Lord Carter’s review of NHS productivity has recommended that a new metric – “care hours per patient day” – should become the principal measure of hospitals’ use of nurses and healthcare assistants from April this year.
The new metric is set out in Lord Carter’s final report on how the NHS could save £2bn through better management of its workforce, which forms part of an overall plan to achieve £5bn in efficiency savings.
The Carter report, published today, confirms the backing of the new measure, which Nursing Times reported last month, after a draft was leaked to Health Service Journal.
The final report said that one of the obstacles to eliminating unwarranted variation in nursing and care staff use has been the absence of a common means of recording and reporting deployment.
It argued that conventional measures – such as whole-time equivalents or staff-to-patient ratios – may not reflect varying staff allocation across the day.
As a result, it proposes the use of care hours per patient day, calculated by adding the hours of registered nurses to hours of healthcare support workers and dividing the total by every 24 hours of inpatient admissions.
It suggested that this metric can be broken down initially by registered nurses and support workers, and, over time, by pay bands within those groups, as previously reported by Nursing Times in January.
It recommended that NHS Improvement begin collecting care hours per patient day on a monthly basis from April 2016, and that it becomes the principal measure of nursing workforce deployment. Similar approaches would be extended to other professional groups the following year.
The final version of the Carter report follows interim findings published in June last year.
- ‘Stronger grip’ on NHS workforce management needed
- Lord Carter to produce ‘clearer guidance’ on nurse staffing levels
- Lord Carter calls for increased reporting of NHS staff data
The report also recommended that NHS Improvement work with the Royal College of Nursing and others to define staffing ranges for different types of wards as a guide for trusts.
Meanwhile, the Carter review identified significant variation across hospitals in staff turnover, sickness and reported bullying. It estimated that rates.vary from 3.1% to 5% – meaning staff are 60% more likely to be absent due to sickness at the worst trust compared to the best.
As a result, the report called for the regulatory body NHS Improvement to launch a “national people strategy” to tackle high levels of bullying, absenteeism and staff turnover, which Lord Carter believes will hamper the service’s efforts to improve productivity.
Carter review to back new measure of nurse productivity
In addition, the people strategy includes an expectation that every trust chief executive leads a campaign against bulling and harassment and that trusts improve data collection for, and management of, sickness absence.
The review stated that improving staff productivity by five minutes every shift could save the NHS £280m a year and urged an end to ”outdated and inefficient” paper rosters.
“Electronic rosters across the NHS will mean the right numbers of staff are in the right place at the right time, so patients get the correct level of care and hospitals do not waste valuable resources by over deploying expensive staff where they are not needed,” it stated.
Lord Carter said: “My experience of the NHS and hospitals internationally is that high quality patient care and sound financial management go hand in hand.
”To improve the quality of care hospitals must grasp resources more effectively, especially staff, which account for more than sixty pence of every pound hospitals spend,” he said.
“This groundbreaking review will help… make sure every penny possible is spent on frontline patient care and bureaucracy is slashed so doctors and nurses can concentrate on caring”
He added: “Giving hospitals the tools and support to better manage resources will make it easier for boards to follow the example of the best trusts and mean every patient can receive the same world class care and taxpayers will also receive a fairer return on their significant investment in the NHS.”
Responding to the report, health secretary Jeremy Hunt said: “This groundbreaking review will help hospitals care for patients, making sure every penny possible is spent on frontline patient care and bureaucracy is slashed so doctors and nurses can concentrate on caring.
“I’m grateful to Lord Carter, his team and those trusts involved in identifying the recommendations and urge all trusts to implement them immediately,” he added.
- Nursing Times will publish further analysis of the report and reaction throughout the day.