The essential stories for healthcare leaders this week, including details of the Carter efficiency review revealed.

We got Carter

With just days left until publication of Lord Carter’s long anticipated review of hospital productivity, HSJ has revealed extensive details of the influential report’s expected recommendations.

Readers will be surely delighted to learn that the Labour peer is expected to recommend capping hospital trusts’ management and administration spending at 7 per cent of income by April 2018.

But the fun doesn’t end there. He is also expected to propose new limits for the amount of underused land trusts can hold, a new “principal measure” of nursing deployment to be adopted by April, and new targets that diagnostics services must hit or face merger or outsourcing.

As an aside, it is understood that hospital trusts have so far acknowledged they can make £3bn of the £5bn savings Lord Carter has promised.

Sir David hits a strike

On Tuesday morning, the British Medical Association suspended next week’s planned industrial action by junior doctors, while negotiations over a new junior doctors’ contract continue with NHS Employers and the government.

HSJ editor Alastair McLellan wondered then if this progress was down to the “calming influence” of Sir David Dalton, who was brought in by Jeremy Hunt to bring the talks to an amicable conclusion.

We may have got the answer on Friday, when HSJ revealed that, in a letter from Sir David, the government has offered major concessions to junior doctors, including over weekend pay. The letter is dated for 16 January - three days before the strike was called off.

However, the BMA warned earlier in the week that “significant, concrete progress will need to be made” if the strike planned for 10 February, which includes emergency care, is to be avoided. As of late Friday, negotiations through Acas are ongoing. 

NICE job

Sir David’s letter was not the only leaked document HSJ made public this week. We revealed on Wednesday the final safe staffing guidelines for accident and emergency departments, which were completed by experts working at NICE last year but were never published after the government suspended its safe staffing programme.

The documents, reproduced on, show that the expert safe staffing committee at NICE agreed to recommend minimum nurse ratios for type one emergency departments in order to ensure patient safety.

The document also recommends NHS trusts reconsider the way they currently plan nurse staffing levels in A&E in order to make sure they can better meet surges in demand.

The guideline was leaked to us after numerous requests for it to be published were refused by NICE and the government.

All is not fine for finance directors

This week also confirmed that letters from the centre remain its go-to method for exerting grip on providers and commissoners..

After being given an ultimatum over access to the £1.8bn “sustainability and transformation fund” last Friday, finance directors received a diktat this week telling them that all fines against providers missing performance targets must be used to improve providers’ and CCGs’ bottom lines.

If local NHS organisations had planned to reinvest the money from fines in schemes to improve performance – as previously expected of them – they can’t any more. This policy decision left HSJ readers confused and exasperated.

Mappers delight

The most popular story of the week (as of Friday afternoon) has been HSJ’s map showing which English health systems have the biggest challenge on their hands, because of serious underperformance across a number of areas, plus two that are doing well.

The health system patches are based on a list of 37 “local areas” identified by Monitor, which was published at the end of last year to inform decisions by NHS organisations about the health system groups they will form to produce “sustainability and transformation plans” this year.

It is highly likely that the footprints which the NHS opts for will in many cases not match these, but in the meantime click away to see how you and your neighbours are doing.

Four more must reads (and a must watch)