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

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

Background Medical pay has increased significantly from Q1 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

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

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

Rootcauseanalysis 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 –

RootCauseanalysis Total Consultants SAS Doctors in N=514 n=177 n=97 training N=240 Vacancy 10.5%↓ 14.1%↓ 12%↑ Turnover 14% 11% 20% No data (0-26%) (0-29%) Budget £8m £2.8m £3.3m outturn

Selected Strategy Driver: strategic approach Quantification * Ease of impact implementation agency spend £6.8m hard Significant consultant spend £2.8m over budget hard Significant non consultant spend £3.3m over budget Medium Significant

Pa ent Exper ence E c ency Implementation Plan MediumLong term Immediate B titi policy and Map agency staff recruitment, re-design and provide real time data Provide regular activity data against expected productivity scrutiny panel new job planning software Review all vacancies over 3 months and consider alternatives Weekly project group, chaired by DMD, reporting to monthly programme ffiffii Relationship building, skil Relationship building, sls uplift, cultural challenge WeeWeeproject group, chaired by DMreporting to monthly programboard Review all vac Re-write job planning policy Establish Procure and implement Provide relar activity data against expec Review leave application Map agency staff recr Re set budgets to 2014/15 outturn udgets i Controls Job planning (consultants) Vacancies Governance OD

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

13 Agency cost trends

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