Daily Insight: A numbers game

Carter’s data dispute

Lord Carter’s review of NHS productivity might have been published two months ago, but there is still a way to go before many of the details are ironed out.

One aim of the project has been to benchmark hospitals against their peers, to encourage the outliers to up their game, but this depends heavily on the fairness and accuracy of the data.

Analysis by HSJ has identified the apparent “outlier” trusts in relation to the use of estates, along with various reasons why this might be the case.

Around half of the trusts that responded to our enquiries acknowledged their problems, but others flagged up concerns with the figures, or offered reasons why their data had been skewed.

And one HSJ reader said: “There are also a lot of issues that the proposed metrics have ignored which undermine their validity including: insourced services versus outsourced and the resultant impact on the estate, and issues such as staff accommodation which has a massive effect on numbers especially if some trusts have sold off their accommodation…

“Carter needed another six to 12 months to come up with something really helpful but the DH/SoS couldn’t wait and this is a huge pity.”

The review is effectively still in progress, but there does seem to be a risk it will all get bogged down and forgotten amid disagreements over the numbers.

Guarding the guardians (of NHS cash)

NHS England this week unveiled a sweeping set of proposals to defend against the impact of conflicts of interest in decision making across the health system.

CCGs will each be required to appoint a “conflicts of interest guardian” to act as a point of contact and expertise on procurement decisions and interaction with commercial organisations.

The proposals were presented to NHS England’s board meeting on Thursday morning, and have been produced to accompany the publication of an audit reviewing conflicts of interest management in CCGs that co-commission primary care.

Other changes include:

• requiring CCGs to have at least three lay members on each governing body to better manage COI;
• mandating commissioners to have “robust” processes for managing breaches in their COI policy – and to publish any breaches on their website; and
• the introduction of compulsory online COI training for CCG staff and the workforce in all member practices, provided by NHS England.

Currently CCGs are only required by law to have two lay members on their governing bodies.

Separately, a cross-system “task and finish group”, led by NHS England chair Sir Malcolm Grant, will also examine changes to national guidance to beef up safeguards against decision making “tainted” by conflicts.

A key proposal to be considered by the group is the introduction of tougher legal sanctions against organisations that display an “ineffective” management of conflicts.

These could include fines under criminal law; challenges to organisations using civil law; regulatory sanctions – including health professionals being prevented from practising; or staff being dismissed for non-compliance.