1. 1 NHS Yorkshire and the Humber Monthly QIPP resource pack November 2009

2. 2 Introduction At the Chief Executives meeting on QIPP, it was agreed that we would produce a monthly resource pack to support organisations in developing their response to the QIPP agenda. The pack has three components: BETTER FOR LESS EXAMPLES: We have worked with you to develop practical examples of schemes which have been developed locally and have potential to deliver better quality at lower cost. These slides summarise the better for less briefings which are published as part of the Healthy Ambitions programme. WORKFORCE ‘HOT TOPIC’: Each month we will produce one ‘hot topic’ briefing which provides more detailed analysis on a subject relevant to QIPP. This month the hot topic is workforce. The analyses presented here are designed to offer insight and raise questions about variation in performance. They need to be interpreted in the local context. INTEGRATED QIPP METRICS: We have developed a set of metrics to help understand system health in the tighter financial climate. We will publish these metrics monthly although some of the indicators will only be updated quarterly. The purpose is to offer insight and improve understanding of how the system delivering with lower growth. The next resource pack will be published week commencing 14 th December. The hot topic will be GPs and their role in managing demand across the rest of the system. If you have any questions or comments on the pack, please contact Ian Holmes (ian.holmes@yorksandhumber.nhs.uk).ian.holmes@yorksandhumber.nhs.uk Introduction

3. 3 1) Healthy Ambitions: Better for Less

4. 4 Better for less – e consultations Better for Less – e-consultations E-Consultations can dramatically reduce the cost of providing diabetes services whilst providing high quality and more convenient services to patients. Why diabetes? Over 220,000 people in the region have diabetes, costing over £100m. This figure is projected to rise to over 350,000 in the next 10 years. Healthy ambitions identified diabetes as an area for concern – as a chronic and progressive disease it affects almost every aspect of life. Emergency admissions are high and variable for diabetes and many are avoidable. Health ambitions pledged to halve the number of preventable admissions from diabetes. How can e-consultations help? At present patients are referred to secondary care for a range of diabetes related conditions. Paper based referrals are slow and consultant appointments may be inconvenient for patients. A system to share patient records between the between GPs and the specialist enables rapid e-consultation – and avoid the need for a face to face outpatient consultation. It is believed that as many as 75% of outpatient appointments can be managed through e-consultations.

5. 5 Better for less – e consultations: Benefits Better for Less – e-consultations Convenience for the patient: Significantly lower volume of outpatient appointments. Faster turnaround in information for patients who can access results at a more convenient location. Clinical quality can be improved: Sharing of medical records and rapid access to a specialist opinion can improve clinical decision making and reduce inappropriate referrals. Significant scope for financial savings: There are significant scope for savings, resulting from the different unit costs between outpatient consultations and e-consultations. Given the high and variable levels of outpatient diabetes consultations across the region (including a follow up ratio of 1:16 in some areas), it is believed that this approach could save £20-25m in Yorkshire and the Humber in outpatient attendance costs alone.

6. 6 Better for less – e consultations: Implementation Better for Less – e-consultations This approach can be implemented in any locality where there is an integrated IT system which allows information to be shared between practice and hospital. Most regions in Y&H will have this system this year, NPfIT can support those regions without integrated systems. Implications for providers need to be discussed and properly managed. Including changes in clinical working practices. Local negotiation between PCT and provider is required to agree the e- consultation tariff. A non-mandatory tariff of £23 exists for non face to face consultations. The same approach could potentially be applied to other long term conditions, such as CHD, epilepsy and COPD. For further information visit www.healthyambitions.co.uk; or contact tim.barton@yorksandhumber.nhs.ukwww.healthyambitions.co.uk

7. 7 Better for less – care homes LES Better for Less – care home LES Providing enhanced medical services to residents in nursing and residential care homes can improve management of chronic conditions, medicines management, address end of life care and dramatically reduce hospital admissions. Why care homes? There are currently 37,000 care home beds across Yorkshire and the Humber. The number of people aged 80 or over is projected to rise by over 80% in Yorkshire and the Humber between 2005 and 2030. In 2007/08, over 70s accounted for 11% of the population but 35% of NHS costs. Whilst emergency admission rates from care homes are high and very variable between practices, many are avoidable. The way that patients are managed in primary care through secondary prevention can significantly reduce these admissions. An example of this variation in admissions is in Sheffield, which varies from 16/100 beds to 135/100 beds. Problems providing services to care homes include inefficient systems, lack of care planning, GPs not visiting, over-reliance on emergency services and a lack of proactive care in managing diseases.

8. 8 Better for less – care homes LES: Benefits Better for Less – care home LES How can we provide better care for less? By delivering an enhanced GP service to rationalise the primary care services to care home residents, by reducing avoidable hospital admissions and by giving patients a better service and saving money. This service could be provided by the PCT agreeing a Locally Enhanced Service (LES) with practices within a PBC consortia. At each visit to the home the GP will review: All new patients regarding medication and any immediate problems; Any residents about whom the staff have concerns; Any resident discharged from hospital in the last week; Any resident about whom the home made contact with A&E or emergency services, such as ECPs in the last week; Any resident about whom a family member or other person actively involved in their care has directly contacted the practice. The number of non-routine visits required will reduce as a result of the enhanced care being provided. Where there are concerns about a resident in between planned visits, the home is encouraged to seek telephone advice from the practice and the named GP where possible.

9. 9 Better for less – care homes LES Better for Less – care home LES Patient benefits Agreed annual care plan and a full medicines review. Regular monitoring and assessment as required. Reduction in hospital visits. Quality benefits Consistent medical care including annual care planning and medicine reviews to ensure patients are being cared for appropriately and chronic diseases are being managed. Efficiency benefits Costs are recouped in reduced avoidable emergency admissions, fewer ambulance call outs and non-routine GP attendances. Evidence In year one of the Sheffield pilot scheme: The scheme reversed the trend of rising emergency admissions across the consortium, and delivered a reduction in emergency admissions of 6 admissions per 100 beds (approximately 9%) compared with the year before. The number of A&E attendances fell by 3 attendances per 100 beds (approximately 10%), at a time when A&E attendances where rising in other areas. The use of Emergency Care Practitioners (ECP) fell by approximately one third. For further information visit www.healthyambitions.co.uk; or contact tim.barton@yorksandhumber.nhs.uk.www.healthyambitions.co.uk

10. 10 2) Hot topic: High level workforce analysis

11. 11 Contents 1)Overview 2)Acute trust productivity 3)Mental health providers 5)Annexes 4)PCT analysis Workforce - Contents

12. 12 Section 1 1)Overview 2)Acute trust productivity 3)Mental health providers 5)Annexes 4)PCT analysis Workforce - Overview

13. 13 Purpose This information pack is the first of a series ‘hot topics’ that will be produced by the SHA to support organisations in developing their understanding of some of the challenges and opportunities presented by the QIPP agenda. While recognising that it may raise more questions than answers, we hope it will stimulate thought and debate within organisations and health communities. Clearly the data presented need to be interpreted in the local context, for example through further local consideration of the links between staff experience, patient experience and health outcomes. We would be delighted to receive comments on the contents together with any ideas for further workforce analysis. Workforce - Overview

14. 14 Historic growth in staff numbers 122,219 FTEs were employed by the NHS in 2008. This represents an increase of 37% over the previous 10 years. The NHS employs approximately 12% of the total workforce in the region. The largest increases have been in doctors & dentists (52%) and qualified ambulance staff (241%) – although these are very small numbers. The lowest growth rates were in GPs (22%) and general practice staff other than nurses (19%). Note that FTE figures are not strictly comparable across years due to changing working practices and the impact of the European Working Time Directive Workforce - Overview

15. 15 Total pay bill by sector In 2008/09 the NHS in Yorkshire and the Humber spent £3.5bn on staff (excluding independent contractor and agency staff). The quarterly total pay bill in Yorkshire and the Humber (total earnings) increased by £62m between Q1 and Q4 2008/09, an increase of 8.1%. The increase was significantly higher in PCTs than other organisations. These data will be broken down into growth by major staff group for the next iteration. Q1 pay billQ4 pay bill% change Acute Trusts£540m£576m6.7% PCTs£138m£156m12.4% MH Trusts£85m£92m7.8% Ambulance£4.1m£4.5m8.3% YaH total£767m£829m8.1% Workforce - Overview

16. 16 Historic growth in cost and volume Total Earnings in Yorkshire and the Humber in 2008/9 was £3.3 billion. The 3 graphs below illustrate the increase in total earnings from Q1 2008/9 to Q1 2009/10 for Acute Trusts, PCTs and Mental Health trusts. The percentage growth in Total Earnings and Staff in Post (SiP) in each of the organisational peer groups during 2008/9 and for a rolling 12 months from Q2 2008/9 to Q1 2009/10 was as follows :- % Change Q1-Q4 08/9% Change Q2 08/9 – Q1 09/10 Total Earnings 2008-9: Trusts6.7% (SiP growth 4.5%)5.2% (SiP growth 4%) Total Earnings 2008-9: PCTs12.4% (SiP growth 10%)8.2% (SiP growth 10%) Total Earnings 2008-9: MH Trusts7.8% (SiP growth 2.7%)1.4% (SiP growth 1.9%) Workforce - Overview

17. 17 High level investment and staff growth over time The NHS in Yorkshire and the Humber has benefited from significant increases in investment over the last 10 years. Just under one third of this growth in spending has translated into growth in staff numbers, and a significant proportion has funded pay increases for NHS Staff. Workforce - Overview

18. 18 Levels of overtime Levels of overtime in 2008-09 varied significantly across organisations and types of organisation. While some level of overtime is necessary, organisations should consider the cost and quality implications of high levels of overtime. Workforce - Overview Acute Average : 1.1%

19. 19 Clinical versus non-clinical staffing ratios This graph shows the ratio of clinical to non- clinical staff across the organisational peer groups – for example the average ratio in Yorkshire and the Humber is 4.1:1 – this means there are 4.1 FTE’s of clinical staff for every 1 FTE of non clinical staff. The ratio is an indicator of the relative proportion of clinical staff compared to ‘infrastructure’ support staff. Whilst there are significant variations in the data, it is important to understand differences in organisations when performing comparisons. Variations in provided services, alternative models of service provision etc will all impact on this measure. In Acute Trusts, the highest ratio of 8.5:1 is in Barnsley FT, the lowest is in Doncaster and Bassetlaw FT at 2.8:1. In Mental Health Trusts the highest ratio of 7.6:1 is in SW Yorkshire Partnership FT, the lowest is in Humber Mental Health Trust at 2.7:1. Source: Medical and Non-Medical Census data – September 2008. Non-Clinical Staff = NHS Infrastructure Support Staff. Clinical Staff = all other directly employed staff (excluding GPs and Practice Nurses). PCTs are excluded from this data set. Workforce - Overview

20. 20 Opportunities – flexible staffing  Accurate flexible worker demand forecasting  Replacing overtime with flexible workers  Paying flexible workers on lower AfC spine points  Optimally mix permanent and flexible staff based on historical data to cover workload and seasonal variation  Eliminate the ability to use high cost agency staff  Use bank over agency  Use good management information to control spend Workforce - Overview

21. 21 Section 2 1)Overview 2)Acute trust productivity 3)Mental health providers 5)Annexes 4)PCT analysis Workforce - Acute trust productivity

22. 22 Understanding acute productivity We have calculated four measures of pay efficiency and productivity at acute trust level. Each of these is relatively crude and need to be viewed alongside other local data and contextual information. Taken together they begin to build a picture of some of the workforce issues in organisations. The measures are as follows: Unit labour cost Unit labour cost measures the total value of activity produced by the organisation compared to the total value of the labour input. The higher the unit labour cost, the more productive the organisation on this measure. Average labour cost Average labour cost is the average cost of an NHS member of staff in the organisation. Relative pay efficiency Relative pay efficiency is the average level of pay for each staff group compared to its regional and cluster 1 comparators. Raw productivity Raw productivity measures the total value of activity produced by the organisation compared with the number of whole time equivalent NHS staff it employs. 1: Affinity cluster groups as used in iView, based on ERIC groupings and updated by the NHS Information Centre. Workforce - Acute trust productivity

23. 23 Understanding acute productivity: Average labour cost The average cost of labour employed in acute providers ranges from Doncaster and Bassetlaw and NLAG with an average cost of £29,900 to Sheffield Children’s Hospital with £35,100. This compares with the National Average of £32,500. These variations are likely to reflect both skill mix differences as well as variations in pay within different groups of staff. We would expect more specialised organisations to have a higher average labour cost The analysis is based on NHS employed staff only (generated from the electronic staff record) so will not include agency spend or contracted out staff. Annex A provides % staff by A4C pay band for each trust – this in part explains variations in average labour costs. Source: Total staff cost by organisation 2008/09, iView, Average FTEs by organisation 2008/09, iView Average labour cost Average labour cost is the average cost of an NHS member of staff in the organisation. Workforce - Acute trust productivity

24. 24 Understanding acute productivity: Relative pay efficiency When comparing each organisation against the its cluster average, Rotherham appears to be the least pay efficient at 1.03, whilst Sheffield Children’s Hospital is the most efficient at 0.85 – despite having the highest average labour cost in our region. On the whole, providers in our region are relatively pay efficient compared with national cluster groups. When comparing each organisation against the regional average, Rotherham again appears to be the least pay efficient at 1.05, whilst Sheffield Children’s Hospital is the most pay efficient at 0.96. These figures apply to NHS employed staff only (recorded in the ESR). Source: Total staff cost by organisation 2008/09, iView, Average FTEs by staff group for region and cluster 2008/09, iView Relative pay efficiency Relative pay efficiency is the average level of pay for each staff group compared to its regional and cluster comparators. Workforce - Acute trust productivity

25. 25 Understanding acute productivity: Raw productivity These results show significant variation in cost weighted output per FTE from £49,057 per FTE, to £31,068. When considering the cost weighted output per medical FTE in 2007/08 the range was larger, from £483,210 to £239,141. This variation is likely to in part reflect complexity in case mix, and the proportion of medical staff required to deliver services. These measures do not adjust for agency staff, the quality of services provided, or the non-activity related outputs that the trust produces. Source: Cost weighted activity by organisation 2007/08, Department of Health, Average FTEs by organisation 2008/09, iView Raw productivity Raw productivity measures the total value of activity produced by the organisation compared with the number of whole time equivalent NHS staff it employs. Workforce - Acute trust productivity

26. 26 Understanding acute productivity: Unit labour cost In 2007-08, it appears that unit labour cost for acute trusts varied from 1.61 (more productive) to 0.92 (less productive) across the region. While these variations are significant, there may be other factors that explain the variation, the volume training activities provided and case mix. The calculation adjusts for agency staff input but may not reflect all contracted out staff. Sources: Cost weighted activity by organisation 2007/08, Department of Health; Organisation staff cost 2007/08, iView and change in SiP data; Agency spend from Trust accounts Unit labour cost Unit labour cost measures the total value of activity produced by the organisation compared to the total value of the labour input. The higher the unit labour cost, the more productive the organisation on this measure. Workforce - Acute trust productivity

27. 27 Putting these indicators together: Sheff. Children’s Hospital Unit labour cost Sheffield Children’s hospital has a unit labour cost of 1.02, implying that on this measure the hospital is the second least productive in the region. The specialist nature of the services and the high average labour cost may explain this. Average labour cost Average labour cost in Sheffield Children’s hospital is the highest in the region by a significant amount. This is likely to reflect the higher skill mix required to deliver more specialist services. Relative pay efficiency In terms of relative pay efficiency, the trust is very efficient compared with the cluster and regional averages. This means that for a given skill mix of staff, the relative cost of the staff is low. Raw productivity Raw productivity in the trust appears low, but again this is likely to reflect the complexity associated with delivering more specialised services. Workforce - Acute trust productivity

28. 28 Comparison with Better Care Better Value indicators Better care better value includes a range of indicators which relate to workforce productivity. The earlier slides identified variations in productivity at organisation level - these should correlate with BCBV indicators such as day case rates, average length of stay and pre-op bed days. Day case surgery rates Average length of stay Pre-operative bed days Source: Better care better value, Q4 2008-09 Workforce - Acute trust productivity

29. 29 Other acute indicators: Staff sickness The graph opposite shows staff sickness in 2008/09 as a percentage of total FTEs and as a cost to the organisation. Leeds Teaching Hospitals has the highest cost of sickness (£20.2m), but this reflects the scale of the organisation rather than a high sickness absence rate. Bradford Teaching Hospitals had the highest rate of sickness in 2008-09, and the associated cost of sickness was £7.3m. The national average Sickness rate for Acute Trusts is 4.2%, shown as a yellow bar on the graph to the right. While a certain level of sickness absence is inevitable, High levels of staff sickness are often an indicator of organisational health, and are also an additional cost burden on the organisation. Source: iView, 2008-09 Workforce - Acute trust productivity

30. 30 Other acute indicators: Staff turnover High staff turnover is often an indicator of organisational health. High turnover also places additional cost burden on providers in terms of cost of recruitment and lost productivity associated with very new and leaving staff. This graph uses the number of FTE leavers from August 08 to July 09. The turnover rate is then expressed as a percentage of the average number of staff. An issue with this data is that it includes transfers of staff between providers which will artificially inflate the figures. This figures exclude junior doctor turnover. Source: ESR Data Warehouse, August 2008 – July 2009 Workforce - Acute trust productivity

31. 31 Other acute indicators: Agency spend The graphs opposite show the agency spend by organisation in 2007/08 for SHAs, PCTs and acute trusts. The range of agency spend amongst PCTs is high, ranging from Sheffield at £2.8m to North Lincolnshire at £0.3m. The range of agency spend amongst acute providers is also high, ranging from Bradford Teaching Hospital at £7.0m to Rotherham with £nil. The availability of a pool of flexible staff is essential for the running of large organisations. Effective bank arrangements or use of NHS professionals is often a cheaper and higher quality way of achieving workforce flexibility. Source: Published annual accounts Workforce - Acute trust productivity

32. 32 Section 3 1)Overview 2)Acute trust productivity 3)Mental health providers 5)Annexes 4)PCT analysis Workforce - Mental health providers

33. 33 Mental health providers: Average labour cost The average cost of labour employed in acute providers ranges from £26,400 in RDASH £30,500 in South West Yorkshire. The National average is £32,400, shown in yellow on the graph to the right. These variations are likely to reflect both skill mix differences as well as variations in pay within different groups of staff. We would expect more specialised organisations to have a higher average labour cost The analysis is based on NHS employed staff only (generated from the Electronic Staff Record) so will not include agency spend or contracted out staff. Annex C provides % staff by A4C pay band for each trust – this in part explains variations in average labour costs. Source: Total Earnings by organisation 2008/09, iView, Average FTEs by organisation 2008/09, iView Average labour cost Average labour cost is the average cost paid for an NHS member of staff in the organisation. Workforce - Mental health providers

34. 34 Mental health providers: Relative pay efficiency When comparing each organisation against the regional average, Bradford District Care Trust appears to be the least pay efficient at 1.03, whilst Rotherham, Doncaster & South Humber FT is the most pay efficient at 0.97. The range across our mental health providers is very small. These figures apply to NHS employed staff only (recorded in ESR). Source: Total Earnings by organisation 2008/09, iView, Average FTEs by staff group for region and cluster 2008/09, iView Relative pay efficiency Relative pay efficiency is the average level of pay for each staff group compared to its regional and cluster comparators. Workforce - Mental health providers

35. 35 Mental health providers: Other indicators – staff sickness The graph opposite shows staff sickness in 2008/09 as a percentage of total FTEs and as a cost to the organisation. Sickness absence varies across MH providers from 5.4% to 6.4%. The highest cost of sickness is in Sheffield Health & Social Care FT, with a cost of £4.2m. The organisation has the 2 nd highest sickness rate of MH Trusts in Yorkshire and the Humber. The lowest annual cost of sickness is in Humber MH with a cost of £2.7m, where the sickness rate was 5.7%. These rates compare with the National average sickness rate for MH Trusts of 5.3%, shown as the yellow bar in the graph to the right. While a certain level of sickness absence is inevitable, high levels of staff sickness are often an indicator of organisational health, and are also an additional cost burden on the organisation. Source: iView, 2008-09 Workforce - Mental health providers

36. 36 Mental health providers: Other indicators – staff turnover High staff turnover is often an indicator of organisational health. It also places additional cost burden on providers in terms of cost of recruitment and lost productivity associated with very new and leaving staff. This graph uses the number of FTE leavers from August 08 to July 09. The turnover rate is then expressed as a percentage of the average number of staff. An issue with this data is that it includes transfers of staff between providers which will artificially inflate the figures. These figures exclude turnover for junior doctors. Source: ESR Data Warehouse, August 2008 – July 2009 Workforce - Mental health providers

37. 37 Section 4 1)Overview 2)Acute trust productivity 3)Mental health providers 5)Annexes 4)PCT analysis Workforce – PCT analysis

38. 38 PCT headlines The 14 PCTs in Yorkshire and the Humber employ 23,000 FTE, 20% of the total workforce. The Commissioning arms of PCTs employ 4,600 FTE, 20% of the total PCT workforce. Commissioners as a % of those employed in PCTs Source: Schedule 3 workforce planning returns – September 2009 Workforce – PCT analysis PCT Employees as a % of total Staff in Post in Yorkshire and the Humber

39. 39 PCT headlines – commissioning staff The number of staff in the PCT Commissioner arms is shown below. The analysis is based on data collected from PCTs which has not been validated. Source: Schedule 3 workforce planning returns – September 2009 PCT Commissioner staff Workforce – PCT analysis

40. 40 Other PCT indicators – average cost of labour employed Average cost of labour employed is the average annual cost paid by the PCT for directly employed NHS members of staff. These figures include both commissioning arm and provider arm staff – and are therefore not comparable across organisations due to differing size and service provision in provider functions. It is not possible to generate productivity measures for PCTs due to the lack of routinely available. Source: iView, 2008-09 Workforce – PCT analysis

41. 41 Other PCT indicators – Staff sickness The graph opposite shows staff sickness in 2008/09 as a percentage of total FTEs and as a cost to the organisation. North Yorkshire & York PCT has the highest cost of sickness (£4.6m), but this reflects the scale of the organisation rather than a high sickness absence rate. North East Lincolnshire Care Trust Plus had the highest rate of sickness in 2008- 09, and an associated cost of sickness of £1.7m While a certain level of sickness absence is inevitable, high levels of staff sickness are often an indicator of organisational health, and are also an additional cost burden on the organisation. Source: iView, 2008-09 Workforce – PCT analysis

42. 42 Other PCT indicators – Staff turnover High staff turnover is often an indicator of organisational health. High turnover also places additional cost burden on providers in terms of cost of recruitment and lost productivity associated with very new and leaving staff. This graph uses the number of FTE leavers from August 08 to July 09. The turnover rate is then expressed as a percentage of the average number of staff. An issue with this data is that it includes transfers of staff between providers which will artificially inflate the figures. Source: ESR Data Warehouse, August 2008 – July 2009 Workforce – PCT analysis

43. 43 Section 5 1)Overview 2)Acute trust productivity 3)Mental health providers 5)Annexes 4)PCT analysis Workforce - Annexes

44. 44 Annex A: Key contacts Tim Gilpin – Director of Workforce and Education (Tim.Gilpin@yorksandhumber.nhs.uk) Helen Smith – Associate Director, Workforce Strategy (Helen.Smith@Yorksandhumber.nhs.uk) Ian Holmes – Associate Director, Economics and System Management (Ian.Holmes@Yorksandhumber.nhs.uk) Workforce - Annexes

45. 45 Annex B: Acute FTEs by AFC band The following five slides show actual NHS FTEs by AfC pay band for acute trusts as a percentage of the organisation’s total NHS FTEs (blue) compared with the average percentage FTEs by AfC band for the cluster as a whole (grey). This data gives an indication of the relative skill mix across AfC bands in the organisation compared with its peers, and is likely to partially explain the average cost of labour and relative pay efficiency measures of productivity. Whilst a low average cost of labour employed appears to be the most efficient in crude terms, we also need to consider the quality and clinical safety issues associated with differing skill mix. Workforce - Annexes

46. 46 FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

47. 47 FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

48. 48 FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

49. 49 FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

50. 50 FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

51. 51 Annex C: Mental health FTEs by AFC band The following two slides show actual NHS FTEs by AfC pay band for mental health trusts as a percentage of the organisation’s total NHS FTEs (blue) compared with the average percentage FTEs by AfC band for the cluster as a whole (grey). This data gives an indication of the relative skill mix across AfC bands in the organisation compared with its peers, and is likely to partially explain the average cost of labour and relative pay efficiency measures of productivity. Whilst a low average cost of labour employed appears to be the most efficient in crude terms, we also need to consider the quality and clinical safety issues associated with differing skill mix. Workforce - Annexes

52. 52 Annex C: Mental health FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

53. 53 Annex C: Mental health FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

54. 54 Annex D: PCT FTEs by AFC band The following five slides show actual NHS FTEs by AfC pay band for PCTs as a percentage of the organisation’s total NHS FTEs (blue) compared with the average percentage FTEs by AfC band for the cluster as a whole (grey). This data gives an indication of the relative skill mix across AfC bands in the organisation compared with its peers, and is likely to partially explain variations in the average cost of labour. Note that these data are not comparable across organisations, due the differing commissioning vs provision split across PCTs. Workforce - Annexes

55. 55 Annex D: PCT FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

56. 56 Annex D: PCT FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

57. 57 Annex D: PCT FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

58. 58 Annex D: PCT FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

59. 59 Annex D: PCT FTEs by AFC band Workforce - Annexes AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1 AfC Band 9 AfC Band 8d AfC Band 8c AfC Band 8b AfC Band 8a AfC Band 7 AfC Band 6 AfC Band 5 AfC Band 4 AfC Band 3 AfC Band 2 AfC Band 1

60. 60 3) Integrated QIPP Metrics

61. 61 Integrated QIPP Metrics Integrated Metrics – Acute Trusts We have developed an initial set of metrics so we can begin to track how health systems are functioning in a tighter financial climate. These focus on productivity, but also on outcomes and other measures of system health. The dashboard will be developed for next months pack to include non-acute provider information and more PCT analyses. As we develop a time series of data we will also analyse how different metrics interact and impact on each other. If you have any comments on these metrics and how they could be developed please contact forrest.frankovitch@yorksandhumber.nhs.uk

62. 62 Integrated Metrics – Acute Providers (1) Integrated Metrics – Acute Trusts

63. 63 Integrated Metrics – Acute Providers (2) Integrated Metrics – Acute Trusts

64. 64 Integrated Metrics – PCTs (1) Integrated Metrics - PCTs

65. 65 Integrated Metrics – PCTs (2) Integrated Metrics - PCTs