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Richard Armstrong, director of registries and real-world evidence at NEC Software Solutions, asks if the NHS can really deliver value-based procurement?
The Department of Health and Social Care’s new guidance on value-based procurement is a positive step for the NHS.
For years, procurement decisions in medtech have been shaped heavily by upfront cost. That is understandable in a system under constant financial pressure. But it has often meant that wider benefits, whether that is better patient outcomes, fewer clinical complications or lower long-term demand on services, have struggled to carry the same weight.
This new framework changes that. It asks NHS buyers to look beyond purchase price and think more broadly about value: outcomes, productivity, resilience and long-term benefit. It’s a positive step in the right direction.
But the intention to make value-driven purchases and being able to prove it are two very different things. Therein lies the heart of the challenge.
Good intent, uneven foundations
The guidance places a big emphasis on evidence. Suppliers are expected to demonstrate real-world outcomes, benchmark performance against existing baselines and continue measuring impact once a technology is in use. Again, that makes complete sense.
The issue is that the NHS does not yet have the same level of evidence maturity across all specialities.
For example, in orthopaedics, the National Joint Registry gives us a rich, long-established dataset on joint replacement outcomes. It remains one of the strongest examples of what good looks like, allowing device performance to be tracked over time and building a clearer picture of patient outcomes. Crucially, it also provides a strong foundation for broadening how we define value by linking clinical outcomes with wider measures such as pathway efficiency, procedural cost and longer-term patient benefit.
In other specialities, such as cardiology and ophthalmology, the evidence base is developing at different rates. The quality and depth of available data vary, which means approaches to assessing value will need to evolve alongside it.
That creates an important opportunity to strengthen how data is connected and interpreted, so measurement reflects what matters most across the full patient pathway.
There is a tendency to think that once you have the data, you have your answer. But as we know, healthcare doesn’t work in this way.
Medtech and health tech don’t exist in isolation. It is used by clinicians with varying levels of experience, in organisations with different processes, and on patients with diverse levels of complexity. All these factors play a part in how outcomes are shaped and determined.
If a new device is implanted in one of the sickest patients first, the results could look worse on paper, even if the product itself is performing well. Likewise, strong outcomes may reflect excellent clinical practice rather than the device itself.
And this is why analysis matters just as much as data collection.
NHS organisations need enough data for it to be statistically meaningful. They also need to understand the context. And the expertise to separate the effect of the technology from everything around it. Without these critical factors, there is a real threat of drawing the wrong conclusions.
Avoiding a box-ticking culture
If DHSC’s new framework is rolled out too quickly, these risks could become procedural.
Procurement teams will be told to score for value, but in some areas, the supporting data simply will not exist yet. That creates a temptation to fill the gap with assumptions rather than evidence.
A better approach is to recognise that different specialities will move at different speeds. In areas where the evidence base is already well established, there is an opportunity to build confidence and demonstrate what good looks like. But that should not limit wider adoption. In parallel, other specialities can continue strengthening their data, building the frameworks and evidence needed to support more sophisticated value-based decisions over time.
Get that right first. Build examples. Build confidence. Then apply those lessons elsewhere.
However, there is another issue that we cannot ignore – the NHS’s financial models aren’t set up to reward long-term thinking and integrated investments.
A trust may know that a more expensive implant will last longer and reduce future complications. In terms of patient outcomes, it is clearly the better choice. But if the extra cost lands with the trust today and the longer-term benefits are realised elsewhere in the system – for example, in primary or community-based care – the incentives to make that decision become weaker.
This remains one of the biggest structural challenges. But it is also where better use of data, and closer collaboration between trusts, commissioners and integrated care systems, can help create a clearer picture of value across the whole pathway.
The intent behind this new guidance is right. Most importantly, the foundations to make it work already exist across many parts of the NHS. The next step is to strengthen how data is captured, connected and interpreted, so procurement teams are supported to make more informed, joined-up decisions based on long-term value rather than short-term cost alone.
The challenge now is turning that ambition into something practical, measurable and scalable across the NHS.
