The Carter Challenge Part 2 - the wider lessons for Service Review
Last time I wrote I said that the Carter review had wider lessons to teach the NHS beyond smarter collaborative procurement, so here are my thoughts…
Carter stressed the importance of collaborative working in the procurement context. To my mind those same skills of collaborative working are even more important in an era of STPs, clinical networks and integrated care. The very behaviours of working together to define, plan and implement a common plan are vital to achieve the scale and style of service transformation needed. So what are those collaborative skills? Well, getting effective shared governance of joint working is the essential place to start. That governance needs to include clear leadership, but also inclusive engagement for all parties, so everyone feels that they are listened to, as they are all important in the joint delivery of services. That's easier said than done.
The other key lesson for me from Carter, is the focus on the basics. The Carter review stresses the importance of simplifying purchasing and then controlling those simpler costs bundles. It is hard work; it requires relentless discipline, but the examples Carter cites shows that it can, and does work. In service change terms, it may mean getting to grips with delayed transfers; not simple, but crucial to the flow of patients. It might mean better out-of-hospital triage; there is enough (UK) good practice around to see that these things can work, and they do not have to be fantastically expensive to implement, but they are hard work.
However, none of these lessons will stick unless all the system leaders (provider/commissioner/regulator etc), have a clear idea of (and agreement on) what their shared priorities are amongst all their tasks, reports, inspections, reviews, initiatives and plans. The Carter review had the huge benefit that it set out a clear target for cost savings (£5bn) and a way to test how NHS bodies are delivering against those common benchmarks. Creating a similar model for service improvement is a bigger challenge, but surely amongst all the outcomes and financial targets we already have, we can find a few key tests to drive our service change priorities; now that would be something!