News

Hospitals must comply with ‘best in class’ performance model – Carter

Hospitals across the NHS will have to comply with a single integrated performance framework based on a ‘model hospital’ from July, which will include a set reporting cycle from the ward to the board.

This requirement is just one of the many focuses of Lord Carter’s much-anticipated final report on how the health service can save £5bn over the next five years through efficiency reforms alone.  

Under this framework, hospitals would have to abide by a defined set of metrics and reporting standards on performance, centring around patients, workforce and finances.

The ‘model hospital’, an abstract fusion of best practice observed nationally and internationally, will act as the single source of advice for trusts on the most efficient allocation of resources and will ultimately allow hospitals to measure their performance against other trusts in the acute sector.

The framework will fully incorporate the CQC’s five existing reporting areas – safe, effective, caring, responsive and well-led, with a recommendation of developing the latter further – but will add a sixth domain around money and resources. This last area will both include financial accounts and reflect areas such as procurement, estates and use of agency staff.

The reporting cycle will also be “sharply focused, rigorous and reliable”, with some things needing to be monitored by senior executives every day, while others must be scrutinised weekly, monthly or quarterly.

According to Lord Carter, who has spoken frequently to NHE during the course of his review, the framework will ensure trusts are no longer subjected to “considerable reporting burden”. During his months working with a cohort of 32 trusts, Lord Carter’s team identified several examples of staff wasting many hours providing similar information to different organisations.

As a result, the single framework will act is a ‘one-stop shop’ for regulators, commissioners and inspectors, all of whom must agree a single set of data on which to base their work.

“This constant analysis of performance for trusts, commissioners and regulators will identify areas of variation (good and bad) that they need to improve,” the report said.

“The framework will also help trust boards hold their executive teams to account. However, there must be only one version of the truth that everybody, locally and nationally, will use to drive improvements, so we must endeavour to reduce and rationalise the plethora of reporting burdens currently placed on providers by commissioners and regulators.”

NHS Improvement should also work with NHS England, CCGs, the Department of Health, the CQC and HSCIC to “rationalise the reporting requirements on acute providers”, the report said, demonstrating a clear reduction in reporting burdens over time.

Such a framework will require hospitals to radically improve their use of modern digital technology, with best performing providers around the world around having real-time monitoring and reporting at their fingertips.

Lord Carter, a Labour peer, said his team was struck “by the immaturity of trusts’ use of such technology [as] e-Rostering systems, e-Prescribing and basic electronic catalogue for procurement”. He recommended that NHS Improvement incentivise trusts to fully utilise their existing digital systems and, where needed, allow them to invest in new technologies.

“My experience of the NHS and hospitals internationally is that high quality patient care and sound financial management go hand-in-hand,” he said. “To improve the quality of care, hospitals must grasp resources more effectively, especially staff, which account for more than 60p of every £1 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.”

Unwarranted levels of variation

As had already been indicated, Carter’s groundbreaking report found “unwarranted” levels of variation in running costs, sickness absence, infection rates and prices paid for supplies and services across the health service. At the same time that it had some of the best hospitals in the world, most trusts still need help and support in order to realise planned £5bn efficiency savings.

An improvement of just 1% in sickness absence would equate to £280m in staff costs, for example, which currently account for nearly £34bn of the total £55.6bn annual trust spend. Staff at the worst-performing trust on sickness absence are 60% more likely to be off sick compared to the best trust, meaning the NHS needs “to change [its] working practices to better motivate and support staff when they return to work”.

The review’s leader also told NHS England that its Vanguard and Success Regime projects – leading the way in terms of collaboration and coordination – should be made available to all trusts to pursue so that local doctors and nurses can help shape services around specific populations.

This is part of his centrepiece recommendation for trusts to work closely with their neighbouring hospitals, both to share services and resources and best practice in order to improve efficiency and bring down costs.

Trusts will also have to learn to be more transparent under a new requirement to publish their receipts for the top 100 items bought on a monthly basis, effective from April.

Another less conventional source of efficiency savings is energy consumption. Acute trusts spend around £500m every year on energy, but this could be reduced by as much as £125m if they invest in energy-saving schemes.

Lord Carter presented these and a string of other recommendations to health secretary Jeremy Hunt, who will urge all trusts to implement changes immediately.

“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,” Hunt said.

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

All trusts must comply

NHS Improvement’s chief, Jim Mackey, said all trusts are expected to comply with the recommendations, but those that fail to do so “will face closer scrutiny” from the regulator until they can “demonstrate appropriate grip”.

NHE has also previously revealed that trusts must proactively support the savings plan by developing a roadmap and reporting regularly on progress towards achieving the £5bn of cuts if they wish to receive a share of the government’s new £1.8bn bailout fund.

Lord Carter, who will become a non-executive director of NHS Improvement in April, also told the government that it should not lose sight of the non-acute sector and primary care. He argued that the methodology and tools developed in his review are transferable to mental health and community trusts, for example, so he sees “no reason why the same approach should not be taken”.