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In the absence of the Audit Commission to remind us what we are doing wrong, we can turn to colleagues in the NHS and the NAO for illuimination.Today, the NAO produced a report "The procurement of consumables by NHS acute and Foundation trusts"with the strapline - "NHS hospitals often pay more than they need to when buying basic supplies".Now, we all know that the NHS is very big. If it were a country, I wouldn't be surprised if it were bigger than Wales. It is also complex. So complex that it is tricky to know what is constraining progress toward its goals (as if they are clear!). However, I am willing to bet that how individual Trusts buy consumables is not a constraint. Sure, it will make good tabloid fodder to read stuff like:"We estimate that if hospital trusts were to amalgamate small, ad-hoc orders into larger, less frequent ones, rationalise and standardise product choices and strike committed volume deals across multiple trusts, they could make overall savings of at least £500 million, around 10 per cent of the total NHS consumables expenditure of £4.6 billion."£500m is a lot of money. But, if the constraint in the Trust (and I am wildly guessing here), is in the capacities or policies in the medical or surgical departments (because is as sure as heck 'aint in patient demand for NHS services), then buying bog roll in bulk will not make one jot of difference to the Trusts' ability to treat people.And the lesson applies to local authorities too. Working on "improving" any part of your system can be at best a waste of your time and resources and at worst positively damaging, unless you get lucky and just happen to work on improving what constrains the whole system's progress toward its goals.Just to take the example of the administration of benefits which I am working on at the moment with a number of authorities. The constraints in benefits are rarely physical things like ability to get claims into the system or the ability to process claims, instead they are nearly always in policy decisions taken by the DWP, auditors, the Benefits Inspectorate and the late Audit Commission; which constrain authorities ability to progress claims.Now that the only game in town is to reduce cost, some benefits operations have so reduced capacity in order to save money that they have already (or are close) to inadvertently creating temporary physical bottlenecks in their systems. When you get an obvious physical constraint like the inability to process claims, it grabs attention, it is easy to grasp and to find ways to deal with the local problem. The excitement of fixing something physical and understandable will obscure the fact that the real constraints are with the aforesaid behemoths of the benefits system and the policies they make. After a while the fix on the physical system will become irrelevant as these external policy constraints are reached and we will be back at square one.So, were I someone working in a Trust I would be inclined to look for the constraints stopping them from making progress rather than ramping up my procurement operation.

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The NAO's and Foundation Trust Procurement - is that really the constraint we should be focusing on?

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