NHS must increase transparency to generate savings, Carter review advises

According to a report conducted by Lord Carter, hospitals must standardise procedures, increase transparency and work more closely with NHS trusts to save money.

Carter’s review proposes a series of recommendations to Health Secretary Jeremy Hunt that are aimed at helping to reduce variation in the quality of care that costs the NHS billions.

The review found unwarranted variation in running costs, sickness absence, infection rates and prices paid for supplies and services. Included in the report, is a ‘model hospital’ which has been developed to advise NHS trusts on the most efficient allocation of resources and enables hospitals to measure performance against other trusts.

The ‘model hospital’ proposes measures that could save hospitals £5 billion annually by 2020-21 and help end variations in services. Of the variances, the report uncovered: average running costs for a hospital (£ per square metre) vary from £105 at one trust to as high as £970 for another; infection rates for hip and knee replacements vary from 0.5 to four per cent; prices paid by different hospitals for hip replacements ranged from £788 to £1,590; the use of floor space - one trust uses 12 per cent for non-clinical purposes and another uses as much as 69 per cent; and sickness absence rates differed from 3.1 per cent to five per cent.

In addition to reviewing hospitals across England, Carter’s review looked at healthcare systems in the US, Germany, Australia, Italy and France where hospitals are reported to have a greater focus on efficiency.

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 60 pence of every pound hospitals spend.

“Giving hospitals the tools and support to better manage resources will make it easier for boards to follow the example of the best trusts and mean every patient can receive the same world class care and taxpayers will also receive a fairer return on their significant investment in the NHS.”

Acute NHS trusts spend £55.6 billion annually, with £33.9 billion going on staffing. Carter estimated that a one per cent improvement in staff productivity could save the NHS £280 million per year, which could save every member of hospital staff five minutes on an eight hour shift.

The report also examined other areas such as staffing: the review called for an improvement in the way the NHS deploys its staff, ending the use of outdated and inefficient paper rosters; procurement: as part of the review, from April 2016, trusts will publish their receipts on a monthly basis for the top 100 items bought by the NHS such as bandages, needles and rubber gloves; use of floor space: trusts’ unused floor space should not exceed 2.5 per cent, and floor space used for non-clinical purposes should not exceed 35 per cent; administration costs: these should not exceed seven per cent by 2018 and 6 per cent by 2020; delayed transfers of care: Carter has called for action to be taken on the ‘major problem’ of delayed transfers of care, which affects hospitals and trusts’ earning and spending capacity; and working with neighbouring hospitals: Carter advises trusts to work closely with their neighbouring hospitals, sharing services and resources to improve efficiency and reduce costs.

In response to the reports findings and recommendations, Hunt said: “I want to make the NHS the safest healthcare system in the world, capable of providing the same world class care every day of the week, powered by a culture of transparency and learning. This groundbreaking review will help hospitals care for patients, making sure every penny possible is spent on frontline patient care and bureaucracy is slashed so doctors and nurses can concentrate on caring.

“I’m grateful to Lord Carter, his team and those trusts involved in identifying the recommendations and urge all trusts to implement them immediately.”