Small changes big differences: A case study of a campaign that took a different approach to potential NHS cuts

By Jane Hughes

When NHS finances are squeezed, nurses feel the pain, too often being asked to do more for less. The Royal College of Nursing’s campaign helped them feel less like victims of cuts and more like active participants in the drive to help the NHS find savings.

You’ll learn:

• How face to face discussions supported by high quality and eye-catching materials can help to spread the word
• How media coverage and social media visibility on the issue of procurement has established the Royal College of Nursing as an authority on the subject
• That case studies demonstrating best practice and innovative procurement approaches are popular and worth sourcing

Small Changes, Big Difference – the problem we faced

The NHS spends billions of pounds a year on buying clinical supplies and services - essential disposable items such as gloves, syringes, incontinence pads and cannulae. 

Millions of pounds could be saved by making better decisions about what to buy, how much and when. Nurses make up 70% of the NHS workforce and are more often than not the ones using the clinical supplies. They know which products work best and where savings can be made. 

Yet too frequently, they were being left out of decisions about which products NHS organisations buy. 

With many nurses feeling powerless in the face of cuts to NHS services and an ongoing financial squeeze, the Royal College of Nursing (RCN) launched a campaign to help put the power in their hands to support their organisations to find savings. 

The Small Changes, Big Difference campaign was run in partnership with the NHS’s purchasing organisation, NHS Supply Chain and a network of nurses involved in purchasing decisions – the Clinical Procurement Specialist Network. 

How we did it

First, we needed to know what appetite and scope there was for change. We partnered with the leading trade magazine, Nursing Times and carried out a survey of nurses which showed that more than 80% of respondents thought they could save money if better buying decisions were made, while a quarter said they weren’t allowed to get involved and a further 28% said they didn’t have time. 

Nursing Times calculated that making better decisions could save the NHS more than £30m a year. It was clear there was the potential to put the power into the hands of nurses to help the NHS find savings without affecting clinical care. 

We needed to reach the nursing leaders with the power to change the way things were done and we needed to do that in a practical way that would help them in their day to day work. 

To do this we produced a toolkit to support Nurse Directors and other senior nurses to make the case for change in their workplace and at the Board table. It guided them though the arguments in favour of having specialist procurement nurses and the savings that could be made.

NHS Supply Chain developed a ‘traffic light’ sticker system to highlight to nursing staff which products were the most expensive, aimed at raising awareness and reduce waste. Red stickers flagged high cost items, steering nurses towards using cheaper alternatives where appropriate, or alerting them to the need to avoid waste.

We launched the campaign and materials at an event in RCN HQ attended by nearly 100 senior nurses. At the same time we had a digital launch, using our social media networks, reinforced by digital advertising to reach a wider audience. 

We produced high quality printed versions of the toolkits and other materials and distributed those through our network of regional staff. 

Every time a Regional Director had a meeting with a Director of Nursing or other senior nurse in their area, they took a printed toolkit and other materials with them and we took advantage of RCN events to share the materials more widely. The ‘traffic light’ stickers went down especially well, with their design helping to make a potentially dry subject more accessible. 

We created a Small Changes website which showcased examples of best procurement and buying practice and used social media to promote the website content. We commissioned films telling the stories of the best examples. Our films were viewed more than 13000 times, with the website visited more than 9000 times in its first year. 

We launched a social media search for more examples of best practice and were rewarded with dozens of examples from around the country. 

We generated media coverage from both Nursing Times and Nursing Standard, as well as featuring success stories in our membership magazine, RCN Bulletin, which goes to all 435,000 members. We held a fringe event for senior nurses at the Chief Nursing Officer’s Conference and we developed a presentation and booklet for RCN staff to use during meetings with senior NHS leaders. 

The outcome

As a result of our work, the RCN’s authority in the area of NHS procurement was reinforced and the college was invited to join a group supported by the NHS Business Services Authority, reviewing commonly used consumables in the NHS. We were also involved in a review of NHS Productivity led by Lord Carter. 

‘Small Changes’ groups have been set up in NHS Trusts around the country, supporting nurses to influence buying decisions and to share best practice. 

The campaign is ongoing, with an evaluation survey to measure improved awareness due this year. Conversations with nurses and NHS leaders, visits to our website and the number of shared success stories, all suggest raised awareness of this issue – while the Clinical Procurement Specialist Network has increased its nurse members. 

A couple of years after the launch of the campaign, the pressure on the NHS is more intense than ever. But thanks to Small Changes, Big Difference, nurses are being shown that there are ways in which they can contribute to finding financial savings, rather than simply feeling victims of cuts. And they are seeing how their involvement can also help improve patient care.


Jane Hughes is Associate Director of Communications at the Royal College of Nursing. She’s passionate about helping improve the health and social care system, so that patients get the care they deserve. She’s spent the last 15 years in health communications – including for the mental health charity, Rethink Mental Illness and as a BBC Health Correspondent.

Twitter: @JaneHug