On the day briefing: Lord Carter final report

Below is high level summary of the Lord Carter report. For more detail please download the NHS Providers on the day briefing at the bottom of this page. If you have any questions arsing from this briefing, please contact Edward.Cornick@nhsproviders.org

Lord Carter has published his final report into hospital efficiency.The scope of his work to date has been focussed on the acute sector - he has now looked at the efficiency of all 136 acute trusts in England to come to a target savings figure. He estimates that if ‘unwarranted variation’ is removed from trust spend, that £5bn of savings could be saved by 2020. His final report gives a more detailed breakdown of how that figure could be achieved, as well as providing a range of recommendations in order to get there.

These recommendations are mixed between what the national bodies – in the main NHS Improvement – need to do and specific actions that providers will be required to take and in some cases be held to account for delivering. The report contains 15 main recommendations in total across different chapters, each with numerous sub-recommendations.

In his letter to the secretary of state prefacing the report, Lord Carter outlines five key points

  1. The provision of high quality clinical care and good resource management go hand-in-hand.
  2. A single reporting framework should be adopted across all trusts, which pulls together clinical quality and resource performance data and compares it to the ‘best in class’.
  3. Delayed transfers of care have a significant impact on achieving efficiency savings.
  4. The need for genuine local and national collaboration and coordination.
  5. Rapid adoption of the review recommendations is paramount.

The introduction to the report outlines

Of the £5bn savings potential, £3bn has been agreed in principle by the 136 acute trusts.

Reiterates the NHS has to deliver the efficiencies of 2-3% per year, effectively placing a 10-15% real terms cost reduction target on trusts to achieve by April 2021. The £5bn of savings identified in the Carter report only go some way to achieving this.

Optimisation of clinical resources

The report outlines there is significant variation across trust regarding sickness, staff turnover and morale. To address this it recommends the development of a ‘national people strategy’ . It also notes a wide variation in how trusts manage annual leave, shift patterns and flexible working, with different approaches to the use of technology and e-rostering, and suggests greater standardisation across shift rotors and planning. It also recommends the adoption of a metric for Care Hours Per Patient Day (CHPPD) metric - CHPPD can be used to describe both the staff required and staff available in relation to the number of patients - and improving supply chain management practices to reduce variation in total pharmacy and medicines costs across acute trusts.

Optimisation of non clinical resources

The report outlines issues with procurement, estates and facilities management and back office costs. Recommendations to address this include implementation of a new purchasing price index with immediate effect for the 100 most commonly purchased items, providers creating estate management plans and limiting trust back office spend to 7% of income.

Quality and efficiency across the patient pathway

The report notes the need for rationalising reporting on clinical quality and variation, the importance of  having national IT funding for IT efficiency measures, and ensuring alignment with other current national policy initiatives (such as the Five Year Forward View) and addressing system wide issues (such as delayed transfers of care).

An integrated performance framework

One of the key recommendations of the report is to create a ‘model hospital’ dashboard, to set out a clear, consistent approach to setting expected standards that a good hospital should meet. The dashboard will include the metrics mentioned throughout the final report, as well as other national standards and benchmarks, so it holds a single view of all the items that providers are reporting on and are expected to be held to account against.

Implementation and further engagement with trusts

The final chapter in the report starts to assess what practical steps both providers and national bodies will have to take the actions throughout the report into implementation, including the individual direct responsibilities for trust directors.




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