HDA Media And Political Bulletin – 5 February 2016
|Carter report paints grim picture of NHS
5 February 2016, Financial Times, Sarah Neville
Recommendations to save the NHS £5bn a year by 2020 are published today in an independent review conducted by Labour peer Lord Carter of Coles, following an interim report in June 2015. The variety across hospitals is highlighted with great differences in the levels of productivity, cost and quality of care. Up to £1bn could be saved with better procurement practices. The government-commissioned report found an “astonishing variety in the numbers of products and suppliers used across and within trusts” with just 22 hospitals using up to 30,000 suppliers. In addition, recruitment practices and use of space are identified as areas with potential for efficiency and cost savings. Health Secretary Jeremy Hunt welcomed the review, stating that it would contribute to improving the quality of patient care and ensuring an efficient use of financial resources. On the other hand, Nigel Edwards, chief executive of the Nuffield Trust thinktank and other NHS experts expressed their doubts over the centralisation of hospital services.
The HDA is working with the Commercial Medicines Unit of the Department of Health as part of the HopMop process that is examining how to make NHS secondary care procurement of medicines more efficient and useful to overall NHS performance. HopMop has fed into Lord Carter’s review and will look how many of its recommendations can be implemented.
4 February 2016, C&D, Samuel Horti
Chemist and Druggist reports that negotiations between PSNC, the Department of Health and NHS England are showing little progress. Chief Executive Sue Sharpe is pushing the Department to provide more information and materials on government proposal for efficiencies and funding cuts.
4 February 2016, Pharmacy Biz, Neil Trainis
Pharmacy Business reports on the launch of the Healthcare Distribution Association at the House of Parliament. The absence of Health Minister Alistair Burt is highlighted. Chair of All Party Pharmacy Group, Kevin Barron, is quoted stating that the Department’s view of medicines and healthcare distribution as a cost is short sighted.
|House of Commons Oral Answers, Pharmacists, 4 February 2016
Sir David Amess, MP: Will my right hon. Friend find time for a debate on pharmacy services? Having visited a local pharmacist in Prittlewell this week, I was horrified to find that as a result of overall reductions in the budget of £174 million, there is every likelihood that the wonderful range of services that our pharmacists offer will be diluted.
Chris Grayling, MP: This concern was raised last week, and the Minister responsible, the Minister for Community and Social Care, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), happened to be on the Front Bench at the time. I was able to provide an assurance to the House that he would treat this matter with great care. He is aware of the concerns that hon. Members have raised and he will be back in the House next week. This is something we have to get right, because pharmacies play an important role in local communities, and the Minister is well aware of that.
|5 February 2016, BBC News, Nick Triggle
Delays in discharging patients out of hospital after treatment could be costing the NHS in England £900m a year, an independent review has said.
Labour peer Lord Carter’s report found nearly one in 10 beds was taken by someone medically fit to be released.
It said it was a “major problem” causing operations to be cancelled and resulting in the NHS paying private hospitals to see patients.
Union Unison said cuts to social care were a major cause of “bed-blocking”.
Lord Carter identified the issue in a wider look at how £5bn could be saved by 2020.
His proposals called for better procurement and staff management, and savings to the drugs bill.
But delayed discharges are likely to be prove a more intractable problem as it is largely not down to the actions of hospitals.
Vulnerable and frail patients cannot be released if there is not the support in the community from home care workers or district nursing staff or a place in a care home.
While official statistics suggest about 5,500 patients a day are affected, the report said information provided by trusts estimates as many as 8,500 beds in acute trusts were being blocked.
It said if you take into account how much staffing and running a bed costs this works out at £900m a year.
But the true cost could be even higher. The report highlighted the growing trend to pay private hospitals to do NHS work, such as knee and hip operations, as a consequence of this.
Last year the NHS spent £11bn in the private sector – a rise of 11% on the previous year. Lord Carter said delayed discharges was likely to be a “contributory factor” in this.
Delayed discharges have also been blamed as one of the causes of growing waiting times in A&E as doctors struggle to find beds for patients who need to be admitted.
Meanwhile, Lord Carter said hospitals across England must end “stark” differences in spending and productivity, Lord Carter added.
He found the average cost of an inpatient treatment is £3,500 but said there was 20% variation between the most expensive trusts and the least expensive.
Lord Carter said: “My experience of the NHS and hospitals internationally is that high-quality patient care and sound financial management go hand in hand.”
Analysis: Savings target is just a start
Hospitals consume £55bn of health spending – about half the annual budget. So a £5bn efficiency target is very ambitious.
But as a sign of the mountain the health service has to climb in the coming years, consider this: it doesn’t even go a quarter of the way to achieving the overall savings the health service is aiming for.
In return for the extra £8bn it is getting this Parliament, the NHS has pledged to save £22bn.
It means the rest will have to come from people improving their lifestyles (and so preventing ill-health), moving care out of hospitals and into the community (which is cheaper) and keeping tight control on salaries. It promises to be a tough few years.
Lord Carter, who published an interim report in the summer, identified the following savings:
Each hospital has been set its own individual savings targets. These are not being released publicly although the progress trusts make will be monitored.
Ministers said they expected the savings to be made.
Christina McAnea, head of health for Unison, which represents many NHS workers including nurses, paramedics and administrative staff, said the report contained many good ideas.
However, she said the report failed to address the lack of social care in the community that was the “main reason why people can’t be discharged”.
“On average social care has been cut by around 25% and that has an almost immediate knock on effect in the NHS, because you can’t discharge patients unless you’ve got the infrastructure back in the community to support them,” she said.
“And that’s where we’ve seen massive cuts, so it’s about care workers, some community nursing, it’s about health visitors.”
Health Secretary Jeremy Hunt said: “This ground-breaking review will help hospitals care for patients, making sure every penny possible is spent on front line patient care and bureaucracy is slashed so doctors and nurses can concentrate on caring.”
Shadow health secretary Heidi Alexander said: “This report is absolutely right to highlight the huge financial pressures that delayed discharges are placing on the NHS. However, ministers cannot shy away from the fact that this is a crisis in care that has happened on their watch.”
5 February 2016, The Guardian, Dennis Campbell
The NHS is wasting billions of pounds a year through inefficient use of staff, paying over the odds for supplies, “bedblocking” and undue reliance on agency workers, two official reports warn on Friday.
Around 8,500 “bedblocking” patients are stuck in NHS hospitals every day – costing the health service £900m a year and driving up use of the private sector.
An inquiry ordered by health secretary Jeremy Hunt into NHS productivity and use of its resources has found that hospitals in England could save £5bn a year of their £55bn budget by 2020 using measures such as cutting their running costs and reducing unacceptable variations in the quality of care that patients experience.
The review, undertaken by the Labour peer Lord Carter of Coles, claimed that hospitals are not making the best use of their income and need to improve urgently if the NHS is going to make the £22bn a year of efficiency savings it has pledged to deliver by 2020-21.
“The NHS is expected to deliver efficiencies of 2–3% per year, effectively setting a 10–15% real terms cost reduction target for achievement by April 2021. While the NHS ranks as the best value healthcare system in the world, we know more could be done to improve quality and efficiency in our hospitals so they can meet this expectation,” the report says.
Carter’s inquiry, based on a detailed examination of how 136 of England’s 156 acute hospital trusts operate, urged trusts to reduce “unwarranted [and] inexplicable variation” in key areas of medical practice as a way of making savings.
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For example, while only 0.5% of patients who have a new hip or knee fitted develop an infection afterwards, in some hospitals it is 4%, which costs money because the patient stays in longer and needs more treatment. If every hospital could reduce that margin to 1%, that would save £300m a year, according to Carter. Tackling variation in running costs could save another £1bn, he estimated.
Similarly, hip replacements cost £788 in some hospitals but elsewhere can cost double that – £1,590. From April, the price trusts have paid for routine items such as bandages, needles and rubber gloves will be published to stop them “paying wildly varying costs for the same goods”.
Less efficient hospitals need to learn from more efficient ones and improve their practice to save money, Carter said.
Tackling “delayed transfers of care”, patients who are fit to go but cannot be released because social care is not in place, would save £900m. Around 8,500 such patients are stuck in hospitals every day, far more than the 5,500 previously thought, Carter’s research found.
Trusts also make “significant” savings by reducing the amount of sick leave staff take, which can also vary widely, and working with nearby hospitals to ensure services are not duplicated unnecessarily.
In a separate report the National Audit Office warns that the NHS’s systems for recruiting doctors, nurses and midwives are “fragmented”, inefficient and expensive.
In 2015 the service was short of 50,000 staff, a 6% vacancy rate, and was becoming increasingly reliant on expensive agency staff to plug gaps in rotas.
“Given the size of the NHS, workforce planning will never ben an exact science, but we think it clearly could be better than it is,” said Amyas Morse, the head of the NAO. Labour said cuts to the number of nurse training places in recent years had created critical shortages of staff.
The Royal College of Nursing warned that Carter’s moneysaving drive could ultimately endanger patient safety. “The focus on efficiencies must not be at the expense of safe care. In the past efficiency drives have eclipsed the focus on safe staffing levels and patient care. In the future the two must go hand in hand,” said Janet Davies, the RCN’s chief executive.
“All the evidence shows that it is the number of registered nurses which has the biggest impact on patient care in acute settings and any new metric to measure staff deployment must not be used by trusts to hide a diluted skill mix,” she added.
NHS experts voiced other doubts about Carter’s plan. Nigel Edwards, chief executive of the Nuffield Trust thinktank, warned that hospitals could see so many NHS-wide targets as “another round of the kneejerk centralisation that has served the NHS badly in recent years”.
The NHS needs to find closer to £10bn of efficiency savings, double the £5bn Carter has identified, but does not know where they will come from, Edwards added.
Chris Hopson, chief executive of NHS Providers, which represents hospitals, said trust bosses would be “nervous” about having targets foisted on them, such as their running costs being no more than 7% of their income. He also questioned a central plank of Carter’s strategy by insisting that there can sometimes be good reason for variation in performance existing between trusts.
5 February 2016, National Health Executive
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”.
5 February 2016, Daily Mail, Sophie Borland
The crisis is costing the health service £900 million a year and is far worse than previously thought.
Separate figures show that the NHS is short of an estimated 50,000 doctors, nurses and other clinical staff.
Almost 6 per cent of posts at hospitals and other organisations are vacant and they are relying heavily on agency workers.
A new report commissioned by the Government estimates that the NHS could save up to £5 billion a year by becoming more efficient.
It was written by Labour peer Lord Carter, who spent 18 months comparing how a sample of 32 hospital trusts are run.
His main findings reveal that:
Patients having hip and knee operations at some hospitals are eight times more likely to develop infections than at others.
More than two-thirds of space in some hospitals is taken up by offices, store rooms and labs – not wards treating patients.
Some trusts are ten times more expensive to run than others.
NHS staff take an average of two-and-a-half weeks off sick each year.
The NHS is facing its worst financial crisis in a generation as it struggles to meet the needs of the ageing population and pay for increasingly expensive treatments.
Three-quarters of hospital trusts are currently in the red, and they are expected to record a combined deficit of £2 billion this year.
Lord Carter – a businessman who has chaired several Government reviews – was commissioned in June 2014 to look at hospital waste.
But one of his main concerns is that hospitals are wasting valuable time and money caring for patients who shouldn’t be there at all.
NHS figures for bed-blocking are currently amongst the worst on record. In the last recorded month a total of 153,000 days were lost due to patients not being discharged because they cannot be looked after in the community.
Labour MPs and health experts blame Government spending cuts, which means councils have less money to pay for elderly care at home.
Lord Carter’s report urges trusts to set up ‘cottage hospital’-style wards to house patients who are well enough for discharge, but not ready to live independently.
This is being trialled by Mid Yorkshire NHS trust, based in Wakefield, which has set up a 42-bed unit outside the main hospital.
Lord Carter said that if hospitals implemented all his recommendations they would save £5 billion a year by 2020.
He said: ‘My experience of the NHS and hospitals internationally is that high quality patient care and sound financial management go hand in hand.
‘To improve the quality of care hospitals must grasp resources more effectively – especially staff – which account for more than sixty pence of every pound 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.’
Health Secretary Jeremy Hunt, who commissioned Lord Carter to carry out the review, added: ‘I want to make the NHS the safest healthcare system in the world, capable of providing the same world class care every day of the week, powered by a culture of transparency and learning.
‘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.’
Lord Carter also found that the average NHS worker is absent for 6 per cent of their working year.
This is equivalent to 13 days working days – two-and-a-half weeks – and three times the amount of sick leave taken by private sector employees.
The new report said hospitals must ensure that offices, labs and store rooms take up no more than 30 per cent of their space.
It also warned that deep wound infection rates following hip and knee replacements varied from 0.5 per cent at the best trusts to 4 per cent at the worst.
This means patients are eight times more likely to develop infections at some hospitals.
The report estimated that 6,000 patients would avoid becoming infected if the worst trusts improved care.
Meanwhile, separate figures from the National Audit Office estimate that 6 per cent of clinical posts are vacant at hospital trusts and other NHS organisations.
This equivalent to almost 50,000 doctors, nurses and other staff, including physiotherapists and radiographers who read x-rays.
Labour MP Meg Hillier, chair of the Public Accounts Committee, said: ‘Demand for healthcare is increasing but the numbers of clinical staff in England is not keeping pace.
‘More than one in twenty of clinical posts are unfilled, putting services and patient care at risk.
‘Alarmingly these posts are budgeted for, so the money is there to pay staff – but still they are unfilled.
‘This means additional pressure on budgets as hospitals often then need to use expensive agency staff, adding to the cost pressures they face.’
5 February 2016, ITV News, Report
A comprehensive 18-month review into how the NHS can become safer and more efficient has found billions is wasted every year by Trusts on variations in care and finances.
The review sets out plans for each trust and aims to save the NHS £5 billion annually. The report, compiled by efficiency expert Lord Carter and set to be published today, found unwarranted differences in hospital running costs, sickness absence, infection rates and prices paid for supplies and services.
In order to maximise the £102bn annual budget allocated to the NHS, Lord Carter has advised hospitals to end variations in quality of care and finances that cost the NHS billions by standardising procedures, be more transparent, and work more closely with neighbouring trusts.
My experience of the NHS and hospitals internationally is that high quality patient care and sound financial management go hand in hand.
To improve the quality of care hospitals must grasp resources more effectively, especially staff, which account for more than sixty pence of every pound hospitals spend.
Some of the variations Lord Carter found across the NHS during his review are outlined below:
Average running costs for a whole hospital (£/m2) vary starkly at different trusts starting at £105 at one trust and going as high as £970 for another.
Infection rates for hip and knee replacements vary from 0.5 – 4% – meaning you’re eight times more likely to contract an infection at the worst trust, compared to the best.
Prices paid by different hospitals for hip replacements vary from £788 to £1590.
The use of floor space varies significantly with one trust using 12% for non-clinical purposes and another using as much as 69%.
Sickness and absence rate vary from 3.1% to 5% – meaning staff are 60% more likely to be absent due to sickness at the worst trust compared to the best.
Some of the recommendations in Lord Carter’s review are listed below:
The NHS should end the use of outdated and inefficient paper rosters and implement electronic rosters.
Improving staff productivity by five minutes every shift could save the NHS £280m a year
Trusts should publish the time doctors and nurses are able to spend caring for patients, to improve patient care.
From April 2016, trusts will publish their receipts on a monthly basis for the top 100 items bought by the NHS.
Increased transparency will drive down prices and end the days of trusts paying wildly varying costs for the same goods – saving hospitals £1 billion a year by 2020-21.
Trusts’ unused floor space should not exceed 2.5%.
Expenditure on administration should not exceed 7% by 2018 and 6% by 2020.
Hospitals should work with local government representatives to ensure patient care is also focused on recovery to tackle the issue of bed blocking
Trusts should work closely with their neighbouring hospitals, sharing services and resources in a bid to improve efficiency and drive down costs.
As part of the review, a ‘model hospital’ has also been developed which will advise trusts on the most efficient allocation of resources and allows hospitals to measure performance against other trusts.
It has been shaped by Lord Carter’s experience of best performing hospitals in the NHS and internationally and will enable trusts to replicate those examples.
Lord Carter suggests implementing the tool will save hospitals £5 billion a year by 2020-21 and put an end to the variation the review uncovered across the NHS.
Health Secretary Jeremy Hunt.
Lord Carter was asked to undertake the review by Health Secretary Jeremy Hunt. Health Secretary Jeremy Hunt welcomed the findings and recommendations of the review.
He said: “I want to make the NHS the safest healthcare system in the world, capable of providing the same world class care every day of the week, powered by a culture of transparency and learning.
“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.”
Lord Carter will continue to engage with and support trusts to realise the efficiency improvements they can make over the coming months.
NHS Improvement will lead the implementation of the recommendations and Lord Carter will become a non-executive director of the regulator in April.
5 February 2016, The Telegraph, Laura Donnelly
The NHS could save £1bn if it sold off swathes of surplus land, a Government report has found, as it reveals hospitals are devoting as little as one third of their space to patients.
The head of the review told The Daily Telegraph that the worst hospitals were operating a “Soviet-style model” which failed to put the needs of patients or taxpayers first.
Lord Carter of Coles said the NHS could release a total £5bn a year in savings if hospitals streamlined their ways of working, to tackle a ten-fold variation in their running costs.
“The worst hospitals are running Soviet-style models with an attitude of ‘you are lucky to have it, now wait in a queue”
The national probe found some hospitals are devoting as much as 69 per cent of their space to “non-clinical” purposes, with swathes of buildings left empty or devoted to offices for administration.
The Labour peer, asked by Jeremy Hunt to review productivity and performance, said “slack attitudes” in the NHS had allowed office space to expand while wards were left mothballed.
Lord Carter said “a significant amount of surplus land” in the NHS should now be sold off, and the use of existing buildings reviewed. Up to £1bn could be released simply by selling off unused land and buildings, and making better use of others, the review found.
Lord Carter said moves to digitise patient records had gone too slowly
At the worst trusts, just 31 per cent of space was used for “clinical” purposes, such as wards, operating theatre, clinics and waiting rooms. On average, 43 per cent of hospital space was found to be being used for “non-clinical purposes” such as office space and staffrooms.
“This ground-breaking review will help hospitals care for patients, making sure every penny possible is spent on front line patient care and bureaucracy is slashed so doctors and nurses can concentrate on caring”
It came as a report by the National Audit Office declared a shortage of 50,000 doctors and nurses, despite a six-fold rise in nurses coming to Britain from other EU countries in the past decade. MPs said widespread staff shortages were putting patients at risk.
Lord Carter last night said the NHS needed to give the needs of patients a higher priority.
Controversially, he called for the wider introduction of “call centre” models to help patients to book hospital appointments, saying current systems were not responsive enough.
“The worst hospitals are running Soviet-style models with an attitude of ‘you are lucky to have it, now wait in a queue,’” he said.
The peer said hospitals needed to radically overhaul their use of hospital buildings, to divert as much money as possible to the frontline, under new efficiency targets.
“When you’ve got a slack attitude you can end up with administrators using large areas which were supposed to be clinical space, and wards shuttered up,” he said.
Extra NHS cash is contingent on trusts promising changes in the way services are delivered
Jeremy Hunt said the recommendations would allow doctors and nurses to spend more time on patient care
“It is in the interest of every citizen for us to run the NHS as efficiently as we can – every £1bn saved stops taxes going up. We’ve got to squeeze everything out of it that we can.”
“Why should a hospital have 68 acres of land which could be used for houses, for businesses, contributing jobs to the local economy?” he added.
The review found that levels of “bed-blocking” are costing almost £1bn a year, with around 8,500 elderly patients a day are stuck in hospital for want of basic care at home or in the community.
Mr Hunt said: “This ground-breaking review will help hospitals care for patients, making sure every penny possible is spent on front line patient care and bureaucracy is slashed so doctors and nurses can concentrate on caring.”
5 February 2016, Sky News
The report highlights areas where the NHS could cut costs as it aims to hit the target of saving £5bn a year by 2020.
“Bed-blocking” patients are costing the NHS £900m every year, a report has found.
The health service looks after around 8,500 patients every day who would be fit enough to leave if care had been organised in the community.
In the Government-commissioned report, Lord Carter of Coles attempts to set out how the NHS can hit the target of saving £5bn a year by 2020.
“Nearly all trusts wrestle with the problem of moving those who are medically fit into settings that are more appropriate for the delivery of their care or rehabilitation, and for the families and carers,” the report said.
“These delays also have a knock-on effect resulting in cancellations of elective operations because of a lack of bed capacity, and work going out to the independent sector.
“NHS expenditure in the non-NHS sector has increased in recent years, and currently stands at over £11bn per annum.”
The report also found large differences between trusts in staff absence and sickness rates.
It said improving staff productivity by five minutes every shift could save the NHS £280m a year.
Health Secretary Jeremy Hunt said: “This ground-breaking review will help hospitals care for patients, making sure every penny possible is spent on front line patient care and bureaucracy is slashed so doctors and nurses can concentrate on caring.”
Shadow health secretary Heidi Alexander said: “This report is absolutely right to highlight the huge financial pressures that delayed discharges are placing on the NHS.
“However, ministers cannot shy away from the fact that this is a crisis in care that has happened on their watch.”
5 February 2016, Health Service Journal, Lawrence Dunhill
Hospitals must rapidly find ways to reduce delayed transfers of care by taking more responsibility for post-discharge services, Lord Carter has told HSJ.
The Labour peer was speaking ahead of publication this morning of his long-awaited review of NHS productivity, which sets out the detailed steps he argues will save £5bn across the acute sector by 2020.
The wide-ranging recommendations touch on almost every aspect of the hospital sector, from clinical workforce management, to procurement, to administration and corporate costs.
HSJ revealed extensive details from the report last month, including recommendations for a “single reporting framework” through which savings opportunities can be identified.
But in an interview with HSJ yesterday, he warned that a “significant proportion” of the estimated £5bn savings in the acute sector “cannot be unlocked” unless delayed transfers are managed more effectively.
He also told HSJ that:
Most hospitals have acknowledged that significant savings can be realised by improving staff rosters. He recommends that all trusts have electronic roster systems by October 2018.
“Persuasion and assistance” must be used to ensure trusts deliver their Carter savings, rather than a “national do this, do that” approach.
His model hospital should give more power to trust non-executives, who in many places have been “powerless” due to a lack of data.
Lord Carter said his work initially focused on ways that hospitals can reduce costs, but he soon realised that delayed transfers were a crucial part of the picture. He found many cases in which trusts were losing revenue due to cancelled elective operations, and salaried clinicians were left “sitting around”.
The blocked beds also resulted in work going out to the independent sector, for which NHS provider expenditure increased by about a third last year, to £482m.
He said hospital trusts should be “taking their own fate into their own hands” by taking responsibility for, or contributing to, the post-acute phase of care. He suggested accountable care organisations, currently being tested in some areas, could ensure the financial incentives are better aligned.
Asked whether hospitals could realistically tackle delayed discharges given the funding cuts to social care services, he said: “A number of hospitals are saying ‘we’re going to contribute to step down care and we’re going to contribute to the post-acute phase so we can clear the beds, (because) it’s in our total self-interest’.
“In some areas they’re working well with local government and social services. They’re saying we’ll pay for some of this, and some areas are now moving towards building, with the independent sector, stepdown care facilities and sort of taking their own fate in their own hands.”
His report cited Mid Yorkshire Hospital Trust, which recently opened a 42-bed stepdown facility in Pontefract, as well as the Dudley Group Foundation Trust, which has halved the days spent in hospital by fit to discharge patients by working with care broker CHS Healthcare, as examples of successful schemes.
His report, Operational Productivity and Performance in English NHS Acute Hospitals: unwarranted variations, estimates that about 8,500 acute beds are “blocked” each day in the acute sector, costing NHS providers around £900m per year.
On staff rosters, Lord Carter said he found cases in which trusts were squeezing nurses on to weekday shifts in order to make up their weekly hours, and said improving productivity by five minutes per shift could save as much as £280m.
Responding to the report, NHS Improvement chief executive Jim Mackey said: ”We will do everything to help trusts implement these recommendations, but those that fail to do so will face closer scrutiny from NHS Improvement until they can demonstrate appropriate grip. ”
When asked about the approach regulators should take, Lord Carter said: “What I’ve constantly advocated is [the recommendations are] not used as a stick, they’re used as a tool to hold the debate…
“I hope what’ll happen is it’s taken on a hospital by hospital basis and it’s bottom up, with the NHS Improvement team understanding line by line the hospital’s challenges. No big sort of national ‘do this or do that’, but ‘you’re doing that very well, perhaps you can tell me so I can make sure the others do it’, or ‘looking at this we don’t think you doing that very well, we’ll be back in a couple of months and you can tell us what you’ve done’.
“This isn’t a system you can run by bullying it, you’ve got to lead it. It’s reall,y really important that we stick together.”
Asked how the NHS could expect to find £22bn of efficiency savings by 2020-21, as required under the Five Year Forward View, given that more than half of NHS England’s budget is spent on the acute sector, Lord Carter said: “There’s community and mental health to go. (But) it’s not something I’ve been asked to look at. I’m very confident we can deliver (£5bn)…..You have to ask the Olympians for the rest of the view. I’m just one of Santa little helpers.”
Lord Carter is now set to join NHS Improvement as a non-executive director.
He recommends the broad set up metrics outlined in the report should begin being collected by regulators from April, with the first full phase of the “model hospital” tool completed by April 2017.
4 February 2016, Pharmacy Biz, Neil Trainis
The Healthcare Distribution Association UK, the organisation that has replaced the British Association of Pharmaceutical Wholesalers, was officially launched to the backdrop of much anticipation at the House of Commons in the absence of one notable figure.
Alistair Burt, the minister for community and social care, was expected to turn up at the ceremony but failed to show, apparently due to “other parliamentary business,” according to one attendee.
The event, however, was attended by Sir Kevin Barron, chair of the All Party Pharmacy Group, and members of the now defunct BAPW along with pharmaceutical company executives.
In the run-up to the launch the BAPW said the HDA would “better reflect the broader range of activity” carried out by its member companies who not only provide medicines and wholesaling services to pharmacists, hospitals and dispensing doctors but also a “more varied and comprehensive healthcare services to ensure that patients gain access to the treatment they need in the right place, at the right time.”
Martin Sawer, executive director of the HDA, said: “The new Association wants to engage with the supply chain partners on a broader front to better represent the changing services our members now offer.
“Our re-launch is also about attracting new more specialised and bespoke health distribution businesses to the Association, as innovative practices and technologies make new services possible for manufacturers and to those who dispense medicines, reflecting the needs and choices of individual patients.”
Barron said he hoped ongoing consultation into the future of community pharmacy and government cuts to funding, which he described as “very worrying,” would consider the value of the distribution industry.
“I hope the current consultation taking place on the future of community pharmacy takes into account the value of the distribution industry. There are no statutory requirements for the NHS to pay for distribution,” he said.
“Medicines and healthcare distribution has been viewed as a cost. This would seem to be very short term and short-sighted. The value of distribution is in consolidating medicines into individual orders and getting those orders when they are required every day by manufacturers, pharmacists, doctors and patients.
“Of course the cost question would be brought into sharp focus if distributors and wholesalers were not around to do this. The correct question would be ‘what would be the cost to the NHS if wholesalers and distribution did not exist?’
“That seems to be a question the NHS never asks. It assumes it’s there, it gets around and they don’t have to deal directly with it.”
From Factory to Pharmacy
As part of our mission to build awareness, understanding and appreciation of the vital importance of the healthcare distribution sector, we developed an infographic explaining the availability of medicines. It identifies the factors that can impact drug supply, as well as the measures that HDA members undertake day in, day out to help mitigate the risks of patients not receiving their medicines.See the Infographic
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