In line with many other NHS organisations, the Taunton and Somerset NHS Foundation Trust was facing financial challenges and wanting to drive efficiency, while at the same time improving care outcomes for patients.
The Trust was forecasting a small deficit outturn for FY17, however this was predicated on delivering significant financial efficiencies. The Trust opted to be part of the NHS improvement-led Financial Improvement Programme and were one of five Trusts that PwC were selected to work with as part of the programme.
"The theatre work with the PwC team has been a real success. We've seen a shift in culture in the hospital so that staff feel empowered to make change. They own day to day problems in their environment and we've standardised loads of processes in theatre, so that there's an improvement in the reliability of care we provide to patients. I think that the keys to the success of this are that the PwC Perform process was structured and tangible, so that staff felt they could get involved; and the PwC team were incredibly hard working and tenaciously pursued an inclusive approach to all staff so that we created a really great partnership".
We initially undertook a financial baseline review, which included reviewing FY16 actual outturn; FY17 forecast outturn; and opportunities for FY17 financial improvement.
Following the initial review, we met with the Trust’s senior management to discuss the recommendations made to help improve the financial position. Part of this included a brainstorm of ideas and review of options to address issues like the unsuccessful attempts the Trust had undergone to improve operating theatre productivity.
It was agreed with the Trust that a team from across PwC’s lines of service would provide hands-on support over approximately 14 weeks, to identify, implement and deliver rapid, in-year financial improvement through five key work streams: theatres productivity; Programme Management Office (PMO); directorate support to ‘Surgery’; helping the Trust understand the potential drivers of the Trust’s deficit; and income optimisation opportunities.
We used our ‘Perform’ framework to encourage engagement with the Trust's operational teams and left them with an approach that could be used in other areas needing improvement.
Over the project’s duration we worked with over 150 staff across the admissions team and 14 theatres, and our change programme delivered a number of efficiencies within the Theatres areas.
From day one our PwC people worked with the client, shadowing the teams across the theatres community and fully understanding what people’s roles were across the organisation. We delivered strong value within this area due to the strong engagement throughout the 14 weeks, becoming fully embedded within the organisation - our people were seen as ‘one of the team’.
At the same time, the Trust developed a greater sense of wider collaboration across their various areas, which helped with the sharing of best practice and developing an ethos of multi-team working.
"I would like to thank the PwC team for the way that you‘ve worked with us over the course of the Financial Improvement Programme. It has felt more like a collaboration and we have valued your input. I’m sure that the work we’ve done together will have a lasting impact and it would be good to keep in touch in the future."
The client has recently confirmed a financial surplus for FY16/17, having previously forecast a deficit before our work with them began.
Across all theatres, the Trust has seen an increase of over 8% in ‘touch time’, which means more of the theatre session time is spent treating patients. There are less cancellations and the capability of the staff supporting improvement activity has been increased, making it more likely to sustain the benefits. Most importantly, the Trust was able to increase by six the number of patients being treated per day, from October to December 2016.
The Trust achieved both quantitative and qualitative improvements through our close working with them. We embedded enhancements - new governance procedures; the introduction of a Quality Impact Assessment (QIA) process; new systems to improve the accuracy of information; staff upskilling; expenditure controls; and an enhanced vacancy approval process - which not only helped on the short term but which will help the Trust to continue to deliver and improve, going forward.
The provision of PMO and directorate support was a key priority for the Trust as part of the Financial Improvement Programme and they appreciated the improvement in terms of CIP delivery over the period - in particular, the focus and attention on the Trust’s PMO and CIP processes which we helped them to embed within the organisation. The Trust considered this to be “something that we needed and that will continue to support us in the continued pursuit of financial improvement.”
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