NHS FIFE
Report to the Finance and Resources Committee on 25 November 2014
UPDATE ON ACUTE SERVICES DIVISION FINANCIAL RECOVERY PLAN
- INTRODUCTION
1.1This report provides a progress update on the Acute Services Division financial recovery plan. It is important that Committee members recognise this is being taken forward in the context of an unprecedented situation across NHS Fife, in relation to patients in delay within the acute hospitals, coupled with an ongoing focus on ensuring the delivery of safe patient care.
- PROGRESS
2.1The recovery plan presented to the Finance & Resources Committee in July provided a framework of specific, measurable actions withan aspiration to deliver a balanced financial position over a two year period.
2.2To support the overall governance and accountability of the Division, a robust set of monthly monitoring meetings were established,from June, with each of the Clinical Directorates. These meetings include attendance by the Director of Finance, to ensure wider Executive Director involvement. In addition, detailed discussions have taken place between the Chair of the Acute Services Committee and the General Managers for each of the Clinical Directorates, to facilitate Non Executive Director oversight of key financial matters and operational financial management.
2.3As previously reported, a number of recovery plan actions related to nursing have now been set in place including:robust scrutiny of bank nursing usage at Directorate level with improved reporting; tighter controls of the authorisation of bank nursing requests; review of observation policy leading to requests for additional staffing; implementation of the nursing workforce tool recommendations; improved roster management; and a leadership development programme for senior nurses;
2.4It was anticipated that these actions should reduce expenditure on bank and agency nursing by at least £0.5m when compared to the previous year’s outturn. The graph below shows a rolling monthly average expenditure on bank nursing for the Division, compared with last year, which highlights a slight improvement year on year. This will continue to be closely reviewed during the coming months.
2.5Additional actions still to be implemented include specific changes in the delivery of the health records service, particularly in light of investments in digital dictation. This requires the buy in of clinical leaders as it directly impacts on medical secretarial support, printing and filing of letters, and reception cover for the minor injuries unit at QueenMargaretHospital. A detailed report on the proposals will be considered by the Acute Services Division Management Team, with partnership input, over the next month. If all proposals were achievable, recurring cost reduction in excess of £200k could be delivered on a full year basis.
2.6Through discussions with the Clinical Directorates, it is evident that further improvements can also be made to controls around a number of areas of non pay expenditure including purchase of equipment, printing and stationery, and the use of taxis. In addition, further scrutiny of acute prescribing is underway to identify opportunities to further control the level of expenditure on acute medicines.
2.7In relation to outpatient services, progress is being seen on the level of “Do Not Attends” (DNAs) and scoping work will commence shortly on the extent to which activity from North East Fife to Tayside can be repatriated
2.8Notwithstanding the actions mentioned above, the feasibility of the current recovery plan to address the full extent of the underlying financial pressures across the acute service is now felt to be untenable. The current year end forecast highlights an overall expenditure in excess of £10m above budget, the majority of which is associated with the cost of staffing.
2.9Over recent weeks, the scale of the financial challengehas become even more prevalent, with other areas of performance being considerably stretched. It is the view of the Director that the solutions to the financial position do not lie within the Acute Services Division alone. Whilst every effort will continue to be made to reduce costs, a more radical approach is required.
2.10The rationale to support this view is the extent to which a number of costs have not been fully addressed through the budget setting process for 2014/15. These include the overall cost of the nursing workforce including incremental progression (c £5m)and the emerging impact of the nursing workforce tool; the underlying costs associated with the impact of delayed discharges and surge capacity; and the level of additional cost required to cover medical vacancies through the use of locums and agency staff.
2.11When considered within the Acute Services Division in isolation, any realistic options to address the position can only compromise other performance targets and quality measures such as the treatment time guarantee, or staffing numbers at ward level.
2.12Financial recovery and a reduction in costs to the level required will require a system wide approach and consideration of options across primary, community and secondary care. Within this, difficult decisions are required on services we should no longer deliver.
- Recommendations
3.1Finance & Resources Committee members are asked to:
- Note the position highlighted above
- Support the Director of Acute Services to commence system wide discussions with Strategic Management Team colleagues and members of the NHS Board for alternative options to deliver the cost reductions required.
HEATHER KNOX
Director of Acute Services
25th November 2014