Lord Carter: grip, standards, data and leadership
04 April 2016
Lord Carter has become known as a producer of trouble-shooting reviews for the government. His latest review, published in February 2016, was potentially the most ambitious yet – how to make the NHS more efficient. Operational productivity and performance in English NHS acute hospitals: Unwarranted variations estimates that if ‘unwarranted variation’ is removed from trust spend, £5bn of savings could be made by 2020.
The report is wide in scope and touches on areas as diverse as clinical rotas, procurement practice, staffing costs and addressing delayed transfers of care. In each topic there is a mix of four key elements that flavour the message of the review – greater central grip, greater transparency, greater standardisation and greater leadership.
Greater central grip
Lord Carter thinks the centre has a more ‘active’ role to play in making trusts more efficient. For example, it says all trusts can spend no more than 6% of their income on back office and management staff by 2020. It says that all trusts will have to use e-rostering systems for their clinical staff. But what it doesn’t say yet is what the consequences might be for providers who decide not to comply, or are unable to. Instead, the report says it will be in the gift of the new system regulator, NHS Improvement, to decide on the approach. The review also created new metrics that benchmark providers’ efficiency levels against each other across areas of spend and at a trust-wide level – expect these to be used by regulators to hold providers to account, and by boards to hold their organisation to account.Greater transparency
However, the report also recognises that in some areas central support rather than grip is required. This means using mechanisms the centre can help apply at scale, such as joining up data sets across trusts. So, for example, providers have been asked to submit data on commonly procured items and their prices, so that once published the sellers’ monopoly of this information is broken, and purchasers in trusts know what their colleagues down the road are paying.The critical issue now is how the report moves from recommendations to reality... striking balance between holding to account and giving the right support to providers
Greater standardisation
Lord Carter is clearly a huge advocate of the work of the Getting it Right First-time (GIRFT) initiative on orthopaedic surgery led by Professor Tim Briggs. He recommends standardising the GIRFT approach for use across the other surgical and non-surgical specialities to create standardised view of what good looks in each, which combined build a picture of how a ‘model hospital’ should function. This ‘model hospital’ will be an online tool with a suite of benchmarks, designed so they can be cascaded down through trusts at appropriate levels from ‘board to ward’ to drive improvement.Greater national leadership
In Lord Carter’s foreword to the report he notes trusts recognise efficiency opportunities if they change the way services are delivered but ‘national support [here] is critical.’ Decoded, this means service reconfiguration is essential in some cases to eliminate unwarranted cost variation and improve patient outcomes, but national leaders and politicians need to be much braver in backing up trusts that pursue these options.What’s next?
The critical issue now is how the report moves from recommendations to reality. Its implementation will be led by NHS Improvement, who must strike the balance between holding to account and giving the right support to providers. The implementation work must also recognise that the engagement and leadership of provider boards in this improvement agenda is absolutely crucial, as greater grip, transparency and leadership at the national level alone will be insufficient to deliver lasting change. But even if this balance is found, it needs to be considered in the wider context – it will deliver just under a quarter of the £22 billion of savings the NHS must make by 2020. The report makes recommendations for improving trust operational productivity, but it is whole-system transformation that will ultimately need to be tackled if the NHS is to become sustainable in the longer term.This blog is also published in The Bulletin, the monthly membership magazine from the Royal College of Surgeons.