The Trust is building upon a sound platform of experienced operation of partnership working with other organisations (Dudley was one of the first NHS PFI sites) and service level management (the Trust has operated a clinically led flat management structure for some years).
The Dudley PFI relationship has now reached a stage of maturity where the parties can work together to improve services. In order to improve PFI performance monitoring, relevant parties have jointly entered into a programme of work to clarify in plain English what the complex structure of legal contracts really mean and how the relative roles and responsibilities actually impact to deliver excellence in patient care. This has resulted in a refinement of key performance indicators.
The devolved clinical management structure in place for several years in Dudley has driven the key involvement of front line clinicians in all aspects of financial management.
In April 2006 the Trust developed and began to roll out to key front line clinical managers a state-of-the-art Executive Information System to aid the development of bespoke online reports for each performance area. This promotes clarity of reporting and performance accountability, the important linkage of clinical and business KPIs and ownership through bespoke design and presentation opportunities.
This has enabled the Trust to benefit from much greater clinical participation in the management of resources than previously. Lead clinicians are able to access performance reports pertinent to them to improve decision-making and performance improvement.
The system is currently being extended to a much greater clinical management base across the Trust through the recent launch of a web based intranet facility and remote access from multiple sites or from home. This improved sharing of knowledge in a more efficient and effective manner has meant that the Trust has been able to involve clinicians to a much greater extent in LDP discussions with PCTs and GPs through the clinical and financial data linkage.
Another benefit has been greater clinical input into reference costs as their understanding and appreciation of cost behaviour issues has been enhanced. This confidence by both management and clinicians in information sharing and relationships has enabled the Trust to embark upon the development of service based costing and reporting and patient costing projects.
The devolvement of clinical decision making is further enhanced by the Trust’s rolling programme of financial training for budget holders and managers who are integrally involved in budget setting and performance management. This is provided in several settings and formats, from one to-one-training; presentations to clinical specialty teams; group discussions and presentations to lead nurses and the introduction of the HFMA e-learning Introduction to NHS Finance.
A good example of remedial action through this process is the identification at Board level of the Trust falling behind its depth of coding benchmark score (provided externally by CHKS and CO). Following detailed local scoring and reporting to specialty based clinicians our score improved significantly through the planned intervention of clinical managers locally. The Audit Commission’s independent study in March 2008 recorded the Trust as now having a better depth score than its peers.