20 May 2011
Like NHS organisations across the country, our Trust is facing an extremely tough financial challenge this year.
The amount we are paid for treating our patients has been reduced by four percent, whilst our primary care trusts are reducing the amount of money they spend with us, focusing on treating more patients closer to where they live, for example in GP surgeries.
To help close the gap between our income and expenditure, we need to save £18.7 million by March 2012. Although this is big target, we are confident we have plans in place to achieve it. However, it does mean that we plan to end the year with a planned deficit of £19.3 million (subject to agreement with our strategic health authority, NHS London).
Improving care, saving money
We are confident that by introducing the following measures, we can save substantial amounts of money, and also further improve the care we give our patients. These include:
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Reducing the amount we spend on agency and bank staff (we currently spend £40 million a year);
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Ensuring our operating theatres are as efficient as they can be (every minute an operation is delayed costs £20);
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Reducing the amount of time patients spend unnecessarily in our hospitals (discharging them when they are clinically fit to go home);
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Getting the best value when we buy goods and services.
In addition, we are planning to change the way staff work across our hospitals ensuring everything we do focuses on our patients.
Matthew Hopkins, Chief Executive, said: "I recognise the high levels of skill, effort and commitment of our staff and appreciate how critical they are in making sure our patients receive the best possible care. However, our workforce accounts for nearly 70% of the money we spend each year and, as such, we must ensure they are working to the best of their ability, with a particular emphasis on removing barriers that block and delay the care we provide patients - whether it's a nurse on a ward, a surgeon in theatres or a receptionist in a clinic.
'Taking stock'
In February, our Medical Director, Dr James Clarke, launched a review to look at how we work. Called 'Taking stock', the review aimed to streamline overcomplicated systems, reduce bureaucracy and duplication, learn from other organisations and make sure we use our staff in the most efficient and cost-effective way.
Today (20 May 2011), we are launching a 90 day consultation with our staff and their representatives which proposes new ways of working in six key areas:
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Leadership - we plan to redesign our leadership team (directors and other senior managers) to ensure we are structured in the best way to manage the running of our hospitals on a day-to-day and long-term basis.
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Directorates - we plan to reduce the number of clinical directorates - the managerial bodies that oversee the running of our clinical specialties - from nine to five. This will help reduce duplication and make it easier for staff to understand where decisions are made.
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Corporate services - we plan to remove roles which duplicate others and to significantly cut down on unnecessary bureaucracy and administration, with a particular emphasis on 'back office' functions. These changes are focussed in finance, estates and information services (IS).
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Medical workforce (doctors) - we plan to increase the efficiency and productivity of our medical workforce through a range of initiatives. This includes reviewing the number of additional hours they work by ensuring our patients are seen promptly.
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Nursing and midwifery - we plan to further standardise the way nurses and midwives work across our hospitals to ensure we have the right staff in the right place at the right time. This, combined with new tighter controls on vacancies, will help minimise our use of expensive agency cover.
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Clinical pathway (including middle management) - we plan to create approximately 200 specialist roles that will be responsible for tracking and supporting our patients from the moment they are admitted to the moment they leave, ensuring they get the best care as quickly as possible. These people will, as much as possible, be recruited from our current workforce.
Possible job losses
As a result of these changes, we may have to lose up to the equivalent of 94 posts over the next year (i.e. whole time equivalent (WTE)). However, via a formal 90 day consultation with our staff and their union representatives, we will try and reduce this number.
Importantly, we hope to avoid compulsory redundancies by reducing our temporary staffing bill, which is currently £40 million per year. We will also look to redeploy staff to vacant roles as other employees retire or leave.
The type of posts affected
The majority of the affected posts are non-clinical, administrative and managerial; they also include a number of senior positions. The breakdown is as follows:
Non-clinical
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Leadership team - 6 (directors and senior managers)
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Corporate services (including finance, estates and IS) - 16
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Middle management and clinical support roles - 46
Clinical
Matthew added: "We are planning to create 200 specialist roles that will be responsible for supporting our patients from the moment they are admitted to the minute they are discharged. Working with our doctors, the new roles will ensure our patients get the best care, as quickly as possible, throughout their stay in hospital.
"Sadly, we may have to lose up to the equivalent of 94 posts over the next year. However, via the consultation and by working with our staff and their union representatives, we aim to minimise this number with a particular focus on reducing our use of expensive agency staff. We will also hope to redeploy staff to vacant roles as other employees leave or retire."
Commenting on plans to change the medical workforce, Matthew said: "Based on evidence, we employ the equivalent of 26 more medical staff than other trusts of similar size.
"As such, we believe we can work more efficiently, treating more patients more quickly and, as a result, reduce the amount of extra hours our doctors have to work. Not only is this good for patients, but it saves money."
Matthew concluded: "I am well aware of the impact that these changes will have on our staff and the uncertainty that the consultation will cause. However, we are facing tough financial times and we owe it to our patients, local people and staff to ensure we are working as efficiently as possible to deliver the best possible care.
"In addition, we have a responsibility to ensure our hospitals are in the best possible shape for the future."
