Carter Report calls on health technology to help save NHS billions

Many of us aspire to be the best we can be, and Labour peer Lord Carter of Coles has set out a series of recommendations on how the NHS can achieve similar aspirations with the support of health technology in his much-vaunted report into NHS productivity and efficiency.

Operational productivity and performance in English NHS acute hospitals: Unwarranted variations is the compelling result of the peer’s work with 32 English trusts on identifying areas of excellence and areas for improvement. By taking note of the recommendations it contains, the report estimates that the NHS could save £5bn every year.

Health technology has a crucial part to play, and Lord Carter has called for all NHS trusts to have key digital information systems in place, “fully integrated and utilised by October 2018, and NHS Improvement should ensure this happens through the use of ‘meaningful use’ standards and incentives.”

The systems are e-rostering, e-prescribing, patient-level costing and accounting systems, e-catalogue and inventory systems for procurement, RFID systems where appropriate, and electronic health records. Some parallels exist with the McKinsey report into systems that have the potential to save the NHS money, as can be found on page 9 of the presentation published by DigitalHealth.net. Could these be the succcessors to the Clinical Five that the NHS was encouraged to adopt?

Meaningful use required for health technology

The report recommends that the NHS Improvement body, due to be set up in April 2016, take the lead by setting the standards for ‘meaningful use’ of such systems and incentivising trusts to achieve them.

Carter takes the definition of ‘meaningful use’ from the The American Recovery and Reinvestment Act of 2009, which specified three main components of ‘meaningful use’:

• the use of a certified electronic health record (EHR) in a meaningful manner
• the electronic exchange of health information to improve quality of health care
• the use of certified EHR technology to submit clinical quality and other measures.

For the report, ‘meaningful use’ means providers need to show they’re using certified EHR technology in ways that can be measured significantly in quality and in quantity. Financial penalties could be put in place if such standards cannot be met.

In the US, where this term originates, the Meaningful Use program (sic) has been declared ‘dead’, and a successor programme is now planned.

On finances, Carter asks that the Department of Health “should make some of the Spending Review investment for IT available for trusts to meet these standards, with a suitable ‘meaningful use’ clause embedded in contracts.” Boards will be held accountable to ensure that IT systems are used to their full potential. It will be interesting to see how that one plays out! Hopefully Microsoft will not be on the phone to say that people are not using the Tasks element of Outlook properly…

However the sentiment is right. Lord Carter and his team were “struck by the immaturity of trusts’ use of such technology from e-rostering systems, e-prescribing and basic electronic catalogues for procurement”. So there is the chance to do more, but hopefully trusts will make choices that do make the most of the technology on offer.

Carter does recognise that data, interoperability and governance are all key to the appropriate use of technology. He states: “To truly performance manage quality and efficiency on a regular basis, seamless real-time data is needed, which in turn requires investment in interoperable information technology.”

Interoperability and data are key

The death knell is sounded for ‘data-huggers’ that do not release information to others involved in healthcare.

“Data, if it exists, currently resides in independent pockets, sometimes guarded by data owners. This cannot continue. The best performing hospital systems around the world have real-time data at their fingertips enabling them to make decisions on a daily, weekly, monthly basis to improve performance. It’s long been said that the NHS, as a national system, has a huge opportunity to join up this data across boundaries but we continue to struggle to make this happen.”

Recommendation 8 has implications for technology projects. It states that “NHS Improvement and NHS England should establish joint clinical governance by April 2016 to set standards of best practice for all specialties, which will analyse and produce assessments of clinical variation, so that unwarranted variation is reduced, quality outcomes improve, the performance of specialist medical teams is assessed according to how well they meet the needs of patients and efficiency and productivity increase along the entire care pathway.”

Data will be an essential part of this process. NHS Improvement is set an immediate deadline in support, to bring “all existing clinical registries and data source feeds into its new structure in order to establish National and Local dashboards for each clinical specialty, to enable real time assessment of clinical performance, to identify and drive the required changes by July 2016.”

The recommendation also promotes “the innovative use of system-wide information and communications technologies approved by the HSCIC that support the clinical processes, with the aim of improving the quality, efficiency and safety of the care delivered.” It will be interesting to hear more about this.

The report is wide-ranging, and looks at the need for greater collaboration and the barrier presented by delayed transfers of care. Technology can help here, with NHS Improvement charged with an online portal to share good practice. Integrated systems can help coordinate care across the patient pathway.

The Carter report recognises that the NHS is the best value healthcare system in the world. But it could do better. We all could, I guess, if we had the time, money and support. Will the NHS get the support it needs to carry out these changes?

Let us hope that perilous finances do not make these recommendations last as long as a New Year’s resolution.    

Further information
Do read the executive summary of the report on the DH website. The NHS Confederation has presented a good summary of the report and its recommendations, and the HSJ focuses on the drive for wider use of technology.