Carter: recipe for success

by Lisa Robertson

28 July 2017

Lord Carter’s report on productivity in acute hospitals provides the platform for individual trusts to understand and act on unwarranted variation across a range of activities. To make a difference, the challenge now is for finance leaders and clinicians to work together to explore the information and create effective solutions.

This was a key theme emerging from the recent Finance Skills Development (FSD) event: Carter review: understanding to implementation. It was great to see sharing in action with a full day, led by Paul Corlass, deputy director of finance at Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, with fast paced discussion of peoples own experiences.  All of us left with a greater understanding of Carter and how it can be used, contacts of others grappling with the same issues plus a new found knowledge of acronyms!

The Carter review set out 15 high-level recommendations across both clinical and non-clinical areas. Many of the recommendations are interlinked. In particular, recommendations one and two on developing people and structure are vital to ensure the implementation of all.

The latest HFMA NHS financial temperature check, published in July, found that over 50% of respondents expect to meet the recommendations in the medium term.  Most progress has been made against the recommendation to report procurement information monthly to NHS Improvement.  The least developed areas are in non-pay cost savings and clinical floor space with 47% and 43% of respondents respectively reporting that they are either not expecting to meet these recommendations in the medium term or do not know how they are performing against them.

There are many reasons for unwarranted variations and the key to reducing this is in first understanding what and why. This is where the Model Hospital, emerging from the Carter review, can be powerful.  In an era where hospitals have developed autonomous working, a picture of comparable performance is a helpful starting point for change.

Recognising that the challenges and solutions may be at a system-wide level, the data can also be provided across a place footprint. Concerns raised by some over the accuracy and comparability of data should not be used as an excuse not to use it. It should be used as a diagnostic tool, supplemented with other trust information, to inform discussions between clinicians and finance managers.

As Emmi Poteliakhoff, NHS Improvement’s director of Model Hospital and analytics, commented at the recent HFMA Convergence conference, it is particularly useful to support difficult conversations within a trust.

What works, as highlighted at the FSD event, can be grouped into the three themes of people, information and time. The common key success factor to progress was getting the people and structure right – are the right people in the right place?  To support this, there is a wealth of information available – such as the Model Hospital, the Getting it right first time programme and NHS Improvements’ 10 point efficiency plan – to help organisations and systems in providing a starting point for review. Then turning ideas into action requires time and understanding.  Is there head room to think ideas through, are clinicians and finance officers working together to ensure a joint understanding, do processes add value and are meetings action focussed?

The FSD event provided much food for thought from people’s own experiences in acting upon the Carter recommendations.  It reinforced the importance of working together and developing a shared understanding to ensure resources available are spent in the best possible way.  The information emerging from the Carter review helps us to understand the issues and it is what trusts now do with this that will make a difference.

The HFMA will be reviewing this area further over the coming months.
If you want to feed into this by sharing the key issues you are facing or feedback from your own experiences, please contact