'Grasp NHS resources more effectively' urges Lord Carter

Lord Carter publishes the final version of his report into NHS efficiency

NHS cuts, recommended in Lord Carter's review of productivity, must not be made at the expense of safe care, the RCN has warned after the final report was published today (February 5).

Lord Carter’s report on his 18-month investigation of 32 acute hospitals in England claims savings of £5 billion a year can be made each year. But RCN general secretary Janet Davies said: ‘The focus on efficiencies must not be at the expense of safe care. In the past efficiency drives have eclipsed the focus on safe staffing levels and patient care. In the future the two must go hand in hand.’

The Labour peer claims the cuts will reduce ‘unwarranted’ variation of service quality. He looked at the care hours provided by nurses and healthcare assistants and found that while the average was 9.1 hours, for some it was as low as 6.3 hours while at the other extreme, overstretched staff were clocking up 15.8 hours.

Sickness and absence rate vary from 3.1% to 5% – meaning staff are 60% more likely to be absent due to sickness at the worst trust compared to the best.

Highlights of his report include:

  • ‘Exceptional’ work done by some trusts, but the overall average is not good enough.
  • Managers face challenge of raising the standard of the poor and mediocre to that of the best.
  • Recommending a ‘model hospital’ structure which sets clear standards for each trust.
  • Just five minutes of improved staff productivity per shift could save £280 million a year.

Lord Carter also set a challenge to the newly formed NHS Improvement organisation – of which he will become a non-executive director – to make tackling nurse shortage a priority in 2016.

Ms Davies said: ‘The report also focuses on the impact of staff sickness absence. Valuing staff and focusing on their wellbeing will improve staff retention and reduce sickness absence, which will not only save money but, more importantly, will improve patient care.’

In a message to NHS Improvement Lord Carter recommends it ‘develop and implement measures for analysing staff deployment during 2016, including metrics such as Care Hours Per Patient Day – calculated by comparing nursing hours relative to patient workload.'

The term ‘model hospital’ was coined when the interim report was published in June last year and since then Lord Carter has worked to develop the concept based on his experience of the best performing NHS and international trusts.

Lord Carter said: ‘My experience of the NHS and hospitals internationally is that high quality patient care and sound financial management go hand in hand. To improve the quality of care hospitals must grasp resources more effectively, especially staff, which account for more than 60p of every pound hospitals spend.

NHS Improvement chief executive Jim Mackey said: ‘The NHS is facing financial pressure and this work will go a long way to relieving that pressure and helping trusts meet the efficiency challenge over the next five years.

‘We will do everything to help trusts implement these recommendations, but those that fail to do so will face closer scrutiny from NHS Improvement until they can demonstrate appropriate grip.’

NHS Confederation represents 85% of NHS providers and its chief executive Rob Webster welcomed the report, but warned full delivery will still only ‘provide less than one quarter of the overall efficiencies we are required to make and it is important to recognise the huge scale of the challenge ahead.’

Read more on the Department of Health website

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