Revealed: The trusts failing to meet national efficiency targets

Less than one in five acute non-specialist trusts are achieving the three targets outlined by Lord Carter in his 2016 review of hospital productivity, despite trusts being told to comply by October 2017.

However, the number of trusts achieving two targets or more has gone up since 2018, and the number of trusts missing all three targets has fallen.

The findings come as procurement chiefs and consultants from Deloitte are working on a new model to drive efficiency in the sector.

An NHS Improvement spokesman said more than £500m has been freed up by most trusts hitting at least one of Lord Carter’s procurement targets, but added “further work is needed to ensure the NHS always get[s] the most value for money”.

In his review, Lord Carter estimated acute non-specialist trusts could save up to £700m through better procurement.

Among his recommendations were three targets designed to boost the efficiency of a trust’s procurement processes.

The targets were:

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

Data obtained by HSJ through the Freedom of Information Act reveals 18 trusts are currently hitting all three targets, compared to just eight trusts in January 2018.

Additionally:

• 57 trusts are hitting two of the three targets (compared to 49 in January 2018);
• 29 trusts are hitting one of the three targets (compared to 34 in January 2018); and
• Five trusts are missing all three targets (compared to 11 in January 2018).

Eighty-one per cent – 109 of 134 – of England’s acute non-specialist trusts responded to HSJ’s request for data.

Commenting on the numbers, Lord Carter told HSJ trusts hitting one or none of the targets “have no excuses, as we have equipped the NHS with the tools, the data and the central purchasing power to deliver efficiencies”.

He said: “Those lagging behind need to learn from their high-performing peers and put immediate actions into place.

“With the long-term plan making clear that procurement savings must be achieved so the money can be reinvested into patient care, NHS trusts cannot afford to stall any longer.”

A spokesman for the Health Care Supply Association, which represents NHS procurement professionals, welcomed the “progress at trust level”.

“A small range of metrics could never represent the full range of services trusts’ procurement teams provide,” he said.

“But, along with the Purchasing Price Index Benchmarking tool and procurement league table, they are further evidence of how important it is to have a well resourced and well supported function at local level.”

Success against the three targets plays a part in determining each trust’s place in the NHS procurement league table, which was created in November 2017. 

HSJ has obtained a copy of the new version of the table, which will be published by NHS Improvement at the end of March. There does not appear to be a correlation between trusts’ league table ranking and their overall financial performance. 

The five trusts missing all three targets are:

Trust	% on catalogue	% with electronic purchase order	% with contract	Position in procurement league table	2018-19 forecast surplus/deficit
George Eliot Hospital Trust	51.39	87.80	Fluctuates between 86-92	121	-£15.5m
Royal Liverpool and Broadgreen University Hospitals Trust	72	73	Not available	130	-£54.2m
Newcastle upon Tyne Hospitals FT	72	89.70	75.60	11	£12.9m
East Sussex Healthcare Trust	76	76	62	94	-£45m
South Tyneside FT	75.30	50.20	78.10	84	-£11m

The table above previously included Royal Surrey County Hospital Foundation Trust, but this was an error by HSJ. The trust is achieving one of the three targets. 

A George Eliot Hospital Trust spokesman said the trust had made a “number of process changes in order to improve our procurement service” as part of a two-year programme.

Examples included in the programme are a new finance and procurement system, catalogue improvements, and enhancements to contract management processes.

In its freedom of information response, South Tyneside FT said its value for spend with an electronic purchase order was low due to “system processing issues” in January, and that its performance “usually sits between 88 per cent and 100 per cent”.

Royal Liverpool and Broadgreen University Hospitals Trust said it is currently implementing a contracts register, which will give the trust a “better understanding” of its performance. 

The other trusts did not respond to HSJ’s request for comment.

The 18 trusts achieving all three targets are: 

Trust	% on catalogue	% with electronic purchase order	% with contract	Position in procurement league table	2018-19 forecast surplus/deficit
Blackpool Teaching Hospitals FT	90.1	98.6	92.1	110	-£5.9m
Gloucestershire Hospitals FT	91.5	90.3	92.6	12	-£29.8m
Chelsea and Westminster Hospital FT	92.2	91.6	92	71	£26.8m
Royal Berkshire FT	92.7	99.7	97.7	132	£8m
Nottingham University Hospitals Trust	93	100	93.3	60	-£40.3m
Lancashire Teaching Hospitals FT	94.9	99.4	96	17	-£46.4m
University Hospitals Plymouth Trust	95	98.1	95.2	5	-£29.5m
Hillingdon Hospitals FT	96.1	99.9	98	19	-£22.6m
East Kent University Hospitals FT	96.9	93.3	90.9	98	-£42.2m
East Cheshire Trust	97.4	95.8	90.32	75	-£17.9m
Imperial College Healthcare Trust	99.7	92.7	91.2	10	£11.5m
Walsall Healthcare Trust	100	100	100	68	-£24m
Wye Valley Trust	100	100	98.3	123	-£33.5m
University Hospitals Coventry and Warwickshire Trust	92.8	93.3	97.2	66	-£33.6m
Barts Health Trust	93.8	96.7	90.2	16	-£84.7m
University Hospital Southampton FT	92.7	93.5	91.9	14	£29.4m
County Durham and Darlington FT	99	100	94	21	£6.2m
University Hospitals of Leicester	96.94	96.94	92.68	34	-£49.5m