The Carter report refuses to acknowledge how crucial non-clinical services are to hospitals
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Last week Lord Carter published his final report for the government into efficiency in the NHS. It sets out how £5bn a year can be saved in English hospitals by 2020, with a focus on workforce, pharmacy, procurement and NHS estates.
The report contains some reasonable suggestions – such as taking advantage of economies of scale through better bulk purchasing of supplies and equipment – but it also has the potential to cause considerable disruption for parts of the English hospital system, particularly in support services and pathology.
There is an understandable focus on delayed transfers of care from hospitals, and a failure to acknowledge the pressing need to rebuild the capacity of social care services, so that many patients who are ready to leave hospital, but require further care, have somewhere to go.
One worrying area of Carter’s report is his plan for a new system – ‘care hours per patient day’ – to ensure the effective deployment of nurses and health care assistants (HCAs). This involves adding the hours of registered nurses to the hours of HCAs and dividing the total by every 24 hours of inpatient admissions.
Nursing workforce experts warn however, that such a system fails to recognise the complexity of care provided by nurses and could lead to unsafe staffing levels.
Significantly, trusts are called upon to ‘rationalise’ their corporate and administrative functions to ensure these costs do not exceed 7 per cent of income by April 2018 and 6 per cent by 2020.
While this may not sound extreme, Carter finds that some trusts currently spend up to 11 per cent on such things, so it will represent a substantial cut for a number of hospitals that are already struggling financially.
Moreover, the concern for many thousands that work in the NHS is that management and administration costs are equated directly with wasted money. Better run hospitals produce better quality of care, and cuts to administration budgets run the risk of clinical staff spending more time carrying out non-clinical tasks.
Carter lapses into the lazy use of the term ‘back office’ to describe non-clinical functions in hospitals, a term that UNISON refuses to recognise in the NHS. Support services are crucial to the delivery of a joined-up, seamless delivery of services and to the patient experience of care.
Perhaps most worrying of all is the report’s focus on privatisation where the NHS is unable to deliver the cuts demanded of it – in pathology, pharmacy and on the wider issue of administrative cost reduction.
Such solutions ignore the long history of failure associated with outsourcing in the NHS and are likely to prove damaging for staff and the services they provide, but also highly counter-productive given the litany of private sector failures to deliver savings in the NHS.
The mass privatisation of hospital cleaning services from the 1980s onwards contributed to a huge reduction in the number of cleaners, which in turn played a part in the rise of hospital acquired infections in the 1990s and 2000s.
More recently trusts across Liverpool opted to pull out of a £27m deal to buy payroll and recruitment services from Capita – fewer than three years into a seven-year contract – as a result of concerns about the quality of service provided.
UNISON is proud to represent health staff that work tirelessly day after day to keep our hospitals and community facilities running smoothly – whether they are medical secretaries and admin staff, chefs and catering staff, porters, cleaners, finance workers, IT staff or managers.
One of the union’s priorities is to the defend NHS support services as part of the One Team campaign and we will be insisting that trusts avoid damaging and counter-productive plans to target such areas for privatisation.
Guy Collis is a policy officer for UNISON. Follow him on Twitter
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