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08.02.16

Planned Carter savings ‘only the tip of the iceberg’

National healthcare bodies have underlined the scale of NHS challenges ahead as many claimed Lord Carter’s recommendations are just the tip of the iceberg of overall necessary savings.

The NHS Confederation’s chief executive, Rob Webster, argued that full delivery of the planned £5bn savings “will provide less than a quarter of the overall efficiencies” the health service needs to make.

“It is important to recognise the huge scale of the challenge ahead,” he added.

“Alongside this work, we will need to keep a focus on system-wide changes that deliver more cost-effective care. Hospitals alone cannot deliver changes required and they will be working on the back of efficiencies achieved in the last Parliament.”

Echoing many other senior healthcare leaders’ responses to the Carter Review, unveiled on Friday, Webster stressed that the capacity to improve services and reduce management costs will be challenging.

He continued: “As we implement the recommendations, there must continue to be close engagement with the sector and a genuine understanding of the challenge NHS leaders are facing locally.

“Overall, we need to develop a supportive working environment for local leaders. This means regulators that align better to reduce their burden on local leadership, support for organisations on quality improvement skills and capacity for change rather than capacity for maintaining the status quo.”

Health Foundation’s chief, Dr Jennifer Dixon, agreed that Carter’s portfolio of savings and supporting initiatives “are only the tip of the iceberg”.

“They won’t be enough to deliver on the £22bn efficiency savings needed by 2020-21,” she added. “What is now needed is a coherent national plan to deliver on these initiatives.

“For Lord Carter’s review to be turned into reality, we need both a supportive working environment to motivate staff and a dedicated resource. Only this will enable change at scale and pace.”

Both Dixon and Webster warned that Carter’s recommendation to cap admin costs must not be allowed to become a false economy, with the Health Foundation even arguing that while it will save money in the short-term, it could ultimately damage the health services’ ability to reform and improve.

The Nuffield Trust also signalled fears that the review’s plans to impose saving benchmarks from the top down “risk turning into another round of the kneejerk centralisation that has served the NHS badly in recent years”.

The think tank’s boss, Nigel Edwards, also claimed that because of the variety permeating the NHS, the goals and standards set out by Lord Carter may not be “flexible enough to provide safe, appropriate targets” for all hospitals.

“Pushing them out from the centre risks creating perverse incentives and encouraging manipulation of the system,” he said, adding: “The fundamental concern about the headline figures is not that there is £5bn of ‘waste’ by NHS hospitals, but that we need to find so much more.

“The savings needed from this sector by the Department of Health will be nearer £10bn. We need a credible picture of where the rest of this is supposed to come from.”

According to Edwards, trusts in England made average cost improvements of around 3.5% a year between 2011-12 and present, “significantly higher” than the 2.3% implied by the Carter review and without any “Whitehall diktats”.

Concerns were also raised about the health service’s ability to attract and retain staff across different fields.

The Hospital Consultants and Specialists Association, for example, highlighted the need to attract and develop the best procurement staff in order to optimise the delivery of the procurement function and effectively implement recommendations.

“The investment in commercial and procurement skills networks needs to be sustained over the longer term and not, as so often is the case, made in the short term and without a plan to build for the future,” its chair, Helen Lisle, said.

Other professional bodies, such as the Royal College of Nursing and the Royal College of Physicians of Edinburgh, brought forth similar concerns relating to safe staffing levels of other occupations in the health and care sector.

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