The Trust sought to achieve a challenging cost improvement programme (CIP) while maintaining operational targets during a merger. It also sought to secure a sound financial footing in preparation for a foundation trust application.
To achieve this, the Trust increased the accountability and performance management responsibilities of clinicians for budgets with greater collaboration between clinicians, managers and the finance department.
Actions taken by the Trust to achieve this were:
- Restructuring of the Trust using Clinical Programme Groups with devolved responsibilities. This included income and expenditure at specialty levels headed by clinicians supported by dedicated operations, nursing managers, a senior accountant and a local OD programme within a Trust-wide framework.
- Introducing a performance management framework for CIPs including risk analysis linked to key merger risks and action plans to mitigate these risks. A central CIP performance monitoring team was set up to monitor and report on progress, facilitate cross-directorate and corporate CIP initiatives to drive best performance overall.
- Close scrutiny of the process from the Board, Executive and Chief Executive driving a strong performance management culture across the Trust; for example current performance being a factor in the selection of clinical leads for the new clinical programme groups in the new management structure.
- Budget monitoring forums include high level and local performance meetings with challenge and scrutiny from the executive team and peer group of a range of key performance indicators. This included CIPs, operational targets and service level agreement and service line reporting performance, including patient pathway changes agreed with PCTs. There was specific focus on underachieving directorates by senior executives including the Director of Finance, which were successful in significantly improving performance in those Directorates (Surgery and Anaesthesia and Pathology).
- Specifically targeting cost and clinical effectiveness in productivity and cost improvement projects, including those which supported the delivery of key operational targets.
- Inclusion of financial and operational targets in Consultant appraisals.
- Delegating management of performance improvement projects that impact on financials (in other words 18 weeks, A and E targets) to key lead clinicians.
- Involvement of senior clinicians in clinical service redesign across the primary and secondary interface with PCTs and the agreement of volumes and clinical protocols underpinning the key SLAs.
- Delegating responsibility to clinicians for the leadership of business development investments supported by management, finance staff and information. For example the development of Bariatric surgery and the bid for designation as a centre to the PCTs, 4 hour A and E target management and service redesign, Head and Neck cancer service development, major trauma and stroke services.
These changes enable the Trust to:
- achieve all key national targets and financial surplus
- deliver £36 million of CIPs
- improve services through the use of service line reporting ensuring these were clinically effective and cost effective initiatives
- demonstrate commitment of clinicians in budget management