Controlling Medical Pay Spend Dr Celia Skinner Medical

Controlling Medical Pay Spend Dr Celia Skinner Medical Director Basildon and Thurrock University Hospital

Background… • Basildon and Thurrock (BTUH) budget £ 330 m, medical pay £ 50 m • Challenged hospital but financially stable until 2013 • Difficulties in medical recruitment

Background • Medical pay has increased significantly from Q 1 in 2014/15, • Local controls appeared to have limited affect • The underlying drivers were not clear to the Board • Board was questioning the value of the spend

The problem • The medical pay budget is significantly overspent • £ 8 m over £ 50 m, budget for 2014/15

The objective • To reduce the medical pay spend by £ 2 m by the end of 2015/16.

Root cause analysis • Jan 2015 project group, weekly meetings to establish root causes and early actions • Initial hypotheses: – poor execution of local controls for bank and agency spend – Increasing demand driving discretionary spend on consultants to achieve waiting lists

Root Cause analysis Total N=514 Vacancy Consultants n=177 SAS n=97 Doctors in training N=240 10. 5%↓ 14. 1%↓ 12%↑ 20% (0 -29%) No data Turnover 14% 11% (0 -26%) Budget outturn £ 8 m £ 2. 8 m £ 3. 3 m

Selected Strategy Driver: strategic approach Quantification * Ease of implementation impact agency spend £ 6. 8 m hard Significant consultant spend £ 2. 8 m over budget hard Significant non consultant spend £ 3. 3 m over budget Medium Significant

Implementation Plan Medium Immediate Budgets Pa ti ent Exper i ence Controls Job planning (consultants) Long term Re set budgets to 2014/15 outturn Review leave policy and application Map agency staff recruitment , re-design and provide real time data Re-write job planning policy Establish scrutiny panel Provide re lar activity data against expected expec productivity regular Procure and implement new job planning software Vacancies Governance Review all vacancies over 3 months and consider alternatives Wee project group, chaired by DM program board Weekly DMD, reporting to monthly programme Efficiency OD Relationship building, sskil ls uplift, cultural challenge

Evaluation plan • Project governed through programme board with updates on milestones • Monthly scrutiny of spend, vacancies, sickness • Development of forcasting for spend

Agency cost trends 13

Learning • Clarity of purpose • Right people in the room with accountable actions • The more you find the less you know