This is an area in which the SHIFT project would benefit from close engagement with the Local Authority and the NWDA. 8.25 The SHIFT Project Team also recognises local development opportunities in the construction process. Clearly, there will be opportunities for local construction workers but the potential to contribute to the wider sustainable development agenda could extend much further, for example in areas such as: ●
waste management
●
energy efficiency
●
new building materials
●
new building techniques.
8.26 The SHIFT Project Team is not aware of the contributions to these and other areas of technical innovation that could be made by universities and businesses in the Region. 8.27 It is important to recognise that any innovative proposals in the above areas that may be attractive in terms of the wider regeneration agenda would nonetheless need to be affordable in the context of the SHIFT project, as well as technically feasible. Equally importantly, any proposals would need to be embedded in the NHS procurement process (see later) which for SHIFT is already underway -it would be necessary to include specific requirements in the tender documentation. However, there still remains some uncertainty about how much influence could actually be exerted over the prime contractors invited to bid for major capital projects and their supply chains. Maintenance 8.28 The actual volume of maintenance carried out in the NHS by private firms is difficult to identify accurately. From a small sample of Trusts, it would appear that, as an approximation, some 0.7% of total turnover on external contracts is spent on maintenance which extrapolated for the Northwest as a whole, represents some £40m pa. This figure is supported by an analysis of Trust Financial Return TFR3D data which gives a total expenditure of £48.4m on building and engineering contracts for the year 2001-2 in the Northwest. It is likely that this sum includes some expenditure which is not relevant to this study, e.g. cross-charging for services from other Trusts.
Page 30
8 NHS and capital projects in the Northwest (cont.) 8.29 In terms of both construction and maintenance work undertaken by the private sector in the NHS, Table 8.3 shows a typical profile. Table 8.3: Expenditure profile Labour
Materials
Total
%
%
%
Maintenance
80
20
100
Construction
60
40
100
The procurement processes for capital projects 8.30 There is a variety of procurement processes applied to NHS contracts each dictated by the size and nature of what is being procured. Because of their very complex and high cost nature, PFI and LIFT projects have dedicated processes that are different from the normal tendering procedures. 8.31 The LIFT/PPP formal tendering occurs under OJEC procedures. The procurement process is similar to PFI, but due to the simpler nature of the contractual agreements, the period from OJEC to financial close is predicted to be much shorter, possibly under 12 months. 8.32 NHS ProCure 21 was introduced during 2000 with the objective of delivering better quality/value for money healthcare buildings in respect of schemes (other than PFI/PPP projects) costing more than £1m. It is a supply-chain collaboration aimed at improving NHS procurement practices: it was designed following extensive consultation between the NHS and representatives of the construction industry. Innovation in the NHS estate 8.33 The NHS is constantly striving to achieve both excellence and innovation in its estate. A key factor in the introduction of PFI during the earlier part of the last decade was to allow the private sector more opportunity to be innovative in its design and solutions for the NHS. One of the quoted objectives of ProCure 21 is to bring benefits to the local environment. 8.34 However, innovation in the estate does not just apply to building design, it also applies to areas such as renewable energy, energy management and environmental issues (reduction in carbon emissions, waste management, etc). Opportunities for companies in the Northwest 8.35 In addition to the construction sector, the capital projects described above also offer opportunities notably to the Region’s environmental technology and services sector. 8.36 This is one of the NWDA’s cluster development targets supported by the networking organisation Envirolink North West. Envirolink addresses high profile environmental issues such as waste management and the impact of climate change. It is involved in strategic partnerships with the NWDA, Renewables Northwest and the Carbon Trust. The latter’s regional agent operates from the Envirolink offices at Wigan. Envirolink currently work alongside c.700 local organisations. Some 95% of the firms in contact with Envirolink are SMEs, many engaged in highly specialised work.
Page 31
8.37 The creation of so-called Active Networks in the UK provides a forum where environmental technology and systems companies, their suppliers, customers and stakeholders, research institutions, funders and public sector agencies can pursue an active, collaborative research and development programme. There are currently five such networks, but none of which involve the healthcare sector. However, it is understood that a health- related network is likely to be established in the near future. 8.38 A common complaint is that, due to their size, the firms have great difficulty in dealing with the NHS. In addition, potential NHS customers are deterred by the fact that many innovative proposals concerning environmental technologies are “front-end loaded” financially, but with varying and often long payback periods. Consequently such proposals are seen as unaffordable in the short term. However, NHS PFI schemes involve long term agreements with the private sector which could facilitate medium/long term payback periods provided they offer value for money. 8.39 The creation of an Active Network for the healthcare sector could be a major step forward in encouraging the adoption of innovative solutions, particularly if financial subsidies become available (which it is understood could be the case). NHS involvement is vital and participation should be carefully targeted at those who can influence local Trusts and capital project teams, perhaps at Strategic Health Authority level. Consideration could also be given to the selection of some pilot Trusts who could be supported financially in implementing innovative projects. This would be a boost to local specialist firms and also the local NHS in being seen at the forefront of exploiting innovative environmental technology. 8.40 In the context of energy and water consumption, a best practice guide on energy consumption in hospitals was published as part of the UK Government’s Best Practice Programme for Energy Efficiency (Energy Consumption Guide 72). The Centre for the Analysis and Dissemination of Demonstrated Energy Technologies (CADDET) has also published a brochure (Maxi Brochure 05) on Saving Energy with Energy Efficiency in Hospitals. 8.41 NHS Estates is co-funding a study called Material Health into baseline environmental impacts of the NHS using resource flow and ecological footprint analysis methods. Conducted by Stockholm Environment Institute, York University and Best Foot Forward (www.materialhealth.com), the project sets out to: ●
estimate the overall the environmental impact of the NHS
●
estimate the environmental impact of NHS hospitals and GP surgeries.
8.42 The findings of these studies into energy and hospitals may provide opportunities to advance the objectives of the strategy set out in From Power to Prosperity: advancing renewable energy in northwest England. Other forms of major capital investment 8.43 The NHS is involved in other forms of major capital investment that offers opportunities for businesses in the Northwest. Notably these include significant NHS investment earmarked for information technology over the next three years. It is understood that an NHS investment of c. £2.3bn is planned. With this level of investment there should be significant opportunities for Northwest firms. Niche market intelligence on upcoming requirements and opportunities could usefully be fed into Northwest business networks representing this industry sector.
Page 32
8 NHS and capital projects in the Northwest (cont.) 8.44 The significance of the NHS and other public bodies in aggregating demand for the implementation of broadband connectivity across the Region has also been raised during this study. Both the requirements of NHS professionals for enhanced communication and data transfer and those concerned with innovative ways to support patients in their homes add to the demand for improved digital connectivity. The opportunities in rural areas such as Cumbria for innovative telemedicine approaches are especially germane. Integrated appraisal of capital projects 8.45 The North West Regional Assembly in partnership with the NWDA, Health Development Agency and others prepared a toolkit for appraising capital projects in the Region - “Implementing Action of Sustainability - An Integrated Appraisal Toolkit for the North West 2003” (IAT). Its purpose is to improve the quality of decision making by integrating sustainability considerations. The use of the toolkit also provides evidence that a comprehensive and systematic appraisal process is in place and helps develop initiatives which maximise economic, social and environmental benefits. 8.46 Each NHS Trust is charged with producing its own Sustainable Development Strategy. The IAT can be used to complement the NHS' Environmental Assessment Tool (NEAT) and help provide "traction" between NHS capital investments and regional priorities for sustainable development. Conclusions and recommendations 8.47 There are major opportunities for local firms in terms of construction and facilities management contracts with the NHS in the Northwest: this applies to both SMEs and larger organisations. The Government’s drive to modernise the NHS via the NHS Plan includes major programmes in new and improved facilities, which offer local firms the opportunity to be considered. NHS-business networking 8.48 Many firms in the Region are already aware of and registered with ProCure21. However, it is clear that current NHS procurement procedures and high initial costs are acting as a barrier to progress especially in the environmental technology sector, despite the local availability of significant expertise. There appears to be little, if any, networking or linkages between the NHS locally and the various private sector organisations in this field. 8.49 The availability of relevant NHS information, which could assist/inform business organisations such as Envirolink North West and its members is still regarded as limited and difficult to access. Given the role of the environment in Sustainable Development this is an area worthy of much more attention. 8.50 A number of recommendations are made to address the perceived deficiency in information and networking between the NHS, and specifically the environmental technology sector in the Region. However, they are likely to have wider relevance. ●
Forum: the NWDA and relevant partners in the Region should take on a leadership role in establishing a forum for the NHS and appropriate SMEs in the environmental technology sector (explore the Active Network model)
●
Pilot sites: assess the feasibility of creating one or more NHS pilot sites for the demonstration of innovative technology projects
Page 33
â—?
Business opportunities: establish a forum/work group involving the NWDA and representatives of NHS Finance and Supplies Departments to explore how financial and other relevant information concerning construction and maintenance expenditures and business opportunities could be made more accessible.
NHS LIFT 8.51 It is important that NHS LIFT project teams gain knowledge and understanding of the wider regeneration process and priorities in the area at an early stage in their process - to find out what is happening and what the ground rules are for taking joint action. A deeper exploration of the wider opportunities presented by the SHIFT project in Salford needs to be progressed speedily if it is to fit the tendering timeline. 8.52 There is a need for one public agency to lead on integration between a LIFT project and wider regeneration needs and opportunities. For SHIFT, this could be Partners IN Salford (formerly Salford Partnership) but we understand that to date it has been interested largely in the opportunities offered by the social and community care aspects of the SHIFT project. While important, this is only part of the potential value to be leveraged. The NWDA and the relevant Strategic Health Authority should provide a strategic framework within which the opportunities to leverage wider development benefits from NHS LIFT projects can be identified, appraised and taken forward.
Page 34
9 Employment and workforce development in the NHS 9.1
The NHS is a major employer in the Northwest. As such it already has a major impact on economic and social development in the Region. The King’s Fund report Claiming the Health Dividend describes the situation across the UK in which the health services may be unable to recruit the number of employees needed to deliver the level of service expected while co-existing – often co-located - with areas of high unemployment.
9.2
The arguments for encouraging the training and recruitment of local people, particularly from areas of higher unemployment and from socially excluded groups, have been widely reported. This is generally accepted as offering important contributions to economic and social development. It is useful here to summarise some of the benefits: ●
employment and training of people who live locally provides a direct link between the health and social care services and the community
●
good quality employment, whether in the health and social care sector or elsewhere, is believed to contribute to improved health – an investment in recruiting from areas that tend to have a higher level of health problems can, over time, reduce the demands on the health service in the future
●
through the wages and salaries paid, this provides an injection of income to deprived areas and through multiplier effects this will have a knock on impact within that community
●
although the employment and associated income may be displaced from somewhere else – i.e. it is not additional employment to the Northwest - there are distributional impacts. The rationale is that an extra pound will give more benefit to a person who is deprived than to someone who is well off
●
as well as addressing some fundamental economic inclusion objectives, encouraging the employment of local staff is more likely to reduce transport journeys and travelling time, allowing a better work/life balance; a greater likelihood of staff retention and satisfaction; as well as bringing environmental benefits.
9.3
With staff shortages and high levels of unemployment in some areas, the question, therefore is how best the health and social care sectors can engage those from deprived areas. To a large extent this is happening already through a very large number and range of initiatives and projects being run by many organisations (see Appendix F). These are being led by a number of organisations in partnership with Trusts. Some initiatives are local to individual Trusts and reflect their own recruitment activities, others are within Health Action Zones and others are being run through Workforce Development Confederations.
9.4
Given this “busy” scene, an important issue for NWDA is to determine how best it can support these activities to ensure that they contribute optimally to the social and economic development objectives set out in the RES. There is certainly a role at a regional level in providing a framework to enhance co-ordination and especially learning, and to evaluate and support the mainstreaming of specific initiatives of promise. Fit with NWDA and Regional Economic Strategy
9.5
The workforce development theme fits closely with two priority issues set out in the 2003 Regional Economic Strategy (RES) for the Northwest: ●
economic inclusion
●
development and maintenance of a healthy labour market.
Economic inclusion 9.6
The NHS is singled out in the RES as an important player in supporting economic inclusion: “The National Health Service (NHS) is a major regional force in terms of services, expenditure, employment and training. The NWDA will undertake further work to understand fully the economic opportunities emerging from the unprecedented investment
Page 35
in the health and social care sector that will lead to substantial contributions to the five RES priorities.” (North West Regional Economic Strategy 2003). Under this heading, the main tier two indicators are: ●
9.7
in those wards within the bottom 20% of the Index of Multiple Deprivation (IMD): ■
number of adults in income support/income based Job Seekers Allowance households
■
unemployment claimant count.
■
ILO Employment rate.
■
% adult population with low or very low levels of literacy/numeracy.
Many of the initiatives identified in this report and suggested for further consideration will contribute directly to the achievement of these targets. Employment and skills
9.8
Clearly, employment related initiatives in the health and social care sector also provide opportunities to contribute to the strategic skills and employment objective in the RES. “An effective skills base is an essential element of a successful economy. The Skills and Employment objective impacts significantly on all aspects of the Regional Economic Strategy, particularly on Business Development and Regeneration.” (North West Regional Economic Strategy 2003).
9.9
The targets set around this objective relate to: ●
Gross Value Added (GVA) per total hours worked
●
% of adults with NVQ Level 2/Level 3/Level 4 or (equivalent) qualifications
●
% of adult population with low or very low levels of literacy/numeracy.
9.10 The principles of the NHS' career skills escalator and the various training for employment activities contribute to the achievement of these targets. The concept of a skills escalator represents a significant cultural shift: rather than only considering recruitment and training for specific levels of staff, the escalator concept promotes the development of people to enable them to move between levels. It puts more of an emphasis on developing people to fill posts rather than recruiting. However, the escalator importantly includes pre-employment training. Much of the activity of Workforce Development Confederations in the Region is concerned with taking forward the escalator concept. Overview of employment in the Region 9.11 It is not the intention of this report to analyse in detail the profile of health and social care employment in the Northwest. Much of this has already been done for the Regional Assembly (CPS op. cit.). However, it is important to re-emphasise the importance of the sector as a source of employment. This section sets out some of the key statistics as a starting point. 9.12 Figure 9.1 shows the total number of people employed in health and social care activities in the Northwest and in other Government Office Regions. The figures are based on employment within six Standard Industrial Classification (SIC92) codes and are taken from the Annual Business Inquiry 2001. The six SIC codes included are: ●
85.11 : Hospital activities
●
85.12 : Medical practice activities
●
85.13 : Dental practice activities
●
85.14 : Other human health activities
●
85.31 : Social work activities with accommodation
●
85.32 : Social work activities without accommodation
Page 36
9 Employment and workforce development in the NHS (cont.) 9.13 In the Northwest, there are 339,661 people employed in these activities based on these 2001 figures. This is the second highest regional UK total, slightly lower than the figure for the South East. Perhaps more reflective of the importance of the sector are the figures shown in Figure 9.2 which show health and social care employment as a percentage of all employment in each GOR area. This suggests that while there is a slightly greater proportion of direct employment in this sector in Wales, the North East and in Scotland, the Northwest is broadly in line with other English regions with just under 12% of employment. Figure 9.1: Health and social care employment by GOR
400,000 350,000 300,000 250,000 150,000 100,000 50,000
nd
es
t
Sc
ot
W
la
al
es W h
ut So
So
ut
Lo
h
nd
Ea
st
on
n er Ea
la
st
nd
s id tM es W
Yo
rk
sh
ire
an
d
Ea
Th
st
e
M
H
id
la
um
W th or
N
nd
be r
t es
st Ea th or N
s
0
Figure 9.2: Percentage of employment in health and social care activities
on nd
h ut So
Lo
Ea
st
rn st e Ea
ds la n id
es tM
W
id st M Ea
ut h
W
la nd
s
es t
t es W th
or
So
Th d an ire rk sh Yo
N
e
H
um
ot la Sc
N Page 37
be r
st or th
Ea
es W al
nd
16% 14% 12% 10% 8% 6% 4% 2% 0%
9.14 Within this total, the proportion of employment varies across local authority districts - from 18% of employment in Burnley and Knowsley, to 7% or less in Warrington, Pendle and Ellesmere Port and Neston. Demand in Greater Manchester 9.15 As an example, in Greater Manchester there is an anticipated increase of 9.6% in total workforce demand for qualified staff between March 2003 and March 2006. Total workforce demand for all staff groups increases by 12% over the period, ranging from 9.8% for GPs to 18.7% for Health Care Assistants (HCAs). ●
Consultants - the predicted demand in the number of Consultants that will be needed to meet activity increases from 1,665 Whole Time Equivalents (WTE) in March 2003 to 1,816 WTE in March 2006, an increase of 151 WTE (9%) over the three year period. However, the majority of this demand occurs in years 1 and 2 (7.7%)
●
GPs - in terms of the Local Delivery Plan (LDP), the predicted demand in GPs needed to meet activity increases from 1,404 WTE in March 03 to 1,542 WTE in March 06. This is a total increase of 138 wte (9.8%) over the three year period
●
Nurses - the predicted demand in the number of Nurses that will be needed to meet activity increases from 17,994 WTE in March 03 to 19,679 WTE in March 06. This is an increase of 1,685 WTE (9.4%) over the three year period
●
Healthcare Assistants (HCAs)/Support Workers - the predicted supply of HCAs shows an increase of 1,942 WTE (18.7%) over the LDP period. This growth takes into account productivity improvements and skill mix transfers from other staff groups – further work to analyse the reality (in terms of need and supply) of this growth is outstanding.
9.16 Overall, the Greater Manchester position shows an under-supply of all staff groups as at March 2003, with the undersupply continuing for nurses throughout the three year period. The projected expansion in the Healthcare Assistant/Support Worker role is very significant (18.7% over 3 years with 6.9% in Year 1). Failure to meet this expansion would impact on skill mix projections (particularly for nurses) and potentially worsen the shortfall in nursing. 9.17 Supply strategies include a range of developments on skill mix transfers (for example GP work transferring to practice nurses); developing new roles (such as Emergency Care Practitioners); productivity improvements and strategies to increase the overall numbers (international recruits, assistant practitioners etc.). Health and social care employment and deprivation 9.18 Figure 9.3 shows a scatter diagram that compares the percentage of health and social care related employment with the average ward deprivation index scores17. The average ward score for each district is shown on the x-axis. The higher the number the more deprived the area and the lower the figure the lower the level of deprivation. 9.19 The Figure shows employment ranging from 18% to 5%, with a slight tendency for the higher levels of employment to be co-related with higher levels of deprivation.
17
Rankings range from 1, least deprived to 354, most deprived. The Index of Deprivation contains rankings and scores on a number of indicators. The values used on the x axis are the rankings of average of ward scores within each district
Page 38
9 Employment and workforce development in the NHS (cont.)
% of employment in health and social care related activity
Figure 9.3: Scatter diagram of % of health employment by deprivation scores for each district in the Northwest
20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 0
10
20
30
40
50
60
70
Deprivation 2000 rank: rank of average of ward scores within district
9.20 Having demonstrated the scale of the sector and its importance both to the employment in the Region and to areas with higher levels of deprivation, we now turn to consider the activities and initiatives that are in place or are being developed to encourage local workforce development. Employment related initiatives 9.21 There is a plethora of initiatives in the Northwest relating to the NHS workforce. This is in part due to the fact that the delivery of Government targets for the NHS is underpinned by the need for both an increased workforce and also for a blurring of traditional roles to allow for greater flexibility within the workforce. Recent policies on improving diversity within the workforce and using NHS employment to benefit the local community have been other influences. 9.22 In addition, the increases in funding for the NHS in the coming years is likely to create more employment just as policy initiatives such as Improving Working Lives (IWL) and the NHS University (NHSU) begin to have an impact. This has the potential to improve the image of the NHS, making it a more attractive employer which provides good terms and conditions plus a career progression route, particularly for unqualified staff and/or those with caring responsibilities.
Page 39
NHS Workforce Development Confederations 9.23 The lead strategic bodies for the NHS workforce are the NHS Workforce Development Confederations (WDCs) linked to the Region’s three Strategic Health Authorities - for Greater Manchester; Cumbria and Lancashire; and Cheshire and Merseyside. The Confederations are responsible for the development of the skills escalator at all levels. 9.24 The responsibilities of the WDC’s were set out by the DoH in Shifting the Balance of Power: The Next Steps. They are partnership organisations, bringing together both NHS and non-NHS employers to plan and develop the whole healthcare workforce. The WDCs have begun to connect with Learning and Skills Councils (LSC) sub-regionally on a range of training issues. This approach recognises that not only the NHS but also local authorities, private and voluntary sector providers, and others need to work together if workforce planning is to be effective. 9.25 The WDC’s are therefore in a pivotal position in terms of assessing, planning and delivery. They are central to the analysis of how the health and social care employment activities contribute to regeneration. The responsibilities of a WDC go much wider than simply recruitment - they cover forecasting future workforce needs; supporting workforce development; developing a shared approach to Human Resource (HR) policy and practice; establishing working relationships with other bodies; promoting input to the development and delivery of healthcare education and training; and co-ordinating the strategic management of local learning and education facilities. 9.26 In this study, interest lies specifically in the role that the WDCs play in providing employment, training and education opportunities that contribute to the economic development and regeneration objectives of the NWDA. Although potentially this could include many of the above activities, the focus here is on activity aimed at supporting local employment opportunities. Examples of initiatives are discussed below. A fuller listing of regional initiatives is provided in Appendix F. Greater Manchester 9.27 The Delivering the Workforce Programme is a major initiative to recruit up to 2,000 new employees over the next five years. It is targeted at unemployed people over the age of 25 who would like to work in the health and social care sector but cannot access current professional routes as they do not have the required qualifications. It aims to recruit people local to the facilities and, through a two year training course, to contribute to a new generation of high level support workers with greater skills and flexibility. 9.28 During the programme, participants are placed in work and paid while studying a range of core skills in the first year. In the second year, more specific new skills are developed relating to Trust's and patients’ needs. At the end of the programme, recruits can stay with the Trust or seek jobs in other related workplaces. The programme is now operating from fourteen sites. Eight are acute organisations, three are mental health sites and three related to primary and social care.
Page 40
9 Employment and workforce development in the NHS (cont.) 9.29 This project is a very good example of the way in which WDCs can provide a co-ordinated response to the recruitment needs of the health and social care sector and match this with local employment circumstances. Through the programme, the health and social care services can address the element of policy aimed at developing a workforce that represents the communities that they serve and at contributing more widely to raising skill levels and promoting social inclusion. 9.30 The Greater Manchester WDC (GM-WDA) is also engaged in a number of other activities to meet workforce development plans. Several of these have a widening access element that would contribute to NWDA objectives. For example, many HEIs and FEs already undertake activities to encourage access from disadvantaged or socially excluded groups. GM-WDC is working with both sectors to build participation. There is also work ongoing with younger people both through cadet schemes and with schools. Cumbria and Lancashire 9.31 This is a highly diverse area in terms of economic activity and community. For the rural areas, there is an aspiration to become a national exemplar for rural delivery of health and social care services. This will require particular skills and also infrastructure to support approaches to telemedicine and e-training. 9.32 To achieve these aspirations, the synergies between NHS and wider economic development needs and opportunities need to be exploited. The engagement of other agencies with the NHS should not be too tightly restricted to “health cluster bounded activity�. One of the consultees for this study recommended that the NHS be considered as a collection of connected SMEs as a way of appreciating its diversity and degree of local autonomy. 9.33 In urban areas of Cumbria and Lancashire, cultural norms among some ethnic minority communities have limited the ability to recruit from some communities to certain jobs. 9.34 The WDC is engaged in the REACHE initiative - Refugee and Asylum Seekers Centre for Healthcare Professionals Education - supporting refugee doctors into work in the NHS. There is scope for extending this scheme to support refugees with other relevant skill sets. 9.35 The WDC participates in 14-16 year old business-education partnership schemes and in the development of a Local Community Responder service involving volunteer first aiders. 9.36 The "black economy" has been identified as competing for the workforce with employers such as the NHS in some urban areas.
Page 41
Cheshire and Merseyside 9.37 There is an anticipated need for the order of 4000 more nurses in the next few years. The current attrition rate among nurses is high: 50% currently leave work after five years. 9.38 The NHS in the area faces severe competition for staff. This is expected to increase as a result of Liverpool’s new status as City of Culture. This will add to the competition for recruiting staff to social care that is already experienced from call centres and in areas such as Blackpool, from tourism. 9.39 The WDC is especially active in three areas: ●
international recruitment – as a short term solution to staffing problems
●
increasing the commissioning of training in particular areas of shortage – notably in radiology at present
●
entry level projects – including cadet schemes, with job guarantees after initial training; the Liverpool Academy to promote the NHS as an employer of choice for school leavers.
9.40 Developments of note here are the creation of a recruitment toolkit and a bank of resources to assist workforce development. In addition, it is understood that work is ongoing to create a database of workforce development initiatives. Health Action Zones 9.41 There are three Health Action Zones in the Northwest - Merseyside, Salford & Trafford and Bury & Rochdale. Of these, two are known to have employment pilots: ●
the Merseyside employment pilot aims to improve occupational health in small and medium enterprises
●
the Salford & Trafford employment pilot aims to improve the care of people with back pain and musculoskeletal disability.
9.42 Neither relates to supporting employment opportunities specifically within the health and social care sector. However, there are a number of HAZ projects in other areas of the UK which do contribute directly to this. For example: ●
Refugee Nurse Employment Pilot (East London & City HAZ) - the East London and City HAZ Employment aims to support jointly (with Barts) training and supervised placements to enable local residents, particularly refugees, with nursing qualifications, to attain accredited nursing status in the UK. The project plans to enable up to 36 nurses each year to attain accredited nursing status, subject to 1st year pilot
●
Health Employment (Hull & East Riding HAZ) - Hull and East Riding Employment Pilot focuses on co-ordination of the work of the Employment Service and the NHS in Hull and East Riding. It is envisaged that the co-ordinator (employed by the pilot) would lead the development of innovative ways for the local health service to link with the New Deal and encourage unemployed people to take up health service posts
●
NHS Employment Initiative (Lambeth, Southwark & Lewisham HAZ) - the Lambeth, Southwark and Lewisham Employment Pilot is a partnership between LSL HAZ, the Health Authority and the Employers Forum on Disability. It aims to make job vacancies in the NHS more accessible to young people with disabilities or double disadvantage in the labour market (e.g. care leavers, young people with learning disabilities) and support the development of more flexible recruitment practices
Page 42
9 Employment and workforce development in the NHS (cont.) ●
Developing and Supporting New Deal Placements (Tyne & Wear HAZ) - Tyne and Wear Employment Pilot focuses on employing a practice manager who will work with 45 practices in 3 Primary Care Groups (each of the three PCGs serves one of the three HAZ Areas of Special Action which are characterised by high levels of social disadvantage including high levels of unemployment) to identify and support placements for the New Deal full time education and training option. The initial intention being to identify 25 placements and to offer training to NVQ Level 2 in either Customer Services, Admin and Clerical or Information Technology
●
Wakefield Health Jobnet (Wakefield HAZ) - the aim of the Wakefield Employment Pilot is to support the setting up of community businesses delivering health related activities, creating job and training opportunities for the unemployed. The project will investigate the needs which could be met by third sector community owned and community managed care-based businesses, identify and apply for start-up and initial running costs for three years, and identify long-term income streams which will sustain the project and other HAZ activities in a community managed setting after the end of HAZ, SRB, ERDF and ESF Funding
●
Promoting Career Pathways (Wolverhampton HAZ) - Wolverhampton Employment Pilot is looking at enabling local disadvantaged people in the community to find opportunities of employment in the NHS. The aim of the project is to enable participants to realise their educational and career potential, and promote awareness of career opportunities and pathways into training and employment in health and social care contexts, by delivering a suite of complimentary schemes in health and social care settings targeting black and minority ethnic communities, teenage mothers and disaffected individuals in Wolverhampton.
Workforce pilots 9.43 The Northwest Regional Taskforce on the NHS workforce has funded three pilots linking with local regeneration initiatives - in Halton, Oldham and Blackpool. The initiative has been widened to include each sub-region in the Northwest (Learning and Skills Council areas) and two further sites have been established for Cheshire and Warrington, and Cumbria. 9.44 Each sub-region also relates to a JobCentre Plus (JCP) regional director and now has an NHS Workforce Co-ordinator reporting to a steering group comprising WDC, LSC, GONW, JCP and NHS University (NHSU). All areas are involved in linking with Learning Partnerships, Local Strategic Partnerships (LSPs) and at neighbourhood level with neighbourhood plans and New Deal for Communities (NDC) areas. This ensures that NHS Workforce initiatives are relevant to priorities within local communities: it provides opportunities for matching and maximising synergy with other funding sources. Health Learning Works 9.45 Health Learning Works is a new initiative led by the NHS University. The scheme provides a pre-employment guarantee of a first level NHS job for local people referred from Job Centre Plus. It is currently being piloted in the Northwest and in Yorkshire & Humberside. Health Learning Works (HLW) is building on the workforce pilots and is managed by the NHS Workforce Coordinators.
Page 43
9.46 The Northwest HLW pilot sites are currently Southport and Ormskirk NHS Trust and West Cheshire Primary Care Trust. Each pilot site will use a different model. Mancat is the provider of pre-employment preparation training for Health Learning Works. In addition, links are being developed with FE and HE institutions. Also, New Deal for Communities (NDCs) is involved in some pilots e.g. North Huyton and Oldham, where a new-build private care home development is employing local people. In places, job preparation activity is in place linked to new capital developments (North Huyton, St Helens and Knowsley). Local Strategic Partnerships are also identifying linked opportunities to deliver their targets through the NHS e.g. cadet schemes for non- GCSE qualified young people and language skills for NHS staff. 9.47 Other local links being made include at Blackpool Victoria NHS Trust: here an NHSU Learning Centre is being developed as part of the Council’s multi-use centre on a housing estate rather than in NHS premises. Funding also comes from the University for Industry. Conclusions and recommendations 9.48 The various initiatives and funding sources provide a complex picture at a national, regional, district and neighbourhood level. However, within the Northwest strategy, funding and delivery links are being made through the work of the NHS workforce pilots and within a framework for Healthy Living and Working. Sharing knowledge and experience 9.49 To advance the agenda to link workforce development with sustainable regional development, it will be necessary to raise awareness of NHS workforce issues as a regional priority involving key regional players (the launch of the Investment for Health Plan supported by this study should help to do this). This needs to be done in tandem with raising awareness of what can be done in practical terms with NHS managers, perhaps using evaluated case study as examples. 9.50 Experience from the workforce pilots suggests that the necessary success factors are strong leadership providing strategic vision and empowerment of local community action across the health and social care sector, and involving a range of agencies. There appears to be a general requirement for more “getting to know you� meetings between economic development professionals and staff in the NHS in order to explore and better understand areas of mutual interest and synergy. This seems to have been a successful way forward for the relationship between the WDCs and the LSC organisations. 9.51 It is widely recognised that there is a plethora of initiatives and too little knowledge among the professionals involved of what is working best, where and for what reasons. There is a need to identify the initiatives that are underway and organise information and learning relating to them on a thematic basis. There is a need to bring people together to review, share, promote and help mainstream what is being done and what is working best. Enhanced cross-initiative learning within the Northwest as well as work to import leading practices from elsewhere would be beneficial. 9.52 The development of toolkits and banks of resources available across the Region available to those engaged in developing and implementing the careers skills escalator would be valuable. The process of achieving this would also bring useful cross-regional opportunities for networking and learning.
Page 44
9 Employment and workforce development in the NHS (cont.) Mainstreaming 9.53 In terms of identifying training initiatives for mainstreaming, the complexity and diversity of workforce needs and local communities across the Northwest will be a challenge. Any model must not be too prescriptive but must allow for local development needs and respond to local opportunities. However, co-ordination of learning and enabling support would be beneficial: one possibility would be that NHSU in collaboration with NWDA provide the co-ordination: ●
supporting the development of local training resource centres
●
developing standards, quality, credit accumulation for training courses across the NHS - this seems to be very fragmented currently
●
accrediting competence in health and health care for local people - could provide useful training both for potential employment and for life
●
potentially providing a common induction across health and social care and a preemployment standard for the NHS - not just for an individual hospital trust as currently.
Links to capital projects 9.54 The potential to link capital development with workforce opportunities for the local community both for construction and within the NHS workforce is already beginning to be recognised. Examples include the SHIFT project in Salford (Salford www.shiftproject.org.uk) and in north Manchester (construction staff training). This should be developed further to become standard practice. Northwest people into health work 9.55 The organisational challenge for the NWDA is in supporting interventions on such a multifaceted, complex of needs and opportunities. Local initiative is necessary and to be welcomed but that alone is unlikely to gain optimum benefits as learn curves can be long and mainstreaming uncertain. To make the challenge more tractable, it is propose that NWDA and its partners develop not new intermediary organisations but rather implement a framework programme of partnering activity with key stakeholder organisations – “Northwest people into health work” – with objectives to facilitate the flow of information; co-ordinate the provision of advice and guidance, encourage and support collaborative ventures; appraise and evaluate pilots; and convene “getting to know you” events between practitioners. 9.56 It is suggested that steering of this programme should be done at a sub-regional level or at levels linked to the key Workforce Development Confederation nodes within the NHS. The NHS University would be an important partner in offering a regional and national perspective.
Page 45
10 Developing the Health and Social Care Industry in the Northwest 10.1 The health and social care sector is generally acknowledged to be large, difficult to define and without a clear and coherent identify in the Region. The supply chain connecting to the NHS can broadly be broken into two elements: ●
the very wide array of goods & services bought to support core health and social care functions - food, uniforms, cleaning products, construction materials, and services such as cooking, reception, security etc.
●
the materials and enabling equipment of health and social care - drugs, medical devices and know-how on procedures (the “medical systems”).
10.2 For the former, the Northwest has a strong food sector and also produces detergents and disinfectants from within its chemical business base (see Appendix G). Although being very significant employers, these are largely not high value adding sectors and are not likely to generate significant strategic advantage to the Region within a global market. Opportunities for substitution of supplies currently sourced from outside the Northwest and to increase market share with the wider NHS are likely to be their prime source of business growth in the context of this study. Resultant increases in local employment will be the prime benefit for sustainable regeneration, coupled in some instances to shorter transport distances. 10.3 For the latter (the “medical systems” purchases), the Northwest has a strong base in the pharmaceutical, biotechnology, speciality chemicals and wider life sciences areas – its strength and status in terms of international competitiveness is variable across different niches. 10.4 Significant efforts are already underway to enhance the chemicals sectors through the North West Chemical Initiative and a range of bio/pharma initiatives and investments in infrastructure. Efforts are being pursued in Merseyside and Greater Manchester to expand the Region’s base of bio/ pharma- businesses, some of which directly tackle the health dimension in their markets e.g. MerseyBio is directly reaching into teaching hospitals to identify commercial opportunities as one strand of its activities. 10.5 The prime regional cluster grouping in the biosciences is Bionow (www.bionow.co.uk) created by the NWDA. It identifies the following areas of strength and capability in the Northwest's science base: ●
bioinformatics
●
clinical genetics and genomics
●
clinical trials
●
medical imaging
●
pharmaceuticals and biopharmaceuticals
●
therapeutics - notably cancer and neuroscience
●
tissue engineering and regenerative medicine.
10.6 Bionow provides support to existing bioscience companies, supports new ventures and encourages inward investment. It works closely with the research base in the university sector and the NHS. It is a single point of information and advice as well as having a key role in strategic project development and management. 10.7 Explicit knowledge of the opportunities and challenges in further developing the health and social care industries in concert with the NHS is patchy within the Region. Interviewees during this research believe that the scale of the NHS and nature of the Region’s existing presence in the biosciences means there must be significant scope in the wider health care market, but detailed knowledge of the barriers and optimal means of achieving aspirations remain anecdotal and/or sketchy.
Page 46
10 Developing the health and social care industry in the Northwest (cont.) 10.8 There are already links between the Region’s R&D base and the clinical front-line for drug trials. There are extensive operational linkages between the university- base and hospitals (as there are with all teaching hospitals). Attempts to accelerate spin-out company activity from the university sector and especially from the clinical research-base in the NHS has enjoyed some success to date but lead time from research to products sales is often long and commercial readiness of individuals and prospective businesses remains limited. The medical devices sub-sector where time to market tends to be shorter may offer earlier wins. Commercial exploitation of research 10.9 There are some underpinning and challenging priorities in relation to encouraging health professionals to think and be more entrepreneurial – the spin-out concept is relatively new to the NHS and in particularly to consultant level staff. A culture change is perhaps just as critical as a skills development programme. Mechanisms should be examined and promoted to permit consultant/inventors to retain their clinical roles while contributing to the creation and growth of new private sector enterprises. A complementary issue will be the availability of the high level commercial management skills for these new ventures, a key factor in securing risk finance. 10.10 Access to finance at the pre-start phase of new venture creation is limited and venture capital at times can be hard to come by for start-ups in the life sciences. The investment market for the commercialisation of life sciences research output is cyclical, albeit in a particular trough as regards early stage financing at present. 10.11 The licensing route to commercialisation of intellectual property in the life sciences is seen as much more feasible and lucrative by some commercialisation professionals in the Region: this approach is one which the University of Liverpool in particular is keen to continue exploiting. The challenge is to achieve not only a reasonable income stream for the university and inventor, but also, wherever feasible, to benefit those Northwest companies that may be capable of exploiting the intellectual property that is coming through. This a challenge faced in most if not all regions in the UK with research strengths in the life sciences. 10.12 Spin-in companies attracted by university expertise is regarded as a significant economic development target in areas of the Northwest with world class research. Networks and initiatives 10.13 There are many established networks and development initiatives for the Region’s businesses which in the words of one consultee “hover around the health and social care sector”, although none are dedicated to the central themes of this study. This seems to be especially true outside the bioscience areas. 10.14 Bionow operates with a number of partners at regional and sub-regional levels, including but not limited to Trustech, the 3Bs Project (Building Biotech Businesses), University of Liverpool, Merseybio (the Mersey biotechnology incubator organisation); UMIST, University of Manchester and Manchester Innovation Limited. 10.15 Strategic bioscience projects involving Bionow and/or partners include:
Page 47
●
NW Genetic Knowledge Park (NowGen), Manchester
●
Genetic Innovation Network (GIN)
●
NW Consortium for post-genomics science (Universities of Liverpool, Manchester and UMIST)
●
National Biomanufacturing Centre, Speke.
10.16 Due to its diversity, it is not easy to define in simple terms the staff/skill’s needs of the research-base and industry serving the health and social care sector. Research excellence is however highly dependent on retaining and attracting key individuals with international research reputations and providing them with world class research facilities. 10.17 Many aspects of the sector are heavily regulated by statute and this generates specific infrastructure requirements. Also, researchers are now coming under increased pressure to formalise their approach to work, especially that conducted between universities and teaching hospitals who have traditionally shared facilities on an informal basis. The Alder Hey scandal and expected EU changes to the regulation of research are both going to have an impact on the research in the health arena. The way ahead for sector development 10.18 At one level, the health and social care business-base may be taken as synonymous with a life sciences/medical devices cluster. This has been at least the implication of studies undertaken in other regions of the UK. The Northwest already has a significant presence in biotechnology, pharmaceuticals and medical devices: the Northwest already has substantial research excellence and infrastructure, networks and commercialisation capability in these areas. The NWDA and others already support substantial efforts to develop clustering activity here (see Appendix G). 10.19 Repeating the observation of one of our consultees that “established networks and development initiatives for the Region’s businesses …. hover around the health & social care sector”, the way ahead is less about the creation by the public sector of new health-centric cluster networks, but rather initiatives which strengthen the health-related aspects of existing cluster networks and infrastructure. The closer involvement of health and social care professionals – end users and procurement professionals – in existing networks should be the primary short-to-medium term goal. Clustering activity in support of different aspects of the health and social care industries sector will develop if this approach is energetically pursued. One health and social care clustering initiative is difficult to envisage addressing all aspects of the sector’s needs and opportunities in the Northwest. 10.20 Because of the diversity of the goods/services purchased and capital investments made, the NHS is relevant to and sits in the supply chain of a very diverse range of industry sectors and cluster groups in the Northwest. Because of the size of its purchasing and investments, the NHS within the Region and the NHS nationally is also a major factor in a diverse set of markets. In some, such as those most directly related to the “medical- systems” industry, the NHS plays a key role in the market not only as an originator of know-how and innovation, but also as an exacting, demanding customer. 10.21 Figures 10.1 and 10.2 illustrate how existing and other emerging clusters in the Northwest relate to the health and social care industries. The nature of existing networks associated with these sectors/clusters are indicated as is the research/mapping work that has been undertaken to date, largely commissioned by the NWDA. A substantial amount of cluster-related research has been conducted in the Northwest which includes to a variable, but often limited degree, the role of the NHS in these clusters and their supply chains. The nature and significance of the NHS dimension in clustering activity is discussed further in Appendix F.
Page 48
10 Developing the health and social care industry in the Northwest (cont.) Conclusions and recommendations 10.22 The following conclusions and recommendations emerge from our consultations with cluster network managers, NHS staff and the individuals in the research-base. Niche market intelligence 10.23 The high growth business potential lies in niche markets. There appears to be a generic need for improved dissemination of the new product and process development needs and opportunities arising in the NHS. Fora which help to link researchers and innovative businesses with the clinical governance machinery in Trusts, with end users and Supplies Managers as appropriate to different niche sectors would be beneficial. Working with and though existing industry and cluster bodies should be adopted wherever possible. 10.24 The NW Food Alliance is working with regional purchasers and suppliers to assist local firms access national supply chains. This kind of work is highly relevant to supplying the NHS. This kind of activity can address the generic need for a greater understanding among Northwest businesses of the opportunities associated with NHS purchasing - locally, regionally and nationally - and how to address them successfully. Linking SMEs to the research-base 10.25 Health-related research activity, capabilities and facilities in the Region are highly regarded but knowledge of what is being done and what facilities are available are viewed by some commercialisation practitioners as patchy at best among the Region’s SMEs. This is not a phenomenon unique to the Northwest. Improved information/knowledge transfer to the more innovative SMEs involved in health and social care market is still required. The Medilink organisation already works to improve connections and information flows in support of innovative SMEs in the medical devices sector. 10.26 Given the diversity of the market and of the business-base (including in terms of innovative capacity), a “one size fits all” regional initiative to promote a health and social care industries cluster would be less effective than encouraging a higher profile for health and social care needs and opportunities amongst existing Northwest cluster networks and business support organisations. High value, high tech opportunities in particular are likely to be in quite specialised niches. 10.27 Any intervention in support of Northwest firms in the health and social care market must distinguish between the different kinds of market needs and opportunities, take account of the supply chain issues facing firms supporting "core" health and social care functions (supply of food, uniforms etc) and those supplying highly innovative, higher tech products in the “medical systems” domain. At the high value/high tech end, this is not a volume activity but rather about having innovative SMEs more closely networked to the clinical governance machinery in place within NHS Trusts. Identifying and exploiting IP in the NHS: 10.28 Sustained effort is required to support the identification and exploitation of IP in the NHS. This includes mechanisms to permit investors and entrepreneurs to reach-in to research that is being conducted and draw out viable business prospects. There would be benefit in creating greater opportunities for the key researchers and the commercialisation function in the NHS to interface with Northwest businesses – as potential “catchers” of its IP.
Page 49
10.29 Even here, a segmentation in terms of novelty/sophistication of the innovation and its commercial exploitation occurs. Trustech, the organisation established to support NHS commercialisation in the Northwest, works with both the “high endâ€? market in terms of research and innovation and also with issues around patient care where process rather than technology is often crucial. The latter can lead to commercial opportunities that are close to market: time to market can be short, making them particularly relevant to the Northwest's SMEs. Risk capital 10.30 Timely access to suitable risk capital remains a major challenge facing new company formation and growth, notably in life sciences sector. Funds especially at the pre-start stage and at levels of ÂŁ10-100k required to assess viability of a business idea are especially difficult to obtain. This view persists among some consultees despite their recognition of the value of support from the Manchester Knowledge Capital plan and from the DTI for proof of concept projects. Figure 10.1: NW business sectors/ clusters and their networks linking to markets in health and social care industries
Page 50
10 Developing the health and social care industry in the Northwest (cont.) Figure 10.2 : Summary of research/mapping of NW sectors and clusters linked to health and social care markets
Page 51
11 Summary of conclusions and recommendations 11.1 The aim of this study has been to understand more fully the sustainable development opportunities in England's Northwest region that are arising from the major investments being made in the health and social care sector. It set out to determine the nature of the economic “footprint” of the NHS in the Northwest and to inform the actions of the NWDA and its partners in harnessing the full potential of health and social care expenditure and investment in the Region. 11.2 The emphasis by the DoH and NHS on local empowerment to meet what are often quite localised needs and opportunities introduces challenges for the practical design and delivery of interventions in the context of the Northwest’s Regional Economic Strategy. This is a recurring theme within this Report - namely the challenge of facilitating appropriate, effective and efficient local action and delivery within the strategic regional framework set for sustainable development. 11.3 A second recurring theme is the pervasive and cross-cutting nature of the health and social care sector – specifically, NHS influence, expenditure and investments - with respect to sustainable development objectives. Strategic objectives as diverse as those concerned with the growth of businesses; social enterprise development; delivery of urban and rural renaissance; enhancing and protecting the environment; securing economic inclusion; labour market development and communications infrastructure (specifically broadband) can all be associated with action areas in which the NHS as a "corporate citizen" can make significant contributions. 11.4 Conclusions and recommendations from this study focus around three key areas of NHS activity - purchasing of goods and services; workforce development; capital /infrastructure projects. Recommendations are also made for the further development of the health and social care industries in the context of the contributions of the NHS to the Region's knowledge-base and to the other industry clusters being supported by the NWDA. 11.5 The priorities for action and allocation of resources within Strategic Health Authorities (SHAs) are emerging in the Northwest, as elsewhere in England, following the formation of the SHAs in late 2002. The SHAs are already involved in assisting with the integration of skills and capacity issues through Workforce Development Confederations. Given their role in creating a coherent strategic framework for health improvement in their area and their commitment to facilitative and developmental approaches across the health and social care "system", the SHAs would seem to be well positioned to work strategically in partnership with the NWDA and others in engaging with Trusts on the wider role the NHS can play in sustainable regional development issues raised below. NHS procurement 11.6 There can be considerable barriers facing SMEs supplying the NHS, especially those wishing to enter this market for the first time or significantly expand their market share, locally or nationally. The complexity of the NHS purchasing procedures stems in part from the diversity of what it buys, its organisational structure and the varied conditions and regulations associated with its tendering and specification processes. Despite the fact that a large number of Northwest companies already deal with these complexities more or less successfully, more information and support is likely to be required if Northwest SMEs' share of the NHS market within the Region is to be increased significantly. 11.7 A key early step is to confirm the nature and role of any aggregation into purchasing confederations (NHS Supply Management Confederations) in the Northwest – where are the key nodes of purchasing capability and activity to be, and what parts of the Region’s NHS will they encompass? There is an opportunity here to reduce complexity of the NHS purchasing function, improving consistency in the way its business is conducted. It is important that Regional initiatives in support of Northwest companies engage with these Confederations as they develop.
Page 52
11 Summary of conclusions and recommendations (cont.) 11.8 It is recommended that action is taken on both the demand- and supply-side of the NHS "market" in the Region: ●
NWDA should work with PaSA and NHS Supplies Managers in Trusts to ensure full appreciation of the feasibility and benefits of local or within-region purchasing - a clearly understood and broadly acceptable approach to local sourcing needs to be developed ■
the means of sharing experience and leading practices between Supplies Managers on sustainable procurement and on local/within-region purchasing should be enhanced
■
a review of how purchasing data are maintained and used by NHS Supplies Managers is required if the NHS is to be more pro-active in identifying opportunities for local or within-Region businesses to substitute for the goods and services presently purchased from outside the Northwest
●
NWDA and NHS Supplies Managers should work to improve the flow of information on new business opportunities at local and sub-regional levels. Information on how to handle NHS procurement procedures needs to be disseminated effectively to Northwest businesses, especially prospective new entrants to the NHS market. More opportunities for NHS buyers to meet prospective Northwest suppliers should be arranged ■
events on selling to the NHS need to be convened with different audiences in mind - for large scale and smaller contractors; for firms in different niche sectors; for local and national market opportunities
●
bureau and passport initiatives for SMEs supplying the NHS should be evaluated by NWDA as soon as practicable. Consideration of mainstreaming however needs to take account of and be designed to leverage the NHS’ own supply-chain initiatives ■
too much “intermediation” between supplier and purchaser should be avoided. Sub-regional initiatives which directly involve the appropriate procurement nodes of the NHS are recommended.
Northwest businesses into the health market 11.9 It is proposed that NWDA and partners develop not new intermediary organisations but rather implement a framework programme - Northwest Businesses into Health - to promote collaborative activity between stakeholders in the NHS, the Business Link network, existing business/cluster networks and individual firms, with objectives to facilitate the flow of information; co-ordinate the provision of advice and guidance; encourage and support alliancing and product/service trials; and convene “meeting NHS end user/purchaser” events. 11.10 Steering of this programme should be done at a sub-regional level or at levels linked to the key purchasing nodes within the NHS, if significant aggregation of purchasing activity emerges. The NWDA, PaSA and Supplies Managers should work with and through existing cluster and business networks in the Northwest to address thematic issues and product/technology niches whenever possible. NHS and capital projects 11.11 The current capital programmes for the three Northwest Strategic Health Authorities in respect of the 5 years ending 2007/8 amounts to a total investment of c. £4.5bn. 11.12 Although many Northwest firms in the construction sector are already linked to the NHS ProCure21 initiative, links between the NHS and other sectors that could contribute to capital projects seem less well developed - the development of enhanced links with firms and research groups in the environmental technology sector for example would appear to offer valuable opportunities. The feasibility of developing pilot sites to demonstrate the use of innovative environmental technology in the NHS estate should be explored by the NWDA together with NHS project directors and Envirolink North West.
Page 53
11.13 It is important that NHS LIFT project teams gain knowledge and understanding of the wider regeneration process and priorities in the area at an early stage in their process - to find out what is happening in the area and what the ground rules are for taking joint action. A deeper exploration by the NWDA of the wider opportunities presented by the SHIFT project in Salford needs to be progressed speedily if it is to fit the tendering timeline. 11.14 There is a need for one public agency to lead on integration between an NHS LIFT project and wider regeneration needs and opportunities. For SHIFT, this could be Partners IN Salford (formerly Salford Partnership), but to date it has been interested largely in the opportunities offered by the social and community care aspects of the SHIFT project. While important, this is only part of the potential value to be leveraged. The NWDA and the relevant Strategic Health Authority should provide a strategic framework within which the opportunities to leverage wider development benefits from NHS LIFT projects can be identified, appraised and taken forward. Workforce development 11.15 The health and social care sector is a major employer in the Northwest - providing directly c.340,000 jobs. A mapping of the current employment and basic skills development initiatives in the health and social care sector the presents a "busy" picture at regional and local levels. 11.16 It is widely recognised that there is a plethora of initiatives and too little knowledge among the professionals involved of what is working best, where and for what reasons. There is a need to identify the initiatives that are underway and organise information and learning relating to them on a thematic basis. There is a need to bring people together to review, share, promote and help mainstream what is being done and what is working best. Enhanced crossinitiative learning within the Northwest as well as work to import leading practices from elsewhere would be beneficial. 11.17 The development of toolkits and banks of resources available across the Region to those engaged in developing and implementing the NHS careers skills escalator would be valuable. The process of achieving this would also bring useful cross-regional opportunities for networking and learning. 11.18 The potential to link capital investments with workforce opportunities for the local community is already beginning to be recognised. Examples include the SHIFT project in Salford. This should be developed further to become standard practice. Northwest people into health work 11.19 There is an organisational challenge for the NWDA in supporting interventions on such a multi-faceted, complex of needs and opportunities. Local initiative is necessary and to be welcomed but that alone is unlikely to gain optimum benefits as learn curves can be long and mainstreaming uncertain. To make the challenge more tractable, it is propose that NWDA and partners develop not new intermediary organisations but rather implement a framework programme – Northwest people into health work – with objectives to facilitate the flow of information; co-ordinate the provision of advice and guidance; encourage and support collaborative ventures; appraise and evaluate pilots; and convene “getting to know you” events between practitioners. 11.20 It is proposed that steering of this programme should be done at a sub-regional levels linked to the Workforce Development Confederations within the NHS. The NHS University would also be an important partner.
Page 54
11 Summary of conclusions and recommendations (cont.) The way ahead for sector development 11.21 At one level, the health and social care business-base can be taken as synonymous with a life sciences/medical devices sector. The Northwest already has a significant presence in biotechnology, pharmaceuticals and medical devices: the Northwest already has substantial research excellence and infrastructure, networks and commercialisation capability in these areas. The NWDA and others support substantial efforts to develop clustering activity in these areas. 11.22 Repeating the observation of one consultee in this study that “established networks and development initiatives for the Region’s businesses …. hover around the health & social care sector”, the way ahead is less about the creation by the public sector of new health -centric cluster networks, but rather initiatives which strengthen the health-related aspects of existing cluster networks and infrastructure. The closer involvement of health and social care professionals – NHS end users and procurement professionals – in existing networks should be the primary short-to-medium term goal. Clustering activity appropriate to the different aspects of the health and social care industries will develop if this approach is pursued energetically. 11.23 Because of the diversity of the goods/services purchased and capital investments made, the NHS is relevant to and sits in the supply chain of a very diverse range of industry sectors and clusters in the Northwest. One health and social care clustering initiative is difficult to envisage addressing all aspects of the sector’s needs and opportunities. A “one size fits all” regional initiative would be less effective than encouraging a higher profile for NHS needs and opportunities amongst existing Northwest cluster networks and business support organisations. Northwest innovations for health 11.24 The high growth business potential lies in niche markets. There appears to be a generic need for improved dissemination of the new product and process development needs and opportunities arising in the NHS. Fora which help to link researchers and innovative businesses with the clinical governance machinery in Trusts, with end users and Supplies Managers, appropriate to different niches, would be beneficial. Working with and though existing industry and cluster bodies should be adopted wherever possible. 11.25 Health-related research activity, capabilities and facilities in the Region are highly regarded but knowledge of what is being done and what facilities are available are viewed by some commercialisation practitioners as patchy at best among the Region’s SMEs. Improved information/knowledge transfer to the more innovative SMEs involved in the health and social care market is still required. It is recommended that NWDA facilitates communication towards Northwest businesses of the NHS' medium term "foresighting" on needs and opportunities for innovative products and services. Linking wherever possible with existing cluster networks and business organisations is recommended to access and engage their business members and the research-base in the Region. Identifying and exploiting IP in the NHS: 11.26 Sustained effort by organisations such as Trustech and others is required to support the identification and exploitation of intellectual property in the NHS. This includes mechanisms to permit investors and entrepreneurs to "reach-in" to research that is being conducted and draw out viable business prospects. There would be benefit in creating greater opportunities for the Region's SMEs – as potential “catchers” of NHS IP - to be informed of the commercial potential of NHS inventions.
Page 55
APPENDIX A: Scope and roles of health & social care issues and stakeholders in regional development A.1
Given the objective of this study is to understand the range of economic opportunities presented by the Health and Social Care economy in the Northwest, it is instructive to review the scope and roles of health and social care issues and stakeholders already identified as important in the Regional Economic Strategy and its Action Plan. All explicit references to health and social care in the Action Plan have been extracted in Table A.1.
A.2
Objectives concerned with growth of business sectors, the competitiveness and productivity of businesses; delivery of urban and rural renaissance; securing economic inclusion; labour market development and strategic communications (specifically broadband) infrastructure all have major actions in which health and social care stakeholders are partners.
Table A.1: Scope and roles of health and social care issues and stakeholders in regional development already identified by NWDA (Objectives and associated actions are extracted from the Regional Economic Strategy 2003) Regional Economic Strategy Objective 1: Exploit the growth potential of business sectors 1.2.1 Establish networks and develop strategic action Including for healthcare sector – with the Directorate plans for sectors not yet operational for Health and Social Care and the NHS among the key stakeholders 1.2.1 Expedite major planned projects to fully operational stage
Including NowGen - with Central Manchester & Manchester Children's University Hospitals Trust
1.2.2 Develop additional major projects and initiatives
Including National BioHealth Informatics Institute, Manchester University
RES Objective 2: Improve the competitiveness and productivity of businesses 2.5.1 Complete the mapping of targeted supply chains for significant NW companies and organisations including the NHS RES Objective 4: Deliver urban renaissance 4.2.1 Annual re- accreditation of LSPs by GONW
With Health sector as a supporting partner
4.2.2 Production of Neighbourhood Renewal Strategies for 21 priority areas
With Health sector as a supporting partner
4.2.3 Support the regeneration of 17 non NRF districts with 20% most deprived wards – identifying actions to strengthen the economic base affecting deprived wards
With Health sector as a supporting partner
RES Objective 5: Deliver rural renaissance 5.5.1 Implement the 17 Action Plans as a Scheme or though the Rural Recovery Plans – for 17 identified Market Towns
With Health Authorities as supporting partners
RES Objective 6: Secure economic inclusion 6.3.1 Ensure private and public sector projects supported by NWDA include relevant economic inclusion measures which link employment opportunities and disadvantaged groups and communities
Supporting partners include the Health Service
6.3.2 Encourage public sector, including Health Service, to consider how mainstream spending can more effectively provide employment for disadvantaged groups
Detailed actions include facilitating discussions with the NHS as a supporting partner and on opportunities and good practice
continued
Page 56
APPENDIX A: Scope and roles of health & social care issues and stakeholders in regional development (cont.) Table A.1: (continued) RES Objective 6: Secure economic inclusion (continued) 6.3.3 Develop public sector network to explore and develop good practice on positive action programmes
With the Health Service as a supporting partner
6.3.4 Promote business case for equality and diversity policies with private sector employees
With the Health Service as a supporting partner
RES Objective 7: Develop and maintain a healthy labour market 7.1.1 Develop and expedite major projects and initiatives Detailed actions include to develop skills within the at a regional level focussing on key priorities NHS in the region through “Shaping the through effective partnership working Future” project led by the NHS 7.2.1 Facilitate, influence and manage/monitor the development and implementation of the five (FRESA) sub-regional plans. Ensure integration fully with the key regional skills priorities (cf. Key Activity 7.1)
Detailed actions include identifying and addressing sector specific skills issues including those of the health and care sector … led by Skills for Health SSC
RES Objective 8: Develop the strategic transport, communication and economic infrastructure 8.4.5 Champion regional broadband aggregation to bring together e-government, e-learning, epublic health and e-business services to secure critical mass to deliver premium broadband services across the Northwest With Strategic Health Authorities as supporting partners Regional opportunity: Health/NHS Investment H1.1 Produce NW Health Investment Plan in agreement with key regional partners to provide a mechanism to tackle inequalities in health and drive forward the region’s investment in better health for all the region’s communities H1.2 Undertake research to understand fully the range of economic opportunities presented by the Health and Social Care economy in the NW
Led by Directorate for Health and Social Care (North) and with Strategic Health Authorities as supporting partners
With Strategic Health Authorities, Workforce Development Confederations and NHS Trusts among the supporting partners
H2.1 Build on success of workforce development pilots With Workforce Development Confederations, in NW – develop a pilot in Cumbria to complement Department of Health and NHS University those in development in Manchester and Merseyside among supporting partners H2.1a Explore opportunities to influence HR policies in NHS to tackle poverty/unemployment and economic exclusion in areas of deprivation
With Workforce Development Confederations, Cumbria and Lancashire Health Authority, Department of Health and NHS University among supporting partners
H2.2 Establish pilot procurement projects to exploit purchasing power of NHS and the opportunity to contribute locally to economic regeneration
Detailed actions include developing sub-regional pilot project to support SMEs to engage with NHS and ensure SMEs are “fit for purpose”- with Cumbria and Lancashire Health Authority and NHS Trusts as supporting partners. Also, establish a food procurement policy for the NHS/ schools and specific programmes, e.g. 5 a day and school fruit schemes – with Department of Health and NHS Trusts as supporting partners
H2.3 Establish regional approach to implementing “Skilled Detailed action on training programme for frontline for Health” agenda for vulnerable client groups workers in the NHS to enable them to identify basic literacy/ numeracy needs in their clients – with NHS Trusts and the Department of Health among supporting partners
Page 57
APPENDIX B: Summary of the priorities and proposed actions in the investment for health plan for the Northwest B.1
Four priorities for action to improve the health of the Region’s population and reduce inequalities in health are identified in the Plan1: ● ●
tackling the wider determinants of health developing the corporate citizen role of the NHS, and its contribution as a major organisation to wider regeneration and sustainability objectives
●
mainstreaming action to reduce inequalities within the NHS to improve prevention, and the accessibility, quality and outcomes of services
●
B.2
B.3
strengthening primary care, particularly in deprived and under-served areas and groups.
In addition, priorities for integrating action on these four areas are identified: ●
developing the health dimension of regional strategies
●
area-based policies
●
programmes for priority groups
●
delivery in the settings of everyday life.
Objectives and Key Activities have now been set for the four priorities for action and the four priorities for integrating action. Figure B1 summarises these and shows in bold the focus of the present study.
Figure B1: priority setting within the Northwest region’s Investment for Health Plan
B.4
The Investment for Health Plan proposes specific actions in each of the areas of employment, purchasing and capital/infrastructure which have helped frame the focus of much of the present study. These are summarised in Table B2.
1 Investment for Health - a plan for Northwest England 2003, Government Office for the North West
Page 58
APPENDIX B: Summary of the priorities and proposed actions in the investment for health plan for the Northwest (cont.) Table B2: Priorities and actions set out in the Investment for Health Plan Objective: To develop the role of the NHS as a “good corporate citizen” and its capacity as a major regional and local player/stakeholder to improve health, reduce inequalities, and contribute to sustainable economic, social and physical regeneration. Key activity: Undertake research to understand fully the range of economic opportunities presented by the Health and Social Care economy in the North West – the implications for business cluster development and the wider impact of NHS activity on regeneration and sustainability objectives Key activity: Build on success of workforce development pilots in NW – develop a pilot in Cumbria to complement those in development in Manchester and Merseyside Key activity: Explore opportunities to influence HR policies in NHS to tackle poverty/unemployment and economic exclusion in areas of deprivation Key activity: Establish pilot procurement projects to exploit purchasing power of NHS and the opportunity to contribute locally to economic regeneration Key activity: Establish regional approach to implementing “Skilled for Health” agenda for vulnerable client groups Key activity: Develop the role of the NHS University in providing employment opportunities and subsequent career development in the NHS for priority groups and areas Key activity: Use the regional “integrated Impact Assessment” toolkit to evaluate the potential impact on local communities of major NHS capital projects Key activity: Produce proposals and targets for implementing the New Environmental Strategy for the NHS and identify benefits to sustainable development from healthy transport plans, energy, waste and procurement policies.
Page 59
APPENDIX C: Health and social care ‘system’ in the Northwest C.1
The provision of Health and Social Care in the Northwest covers a wide range of activity and a complex of organisations. Providers within the private sector, the voluntary sector and especially the contributions of individual carers are acknowledged as important contributors.
C.2
However, in the context of this examination of the health and social care sector in the Northwest which addresses issues of employment, procurement and capital/infrastructure, factors of scale in terms of actual or potential contribution to sustainable development have led to a concentration on the NHS.
Figure C.1: Public health and social care provision – the organisation framework
C.3
Managing the delivery of health and social care services across England is the responsibility of the Department of Health (See Figure C.1). Its specific responsibilities include:
C.4
●
managing the overall health and social care system
●
developing NHS policy and managing major change
●
NHS regulation and inspection.
Health and Social Care delivery is primarily undertaken by the National Health Service (NHS) and Local Authority Social Services. The NHS is responsible for the delivery of healthcare services through NHS and Primary Care Trusts. Local Authorities have responsibility for the provision of social care, primarily through social services departments but also through contracts with third parties from the independent sector. Strategic Health Authorities and the Social Services Inspectorate link local activities with the Department of Health.
Page 60
APPENDIX C: Health and social care ‘system’ in the Northwest (cont.) Social care C.5
A wide range of services come under the area of social care some of which are paid for by recipients, others being free of charge. Providers include 22 Local Authorities as well as organisations in the independent sector, such as charities, private and not-for-profit agencies, and volunteer groups. The scale of spend is shown in Table C1. Social care may include services such as: ●
care in the home,
●
day centre
●
residential or nursing home care
●
meals on wheels to the elderly
●
home help for those with disabilities
●
child protection or fostering services.
Table C.1 : Local Authority expenditure on social services in the North West (1999-2000) Total spend
£2.2bn
Residential care
£5.904m (46%)
day and domiciliary care
£5,035m (32.9%)
assessment and care management
£1,909m (14.8%)
% expenditures by client group older people
45.9%
children’s and families’ services
22.3%
learning disabled adults
13.6%
physically disabled adults
6.7%
mentally ill adults
5.3%
asylum seekers
4.3%
Source: CPS (2003) report
Health services C.6
Strategic Health Authorities are responsible for developing strategies for the delivery of healthcare services in local (sub-regional) areas: they provide a link between Department of Health policies and local delivery. There are three Strategic Health Authorities for the Northwest area: Cumbria and Lancashire, Cheshire and Merseyside and Greater Manchester (See Figure C3).
C.7
The healthcare “system” is split into the delivery of primary care and secondary care, as well as the delivery of remote services such as NHS Direct (the 24 hour personal health advice telephone service). Primary care covers frontline services to the public and includes GP’s, Dentists, Nurses, Health visitors, NHS Walk-in Centres etc. Secondary care covers the provision of more specialised care such as hospital treatment and mental health services.
Page 61
Figure C.2: NHS healthcare ‘system’ in the North West
C.8
Primary Care Trusts (PCTs) hold responsibility for ensuring the availability of health services and improving health in the local population. They have a particular role in ensuring integration between health service and social service provision. PCTs are responsible for ensuring the availability of the following in the local area:
C.9
●
General practitioners
●
Hospitals
●
NHS Walk-in Centres
●
Dentists
●
Pharmacists
●
Opticians
NHS Trusts provide secondary care to the public and are responsible for the delivery of hospital services. The role of the NHS Trust can vary. Whilst the majority of NHS Trusts provide a wide range of acute services, some have specialist roles at a regional or national level; others are University NHS Trusts with a role in teaching health professionals. In addition, a number are NHS Ambulance Trusts. Partnership working
C.10 Care Trusts are a relatively new form of partnership organisation available to Local Authorities and the NHS which can be established on a discretionary basis. This form of organisation allows a Local Authority to delegate health related functions in order to improve the level of integration between health and social care provision in the local area. In 2002, four Care Trusts were established in England. One of these, Manchester Mental Health, was established in the Northwest.
Page 62
APPENDIX D: The company base D.1
The Northwest has c. 250,000 “business sites” that are registered for VAT or PAYE according to the Northwest Economic Review-Economic Report 2002. Table D.1 shows the pattern of VAT-based enterprises in the Region that are in the health-related sector.
Table D.1: Number and distribution of VAT based enterprises (%) and numbers in 2001 (Source: IDBR) Cheshire
Cumbria
Total number of enterprise
26,945
15,600
56,410
34,150
23,380
Health sector firms (%)
0.5
0.6
0.5
0.6
0.7
Health sector firms (number)
135
94
282
205
164
D.2
Gtr Manchester
Lancashire
Merseyside
The companies in the Northwest with a business interest in the health and social care sector can be identified in the following ways: ●
companies that hold national contracts with the NHS - 219 Northwest companies are listed in the NHS Purchasing and Supplies Agency (PaSA) suppliers directory
●
companies that contract directly with individual Trusts for the supply of goods and services - e.g. 922 out of 2393 companies supplying directly the Royal Liverpool Children's Hospital are located in the Northwest
●
other relevant firms in the Northwest from their profiles on the membership lists of Northwest Cluster Networks and from other trade associations
D.3
●
relevant firms from the list of tenants in business incubators and science parks in the Region
●
firms in the construction industry registered with the NHS ProCure21 supply chain initiative
●
relevant new firms from information on spin-outs provided by universities in the Region, and importantly
●
exporting firms listed in the Trade Partners UK directory of firms in the healthcare sector.
In addition, it is possible to take information on what the NHS buys, convert these goods and services to Standard Industrial Classification (SIC) codes and use these to search business directories for companies in the Region is the relevant sectors.
D.4
The Yellow Pages website (www.yell.com) allows the user to search on each code specifying a geographical area. Using these codes, Yell was interrogated to establish the number of businesses within the Northwest under each relevant code. The number of businesses found is contained in Table D.2. (Note, this is the number of firms in the Northwest engaged in selling goods and services of the type purchased by the NHS - not actual suppliers to the NHS in the Northwest. For the latter, see Chapter 6 of the main report.)
Table D.2 : Number of businesses in the Northwest selling goods of the types which the NHS purchases PaSA Category Non-medical consumables
11,304
Medical
2,515
Facilities Management
5,579
Diagnostic Medical Equipment
109
Rehabilitation Services
109
Pharmaceutical IT Total:
Page 63
Number of businesses in the North West
43 1162 20,821
APPENDIX E: Procurement processes for goods and services E.1
Chapter 5 of the main report analyses what the NHS purchases in terms of goods and services as a basis of understanding the nature and scale of the market opportunity for businesses in the Region. In Chapter 6, the nature of the supply-base present in the Region was examined, including the company-base with the capability and capacity to win national contracts and those firms doing business with (a sample of) individual Trusts. Chapter 7 introduces the NHS' purchasing procedures and summarises a number of current supply chain development initiatives. Procurement practices are described in more detail below. Procurement practices in the NHS
E.2
The NHS Purchasing and Supply Agency (PaSA) provides the central policies and principles for procurement by the NHS. Its remit is "to take the lead role in modernising and improving the performance of the NHS purchasing and supply system and to be the centre of expertise, knowledge and excellence on matters of purchasing and supply for the NHS, for the benefit of patients and the public." Its highest profile activity is to develop national framework agreements (or contracts). It produces a products/suppliers catalogue which NHS organisations may chose to use in selecting and buying goods and services to meet their own needs.
E.3
PaSA provides details of the suppliers they work with but not the level of demand or expenditure from individual Trusts.
E.4
NHS Logistics is the storage/warehousing element of the NHS. Individual Trusts use NHS Logistics to obtain regular lines, major stocks and common-use items.
E.5
A number of relatively recent organisational changes have occurred in the NHS, notably the establishment of Strategic Health Authorities and Primary Care Trusts. For both, strategic and operational issues concerned with procurement remain relatively new. Procurement and stakeholders
E.6
At its simplest level, procurement is an activity that matches supply with an identified user need. It involves a decision making procedure that includes: ●
identifying a need
●
finding a supplier
●
negotiating a ‘contract’
●
deciding to purchase
●
arranging delivery
Who makes the purchase? E.7
The principle stakeholders in the procurement process are: ●
end-users within Trusts: ■
individual end users
■
end user groups/departments, including but not limited to pathology pharmacy estates/works
●
the commercial suppliers.
Page 64
APPENDIX E: Procurement processes for goods and services (cont.) E.8
In addition there are a number of stakeholders that facilitate the decision-making process (see Figure E.1): ●
PaSA - responsible for negotiating: ■
national contracts (or ‘Framework agreements’) with suppliers
■
national agreements with suppliers of standard goods distributed by NHS Logistics
●
NHS Logistics - responsible for the delivery of standard supplies nationally
●
Trust Supplies Managers - who may be the pharmacy manager; the estates/facilities manager; the pathology manager; the catering manager etc. empowered to enter into legal contracts on behalf of their Trust and responsible for ensuring value for money
●
Trust Finance departments - responsible for ensuring expenditure is within budget, and for authorising expenditure when this exceeds budget levels.
The decision making process E.9
Procurement decision-making can be seen as a process involving a number of stages from identifying a need to sourcing a supplier. The procurement decision procedure varies but depends primarily on contract value. Contracts are demarcated into specific contract value ‘thresholds’.
E.10 The number and complexity of stages increases with contract value, shown in Figure E.1. Small purchases are handled in a straightforward manner, larger purchases require significant consideration.
Figure E.1: Stages in decision making vary with contract value
Page 65
E.11 Higher contract value thresholds demand more stringent procurement decision-making procedures. Procurement governance refers to the set of procedures that a Trust must adhere to in relation to specific purchases. The procedures are either set out by the Trust or set out in legislation. Typically, a Trust will have a hierarchy of procedures relating to the contract value, to ensure legal compliance and value for money: ●
Official Journal of the European Communities (OJEC) - Europe wide legislation specifying open tender for supplies and services contracts
●
Formal tender - written invitation to approved suppliers (usually 3 or more) to tender for a specific contract
●
Formal quotation - written invitation to quote for a specific contract
●
Informal quotation - verbal invitation to quote for supplies or services.
E.12 The OJEC procedure is Europe-wide and is specifically for contract values over £100,000. The remaining procedures operate at a contract value specified by individual Trusts. Thresholds therefore vary between Trusts although PaSA offers the following guidelines: ●
formal tenders – >£20,000
●
formal quotes - > £5,000
●
informal quotes - < £5,000
E.13 Decision making on purchasing from the perspective of the end-user within the NHS can be described in terms of a decision-tree (See Figure E.2). Knowledge of these processes and decision points are important for new prospective suppliers to understand. The Figure also indicates something of how the NHS engages in new product development and how it can contribute through either development funding and/or the provision of facilities for new product trials. How and where decisions are taken E.14 For existing or new, prospective suppliers it is important to know how and where purchasing decisions are taken. From the end-user perspective they are likely to be taken on the basis of: ●
meeting the functional needs and standards
●
meeting quality levels
●
price within budget
E.15 However, there are additional criteria used by the end-user and other stakeholders, particularly the Supplies Manager. These can include: ●
lowest cost (Trusts are under pressure to save money)
●
capacity of supplier to deliver
●
supplier's health and safety accreditation
●
inter-operability and standardisation of products.
E.16 PaSA has also been concerned to ensure that companies in its supply chain are themselves good corporate citizens by adhering to environmental management standards within their own operations.
Page 66
Figure E.2: End-user procurement decision tree
APPENDIX E: Procurement processes for goods and services (cont.)
Page 67
E.17 Procurement professionals support end-users’ purchasing decision in the following ways: ●
PaSA - negotiates joint purchases on behalf of all Trusts
●
NHS Logistics - acts on behalf of end-users for standard supplies
●
Supplies Managers ■
administer procurement
■
support high value purchases
■
negotiate joint purchases on behalf of a limited number of local Trusts.
E.18 End-users within Trusts rely increasingly on support as the value of the contract increases (Figure E.3). However, the form of the support also varies with contract value. NHS Logistics supports low unit cost purchases for example, whilst Supplies Managers administer lower unit cost purchases but provide increased support to larger unit cost purchases. Improving procurement practice E.19 Given procurement decision-makers are either PaSA or stakeholders in local Trusts, the responsibility for improving procurement practice lies largely with these organisations. PaSA has responsibility to advise on the strategic development of procurement across the NHS.
Figure E.3: Decision support for procurement
Page 68
APPENDIX E: Procurement process for goods and services (cont.) E.20 The response to improving national procurement1 decision-making has been to: ●
increase the share of national contracts in NHS procurement expenditure
●
“greening” procurement practice.
E.21 The PaSA target of increasing its share of Trusts’ procurement expenditure to 35% by 2005 suggests a drive towards larger, longer term contracts with suppliers. It is argued that such contracts will leverage better value and may encourage improvements in standards amongst suppliers, for example environmental standards. However, an added factor might be to enhance the national product portfolio (Figure E.4). Nationally purchased products are available as a result of: ●
historical precedent - “we have always bought this”
●
pressure on PaSA from a number of Trusts who are interested jointly in a product and are looking to leverage an improved "deal" though PaSA's contracting process.
Figure E.4: Improving the national product portfolio
1
Page 69
‘Claiming the Health Dividend, unlocking the benefits of NHS spending’, Kings Fund report, Anna Coote. 2002.
E.22 PaSA is encouraging inter-Trust collaboration to: ●
achieve regional or sub-regional purchasing
●
improve procurement practice.
E.23 A shift to more regional/sub-regional purchasing is likely to encourage more product standardisation, and through upward pressure on national contracts, improve the national product portfolio (the PaSA catalogue). However, standardisation may tend to concentrate purchasing in fewer suppliers, increase contract values and result in more demanding procurement procedures (for example more contracts becoming formalised and perhaps having to be published in the OJEC). E.24 Greening procurement practice has looked at how environmental performance can be enhanced in the procurement process. This has involved working groups representing PaSA buyers, NHS suppliers and NHS purchasers looking at such issues as environmental conditions in contract specifications, whole life costing, and environmental management standards amongst suppliers. E.25 The response to improving local procurement has involved PaSA, as well as individual Trust activity. PaSA is encouraging Trusts to improve procurement practice in a progressive, logical manner: ●
identify larger expenditure items
●
bring together users of these items
●
examine specific procurement issues/problems.
E.26 Some individual Trusts have established specific end-user groups (such as catering, estates, pharmacy and pathology) to discuss key procurement issues, for example around: ●
standardisation
●
contracting arrangements
●
sharing information.
Page 70
APPENDIX F: Summary of NHS employment-related initiatives in the Northwest INITIATIVE/LOCATION
DESCRIPTION
Recruitment - general/local Central Liverpool Primary Care Trust with Jobs,
- the Trust uses JET Centres to help it target local people when
Education and Training (JET) Centres
recruiting all non-clinical posts.
"Health Learning Works" pilot, Cumbria - NHS
- national initiative being piloted in Cumbria. Jobcentre Plus identifies
University
a selection of candidates who may be unemployed or on benefit who would like to work in the NHS. NHS Trusts participating in the programme identify and reserve a number of full or part-time vacancies across disciplines (e.g. catering, ward housekeeping, admin and clerical, portering and Central Sterilising Service Departments, others) for participants in the programme. NHSU then brings together potential employees and employers, and provides pre-employment training at no cost to potential employee or employer.
Central Cheshire: pre-employment training and
- 6 week pre-access programme via Health Learning Works followed
supported Intermediate Labour Market jobs
by matching of the trainees with NHS and Social Care ILM vacancies
managed through the Workforce Development
on a 6-12 month contract. While in employment, the staff will be
Confederation
supported through mentorship/assessment/work supervision by the NHS/Social Care organisation to undertake a NVQ level 2 and modules from ECDL.
"Delivering the Workforce" scheme - Greater
- the scheme gives people over 24 years old the chance to work in
Manchester Workforce Development
health care as Assistant Practitioners. It is aimed at "mature" people
Confederation (WDC)
who may have life skills and experience of caring, rather than traditional GCSEs etc.
Widening access to part-time Occupational
- this project addresses recruitment and retention problems within the
Therapy Course - Manchester area
OT speciality within Greater Manchester.
Liverpool Domiciliary Care initiative
- provided by a consortium of private and voluntary sector care
- "People Pool"
providers, this involves a skills passport course for trainees who are guaranteed interviews by social care employers.
Increasing Capacity in Audiology: Greater
- to increase awareness of the need for audiology student training in
Manchester WDC / Salford Royal Hospitals
order to modernise the service.
NHS Trust Pharmacy Workforce Development Partnership:
- to improve recruitment and retention of the pharmacy workforce. To
GM, C&L, C&M WDC's
engage and empower service managers in the workforce planning process. To provide structures to support the pharmacy workforce. To map existing provision and perform training needs analysis and to develop and deliver priority programmes. GMWDC is working with four education providers to develop a standardised programme and Trusts and PCT's are being prepared on how to implement this initiative for maximum benefit.
Page 71
INITIATIVE/LOCATION
DESCRIPTION
Recruitment - general/local Retention and Recruitment Initiative- returnees:
- to provide support and structure for returnees to the NHS. The
Greater Manchester WDC wide activities
GMWDC has been appointed by the DoH to lead on return to Practice for Healthcare Scientists. GMWDC is currently working on a protocol and guidance book for all the coordinators throughout the GM healthcare economy to help support and unify standards and delivery / information with regard to the initiative. Publicity for Return to Practice was secured, with coverage on the local BBC GMR radio programme.
Retention and Recruitment Initiative: Pennine
- to improve recruitment processes and retention systems.
Acute Hospitals NHS Trust Retention and Recruitment Initiative: Salford
- to improve recruitment processes and retention systems.
Royal Hospitals NHS Trust Retention and Recruitment Initiative: Bolton,
- to improve recruitment processes and retention systems.
Salford & Trafford Mental Health Partnership Retention and Recruitment Initiative: Bolton,
- Recruitment & Retention Diagnostic Workshop. Training in the use of
Salford & Trafford Mental Health Partnership,
the diagnostic tool(s).
Pennine Acute Hospitals NHS Trust, Salford Royal Hospitals NHS Trust Retention and Recruitment Initiative: Bolton,
- Improvement Skills Development Programme (ISDP) includes
Salford & Trafford Mental Health Partnership,
Measurement for Improvement, HR Metrics, Building Local HR
Pennine Acute Hospitals NHS Trust, Salford
Capacity, Impact-based Modelling and other core improvement
Royal Hospitals NHS Trust
management skills. HR Leaders Masterclass series for Executive Sponsors.
Retention and Recruitment Initiative - R&R co-
- to support the R&R co-ordinators in Trusts in the provision of
ordinators: Greater Manchester WDC wide
guidance and resources to support career/recruitment initiatives and
activities
events to assist in raising the profile of a wide range of opportunities within the NHS.
Recruitment- targeting special groups Deaf People's Access to Nurse Education
- widening access to pre-registration education for deaf people, the
Project, University of Salford School of Nursing
aim of the project is to create an educational environment that is accessible, supportive and effective for deaf people. This environment will enable deaf students to attain the qualification of RMN (Registered Mental Nurse).
Page 72
APPENDIX F: Summary of NHS employment-related initiatives in the Northwest (cont.) INITIATIVE/LOCATION
DESCRIPTION
Ethnic Minorities Equality & Diversity in Cumbria & Lancashire
- this assists Trusts in raising the awareness of the needs of all minority groups including black and ethnic minority staff and service users; disabled staff and service users; asylum seekers etc. It raises awareness of diversity and equality issues within Trusts by presentations and information packs, or by discussions at meetings. A resource pack is produce which includes contact details; CD ROMs and publications of interest.
Minority ethnic health and social care
- the project aims to take positive action in recruiting and retaining
development programme - Royal Oldham
staff from minority ethnic communities in the social and health
Hospital
workforce so that these services are culturally sensitive and better meet current and future need.
Liverpool City Council Positive Action Training
- this forms part of LCCâ&#x20AC;&#x2122;s positive action training scheme targeted
and Merseycare NHS Trust
on black and ethnic minority groups. Trainees are seconded to the NHS Trust.
Minority Ethnic Project Officer -
- aims is to increase further the recruitment and retention of a
Burnley Health Care NHS Trust
diverse workforce â&#x20AC;&#x201C; particularly from Black & Ethnic Minority backgrounds and those with disabilities; to make a renewed effort to identify local representative leaders to help to identify potential employees; to achieve "working together" targets and creating a workforce which, year on year, most closely resembles the make up of the community; to build on the work already done to achieve "Improving Working Lives"; to identify other sources of funding to help people from disadvantaged groups into NHS employment.
Minority and ethnic health and social care
- to take positive action in recruiting and retaining minority ethnic
development programme: Greater Manchester
communities in to the social and health workforce.
WDC Funded Pennine Acute Hospitals Trust Pharmacy Workforce Development Partnership
- to enable the expansion of refugee doctors schemes to include
- refugees: C&L & GM WDC's
the identification and training of other refugee health care workers. The centre will take full responsibility for trainee doctors up to a stage where they would be eligible to apply for recognised posts and possibly supernumerary appointments at which stage they would pass to the Postgraduate Deanery.
Liverpool City Council Translation & Interpreting Service
Page 73
- staff undertake testing of verbal and written skills of bilingual candidates for jobs in the health and social care sector.
INITIATIVE/LOCATION
DESCRIPTION
The unemployed "Positive Thoughts" Intervention - Netherton
- nurse-led course for the unemployed and depressed.
Feelgood Factory and Sefton Primary Care Trust Central Liverpool Primary Care Trust and
- a Partnership between the PCT and ELECT, a community enterprise
Kensington Regeneration - creating
in Liverpool. It aims to support unemployed people into employment
intermediate labour market jobs
to the health sector with training and intensive personal support.
Calderstones NHS Trust and East Lancashire
- a partnership formed with JobCentre Plus as part of its New Deal
Hospitals NHS Trusts: New Deal and work
Programme. The focus at Calderstones was on non-patient areas -
experience scheme
successful candidates within the 18-24 age group were “employed” on 20hours per week; aged 25+ were given a 13-16 week placement. Examples of skills development given to placements included driving lessons and college courses to help obtain skills. In East Lancashire, placements were arranged on an individual basis. New Deal funds were available to finance Child Care arrangements.
Young People "Schools in the Real NHS" (SIREN)
-an initiative supported by Neighbourhood Renewal Funds for work in three Education Action Zones in Liverpool to open up NHS employment for local young people. It aims to support 250 students undertake a GNVQ in Health & Social Care. It also aims to improve curriculum, offer real placements and enhanced careers advice.
Liverpool NHS training academy
- originated as a proposal to co-ordinate training and development of young people for the NHS. Started with the development of the Cadet Scheme and has plans to develop and co-ordinate a range of routeways for people seeking employment in the sector – this could be used to support mature entry cadets, use New Deal and basic skills courses.
Royal Liverpool Hospital and New Deal 18 – 24
- the Royal Liverpool Hospital has been using New Deal full time education option for training and employment.
Central Cheshire: Health and Social Care Awareness Day
- one day meeting to promote awareness of the diversity of placements available for 14-19 year olds. The meeting is aimed at Connexions advisors.
Refugees and Asylum Seekers Liverpool City Council - asylum seekers/refugee adviser
- provision of specialist advice for health professionals who are asylum seekers /refugees to require help get through UK registration process.
Page 74
APPENDIX F: Summary of NHS employment-related initiatives in the Northwest (cont.) INITIATIVE/LOCATION
DESCRIPTION
Refugees and Asylum Seekers REACHE - Refugee and Asylum Seekers Centre
- funded by the Lancashire & Cumbria and Greater Manchester
for employment in the NHS
Workforce Development Confederations, "REACHE – North West" is a new development to assist Refugee Healthcare Professionals in the North West gain the appropriate national qualifications which will enable them to be eligible to obtain professional employment in the NHS. Currently there are approximately 90 Refugee healthcare professionals in the Greater Manchester and Lancashire & Cumbria area known to REACHE.
Recruitment - to nursing Aintree University NHS Trust - Volunteer Scheme - volunteering leading to nursing. Linked to Edge Hill College which advises potential applicants to its nursing and midwifery courses to gain some experience of health care prior to applying. The Scheme proves especially useful for potential applicants who find it difficult to gain this prior experience through paid work. Aintree Hospital Trust - Liverpool Cadet
- Cadet nursing scheme 16 – 19 year olds. 12 week pre-cadet and 2
Programme
year cadetship with first year funded by LSC.
The Academy - nursing cadet scheme,
- a nursing cadet programme at Knowsley Community College. Its
Knowsley
aim is to enable access into pre-registration training, providing young people with new opportunities at the same time as addressing the need to train more nurses. Aimed at 16-19 year olds, the two-year course will provide 24 young people with the necessary academic qualifications to access pre-registration training, namely NVQ levels 2/3 in Direct Care with key skills. In addition, the programme’s structure will allow the cadets to experience all aspects of health care. By September 2003, the programme aims to have 120 nursing cadets, up to 30 social care cadets and business administration student apprentices participating in courses at three colleges and all interested Trusts in the Greater Merseyside area. Work is underway with Trusts in Cheshire to roll out a similar programme. The Project is being delivered in partnership with the Greater Merseyside, Cheshire and Warrington Learning Skills Councils and a number of further education colleges.
Page 75
INITIATIVE/LOCATION
DESCRIPTION
Retention and Recruitment Initiative - overseas
- this project has successfully facilitated the integration of over 550
nurses: Greater Manchester WDC wide activities
overseas nurses to the NHS. The team has worked collaboratively with Trusts from in GM area to develop a common supervised practice / induction programme. A pilot clearing house system has been set up to manage speculative applications received by the project team from health care professionals from overseas. Support materials have been developed to help organisations recruit from overseas. A specific programme to recruit GP's is currently under initiation with Ashton, Wigan and Leigh.
"Recruitment, Retention and Return to Practice"
- supporting the recruitment, retention and return to practice (3Rs)
Coordinators - NHS Trusts in Cumbria and
project. This involves processing queries from anyone wishing to
Lancashire Workforce Development
return to nursing and assisting with events throughout the area to
Confederation area
promote the NHS as an employer.
"Widening Access" â&#x20AC;&#x201C; pre-nursing cadets-
- in September 2001, a pilot group of 'pre-nursing' cadets
Morecambe Bay Hospital NHS Trust
commenced work for the Trust for six months. Two were based at the Furness General Hospital and two at the Royal Lancaster Infirmary. The cadets were paid the minimum wage during the 6 months and progress regularly evaluated. The cadets and ward managers/mentors completed evaluations. Upon completion of the six-month placement, exit interviews were undertaken prior to the cadets starting nurse training. Key issue for the Trust was to develop a seamless transition from FE to HE for students which would reduce the potential to lose students because of long waist for training places at St Martin's College.
Burnley "Healthcare Cadets" - Burnley
- the Burnley ' Healthcare Cadets' has been running for two years,
Healthcare NHS Trust
initially starting with twelve students in its first year and increasing to twenty in its second. The second group has had the opportunity to experience Primary Care clinical placements for the first time. The two-year course leads to a NVQ level 3 in Healthcare, which involves spending time in both the Trust and Burnley College. Cadets can access the nursing diploma/degree course directly but it is hoped to expand the scheme to assist those cadets who wish to access training to other professions as well.
Page 76
APPENDIX F: Summary of NHS employment-related Initiatives in the Northwest (cont.) INITIATIVE/LOCATION
DESCRIPTION
Other cadet schemes "Apprentices into Care" - Cadet Scheme of
- 'Apprentices in Care' is a two year scheme leading to a NVQ level 3
Blackburn, Hyndburn and Ribble Valley
in Health and Social Care, with both the clinical and educational parts
Healthcare NHS Trust
being delivered by the Trust. Each cohort is a group of twelve students who on successful completion of the two years can access a nursing diploma/degree course directly. There is also a one year Healthcare Assistant cadet scheme that allows the successful students to apply for a Healthcare Assistant post.
Blackpool "College Cadets" - Fylde Hospitals
- the Blackpool 'College Cadets' started in 2002 with sixteen
NHS Trust & Blackpool, Wyre & Fylde Primary
students, with a further twenty-two students in 2003. The course is
Care Trusts
run in partnership with Blackpool and Fylde College, with the students achieving NVQ level 3 in Health and Social Care and practical healthcare experience.
Potential cadet scheme at Lancashire Teaching
- the Lancashire Teaching Hospitals NHS Trust is looking to introduce
Hospital NHS Trust and Preston Primary Care
a scheme in 2003. This will be a three year course for 30 students
Trust
with a NVQ level 3 in Care obtained at the end of year two and a foundation degree at the end of year three. This will allow cadets to access further training in science and technology, therapy or nursing.
Multi-professional Cadet Scheme: Greater
- to increase the numbers of young people accessing NHS and social
Manchester WDC wide activities
care careers via a multi-professional cadet scheme. There are 29 students who have identified their future pathway in various health and social care settings.
Central Cheshire: Health and Social Care Cadet
- 26 cadets will be offered diverse placements across all participating
Scheme for Central Cheshire PCT, Social
organisations. A Central Cheshire Cadet Co-ordinator will be
Services, Cheshire and Wirral Partnership Trust
appointed.
and Mid Cheshire College Promoting NHS as a career option Promoting NHS Careers in Schools and
- implementing a strategy to promote NHS careers which will ensure
Colleges - Cheshire and Merseyside Workforce
that all school children and college students in the area are made
Development Confederation
aware of NHS career opportunities. This will build on links that some Trusts already have with local schools. It will develop an infrastructure to support careers advice and guidance throughout the educational career, and promote movement from all levels of education into employment. It will among other things develop a "teacher placement" programme and a programme of work experience in every health community.
Page 77
INITIATIVE/LOCATION Central Cheshire: work experience for school
DESCRIPTION - extended vocational placements are offered to students taking
pupils
vocational GCSEs.
Retention and Recruitment Initiative:
- to assist in raising the profile and awareness of career opportunities
Greater Manchester WDC wide activities
in health and social care amongst the population of GM. To develop resources and links with key stakeholders such as Learning and Skills Council, careers service, schools and FE colleges. In conjunction with key partners GMWDC hosted an awards event at the URBIS in May to celebrate National Adults Learners Week.
North Cumbria: "Stepping Stones" towards
- training programme designed for those looking for a career change
working in the NHS - training programme
and interested in finding out about work in the NHS without leaving their current jobs. Ten weeks course of night classes concentrating on providing basic awareness of Mental Health and Learning Disabilities services as well as topics to enable successful candidates to be registered as Healthcare Assistants on the nursing bank.
Job guarantee schemes Liverpool Health Employment Project - job
-a partnership between three PCTs in the Liverpool area, the Project
guarantee scheme
has a small team acting as a bridge between employment support agencies, educational institutions and health service providers. Resources from Neighbourhood Renewal Funds and Objective 1are being used to build capacity in mentoring, support and assessment of individuals, and to pay for individuals to train and to overcome barriers to employment. A "bursary" is paid to participants in the 12 month programme. Those who complete it successfully are guaranteed a permanent job. Aim is to enrol 150 people over two years.
Other initiatives "Health and Safety@Work in Wirral" -
- one of 9 HAZ Employment Pilots nationally1, this project aimed to
Merseyside Health Action Zone
audit and improve health and safety practices in local SMEs supplying to HAZ partners, the NHS and Local Authorities.
‘Boosting Employment Boosting Health’ - guide
- briefing pack produced by the Cheshire & Merseyside Workforce
to regeneration & employment in health & social Development Confederation (WDC) to demonstrate to health and care
social care organisations: • their potential role, as employers, in regenerating deprived areas of Cheshire and Merseyside • how this can help in tackling both staff shortages and targets for health and wellbeing • practical ways of meeting these challenges, including identifying potential partners and finding help and funding.
1
For information on the other national employment pilots see http://www.haznet.org.uk/hazs/progress/innovation/index_employment.asp
Page 78
APPENDIX F: Summary of NHS employment-related initiatives in the Northwest (cont.) INITIATIVE/LOCATION
DESCRIPTION
Other initiatives "Shaping the Future" - primary care education
- this NWDA funded project seeks to enhance the collaboration
& training project directed by the Institute of
between HEIs throughout the North West, as well as developing
Health and Social Care Research, University of
closer relationships with other key agencies, such as the NHS and
Salford
NWDA, who are involved in workforce development and employment. Communities of learning and collaboration will be developed, ensuring shared understanding of the issues related to delivery of integrated health and social care services within the Primary Care sector. The key objectives of the project are: ●
to provide a comprehensive literature review of the evidence base for integrated health and social care services within the regional, national and international contexts
●
to identify areas of Best practice in collaborative working and integrated health and social care in the community, including education and training initiatives
●
to map Higher Education/Further Education provision of education and training which can support the delivery of integrated health and social care services
●
to identify visions for the future for both health and social care workforce and service users through the preparation of a report which identifies for both groups perceptions of strength and weaknesses associated with integrated health and social care education and training, perspectives on future training requirements and dissonance between perspectives of Primary Care workforce and service users about the quality of current health and social care service and education and training needs
●
to develop and pilot an Education and Training Needs Analysis Model and Tool (ETNA) for identifying the education and training needs of the Primary Care Workforce to meet the NHS and Social Care agendas (this includes both clinical and health management staff).
Page 79
Appendix G: Summary descriptions of NW sectors/ clusters relevant to the health and social care sector G.1
This Appendix summarises the character of a number of industry sectors and clusters in the Northwest supported by NWDA- textiles, biotechnology, chemicals, environmental technology, food and drink. Their relationship with the health and social care sector is explored. Initiatives to support clusters in areas such as sport, construction and energy are also underway and should be examined in similar terms in future work. The recent construction cluster mapping by KitshoffGlaeves & Co and others will be especially relevant in the context of the major building projects planned for the NHS in the Northwest.
G.2
Cluster descriptions below (G.12 onwards) address key characterisation elements shown in Figure 3.2 (main report) intellectual capital; intellectual property and innovation; business support; skills and employment; infrastructure; networks and the business base. Business clusters in the Northwest
G.3
The Department of Trade and Industry (DTI) defines clusters as concentrations of competing, collaborating and interdependent companies and institutions which are connected by a system of market and non-market links. It indicates that clusters of firms and skilled workers are key drivers of economic growth in localities, cities and regions. Informal networking, developing supply chains and improving workforce skills are also identified as ways of creating business to-business links, increasing knowledge and spreading best practice to improve competitiveness and create growth. NWDA and cluster development
G.4
The NWDA has a major, long-term strategic commitment to cluster development. It is focusing resources on 12 clusters which have networks and action plans in place. It also wishes to establish cluster networks and strategic action plans for an additional 6 sectors, including healthcare. The sectors/clusters receiving support are listed in Table G.1.
Table G.1: Clusters being developed with support from NWDA Clusters with existing networks and action plans
aerospace
biotechnology
chemicals
digital industries
environmental technologies
financial and professional services
food and drink
renewable energy
textiles
creative industries
tourism
Next phase of development:
automotive
healthcare
energy
maritime
sport
construction
aviation G.5
The Northwest Regional Innovation Strategy classified growth clusters directly relevant to health in the following way: the life sciences industries, divided in turn into the sub-groups of biotechnology, pharmaceuticals, and medical equipment and technology. DTI Regional Cluster study, 2001
G.6
The DTI published an account of regional cluster activity in the UK in 20011. In its account of the Northwest, it identified a number of sectors/clusters related to the Health and Social Care economy.
1
DTI (2001) Business clusters in the UK â&#x20AC;&#x201C; a first assessment
Page 80
Appendix G: Summary descriptions of NW sectors/ clusters relevant to the health and social care sector (cont.) G.7
In pharmaceuticals, the manufacture of medical pharmaceuticals in Macclesfield, Liverpool and South Lakeland was the main regional strength identified. Some 15,000 people are employed in the cluster, double the 1991 figure. Manufacture occurs in a few large plants – 31 establishments (10% of the UK total) account for 20% of UK employment in pharmaceuticals. The Region also has strengths in areas of technical testing and analysis linked to the pharmaceuticals.
G.8
In biotechnology, the Region has 7% of UK companies but only 2% of UK employment. Small sectors engaged in producing medical and surgical equipment were identified but at levels of concentration slightly less than the UK average.
G.9
Although regarded by the DTI study as small in UK terms, the Northwest’s pharmaceuticals sector when linked to the Region’s chemicals cluster is one of the most significant in the UK. The Northwest has the UK’s most extensive and deep chemicals cluster, employing c. 45,000 people. However in 1991 employment was c. 60,000, the reduction due at least in part to increased automation and contracting-out following the break up of major players such as ICI. A significant proportion of the Region’s limited corporate R&D is located in the chemicals cluster and the Region’s universities account for 13% of university research expenditure on chemistry and chemical engineering.
G.10 The universities in the Northwest were found to undertake a significant amount of research in the life sciences, biotechnology and medical research, as in many other UK regions. G.11 The Region’s Textiles cluster was recognised as having an involvement in workwear and an increased involvement in “technical textiles”. These are both areas relevant to the health and social care sector. Overall research support for the textile cluster was not considered to be strong. Textiles G.12 The textiles industry in the Region has a turnover of £10bn (in 1997) and presently employs between 50,000 and 60,000 people directly. It has three key sectors: ●
apparel – performance sportswear, workwear etc
●
interior textiles – e.g. curtains
●
technical textiles – including textiles for the following sectors - medical, industrial, construction/building, aerospace, automotive.
G.13 All three have markets in the health sector. The latter is seen as an area with important growth potential – a niche market for low volume but high added value products. G.14 Cluster mapping in 2000 indicated that there were 1010 textile-related companies in the Region, including c. 700 apparel companies. The Region has a higher proportion of companies involved in the newer and high growth end of the textile industry, namely in technical textiles, than the rest of the UK. Indeed, the Northwest is reported to have the largest concentration of technical textiles companies in Europe. G.15 Globalisation is a major factor in this industry. Fabric can be exported and imported through multiple cycles before becoming a finished article. Nurses’ uniform fabric is typical of the textiles supply chain – uniform fabrics are manufactured in the Far East before being imported by UK dyers and printers. These in turns are exported to the Far East for finishing before being imported as the finished article.
Page 81
Company base G.16 There are no longer large textiles companies in the UK. There are very few primary manufacturers (spinners, weavers) in the Northwest although dyeing and printing remains reasonably strong. Today the sector is composed mainly of SMEs, many employing fewer than 10 people. G.17 Key global market drivers include labour costs, with labour intensive activities now mostly undertaken overseas. China is especially cheap but because of distances to the UK market it is only competitive so far in high volume production. For small production volumes, Turkey and Eastern Europe are very competitive. The UK strengths are in just-in-time production, low volume, locally-based and short production runs. G.18 Most companies in the Region are retaining their marketing and product development functions, but outsource manufacture to overseas factories. Only niche market companies in commodity (high volume) manufacture can compete on price. An example is warfare garments for the Ministry of Defence that require a microbiological finish: even here the basic garments are made overseas. G.19 Key companies in the sector include: ●
Simon Jersey (Lancashire) – specialising in quality assurance and have almost all their production done elsewhere
●
Bennet Safety Wear – began making protective gloves for heavy industry and now make products for the medical
●
SSL – a leader in bandage technology
●
Perseverance Mills Ltd – strong but light “cobweb” fabric that may have medical applications.
market
Research and development G.20 Other key companies which are performers of specialist R&D in the Region include: ●
Advanced Medical Solutions
●
Smith and Nephew
●
Laminates Technology.
G.21 In the Higher Education sector, the key research groups are located at UMIST and at the Bolton Institute which has local, national and international R&D collaborations with commercial partners in areas such as medical textiles/composites and flame retardant materials. Medical textiles G.22 The focus of the technical textiles cluster in the Northwest includes medical textiles. Most of the larger firms have international markets but smaller firms still tend to operate mostly locally. G.23 Many of the manufacturers are providing products which are components in other products or systems. Therefore they require intimate knowledge of their customers’ own markets and underlying technologies.
Page 82
Appendix G: Summary descriptions of NW sectors/ clusters relevant to the health and social care sector (cont.) G.24 The medical technical textiles organisations in the Region had the status to attract an international conference MEDTEX ‘03 (July, 2003) to Bolton. Organised by the Bolton Institute in association with Tampere University, Finland and with the support of a number of companies located in the Region, the conference addressed advances in science and innovation in the following topic areas: ●
woundcare
●
bandaging
●
implantable devices
●
sutures, ligaments, vascular prosthetics etc
●
healthcare and hygiene
●
disposable / reusable textile products
●
new technologies
●
modern biomaterials
●
clinical trails, standards, directives.
Links to the NHS G.25 There is little evidence of significant collaboration between textiles companies and the NHS in the Region – the NHS purchases goods from Northwest firms but there is little evidence of the NHS engaging in cluster activities. G.26 The NHS represents two quite distinct market sectors for textiles companies: ●
a base product sector which is associated with high volume products, including disposables
●
a sophisticated product sector which is low volume and includes products such as artificial veins.
G.27 Although the NHS is an important buyer of textile-related products, it is difficult to assess how important it is to the companies in the Region’s textile cluster network, NWTexNet. In many cases, NWTexNet members will be 3rd or even 4th tier suppliers. However, public procurement is being seen as an area of opportunity - supplying medical, military, police and fire service customers. Two potential barriers to market entry can be identified: ●
purchase price appears to be a major driver in procurement decisions
●
confusion amongst companies over how to bid for public sector contracts.
G.28 Northwest companies known to supply directly to the NHS include: ●
Vernon Corus
●
Vernacare
●
SSL
●
Shilo Healthcare
●
Smith & Nephew.
G.29 Companies known to supply the NHS indirectly include Lantors, supplying swabs. Cluster priorities and opportunities G.30 The following trends have been identified by NWTexNet for the cluster: ●
move towards providing quality of life products e.g. incontinence pads
●
exploiting just-in-time manufacturing and moving to higher value add products
●
potential to apply new technology to enhance existing products and investment in “blue sky” research on drugs in fibre e.g. using nanotechnology.
1
Page 83
DTI (2001) Business clusters in the UK – a first assessment
G.31 Recommendations for NWDA and NHS action with the textile cluster include: ●
explore with the NHS the potential for local textile manufacturers, for example in uniforms manufacture
●
trialling with the NHS just-in-time delivery of products as an alternative to the overhead of warehousing of NHS supplies
●
description and dissemination of the NHS procurement procedures to improve levels of awareness and understanding among Northwest companies. Establish a forum to links end users, NHS Supplies Managers and suppliers.
TECHNICAL TEXTILE CLUSTER SUMMARY CHART Cluster mapping: by David Rigby Associates Cluster networks NWTexNet
- technical textiles cluster mapped by a working group
TechniTex
- a Faraday Partnership in technical textiles with regional
involving 20 companies involvement Company base Employment
- 8,000 people employed in technical textile companies
Medical textiles companies
- includes large companies with international markets - many manufacturers are supplying products which are components of other products/systems
Intellectual capital – NW research-base Bolton Institute, UMIST and Manchester Metropolitan University
– expertise in textiles, fibre science and clothing
UMIST, Manchester University, Liverpool University and Manchester Metropolitan University
– expertise in materials science
British Textile Technology Group Intellectual property and innovation Smart fibres and intelligent textiles
- building expertise and developing new products in these fields are regarded as areas of significant opportunity
Business/professional service provision Bottlenecks to growth identified
- more investment finance and commercial expertise required
Infrastructure Textiles Incubator
- business incubator located at Bolton Institute aims to help create 15 new businesses - research infrastructure in need of modernisation
Product Design and Innovation Centre
- recommendation for Centre made in NWTexNet submission to NW Science Council, 2002
Education and training/ people issues Workforce development
- shortages of high quality research staff - ageing skill base - need to attract highly qualified young people to study for vocational qualifications and support manufacturing companies
“Sunset industry” image
- need to raise public awareness and improve image
Page 84
Appendix G: Summary descriptions of NW sectors/ clusters relevant to the health and social care sector (cont.) Biotechnology Cluster G.32 The Region is regarded as having all the elements of a biomedical/biotechnology cluster but one that has not yet reached critical mass in all its parts. The key strengths and capabilities of the cluster's science-base identified by Bionow, the cluster development group established by the NWDA, are in bioinformatics; clinical genetics and genomics; clinical trails; medical imaging; pharmaceuticals and biopharmaceuticals; therapeutic areas, especially cancer and neuroscience; and tissue regeneration and regenerative medicine. G.33 The cluster is geographically focused between Manchester and Liverpool, along the M62/M56 corridor and down to Cheshire. Bioscience businesses are networking in these areas but much appears to be public sector driven – business clustering still needs to develop more momentum of its own. G.34 Biotechnology related projects supported by Bionow and in which the NHS or Department of Health are involved include: ●
Trustech – consortium of NHS Trusts in the Northwest established to enhance exploitation of NHS intellectual property
●
NW Genetics Knowledge Park (NowGen) – includes Department of Health funding
●
Molecular Imaging Centre – with Christie Hospital as partner
●
Central Database of Clinical Research – Trustech on behalf of NHS.
G.35 The proposal for a Central Database of Clinical Research Capability within the Region’s NHS Trusts would build on Liverpool Clinical Trails Centre. G.36 Other strategic projects listed on the Bionow web-site (http://www.bionow.co.uk/images/bioprojects.gif) include: ●
the National Biomanufacturing Centre, Speke
●
NW Genomics Consortium
●
Institute for Biomedical Informatics.
Market drivers G.37 Key market drivers include: ●
un-met health needs – notably in the context of changing demographics and an aging population
●
bio-defence
●
renewed awareness of perceived threats of infection
●
perceived under-performance in the pharma/bio sector driving a search for new technologies
●
increased regulation which is leading to new opportunities.
G.38 Technology has not been the prime driver, a backlash due perhaps to an overselling of technologies which failed to achieve immediate market impact. G.39 Supply chain issues have not been too important in the past but are beginning to emerge as margins, competition and regulations tighten. The quality of local specialist engineering businesses supplying the life sciences sector will come under closer scrutiny. G.40 Bionow, MerseyBio, Medilink and Trustech are the key networking bodies. The 3Bs Project (Building Biotech Businesses) is a key focal point for new venture support (www.3-bees.net).
Page 85
Venture capital G.41 There is a growing venture capital business in the UK and internationally focusing on the life sciences sector. However, there is limited track record of VC investment in the Northwest. There is a perception that VCs may wish emerging Northwest businesses to move to the south-east rather than support them locally. G.42 To mitigate against this at least in part, there are initiatives in the Region to establish early stage funding for new start companies. For example, MerseyBio is establishing an incubator seed fund for pre-starts and the Rising Stars Fund has benefited some bioscience businesses. Research and development G.43 The Region’s university research-base is vital to the biotechnology cluster. The universities in both Liverpool and Manchester especially have a track record of not only spinning out new firms but also of attracting firms to the cities to be co-located with university expertise. G.44 Investors and entrepreneurs still need to do be encouraged to do some far in-reach work to identify and draw out potentially viable business enterprises from the research being conducted. Links to the NHS G.45 The large teaching hospitals in the Region are especially important intellectual capital resources for the cluster. They are a major source of intellectual property although commercialisation practitioners point to difficulties in “extracting” IP held by NHS consultants. Although the NHS still has some way to go in developing its commercialisation capability – one consultee suggested it is where the UK university sector was 20 years ago - one can point to the positive developments in the NHS over the past 2-3 years e.g. establishing a national framework for managing intellectual property and establishing regional commercialisation "hubs", such as Trustech in the Northwest. G.46 The NHS is a key resource for innovation, in enabling access to patients for appropriate trialling of new technology. G.47 Interventions by the public sector in further cluster development need to be very well defined and mindful of existing roles and activities. There is great potential for unhelpful overlap. There is already a great deal going on in the Northwest in support of biosciences in which the NHS and its capabilities in research and invention do and can play a major part.
Page 86
Appendix G: Summary descriptions of NW sectors/ clusters relevant to the health and social care sector (cont.) BIOMEDICAL/BIOTECHNOLOGY CLUSTER SUMMARY CHART Cluster mapping: by Angle Technology (2000); updated by Bionow (2002) plus information from Bionow website Cluster networks Bionow
- Regional cluster development group established by NWDA
MerseyBio and Manchester BioIncubator (Manchester Innovation Limited)
- biotechnology incubation organisations
Pro Bio
- Faraday Partnership in biocatalysis with regional
Biomanufacturing Faraday Partnership
- proposed/established
Medilink (NW) Limited
- brings together medical manufacturing and distribution
involvement
companies, hospitals and universities to stimulate innovation in the medical technology and systems sector Company base Employment
- c. 20,000 people employed in over 170 companies
Biomedical/biotechnology companies
- over 70 "core" companies - i.e. "companies using modern biological techniques to develop products or services to serve the needs of human healthcare"
Total number of companies contributing to the cluster
- over 170 companies - includes seven multi-national pharmaceutical companies, including AstraZenica's largest R&D centre, located in Cheshire - also includes one of the most profitable biotech companies in the UK – PowderJect Pharmaceuticals Plc one of the world’s leading vaccine companies which recently announced a £85 million investment programme at its facilities in Liverpool.
Medical devices
- pockets of strengths – e.g. disability aids in Merseyside; domiciliary care technology (remote monitoring)
Intellectual capital/research base Strong biosciences research base
- notably in the research-intensive universities Manchester and Liverpool universities and UMIST
Excellent clinical research, clinical trials capability and teaching in NHS Trusts hospitals
- including but not limited to Paterson Institute for Cancer Research and the Christie Hospital NHS Trust; Central Manchester and Manchester Children's University NHS Trust; Royal LIverpool an Broad Green University Hospitals NHS Trust; Clatterbridge Centre for Oncology
Strengths in complementary research areas
- computing science, chemistry, physics, informatics
Other universities Lancaster, Salford, Liverpool John Moores, Manchester Metropolitan
- contribute to the research base and more significantly to education and training
Daresbury Laboratories (CRCL) Westlakes Research Institute
Page 87
- bioinformatics
BIOMEDICAL/BIOTECHNOLOGY CLUSTER SUMMARY CHART (cont.) Intellectual property and innovation Areas of expertise in which the Region is regarded as having a competitive advantage in the global market:
- clinical genetics and genomics; clinical trails; medical imaging; pharmaceuticals and biopharmaceuticals; therapeutic areas, especially cancer and neuroscience; and tissue regeneration and regenerative medicine.
IP management and commercialisation
- Trustech supports NHS research commercialisation - university capability and track record in licensing and spin-outs – notably Manchester Innovation Limited
Genetic Innovation Network
- universities of Liverpool, Manchester and UMIST
Business/professional service provision Spin-outs
- track record and capability to achieve biotech spin-outs.
Venture capitalists
- few in number.
Entrepreneurs and business development professionals
- lack of critical mass of specialist professionals
Expertise/experience available in the Region.
Infrastructure Animal house provision
- development and maintenance crucial for therapeutics research work.
Business incubators
- Manchester Innovation Biotechnology Incubator and MerseyBio Incubator
NW Genetics Knowledge Park Key capital equipment
- Molecular Imaging Centre, Manchester
National Biomanufacturing Centre, Liverpool
- £30m facility on Estuary Business Park, Speke, Liverpool
Education and training/ people issues Undergraduate teaching
- 12 institutions in Region offer life science degree courses
Staff shortages
- research assistants in academia and industry - commercial/managerial skills - bioinformaticians – global shortages but teaching in bioinformatics regarded as world-class
CASE studentships
- attractive mode of university-industry action but administratively cumbersome
Chemicals sector G.48 The Region has the UK’s most extensive and deep chemicals cluster. The speciality chemicals component is regarded as having very significant growth potential over the next decade. To achieve sustained success, the interface between industry and the research-base, between new science and its exploitation, is emphasised by the NW Chemical Initiative’s strategy. New technology spin-out businesses are considered to be an especially important factor, as are potential developments at the interfaces with other clusters in the Region. G.49 A number of Northwest businesses in the sector are start-ups - some are spin-outs from ICI. The NW Chemicals Initiative is pursuing a start-up incubator project which will focus on bringing financial, technical and legal support together rather than business co-location.
Page 88
Appendix G: Summary descriptions of NW sectors/ clusters relevant to the health and social care sector (cont.) Markets and the company base G.50 Key market niches for the region’s business base include: ●
disinfectants
●
cleaning materials
●
specialist gases
●
speciality coatings for use in clean areas, and
●
high tech textiles.
G.51 High tech polymers and bio-polymers are increasingly important for implants and prosthetics. G.52 Innovative technology and R&D likely to be shared by the chemicals and medical sectors include: ●
sensor devices
●
analytical techniques
●
artificial blood – replacement body fluids
●
absorbents – including activated carbons for absorbing gases and liquids (Cabot Carbon)
●
zeolites – for absorbing anaesthetic gases to permit their recycling (Ineos Silicas)
●
speciality polymers (Victrex).
G.53 Astra Zeneca, in the pharmaceuticals sector, is not considered by some as strictly part of the chemicals cluster but they do make very specialist chemicals including specialist polymers/bio-polymers for contact lenses and the treatment of glaucoma. The company outsources some of its pharma-chemical R&D, product development and delivery. Research and development G.54 The Region has leading-edge research groups in its universities, e.g.: ●
Chemistry Department, University of Liverpool leads a LINK Programme relating to pre-clinical trialling
●
Molecular Materials Centre at UMIST developing polymer technologies
●
Manchester Materials Science Centre has links to pharma, performance and organic materials
●
Organic Materials Innovation Centre, University of Manchester is involved in novel materials technology.
G.55 These groups have good links with industry. Industry contacts help shape research programmes. Some 86 academics in the Region are listed in the NW Chemicals Initiative directory of regional expertise. Key issues for the sector G.56 Key issues include exploiting opportunities to attract inward investments to the Region in the area of materials science. G.57 The sector faces problems in skills and training to replace an aging workforce. A Modern Apprenticeship scheme is being supported. G.58 Major challenges are emerging from competitors in China and India. Continued investment in technological development is required to maintain competitive advantage.
Page 89
CHEMICALS CLUSTER SUMMARY CHART Cluster mapping: see Northwest Chemical Initiative website www.nwci2.org.uk Cluster networks NW Chemical Initiative Relevant Faraday Partnerships
- Including IMPACT; CRYSTAL; Technitext; Pro-Bio; Remediation of Polluted Environment
Company base Chemicals manufacture
- c. 45,000 people employed directly in >400 companies; include new spin-outs to major global companies. - (21% of UK chemicals industry and 4% of NW workforce)
Industry support services
- c. 350 companies in sales and distribution; engineering contractors; analysis; waste treatment; plant and lab equipment manufacture
Sector breakdown: Commodity chemicals
- 19,000 employees
Pharmaceuticals - intermediates and formulated products
- 13,000 employees
Plastics processing
- 35,000 employees
Soap, detergents and cosmetics
- 8,600 employees
Miscellaneous speciality chemicals â&#x20AC;&#x201C; incl. photographic, catalysts, fuel additives
- 8,300 employees
Paints and allied industries
- 6,700 employees
Pesticides
- 400 employees
Export capability
- 54% of chemicals manufactured in the Region were exported in 2001
Intellectual capital/research base Research strengths
- UMIST receives significant industrial funding for chemicals research. It has research in chemical engineering of international excellence (Grade 5 in 2001 Research Assessment Exercise). Links between industry and academia elsewhere are weaker. Liverpool and Manchester universities have Grade 5 research groups in chemistry.
Intellectual property and innovation Areas of expertise in which the Region is regarded
- Halo-chemicals
as having a competitive advantage in the global
- Photographic chemicals
market:
- Primary polymers - Formulated paints - Detergents and toiletries - Inorganic chemicals
Investment in innovation
- ÂŁ400m per annum of which 72% is investment in new product development
Spin-outs
- track record of spin-outs notably from UMIST (e.g. BRITEST) and Liverpool University (e.g. Stylacats), but overall level of activity is low
Page 90
Appendix G: Summary descriptions of NW sectors/ clusters relevant to the health and social care sector (cont.) CHEMICALS CLUSTER SUMMARY CHART (cont.) Advanced analytical techniques, process chemical
- all key areas of need and opportunity for innovation
technology, synthetic chemistry and materials
- alternative methods for waste reduction, elimination or
science and technology
treatment; accelerated introduction of “green” chemicals
Business/professional service provision Decision making
- much of what affects the industry is now taken overseas
Infrastructure Business incubators
- proposal for a Chemical Rapid Development Park to support formation and growth of specialist chemical businesses
Organic Materials University Innovation Centre (UIC)
- located at the University of Manchester and coordinating activity between universities and industry across the Region
Molecular Materials Centre
- collaboration between UMIST and Manchester and Liverpool universities to conduct industrially relevant research
CEMIST
- pilot plant at UMIST with measurement and instrumentation open to NW companies
Education and training/ people issues Staff shortages
- difficulties in attracting highest quality research staff to the Region. Difficulties in attracting sufficient young people to the industry
Technical training facilities
- TTE has good facilities but numbers in training too low
Poor industry image Source: NW Chemical Initiative (2002) submission to NW Science Council
Environmental technology G.59 The environmental technology industry is very diverse in terms of the goods and services it provides. A useful basis for describing its scope is the sub-sectors listed by the Joint Environmental Markets Unit (JEMU) of the DTI: ●
air pollution control
●
water and wastewater treatment
●
waste management
●
contaminated land remediation
●
environmental consultancy and services
●
environmental monitoring and instrumentation
●
energy management
●
renewable energy technologies and services
●
noise and vibration control
●
cleaner technologies and processes
●
marine pollution control.
G.60 Envirolink NW acts as a facilitator, bringing suppliers and customers together, and linking needs with solutions. Around 95% of 700 environmental technology firms in the Region it works with are SMEs.
Page 91
G.61 It works through Active Networks which help leading companies in the Region network and explore new markets, including export markets. The networking also encourages collaboration in R&D. G.62 There are currently four Active Networks: ●
using materials sustainably – focused presently on chemicals, food, paper, textiles and glass industries
●
creating a low carbon economy – exploring new opportunities for the use of renewable energy technologies
●
regenerate the environment – land regeneration and remediation
●
measuring and monitoring environmental impact – developing regional expertise.
G.63 Consideration is being given to establishing a further Active Network, with a health-related network an option. Envirolink have recently recruited a post-graduate student to work on NHS-related issues. The attractiveness and feasibility of a health-related Active Network in the Northwest should be explored by the NWDA with Envirolink and the NHS. G.64 The Region has The Lancaster Environment Centre based at Lancaster University, one of the largest groups of its kind in Europe. The work of the Centre includes support for existing SMEs in the Northwest and assistance in the creation of knowledge-based businesses. G.65 In descriptions of the Environmental Technology and Services cluster given in documents prepared by Envirolink NW there are few if any references to health and social care. There are no explicit references to the NHS as part of the cluster – as a major buyer locally or nationally, nor as a contributor to R&D relevant to the industry. G.66 The major capital projects in the NHS to refurbish or renew its buildings and estate provide significant opportunities to demonstrate innovation in the application of environmental technology and "systems". The NHS project teams should be encouraged to engage with Envirolink and its members in the research and business base in the Northwest to communicate needs and explore opportunities. ENVIRONMENTAL TECHNOLOGY AND SERVICES CLUSTER SUMMARY CHART Cluster mapping: Techsafe Consultants on NW Environmental Alliance; Envirolink NW on environmental technologies and services in the North West Cluster networks Envirolink NW
- Strategic partnerships with NWDA, Renewables North West
Renewables North West Limited
- developing industry-academic links and stimulating R&D
and the Carbon Trust Company base Employment
- 24,000 people employed in c. 700 companies who work
Company profile
- c. 90% of firms are SMEs, many are micro-businesses
with Envirolink (<10 staff) - a few are medium sized businesses with niche products and global markets (e.g. Dunphy Combustion and Sutcliffe Croftshaw – filtration systems) - very few HQ’s of international companies (e.g. BNFL and United Utilities – water treatment and “green” energy)
Page 92
Appendix G: Summary descriptions of NW sectors/ clusters relevant to the health and social care sector (cont.) ENVIRONMENTAL TECHNOLOGY AND SERVICES CLUSTER SUMMARY CHART (cont.) Manufacturing
- c.25% of companies are involved in manufacturing. Their technologies are often controlled outside the NW - some major manufacturers of analytical equipment â&#x20AC;&#x201C; VG, Kratos and Micromass
Services
- consulting, contracting training and operating services
Regional strengths
- environmental consultancy services; water and wastewater
dominate the sector in the Region treatment; waste management; energy management; renewable energy Export capability
- presently around 12% of sales from export or ÂŁ200m per annum. 25-30% of manufacturing sales comes from export.
Intellectual capital/ research base Business R&D performers
- for example EA Technology, C-Tech Innovation, Westlakes
University capabilities
- including UMIST, Manchester University, Liverpool University, Salford University, University of Central Lancashire and Lancaster University
Specific areas of strength
- environmental analysis and modelling; measurement and monitoring of specific pollutants and processes; energy technologies and alternative transport fuels; waste management and recycling/reuse of waste; land remediation; cleaner technologies and processes; built environment, planning and civil engineering
Fragmentation
- substantial, diverse but fragmented university capabilities in Region
Intellectual property and innovation High growth opportunities for NW organisations
- waste management â&#x20AC;&#x201C; recycling and reuse of waste materials - cleaner processes, process control, materials and product design - land regeneration - renewable energy and energy management - air pollution control - monitoring and instrumentation - consultancy services - transport pollution control and management - education, training and R&D
Strengths and opportunities in emerging areas
- nanotechnology (e.g. for membranes and solar cells);
University spin-outs
- for example IPSA in power systems software
Biotechnology solutions
- links to biotech cluster and to biomedical applications
biotechnology ( e.g. for biosensors and remediation)
Page 93
ENVIRONMENTAL TECHNOLOGY AND SERVICES CLUSTER SUMMARY CHART (cont.) Business/professional service provision Infrastructure North West Environmental Alliance (NWEA)
- proposed university partnership to develop lab facilities, site
Business incubation
- growth in incubation units considered to be a strength
investigation methods, modelling techniques and training Education and training/ people issues Study of skills needs
- see University of Manchester Environment Centre report on “Environmental Technologies: matching NW HEI supply with evolving demand”
Shortages
- skills shortages especially in science and engineering viewed as a threat. Requirement for more flexible, experience based learning.
Food and drink cluster G.67 The food and drink industry in the UK is mature and price competitive. Consolidation has resulted from pressures to gain economies of scale to gain market share. There is a strong trend towards internationalisation and export, with the globalisation of brands. G.68 Convenience, health and pleasure are the three principal consumer demands in developed countries and these are the areas where growth opportunities will occur for new product development. G.69 Work commissioned by the North West Food Alliance revealed relatively little clustering activity within the food and drink industries on Merseyside. The survey revealed that c.50% of companies were dependent on customers located outside the Northwest and that two thirds of the sample obtain most of their supplies from outside the Merseyside area. Most local companies are operating within UK-wide supply chains involving the multiple food retailers. G.70 In the Northwest as a whole there are more manufacturing units employing less than 9 people than anywhere else in the UK but also more employing between 100 and 499 people. The Region has some of the UK’s major players in the agri-food and drink sector, including for example plants belonging to Diageo, Nestle, Heinz and Kellogg's. G.71 The sector is not especially high tech but it is technically demanding. G.72 Research by Promar International (2002) points up new or emerging market areas of higher value, including nutritionally enhanced food and nutraceuticals. G.73 There is very little specific reference to the contributions of the research-base in the documents concerning the Northwest's agri-food and drink cluster, although mention is made of links to Northwest universities on the NW Food Alliance web-site. There are little or no references to health and social care, nor to the NHS in any capacity, except in the RCM Enterprises (2001) report where within its strategic priority “image”, it proposes action towards improving health promotion in the Region and encouraging acknowledgement of the industry’s role in providing healthier food.
Page 94
Appendix G: Summary descriptions of NW sectors/ clusters relevant to the health and social care sector (cont.) G.74 SMEs in the Region’s food sector are interested in the opportunities provided by the NHS for local sourcing of supplies. The NHS’ procurement policy has a local Discretionary Model which allows it to side-step national procurement procedures. Food is a significant cost for the NHS – mainly in the provision of meals. G.75 No clustering behaviour is currently demonstrated by the food and the health care sectors. G.76 The NW Food Alliance is seeking NWDA support to work with regional purchasers and suppliers to assist local firms access national supply chains. This work will be done in collaboration with Salford University. This should include access to the purchasing procedures of the NHS. FOOD AND DRINK CLUSTER SUMMARY Cluster mapping: mapping of Merseyside area by Optimat with Campden and Chorley Food Research Association (2002). Mapping of North West agri food and drink cluster by Promar International (2002). See also RMCM Enterprises (2001) Agri-Food Sector Strategy Cluster network North West Food Alliance
- Supports networks on Merseyside (2), Wigan and Manchester
Company base Employment (agriculture)
- 38,900 jobs (c. 29,600 FTEs) in c. 18,000 farm holdings in the North West – red meat, dairy and horticulture dominate. Diary sector is the single biggest sector in the Region
Employment (food and drink processing)
- c. 64,4300 jobs in c. 1,295 business units (2002), 12/5%
Employment (Merseyside)
- c. 10,000 people employed in c. 250 companies
Sub-sectors
- primary production, primary processing, secondary
of the U|K total. 25 employ more than 500 people
processing and equipment/service businesses Primary production
- insignificant. Some horticultural businesses around Stockport
Primary processing
- >40 companies mostly in cereals and dairy processing
Secondary processing
- largest sub-sector accounting for c. 80% of employment with a few large companies in snacks, ingredients, drinks employing >1000 in total; larger number of medium companies in bakery and meat processing; smaller companies in other niches employing <500 in total
Equipment/service sector
- >40 companies providing equipment, import/export services and packaging
New start businesses
- 50% of firms in the cluster were formed after 1995. Many have niche products for large retailers
Larger businesses
- most are branch plants of food groups
Export capability
- export/import intensity level is low
Intellectual capital – NW research-base Relationships with HE and FE sectors
- limited levels of engagement compared to that in other Regions. Private sector as likely to go outside Region for support
Page 95
FOOD AND DRINK CLUSTER SUMMARY (cont.) Intellectual property and innovation Investment in innovation
- mostly in process innovation to reduce costs and to comply with new legislation
Commodity production
- this dominates with only a few added value prepared food manufacturers and speciality bread producers
Business/professional service provision Strengths
- companies in the sector regard themselves as strong in ICT,
Weaknesses
- in export and marketing for business diversification
management skills and distribution management External business support
- weak, especially for product/service development
Support organisations
- duplication and many organisations with limited resources/budgets
Infrastructure Merseyside
- companies regard local support infrastructure as weak
Distribution centres
- ready access to retailer distribution centres is an important
Merseyside Port
- opportunities to exploit these in support of exporting
Innovation centre/incubator
- identification of a need for a Product Innovation Centre or
factor
Incubator Education and training/ people issues Skills shortages
- in specialist food-skilled labour and resistance to multiskilling required for lean manufacturing
Page 96
APPENDIX H: Research base in the Northwest H.1
The Region has nine universities and seven Higher Education colleges. This is a very diverse group of institutions in terms of size, history and nature of the contributions made to the health and social care sector. It includes institutions such as the universities of Liverpool and Manchester which have long traditions of medical research and training – the Medical School at Manchester University is the largest in the UK and has a history going back over 200 years. Younger but large institutions such as Liverpool John Moores University and the Manchester Metropolitan University make major contributions in education and training across a wide range of health and social care disciplines. A number of the Region’s HE colleges such as Edge Hill, St Martin’s, Chester and Liverpool Hope provide training in subjects as diverse as nursing, sports science and others allied to health and social care.
H.2
The research spend by the university sector in the Northwest ranks fifth of twelve regions in the UK, accounting for c. 8% of total UK expenditure (Northwest Strategy Review: Economic Report, April, 2002)
H.3
There is a large amount of joint research work going on in the Northwest between universities and the NHS. Medical and dental schools in particular have interactions with many Trusts. There is strong research interaction: clinical and research staff have cross-over activities and in many cases joint NHS and university appointments. The research offers potentially very high value, exploitable intellectual property.
H.4
There is a growing axis of research collaboration between Manchester, Liverpool and Lancaster on medical and related research. In general, the Northwest has much expertise in the medical life science and many networks.
H.5
The two most research intensive universities alone – Manchester and Liverpool – together attract c. £42m to their research in health and allied subjects. The proportion of research income from this activity is very significant - for example of the £60m per annum research income to the University of Liverpool, one third goes to the Faculty of Medicine. Between 15-20% of this comes from the private sector.
H.6
The university sector is active in licensing and spin-out company development. An ability to attract spin-in companies, companies choosing to locate close to university expertise/facilities is also evident, especially in Manchester. Licensing is proving more commercially attractive to some universities than the spin-out route for exploiting their IP.
H.7
The Department of Health’s Framework for Governance in Health and Social Care requires relationships to be put in place by Trusts for joint research activity. There is also a growing importance being accorded ethical issues in research. The EU Directive on clinical trails is important here. University perspective on the NHS
H.8
University-NHS research relations in the past have often been ad hoc, but this is changing. There have been disagreements in the past over responsibilities for site management and over time spent by clinical staff working for the university but paid by the NHS. The terms and conditions of research interactions are being tightened up. Pressures on clinical time may result in reductions in time available for research by clinical staff.
H.9
Trusts are seen to be under great pressures to improve clinical services and do not receive core funding to undertake research. Universities on the other hand are core funded to do research. A lot of NHS Trust research is considered to relate to diagnostic treatment trials and some universities are keen to push this onto NHS sites. Non-patient work is more readily shared on both NHS and university sites.
Page 97
Initiatives supporting commercial exploitation of research H.10 A number of key initiatives in the Region are important e.g.: ●
Science Enterprise Challenge – working to make more graduates aware of enterprise and management skills. A growing number of clinicians have ideas they could exploit but lack appropriate management skills
●
NowGen, the Genetic Knowledge Park, is working to ensure that benefits arising from developments in genetics are available to patients
●
the bio-incubator at Manchester Innovation provides support and funds for start-ups in the biotech sector.
H.11 Lack of suitable risk capital is a problem facing new company formation and growth in the life sciences sector, especially at pre-start stage and at the £10-100k level when the requirement is to assess viability of business ideas. However, Trustech the NHS innovation ‘hub’ for the NHS in the Northwest points to the value of funding available from Wellcome, the Manchester Knowledge Capital plan and the DTI, for proof of concept studies. Trustech- supporting exploitation of NHS research and invention H.12 Trustech now serves all NHS Trusts in the Region. Its role is to provide capability in the exploitation of NHS research and invention. It is funded from the DTI, the Office of Science and Technology, the Department of Health/NHS and NWDA. It also levies £50k overall from Trusts’ R&D budgets. H.13 Trustech conducts market scanning and technology audits; licenses intellectual property; and undertakes other activities such as promotion, events organisation and consultancy. Its core market focus is health-related rather than the social care sector. H.14 Hospital-based NHS research in the Northwest is considered to be well linked into the Region’s university base and technology transfer infrastructure (notably with Manchester Innovations and UMIST Ventures). This provides a highly effective exploitation route for most types of “high end” NHS funded research. Mental health is the key exception but levels of R&D spend in this area are small. H.15 Trustech does not only work with this “high end” market but also with innovations in patient care derived from clinical practice. Commercial prospects are often quite close to market and time to market can be short. H.16 There appears to be a shift in NHS research from a focus on departmental areas of specialism and increasingly towards integrated research programmes (heart, trauma, cancer etc.) which are brokered and led by the Department of Health. This means that improving the links within and across the Region’s health community is more important than ever. Exploiting NHS IP and the Region’s company base H.17 The link between the exploitation of NHS IP derived from patient care and the Region’s companies is an area for further development. Pro-active attempts to improve links are emerging as evidenced by Trustech’s engagement with the NWDA to assess the Region’s medical devices sector and clinical trialling capabilities in order to identify opportunities for collaboration and technology transfer. Medilink Northwest is already actively networking within the medical devices sector.
Page 98
APPENDIX H: Research base in the Northwest (cont.) H.18 Trustech is also developing links with major companies in the Region such as Astra Zenica and Glaxo Smith Kline. This will help address the perception that although located “in the Northwest”, these major companies are not “of the Northwest”, reflecting their prime role as global players in the pharma market. Trustech is interested in discussing opportunities for R&D, technology transfer and trialling with these major firms in the Region. Issues and recommendations H.19 Co-ordination of medical life sciences research involving universities and the NHS could be better co-ordinated. The overall view is that there is a lot happening in the Region but poorly co-ordinated and not “driven”. Collaboration still seems to be difficult to achieve. The NHS will be an important customer of many of the products that derive from university research. H.20 Research capabilities and facilities in the Region are highly regarded but knowledge of what is being done and what facilities are available are regarded by some commercialisation practitioners as not well known by the Region’s SMEs. Improved information/knowledge transfer to SMEs involved in health and social care market is required. H.21 The Region is considered to be well served by networks such as the Pan Manchester R&D Group, the NW NHS R&D Managers Group, Medilink, the NWDA’s Bionow network and groupings focused on for example Manchester Innovation Ltd. H.22 Evidence of effective clustering activity in the health care sector is identified by Trustech especially around Manchester. No such evidence is apparent in social care and from its own operating experience only to a limited extent between medical devices companies. University research quality in the Northwest H.23 The tables below summarise the outcomes of the 2001 Research Assessment Exercise for universities in the Northwest. Subjects relating to medicine and the life sciences figure strongly.
Table H.1: Quality rating of all university research in the NW in subjects associated with health and social care (RAE, 2001: where ratings of 4 and upwards relate to research that to some degree attains international standards of excellence, with 5* the highest rating awarded) Research subject area
Page 99
Institution
2001 Rating
Number of active research staff
clinical dentistry
Liverpool University
4
20.1
clinical dentistry
University of Manchester
4
39.6
clinical laboratory sciences
Liverpool University
5
39
clinical laboratory sciences
University of Manchester
4
19
community-based clinical subjects
University of Manchester
5
55.1
community-based clinical subjects
Liverpool University
4
32.7
hospital-based clinical subjects
University of Manchester
5
114.3
hospital-based clinical subjects
Liverpool University
4
66
nursing
University of Central Lancashire
3b
18.4
nursing
Liverpool University
3a
11
nursing
Liverpool John Moores University
3a
16.9
nursing
University of Manchester
5
35.5
Table H.1: Quality rating of all university research in the NW in subjects associated with health and social care (RAE, 2001: where ratings of 4 and upwards relate to research that to some degree attains international standards of excellence, with 5* the highest rating awarded) cont. Research subject area
Institution
2001 Rating
Number of active research staff
other studies and professions allied to medicine
UMIST
5*
11.5
other studies and professions allied to medicine
University of Central Lancashire
3b
6
other studies and professions allied to medicine Manchester Metropolitan University
3b
15.2
other studies and professions allied to medicine
Liverpool University
3a
14.3
other studies and professions allied to medicine
University of Salford
3a
32.1
other studies and professions allied to medicine
University of Manchester
5
9.6
other studies and professions allied to medicine Liverpool John Moores University
4
21
pharmacology
Liverpool University
5
14
University of Manchester
5*
30
Liverpool University
5*
16
pharmacy physiology pre-clinical studies
University of Manchester
5*
27
Liverpool John Moores University
3b
15
social work
University of Central Lancashire
3a
11.8
social work
Manchester Metropolitan University
3a
10.5
social work
social work
Lancaster University
5
24.2
sports-related subjects
Liverpool John Moores University
5*
12
sports-related subjects
Manchester Metropolitan University
5*
12.3
sports-related subjects
Liverpool University
2
3.2
anatomy
Liverpool University
4
14.3 TOTAL 767.6
Table H.2: NW university research attaining international standards of excellence universities in potentially relevant areas other than in those allied to health and social care (RAE 2001) Research subject area biological sciences
Institution
2001 Rating
Number of active research staff
Liverpool University
5
43.8
biological sciences
UMIST
5
33
biological sciences
Lancaster University
4
28.5
biological sciences
University of Manchester
5*
68
computer science
University of Manchester
5*
55.4
computer science
Lancaster University
5
28.2
computer science
Liverpool University
5
22
UMIST
4
27
Liverpool University
5
18
computer science electrical and electronic engineering electrical and electronic engineering
UMIST
5
45.1
electrical and electronic engineering
Lancaster University
4
8.5
UMIST
4
14
electrical and electronic engineering instrumentation and analytical science
Page 100
APPENDIX H: Research base in the Northwest (cont.) Table H.2: NW university research attaining international standards of excellence universities in potentially relevant areas other than in those allied to health and social care (RAE 2001) (cont.) Research subject area
Institution
metallurgy and materials
University of Manchester with UMIST
5*
8
metallurgy and materials
Liverpool University
5
15.4
metallurgy and materials
Bolton Institute of Higher Education
4
10.7
metallurgy and materials
Manchester Metropolitan University
4
19
metallurgy and materials
University of Salford
4
24.4
UMIST
4
7
metallurgy and materials - paper science metallurgy and materials - textiles
2001 Rating
Number of active
UMIST
4
16
applied mathematics
Liverpool University
5
17
applied mathematics
University of Manchester
5
19
applied mathematics
UMIST
4
15
built environment
Liverpool University
4
13
business and management studies
Lancaster University
5*
73.3
chemical engineering
UMIST
5
33.9
Liverpool University
5
34.5
chemistry
UMIST
4
29.6
chemistry
University of Manchester
5
32.2
civil engineering
University of Manchester 5
10
chemistry
with UMIST civil engineering
Liverpool University
4
13
environmental sciences
Lancaster University
5
17.8
general engineering
Liverpool John Moores University
5
6
general engineering
Lancaster University
4
12.4
Liverpool University
5*
21
University of Manchester
5
23.5
UMIST
5
34.2
physics
Lancaster University
5*
20.8
physics
Liverpool University
5
35.2
physics
University of Manchester
5
59
physics
Liverpool John Moores University
4
16
mechanical, aeronautical and manufacturing engineering mechanical, aeronautical and manufacturing engineering mechanical, aeronautical and manufacturing engineering
physics
Page 101
UMIST
4
31.3
psychology
Lancaster University
5
23
psychology
University of Manchester
5
20
psychology
Liverpool University
4
21
sociology
Lancaster University
5*
28.3
statistics and operational research
Lancaster University
5*
16
statistics and operational research
University of Salford
5
8
Table H.2: NW university research attaining international standards of excellence universities in potentially relevant areas other than in those allied to health and social care (RAE 2001) (cont.) Research subject area
Institution
2001 Rating
Number of active
statistics and operational research
Liverpool University
4
6
statistics and operational research
University of Manchester
4
4
statistics and operational research
UMIST
4
5
NHS R&D H.24 The organisation of NHS-funded R&D has undergone considerable change in recent times. R&D is no longer to be commissioned through Regional Programmes. Three new national R&D programmes replace the large number of time-limited programmes which existed before. These national programmes which aim to be “sensitive” to local needs are: ●
Health Technology Assessment (HTA)
●
Service Delivery and Organisation (SDO), and
●
New and Emerging Applications of Technology (NEAT).
H.25 Alongside these three programmes are a number of cross-cutting themes for the research to be supported: ●
methodology
●
research capacity
●
consumers in NHS research.
H.26 It is now through these programmes than much of the new intellectual capital within the NHS in the Northwest will be generated. It is within these programmes that new research to address local and regional needs and opportunities will look for funding. From the portfolio of work supported through these programmes, there may be opportunities to commercialise output through new or existing firms in the Northwest, or to transfer new knowledge to the benefit of health care and the Region’s wider socio-economic objectives. H.27 Health Technology Assessment (HTA) is the largest element and covers devices, equipment, drugs and procedures across all healthcare sectors. It is a “needs led” programme in which calls for proposals are issued following prioritisation of subject areas through consultations within the NHS and with users. Applicants need not be limited to universities or NHS research staff – “anyone, anywhere who can carry out high quality health-related research” can apply. H.28 HTA has three advisory panels: ●
Diagnostic Technologies and Screening
●
Pharmaceuticals
●
Therapeutic Procedures.
H.29 Staff based in the Northwest are presently members of two of these panels – the Head of Clinical Support and Health Protection, DHSS (North) in Manchester sits on the Therapeutic Procedures panel; the New Products Manager at the National Prescribing Centre, Liverpool sits on the Pharmaceuticals panel.
Page 102
APPENDIX H: Research base in the Northwest (cont.) H.30 Service Delivery and Organisation (SDO) addresses issues around organisation and delivery of services in new and improved ways to increase the quality of patient care, ensure better outcomes at a strategic level and contribute to improved health. H.31 Key themes within the SDO at present are: ●
access to health care
●
carers
●
change management and quality improvement
●
continuity of care
●
evaluating models of organisation and delivery of health services
●
nursing and midwifery
●
organisational form and function
●
SDO research methods
●
workforce issues.
H.32 A full analysis of the SDO portfolio for relevance to this study and the goals of the NWDA are beyond the scope of this work but a brief examination of the “workforce” related activity reveals relevant research topics which include the following: (scoping studies are planned in each topic - see www.sdo.1shtm.ac.uk/workforce) ●
relationship between workforce issues and health outcomes
●
skill mix issues in secondary care
●
impact of local labour market issues on the delivery and organisation of services.
H.33 Given the capability in the Northwest Region in the subject of health informatics, it is also relevant to highlight the SDO project entitled Evaluating the innovation and implementation of electronic patient records and methods to improve the quality of routine data being led from the London School of Hygiene and Tropical Medicine. This will last over two years and has a budget of c. £345k. H.34 New and Emerging Applications of Technology (NEAT) aims to promote and support strategic and applied research to develop the new or emerging technologies relevant to health care products and interventions. It is concerned with enhancing quality, effectiveness and efficiency of health and social care. NEAT has been designed to fill a perceived “funding gap” in early stages of innovative product development. NEAT is open to academics and NHS staff. Projects can be co-funded from other public sources or from industry. H.35 Current NEAT priorities are in the following areas:
Page 103
●
cancer
●
coronary heart disease and stroke
●
mental health
●
children’s services
●
older people’s services
●
waiting lists and times
●
modern primary care.
H.36 The portfolio of R&D conducted within the NHS can be searched through a number of routes â&#x20AC;&#x201C; the Research Findings Register (ReFeR); the National Research Register; The Cochrane Library. The Department of Health provides substantially more information on the processes and awards for R&D available to NHS staff and other researchers (http://www.doh.gov.uk/research/). H.37 There are a number of research active NHS Trusts in the Region - including the Central Manchester and Manchester Children's University Hospitals NHS Trust; the Christie Hospital NHS Trust and the Royal Liverpool and Broadgreen University Hospitals NHS Trust. With the Wellcome Trust Clinical Research Facility in Manchester and the Liverpool Clinical Trials Centre, the Region has a strong capability in the conduct of clinical trials. H.38 NHS in the Northwest also has particular expertise in the area of medical imaging notably at the Salford Royal Hospitals NHS Trust, the South Manchester University Hospitals NHS Trust, the Christie and the Royal Liverpool trusts, and the Clatterbridge Centre for Oncology, in addition to expertise in UMIST, the universities of Liverpool and Manchester, and at the Daresbury Laboratory. The Paterson Institute for Cancer Research which is part of the Christie Hospital NHS Trust also has an international reputation for excellence in its research into cancer treatment.
Page 104
APPENDIX I: Provision of education and training in health and social care by the HE and FE sectors I.1
According to the North West Universities Association & Higher Education North West, more than 4,500 doctors and dentists train in the Northwest, together with more than 17,000 students undertaking nursing or other professional qualifications allied to healthcare.
I.2
Table I.1 and I.2 list the institutions providing higher and further education courses in the Northwest relating to health and social care.
I.3
The number and range of providers is very large. It is recognised that volume and diversity are not the only, nor necessarily the most important, parametersâ&#x20AC;&#x201C; quality of teaching, numbers of students taught and retained in appropriate employment in the Region, and the match between the curriculum and the evolving needs of the health and social care sector are also crucial. A full assessment of these issues is beyond the scope of the present study.
Table I.1: Higher education providers of courses relating to health and social care in the North West Institution
Level of qualification available
Bolton Institute of Higher Education
BA (Hons) BSc (Hons) Foundation Degree
Edge Hill University College
E.N.Conversion Diploma/Degree including ENB Framework and Higher Award Professional Registration Post Registration DipHE
Lancaster University
MA MRes Doctorate MPhil Research degrees
Liverpool Hope University College
BA/BSc Combined Honours programme MSc
Liverpool John Moores University
Degree Courses BA DipHE MSc Research degrees
Manchester Metropolitan University
BA (Hons) PGDip/BSc (Hons) MA MSc Postgraduate Certificate/ Postgraduate Diploma/MA MSc, MPhil, PhD research degrees
The University of Liverpool
Diploma courses MSc MPH BA (Joint Hons) BA (Hons) MPhil/PhD research degrees
Page 105
Table I.1: Higher education providers of courses relating to health and social care in the North West Institution
Level of qualification available
The University of Manchester
BSc (Hons) Modular Conversion Diploma Postgraduate Diploma/MA MPhil/PhD Post Grad Diploma/MSc
St Martin's College, Lancaster
Pre-Registration and Post-registration Midwifery Continuing Professional Development (CPD) courses DipHE & BA/BSc(Hons) incl some Joint Honours options
University of Central Lancashire
B.A./B.Sc. (Hons) DipHE DipSW
University of Salford
BSc (Hons) Diploma DipSW MSc/PG Dip MRes MA MA/PG CONVERSION PROGRAMMES
Table I.2: Further education providers of courses relating to health and social care in the Northwest Institution
Broad Subject Areas
Level of qualification available
Health and Social Care
Foundation GNVQ
Accrington & Rossendale College
Intermediate GNVQ Advanced VCE BTEC Blackburn College
Care, Health and Childhood Studies
BTEC NATIONAL DIPLOMA GNVQ
Blackpool and The Fylde College
Health & Social Care Includes:
GNVQ
Drug awareness
NVQs BTEC
Promoting health
Diplomas
Mental health
Foundation Degrees Community Mental Health Certificates CFCC
Page 106
APPENDIX I: Provision of education and training in health and social care by the HE and FE sectors Table I.2: Further education providers of courses relating to health and social care in the Northwest (cont.) Institution
Broad Subject Areas
Level of qualification available
Cardinal Newman College
Health & Social Care
BTEC First Diploma in Caring (Care Pathway) Advanced VCE Health & Social Care (Double A Level) Advanced VCE Health & Social Care (Single A Level) Advanced VCE Health & Social Care (Advanced Subsidiary - one year course) Foundation GNVQ Health & Social Care
Carlisle College
Chester College
Health & Social Care
Progression award
Includes:
BTEC National Diploma
Caring
Foundation Degree
Health and Care
Vocational GCSE
Counselling
ABC Certificate
Adult Nursing
DipHE (Nursing and Midwifery)
Mental Health Nursing
MSc
Children's Nursing
MPhil & PhD
Midwifery Studies
BSc (Hons)
Learning Disabilities Nursing
Post Qualifying Award
Reproductive and Sexual Health Supplementary Prescribing and Extended Independent Nurse Prescribing Programme Health Promotion Halton College
Health and Social Care
GNVQ Foundation BTEC
Liverpool Community
Health and Social Care
Advanced Vocational Certificate in
College
Community Mental Health Care
Education (AVCE)
Drug Awareness Studies
Certificate
Fresh Start Food & Health
EDEXCEL GNVQ Foundation
Fresh Start Introduction to Health & Hygiene
GNVQ The Access Programmes
Intermediate in Health and Social Care
BTEC Higher National Certificate
Health Professions (Humanities & Social
Diploma in Social Work/BA
Sciences Route)
Based Diploma
Health Professions (Science Route) Skills for Working Life in Health & Social Care: Entry Level. in Care Practice Social Work Studies Employment - in Social Work (Part Time) Preparation for Professional Social Work Training Social Work/Youth & Community
Page 107
Table I.2: Further education providers of courses relating to health and social care in the Northwest (cont.) Institution
Broad Subject Areas
Level of qualification available
Health and Social Care
GVNQ Foundation
Manchester College of Arts and Technology
GVNQ Intermediate AVCE Mid-Cheshire College
Health & Social Care
Entry Level (EDEXCEL)
Caring for Children
EDEXCEL GNVQ Foundation
Health Science
EDEXCEL GNVQ Intermediate
Counselling
EDEXCEL VCE A level Double Award EDEXCEL National Diploma CACHE Found Awards
Preston College
Mental Health
Open College Level 2
Childcare & Health
National Diploma
Health Studies
AVCE Double Award
Health & Social Care
Access Certificate
Counselling
GNVQ Foundation GNVQ Intermediate ABC Introduction
South Cheshire College
Health & Social Care
OCN
Access to Nursing
NVQ Level 2 (full-time) (Edexcel)
Access to Social Care
NVQ Level 3 (part time) (Edexcel)
Advice and Guidance CareCare
NVQ Level 4 (Edexcel)
Care
GNVQ Foundation (Edexcel)
Counselling & Communication Skills for
GNVQ Intermediate (Edexcel)
Working with Young People
Reception Diploma (Amspar)
Counselling Diploma (University of Manchester)
Diploma
Counselling Skills Foundation Counselling Skills Intermediate Health Services Southport College
St Helen's College
Care
BTEC/EDEXCEL NVQ
Health & Social Welfare
Foundation Degree
Early Years
Level 3 - BTEC National Diploma
Health and Social Care
New Deal â&#x20AC;&#x201C; GNVQ Foundation
in Managing Health & Care Services
HNC
Care Practice
GNVQ Foundation, Intermediate
GNVQ Health and Social Care
Vocational A Level, Advanced Level
in Health and Social Care
Diploma
Health and Social Care Reflexology Medical Administration Complementary Therapies
Page 108
APPENDIX I: Provision of education and training in health and social care by the HE and FE sectors (cont.) Table I.2: Further education providers of courses relating to health and social care in the Northwest (cont.) Institution
Broad Subject Areas
Level of qualification available
Warrington Collegiate
Caring, Childcare & Health
Diploma
Institute
Caring First
NVQ Level 3
Caring for Children & Young People
NVQ Level 4
Community Mental Health Care Certificate
GNVQ Foundation
Health & Social Care
National Diploma (2 Yrs)
Health Studies
CACHE
Promoting Independence
NCFE
Dental Nursing Social Care Childcare & Education Certificate Childcare & Education Childcare Foundation Special Needs Assistants Certificate Wigan and Leigh College Wirral Metropolitan College
Health Studies
BA or BSc Combined Honours
Health & Social Care Health Studies
HND
Access to Higher Education
Foundation Degree
Social & Health Care (award of Liverpool Univ.)
GNVQ Foundation
Health & Social Care
GNVQ Intermediate
Care Practice
Higher National Diploma
Dental Nursing
National Certificate
Oral Health Education
NVQ 2
Care
NVQ 3
Care/Promoting Independence
NVQ Level 3
Oral Healthcare Support Worker
NVQ Level 4
Dental Nursing Part-time
Vocational Cert of Education
Care / Registered Managers
(Adv. Award)
Health & Social Care Full-time
Page 109
APPENDIX J: Sources of primary research information and advice The following people made contributions to this study through direct contact with members of the Study Team. Their assistance and that of the many other individuals not mentioned below who forwarded prior research information and other documentation is gratefully acknowledged. K Ashford – East Cheshire NHS Trust S Begley – Royal Liverpool Children's NHS Trust T Batty - Government Office North East K Berry – Cheshire & Merseyside Strategic Health Authority J Booth – Sir Alfred McAlpine Ltd D Burton – St Helens & Knowsley Hospitals NHS Trust K Chantler - Central Manchester Healthcare NHS Trust R Deed - Trustech C Dunn – Tameside & Glossop Acute Services NHS Trust P Foreman – NW Food Alliance P Flynn – DoH (NW) Public Health Team B Greenhalgh - NWDA N Grice - St Helens/Knowsley/Halton/Warrington LIFT S Henry - NWDA D Harrison - Health Development Agency C Jeffries – Greater Manchester Workforce Development Confederation J Lyne – Central Manchester & Manchester Children’s University Hospitals NHS Trust J Moran – Lancashire & Cumbria Strategic Health Authority J McQuillian – MerseyBio M Miller – MBM Healthcare Ltd C Mullen - Greater Manchester Workforce Development Confederation S Neville - Project Director, SHIFT Project, Salford D Prior – University of Liverpool Research and Business Services Z Richards – Cheshire and Merseyside Workforce Development Confederation T Rowe - NWTexnet W Sang – Cheshire and Lancashire Workforce Development Confederation J Seddon – Envirolink North West C Shearlock – Envirolink North West I Sibbick – The Carbon Trust A Sleigh - Wirral Hospital NHS Trust C Spencer – NHS Purchasing and Supply Agency J Toller – North West Chemical Initiative P Wagner – Envirolink North West D Woodyatt – St Helens & Knowsley Acute Services Trust K Wright – DHSC (N)
Page 110