The Carter Challenge – Part 1
A while ago I commented (favourably) on the newly published Carter report. Last week I heard the great man again and he was his normal persuasive, incisive, and quietly provocative self and it prompted me to ask "So how we are going to deliver the overall improvement he has starkly identified?"
Lord Carter highlighted again the real challenge of unwarranted variation in acute sector performance and costs, and added extra spice by a few well-chosen international comparisons. This was for me at the heart of his initial work, and its real strength; but what next?
The NHS shelf of worthwhile reports is overflowing, but in large part that is because many of them get mired in the harsh realities of implementation. I can see three difficult, but crucial ways that the Carter report can avoid that fate.
First, the data is good enough so let's get on. The NHS is not short of data but it has a fearsome ability to say "Yes, but could we just confirm…". The data can always be refined, but Carter has already shown clearly enough the areas of variation to explore – so refine data later; use what there is now.
Second, collaboration will be vital to delivering improvements. Carter has identified a number of areas like Procurement, Estates and Pharmacy where a few simple things could raise the overall performance of the whole NHS. Those actions are not, bluntly, wildly innovative, (eg better stock control of drugs) so let's try and develop programmes once, and then roll them out many times. A large corporate would work that way, without question, and for all the NHS values we hold so dear, we need to do so too. More than that, the better suppliers would welcome some consistency and standardisation.
Third, the process has to be relentless, realistic and incremental. If you look at the long-term supply partnerships that giants such as Toyota have with their supply chain, the pressure to improve quality and reduce cost is continuous, not occasional; compulsory, not optional. For the foreseeable future the NHS will be facing funding challenges, so we need to hard-wire the persistent disciplines of seeking continuous, incremental reductions in costs into all levels of the NHS – not just at the point of re-procurement.
However, I am convinced Carter is about much more than cost reduction, as I will spell out in my next blog…
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