The Carter review âￜￜ where are we now and what happens next?

Since its publication the Carter review has raised the bar in terms of the performance improvement expectations being placed on acute providers from NHS England and local commissioners. Each trust has now received their individual local information pack detailing the scope for local improvement. It is clear from regulators and advisory bodies like NHS Improvement that a prerequisite for any future turnaround funding support will be tied to delivering plans around addressing the Carter issues.

While at present there isn’t a definitive comprehensive set of specific measures being developed around the Carter agenda, it is clear that trust boards will need to demonstrate that they are actively assessing performance, are able to identify unwarranted variations and can deliver strategies for reducing these wherever they occur.

Our view
The Carter review has stimulated a debate around the need for trust boards to become more proactive in routing out unwarranted variations in cost and quality within their own organisations. It has also reaffirmed the need for accurate coding of cost and activity in order to create a true picture of these variations.

Most trusts already have the tools and data required to undertake this work but need to look at joining this up from a financial perspective and disseminating it to their clinical teams across the trust. This will need to be backed up with an improvement process plan and trusts must be flexible to adjust service models. 

Too often there is reluctance to open up a fact-based, internal transparent debate around these issues and to call to account those individuals whose working practices are contributing to the needless variation.

Instead, discussions get bogged down in the confounding factors, clinical differences and data quality concerns associated with the performance assessment. Although these will always exist it’s the magnitude of their impact that really matters.  A 30 per cent variation in length of stay at the same hospital for a similar case mix adjusted patient cohort should not be ignored by a team just because 10 cases out of 150 were deemed to be wrongly assigned. 

If data is truly unreliable then the first step will be to get to grips with this through assessing the coding process and making the necessary amends to ensure the objective of accuracy is achieved and continuously sustainable. The reporting tools should then be calibrated to identify and financially quantify the areas of significant unwarranted variation and used to drive a transformation programme across the trust.

To find out more about our coding and financial support available, please click here. 
Since its publication the Carter review has raised the bar in terms of the performance improvement expectations being placed on acute providers from NHS England and local commissioners.