The Trust wanted to strengthen the role of senior managers and clinicians and increase their responsibility and understanding of how activity within their specialty and division impacts on both income and expenditure. To do this the Trust wanted divisions to be aware and manage both income and expenditure. A key aim was also to produce fully costed divisional and specialty business plans for 2009/10 during 2008/09.
To achieve this a number of steps were taken:
- From month 1 of 2008/09 all PbR income was reported at specialty level.
- Based on the level of devolved specialty income, income was apportioned to support divisions, such as facilities, diagnostics and corporate services, so that support services could also understand and be aware of their level of over or under recovery of income.
Monthly income and expenditure budget reports were prepared each month showing the overall budget position. These reports enabled budget managers to consider under or overspends for income and expenditure and efficiency savings within one budget report.
The introduction of income and expenditure budget reports allowed decisions and corrective action to be taken based on the full financial position, together with information on current and forecast capacity levels. During 2008/09 joint decisions were taken between the Management Board and the divisional teams on whether to release capacity or to use capacity and the impact this would have on income during the year for the different specialties and divisions.
In preparation for 2009/10 the divisions have produced specialty business plans based on agreed activity levels and the expected income and expenditure relating to those activity levels. The specialty lead clinicians and managers have agreed these plans and made decisions on how these expected activity levels would be met.
This approach has improved decision making and ensures the Trust is aware of the consequences of changing activity levels in one specialty to release capacity in another so that national targets can be achieved.
Clinicians are more involved in budget management and accountability and responsibility has improved at specialty and divisional level. These arrangements have strengthened the business planning process and resulted in a more robust overall Trust Business Plan.