Daily Insight: Carter tells trusts to 'up their game'

Hospitals off target

When Lord Carter published his review into efficiency at acute trusts two years ago, a light was shone on the complex world of NHS procurement.

For decades the sector received minimal attention from national leaders, but over the last 10 years there has been increasing focus on how the NHS spends its cash – the Carter review bringing the subject to the fore.

Among his recommendations, which were welcomed by the government, was that all acute non-specialist trusts should hit three targets that measure the efficiency of their purchasing process.

Lord Carter said these targets should be achieved by September 2017, but HSJ analysis has found only a handful have reached this level – and some are not hitting any.

It’s important to stress the targets do not measure how much value a trust gets for its product, but instead looks at how well a trust manages its non-pay spending process.

While the targets address only a portion of the overall NHS efficiency drive, our findings show there is still much work to be done before the NHS can say to Treasury: “We’re squeezing maximum value from every penny you give us.”

When presented with our findings, Lord Carter said trusts “must up their game” and he expects a very different set of figures by next year.

At a time when control over NHS procurement is swinging back towards the centre, performance against these targets is still very much in the hands of trusts.

No quick fix for hip op waits

The time elderly people wait for urgent hip fracture surgery is on the increase – after nearly a decade of improvement.

The number of people receiving the surgery within the recommended 36 hours dropped by 2.6 percentage points between 2015 and 2016. It fell by 0.6 percentage points in 2015 compared to the year prior. These were the first drops since 2007.

It meant that in 2016, 28 per cent of over 60s needing the operation, normally in pain and immobile, waited longer than this. Experts say this likely undermined “compassion and dignity” in the care they were given.

Antony Johansen, the Royal College of Physicians’ geriatrician clinical lead for the national hip fracture database, on which the data – published by NHS Digital – is based, said the fall was due to the “increased pressure and strain the system is under”. He warned there is “no quick fix”, with monthly data from 2017 data suggesting the decline is continuing.

Additional information from the database indicates one of the main factors is theatre capacity – 11 per cent of all hip fracture operations performed in 2016 were delayed due to a wait for theatre space, up from the previous year.

Hip fracture is one of the most serious consequences of falls in the elderly, with a mortality rate of 10 per cent one month afterwards and 30 per cent after a year, so timely treatment is critical.

Despite the well publicised and intense pressure on the NHS in recent years, outside of the flagship waiting time targets, curiously few formal indicators of care quality have shown clear deterioration – so this news is particularly worrying as a signal that other hard fought standards are now being undermined.