The Trust achieved challenging cost improvement plans (CIPs) during a large scale and complex merger (mid year which compounded the challenge) while maintaining operational targets so that the new organisation was created with a sound financial footing.
The Trust changed the way it did business to increase the accountability and performance management responsibilities for budgets with greater collaboration between clinicians, managers and the finance department. Specific actions included the following:
- Restructuring of the new Trust using clinical programme groups (CPGs) with devolved responsibilities including income and expenditure at speciality levels. In restructuring the organisation into six clinical programme groups to realise clinical and cost efficiencies, the Trust mapped services to patients and research flows, for example renal, vascular and cardiac sciences. They promoted local autonomy by delegating a head of research, head of nursing, head of finance and HR support for each CPG and emphasised the necessity of clinical leadership in achieving success by the appointment of CPG directors to oversee all aspects of clinical and operational management.
- Performance management framework for CIPs including risk analysis linked to key merger risks and action plans to mitigate these risks. Budget monitoring forums include high level and local performance meetings with challenge and scrutiny from the executive team.
- Performance reviews include meetings with representatives of each senior team and include comprehensive CIP review supported by service line reporting and the identification of new business opportunities.
- Focus on cost and clinical effectiveness in CIPs and improvement projects – including those which supported the delivery of key operational targets.
- Inclusion of financial and operational targets in consultant appraisals. Lead clinicians managing performance improvement projects that impacts on financials, for example 18 weeks and A&E targets. CIPs have been achieved (£30 million saved). There has been an improved local position regarding directorate budgets.
- Improved financial position supported investment in the environment and equipment, for example new theatre equipment and renovations, thereby improving the patient experience and the working environment for staff.