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Carter efficiency review reveals interim findings


Changes to the way the NHS workforce is managed could produce “significant” savings for the health service and reduce reliance on agency staff, according to early findings from a major efficiency review of hospitals in England.

A report on interim findings from the Review of Operational Productivity in NHS Providers said there needed to be a “stronger grip” on workforce management, particularly for dealing with annual leave.

However, it also backed the development of safe staffing guidance by the National Institute for Health and Care Excellence, which may prove awkward for NHS leaders in the wake of the current controversy over the work.

“In some hospitals, bank nurses are not remunerated in a way to attract them from going to, or moving from, agencies”

Review findings

The review is based on an ongoing examination of 22 hospitals. It is being led by Labour peer Lord Carter of Coles and was commissioned by the Department of Health a year ago.

Lord Carter said “tight” management of annual leave, sickness, and training for staff, alongside better organisation of rosters and improved guidance on staffing levels and skill range for different wards could save the NHS up to £2bn a year.

Overall, the review predicted £5bn a year could be saved by 2020 if changes were also made to hospital pharmacy, management of estates, and the way in which the health service buys products.

The interim report noted that a stronger focus by hospitals on safe staffing in recent years, alongside an increase in the number of permanent staff leaving the profession, had led to a larger bill for agency staff.

“There are inequalities in how nurses are utilised, with many nurses working longer hours than they are contracted for”

Lord Carter

It said that while health secretary Jeremy Hunt had already announced a cap on agency rates, the focus now needed to be on the “root causes” of the increase in demand on agency services.

The report included an analysis of one hospital’s rostering for February this year, which found on many days there were not enough registered nurses on duty, but there were more staff overall than required. It suggested managers were being too flexible when rostering staff for shifts.

“We also identified that in some hospitals bank nurses are not remunerated in a way to attract them from going to, or moving from, agencies,” added the report.

It stated: “All of this leads us to assume there may not be enough nurses to meet the post Francis demands of the NHS, and there are inequalities in how nurses are utilised, with many nurses working longer hours than they are contracted for.”

Labour Party

Lord Carter of Coles

It pointed to good examples of workforce management it had seen, such as regularly reviewing incentives to ensure substantive staff are not tempted to work for agencies.

Evaluating flexible working arrangements and improving guidance on staffing levels and skill mix for particular ward types were also commended by the review.

In addition, it highlighted “good practice” to improve guidance on appropriate staffing levels and skill mix for particular ward types by the National Institute for Health and Care Excellence.

However, the backing of the safe staffing guidance programme by NICE comes just after it was halted last week, followed by announcements that work on this area would be taken over NHS England.

“From the data so far available we could look to make savings of up to £5bn per annum by 2019-20”

Lord Carter

In its eight initial recommendations, the report states that to save money hospitals should establish improved workforce standards, including how staff time is used and the skill range required for shifts.

“Whilst I am reluctant to set detailed targets, I believe from the data so far available we could look to make savings of up to £5bn per annum by 2019-20 providing there is political and managerial commitment to take the necessary steps,” said Lord Carter.

He is due to publish his final conclusions in the autumn, after continuing work with the 22 hospitals and adding a further 10 to the review this summer.

The interim report was welcomed by the Royal College of Nursing, which highlighted Lord Carter’s finding that the NHS could be making better use of its staff.

“By investing in permanent staff, with training and development, sufficient incentives and improved rostering arrangements, the NHS could reduce its staff turnover and save on the cost of temporary staff,” said Peter Carter, RCN chief executive and general secretary.

He added it was “gratifying” to see Lord Carter advocating safe staffing levels, in light of last week’s announcement that the National Institute for Health and Care Excellence had been asked to suspend its work on this area.

Unison head of health Christina McAnea said: “Of course it’s essential that savings can be made, particularly at a time when NHS budgets are being cut.

“But there is an irony that over the past five years, there has been an almost constant criticism of what the government calls ‘back office’ staff in the NHS,” she said. “Many of these jobs have disappeared in the name of greater efficiency.”


Lord Carter’s workforce management ‘good practices’:

  • Regular review on appropriate headroom levels
  • Regular review of flexible working arrangements
  • Reviewing the incentives to ensure substantive staff work substantive shifts
  • Assisting workforce planning and rostering by promoting the use of eRostering systems and the adoption of best practice roster policies
  • Improving guidance on appropriate staffing levels and skill mix for particular ward types in collaboration with RCN and NICE
  • Reviewing the demand and supply of additional nursing hours, particularly with respect to specialling care

Readers' comments (6)

  • ie pay nurses less to work 24 hour days

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  • A happy workforce is a cooperative, flexible workforce.

    NHS management expects "cooperative" and "flexible" but doesn't care two hoots about the "happy" part.

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  • So, I wonder, is it a brave move by Lord Carter to cast a light on the issue of workforce management? Clearly it is a skeleton in the closet, often overlooked as a problem in the NHS as managers and leaders are scared to take on Staff who abuse systems and Unions they hide behind (I don't blame the Unions btw)
    However, I can't help but think The credibility of this report would be helped enormously if Lord Carter didn't have such a vested interest (conflict of interest anyone?) in McKesson who happen to be a major supplier to the NHS of electronic staff records and eRostering solutions?

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  • re-above comment

    What a surprise!!

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  • I am a bit concerned about "regular review of flexible working" and "tightening"staff sickness. The use of e - rostering in my trust plus this drive to 24 hour nursing in the community with little heed to the current workforce and their needs has led to the loss of many experienced members of staff in the community who WANTED flexible working because they believed this was supposed to benefit them, in fact the flexible working required is only to benefit the Trust. Nurses with children who had chosen to either work 9-5 so they could have a child minder or send them to school or nursery and be able to meet them and spend time with their children in the evening, or nurses who chose to work evenings only and share child care arrangements with their husbands who worked in the day, all were driven out by the introduction of a hospital type shift system in the name of progress. This is a root cause of nursing shortages in the community today as traditionally this has been where many of those with children have chosen to work. Oh by the way 24 hour nursing in the community existed much more strongly before all this "progress". Now we have to promise too if we exceed a certain level of sickness, as one of my colleagues with serious and genuine reasons for her sickness has had to, that we "will not be sick again". How can we promise this, are we clairvoyant? I am not sure this piece of work should be celebrated at all it seems to me it is going to lead to even more inflexibility by employers and even worse treatment of their staff. A caring profession? Not to their own.

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  • e rostering is the root of all evil

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