Lord Carter: Savings must ‘pursue value with same rigour as quality’

With the provider deficit on course to hit £550m this year, NHS trusts must make sure all their resources are working as best as they can and are driving efficiencies, Lord Carter has said – including plans to consolidate back-office and pathology services.

Speaking at the Health+Care Show, the procurement tsar, who has identified £5bn of savings for acute trusts by 2020, told  delegates that while quality is always top and is non-negotiable, “that does not mean we shouldn’t pursue value with the same intent and rigour”.

He also referred to an NHS Improvement (NHSI) letter, sent out by Jim Mackey and Ed Smith this week, which says the regulator has set a target to reduce the deficit to £250m through a combination of efforts, mainly driven by STPs.

Lord Carter said NHSI is really important as it is trying to work out an operating model which is based firmly in the belief that people need support.

“You will see the first two of these things coming through soon, as it is going to be about back-office functions and pathology,” he added.


The letter highlighted that NHSI will try and reduce the deficit by reducing paybill growth in selected providers, and back-office, pathology and elective services through consolidations.

“I know a little bit about pathology because I wrote a report 10 years ago, which said we could save £300m per year,” said Lord Carter. “That is 10 years ago now, and we blew £300m. How long can we go on like this? How long can we not be doing what we should be doing? We need to work it through.”

The NHSI letter referenced Lord Carter’s recent review, and his pathology report, stating that “there is still a significant potential saving if back office services and pathology services are consolidated on a regional basis”.

The regulator added that it will be asking all 44 STP leads to develop proposals to consolidate back-office and pathology services with outline plans to be agreed before the end of July.

“When you look at integrated care we still work in all these silos,” said Lord Carter, a non-executive director of NHSI. “I think it is the major area to drive productivity.

“One of the things that the back-office work is going to show us is how much time is still going to processing paper, when it should flow into the patient record electronically. That, really, is what’s going to come out of the next piece of work.”

The NHSI letter added that by the end of July, STPs will be asked to identify where planned services that are heavily reliant on locums could “either be consolidated, changed or transferred to a neighbouring provider”.

Earlier this week, NHSI also opened a consultation to introduce a new single oversight framework for both NHS trusts and foundation trusts

STP challenges

The potentially game-changing STPs have, however, come under pressure in recent weeks with yesterday’s submission deadline watered down to ‘work in progress’, with the plans only forming “the basis for discussion”. Jeremy Hunt also recently described the STPs as “very simply” being about reducing hospital bed days.

But Stephen Dorrell, the chair of NHS Confederation, said STPs should be used to deliver “a new vision” of integrated public services. But some speakers at this week’s Health+Care conference warned that STPs may face challenges to implementation.

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Anon   05/07/2016 at 13:47

Given all the problems with TPP/Addenbrokes, which was predicated on Carter's Pathology report, this looks shaky. Addenbrokes have haemoraged £15m last year alone, and now are set to pull out. If a 4 year process can't get that right, how on earth can trusts pull it off in a month?

Anaon   12/07/2016 at 00:04

Pathology is not a back-office function; it is integral to the patient pathway. "Now is a good time for boards to review their approach to pathology as one of the key diagnostic disciplines. Strategies that go well beyond delivering efficiency savings are essential if providers are to deliver the full value of what pathology can offer to service transformation." Nuffield Trust. Let's not forget the savings already made by Pathology and how cheap pathology in the UK is compared with the rest of the world. To focus just on reducing cost will stifle innovation and service transformation and risks destroying a key essential service.

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