In this section

The Carter Review

In June 2014, Lord Carter was asked by the Secretary of State to look into what could be done to improve efficiency in the NHS in England. Over 18 months he worked with 136 non-specialist hospital trusts in England and found significant unwarranted variations. The cost of providing a hip replacement varied between £800 pounds to over £1500 between trusts. Lord Carter’s report contained not only his findings, but also recommendations, and suggested steps to achieve them.

NHS Improvement Work

With the aim of realising these recommendations, NHS Improvement (NHSI) have established themed work streams under their ‘operational productivity programme’ including an AHP Productivity Project. The overall NHSI programme is also referred to as the ‘Carter Programme’ and includes a digital Model Hospital Portal. The programme will be rolled out in phases over several years. 

The Model Hospital Portal

The model hospital is a digital platform that any employee of an England based NHS provider Trust can log onto. There are several compartments to click on, each providing an array of metrics (quality, productivity and financial) from NHS trusts in England. The data used to populate the platform comes from data feeds that are already in the public domain such as via NHS digital or the electronic staff record (ESR).

Metrics are shown in distribution curves, so you can find your own trust on the curve and also compare yourself to your chosen peer trusts. In the future, it is hoped these curves can be used to identify where you are performing well and where there are opportunities to improve. 

Initially the model hospital platform was tested with acute non-specialist trusts but now the digital platform has been rolled out to include mental health, ambulance trusts and specialist trusts.

AHP Compartment

Within the Model Hospital Portal, there is an AHP dashboard showing many metrics including:

  • workforce numbers (e.g. total dietetic staff (F.T.E), dietetic staff by band),
  • spend on AHPs (e.g. total cost and cost as a percent of trust total staff costs)
  • AHP staff cost per WAU (weighted activity unit)
  • staff retention

Rosalind Campbell is Allied Health Professionals Productivity Lead at NHSI and is leading the development of the AHP compartment. This highly complex piece of work is iterative. Some trusts have been involved as pilot sites and have a deeper engagement with the programme as they have been involved for longer. Some Dietetic Service Managers and AHP Leads have already been actively involved in collecting and cleansing data for their trusts, whereas others have had little or no involvement so far.

Action for Dietetic Managers and AHP Service Leads within the NHS in England who have little or no involvement in Carter work

  • Register and log on to the Model Hospital
  • Find out who is the Carter Lead is in your Trust
  • Start a dialogue with them as to your role in the provision of data for your staff and services
  • Consider how data may need to be cleansed. Is the data pulled from electronic staff record or stats systems accurate?
  • Consider how you may need to substantiate any data on your staff or service.
  • Work with your informatics team, finance team and Carter Lead to be clear on what the data does and does not reflect with regards your staff and services.

Action for Dietetic Managers and Service Leads within the NHS in England who have had some involvement

  • Let the BDA know. We are creating a network for those involved and keen to support as required.
  • Get involved with current work that is happening such as: Job Plans/ Complexity Tools/ Therapy Hours to Contact (deployment metric)/ ways to measure the high level impact that dietitians have on Trust targets.


Further Information

There is an informal email group of managers who have been involved so far. The BDA is looking to formalise this as engagement rises. Should you want to know more information, share information and/or be added to the informal email network please contact us.

AHP Job Plans

NHS Improvement have publsihed job planning guidance as it has been recognised that this will help quantify the AHP workforce’s capacity in a way that a budgeted or whole-time equivalents (WTE) number cannot.

The Job Planning guide offers advice to trusts to ensure their approach to AHP job planning is consistent with best practice. Classification of activities within the document is fairly broad as it has to be applicable to all AHPs. There is a more detailed table of classified dietetic activities that has been developed in conjunction with dietetic managers who are engaged in Carter work streams. Please refer to this when devising job plans to ensure consistency across the profession.

NHS Electronic Staff Record and Workforce Data Set

Guidance documents have been produced for organisations that use the NHS Electronic Staff Record (ESR).  They provide guidance on the use of key data items from the National Workforce Data set (NWD) to enable those using ESR to make informed and consistent coding decisions that improve data quality.