Care Pathways


Lord Carter finds ‘critical variations’ in community and mental health review

Provision and efficiency of community health services need to be “significantly strengthened,” alongside a greater and stronger workforce to meet the needs growing demand for mental health, are amongst the findings in the latest review into NHS practices by Lord Carter.

Today’s delayed but much-anticipated and major 86-page report, which is the result of engagement with several mental health trusts and providers of community services since January last year, found the need for a stronger mechanism for sharing between the two services.

“As a result of that engagement, this review has identified critical and unwarranted variations in all key resource areas,” the document’s foreword said.

“It is clear from the performance of some providers that parts of the sectors know what to do well – the challenge we face is how we raise the average standard of performance closer to the level of the best. Our work has identified four important areas where operational improvement must be made.”

These areas include contract specification, currently “inconsistent and overly bureaucratic”; technology, whose use is not optimal at present, lagging behind even other public sector services; delivery, which included a proposed new regional structure across NHS Improvement and NHS England; and staff. 

For example, effective staff rostering, training, and job planning were cited as factors currently “missing in too many providers” of mental and community services, and a high level of bullying and staff harassment were identified by Carter as “inconsistent” with the national mantra that medical staff are the NHS’s most valuable asset.

The use of technology was particularly of interest in the report – with over a quarter of community nursing services still operating paper-based systems, the inability to provide a single view of the patient across organisations was labelled “lamentable.”

“This lack of investment in adequate systems is indefensible in 2018, and means valuable staff time is wasted and patients do not receive the best care,” Lord Carter continued.

Effective national leadership across community and mental health were seen as the main driver behind productivity improvement within community hospitals, as it gives services a “much clearer idea of ‘what good looks like.’”

Lord Carter also recommended extending the scope of community and mental health services to the Getting it Right First Time (GIRFT) programme and identifying more efficient and high-quality pathways of care for patients.

The report added: “In summary, we could find no reason why the system should not move more quickly to adopt best practice, save for the constraints of capability and capacity.”

Providers ‘look forward’ to implementing recommendations

Responding to the findings, head of policy at NHS Providers Amber Jabbal said: “Highlighting unwarranted variation in key areas for the first time presents a new opportunity for trusts to improve their productivity and providers look forward to working with NHS Improvement to implement the recommendations.

“The inclusion of mental health services in GIRFT is a welcome – if overdue – recognition that this is as important as acute physical health services, and we strongly support the recommendation to extend this to community health services.”

But Jabbal noted that above all, the services require adequate funding and action to address staff shortages.

“We need to seize the opportunities presented by the push for integrated care and the prime minister’s commitment to increase long-term health and care funding to make good on past promises, and bring NHS community services centre stage,” she added.

Today’s report follows on from Lord Carter’s major review of operational productivity and performance in the acute sector, which identified a potential £5bn worth of savings across the health service.

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