The Asymmetric Bars

John Yates and Helen Simpson consider how NHS trusts can address the imbalance of knowledge and experience when negotiating IT contracts with suppliers.

We want to talk about asymmetric bars – not in the context of Olympic gymnasts but in the even trickier context of the bars affecting successful NHS procurement. Put simply, there is an asymmetry between the knowledge and experience of suppliers and the knowledge and experience available to the NHS team involved in a major deal. And this is especially true in the context of high value tech-related projects like EPR (electronic patient records).

Since we have mentioned gymnastics, let’s remember that even the greatest, like Simone Biles, specialise to some degree. Nobody can be the best at everything. Most of us accept that we have our strengths – and one of those should be knowing where our weaker areas lie. The asymmetry in knowledge and experience is an inevitable product of the fact that supplier teams are doing something with which they are familiar – it’s what they do, day in and day out. NHS teams have other pressures, other tasks. While this is true for teams from many large private-sector or public-sector organisations dealing with specialist suppliers, most readers of this will well understand that NHS Trusts face additional pressures, internal and external, that make it even harder to correct the asymmetry

In our many years working with NHS Trusts on major deals, we have seen a massive improvement in the sophistication and commercial awareness of those negotiating and implementing major projects on behalf of NHS Trusts. The NHS Digital Academy, with which John Yates is so proud to be associated, must take a good deal of credit for the improvements. And yet we still see difficulties arising from this asymmetry.

So, what can you do to correct that mismatch?

  • First, make sure your team is diverse and reflects a proper understanding of the need in question. IT, procurement and finance (using external consultants if necessary) but you might well need more. Involving stakeholders is crucial. Widening the team may be important for buy-in at a later date – combating the resistance from those feeling that innovation is something ‘done to them’ rather than for them and those impersonating the thwarted teenager with a despairing ‘you just don’t understand’.
  • Secondly, make time for education for everyone involved. This might be via the NHS Digital Academy or by involving specialists who can offer bespoke training. You know about the need for training if you are to optimise the benefits of implementation, consider the need to educate right at the start and, yes, that might include your needs too.
  • Thirdly, work with your suppliers and try to create a collaboration not a confrontation. It may even be right to point out their oversights in pricing and agree increases. But you do need to be a little wary – not every supplier is immune from the temptation to exploit ignorance for their own benefit.
  • Fourth, make sure you have a contract you understand and that actually works – and will continue to work for the life of the project in question. Every model contract is an empty vessel that needs a lot of work. There are many specialist lawyers that can help with this (and don’t even think about using a non-specialist!) but, while the contract wording is important, it is not just about risk and liability. Having a workable contract is about more than the law; it should be active in informing project management not festering in a drawer. You need input that actually grasps the realities and complexities of NHS life.
  • Fifth, and crucially, find someone who will ask the really difficult questions. That might be someone in a senior position in the Trust (ideally, the most senior) or it might be people like us who have years of experience of major deal negotiation and implementation in the NHS context. If you don’t ask those difficult questions, you will end up muddling through – and that mud can really stick.

Follow those steps in your asymmetric bars routine and then you can start worrying about that triple-somersault dismount that will result in top marks!