• Most acute trusts failing to hit all three procurement efficiency standards
  • Handful of trusts complying with the three targets set out in the Carter Review
  • Lord Carter says trusts must ”up their game” 

The majority of NHS hospital trusts have failed to hit the three key efficiency targets set out in the Carter review on time, HSJ research has found.

All acute non-specialist trusts should have been compliant with the procurement metrics, which aim to ensure hospitals better control their spending, by September 2017, according to the 2016 efficiency review by Lord Carter.

However, our analysis of figures from 102 non-specialist acute trusts has found only eight were hitting all three targets by the end of last year (see first table), while another eight were not hitting any (see second table).

The findings prompted Lord Carter, whose review suggested acute trusts could save £700m by improving their procurement, to say non-compliant trusts need to “up their game”.

Among the recommendations of the Carter review, which identified £5bn worth of savings for the acute sector, was that trusts comply with the following three metrics by September:

  • 80 per cent of spending should be on goods in catalogues;
  • 90 per cent of spending should be with a purchase order; and
  • 90 per cent of spending should be under contracts.

The percentages relate to trusts’ “addressable spend”, which excludes spend categories like pay, taxes and depreciation.

Most trusts were achieving one or two of these targets, according to data obtained by HSJ under the Freedom of Information Act. The FOI request was sent in December.

There is no strong correlation between hitting the three targets and how trusts are placed on the NHS procurement league table, which was published in November.

An NHS Improvement spokeswoman said more can be done to ensure trusts are “making efficiency business as usual”.

Trusts meeting all three key procurement targets (December 2017)

Trust% on catalogue  % with purchase order % with contractPosition in NHSI league table2017-18 forecast surplus/deficit 
Gateshead Health FT 100 100  92 136 -£2.2m
Harrogate and District FT 87 90  90  65 £5.9m
Heart of England FT  90 100 90 12 -£48.1m
Isle of Wight Trust 90.6 100 90.6 119 -£18.8m
Portsmouth Trust 94.7 100 95 51 -£36.8m 
Royal Berkshire FT  85  100  100  110  £4.6m 
The Hillingdon Hospitals FT 95 100 94 39 -£8.5m
University Hospitals of Leicester Trust 94.9 94.2 93.7 37 -£26.7m

Eight trusts were not compliant with any of the targets, while another three were not compliant with two targets and did not have the ability to check compliance against the third in December.

Forty-nine trusts were compliant with two targets and 34 trusts were compliant with one. Thirty trusts did not respond to HSJ’s request or refused to give figures. 

Trusts missing all three key procurement targets or unable to provide figures (December 2017)

Trust% on catalogue % with purchase order % with contract Position in NHSI league table 2017-18 forecast surplus/deficit 
Bradford Teaching Hospitals FT 71 81 63 4 £1.8m
Calderdale and Huddersfield FT  23.2   87.5   88   128   -£16.2m  
North Tees and Hartlepool Hospitals FT 59  61  86  92  £3m 
Oxford University Hospitals FT 67  80  67  45  -£5.2m 
Pennine Acute Hospitals Trust  55  73  60  58  -£13.2m 
Royal United Hospitals Bath FT  70  75  72  82  £12.2m 
South Tyneside FT  77  63  72  43  -£10.1m 
South Warwickshire FT  21  22  48.5  127  £7.8m 
Chesterfield Royal Hospital FT  44.2  44.2  Could not provide figure  69  £6m 
Epsom and St Helier University Hospitals Trust   75  32  Could not provide figure  121  -£17.8m 
Royal Liverpool and Broadgreen University Hospitals Trust 72 73 Could not provide figure 130 -£14.4m

Oxford University Hospitals and Bradford Teaching Hospitals both said as of February they are achieving two of the targets, while North Tees and Hartlepool FT said it was now meeting one.

A spokeswoman for South Warwickshire FT said the trust is implementing catalogue management and e-procurement systems to “help ensure these targets are met”. She said the trust is investing in “additional resource” to embed contract management processes across the organisation.

The other non-compliant trusts did not respond to HSJ in time for publication.

Lord Carter told HSJ: ”It is encouraging that some trusts are achieving all three targets, but others need to up their game. 

“It’s been two years since my final report and since then we have equipped the NHS with the tools to help them achieve these targets. I now fully expect all trusts to use these tools and strive to achieve all three targets so that savings can be reinvested into patient care.”

The NHSI spokeswoman said the purpose of the “initial targets” was to give trusts something to aim for and help them identify which areas needed improvement to ensure value for money.

She said the regulator is supporting trusts to improve procurement processes through its price comparison tool and Nationally Contracted Products programme. So far, eight basic products (such as toilet paper, plastic examination gloves, and temporary shoes) have been bought through the programme on behalf of the whole NHS.

Commenting on HSJ’s findings, the head of procurement at a large trust, speaking on condition of anonymity, said: “It’s a result of a landscape where there’s no mandatory national contracts and trusts have a choice of varying routes to market.

“I’m not surprised by the figures. We have worked in a service that historically hasn’t had key performance indicators, league tables or performance measures.”

Asked about how much importance should be placed on hitting the targets, the source said: “It should be something on heads of procurement’s agendas and directors of finance’s agendas and reported to the board along with the procurement transformation plans that we all have to do. I would argue it should be a key priority.”

A spokesman for the Health Care Supply Association, which represents NHS procurement professionals, said the Carter Review offered staff a “great opportunity to raise the profile and enhance the delivery of non-pay efficiency”.

“We have waited a long time for some nationally accepted metrics and let’s use them to support our work,” he said.

But he added: “Trusts will need to ensure sufficient investment in people and systems to support delivery.”