Title of driver: Operational productivity and performance in English NHS Acute Hospitals: Unwarranted variations

Alternative Titles: Productivity in NHS hospitals Carter Review

Source: Lord Carter of Coles (Independent report commissioned by the Department of Health)

Link to main document https://www.gov.uk/government/publications/productivity-in-nhs-hospitals

Publication format: PDF

Date of publication: February 2016

Summary of driver:

Report sets out the findings of Lord Carter’s review of how non-specialist acute hospital trusts can reduce unwarranted variation in productivity and efficiency to save the NHS £5 billion each year by 2020 to 2021.

15 recommendations are made to reduce this variation, including proposing a set of metrics be developed for a ‘model hospital’ for trusts to be benchmarked against.

Key features of driver:

Various sources of unwarranted variation in productivity, costs and efficiency in acute hospitals were identified.

The review looked at clinical staffing, pharmacy and medicines, diagnostics and imaging, procurement, back-office functions, estates and facilities; and at the quality and efficiency of clinical specialties.

The report makes recommendations in 15 areas to reduce this variation, improve quality and productivity, make cost savings, use resources in a cost effective manner and increase efficiency.

The report calls for action by NHS Improvement, NHS England, the Department of Health and hospital trusts with recommendations for the below areas:

• Developing and implementing a national people strategy – simplifying system structures, raising people management capacity, building greater engagement and improving leadership capability.
• Ensuring hospital pharmacies and pathology and imaging departments achieve their benchmarks – resulting in pharmacists spending more time on clinical activities, and a consistent approach to the quality and cost of diagnostic services
• Procurement – trusts should report procurement information monthly to NHS Improvement; collaborate with other trusts and the NHS Supply Chain; and commit to the NHS Procurement Transformation Programme – resulting in increasing transparency and at least 10% reduction in non-pay costs across the NHS.
• Estates and facilities management – trusts should meet or operate above NHS Improvement’s benchmarks. Including not exceeding a maximum of 35% of floor space for non-clinical functions and 2.5 % of space unoccupied/underused.
• Trust corporate and administration functions – should be rationalised so that costs don’t exceed 7% of their income by April 2018 and 6% of income by 2020, or have plans for shared service consolidation or outsourcing to other providers.
• NHS Improvement and NHS England should establish joint clinical governance to set standards of best practice for all specialties.
• Key digital information systems – should be in place in all trusts.
• The Department of Health, NHS England and NHS Improvement should work with local government to provide a strategy for trusts focusing patient care on recovery and how patients can leave acute hospital beds as their clinical needs allow.
• Quality and efficiency opportunities for better collaboration and coordination of clinical services across local health economies – NHS England and NHS Improvement should work with trust boards to identify these.
• NHS Improvement should develop the Model Hospital and underlying metrics so there is one source of data, benchmarks and practice.
• Metrics and reporting – NHS Improvement should develop an integrated performance framework to ensure there is one set of metrics and approach to reporting; reducing the reporting burden for trusts.
• Various deadlines are suggested- all trusts should work towards these and national bodies should develop timetables for efficiency and productivity improvements.

Primary audience: Department of Health, NHS Improvement, NHS England, Acute Trust Boards

Impact on library policy/practice:

Libraries are not specifically mentioned but:

• The focus on efficiency, quality and benchmarking may lead to increased interest in resources for business decision making, and clinical/service auditing.
• Consortia purchasing of library resources could contribute towards cost reduction.
• Libraries can supply resources on leadership and people management to support the staffing changes proposed.
• Library staff could partake in any leadership training and development made available by their trusts – for CPD and to improve the structure and leadership of the library service.
• Library services can highlight that by having trust computers available in their setting – they are supporting staff to have access to the digital information systems the report calls for.
• Working in collaboration with other libraries to deliver projects and services e.g. inter-library loans could support the initiative of collaboration and cost reduction.

However with the stipulation for the maximum percentage of hospital floor space for non-clinical functions – if trusts feel they need to reduce non-clinical floor space, libraries may be one of the areas that faces challenges to their use of space. Library managers will need to highlight the value of the library service to counter this pressure.

Date last updated: November 2016

Due for review: November 2017

Group member responsible: FG

Tagged: Benchmarking, Efficiency, Improvement, Productivity, Quality, Quality and Improvement