Carter breaks down £5bn savings by specialty ahead of NHS-wide travels

Following Lord Carter’s June report that identified the NHS could save up to £5bn a year by 2019-20 through efficiency measures, he has now published this data broken down by clinical specialty – revealing huge variations across hospitals.

For the first time, the activity undertaken by all NHS hospitals was reviewed together, with results showing huge variations in terms of clinical costs, infection rates, readmission rates, litigation payments and device and procedure selection.

The review helped emphasise the massive opportunity to tackle variations and reduce spend while improving patient care, such as by adopting best practice or reducing supplier costs for medical devices.

Carter is sending this data to the 137 acute trusts across England today (21 October) to allow them to compare how they are performing by clinical area, such as paediatrics or orthopaedics, against hospitals with similar levels of demand.

He will also be spending the coming weeks meeting with trusts to discuss the savings target he gave them in each clinical area in order to finalise and publish these targets early next year.

The targets will be published alongside a ‘model hospital’ showcasing best practice so that local leaders can mirror these performances, but further details of this will be announced in 2016.

Carter hopes to enable trust bosses to draw up more detailed improvement plans specifically targeting waste and identifying areas of potentially large improvements by reducing service variation.

“Our best hospitals offer patients an excellent service and they are up there with the very best in the world and we want to make sure all NHS hospitals meet these high standards of care.

“The route to better care is to empower NHS leaders, so giving them the data and support they need means they can improve how they care for patients and make savings which can be reinvested in front-line care,” Carter said.

The £5bn savings, broken down by specialty, are:

  • General Medicine: £381m
  • Obstetrics and Gynaecology: £362m
  • Trauma and Orthopaedics: £286m
  • Pathology: £256m
  • Cancer Services: £255m
  • Emergency Medicine: £254m
  • General Surgery: £235m
  • Community Nursing: £217m
  • High Cost Drugs: £213m
  • Paediatrics: £209m
  • Intensive and Critical care: £209m
  • Cardiology: £184m

How to achieve savings

Carter looked into national finance data, reference costs and other information from each specific trust, as well as studied healthcare systems from abroad – programmes in the US, Germany, Australia, Italy and France.

He found that savings could be achieved through a variety of ways, but often come down to improving simple processes. North Bristol trust doctors, for example, could buy fewer types of replacement prosthesis in larger quantities through better procurement and clinical practice – driving down the price due to their larger buying power and saving around £227m a year.

Similar savings could be made by reviewing the policy of hip replacements for over 70s and adopting robust clinical evidence to drive money-saving changes that offer better mobility for patients and reduce the chances of unwanted revision surgery.

Likewise, Leeds Teaching Hospitals saved on cash by encouraging clinical staff to put together sessions for patients needing treatment with expensive injectable medicines. Pharmacy staff then prepared the medicines in batches in advance prior to patients’ clinical attendance, helping reduce waiting times and making better use of resources and expertise. Preparing medicines in pharmacy also decreased expensive waste since vials of medicines could be shared between patients. As a result, the trust has saved £1.25m each year – equivalent to the cost of 30 extra nurses.

NHS interviewed the trust’s head of supplies and procurement last year, Chris Slater, during which he explained the Leeds provider’s approach to central materials management and procurement processes, such as within elective orthopaedic stock.

And Professor Tim Briggs, the newly-appointed national director for clinical quality and efficiency, pioneered a programme in orthopaedics set to improve patient care by reducing the need for expensive revision surgery by cutting down on less effective surgical products and promoting better techniques to improve post- treatment infection rates.

Briggs, who NHE interviewed in his capacity as director of strategy and external affairs at the Royal National Orthopaedic Hospital, will work with other leading surgeons and physicians to roll out this programme to another nine clinical specialities – such as emergency medicine, intensive and critical care, and paediatrics.

He said that, while delivering a national review of elective orthopaedics as the president of the British Orthopaedics Association, he visited 211 hospitals across the NHS. During his visits, he identified areas of unwanted variation in practice that led to unsatisfactory outcomes.

“In light of the financial austerity the NHS faces, we have a duty to make sure that we reduce unwanted variation and complications, in order that our resources can provide patients with the high quality care they require.

“I have now been tasked with implementing the solutions to drive up quality in orthopaedics, and lead the same methodology and approach across a further ten specialities in my capacity as the national director of clinical quality and efficiency,” Briggs added.

A safer and more efficient NHS

Carter and Briggs will work with clinical and non-clinical experts and advisers who will travel the country over the next few months to support trusts in implementing improvements.

The review also forms an essential part of the health secretary’s drive to make the NHS safer and more efficient.

The health secretary, Jeremy Hunt MP, said: “We’ve giving the service £10bn extra during this Parliament, and it is vital to use that money to secure the best outcomes.

“So I’m grateful to Lord Carter, his team and those trusts that have worked to identify ways in which hospitals can become more efficient precisely by doing the right thing by patients.”

He added that he was delighted to appoint Briggs to his new role, saying he will help the NHS save money in the long-term by adopting “good care that costs less”.


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