Lord Carter says some community hospitals need to be made “bigger”

He is leading a review of efficiency at community and mental health providers

Cited American army’s ”wreckingball” strategy as an example of effective estates rationalisation programme

Many community hospitals are “too small” and cost too much to keep open, according to the Labour peer in charge of reviewing the efficiency of community and mental health services.

Lord Patrick Carter, the Labour peer who is now also a board member at NHS Improvement, was speaking at an event on Tuesday.

He also praised the “remarkably effective estates rationalisation programme” of the US army whose “secret was… ‘the wrecking ball’”.

Lord Carter is currently reviewing the efficiency of community and mental health providers. This follows his review which reported to the government last year on NHS efficiency and  productivity.

He told the event that “time and time again” his team found community hospitals costing £100,000 per bed year to keep open, which “isn’t going to work”.

Many health economies have closed, or are seeking to close, community hospital beds, arguing they are inefficient to run. However, it is often controversial, and in some areas there are concern about reducing the overall number of beds amid huge pressure on capacity.

Lord Carter said: “On property in community trusts one thing that jumps off the page at you is the very high cost of community hospitals because many are too small.

“Time and time again we find these hospitals cost £100,000 per bed year to actually keep open and that isn’t going to work so we need to find a way of making them bigger, and we also have to work on that key thing about what is an acute hospital for?”

Speaking further about how the NHS can maximise the use of its estates, Lord Carter cited the US army as having a “remarkably effective estates rationalisation programme”.

“We asked them what the secret was and they said ’the wrecking ball’,” he said. “They said, ‘knock it down; if it’s knocked down and it’s not being used you don’t insure it, guard it, or pay tax on it.’

“They said you have to be absolutely ruthless about what you are using your estate for. No sentiment, just keep moving on and I think that’s one of the key things.”

Lord Carter also told the Hospital Innovations Conference in London that new comparative data on trusts’ use of estates would be published in future, which would form the basis for the discussions about energy, estate, cleaning costs, and “all those detailed things we need to do”.

He added that one of his disappointments was that the NHS hadn’t “cracked getting access to enough capital to help trusts meet some of those productivity improvements”.

And addressing how the NHS can learn from best practice, Lord Carter said it was “tragic” that the NHS in England has done “everything right once somewhere”.

“Where we in the centre have not done as well as we should is to systematise the learning,” he said.

“We are really good but we are not good at replicating it, industrialising it, and sharing it. That’s been our failure.

“And the challenge now for NHS Improvement is to actually take that knowledge and share it, and make sure it’s used.”