A three-hospital acute NHS Trust with 700 in-patient beds and an annual income of £355m.
The Trust faced significant financial issues that were uncovered in FY15/16. A planned surplus of £0.7m moved in year to a deficit position for the year was £38.4m. Subsequently a control target deficit for FY16/17 of £27m was set which the Trust was required to deliver in the financial year ending March 2017.
In order to achieve this, a CIP Improvement Programme to deliver 4% savings in-year was required and a turnaround approach was required which would be led by the Trust but key external support in critical areas would be required to support delivery of more complex areas. This was not a standard crisis-intervention approach. Monitor intervened and agreed with the Trust that it would be allowed to use an internal turnaround team, supported by an experienced external firm, to mentor the Trust’s Turnaround Director and to support specific work streams as part of the wider transformation programme.
The Trust appointed external consultants, Kingsgate, led by Steve Swayne. Key was to quickly:
• Establish grip and control and an accountability framework
• Prepare a Turnaround plan
• Fill short term resource gaps e.g. turnaround support, CIP Accountant and other finance capacity
• Perform an investigation into the cash and liquidity position – this work would be performed by KPMG
Steve’s key role was to provide support to Dawn, the Trust’s internal Turnaround Director. Dawn led the delivery of the transformation programme, supported by Steve.
Kingsgate filled key skills gaps in the following areas of support to the Trust including:
• Financial support to the CIP programme:
• SRO and project management support for clinical administration project
• Medical Productivity/Demand and Capacity
The Trust further engaged Kingsgate and Dearden HR to undertake comprehensive medical productivity reviews on a number of clinical specialties. This would be an end to end process from demand and capacity-based planning through to cost out savings achieved through job planning – effectively changing the payroll for certain clinical staff to ensure expenditure matched the resource required to meet an expected demand.
Software based approach to embedding skills
A key project component was to embed the above skills and processes into business planning, consultant negotiation and job planning. The Trust also engaged Kingsgate to develop and deliver a bespoke software package for which DBFT would act as a reference site.
The software, developed jointly by the Trust, Kingsgate and Dearden HR, underpins the approach to a medical productivity review. Kingsgate trained a cadre of 10 Super Users and key staff in each of the Clinical Care Groups in order to progress future reviews in house with limited ongoing expert support.
The Trust achieved its CIP programme for the next two years.
Additionally, the DC exercise delivered savings in excess of £1 million within medical pay.
Kingsgate’s software was used by the trust to do subsequent D&C exercises in following years.
Taking cost out of medical pay and achieving lasting changes in medical behaviour whilst improving clinical productivity, represents the very best in NHS turnaround; not only was a successful outcome delivered but, new approaches developed and embedded within the Trust, culminating in the joint development of a new software product to enable demand and capacity based business planning in the future.