NHS Improvement - Desk Study Review - Carter 2 - Community & Mental Health

The Independent Report by Lord Carter of Coles into the Operational productivity and performance in English NHS acute hospitals: Unwarranted variations, was published in February 2016. The report looked at what could be done to improve efficiency in acute (non specialist) hospitals in England and identified unwarranted variation at least £5bn of the £55.6bn spent annually by acute hospitals could be saved and made a series of recommendations. The Report also identified the need to look at the £20bn of annual expenditure in mental health and community health services.

The second review commenced in October 2016 and is currently in an early phase of engagement and development. The objective of the overall programme of work is to review the operational productivity of NHS providers in delivering community health and mental health services. Latest available data suggests that the NHS spends around £10 billion annually on community health services. There are 18 community healthcare trusts and around 103 trusts in total England provide community health services. There are 57 mental health trusts in England with operating expenses of around £11bn (this will include some community health services).

The sector is highly fragmented, commissioning is generally through block contracts and data is more limited than in the acute sector. The objective is to identify unwarranted variations in the operational productivity and performance of NHS providers. It is anticipated that the review will also consider the wider performance of the system and in particular the transition points between provision in acute, community, primary and social care for both physical and mental health.

The programme of work will consist of a number of key workstreams including:

• Sector analysis - understand the funding and expenditure patterns • Data analysis and initial benchmarking of performance for provider trusts • International analysis into how services are specified, commissioned and delivered • Working with the sector primarily through a cohort of trusts and wider stakeholders to identify good practice and build the evidence base • Functional analysis including pharmacy, procurement, corporate and back office, and estates

This specification focuses on securing an initial understanding of how services are commissioned and delivered internationally to identify good practice and innovative use of technology. This will provide the basis for targeted follow up work and inform the thinking within the programme more generally.