Exclusive: Trusts missing key Carter targets

All acute non-specialist trusts should have been compliant with the procurement metrics, which aim to ensure hospitals better control their spending, by September 2017, according to the 2016 efficiency review by Lord Carter.

However, our analysis of figures from 102 non-specialist acute trusts has found only eight were hitting all three targets by the end of last year (see first table), while another eight were not hitting any (see second table).

The findings prompted Lord Carter, whose review suggested acute trusts could save £700m by improving their procurement, to say non-compliant trusts need to “up their game”.

Among the recommendations of the Carter review, which identified £5bn worth of savings for the acute sector, was that trusts comply with the following three metrics by September:

• 80 per cent of spending should be on goods in catalogues;
• 90 per cent of spending should be with a purchase order; and
• 90 per cent of spending should be under contracts.

The percentages relate to trusts’ “addressable spend”, which excludes spend categories like pay, taxes and depreciation.

Most trusts were achieving one or two of these targets, according to data obtained by HSJ under the Freedom of Information Act. The FOI request was sent in December.

There is no strong correlation between hitting the three targets and how trusts are placed on the NHS procurement league table, which was published in November.

An NHS Improvement spokeswoman said more can be done to ensure trusts are “making efficiency business as usual”.

Trusts meeting all three key procurement targets (December 2017)

Trust	% on catalogue	% with purchase order	% with contract	Position in NHSI league table	2017-18 forecast surplus/deficit
Gateshead Health FT	100	100	92	136	-£2.2m
Harrogate and District FT	87	90	90	65	£5.9m
Heart of England FT	90	100	90	12	-£48.1m
Isle of Wight Trust	90.6	100	90.6	119	-£18.8m
Portsmouth Trust	94.7	100	95	51	-£36.8m
Royal Berkshire FT	85	100	100	110	£4.6m
The Hillingdon Hospitals FT	95	100	94	39	-£8.5m
University Hospitals of Leicester Trust	94.9	94.2	93.7	37	-£26.7m

Eight trusts were not compliant with any of the targets, while another three were not compliant with two targets and did not have the ability to check compliance against the third in December.

Forty-nine trusts were compliant with two targets and 34 trusts were compliant with one. Thirty trusts did not respond to HSJ’s request or refused to give figures. 

Trusts missing all three key procurement targets or unable to provide figures (December 2017)

Trust	% on catalogue	% with purchase order	% with contract	Position in NHSI league table	2017-18 forecast surplus/deficit
Bradford Teaching Hospitals FT	71	81	63	4	£1.8m
Calderdale and Huddersfield FT	23.2	87.5	88	128	-£16.2m
North Tees and Hartlepool Hospitals FT	59	61	86	92	£3m
Oxford University Hospitals FT	67	80	67	45	-£5.2m
Pennine Acute Hospitals Trust	55	73	60	58	-£13.2m
Royal United Hospitals Bath FT	70	75	72	82	£12.2m
South Tyneside FT	77	63	72	43	-£10.1m
South Warwickshire FT	21	22	48.5	127	£7.8m
Chesterfield Royal Hospital FT	44.2	44.2	Could not provide figure	69	£6m
Epsom and St Helier University Hospitals Trust	75	32	Could not provide figure	121	-£17.8m
Royal Liverpool and Broadgreen University Hospitals Trust	72	73	Could not provide figure	130	-£14.4m

Oxford University Hospitals and Bradford Teaching Hospitals both said as of February they are achieving two of the targets, while North Tees and Hartlepool FT said it was now meeting one.

A spokeswoman for South Warwickshire FT said the trust is implementing catalogue management and e-procurement systems to “help ensure these targets are met”. She said the trust is investing in “additional resource” to embed contract management processes across the organisation.

The other non-compliant trusts did not respond to HSJ in time for publication.

Lord Carter told HSJ: ”It is encouraging that some trusts are achieving all three targets, but others need to up their game. 

“It’s been two years since my final report and since then we have equipped the NHS with the tools to help them achieve these targets. I now fully expect all trusts to use these tools and strive to achieve all three targets so that savings can be reinvested into patient care.”

The NHSI spokeswoman said the purpose of the “initial targets” was to give trusts something to aim for and help them identify which areas needed improvement to ensure value for money.

She said the regulator is supporting trusts to improve procurement processes through its price comparison tool and Nationally Contracted Products programme. So far, eight basic products (such as toilet paper, plastic examination gloves, and temporary shoes) have been bought through the programme on behalf of the whole NHS.

Commenting on HSJ’s findings, the head of procurement at a large trust, speaking on condition of anonymity, said: “It’s a result of a landscape where there’s no mandatory national contracts and trusts have a choice of varying routes to market.

“I’m not surprised by the figures. We have worked in a service that historically hasn’t had key performance indicators, league tables or performance measures.”

Asked about how much importance should be placed on hitting the targets, the source said: “It should be something on heads of procurement’s agendas and directors of finance’s agendas and reported to the board along with the procurement transformation plans that we all have to do. I would argue it should be a key priority.”

A spokesman for the Health Care Supply Association, which represents NHS procurement professionals, said the Carter Review offered staff a “great opportunity to raise the profile and enhance the delivery of non-pay efficiency”.

“We have waited a long time for some nationally accepted metrics and let’s use them to support our work,” he said.

But he added: “Trusts will need to ensure sufficient investment in people and systems to support delivery.”