Transformation programme 

Our financial transformation

What’s happening?

In 2016/17, the Trust continued to make good progress against each of its three strategic priorities - quality, people and money. This has been nationally recognised and we are proud that we have been selected to be one of the first eight Accountable Care Systems in the country. 

Last year, we committed to getting back into financial surplus within three years. And that is what we are doing. We have made a great start with our financial transformation plan. The good news is that the accounts for the year ended 31 March 2017 showed a deficit of £1.8m compared to a 2015/16 end of year deficit of £10.9m. What was more impressive, and confirms our progress in financial transformation, is that after adjusting for system transformation funding (based on delivery of financial and operational performance targets) and exceptional items, we have reduced our underlying deficit by about 30% from £12m to £8m. 

We have received favorable comments from our auditors on the improvement in our financial position and this is good news for our patients in our drive to be one of the safest healthcare systems in the country. Local ownership amongst teams to tackle quality and efficiency improvements at the same time has made a real difference and is a critical part of meeting our strategic priorities around quality, people and money. One of the best examples is how we have tackled agency spend over the last year across all areas of the Trust. Our expenditure has fallen from circa £18m to circa £12m for 2016/17 and the Trust has reported agency expenditure that is lower than the cap set by NHS Improvement. In 2017/18 we plan to reduce this figure still further as we focus on reducing our reliance on temporary staff and creating and investing in a sustainable, employed workforce for the future.

Furthermore, we have made significant progress in improving our operational productivity in areas such as length of stay, theatre efficiency and pharmacy transformation. For example, improving theatre efficiency has reduced the number of cancelled operations, reducing the waiting time for patients and improved the patient experience. Evidence from the most effective high performing healthcare systems across the world demonstrates that there is a clear and positive link between sound management of resources and quality of care. Continued improvement in our operational productivity will be a key focus area as we take the next steps in our financial transformation. Looking to the year ahead, we know that we will need to do things differently if we are to continue with this rate of improvement and that in some areas we can provide more support to help make things easier.

Plans for 2017/18

As we move into the second year of our transformation programme, our strategic priorities of quality, people and money remain.  Our plans for 2017/18 include:

• Delivering improvements in the new financial year of £17.6m whilst maintaining our commitment to quality and improving patients’ experience. These include:
  
  
  • Improving our theatre efficiency so as to allow more patients to have operations. This will include reducing our waiting lists and the number of cancellations as we reorganise our operating theatres. To achieve this some operations will move from overnight stay to day cases and from day cases to other settings. This will reduce pressure on the theatres and ensure that patients are seen in the most appropriate setting. It is anticipated that these changes will also speed up recovery time for the patients.
  • About one in ten appointments are missed or forgotten. As a result, last year, the Trust did not use £4m worth of resources due to patients not attending. By using the latest technology to automatically generate hybrid communication, we are improving efficiency as well as the patient experience. For example, an automatic text will now be sent to patients booked to attend outpatient appointments to remind them of their appointment. The reduction in missed appointments will help clinics to run more efficiently, allow appointments to be offered to others on the waiting list and speed up access to clinicians.

• We will continue to tackle high turnover, staff sickness and work to ensure we have our own staff, not agency staff, in the right place seven days a week. Last year, we spent £11.8m on agency staff which is below the agency cap we were set but is still significant. We are maintaining tighter controls on nurse and medical agency spend and have a proactive range of recruitment activities scheduled throughout the year to attract and retain the best possible talent. We are also involving our staff in looking at how best we can meet patient needs, including the creation of new roles and rotational posts. This is already proving to be successful with greater staff engagement and job satisfaction which leads to a better experience for our patients.
  
• We are empowering our local managers to change our culture and ways of working. Managers have played a key role in setting the budgets they require in the new year to manage their services and departments. Challenging, but realistic budgets have been set with the budgetary uplift totaling £23m for the year. Managers will be wholly responsible for managing their income and expenditure. We will provide training for every budget holder within the Trust to provide them with any support they may need.

Meanwhile we continue to work collaboratively and proactivity with health sector partners as part of both the Sustainability & Transformation Partnership (STP) and in the development of plans for the Buckinghamshire Accountable Care System.

We are pleased to have been selected by NHS Improvement to be one of 11 organisations taking part in wave two of their financial improvement programme. This programme will provide impetus to our financial transformation and our recovery bringing additional external capacity and insight from other transformational projects to support delivery of our challenging targets.

We are working alongside experts from FTI Consulting - jointly selected by ourselves and NHSI - who bring extra capacity to our own teams and offer fresh insight, skills and experience to support the delivery of our transformation programme.

Our clear and achievable plans in place to eliminate our historic deficit within three years are working and we know what we need to do next. We are doing this by remaining focused on delivering our quality, people and money priorities in a joined up way, rather than tackling each in isolation. Only by continuing to work in this way will we achieve our ambition of becoming one of the safest healthcare systems in the country.