When the Department of Health and Social Care published its national standard guidance on value-based procurement (VBP) for medical technology in June, there was real excitement across the health tech sector. For years, innovators had been told the NHS wanted to buy on value, not just price. The guidance sets out a methodology to make that happen, with five value domains, a minimum 60% weighting on value and a cap of 40% on whole life cost.

Four months on, that early promise is not yet translating into change on the ground. That is why Lord Hunt of Kings Heath's amendment to the Health Bill, requiring the secretary of state to report to Parliament each year on progress in adopting VBP, is so timely. Industry needs to know whether the guidance is changing how the NHS buys, not just how tenders are written.

Policy to practice

Last year, the Health Tech Alliance's Unlocking Innovation report brought together NHS procurement leaders, clinicians, industry and policymakers to look at why proven technologies struggle to reach patients. One theme came up again and again: VBP was officially a priority but narrowly applied, and decisions were still driven by headline price.

The new guidance addresses much of what we called for and it is encouraging to see value questions now appearing in live procurement processes. But as with any reform, implementation is bringing some teething problems.

Implementation issues

There are early signs that cost thresholds and heavy price weightings are still shaping decisions, in some cases above the guidance's 40% cap. Without a clear definition of good value, price remains the default.

Suppliers are also unsure what they need to show. There is no agreed benchmark, category by category, for the level of improvement that justifies paying more, or for how different types of evidence will be scored. It is not clear, for example, whether UK real-world evidence will carry the same weight as controlled trial data from overseas. Until that is settled, companies cannot plan their evidence generation, and as our report found, it is smaller companies with fewer resources that feel this most.

Consistency is another problem. The guidance is being interpreted differently across frameworks, categories and trusts. Some frameworks are built around value, while others include only a handful of value questions. Locally, there is still little sign of the methodology being used, which risks making access to innovation depend on where a patient lives.

The biggest barrier, though, is money. Most NHS trusts sit in segments 3 and 4 of the NHS Oversight Framework, where every spending decision is closely scrutinised. A trust trying to balance its books will ask two questions: does this technology release cash, and is that saving recurrent? Freeing up bed days, theatre time or staff time does not pass that test, however good it is for patients. Even the top-performing trusts have often got there by holding spending down.

When the benefits of a technology land in another organisation's budget, or in a later financial year, a trust has little reason to pay more today. And without central funding, stretched trusts simply cannot absorb higher upfront costs. The 10-Year Health Plan's commitment to multi-year budgets is welcome, but it needs to reach procurement decisions, with revenue funding alongside capital. Next year's Spending Review is the moment to make that happen.

None of this is a reason to step back from VBP. What we need now is a clear delivery plan setting out which product categories will be covered and when, starting where benefits are easiest to measure, with accountability for organisations that keep buying on cost alone.

This is where Lord Hunt's amendment could make a real difference. Asking organisations to explain departures from the guidance is helpful, but it does not show what is happening across the system. To be meaningful, the annual report it calls for should set out:

●        how many medtech procurements use the national VBP standard, at national, integrated care board and trust level

●        progress against a delivery plan, by product category

●        where weightings depart from the 60/40 split, and why

●        how often price thresholds have excluded bids

●        how often the highest-value bid beats the lowest-price one

●        the share of contracts going to smaller companies and new entrants

●        whether benefits promised at tender have been realised.

Alongside this, suppliers need proper feedback on how their submissions are scored, so they can align their evidence with NHS priorities. Clinicians and patients should also have a stronger voice in shaping the value questions. The 10-Year Health Plan puts procurement reform at the heart of a more productive NHS, and VBP is one of the most important tools for delivering it. But no one can make it work alone. The Government sets the policy, the NHS buys and industry generates the evidence, and each needs to understand the pressures the others are under.

That is what the Health Tech Alliance is for. Our Unlocking Innovation work showed the value of bringing procurement leaders, clinicians, suppliers and policymakers together. We want to build on that, working in partnership with the Department, NHS leaders, ICBs and Parliament to share what is working, fix what is not, and make sure the annual report Lord Hunt is calling for has real substance. The measure of success will not be how many tenders mention VBP, but how many patients benefit from better technology, sooner.