Download NHS FIFE

NHS FIFE
Report to the Finance and Resources Committee on 25 November 2014
UPDATE ON ACUTE SERVICES DIVISION FINANCIAL RECOVERY PLAN
1.
INTRODUCTION
1.1
This 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.
2.
PROGRESS
2.1
The recovery plan presented to the Finance & Resources Committee in July provided a
framework of specific, measurable actions with an aspiration to deliver a balanced
financial position over a two year period.
2.2
To 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.
2.3
As 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;
2.4
It 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.
80,000
Bank Nursing - Monthly Average
70,000
60,000
50,000
40,000
30,000
2013/14
2014/15
20,000
10,000
-
2.5
Additional 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
Queen Margaret Hospital. 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.
2.6
Through 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.
2.7
In 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
2.8
Notwithstanding 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.
2.9
Over recent weeks, the scale of the financial challenge has 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.
2.10 The 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.
2.11 When 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.
2.12 Financial 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.
3.
Recommendations
3.1
Finance & 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