What We Do

Carter Review


In June 2014, Lord Patrick Carter of Coles was appointed as ‘NHS Procurement Champion.’ This new role came from 2013 NHS procurement review, Better Procurement, Better Value, Better Care. The report highlighted a NHS procurement’s need for strategic leadership from a credible business leader. Lord Carter had worked on government reviews before, including legal aid procurement in England and Wales, and NHS pathology services.

He quickly found that hospital procurement improvements were inextricably linked to wider NHS efficiency and productivity. He found that hospitals lacked data on non-staff budgets, as well as an absence of efficiency metrics which would aid comparison between organisations. To address these, he broadened his remit to include measuring and improving hospitals’ efficiency and productivity. This is where the “Carter Review” began.

ABHI’s Engagement

ABHI swiftly engaged with this work, demonstrating how medical technologies help deliver an efficient and productive health system. It was hugely encouraging and refreshing to see NHS efficiency being benchmarked with measures and metrics.

The interim report and NHS finances

Through 2014/15 and 2015/16, NHS hospitals’ financial health deteriorated, starkly. This was largely driven by over-budget spend on temporary and agency staff. Soon after the 2015 general election Lord Carter published an interim report.

ABHI’s statement responding to this publication are here.

The interim report detailed how to develop an efficiency metric: the Adjusted Treatment Index (ATI). It also highlighted the cumulative impacts of inefficiency (from variations in staff deployment, asset utilisation and goods and services purchasing) on patients. Through the summer and autumn of 2015, Lord Carter and his team used the new ATI with trust leaders. They arrived at a “bottom-up” efficiency target.

The final report

NHS finances worsened sharply as 2015 progressed. November’s Spending Review settlement front-loaded NHS investment, but not nearly enough to bridge the gap between funding and demand. In this context, the review took on significant prominence.
The final report analyses the range of hospital activities and outlines possible ways for the NHS to save £5bn a year by 2020.

It is ambitious in vision and breadth. But it is also disappointingly light in terms of the role of technology in driving efficiencies.

ABHI’s response is here.

The role of NHS Improvement

The Carter Review team is moving to NHS Improvement. Their priority is to support NHS hospitals balance their finances. A number of short-term and tactical interventions to deliver this are planned, including price-benchmarking, and standardisation of surgical/medical techniques and products.

ABHI is engaging on these initiatives supported by the work of our Commercial Policy Group.