A law could be introduced to force medical sales representatives to report all financial relationships with hospitals in a bid to drive down NHS procurement costs, a government backed review has said.

  • Lord Carter’s interim report into provider productivity makes recommendations to save NHS up to £5bn by 2020
  • Review will look at US style “Sunshine Act” to increase transparency in procurement
  • Government backed review says workforce management a priority

The suggestion comes in Lord Carter’s interim report into NHS provider productivity, which includes recommendations he believes could save the service up to £5bn a year by 2019-20.

In the report he says that while providers of clinical goods have a legitimate support role, “this is often clouded by the need to make sales”.

He adds: “The proliferation of sales representatives selling in the NHS is a huge cost which neither the NHS nor its suppliers want or need if alternative models of doing business could be developed.”

The review says a US style “Sunshine Act” could be introduced. This American law requires medical supplies organisations to collect and track all financial relationships with clinicians and hospitals and to report these to the government.

Lord Carter also calls for a “tightly controlled” electronic catalogue of healthcare products supported by “strict policies so that employees and suppliers know there are no alternatives”.

He says that while clinicians must retain the authority to make purchasing decisions about particular products these choices could be “better informed”.

He adds: “Often… such decisions are made between clinicians and sales representatives from the medical companies without proper recourse to all the facts and evidence.”

Lord Carter’s other recommendations include:

Lord Carter says that while he is “reluctant to set detailed targets” he believes savings of £5bn per year could be made by 2019-20.

He says he came up against two main obstacles during the review – a lack of good data and an absence of metrics to measure performance between hospitals.

There is currently no consistent approach to measuring efficiency across the NHS, Lord Carter says.

Lord Carter

There is no consistent approach to measuring efficiency across the NHS, Lord Carter said

The review team has worked with 22 hospitals to develop the adjusted treatment index, which Lord Carter believes can be used across all providers, not just the acute sector.

In a speech last week health secretary Jeremy Hunt said providers would be given set savings targets in their procurement processes from January.

In the pursuit of cost saving measures, the Carter report says: “No stone should be unturned and nothing sacred or exempt from examination.”

The productivity and management of workforce is a priority and up to £2bn could be saved by improving workflow and containing workforce costs, the report adds.

The pay bill of the NHS was £45.3bn in 2013-14, the largest area of spending.

The report says there is “considerable variation” in how providers manage the one on one care of patients, staff rostering and flexible working policies.

The review also found a “tenfold” difference in management costs between hospitals. This will be investigated over coming months.

From analysing detailed nursing roster data from the 22 providers engaged in the review, Lord Carter says there may not be enough nurses “to meet the post-Francis demands of the NHS”. Some hospitals bank nurses were not paid enough to prevent them from joining agencies – a more costly approach to booking staff.

Nurses are “overburdened” with administrative tasks “that should be taken care of through better procurement and logistics management”, he says.

He says one area of “good practice” is to improve guidance on appropriate staffing levels and skill mix for particular ward types in collaboration with the Royal College of Nursing and the National Institute for Health and Care Excellence.

HSJ revealed last week that NICE has stopped its work on safe staffing levels.

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