The West Yorkshire & Harrogate Sustainability and Transformation Plan (STP) shows that the area’s hospitals are to make Carter programme “operational productivity” savings of £101m by 2020/21: £8m from Estates, £93m from “all other”.
West Yorkshire & Harrogate Sustainability and Transformation Plan has not published its appendices including Collaborative Productivity and Workforce Strategy, so you can’t really tell what cuts and changes hospitals are going to have to make to save this £93m.
But from the notes on p59 in the STP, it looks as if the West Yorkshire hospitals’ Carter savings will come from
- workforce “efficiency”
- sharing corporate services eg procurement, pathology services, estates and facilities management, informatics and other infrastructure.
There are big questions about the safety and effectiveness of these proposals.
What is the Carter programme?
Carter’s review of Operational Productivity in the NHS says acute hospitals in England could save £5bn/year.
He proposes they should basically barcode patients so that each interaction they have with a hospital is costed. This is meant to standardise costs across all hospitals.
Some of the proposed £5bn/year productivity savings could come from hospital Trusts sharing corporate services , including pathology services.
Royal College of Pathologists rubbish Carter’s pathology recommendation
Lord Carter is one of the 15% of peers in the House of Lords with financial interests in private health care companies – in his case, extensive interests in private pathology services.
Carter recommends that pathology and imaging departments achieve standardised benchmarks agreed with NHS Improvement, by April 2017, but if benchmarks for pathology are unlikely to be achieved, trusts should have agreed plans for consolidation with, or outsourcing to, other providers by January 2017.
The Royal College of Pathologists says there is no support for Carter’s recommendation on pathology and imaging departments:
“The experience of service transformation in pathology is that…the cheapest service is not necessarily the best, and consolidation not always the answer.”
For example, the 2009 takeover of the NHS’s biggest pathology labs by a public-private consortium led by the multinational Serco was followed by a series of clinical and financial failures.
Workforce efficiency savings
£2bn of Lord Carter’s proposed £5bn/year savings is from hospital workforce “efficiency” savings through:
- Better use of nursing staff – how to improve productivity, reduce absences, manage the need for bank and agency staff and review new nursing roles.
- Replacing fixed staff ratios with Care Hours Per Patient Day (CHPPD).
- Extension of e-rostering to deploy staff in the most productive way.
The West Yorkshire & Harrogate STP Acute Collaboration page (59) says that West Yorkshire Association of Acute Trusts is doing Workforce Planning At Scale and managing workforce risk at system level supporting free movement of bank and agency staff under single shared Bank arrangements.
The South West London STP , which has published its appendices including Collaborative Productivity, shows that this means aligning rosters across hospital trusts and buying software that gives staff from the whole area access to shifts at other hospitals, helping to fill shifts with NHS bank staff rather than agency staff.
What the STP doesn’t say about workforce efficiency
The Health Service Journal has reported that NHS Improvement is telling hospitals to close services that rely on locum doctors on more than £150K/year; this includes many A&E units.
Does this mean that WY & H hospitals may lose some of their departments? Including A&E?
Threats to patient safety
The WY&H STP doesn’t say that throughout 2016, as the Sustainability and Transformation Plan financial clampdown has started to bite, many reports from professional bodies, trade unions, think tanks and NHS organisations have warned about threats to patient safety from staffing shortages.
But Carter recommends replacing fixed safe staff ratios with Care Hours Per Patient Day – an import from the privatised American health care system, that says nothing about the skills, knowledge and experience of whoever’s doing the caring. But a recent study showed that wards with a higher ratio of registered nurses to healthcare assistants had fewer slips, trips and falls. Those with more Health Care Assistants had a higher than average amount of falls.
The study also showed there were fewer incidents of nausea and vomiting on wards where there was a total establishment of 30 or more whole-time equivalent nurses. According to the research, replacing six HCAs with six registered nurses on the six wards with highest incidents of falls could decrease monthly total falls at the trust by 15%.
So let’s hope that replacing safe staffing ratios with Care Hours Per Patient Day is not part of West Yorkshire and Harrogate STP. Is it?
Update 14.12.2020: Care Hours Per Patient Day was introduced in April 2018, focussing on acute and acute specialist trusts. The current NHS England/Improvement Care Hours Per Patient Day Guidance is for all inpatient trusts. It says since the Carter Operational Productivity Report,
“CHPPD has…become the principal measure of nursing, midwifery and healthcare support staff deployment on inpatient wards. It has now expanded to include all ward-based clinical professionals who are budgeted to the ward establishment and rostered into the 24/7 roster…
“…this updated guidance…includes a wider workforce that includes registered and non-registered allied health professionals (AHPs), and all registered and non-registered nursing associates (NAs).”
New care models with many new lower skilled and lower qualified grades of staff
West Yorkshire & Harrogate STP wants to introduce “new care models” delivered by multidisiplinary teams with many new lower skilled and lower qualified grades of staff, so that the skilled qualified staff look after patients with more complex conditions.
Where is the evidence that this is going to be safe? There is a reason for having skilled and qualified staff, and that reason is patient safety.
Sharing corporate services
The WY &H STP Acute Collaboration page (59) identifies savings from economies of scale in corporate services, “eg procurement, pathology services, estates and facilities management, informatics and other infrastructure.”
It says West Yorkshire Association of Acute Trusts (WYAAT) has established a Radiology Collaborative.
P 59, Acute Collaboration, mentions the WY Pathology Strategy which includes specialist services and integrated IT platform. What does this mean?
Pathology may sound boring but it underpins most patients’ NHS treatments. It matters.
P60 says that in October 2016 WYAAT were to start developing a Case for Change for Pathology and Corporate Services.
In December 2016 they were to produce a Business Case for the Acute Collaboration programme and decision making framework. In March 2017 they will agree the Pathology and Corporate Service programme.
An “alternative service delivery model for corporate services” is to be established in June 2017
There is no information about what any of this means.
What the STP doesn’t say about the West Yorkshire hospitals’ Radiology collaborative and Pathology service
A Report on the Yorkshire Radiology Collaborative says this will provide imaging in hospitals and communities, and patients will manage access and control their own data.
If I’m dying of some horrible illness or suffering a painful fracture, am I going to want to have the hassle of managing, accessing and controlling my own data? NHS England’s pathology report(p 4) refers to this as
“a Kaiser Permanente innovation that reduces the number of visits required by patients.”
Part of a global telepathology hub based in China
The Regional Imaging Collaborative is hosted by Bradford Hospitals teaching NHS Trust, which has funding from Guangzhou District Government to develop a China-UK remote digital pathology system in partnership with Huayin Medical Laboratory Centre.
The Deputy Director of Huayin Pathology Diagnosis Centre said:
“Our vision is of an international connected pathology community, enabled to provide rapid, accurate and cost-effective diagnosis of disease using the best information technology available. We believe this collaboration represents an important step, enhancing Huayin as a global telepathology hub…”
That is all about the digital stuff – what about the blood tests etc?
Update 20 July 2018
West Yorkshire and Harrogate Integrated Care System (formerly Sustainability and Transformation Partnership/Plan) has announced that the Department of Health has given them £6.1m capital funding for the Yorkshire Imaging Collaborative, which includes the six NHS acute hospital trusts in West Yorkshire and Harrogate plus Hull and East Yorkshire hospitals trust and North Lincolnshire and Goole NHS Foundation Trust.
ICS Director Ian Holmes’ blog post is typically vague:
“The funding will be used for the collaborative procurement of imaging solutions to transform radiology services to meet some of the capacity and demand issues. Improving quality and create efficiencies across … key areas of the radiology service … will then provide the opportunity for further regional clinical service transformation.”
A presentation at the 2017 Digital Imaging Conference on the Yorkshire Imaging Collaborative, by Nick Spencer (Consultant Radiologist, Mid Yorkshire Hospitals NHS Trust and Clinical Lead, Yorkshire Imaging Collaborative), presumably made sense to its specialist audience – but without specialist knowledge it doesn’t.
It announces that Yorkshire Imaging Collaborative is about “Service Transformation through new technology” and that the future might look like:
- Fewer boundaries – explained somewhat here as: “The refresh of picture archiving and communications systems triggered by the end of national contracts…Trusts are now turning their attention to sharing images with different ‘ologies’[ophthalmology, cardiology, medical photography, endoscopy and others], with different trusts and – shortly – other services, such as primary care.”
- System inter-operability
- Imaging provided in hospitals and in communities
- Care record joined up between primary and hospital sectors, with imaging integrated
- Patient will manage, access and control their own data