Safe and Financially Effective (SaFE)

St George’s Healthcare NHS Trust Text

15 September 2011

1 Footnote SOURCE: Source 0

Agenda

1 Introduction 2 Methodology 3 Conclusions for St George’s

(from Phase 1)

4 Supporting London Acute Productivity Gain 5 Discussion Points Appendix • Peer Groups • Medical Oncosts for St George’s

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 St George’s

(from Phase 1)

4 Supporting London Acute Productivity Gain 5 Discussion Points Appendix • Peer Groups • Medical Oncosts for St George’s

3

Approach: We estimated Trusts ’ financial position to 2014/15 in 5 steps

Establish 10/11 baseline Estimate income changes by 14/15 Estimate cost changes by 14/15 Develop year-by year forecasts

▪ 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.

▪ ▪ 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)

Evaluate financial outlook

▪ ▪ 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 4 1 Cost scaling assumptions modelled at level of detailed cost categories, reflecting differences in proportions of fixed and variable costs

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 Assumption / approach in this work

▪ Costs scaled at 70-80% with increases in activity, and 55-65% with decreases

Potential downside

▪ Some Trust operating plans imply higher scaling with increases and lower / no scaling with decreases

Cost inflation Tariff uplift & price changes PFI & other capex

▪ ▪ ▪ 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) ▪ ▪ ▪ 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 SOURCE: SaFE modelling assumptions

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… The ‘20% cap’ translates to:

▪ 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

…based on not having seen evidence of higher levels of cost savings sustained over a long period

Examples of hospital cost reduction programmes

% reduction in total cost base, CAGR Time frame

US private hospital ~5 2-3 years Germany private hospital 4-5 4-5 years Portugal private hospital Germany public hospital Sweden public hospital 4-5 ~4 ~4 2-3 years 3-4 years ~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 St George’s (from Phase 1) 4 Supporting London Acute Productivity Gain 5 Discussion Points Appendix • Peer Groups • Medical Oncosts for St George’s

8

Forecast underlying I&E 2010/11 to 2014/15

Units: £m

Income 2010/11 – 14/15 14

43 12

11

27 596 Net impact from volume changes = + £34m 5 0 598 2010/11-11/12 (Trust Operating Plans) ST GEORGE ‘S

Costs 2010/11 – 14/15

599 21 56 0 5 4

28

92 Net change of +£21m from £1m 11/12 and +£22m 12/13 to 14/15 Net surplus 2014/15: +£30m (+5.1%) 2 Net surplus 2014/15: +£32m including community 1 567 Income 2010/11 Under lying demand Demand manage ment Tariff uplift Other oper ating income 1 Non oper ating income Income 2014/15 Cost 2010/11 Impact of net change in activity Cost inflation PFI Other oper ating ex penses Non oper ating ex penses Pro duc tivity Impact of new 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 Cost 2014/15 9

ST GEORGE ‘S

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

Lines may overlap.

EBITDA and net surplus shown for matching ‘peer at top quartile threshold’ (+2% with cap) 35.0

30.0

25.0

20.0

15.0

10.0

5.0

0 -3.9

-5.0

2010/11 (underlying) 1.5

14.3

23.4

2011/12 operating plan (underlying) 2012/13 forecast 2013/14 forecast

Underlying EBITDA

% of income

Underlying net surplus

% of income 4.1% -0.7% 5.1% 0.2% 7.4% 2.4% 9.2% 3.9% 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).

30.3

£32m including community surplus 2014/15 forecast 10.5% 5.1% 10

ST GEORGE ‘S

Benchmark analysis on cost saving opportunities

Units: £m, %

Cost savings (2010/11 – 14/15)

% CAGR £m Modelled scenarios on next page

Forecast underlying net surplus (2014/15)

% £m Required savings to achieve 1% surplus by 2014/15 Matching ’peer at top quartile threshold’ (+2% no cap) Matching ’peer at top quartile threshold’ (+2% with cap) Matching ’average of top 3 peers’ (+2% no cap) Matching ’average of top 3 peers’ (+2% with cap) 4.3

5.9

5.4

5.4

8.1

96.8

128.5

119.9

172.8

119.9

1.0

6.6

5.1

5.1

14.4

6.0

39.4

30.3

£32m including community surplus 86.2

30.3

£32m including community surplus 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

ST GEORGE ‘S

Identified cost saving opportunities

Units: £m, % Category Current operating cost 10/11 Cost saving opportunity (before adding 2% per year or 20% cap) Matching peer at top quartile threshold (Sheffield) Matching average of top 3 peers (Royal Devon, Norfolk, North Staffordshire) Top quartile on each metric ALOS 1 0 -8 -7 Medical pay Nurses pay 2 ST&T pay Non-clinical pay Clinical supplies Other variable costs 3 Fixed costs 4 Total 5 Savings (% of total costs) Savings (4-year CAGR) 117 134 71 59 104 10 106 599 -4 (-4%) -27 (-20%) -33 (-47%) -7 (-12%) -9 (-8%) -2 (-20%) n/a -82 -14% -3.6% -31 (-26%) -24 (-18%) -41 (-59%) -1 (-1%) -20 (-19%) -1 (-13%) n/a -126 -21% -5.7% -14 (-12%) -32 (-24%) -37 (-53%) -10 (-16%) -12 (-12%) -1 (-12%) n/a -114 -19% -5.1% 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 10/11 underlying position) 12

ST GEORGE ‘S

Cost savings breakdown

Category ALOS 1 Medical pay Metric ratio Casemix adjusted average length of stay 2 Medical WTE per £1m clinical income Medical pay per medical WTE Units Days WTE £k Nurses pay ST&T pay Nurse WTE per 1,000 bed days Nursing pay per nurse WTE ST&T WTE per 1,000 spells ST&T pay per ST&T WTE WTE £k WTE £k Non-clinical pay Non-clinical WTE per 1,000 bed days Non-clinical pay per non-clinical WTE Clinical supplies Clinical supply costs per £1,000 clinical income Other variable costs Laundry cost per bed day Cleaning costs per bed day Catering costs per patient per bed day £ £ £ WTE £k £ Trust 5.4 2.9 89.1 8.8 32.0 11.4 36.5 4.6 28.1 260.7 Peer at top quartile threshold Average of top 3 peers Top quartile on each metric 6.5 2.6 96.4 8.0 27.3 7.1 29.9 4.0 29.0 239.2 4.6 2.2 86.7 6.1 39.3 4.4 39.6 4.2 31.5 210.2 4.7 2.5 92.1 6.6 32.4 5.8 33.1 3.9 27.6 230.3 6.0 20.9 3.6 18.4 5.9 2.1 18.2 6.2 3.2 16.7 6.8 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 – St George’s is viable if productivity is improved to “top quartile peer” level

Categories Definition 1 Viable if improving productivity to “top quartile peer” level At least 1% surplus achievable if (capped) Top Quartile productivity delivered St George’s 2 Viable if improving productivity to “top 3 peer” level (Capped) Top 3 peer productivity required to secure 1%+ surplus 3 Become viable after an extended period 4 Not viable under any tested scenario 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

•

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

14

Agenda

1 Introduction 2 Methodology 3 Conclusions for St George’s(from Phase 1) 4 Supporting London Acute Productivity Gain 5 Discussion Points Appendix • Peer Groups • Medical Oncosts for St George’s

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

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

Five cross-cutting actions we want to take to embed changes

▪

Develop a compelling narrative

explaining the need for unprecedented change in quality and operational efficiency ▪

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 ▪

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 ▪

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

Additional centrally-led initiatives that can help Trusts capture savings

▪ Support one or more organisations to become a

“model hospital”

▪ 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

▪ Consolidate or

outsource clinical support

such as pathology ▪ London-wide support for radical action on non-clinical back office and estates ▪ Increase the leverage and scope of the

London Procurement Programme

, including building on existing work for improving medicines management 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 St George’s (from Phase 1) 4 Supporting London Acute Productivity Gain 5 Discussion Points Appendix • Peer Groups • Medical Oncosts for St George’s

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 St George’s (from Phase 1) 4 Supporting London Acute Productivity Gain 5 Discussion Points Appendix • Peer Groups • Medical Oncosts for St George’s

19

Peer groups

Ordered alphabetically

Teaching

▪ ▪

Peer selection

Peers selected considering trust’s: ▪ Academic/ non academic status Size Single/multi site status where relevant Other peer characteristics not found to have as statistically relevant impact on performance

Included:

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) Due to small number of ‘large non-teaching Trust’, Trusts in this peer group have been benchmarked against all non teaching Trusts irrespective of size.

Additional ‘large’ Trusts included:

East Kent 1 (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

Non-teaching Large Bold

indicates London non-FTs

Grey

indicates exclusions due to bottom quartile HSMR

Medium Single site

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

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:

Ashford and St Peter's Aintree (FT)

Barnet and Chase Farm BHRT

Royal Berkshire Royal Bournemouth and Christchurch (FT) Royal Cornwall Sandwell and West Blackpool, Fylde & Wyre (FT) Bradford (FT) Birmingham Sherwood Forest (FT) Calderdale and Huddersfield (FT) Colchester (FT) County Durham and Darlington (FT)

Epsom and St Helier

Heatherwood and Wexham Park (FT) Lancashire (FT) Maidstone and Tunbridge Wells Mid Essex Services Morecambe Bay Northern Lincolnshire and Goole (FT) Northumbria (FT)

NWLH

Peterborough and Stamford (FT) Stockport (FT) West Hertfordshire Worcestershire Wrightington, Wigan and Leigh (FT)

Excluded:

Buckinghamshire Doncaster and Bassetlaw (FT) East and North Hertfordshire East Lancashire East Sussex Mid Yorkshire North Cumbria North Tees and Hartlepool (FT) Shrewsbury and Telford Sunderland (FT) United Lincolnshire Western Sussex

Small Single site

Included:

Airedale Basingstoke and North Hampshire (FT) Bedford Burton (FT) Chesterfield Royal (FT) Countess of Chester (FT)

Croydon

Dartford and Gravesham Dorset County (FT)

Ealing

East Cheshire Gateshead (FT) Harrogate and District (FT) Hereford Hinchingbrooke Homerton (FT) James Paget (FT)

Kingston Lewisham

Milton Keynes (FT)

Newham

Northern Devon Poole (FT) Princess Alexandra Queen Elizabeth King's Lynn South Tyneside (FT) Walsall

West Middlesex

West Suffolk Weston Area

Whittington

Excluded:

Barnsley (FT) George Eliot Kettering General (FT) Mid Cheshire (FT)

North Middlesex

Rotherham (FT) Royal Bolton (FT) Surrey and Sussex 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 1 East Kent not included in analysis due to gaps in data 20

Impact of new service standards in emergency services and obstetrics, 11/12 & 14/15

St George’s

Emergency care services 11/12 Paediatrics A&E Anaesthetics General medicine General surgery Maternity Obstetrics

Trust St George’s Additional 1 Additional consultants (WTE) Cost £m Additional Additional consultants (WTE) Cost £m Additional Additional consultants (WTE) Cost £m Additional Additional consultants (WTE) Cost £m Additional Additional consultants (WTE) Cost £m Additional consultants (WTE) Additional Cost £m 0.0

4.1

0.5

(0.1) (0.0) 3.0

0.3

-

Total

Additional Additional consultants (WTE) Cost £m

7.0

0.8

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 Anaesthetics General medicine General surgery Maternity Obstetrics

Trust Additional 1 Additional consultants (WTE) Cost £m Additional Additional consultants (WTE) Cost £m Additional Additional consultants (WTE) Cost £m Additional Additional consultants (WTE) Cost £m Additional Additional consultants (WTE) Cost £m Additional consultants (WTE) Additional Cost £m 0.0

0.0

4.9

0.6

0.0

0.0

0.3

0.0

3.3

St George’s 1 Additional consultants estimated based combination of WTE and PA analysis, assuming £121k per WTE in 14/15 0.5

0.0

0.0

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

Total

Additional Additional consultants (WTE) Cost £m

8.5

1.1

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