The NHS should look beyond the initial price of medical products and consider whether higher upfront spending can improve patient care and reduce long-term costs, peers argued during a House of Lords debate on the Health Bill. The value-based procurement approach received cross-party support, with an amendment tabled by Labour’s Lord Hunt of Kings Heath and backed by crossbench peer Baroness Finlay of Llandaff.
The amendment would require ministers to report annually to Parliament on progress in adopting value-based procurement across the NHS and social care in England. Under the approach, purchasing decisions would take account of patient outcomes, clinical benefits and the wider costs of care rather than focusing solely on the purchase price. National guidance published in June means the approach is already being introduced across the health service.
Pilot cited as evidence
Lord Hunt, a former health minister and longstanding advocate of the policy, said procurement exists to secure value for money but “can do much more”. He argued that the goal was to move away from always choosing the lowest price and towards quality that improves patient outcomes.
He cited a pilot at South Tyneside and Sunderland NHS Foundation Trust, conducted with health and hygiene company Essity. Providing patients with continence products suited to their individual needs led to a 48% reduction in leaks and an 8% fall in product use, he said.
Baroness Finlay, a professor of palliative medicine, praised the work of the Department of Health and Social Care’s Medical Technology and Innovation Directorate and called for wider adoption across the NHS and social care. She argued that cheaper equipment could prove a false economy if it caused complications or further treatment, with the resulting costs often falling on different NHS budgets. She pointed to specialist cardiac pacemakers as an example of how more expensive devices could help prevent serious infections in vulnerable patients and potentially avoid costly intensive care.
“It is the clinicians who know that the cheapest is not necessarily the best,” Baroness Finlay said, adding that clinicians understand outcomes for particular devices and that this knowledge should be embedded in tendering.
Government commitment and monitoring
Conservative peer Lord Lansley, a former health secretary, warned that rigid pricing thresholds could prevent more expensive products from being properly assessed for their wider benefits. Liberal Democrat health spokesperson Lord Scriven described the national guidance as a “genuine step forward” but cautioned that financial pressures could still encourage NHS buyers to favour immediate savings over better long-term outcomes.
Health minister Baroness Merron reaffirmed the government’s commitment to value-based procurement. She confirmed that NHS Supply Chain had adopted a “comply or explain” approach for future purchasing frameworks and said the intention was for value-based procurement to become routine practice when NHS teams buy medical devices, consumables and services. The government has also commissioned independent monitoring of the national guidance, with annual reports over the next three years to assess its impact.
Core List concerns
Despite the broad support, the debate exposed concerns about whether existing purchasing practices were consistent with the policy. Lord Hunt questioned NHS Supply Chain’s recent decision to identify 79 additional product categories for potential inclusion in its Core List of standardised supplies, including urinary catheters and colostomy bags. He warned that these were highly personal products rather than standard commodities and criticised the lack of prior consultation with relevant trade associations.
Baroness Merron acknowledged the importance of products being tailored to individual patients but did not directly address the proposed expansion of the Core List. Questions therefore remain over how the NHS will balance greater standardisation with its commitment to clinically led, patient-centred procurement.
Chris Whitehouse, a health policy lobbyist whose agency Whitehouse Communications worked on the amendment with Essity, said there was now “great support” for value-based procurement across political parties and a “real desire to see it rolled-out with momentum across the NHS in England”.