Will the NHS Get Carter?
It is rare for a publication like the much heralded Carter report, about a topic which is so sensitive to the NHS; to get such considered praise and so few brickbats. Why is that and will it make any difference anyway?
The Good Bits
At a basic level the Carter report has been heavily trailed for months; the amount of savings being targeted, the benchmarking of variance and the emphasis on workforce are all familiar themes. The NHS needs to be managed carefully and Carter and his team have been very shrewd in minimising the surprises.
Equally much of what Carter has said is not new; we have known for ever that some trusts are more efficient than others and buy smarter.
What is refreshing and makes the report credible is that it does not pretend there is one magic bullet, and that all parts of running the NHS, from administration to estates, to yes procurement, can be done better and more efficiently. There is no simple cut management mantra. That instinctively feels right and realistic.
What also gives the report authenticity is a focus on staff, the biggest cost. This is not a "cut cut cut" message (that would be impossible post-Francis inquiry report anyway), but rather a plea and demand for intelligent recruitment, development engagement and retention of what is the biggest asset of the NHS as well.
Is it Enough?
So far so good – but and there is a big but – is it enough? Well to answer the question in a different way, it is probably as much as can be expected to be saved at a time of inexorable growth in demand. Delivering the kind of change that the Five Year Forward View (FYFV) calls for will take time, and it cannot be delivered without keeping the "business as usual service" on track. This has been one of the big lessons of the last half of this financial year – providers and indeed health economies have to be kept in some sort of financial balance at the same time as the change occurs.
For me however, the starkest truth is that while Carter shows what can and needs to be done in terms of savings, Carter also points to the hard truth that we will not deliver the balance (majority) of savings the NHS needs to deliver for the FYFV, unless NHS services change radically, work in a more integrated way and that above all the NHS will not be sustainable until health and social care together are sustainable. However cogent and credible Carter is – and he is – his remedies will not solve all the ills of the NHS.