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Chief Executive’s Message – Friday 3 February

February 3, 2023

This week I am concentrating on the very important task we have of constructing our Trust plan for the financial year 23/24. We have a clear strategy now as a Trust and three clear strategic objectives (Patients, People, Population).  We also have increasingly clear ways of delivering those objectives. For example, the fundamentals of care framework launched last autumn, will help us to tackle the inconsistencies in the delivery of the basics and fundamentals of good inpatient, outpatient and community care. This will help us to achieve our patient objective of being good or outstanding in everything that we do. Similarly, our People Plan, recently adopted by the Trust Board, will tackle issues of team dynamics, recruitment, leadership and culture which we think will significantly improve our working environment and make us a more attractive proposition in a highly challenging workforce environment. Our population objective will be delivered through our place based partnerships and our work on regeneration and sustainability, which are focused on improving the life chances and healthy life expectancy of the people in our communities.

Our patient objective also has an element within it that focuses on good financial stewardship and use of resources. It is this element that we have been focusing on this week as a senior team, as we create the plan for our Trust for the next 12 months.

Our financial health is not very strong and I cannot dress that up or soften the blow of that reality. We have seen nearly 12 years of funding for the NHS and social care which is either below the rate of inflation, or a real terms reduction in our resource, because demographic change (demand) has outstripped the income we have received. Conversely, national expectations about how our services are more safely staffed and the cost implications of managing COVID have significantly increased our cost base and so now the Trust is facing a recurrent financial deficit for the first time in its history.

We are in the process of setting out the exact size of that deficit and also setting out how we are going to minimise it.  The key actions that will reduce the size of that deficit are split between the Integrated Care Boards who commission our services and secondly, the actions we can take ourselves. I have long since maintained that it is our responsibility to “sweep our side of the street clean” and since COVID hit us, we have not demonstrably done that.  We must now reverse that tide.

Our approaches to reducing the size of the deficit include:

  • Securing the additional money on the recurrent basis from our commissioners that we need in order to safely and effectively deliver the benefits of the new Midland Metropolitan care model
  • Securing the additional money on the recurrent basis from NHS England to pay for the capital charges of the Midland Met
  • Improving our recruitment so that we rely on temporary staffing far less than we do at the moment and therefore reduce our increasingly high agency costs
  • Deliver an elective care production plan which ensures that we treat more patients on elective pathways than we did in 2019/20 (108% of the 19/20 activity levels is required to secure additional income)
  • Invest in quality improvement that will allow local leaders and team members to reduce waste in their departments and services, whilst maintaining or improving the quality of care we provide to our patients
  • Taking a different approach to managing investment in clinical service developments, so that we only invest on the grounds of patient safety/risk or where we think there will be a clear financial return on that investment. This will necessarily mean some real disappointment for colleagues who may expect the Trust to be able to invest in improving their services. We will simply not have the money to be able to do that without the case for investment being scrutinised very heavily indeed.

I know this is quite a grim picture to paint but it is the reality. The “additional money” the government says it has provided the NHS still does not keep pace with changes in demand or demography and therefore what we are seeing is a scenario in which our income next year is likely to be less than that we received this year. Unless we take the action described above and do that together in a diligent and focused way, we will not be able to create the headroom to invest in the things we need to do. Clearly, we will seek to protect the Midland Met and its care model from this austerity but can only do so if our two Integrated Care Boards find the funds to support that. In last week’s Friday Message, I set out how we were trying to secure that income.

Have a good week