Financial improvement plans: Reinvigorating the basics and leveraging new opportunities through collaboration

Financial improvement plans are a standing priority for integrated care boards and NHS organisations, particularly in light of the recent NHS England announcement of up to 6 per cent savings targets in the financial year 2023-24 – a significant feat, exceeding that of pre-pandemic targets.

With the drive for efficiencies rightly paused during the pandemic, there remains some scope to deliver productivity improvements through traditional levers to regain lost ground. These levers include re-establishing robust spending and cash controls, maximising non-pay opportunities, and improving the length of stay, and theatre and outpatient utilisations – by no means ground-breaking but important, nevertheless.

However, given the scale of the financial challenge, these levers alone are unlikely to be sufficient, particularly given the context of the ever-increasing service demands, an overburdened workforce, and the poor condition of NHS infrastructure with limited funding available for investment.

Despite this, through technology, and with greater opportunity for cross-system working with ICBs and provider collaboratives, new approaches with proven efficacy are now available to address the financial improvement challenge, whilst also achieving clinical, operational, and patient benefits.

A summary of these approaches and key areas of opportunity are as follows:

Use of data, technology, and digitalisation to automate processes, reduce administrative burden, and provide care closer to home, whilst releasing staff time and resources through:

• Virtual wards and remote monitoring – releasing bed days through admission avoidance and delayed discharges, with a well-defined benefits framework.
• Robotic process automation for both front office activities, such as patient administration, and corporate services e.g. finance and HR systems.
• Inventory management and point of care solutions. A recent review found that improved inventory management represents the most significant cash-releasing saving and operational efficiency available in supply chain management within the NHS.

Establishing shared support and collaborative functions in clinical support services, such as:

• Regional pathology networks to deliver the recommendations of the Carter report, recognising the capital funding challenge. One in three pathology networks is still running at trust level, despite the roadmap to service consolidation published more than five years ago.
• Developing innovative pharmacy supply chain functions at an organisation and provider collaborative level, delivering benefits of inventory reduction, net operating cost savings, and release of clinical time to care.
• Implementing collaborative procurement functions to leverage economies of scale and switching to evidence-based lower priced products.
• Centralising sterile service functions across providers to promote standardisation and reduce operating costs.

Optimisation of resources across traditionally distinct pathways informed by best practices and clinical guidance, utilising population health management tools and Getting It Right First Time benchmarking for:

• Innovative cross-pathway workforce models such as the use of advanced practitioners and nursing staff in the community and acute settings, recognising current recruitment constraints.
• Improving workforce productivity and elective recovery by using analytical tools to understand, predict, and plan for system-wide capacity and demand flux.
• Reducing agency spending through collaboration by operating joint banks, aligning agency rates, and sharing specialised clinical resources, rather than competing to recruit from the same pool.
• Self-management of chronic conditions such as asthma, chronic obstructive pulmonary disease, and diabetes. Recent evidence also suggests prehabilitation is cost-effective in reducing the need for surgery, reducing complications by 50 per cent and improving recovery.

Please get in touch with Akeso or Seagry if you would like to learn more about working in partnership.