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Carter review to back new measure of nurse productivity

  • 7 Comments
  • Carter to call for new ‘principal’ measure of nursing deployment from April
  • ’Care hours per patient day’ derived from nursing and HCA hours per inpatient
  • Expected call for national strategy to tackle absenteeism, bullying and turnover

Lord Carter’s review of NHS productivity is to recommend 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, it has been revealed.

The new metric is due to be 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.

“I know other directors of nursing share this view that this appears to have no reference at all to the safe staffing work that is going on”

Nursing director

The Carter report, currently in its draft form, is expected to say 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 argues 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 will propose 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 will suggest that this metric can be broken down initially by registered nurses and support workers, and, over time, by pay bands within those groups, according to Nursing Times’ sister title Health Service Journal.

It is expected to recommend 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, which is due to be finalised shortly having originally been expected in the autumn, follows interim findings published in June last year.

The care hours recommendation is likely to generate concern among some nursing directors, unless there is explicit acknowledgement that safe staffing work done by the National Institute of Health and Care Excellence – and to be taken on by NHS Improvement – is the primary work trusts should be focused on.

One nursing director with knowledge of the proposals said: “The worry for me, and I know other directors of nursing share this view, is that this appears to have no reference at all to the safe staffing work that is going on.”

The report is expected to recommend 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.

The Carter review is understood to have identified significant variation across hospitals in staff turnover, sickness and reported bullying. It is expected to estimate that the real rate of sickness absence in the NHS is close to 6%, higher than both the private and public sector averages.

As a result, the report is expected to call 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.

In addition, the people strategy will include 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.

  • 7 Comments

Readers' comments (7)

  • Is this yet another lean 'tool head?' Poke yoke this will Lord Carter mean Lord of the Flies? So saving money on the little staff we have already is moral efficiency? In my understanding lean deletion means staff issues and numbers are simply not a marker of effectiveness. Bring on the strikes more likely and denial of problems that's one way of going back to 1970s scientific working, is it not?

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  • We are already working SMART and very hard at that. Nursing is complex and we support people who add another dimension to the equation.
    what we need is generous staffing levels to enhance quality care but whether we get it or not is a different matter

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  • All I have to say about this is lol!! (note the sarcasm) how is that going to work. Let me see the people at the top ranks of the NHS trust would be left to calculate this and we all know how that is going to turn out!

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  • Lean is not the equation. Millions and thousands have been spent on this nonsense including sending management on jollies to America to learn what I see as twaddle. The establishment are using this double talk approach towards privatisation, including the above Spleen methodology. it didn't work in Canada and caused strikes in Minesota. VM had strikes also, including legal issues with clean equipment and I believe surgery issues. In my view all of the above is what Jeremy Hunt is pushing and money would be better saved by not expounding it. Look at the hospitals in the news and where they use this nonsense, is it just pure coincidence? All wer'e getting is more of the same when it obviously doesn't work. Is this mass fraud and is Lord Carter promoting its likelihood where applied? Come on unions time to rise up and true Tory opposition identify it.

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  • michael stone

    I've only glanced at this piece - I must be missing something.

    '... may not reflect varying staff allocation across the day. As a result, it will propose 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.'

    How does dividing the hours on nurses/HCPs worked by 'every 24 hours of inpatient admissions', address that the previous metric 'may not reflect varying staff allocation across the day'. I'm assuming that means one calculation per day - if it means 'we do the calculation every hour of the day' then my 'paradox' isn't there.

    Clearly I would need to put more effort into reading what this new proposal is, because on the face of, I seem to see a contradiction [which is so obvious, that I assume the contradiction isn't actually there].

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  • 22 JANUARY, 2016 7:20 PM

    You're so right dude, lol - theyre all getting on the gravy train to quick profit and self-presevation, and all these big boys like Lord Smarter are getting mega bucks for selling this stuff. Whilst saving money on the frontline I wouldn't be surprised if the ceo's and establishment mock gurus are bringing in the dosh for themselves. Didn't they have a strike about that too somewhere in America. Lol

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  • This is unreal! Yet another business ethos to cull registered nurses and lump us on with unqualified staff. Alarm bells did ring when NICE suspended the safe nurse ratios...i smelt a rat there. Now we know why. We're not professionals, we dont work in a hospital caring for the vulnerable and sick, we're a business. So now patients are seen as nothing more then a commodity to be serviced and a fast 'throughput' is given regardless of their situation, circumstances or clinical need. Shame on the Govt and other 'workforce HR etc' for allowing this. I hope the RCN can change these proposals? Privatisation here we come!

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