This is HSJ’s fortnightly briefing covering quality, performance and finances in the mental health sector. Feedback and comments are welcome, so please feel free to email me in confidence.

Where is the Carter review for mental health?

It has been nearly a year since Lord Carter launched his second efficiency review into organisational productivity and performance at mental health and community trusts.

The Labour peer and his team selected 23 trusts to provide detailed information about:

  • how their organisations operated;
  • what “good” looks like in quality and efficiency terms;
  • what approaches to improving productivity and efficiency are already in place, and opportunities to drive these further; and
  • what metrics and indicators are required to support the development of the model for these sectors.

Despite saying the report would be published in autumn 2017, there is no sign of it nor any indication of when it will be released.

It is hard to miss the irony of an efficiency review being behind schedule. Some well placed sources told HSJ it was almost ready around the time of last year’s general election, and given neither the government nor health secretary haev changed, it is a mystery why it has taken this long to get it out the door.

Dominating discussions

Lord Carter’s previous investigation into hospital productivity, published in 2016 was a watershed moment for the acute sector. It set out 15 recommendations aimed at saving £5bn a year by 2020. It has dominated the discussions about back office efficiency and service redesign, with the acute sector – supported by NHS Improvement – going to great lengths to implement its recommendations.

But it is not clear if the mental health and community services report will have anything like the same impact.

What we know is that it is likely to make recommendations in the same areas as the acute review – estates, bed numbers, procurement, staffing and back office efficiencies.

Preliminary findings have also suggested the mental health and community sector can save £181m through scaling up trust corporate services.

When they turn their attention to mental health, NHS Improvement and Getting it Right First Time are also expected to focus on eliminating out of area placements.

But because mental health only accounts for 14 per cent of the NHS budget, don’t expect a savings target as headline grabbing as the £5bn for acute trust.

A damp squib?

As there often is in mental health, there is also an issue around data quality.

This is becoming a bit of recurring theme of these expert briefings, but it is worth labouring the point when it threatens to reduce an important national review to a damp squib.

NHSI director of sector development Luke Edwards told delegates at the King’s Fund in October that gathering the data to support the Carter review had been a “real challenge”.

He added that despite being 10 months into the review, NHSI has only been able to establish “relatively limited opportunities for improvement that can be evidenced by benchmarking providers”.

The lack of good quality data makes it almost impossible to hold providers to account against targets for quality and financial improvement.

Some of this comes down to there being very few consistent service line definitions, with a wide diversity of team names and specifications.

Without good quality data, it will only be possible to chip away at improvements, making small scale changes where there is enough evidence to show it is beneficial.

Where next?

HSJ understands NHSI is going to continue collecting data from mental health and community trusts and expand on this work.

However, with no date set for the publication of the second Carter review it is still not clear when its impact will be felt.