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Carter review recommends new measure of nurse productivity


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.

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

Lord Carter

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”

Jeremy Hunt

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.

Readers' comments (12)

  • Here's a thought. More resources?

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  • We tried this in the 90s. Very rarely worked out that we were adequately staffed and were there ever any nurses to spare for the understaffed wards? Guess.
    I trained in the 70s and we had time to support patients and relatives. We learned a lot that was helpful in caring for them - by the time I retired (thank god) the work pace was so hectic that the only private time with a patient was when giving them direct care, nurses finding it easier to put someone on a commode rather than walking them to the toilet, ambulant patients pretty much left to their own devices with their emotional needs possibly not being met, whilst the nurses fill in endless paperwork.
    Good luck with the (at least) hour it takes to fill the form in and good luck with trying to get extra nurses when you prove you are short-staffed.

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  • I am appalled by this suggestion of yet another metric to quantify nurses ( and no doubt midwives') time. The whole point here is that nurses and midwives' no longer have TIME to care in the way that engages and is relational with patients or women. No authority values time because of course 'time is money'. If this new metric comes to your areas I suggest all nurses and midwives be pro-active. Do the job for which you are trained. Stop the paper work and be at the the bed side. Provide quality time, engage and relate and use your knowledge and skills. Then let some one count that time and see then what happens. If we play this game we are lost. It is time to fight back. Care takes TIME.

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  • This is not Rocket Science,. for a good nurse to do her job properly a ratio of 1 trained nurse to 7 patients should be the basic requirement on a busy medical/surgical ward. IF there is then spare time all the better for the patient. Most days in most hospitals nurses are so busy they are run off their feet, working way over the hours they are paid for.and not taking breaks on top of that. What on earth is this new Carter nurse productivity measure going to prove?
    If he wants to save nurse time let him address the amount of totally unnecessary paperwork that takes us away from the patients, most of which is a box ticking exercise for the management to feed back to the government.

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  • Nurses need time to provide individualised holistic care, NOT yet more paperwork. This reduces nursing to robotic functions completely missing the essence of nursing.

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  • Pray tell what does some old Lord Fossil 'psychic insight' powers?? have to do with staffing effiency. He will never have worked on a busy ward let alone have any idea what nurses do. Its an absolute insult to our profession. Please have people that know the multi faceted intricacies of running a ward/unit advise on these matters HE HAS NO CLUE

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  • Lord Carter is a Director and shareholder of private health company Glenholme Healthcare Group. Surely this creates a conflict of interest? How can any recommendations on NHS staffing and efficiency by someone with strong private healthcare business links be unbiased?

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  • Obviously has no clue as to what nursing is about. Had just said he must think he is programming robots, then noticed 'anonymous 5.08 pm has mentioned this. He needs to put on a uniform and go and work at least year on the wards. Another one undervaluing nurses - again I stress, no wonder nurses a leaving the profession. Very concerning that he has a private Healthcare group as highlighted by Victoria Young. This man needs to retire.

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  • Chief execs to lead campaigns against bullying and harassment?

    Don't make me laugh! My last chief exec was one of the worst offenders in that regard...

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  • The CEO of Derbyshire Healthcare NHS Foundation Trust has just resigned after being suspended for similar charges. Sadly he was a nurse, I hope the NMC will be reviewing his case. The cost to the Trust has been enormous and the emotional upset to those who had the misfortune to cross his path, myself included, is immeasurable.

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