William Beharrell

Consider the following job specification. “Requires nerves of steel and a willingness to undergo sleep deprivation. Skilled at negotiating with Chinese officials by night and working across multiple time zones. Willing to make snap judgements with tens of millions of pounds at stake, knowing a nation is relying on you.” MI6? Government minister? Arms dealer? Gambler? Head of Procurement at Cardiff & Vale UHB?

Claire Salisbury is our Head of Procurement and the Assistant Director for the National Wales Shared Services Partnership (NWSSP). At the start of the Covid-19 pandemic, Claire received an invitation to a planning meeting on a Friday evening. The meeting took place the following day during which she understood we needed to build a 2000 bed hospital in just four weeks. By the Sunday she had prepared an order worth £8m so that by the Monday all the equipment and supplies required to open the Dragon’s Heart Hospital were on their way to Cardiff.

Several weeks later, she found herself negotiating with Chinese officials through an agent in the early hours of the morning. She had been allocated a manufacturing slot and knew that she must make a decision within an hour if she was to secure critical supplies such as PPE for Wales. We had a two-month supply of FFP3 masks and our Type 2 R masks would run out within weeks. Faced with a massive shortfall in Pip stock, Claire mobilised her network, and set her team working on a 24/7 rota. On her shopping list were the following items; 65 million fluid resistant masks for the four nations, and a further 189 million for Wales for £59m, 3.8 million FFP3 masks for £20.1m. This carried on for several weeks by which time Claire had bought 470 million gloves from two suppliers in the far east for £48.2m.

The due diligence which her team applied to these potential suppliers revealed that the global supply chains were widely fractured. The market was awash with fraudulent certificates and the clamour of global demand made for pressured and often disrupted communication. In this context, the challenge of securing safe and high-quality PPE for NHS Wales and the Social Care sector at a fair price fell to Claire and her team. If you think of procurement as a back-office function that is vaguely to do with buying stuff, then think again.

I was fortunate to distract Claire this week from a list of tasks that were very much more important than talking to me. This tells you something about the charm and efficiency that characterise Claire’s work. When she says, “People are our greatest strength” she means it. Her team won the HCSA Team of the Year and Go Awards Wales last year and Claire was highly commended and made Leader of the Year. Unusually perhaps, this charm sits alongside an uncompromising focus and a gaze which implores you to get to the point. Claire puts this down to being married to an accountant whose business-like approach to problem solving has been of great service to Claire in her work.

In listening to Claire’s story, there are two themes that stand out as key influences on her work: the sense of belonging that comes from strong and enduring relationships with her local community but also with colleagues and suppliers; and the value of a long apprenticeship with exposure to different leadership styles and the space to develop her own way of leading.

Having been born in Cardiff and then resident of both Barry and Penarth, Claire has strong ties to her local community and a sense of belonging. She has learned to take an interest in how patients are managed in the community and attributes this to her father’s experience. He required a liver transplant but his body rejected the donor’s liver. Despite being given a prognosis of only three months, he has shown unwavering fortitude in the years that have since passed and remains inspiration to Claire, along with her mother who worked in social care.

Claire has served a long apprenticeship and has benefited from working under several effective leaders. Having joined the Welsh Common Service Authority (WCSA) in 1994 she has been part of its centralisation, followed by its decentralisation under John Redwood, and then more recently its re-centralisation under a devolved government into a more hybrid model. Her first job upon leaving school aged seventeen, was in ‘Personnel’ in Crickhowell House, which is now just behind the Senedd. She didn’t know what ‘Procurement’ meant but was fortunate to have been mentored by strong leaders such as Larry Peterson. Claire recalls that Larry was never afraid to try something different. He pioneered the concept of ‘deep dives’ and ‘spend management’ and taught Claire how to mobilise services and equipment to support clinicians on the frontline. A significant breakthrough came for Claire when Larry asked her to manage the introduction of an ultrasound services, the first of its kind in Europe. “He expected us to know are our areas of business and to ‘walk the floor’. He promoted talent and he always had an eye on the horizon.”

Now, in her 26th year in procurement services, Claire has an unrivalled grasp of what it takes to support our clinicians to deliver the best possible healthcare to our patients. Although she has been trained to achieve the best possible price based on volume, she has learned that this approach does not necessarily equate to the best value. She has learned the importance of listening to the clinicians in order to be able to write the kind of detailed and realistic specifications that attract the best suppliers. She sees her partnerships with suppliers as a crucial. “We’re in this together. We’re here to make a difference.” She gives the example of a gain-sharing model in managed services in which suppliers help to share both the risk and the reward of working together in partnership. For services such as biochemistry, haematology or radiology, they might contribute consumables, equipment, and maintenance in return for a set fee. Their fee increases in line with an increase in volume or performance.

The insights that Claire has gleaned from her years of service are reflected in the Government’s Green Paper ‘Transforming Public Procurement’ (2020). The UK spends £290 billion on public procurement every year. Claire is emphatic that this spending could spur recovery if public contracts were opened up to small businesses and social enterprises to innovate in public service delivery. Value-based procurement is predicated on using industry and suppliers to help us in ways that go well beyond business as usual. It is based on the idea that we procure an outcome rather than a product or service per se. Nowhere is this more apparent that in the challenge to become carbon-neutral by 2030. There are opportunities here to move towards a life-time cost for products and to move away from single-use. Innovations in materials, maintenance, clinical use, recycling and disposal, and supply chains offer a cradle to grave model that could serve to reduce our carbon footprint but also strengthen the ‘Welsh pound’.

“We can’t do this on our own,” says Claire before reeling off a list of exciting innovations to illustrate her point. She refers to the sacral nerve stimulation (SNS) work being used by consultant Colorectal surgeon Julie Cornish to address faecal incontinence; the medical genetics work that avoids the systemic harm caused by a drug like Doxitaxol in favour of a stratified treatment in a panel; and the work being pioneered by our clinical renal lead Gareth Roberts to create fistulas for dialysis as a day-case rather than having to go to theatre. In the centre of all these exciting innovations sits Claire’s procurement team, painstakingly building relationships with suppliers and clinicians alike and diligently refining their processes so that our spending can transform our services for the benefit of our patients, our clinicians and our communities. Claire has been invited to Windsor Castle in February to collect the MBE that she was awarded last year. With typical humility, she praises her team and her family, without whom the heroics described above would have been unthinkable.