Carter Report on NHS Performance – Initial Reaction and Procurement in the Media Eye

The Carter report on efficiency in the National Health Service was issued last Friday and made the headlines. With the snappy title “Operational productivity and performance in English NHS acute hospitals: Unwarranted variations” it exposed the range of operation practices, processes and outcomes in different hospitals around the country. Procurement (or third-party spend to be precise) forms a significant element of the report.

The FT said it “painted a damning picture of a health service where bullying and harassment of staff is rife and there is little attempt to harness the NHS’s huge collective buying power”.

Others thought the identification of £5 billion a year potential savings showed the NHS could do a lot more within current budgets; others pointed out that even if this were achieved, it was less than a quarter of the £22 billion “savings” the system has to find in the next four years.

This week, we will get into a fairly detailed review of the report. There is a lot to discuss; our overview would be that there isn’t a lot to disagree with in terms of the diagnosis, but rather more to argue about in terms of the proposed treatment. We’re swinging between hope and cynicism at the moment, to be honest*. But for today, we will mainly just highlight some of the commentary on the report.

BBC TV had a feature that showed how good supply chain practice was working in Guy’s and St Thomas’ Trust. It featured their stock control system – “Doctors are shown the cost of each item as they take supplies, encouraging them to draw only the minimum they require”.

Our sources tell us that what was described as the “new system” is actually six years old, and we were disappointed not to see David Lawson on camera but it was good to hear of the procurement contribution - “the trust spends £40 million a year on clinical supplies. As a result of the new stock control system it has managed to save £4 million”. The report itself features Guys too, with a mention for the Virtualstock system we featured here.

Then we had Andy McMinn, CPO in the Plymouth Trust who was interviewed live on the Peter Allen show on BBC Radio 5 Live on Friday The feature on the Carter report is at 1.08.30 if you want to listen again (just after the hour), McMinn is on at 1.17.00.

I thought he was very good – he came over as very sensible and managed to get some good points over –issues of brand variety, data and intelligence, identifying good practice, bringing advantages via spend benchmarking. He brought up the need for the NHS to compare prices, linking it to the consumer’s ability to do price comparisons these days. He also mentioned the war for talent; the difficulty of getting good staff at the price that the NHS wants to pay.

There was a thoughtful response to the report from the HCSA (Healthcare Supply Association) which represents procurement professionals across the system. Whilst they generally welcomed the report -   - they sounded a couple of warning notes in terms of leadership and the role of the centre.

“In responding to previous DH reports HCSA has consistently pointed to a lack of leadership of the function at national level in England since the abolition of the NHS Purchasing and Supply Agency in 2010, which until its demise oversaw the development of stakeholder focused collaboration, the procurement of key categories at a national level and the development of procurement capability.

HCSA is concerned that the pace of reform needs to be accelerated in relation to the re-design of the NHS procurement landscape and its leadership. It urges the DH to publish its plan for the future Operating Model and timescales for its implementation as soon as possible and to continue to engage with those working in the profession”.

Whilst the HCSA “broadly welcomes” the report, it rightly brings up the issue of people and skills. “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”.

So what is the Spend Matters view? Not too dissimilar to HCSA really. There is lot of good stuff in the report, and when we get into it in more detail, we don’t want to sound negative or cynical. Directionally, there is little to argue with – more sharing of data, more collaboration, more joined up supply chain management, much better use of systems – it is all very good and sensible stuff.

The problems come in two main areas really. One is the perhaps inevitable “devil is in the detail” type of issue. When we look really closely, we might find fault with some of the findings. But perhaps more serious are the questions about implementation of the recommendations, as HCSA points out. More on that tomorrow anyway.

*Lord Carter has a history of taking on very complex problems like this; he produced a report on the Legal Aid system back in 2006. It read well, and like this one, it was generally well received, and yet ten years later its recommendations in the main have either proved unworkable or have just not been implemented.

Voices (2)

  1. DrGordy:

    Trouble is Pete those same headlines could have have been written 10 years ago and the real question is, what is blocking change?

    1. Mark Lainchbury:

      Nothing much is “blocking change”. But nothing is facilitating it either

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