The must-read stories and debate in health policy and leadership.

Carter’s criticisms

How the NHS spends its money is the subject of much scrutiny, but – until recently – the way in which acute hospitals manage their transactions has not received much attention.

That changed with the publication of the Carter Review in 2016, in which NHS efficiency driver Lord Carter set out three clear targets for how hospitals should buy what they need to look after patients.

Lord Carter correctly highlighted that far too much spending was not transacted properly and this required urgent change.

For example, hospitals would have deals with suppliers without actual contracts in place, while some procurement departments sent their purchase orders through the post, increasing the chances of error.

Lord Carter’s review, which was backed by NHS Improvement, called for all acute non-specialist trusts to get their transaction processes in line by October 2017.

But the deadline has proved too ambitious. HSJ revealed last year only eight trusts were complying with all three metrics.

Fast forward to March 2019 and performance has improved – 18 trusts are now achieving all three targets – but nowhere near the level Lord Carter’s review expected.

The Labour peer told HSJ that trusts “lagging behind have no excuse” for their failure to improve processes, but procurement departments across the land will undoubtedly point to years of underinvestment in purchasing and contracting systems.

Many trusts could also be waiting for the new blueprint for the procurement of non-NHS Supply Chain products before deciding upon a course of action.

Whatever the reasons for the slow progress, the result so far means many missed savings opportunities.

Still waiting

NHS England has just two years to hit the government’s deadline for eliminating so-called “inappropriate” out of area mental health placements, defined by NHS Digital as those placements caused by a lack of available beds. 

HSJ appreciates the optimism, but the latest data reveals little change in the numbers of mental health patients being sent out of area since September 2017 and nearly all – 96 per cent – of these placements were classed as inappropriate. 

Worryingly, what also emerged was an increase in the proportion of placements lasting 15 days or more, while the proportion for 14 days or less decreased.

With just 15 months of data, it is too early to make strong judgements, but the fact more patients are waiting in a bed for longer periods could suggest a number of things.

It could be explained by an increase in complex cases, a decreasing capacity within community mental health services to discharge patients into, or a decrease in ability of social care to support patients… we could go on. 

With the government’s deadline looking like a tall order, national bodies will want to keep an eye on the length of stay figures and ensure complex patients are not left languishing.