In the wake of the Carter report, prominent healthcare leaders must now bring their A-game to iron out unwarranted variations in NHS efficiency

When Lord Carter’s report on NHS efficiency is finally published the focus will be on the new targets it sets the system. Thanks to the details of the final draft obtained by HSJ last week, we will also be able to see which of the proposed goals NHS Improvement is prepared (or has been persuaded) to adopt.

But once the smoke has cleared on the advisability and practicality of those targets and the data they will rely on, the true legacy of Lord Carter’s work should be a better quality debate about the role and importance of NHS management.

‘Should’ does not mean ‘will’ of course. There is the ever present danger of a reductive row concentrated on management numbers. Hopefully the published version of the report will better celebrate the fact that NHS managers often run admirably efficient services and that the service has shown to be under-managed (though over-administered) by a range of recent and robust research projects.

What is undeniably impressive about the Carter review is the breadth of its vision. It highlights the contribution of a wide range of departments and roles that have spent too long in the shadows.

Supply chain management, estates, facilities, procurement, HR, pharmacy among others all get attention from Lord Carter, along with many aspects of clinical service management. Whether the solutions proposed are exactly the right ones matters less than that their importance to an effective health service are recognised and acted upon.

The headline of the Carter reviews is that there is too much unwarranted variation in NHS efficiency. To reduce that variation it calls for better identification and adherence to best management practice. This is the mantra of the Enterprise model propounded by Salford’s Sir David Dalton, the Royal Free’s David Sloman and, of course, former Northumbria CEO Jim Mackey, who will soon receive Lord Carter’s report in his new role at NHS Improvement.

If these leading figures – and others – can use the Carter review as an opportunity to create a serious and informed drive to improve the contribution of NHS managers and management – in all its aspects – then it will have a much greater impact than a score of centrally imposed efficiency targets.