Transcript Turnaround Plan 22 Jan 2010

Executive summary
Turnaround Plan
Turnaround Recovery Plan 2010/11 to 2012/13
Presented to - The Royal Borough of Windsor and Maidenhead Overview and Scrutiny Committee - May 2010
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Executive summary (1)
The objective of the Turnaround Plan
How the problem has manifested itself
The objective of the Turnaround Plan is to return the Trust to financial balance, by
addressing the Trust’s underlying operational and financial problems, to deliver high
quality clinical services, achieve recurrent financial balance over the next three
years and attain a Monitor Financial Risk Rating of 3.
The problem has manifested itself in a number of ways, including:
Our vision for the Trust
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A deteriorating financial position – the Trust is forecasting a deficit of £9.9m for
2009/10 (even after implementing a £10.3m savings plan) and deteriorating
liquidity.
•
Governance, compliance and data quality issues – the Trust was unable to
provide sufficient assurance for seven of the 44 core Standards for Better
Health and is currently working with an external organisation to review its
governance procedures for two of the core standards.
We have a clear vision for the Trust that will be implemented as an integral part of
the Turnaround process:
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Our hospitals and services will be better and more efficient with patients,
safety and quality at the heart of everything we do
–
We will offer a full range of core DGH services with a strong emphasis on
improving the patient experience
–
The organisation will be financially viable and provide value for money
through a new patient focused and clinically led divisional structure
Other manifestations of the problem include:
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Inappropriate focus of the management team.
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Inefficient clinical process that have increased costs – the Trust has not
implemented efficient practice such as Hospital at Night. The late
implementation of changes such as EWTD have been rushed and not provided
best value.
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Poorly managed services that do not provide the best care for patients – the
Trust was bottom of 132 Trusts on new to follow up outpatient ratios.
•
Overtrading and poor margins where the Trust has expanded services, but has
not achieved the financial margin and surplus that other FTs have.
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Excess estate, as the Trust has a large estate which is not optimally
configured. There are too many beds for the level of activity that should be
undertaken by the Trust which have kept costs high.
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Back office functions that rely on inadequate systems and processes which
need significant manual intervention.
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A divisional management structure that employs too many staff compared to its
more efficient peers.
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Additional costs from poor investment decisions.
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A lack of clinical engagement and a general inability to grasp the need to focus
on efficiency and modernise clinical service delivery.
•
Poor relationships with commissioners, which has resulted in disputes over
income that have not been promptly resolved.
Why is there a problem?
The Trust’s problems stem from a legacy of three inherent structural weaknesses:
a) Weak leadership :
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The Trust has traditionally administered processes, rather than providing
real leadership and has been unable to grasp and address problems
unfolding within the organisation.
b) Inadequate systems and processes:
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Poor reporting information – management information has been poor, which
has hampered decision making from the Board down and across the
organisation.
c) A range of governance issues, such as:
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Poor planning – financial problems have appeared as a ‘surprise’ and were
not anticipated as part of the planning process.
Optimistic business decision making processes – the Trust has expanded its
range of services and facilities, but these have not always been connected
to improving the financial position of the Trust.
Presented to - The Royal Borough of Windsor and Maidenhead Overview and Scrutiny Committee - May 2010
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Executive summary (2)
The options considered
The Turnaround Plan
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Ensures patient safety and care are a top priority for the Trust
Addressing the inherent inefficiencies internally – changing clinical practice
to become more efficient and reduce costs.
•
Addresses the Trust’s structural weaknesses.
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Produces break even in each year of the three year turnaround period.
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Increased trading – this has been considered but rejected because of the
economic climate and the Trust not being recognised by commissioners as
a cutting edge service provider.
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Is supported by a coherent savings programme and implementation plans that
deliver £51.4m savings per annum from 2012/13.
•
Service rationalisation and reductions – these were also considered but
rejected, as the scale of income reduction was so great, it was not possible
to implement a Turnaround of sufficient size within the timescales required.
The Trust has considered a number of factors in developing its plans:
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Workstreams within the Turnaround Plan:
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WS1 - Clinical Service Efficiency
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WS2 - Clinical Workforce Review
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WS3 - Clinical Support Service Development
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WS4 - Back Office Consolidation
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WS5 - Estate Management and Optimisation
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WS6 - Data Quality & Income
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One of the key constraints in considering options is the Trust’s cash position, which
is weak and relies on long creditor payment periods as well as cash support from
the PCT. If the Trust does not implement the Turnaround Plan to address the issue
of excess costs quickly, it will not be financially viable, even taking account of PCT
cash support.
The Trust has identified additional capacity within the Plan to support the execution
of Turnaround , whilst maintaining day to day ‘business as usual’. The Trust will
however need to raise Transitional Funding to cover the costs of implementing the
plan.
The impact of these issues are that the Trust must:
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Quickly address its inherent clinical and operational inefficiencies to secure
its future as a standalone organisation.
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Implement changes as quickly as possible in 2010 to address the Trust’s
weak cash position.
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When Turnaround is successfully implemented, the Trust will be in a strong
position having identified and addressed foreseeable problems over the next
three years.
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Patient pathway, Beds - theatres - outpatients
Workforce management
Pharmacy - Pathology - Rehabilitation - Radiology
Finance - HR - IT and Procurement - Patient Records
Rationalisation of footprint
Local pricing challenges - coding
What the Turnaround Plan will achieve
This plan sets out the way to turn around the Trust, making it a financially viable
standalone organisation and an asset for the local health economy.
The plan releases cash savings of £110m over three years
The plan is dependent on the Trust raising transitional funding of up to £45.3m. The Trust
recognises the current external constraints and is exploring a number of pragmatic options
to either reduce the requirement and/or raise the funding required.
Presented to - The Royal Borough of Windsor and Maidenhead Overview and Scrutiny Committee - May 2010
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Executive summary (3)
Risk
This transformation will deliver improvements to patients by:
The Trust has developed an integrated approach to managing risks. The programme
and plans have been evaluated using this approach and robust plans put in place to
evaluate and address risks throughout the Turnaround period.
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Ensuring the Trust’s services are delivered to recognised standards of clinical best
practice
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Not being admitted to hospital when care can be provided on an ambulatory basis, so
patients can go home straight after they have been treated
Dependencies
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Patients spending less time in hospital and being discharged promptly as soon as they
are deemed fit for discharge
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Shorter waiting times in A&E in line with national targets
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Patients are treated by clinical staff that have the right skills and experience to provide
the best quality care for the best possible outcomes
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Ensuring our hospitals are clean and the services we provide are safe
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Providing best value across the organisation so we maximise the money spent on
direct patient care and minimise the money spent on overheads.
The Trust acknowledges there are aspects of the Turnaround that will be dependent
on Commissioners and other stakeholders, most notably the need to raise
transitional funding. The Trust will work with stakeholders to agree more efficient
discharge processes, alternative discharge routes and other parts of care pathways
to facilitate the implementation of Turnaround schemes. However, an analysis of
individual turnaround schemes shows that 82% of these schemes are within the
direct control of the Trust.
What a successful Turnaround will bring
The Trust’s objective is to survive and provide excellent care for patients by:
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Providing safe and high quality services that comply with best practice clinical
guidelines, with low mortality and low re-admission rates.
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Not just meeting but beating national targets and be recognised as being
amongst the best.
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Making good use of taxpayer’s money, providing efficient services across our
sites.
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Having a smaller establishment and ensuring that employees have the right
skills to deliver high quality care.
The Trust will have strong clinical leadership – doctors and nurses will be empowered
to deliver all aspects of services but also be clearly accountable for their success.
We will work with commissioners, other local healthcare organisations and a range of
interested community stakeholders to develop and deliver the right services for
patients. The Trust is actively working with commissioners to ensure the Turnaround
Plan is aligned with their proposals for service changes.
Presented to - The Royal Borough of Windsor and Maidenhead Overview and Scrutiny Committee - May 2010
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