Transcript Forecast I&E 2011/12 to 2014/15

Safe and Financially Effective (SaFE)
North West London Hospitals NHS Trust
Text
16 September 2011
1 Footnote
SOURCE: Source
0
Agenda
1 Introduction
2 Methodology
3 Conclusions for NWLH (from Phase 1)
4 Supporting London Acute Productivity Gain
5 Discussion Points
Appendix
• Peer Groups
• Medical Oncosts for NWLH
1
Introduction
▪
Healthcare for London, published in July 2007, illustrated a compelling case for change in health and healthcare services across
London. Four years on, the case for change is as powerful as ever.
▪
London’s NHS faces pressure from increasing demand for healthcare:
– a growing and ageing population;
– changing patterns of disease and health;
– innovations in medical technology; and
– changing public expectations.
– which alongside the slowdown in funding growth for the NHS poses a significant challenge to the overall affordability of
London’s healthcare system.
▪
In 2009, NHS London undertook detailed modelling that showed that on a ‘do nothing’ basis, by 2016/17, there would be a
£4.4billion funding shortfall for commissioners in London on a recurrent basis over a 9-year period, to be addressed by tariff pricing
(£2.4bn) and commissioning levers (£2.0bn). Analysis also demonstrated additional pressure of up to £1.9bn on acute providers
from activity changes.
▪
Implementing Healthcare for London proposed an approach, underpinned by financial analysis, that achieved both clinical
sustainability and financial viability for PCTs in London. But major service reconfiguration and/or organisational changes would be
necessary to deliver viable Trusts capable of achieving FT status.
▪
The NHS in London is running out of time to undertake these changes in order to achieve a viable provider landscape. Although
London’s integrated plan for 2011/12 and beyond reflected an updated commissioner model, in many cases PCT Clusters’ plans
fail to reveal the scale of changes needed, partly because of the complex policy and political environment within which the NHS
operates.
▪ Therefore, SaFE provides a simulation based on standardised modelling of financial, quality and safety issues. It is consistent
across London and determines whether the 18 acute NHS Trusts in London can achieve FT status by 2014, taking into account
current cost and income trajectories, quality requirements and potential productivity improvements.
▪
Following discussions with NHS leadership and Secretary of State, a number of workstreams have been developed to take this
work forward, central to which is a dialogue with each Trust Board regarding its response to the challenges and opportunities
presented by the analysis. This will inform the development of detailed milestones to be included in finalised TFAs.
2
Agenda
1 Introduction
2 Methodology
3 Conclusions for NWLH (from Phase 1)
4 Supporting London Acute Productivity Gain
5 Discussion Points
Appendix
• Peer Groups
• Medical Oncosts for NWLH
3
Approach: We estimated Trusts’ financial position to 2014/15 in 5 steps
Establish 10/11
baseline
▪
Used Trusts’ underlying position in 10/11 (net of non-recurrent income and costs) as baseline
▪
Forecasted income until 2014/15 based on 3 factors:
– Net clinical activity growth based on commissioner plans
– underlying demand growth assumptions (range 1.9%-5.0%)
– demand management net of reinvestment (range 1.1%-8.9%)
– Price reduction of -1.5% per year across both PbR and non-PbR clinical income
– Forecast of non-clinical income (R&D, education and training) based on NHS London teams’ view
– Modelling excludes all potential future reconfigurations and service changes
▪
Estimated change in cost as a result of changes in activity (assuming cost scales 70-80% with increase in activity
and 55-65% with decrease in activity)1
Added expected PFI cost development based on DH schedules
Added non-activity-related operating expenses, assuming increases with inflation
Estimated opportunity to reduce cost by closing productivity gap vs. benchmark peers:
– Peers selected considering Trusts’ academic/non-academic status, size and single/multi-site status where
relevant
– Peers with bottom quartile quality excluded (HSMR used as proxy for quality)
– 2 levels of potential savings modelled:
1) Close gap vs. peer at upper quartile productivity threshold, assuming the peer reduces costs by 2% p.a.
2) Close gap vs ‘average of top 3 peers’, assuming the peers reduce cost by 2% p.a.
– To avoid assuming unsustainable nursing cost reductions, we set a “floor” of 8 nurse hours per patient bed day
– Set a cap of 20% reduction on the total cost base over 4 years as the maximum sustainable improvement
Ensured Trusts met minimum medical resource standards for key specialties (Obstetrics and Emergency services)
Inflated the cost base net of all other changes by 2.5% p.a.
Estimate income
changes by 14/15
Estimate cost
changes by 14/15
▪
▪
▪
▪
▪
Develop year-byyear forecasts
Evaluate financial
outlook
▪
▪
▪
▪
Used Trusts’ 2011/12 plans as short term forecast and re-profiled demand management and productivity
improvement of the 4-year period accordingly
Modelled impact of community services component of merged acute and community Trusts (assuming 3% surplus)
Assessed Trusts’ viability based on whether they achieve 1% underlying net surplus position in 2014/15
For Trusts that would achieve 1% net surplus by 2014/15 if it were not for the 20% cap, the forecast period has
been extended to check if the target can be achieved given more time
1 Cost scaling assumptions modelled at level of detailed cost categories, reflecting differences in proportions of fixed and variable costs
4
There are a number of potential downsides that have not been included in this
analysis and that would make Trusts’ prospects of financial viability lower
Scaling
Cost inflation
Tariff uplift &
price changes
PFI & other
capex
SOURCE: SaFE modelling assumptions
Assumption / approach in this work
Potential downside
▪ Costs scaled at 70-80% with
▪ Some Trust operating plans imply
increases in activity, and 55-65%
with decreases
▪ 2.5%pa cost inflation assumed on all
cost categories (based on the
average cost inflation assumed in
operating plans 2011/12)
▪ An alternative scenario with
additional 1%pt unfunded cost
inflation has been modelled
▪ -1.5%pa price reduction per year,
across both PbR and non-PbR
clinical income
▪ Only includes agreed PFI and capex
programmes (+ known requirements
for immediate sustainability in 2
cases)
higher scaling with increases and
lower / no scaling with decreases
▪ Potential higher cost inflation
through pay drift and other cost
pressures
▪ Additional price pressures from new
tariff rules (e.g. emergency
readmissions)
▪ Potential income caps imposed by
commissioners if demand not
contained
▪ Trusts with aging estates may need
major capex programmes beyond
current plans
5
We have limited the potential savings that can be achieved to 20% over the 4-year
period, which is at the very top end of savings seen internationally
We have set an upper limit on the total cost
savings that can be achieved over 4 years…
…based on not having seen evidence of higher
levels of cost savings sustained over a long period
The ‘20% cap’ translates to:
Examples of hospital cost reduction programmes
% reduction in total Timecost base, CAGR
frame
▪ 20% of total cost base over 4 years
▪ 5.4% annual cost reduction on total cost base
▪ 24% of variable and semi-variable costs over
4 years
▪ 6.6% annual cost reduction on variable and
semi-variable costs
US private
hospital
~5
2-3 years
Germany private
hospital
4-5
4-5 years
Portugal
private hospital
4-5
2-3 years
Germany public
hospital
~4
3-4 years
Sweden public
hospital
~4
~2 years
The highest levels of productivity savings
have only been achieved in the private sector
6
Costs to ensure minimum standards of emergency and maternity care
included
Emergency care
▪
Early involvement of senior doctors in assessment and management of acutely ill patients improves
health outcomes
▪ Significant variation between clinical staffing levels on weekdays compared to weekends. In
London’s hospitals consultant cover at weekends is only half of what it is during the week, which
means that patients admitted to hospital at weekends face a significantly increased risk of death.
In London, the risk is in excess of 10%, meaning that there will be more than 500 deaths per year
that need not have occurred
Clinicians have developed a series of minimum standards for on-call 24/7 rotas, together with
appropriate 24/7 consultant cover for A&E departments and for anaesthetics
Estimated cost of implementing these across the 18 Trusts: £64m (2014/15)
Maternity care
▪
Royal College guidance emphasises the importance of midwives, 1:1 care during labour and
increased presence of consultant obstetricians on labour wards.
▪
London's maternity services do not perform uniformly well, with unacceptable inequalities in
outcomes
▪
Due to concerns about the rate of maternal deaths in the capital - 19.3 deaths per 100,000
maternity episodes in 18 months - a review commissioned by NHS London into 34 deaths showed
26 had avoidable factors, some of which may have contributed to the outcome
Estimated cost impact of recommended minimum standards for appropriate staffing levels of
consultant obstetricians across the 18 Trusts: £6m (2014/15)
7
Agenda
1 Introduction
2 Methodology
3 Conclusions for NWLH (from Phase 1)
4 Supporting London Acute Productivity Gain
5 Discussion Points
Appendix
• Peer Groups
• Medical Oncosts for NWLH
8
NWLH
2010/11-11/12
(Trust Operating Plans)
Forecast underlying I&E 2010/11 to 2014/15
Units: £m
Income
Costs
2010/11– 14/15
15
51
2010/11– 14/15
13
2
0
4
31
70
20
55
13
6
7
0
Net change
of -£0.1m
from +£11m
11/12 and
-£11m 12/13
to 14/15
Net impact from
volume changes =
-£17m
Net surplus 2014/15:
-£16m (-4.9%)2
375
363
344
328
Income Under- Demand Tariff
2010/11 lying
manage- uplift
demand ment
Other
operating
income1
Non
operating
income
Income
2014/15
Cost
Impact Cost
PFI
2010/11of net inflation
change
in
activity
Other
operating
expenses
Non- Prooper- ducating tivity
expenses
Impact Cost
of new 2014/15
quality
standards
Note: All figures are nominal (i.e. the effects of inflation are included in the future years). Cost inflation is applied after the effects of net changes in
activity and productivity.
1 Includes R&D, education, private patient, etc.
2 Underlying net surplus modelled under DH Control Totals adjusted for non-recurrent items.
SOURCE: Trust Operating Plans 2011/12; Modelled impact of commissioning plans; Benchmark productivity targets
9
NWLH
Forecast financial position 2010/11 to 2014/15
Units: £m, %
Matching ’peer at top quartile threshold’ (+2% with cap)
Matching ’average of top 3 peers’ (+2% with cap)
Underlying net surplus (in year), 2010/11 – 14/15
0
-5.0
Lines may overlap.
EBITDA and net
surplus shown for
matching ‘peer at top
quartile threshold’
(+2% with cap)
-10.0
-11.7
-15.8
-15.0
-17.6
-20.0
2010/11
(underlying)
Underlying
EBITDA
% of income
Underlying net
surplus
% of income
-16.7
-16.1
2014/15
forecast
2011/12
operating
plan
(underlying)
2012/13
forecast
2013/14
forecast
3.1%
1.7%
2.6%
2.7%
3.2%
-3.2%
-4.9%
-4.6%
-5.0%
-4.9%
SOURCE: 2011 Trust Operating Plan (Apr 2011); 2010/11 Trust draft accounts (Apr 2011); PCT Commissioning Plans
(Apr 2011); Update to Monitor’s financial assumptions (April 2011).
10
NWLH
Benchmark analysis on cost saving opportunities
Modelled scenarios
on next page
Units: £m, %
Cost savings (2010/11 – 14/15)
Forecast underlying net surplus (2014/15)
% CAGR
%
£m
Required savings
to achieve 1% surplus
by 2014/15
6.9
93.4
Matching ’peer at
top quartile threshold’
(+2% no cap)
7.3
97.6
Matching ’peer at
top quartile threshold’
(+2% with cap)
5.4
Matching ’average
of top 3 peers’
(+2% no cap)
Matching ’average
of top 3 peers’
(+2% with cap)
75.0
8.6
5.4
£m
7.9
2.4
-16.1
-4.9
112.9
75.0
3.3
1.0
23.9
7.3
-4.9
-16.1
NOTE: Benchmarks are based on current (2009/10) performance, so targets are increased 2%pt per annum to simulate the peer group continuing to
improve over the period 2011/12 to 2014/15 (note that although benchmarks are based on 2009/10 performance, the 2%pt is not added for 2010/11
year because the baseline costs on which the savings are applied are 2010/11, so already includes the change for this year)
SOURCE: FIMS 09/10, Annual Reports 09/10 , HES 09/10, ERIC 09/10, Trust operating plan 2011/12 (for 10/11
underlying position)
11
NWLH
Identified cost saving opportunities
Units: £m, %
Cost saving opportunity (before adding 2% per year or 20% cap)
Matching average of
Matching peer at top
top 3 peers
quartile threshold
Top quartile on each
Category
Current
operating cost 10/11 (Royal Cornwall)
ALOS1
(Sherwood, County Durham,
Northumbria)
metric
-1
0
0
Medical pay
72
-15 (-21%)
-23 (-31%)
-20 (-28%)
Nurses pay2
85
-31 (-37%)
-31 (-36%)
-36 (-42%)
ST&T pay
39
-14 (-36%)
-14 (-35%)
-20 (-51%)
Non-clinical pay
35
-2 (-6%)
0 (0%)
-6 (-18%)
Clinical supplies
61
-4 (-7%)
-15 (-24%)
-12 (-20%)
8
-1 (-11%)
-2 (-27%)
-2 (-30%)
76
n/a
n/a
n/a
375
-69
-84
-96
Savings (% of total costs)
-18%
-22%
-26%
Savings (4-year CAGR)
-4.9%
-6.1%
-7.1%
Other variable costs3
Fixed costs4
Total5
1 Bed day opportunity estimated at £150/day. Note that ALOS is assumed to stay at current rate or move to target, whichever is shorter. Impact on costs is apportioned
to other cost categories in the model (Medical – 10%, Nursing – 52%, ST&T – 13%, Non-clinical – 9%, Clinical supplies – 16%)
2 Nursing WTE level capped at minimum of 8 nurse hours per occupied bed day
3 Other variable costs include catering, cleaning and laundry
4 Fixed costs include estate and establishment costs, and non-operating costs (PDC, interest, depreciation, etc.)
5 Total Trust expense used to arrive at net surplus
SOURCE: FIMS 09/10, Annual Reports 09/10 , HES 09/10, ERIC 09/10, Trust operating plan 2011/12 (for
12
10/11 underlying position)
NWLH
Cost savings breakdown
Category
Peer at top
quartile
threshold
Average
of top 3 peers
Top quartile
on each metric
Metric ratio
Units
ALOS1
Casemix adjusted average
length of stay2
Days
4.5
4.4
5.5
4.5
Medical pay
Medical WTE per £1m clinical income
Medical pay per medical WTE
WTE
£k
2.9
89.6
2.1
96.9
2.1
84.0
2.1
91.8
Nurses pay
Nurse WTE per 1,000 bed days
Nursing pay per nurse WTE
WTE
£k
6.1
47.0
6.1
28.1
5.4
32.6
5.2
30.8
ST&T pay
ST&T WTE per 1,000 spells
ST&T pay per ST&T WTE
WTE
£k
8.6
38.5
5.6
38.0
5.9
36.5
4.8
33.1
Non-clinical pay
Non-clinical WTE per 1,000 bed days
Non-clinical pay per non-clinical WTE
WTE
£k
3.8
30.5
3.8
28.3
3.7
42.9
3.5
26.7
Clinical supplies
Clinical supply costs per
£1,000 clinical income
£
208.1
193.3
157.4
166.5
Other variable
costs
Laundry cost per bed day
Cleaning costs per bed day
Catering costs per patient per bed day
£
£
£
4.0
22.4
5.3
4.2
13.1
10.8
4.0
12.4
6.7
3.4
13.4
5.4
Trust
Note: All figures are from 2009/10
1 Bed day opportunity estimated at £150/day. Reapportioned to other cost categories in the model
(Medical – 10%, Nursing – 52%, ST&T – 13%, Non-clinical – 9%, Clinical supplies – 16%)
2 Adjusted for differences in HRG mix, specialties and elective / non-elective inpatients. Daycases excluded from analysis
SOURCE: FIMS 09/10, Annual Reports 09/10 , HES 09/10, ERIC 09/10
13
Trusts were placed into four categories – NWLH was not viable under any
tested scenario
Categories
Definition
1
Viable if improving productivity
to “top quartile peer” level
At least 1% surplus achievable if (capped) Top Quartile
productivity delivered
Viable if improving productivity
to “top 3 peer” level
(Capped) Top 3 peer productivity required to secure 1%+
surplus
2
3
Become viable after an extended
period
Significant productivity opportunity constrained by cap,
meaning that longer period required to reach 1%+ surplus
(or productivity performance exceeding the capped level)
Either:
• Productivity opportunity not sufficient to deliver 1%
surplus even without capping
4
Not viable under any tested
scenario
Or:
• Significant productivity opportunity constrained by cap,
but not sufficient to reach 1%+ surplus even over
extended period – therefore would need immediate
productivity performance exceeding the capped level
NWLH
14
Agenda
1 Introduction
2 Methodology
3 Conclusions for NWLH (from Phase 1)
4 Supporting London Acute Productivity Gain
5 Discussion Points
Appendix
• Peer Groups
• Medical Oncosts for NWLH
15
Even before corrective action, change is necessary to secure delivery of
the £1.2bn productivity opportunity identified
Building blocks required to reach high
productivity
System leadership
Political, clinical and managerial
leadership to create a compelling
narrative and explain need for change
Five cross-cutting actions we want to take to
embed changes
Additional centrally-led
initiatives that can help Trusts
capture savings
▪
Develop a compelling narrative explaining the
need for unprecedented change in quality and
operational efficiency
▪
Support one or more organisations
to become a “model hospital”
▪
▪
Establish graduated performance regime of
support and incentives for Trusts, including the
possibility of failure. This should link support of
deficits and financing of debt to changes in
operating model and productivity
▪
Invest in leadership development and
capability-building for Boards and clinical leaders
to equip them to drive change
Drive a transformation in
nursing, including:
– creating targeted incentives
for nurses to work in deprived
areas and/or ‘failing’ Trusts;
– establishing nursing banks
across a network of Trusts;
and
– benchmarking nurse staffing
mix
▪
Develop more detailed information for Trusts to
identify the right productivity opportunities, including
supporting them to use SLR/PLICs to drive
efficiencies and require Trusts to provide
operational data that is sufficiently detailed to
assess progress against productivity requirement
▪
Consolidate or outsource clinical
support such as pathology
▪
London-wide support for radical
action on non-clinical back office
and estates
Productivity support programme for Trusts to
help Trusts build the skills of clinical and managerial
leaders and share best practice, including driving
the roll-out of Lean methodology
▪
Increase the leverage and scope of
the London Procurement
Programme, including building on
existing work for improving
medicines management
Incentives
Incentives in place to drive high
performance at the system, organisation,
team and individual level
Internal leadership
Strong Board-level and clinical leadership
to drive productivity
Information
Timely and accurate information that
provides insight into performance and
productivity relevant to peers
Tools & Skills
Well-defined tools and the skills and
capabilities to use them
▪
Success of all actions and initiatives is predicated on Trusts having right leadership talent in place – with indications that the system does not
currently have this. Four options, which could be linked to the performance/ failure regime, might address this:
▪ Mergers and Acquisitions to extend management capability of effective boards
▪ Academic Health Science Systems (AHSS) to raise reputation and clinical leadership of Trusts through networks
▪ Private sector operators to bring in additional leadership
▪ Heavily incentivise top team posts to attract best talent from UK and abroad
16
Agenda
1 Introduction
2 Methodology
3 Conclusions for NWLH (from Phase 1)
4 Supporting London Acute Productivity Gain
5 Discussion Points
Appendix
• Peer Groups
• Medical Oncosts for NWLH
CONFIDENTIAL
|
17
Discussion points
• Does the Trust recognise the challenges signalled by the SaFE analysis?
• What are the Trust’s productivity opportunities?
• What is the Trust’s plan for maximising the productivity opportunities?
• What other strategic options could be implemented beyond productivity?
• On what does the Trust need help?
18
Agenda
1 Introduction
2 Methodology
3 Conclusions for NWLH (from Phase 1)
4 Supporting London Acute Productivity Gain
5 Discussion Points
Appendix
• Peer Groups
• Medical Oncosts for NWLH
19
Bold indicates London non-FTs
Grey indicates exclusions due
to bottom quartile HSMR
Peer groups
Ordered alphabetically
Peer selection
Peers selected
considering
trust’s:
▪ Academic/
nonacademic
status
▪
Size
▪
Single/multisite status
where
relevant
Other peer
characteristics
not found to
have as
statistically
relevant impact
on performance
Teaching
Non-teaching
Included:
Large
Barts and The London
Brighton and Sussex
Bristol (FT)
Cambridge (FT)
Chelsea and Westminster
(FT)
Coventry and Warwickshire
Guy's and St Thomas‘(FT)
Imperial
King's College (FT)
Leeds
Leicester
Newcastle Upon Tyne (FT)
Norfolk and Norwich (FT)
North Staffordshire
Nottingham
Oxford Radcliffe
Plymouth
Royal Devon and Exeter (FT)
Royal Free Hampstead
Royal Liverpool and
Broadgreen
Sheffield (FT)
Southampton
St George's
University College London
(FT)
Medium
Small
Single site
Due to small
number of ‘large
non-teaching
Trust’, Trusts in
this peer group
have been
benchmarked
against all nonteaching Trusts
irrespective of
size.
Additional ‘large’
Trusts included:
East Kent1 (FT)
Gloucestershire
(FT)
Heart of England
(FT)
North Bristol
Portsmouth
SLHT
South Tees (FT)
Excluded:
Pennine Acute
Excluded:
Birmingham (FT)
Central Manchester (FT)
Derby (FT)
Hull and East Yorkshire
1 East Kent not included in analysis due to gaps in data
Included:
Frimley Park (FT)
Great Western (FT)
Ipswich
Luton and Dunstable (FT)
Medway (FT)
Royal Surrey County (FT)
Royal United Bath
Salford Royal (FT)
Salisbury (FT)
South Devon Healthcare
(FT)
Multi site
Single site
South Manchester (FT)
Southend (FT)
St Helens and Knowsley
Taunton and Somerset (FT)
Whipps Cross
Wirral (FT)
York (FT)
Excluded:
Basildon and Thurrock (FT)
Dudley Group (FT)
Northampton General
Royal Wolverhampton
Included:
Royal Berkshire
Ashford and St Peter's
Royal Bournemouth and
Aintree (FT)
Christchurch (FT)
Barnet and Chase Farm
Royal Cornwall
BHRT
Sandwell and West
Blackpool, Fylde & Wyre (FT) Birmingham
Bradford (FT)
Sherwood Forest (FT)
Calderdale and Huddersfield Stockport (FT)
(FT)
West Hertfordshire
Colchester (FT)
Worcestershire
County Durham and
Wrightington, Wigan and Leigh
Darlington (FT)
(FT)
Epsom and St Helier
Heatherwood and Wexham Excluded:
Park (FT)
Buckinghamshire
Lancashire (FT)
Doncaster and Bassetlaw (FT)
Maidstone and Tunbridge
East and North Hertfordshire
Wells
East Lancashire
Mid Essex Services
East Sussex
Morecambe Bay
Mid Yorkshire
Northern Lincolnshire and
North Cumbria
Goole (FT)
North Tees and Hartlepool (FT)
Northumbria (FT)
Shrewsbury and Telford
NWLH
Sunderland (FT)
Peterborough and Stamford United Lincolnshire
(FT)
Western Sussex
Included:
Newham
Northern Devon
Airedale
Poole (FT)
Basingstoke and North
Princess Alexandra
Hampshire (FT)
Queen Elizabeth King'sBedford
Lynn
Burton (FT)
South Tyneside (FT)
Chesterfield Royal (FT)
Walsall
Countess of Chester (FT) West Middlesex
Croydon
West Suffolk
Dartford and Gravesham Weston Area
Dorset County (FT)
Whittington
Ealing
East Cheshire
Excluded:
Gateshead (FT)
Harrogate and District
Barnsley (FT)
(FT)
George Eliot
Hereford
Kettering General (FT)
Hinchingbrooke
Mid Cheshire (FT)
Homerton (FT)
North Middlesex
James Paget (FT)
Rotherham (FT)
Kingston
Royal Bolton (FT)
Lewisham
Surrey and Sussex
Milton Keynes (FT)
Tameside (FT)
Yeovil District (FT)
Multi site
Included:
Hillingdon (FT)
Mid Staffordshire (FT)
Trafford
Warrington (FT)
Winchester and Eastleigh
Excluded:
Scarborough
South Warwickshire (FT)
Southport
20
NWLH
Impact of new service standards in emergency services and obstetrics,
11/12 & 14/15
Emergency care services 11/12
Paediatrics
A&E
Maternity
Anaesthetics
General medicine
General surgery
Total
Obstetrics
Additional1 Additional Additional Additional Additional Additional Additional Additional Additional Additional Additional Additional
consultants Cost
consultants Cost
consultants Cost
consultants Cost
consultants Cost
consultants Cost
£m
£m
£m
£m
£m
£m
(WTE)
(WTE)
(WTE)
(WTE)
(WTE)
(WTE)
Trust
NWLH
2.0
0.2
17.0
1.9
16.7
1.8
2.8
0.3
1.5
0.2
3.3
0.4
Additional Additional
consultants Cost
£m
(WTE)
43.4
4.8
Note: For general medicine and general surgery secretarial costs are included in the cost
1 Additional consultants estimated based combination of WTE and PA analysis, assuming £110k per WTE in 11/12
Emergency care services 14/15
Paediatrics
A&E
Maternity
Anaesthetics
General medicine
General surgery
Total
Obstetrics
Additional1 Additional Additional Additional Additional Additional Additional Additional Additional Additional Additional Additional
consultants Cost
consultants Cost
consultants Cost
consultants Cost
consultants Cost
consultants Cost
£m
£m
£m
£m
£m
£m
(WTE)
(WTE)
(WTE)
(WTE)
(WTE)
(WTE)
Trust
NWLH
7.2
0.9
19.1
2.3
25.9
3.1
4.6
0.6
2.3
0.3
0.0
0.0
Additional Additional
consultants Cost
£m
(WTE)
59.1
7.3
1 Additional consultants estimated based combination of WTE and PA analysis, assuming £121k per WTE in 14/15
Sources
Numbers of consultants required based on:
• Paediatrics : consultant delivered service and 24 hour EWTD compliant rota
• A&E: <80,000 attendances = 10; 80,000 – 100,000 = 12; 100,000+ = 14
• Anaesthetics: 11 for each of surgery and obstetrics
• General medicine and general surgery: numbers necessary to achieve 12/7 in line with AES standards
Current numbers of consultants based:
• Medicine and surgery, Trust reported for AES project
• Other specialities, NHS Hospital and Community Health Services (HCHS) : Medical and dental staff by SHA, Organisation, Specialty and
Grade, 2009
21