Carter review

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Title of Report: Carter review
Lord Carter of Coles
Year of Publication
Commissioned by Department of Health to examine what could be done to improve efficiency in hospitals in England
Scope of report
Main Findings or Recommendations
Criticisms and Limitations
Other comments

Lord Carter of Coles was asked in June 2014 to examine what could be done to improve efficiency in hospitals in England. The conclusion was that hospitals must standardise procedures, be more transparent and work more closely with neighbouring NHS trusts. A reference model hospital has been created as a benchmark for efficiency. The new metrics to be used are the adjusted treatment cost (ATC) and the weighted activity unit (WAU). Care Hours Per Patient Day (CHPPD) will from April 2016 become the standard metric for healthcare assistant and nursing staffing on NHS wards.

This unwarranted variation was worth £5bn in terms of efficiency opportunity, about 9% of annual spend on secondary and tertiary care. NHS Improvement will commence monthly monitoring of new metrics.

The final report was published on 5th February 2016 [1]. An interim report was published June 2015[2]

The review identified as examples the following unwarranted variations:

  • Running costs for a hospital (£ per square metre) range was £105 to £970 (aim to be lower than £320)
  • Deep wound infection rates for hip and knee replacements range 0.5% to 4% (aim 1%)
  • Hip replacement prosthesis had a cost average/hospital of £788 to £1,590
  • Floor space - non-clinical purposes space reported to range between 12% to 69% (aim to be lower than 35%)
  • Staff sickness absence rates range 3.1% to 5%

Aims should include:

  • Stock hold only average 15 days supply medicines
  • Cost of pathology to be less than 1.6% of operating expenditure
  • The cost of delayed transfers of care to the acute sector was noted and these must be reduced