It’s been dubbed the most ambitious ever plan for efficiency savings in the NHS. There has been speculation that it is undeliverable.

But amid all the debate about the planned £22bn of annual savings by 2020 in the NHS in England, one man has been rooting around the system working out how some of it might be achieved.

Now he has come up with a new set of proposals, some surprising, some controversial.

Lord Patrick Carter, a Labour peer as it happens, is advising Health Secretary Jeremy Hunt on how hospital budgets can be better spent.

‘Variations in care’

In June he said up to £5bn a year could be saved annually by 2020. In his first report then he argued that some of it could be delivered by smarter procurement of hospital supplies and some by better management of staff rosters.

Now he has attempted to put more flesh on the bone, outlining other areas which could contribute to that £5bn figure.

In a nutshell, Lord Carter believes that just as there is variation in levels of care around the NHS, as identified by the Care Quality Commission, there are also variations in the use of money by hospitals – some are doing it well and providing good value for the taxpayer, some are not.

He is a firm believer in good leadership leading to high-quality patient care and the most efficient use of resources.

If hospitals all adopted the best practice for different surgical procedures and treatments, he argues, then outcomes for patients would be better and money would be saved.