The mother who showed the NHS how to cut costs
Shocked to learn what health trusts were paying for supplies, school administrator Sarah Caulfield decided to do something about it. Victoria Lambert reports
When it comes to the NHS, there’s one area we all seem to agree on: a need for the health service to be efficient. And as the service has turned 70, that concern is more urgent than ever.
But, while most of us confine our frustration to moaning about waste in the system, Sarah Caulfield, a primary school administrator from Tenterden, Kent, has taken action – inspired by a newspaper article.
“Eight years ago,” says Caulfield, 47, who lives with Terry Collette, a 61-year-old consultant in mergers and acquisitions, “I read about the inflated prices the NHS pays for basic orthopaedic equipment and it really stuck with me. The idea that a basic screw costs pennies in B&Q but nearly £100 to an NHS Trust was both ridiculous and abhorrent. There had to be a better way.”
The need for change is obvious: in November 2015, the Government set the NHS a target to achieve savings of £22billion by 2020-21, which some trusts are struggling to meet.
And despite the Prime Minister promising this summer that the NHS would get an extra £20billion a year by 2023, the Office for Budget Responsibility (OBR) has warned that the health budget is likely to rise to 8per cent of GDP by 2024 from the current level of just over 7per cent. The OBR estimated that the budget would rise further to 13.8per cent by the mid-2060s as the population ages at a faster rate.
One way to tackle the spiralling budget would be to reduce costs. Last November, Jeremy Hunt, the health secretary at the time, told the NHS Providers conference in Birmingham that the NHS could save up to £1billion a year by opting for cheaper products, and that trusts needed to use their resources more efficiently.
What was frustrating at the time was data Hunt released showing that hospitals were paying wildly different amounts for the same basic items. Trusts paid between 35p and £16.47 for the same single pack of 12 rubber gloves – a 47-fold difference, the data showed. And a box of 100 plasters cost one trust £1.68, while another paid £21.76 – 13 times more.
A recent investigation by The Daily Telegraph also found that the highestpaying trust paid £49.62 for a bumper pack of swabs in 2017, yet the same pack was bought by another for just £39.20. If all 232 trusts in England paid the lower packet price, the health service could save £2,417 a time.
Last month, official figures showed that in 2017, the NHS spent more than £3million on toiletries such as anti-dandruff shampoo, moisturising body wash and toothpaste, all of which can be bought easily – and more cost-effectively – in supermarkets.
NHS waste usually springs from poor record-keeping, explained Siva Anandaciva, chief analyst at independent health think tank The King’s Fund, who was reported as saying: “There has been a lack of data on what different organisations are paying and a fragmented approach to using the NHS’S collective buying power to best effect, with organisations often operating as islands rather than archipelagos.”
Caulfield couldn’t get the problem out of her mind. “Terry and I kept talking about it,” she says, “and eventually he asked what I was going to do about it.”
She was reluctant at first – “I really felt I wouldn’t know where to start.” But now, nearly a decade on, Caulfield is in the astonishing position of being ready to offer surgical plates and screws to NHS procurement officers at prices 35per cent cheaper than rivals.
“I’m no different to anyone else,” she says. “We all feel passionately about the NHS. I gave birth to my two children in NHS hospitals, had my shoulder pinned together by NHS surgeons, watched my mother have three hip operations. Terry has relied on the NHS his whole life as he has type-1 diabetes, and NHS doctors were there when he had a heart attack at 48 and a stroke at 59. We all want the NHS to survive. I kept thinking: why can’t something be done?”
Her first step was to get a small amount of funding to allow her to research the process of procurement and other surgical options to the expensive screws available. A backer came forward and invested £60,000 to get the ball rolling.
“It was a long slog after that,” Caulfield says. “Weekends and evenings, summer holidays, the Easter break… I used all that time to make contacts and carry out research. It was like a bizarre hobby.”
It became an increasingly joint passion for Collette and Caulfield, who have seven children between them from previous relationships. “Terry was brilliant at the business and technical side of things and encouraging me on,” she says. “All our family and friends thought we were quite mad though.”
Their research found that the cost of orthopaedic screws was even more outrageous than they had believed. The NHS relies on supplies from about six large companies, who charge, on average, £252 for a set of two screws, meaning that the price the NHS typically pays per screw is £126. The unit price can rise as high as £148 for titanium screws and other products with additional attributes.
As every year the NHS spends up to £1billion on such devices, with each trust spending between £3 million and £4 million per annum, the potential for saving money was significant.
The process began to snowball in 2016 when the couple identified a new Spanish company called Implantes Y Protesis Altorreal SL, which was making titanium maxiangle locking plates and compression screws. “The company had exactly the same idea as us: how can you make these simple but essential items more affordable? The screws they produce are of high quality and meet all the required EU standards. In fact, they are already supplying a growing percentage of Spain’s hospitals.”
After Collette went to Spain and completed a sole-supplier deal, the pair then had to re-enter the confusing world of NHS tenders and red tape. But they had a stroke of luck. In 2017, a law passed allowing start-ups to supply NHS Trusts, which opened the door for them to offer their affordable screws. In the past, young companies were not allowed to offer products in case they were too small to survive.
“Everything is in place,” says Collette, “we are ready to start tendering and ordering stock. Now we need to crowdfund the next level of investment via the Crowdcube platform [crowdcube.com].”
The best part of the experience, says Caulfield, has been “when people say yes”.
“You think you are up against a brick wall and then something gives,” she says. “But it is a slow process, and that’s why I still work at the school. It’s all been little by little.
“The most difficult thing was finding out what the NHS actually pays for things. But we’ve enjoyed the process and feel we’ve done our bit to help the health service.”