CLINICAL FOCUS
Contracting for enteral tube feeding
376
What is somewhat disappointing is an apparent lack of innovation in key areas such as jejunostomy tubes, wound care, paediatrics and methods to detect feeding-tube position. For example, at a 2013 international conference, despite a strong industry presence, not a single tube, test kit or dressing was displayed (though that may be a reflection of how few nurses attended the conference). The recent development of ENFit connectors (a new universal connector for feeding tubes) showed what can be achieved when industry and clinicians work together and company boundaries are crossed. Much like party politics being ignored at times of crisis or conscience, perhaps industry-wide initiatives should be more widespread where safety is concerned. We still struggle to tell where nasogastric tubes are. Is it time for a team effort to solve this?
Our role is to represent our patients and colleagues, I urge you to get involved and make your experience count Nutrition nurses are often sole post holders, or work in a small team, and may question the value of spending time in protracted, often offsite, contract meetings. I believe that clinical nurse specialists (CNSs) have a skill set to bring to the table with specialist knowledge of tubes, pumps, plastics and an understanding of the company nursing service we want for our patients. CNSs therefore need to be a part of the tendering process. An enormous amount of work goes into every contract tender. It could be argued that if teams are happy with the products in use, there is no need to change—especially as such a big change can be expensive and hard work for all involved. However, we have a legal duty to go out to tender. So it is essential to enter into any tender process with an open mind and a willingness to embrace change. It is a huge opportunity to see what others can offer your patients, but it is just as important to look at new developments in your current company, rather than accept the status quo. It is, after all, a new contract. Within the county-wide approach, it is really important to have a local tender team within your trust to ensure that all stakeholders are
able to contribute fully. The contract is for all enteral feeding (not just home enteral feeding). In our case, our team needed to consider issues specific to hospital practice. We needed to start preparing early for the process, work to a strict timeline and have a real clinical voice with clinical leadership, not just that of managers, and finance and procurement teams. Our team included a patient representative, adult and paediatric dietitians and CNSs, pharmacy staff and a procurement lead. We worked closely with our ward-based colleagues, infection-control team and clinical engineering department. We set up company presentation days to improve our product and service awareness, and also allowed time for our ward-based colleagues to see what was available and for them to make their views known. This was made possible by starting the process early. Having a robust marking schedule for tender presentations and offers is essential to a successful outcome. It is a given that companies who tender can provide a competent service—all will impress you in key areas.When it comes to making a decision, it may be hard to choose between them. So your marking criteria, reflecting quality, safety, clinical, patient and parent opinions, are what make the difference—so spend time creating this. It is not all about who is cheapest. It is clear that the political and financial landscapes change continuously. The role of clinical commissioning groups (CCGs) in the tender process will alter the balance between hospital and community needs. However, the tender process itself has changed little over time. Wherever we work, our role is to represent our patients and colleagues, to ensure they receive excellent enteral products and services. I urge you to get involved, and BJN make your experience count. The views expressed in this column are those of the author Department of Health (2011) Commercial Medicines Unit http://tinyurl.com/oyg76bl (accessed 25 March 2015)
Hazel Rollins CBE
Clinical Nurse Specialist, Gastroenterology & Nutrition, Department of Paediatrics, Luton & Dunstable University Hospital NHS Foundation Trust
© 2015 MA Healthcare Ltd
O
ver the past four decades, enteral tube feeding has changed from a hidden area of hospital practice, left largely to dietitians and general nurses, to a specialist, multiprofessional field of practice, crossing care boundaries and working with patients and families. Political, financial, clinical and industry changes have underpinned the change. First, an awareness of disease-related malnutrition led to increased use of enteral feeding. Second, a reduction in length of hospital stay and number of hospital beds was linked to a greater demand for home enteral tube feeding. Third, a homecare industry developed to support clinicians, patients and families in delivering safe enteral tube feeding at home. You may be familiar with the market leaders in enteral tube feeding, and could be forgiven for thinking that once you are set up with one company, there is no need to change, but this is not the case. This column presents a personal perspective of my experience of contracting for enteral tube feeding goods and services over almost 15 years. When I was first in post (in 1990), with only 16 patients on home enteral tube feeding, our feeds came from one company, pumps and plastics from another, and ancilliaries from wherever we could get them. It was an education to join forces with neighbouring hospital and community trusts on our first county-wide contract. We still believe that this offers the best service to our patients; it is the best value for money and an attractive contract size for companies. We now have a contract that includes feeds, pumps, plastics, ancilliaries and a nursing service. Previously it was possible to include training budgets and support posts in the contract. Hospitals paid very little for plastics, with pumps on loan at zero cost.This appeared to be a very attractive model for hospitals but was less favourable for community trusts, who might be paying the full price. In reality, everything is paid for within the contract and nothing is really free. Department of Health (DH) guidance should be followed regarding what is acceptable (DH, 2011), and prices should be agreed that are fair for the whole health economy. It could be argued that this ‘complete service model’ with low-cost pumps and plastics disadvantaged others in the field, especially those not manufacturing feed. While this may be true, it is clear that new companies have thrived during this time, notably specialists in feeding tubes.
British Journal of Nursing, 2015, Vol 24, No 7
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on November 30, 2015. For personal use only. No other uses without permission. . All rights reserved.
Contracting for enteral tube feeding
376
What is somewhat disappointing is an apparent lack of innovation in key areas such as jejunostomy tubes, wound care, paediatrics and methods to detect feeding-tube position. For example, at a 2013 international conference, despite a strong industry presence, not a single tube, test kit or dressing was displayed (though that may be a reflection of how few nurses attended the conference). The recent development of ENFit connectors (a new universal connector for feeding tubes) showed what can be achieved when industry and clinicians work together and company boundaries are crossed. Much like party politics being ignored at times of crisis or conscience, perhaps industry-wide initiatives should be more widespread where safety is concerned. We still struggle to tell where nasogastric tubes are. Is it time for a team effort to solve this?
Our role is to represent our patients and colleagues, I urge you to get involved and make your experience count Nutrition nurses are often sole post holders, or work in a small team, and may question the value of spending time in protracted, often offsite, contract meetings. I believe that clinical nurse specialists (CNSs) have a skill set to bring to the table with specialist knowledge of tubes, pumps, plastics and an understanding of the company nursing service we want for our patients. CNSs therefore need to be a part of the tendering process. An enormous amount of work goes into every contract tender. It could be argued that if teams are happy with the products in use, there is no need to change—especially as such a big change can be expensive and hard work for all involved. However, we have a legal duty to go out to tender. So it is essential to enter into any tender process with an open mind and a willingness to embrace change. It is a huge opportunity to see what others can offer your patients, but it is just as important to look at new developments in your current company, rather than accept the status quo. It is, after all, a new contract. Within the county-wide approach, it is really important to have a local tender team within your trust to ensure that all stakeholders are
able to contribute fully. The contract is for all enteral feeding (not just home enteral feeding). In our case, our team needed to consider issues specific to hospital practice. We needed to start preparing early for the process, work to a strict timeline and have a real clinical voice with clinical leadership, not just that of managers, and finance and procurement teams. Our team included a patient representative, adult and paediatric dietitians and CNSs, pharmacy staff and a procurement lead. We worked closely with our ward-based colleagues, infection-control team and clinical engineering department. We set up company presentation days to improve our product and service awareness, and also allowed time for our ward-based colleagues to see what was available and for them to make their views known. This was made possible by starting the process early. Having a robust marking schedule for tender presentations and offers is essential to a successful outcome. It is a given that companies who tender can provide a competent service—all will impress you in key areas.When it comes to making a decision, it may be hard to choose between them. So your marking criteria, reflecting quality, safety, clinical, patient and parent opinions, are what make the difference—so spend time creating this. It is not all about who is cheapest. It is clear that the political and financial landscapes change continuously. The role of clinical commissioning groups (CCGs) in the tender process will alter the balance between hospital and community needs. However, the tender process itself has changed little over time. Wherever we work, our role is to represent our patients and colleagues, to ensure they receive excellent enteral products and services. I urge you to get involved, and BJN make your experience count. The views expressed in this column are those of the author Department of Health (2011) Commercial Medicines Unit http://tinyurl.com/oyg76bl (accessed 25 March 2015)
Hazel Rollins CBE
Clinical Nurse Specialist, Gastroenterology & Nutrition, Department of Paediatrics, Luton & Dunstable University Hospital NHS Foundation Trust
© 2015 MA Healthcare Ltd
O
ver the past four decades, enteral tube feeding has changed from a hidden area of hospital practice, left largely to dietitians and general nurses, to a specialist, multiprofessional field of practice, crossing care boundaries and working with patients and families. Political, financial, clinical and industry changes have underpinned the change. First, an awareness of disease-related malnutrition led to increased use of enteral feeding. Second, a reduction in length of hospital stay and number of hospital beds was linked to a greater demand for home enteral tube feeding. Third, a homecare industry developed to support clinicians, patients and families in delivering safe enteral tube feeding at home. You may be familiar with the market leaders in enteral tube feeding, and could be forgiven for thinking that once you are set up with one company, there is no need to change, but this is not the case. This column presents a personal perspective of my experience of contracting for enteral tube feeding goods and services over almost 15 years. When I was first in post (in 1990), with only 16 patients on home enteral tube feeding, our feeds came from one company, pumps and plastics from another, and ancilliaries from wherever we could get them. It was an education to join forces with neighbouring hospital and community trusts on our first county-wide contract. We still believe that this offers the best service to our patients; it is the best value for money and an attractive contract size for companies. We now have a contract that includes feeds, pumps, plastics, ancilliaries and a nursing service. Previously it was possible to include training budgets and support posts in the contract. Hospitals paid very little for plastics, with pumps on loan at zero cost.This appeared to be a very attractive model for hospitals but was less favourable for community trusts, who might be paying the full price. In reality, everything is paid for within the contract and nothing is really free. Department of Health (DH) guidance should be followed regarding what is acceptable (DH, 2011), and prices should be agreed that are fair for the whole health economy. It could be argued that this ‘complete service model’ with low-cost pumps and plastics disadvantaged others in the field, especially those not manufacturing feed. While this may be true, it is clear that new companies have thrived during this time, notably specialists in feeding tubes.
British Journal of Nursing, 2015, Vol 24, No 7
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on November 30, 2015. For personal use only. No other uses without permission. . All rights reserved.
