Lord Carter’s long awaited review of hospital productivity has today published 15 recommendations aimed at saving the NHS £5bn a year by 2020.
The recommendations touch on almost every aspect of spending in the hospital sector – from clinical workforce management and hospital pharmacy, to procurement and imaging services.
Their broad theme is improved and standardised use of data to identify and drive out unnecessary expenditure. Lord Carter has set out what is likely to be a gruelling timetable of work for acute trusts and NHS Improvement (see box).
The report’s 15 recommendations are:
1. NHS Improvement should develop a national people strategy
This and the implementation plan should be complete by October to set a timetable for simplifying system structures; raising people management capacity; building greater engagement; and creating an engaged and inclusive environment for all staff by significantly improving leadership.
This will include every trust chief executive leading a “sustained campaign” to reduce the NHS’s high levels of bullying and harassment.
It will also mandate succession planning and the initial use of NHS Executive Search to develop candidate shortlists for director roles, to drive down spending on headhunters.
It will require improved collection and management of sickness absence data, to help drive down high rates of sick leave.
2. NHS Improvement to develop and implement measures for analysing staff deployment
This includes metrics such as “care hours per patient day” and consultant job planning analysis, so the right teams are in the right place at the right time collaborating to deliver high-quality efficient patient care.
NHS Improvement should begin collecting CHPPD on a monthly basis by April 2016, and aim for a daily basis by April 2017 so it “becomes the principal measure of nursing and healthcare support worker deployment”.
3. Trust plans by April 2017 to ensure hospital pharmacies achieve their benchmarks
Targets include increasing pharmacist prescribers; e-prescribing and administration; accurate cost coding of medicines; and consolidating stockholding by April 2020, in agreement with NHS Improvement and NHS England so their pharmacists and clinical pharmacy technicians spend more time on medicines optimisation with patients.
This will involve “ensuring that more than 80 per cent of trusts’ pharmacist resource” is used for direct medicines optimisation, medicines governance and safety, and reviewing the provision of all local infrastructure services, which could be delivered collaboratively with another trust or third party provider.
4. Ensure pathology and imaging departments achieve benchmarks by April 2017
These will be agreed with NHS Improvement, so there is a consistent approach to the quality and cost of diagnostic services across the NHS. If benchmarks for pathology are unlikely to be achieved, trusts should have agreed plans for consolidation with, or outsourcing to, other providers by January.
5. Trusts to report procurement information monthly to NHS Improvement
This will create an NHS Purchasing Price Index from April. Trusts will collaborate with other trusts and NHS Supply Chain with immediate effect, and commit to the Department of Health’s NHS Procurement Transformation Programme, so there is an increase in transparency and a reduction of at least 10 per cent in non-pay costs is delivered across the NHS by April 2018.
6. Achieve targets agreed by NHS Improvement for estates management by April 2017
All trusts (where appropriate) should have a plan to operate with a maximum of 35 per cent of non-clinical floor space and 2.5 per cent of unoccupied or underused space by April 2017, and deliver it by April 2020.
7. Trust administration costs below 7 per cent of their income by April 2018
Then falling to below 6 per cent of their income by 2020. Or trusts should have plans in place for shared service consolidation with, or outsourcing to, other providers by January 2017.
8. NHS Improvement and NHS England to set best practice standards for all specialties
The national bodies should establish joint clinical governance by April. The standards will analyse and produce assessments of clinical variation, so unwarranted variation is reduced; outcomes improve; the performance of specialist medical teams is assessed according to how well they meet the needs of patients; and efficiency and productivity increase along the entire care pathway.
9. Key digital systems fully integrated and in use by October 2018
The digital information systems cover e-rostering, e-prescribing, patient level costing and accounting, e-catalogue and inventory for procurement, radio-frequency identification where appropriate, and electronic health records.
10. Strategies for trusts to ensure patient care is focused equally on recovery and how they can leave hospital
The Department of Health, NHS England and NHS Improvement should work with local government to provide strategies to ensure patient care is focused on patients’ recovery and how they can leave acute hospitals beds, or transfer to a suitable step-down facility as soon as their clinical needs allow so they are cared for in the appropriate setting for them, their families and carers.
11. Identify opportunities for collaboration across health economies
NHS England and NHS Improvement should work with trust boards to identify quality and efficiency opportunities for better collaboration and coordination of clinical services across their health economy.
12. NHS Improvement to develop the ‘model hospital’
Plus the underlying metrics, to identify “what good looks like”, so there is one source of data, benchmarks and good practice.
13. A single, integrated performance framework developed by NHS Improvement by July
NHS Improvement, in partnership with CQC and NHS England, to develop an integrated performance framework to ensure there is one set of metrics and approach to reporting, so the focus of the NHS is on improvement and the reporting burden is reduced.
14. All acute trusts prepare to implement these recommendations to timetable
All acute trusts should make preparations to implement the recommendations of the Carter review according to the dates it sets out, so “productivity and efficiency improvement plans for each year until 2020-21 can be expeditiously achieved”.
15. National bodies engage with trusts to develop efficiency timetables
Their efficiency and productivity improvement plans should go up until 2020-21. A system will track the delivery of savings, so there is a shared understanding of what needs to be achieved.
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Carter review: the 15 recommendations