Whistleblower: Medical Rep Claims NHS is ripped-off- Daily Mail Newspaper- ***September 2010***

An NHS whistleblower contacted us to tell the story of how they believed the NHS was being ripped by medical sales reps.


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The story appeared in the Daily Mail newspaper.


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Every year, the NHS spends £500 million on orthopaedic equipment, but according to one insider they are being completely ripped off. In a damning expose, a medical sales rep, under the cover of anonymity, talks to VICTORIA ­LAMBERT about the used-car-sales ­tactics of ­companies which make millions from the NHS.

The NHS needs to save ­£20 billion in the next four years, according to the British Medical ­Association — yet in all the debate over which operations are at risk and whether we can afford new cancer drugs such as Avastin, there is one solution which could save the health service ­millions of pounds without costing a job or ­delaying treatment.

What could be so simple that politicians, ­doctors, managers and the public haven't already considered it? Well, just this: the NHS needs to learn smarter shopping.
At the moment, most health trusts ­squander ­a fortune paying deliberately over-inflated prices for surgical supplies, each trust ­spending between £3million and £4million a year on ­orthopaedic supplies alone — money that could be saved overnight if managers just got together and agreed to flex their vast ­purchasing power and demand lower prices from the companies which produce the goods they need, or by being more rigorous in their decisions over which product to buy.

Most NHS health trusts spend between £3million and £4million a year on ­orthopaedic supplies alone

Unfortunately, most don't seem even to ­realise the situation exists, let alone how to change it.

How do I know this financial black hole exists? I'm on the other side: an anonymous sales rep for one of the orthopaedic supplies companies which currently make millions each year from the NHS.

How overpriced are the supplies we sell? Well, think of the small surgical screws that get used in lots of orthopaedic work, such as attaching a metal plate to a fractured bone. We sell screws that are barely any different from the ones you see in B&Q, priced five for £1. Yet ours cost between £30 and £40 — each. And while they cost us, at most, £10 to make, we justify the mark-up because they are slightly finer. Oh, and sterile.

The cost of our screws can actually go up to £99 each for the basic ones. A screw with a hole down the middle for inserting a wire is a ­staggering £148.

So how do we get away with selling such expensive products? We use standard sales techniques — the same type that have been practised by double-glazing men and people who go door-to-door selling conservatories. 


Although some staff have a ­medical background, such as a ­science degree or experience ­nursing, these days your ability to sell is more important than your special education, so fewer come from that profession. These days they are more likely to come from car sales, and after a few weeks' training are as easy with medical ­patter as formerly they were with torque and braking.

To begin with, we make friends with the staff. There is a compliance act which officially prevents ­surgeons accepting gifts in return for using a particular brand. But we build up great ­relationships with doctors, inviting them to ­conferences all over Europe, where they stay in top hotels and are wined and dined.

Sometimes we offer them specialised advanced training courses in countries across the world. They are the sort of opportunities doctors don't want to miss, as the NHS can't afford to offer extra training.

But the closeness of our ­relationships doesn't end there.

How shocked would you be if I told you that in many operating theatres, standing next to the surgeon — wearing his own scrubs and clogs — is a sales rep? He or she is not wielding the scalpel, but they are leaning in and offering advice.

Say, it's your elderly mother ­having hip replacement surgery. Did you ever consider that her highly trained consultant would be taking advice about just how many millimetres of bone to shave off the femur joint from a guy who six months ago was flogging BMWs or conservatories?

Some senior surgeons are often so unfamiliar with the instrumentation they are using that they will cancel the operation if the rep cannot attend, sometimes on the day of the procedure.

How do I know all this? ­Because I've been that sales rep. I've popped into ­hospitals (like most of my ­colleagues) where I am well known and signed in with the receptionist (often no need for ­special ­permission), before ­nipping into the scrubs room and getting into my 'blues' so that I can join the theatre staff. It's such common practice that no one even questions why I'm there.

I'm no would-be doctor, and I'm not going to take over the op from the surgeon. Your mother is in no danger from me; I'm ­hygienic and careful not to get in the way.

But going into theatre is one of our favourite techniques to ­persuade healthcare professionals that our products are the best. Once there, we can subtly discuss how our product beats the ­competition and why this or that design is so superior in its results. Practical demonstration and the personal touch beats a leaflet any day. And the doctors don't mind —they seem to enjoy our company.

In fact, going into theatre is one of our favourite techniques to ­persuade and influence healthcare professionals that our products are the best. We want the doctors then to request our screws or hip joints from the ­purchasing department, which they usually do. Of course, the managers should then look at the cost of our product and its results compared to its rivals and make an informed choice. But often they are in thrall to the ­consultants who have years of ­training and experience, while they, the managers, may have worked in ­hospital procurement for only a year or two. There is an imbalance of power. No contest.

And once we've made the sale, we get a signature on 12-month or two-year contracts for our products, and ­everyone — except the NHS accountant and the taxpayer — is happy.

Ironically, Bupa and other private healthcare providers get their ­products cheaper because they have central procurement ­departments, and cheaper ­products mean better profit ­margins per procedure for them.

Should we reps feel guilty? ­Actually, our profession is not evil. But the pressures on us to succeed are huge, as are the rewards when we do.

I've lost count of the exotic ­locations my company has held conferences where the top ­salesmen can expect to be singled out for high praise and win fabulous family ­holidays — from Caribbean cruises to luxury city breaks and ­glamorous spas. Do well and you'll get a ­fabulous car; executive cars are an industry standard.

And then there is the bonus. ­Commission is typically 5 per cent on target sales. So the top ­earners, who are shifting in excess of £2 million worth of goods to the two or three hospitals they service, can receive staggering £100,000 annual bonus cheques.

(Reps do not cover larger areas because the smaller the number of hospitals they service, the more intensive and intimate their ­relationships with the surgeons.)

So why would I want to blow the whistle on the practices my ­profession ­follows? I'm writing this anonymously, so it is not like I want to leave my job.

And I'm good at it. I may not be in the £100,000 club, but I am well rewarded. I even like my boss.

But a few weeks ago, I was ­browsing a website which held ­suggestions for cost-cutting in the NHS, and it really came home to me how my industry had lost touch with the rest of the UK.

I had already begun to feel sickened by the bonus culture, watching my fellow reps being encouraged to make more and more over-priced sales at a time when we should all be ­economising — so ­ordinary patients can get their hands on that Avastin if they need it.

I'm not saying I have a problem with anyone making a good living or companies making a fair profit. This is commerce and I'm not naïve. But it hit me that my ­industry needs to clean up its act. While the rest of the country tightens its belt, it is ­unreasonable for it to be ­business as usual in ­medical supplies.

So, what should be done?

The NHS needs to examine its ­purchasing chain and realise its huge bargaining power.

Individual hospitals don't have the leverage to bargain us down — we don't need one hospital's order; we'd stop ­supplying them if they started to negotiate — but ten hospitals, a region, a whole country? We couldn't afford to walk away from those orders.

Scottish NHS teams are already beginning to adopt this strategy. But in England and Wales there is no appetite to truly centralise the process. They have to learn to ­purchase more intelligently.

We talk of partnerships in our sales literature, but it is meaningless. Some medical suppliers have long seen the NHS as a cash cow. We need to reconsider our attitudes — and the health service needs to refuse to be milked.


Click here to read the story on the Daily Mail website.



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