Wednesday, 2 April 2014

The bottom line

Welcome to my first blog post!

I have had positive feedback on my efforts to be as open and transparent as possible, so thank you. Both Twitter and Trust communications have been well received so far and the idea of this blog is to provide further thoughts on Trust strategy, challenges and the wider health and social care system.

It’s intended to contribute to the reader’s thoughts and views, I hope, and promote discussion and debate.  It is primarily for Trust staff, but stakeholders and interested others are also very welcome.

So, where to start?
In April we will launch the Trust’s vision and strategy. I will soon blog about that specifically. However, I’d like to take a few steps back for this first blog and talk about money.

Surely I should be talking about patient care, quality and values? Well yes, it is the reason I joined the NHS as a student nurse in 1984 and why I get up each day for work, to deliver the best care possible.  But I don’t think we can get on to that without discussing the financial context in which we work.

As a student nurse, even as a staff nurse and a ward manager, I didn’t understand where the money came from to run services. It didn’t cross my mind to think who paid my wages. We are now in different times.

Nowadays I think we all have to have an awareness of the costs of care and the restraints on funding. It has to be an integral part of our plans alongside developing the best care possible. It isn’t easy to do but we must.

There are misconceptions that the NHS budget has been spared from financial efficiencies but in reality it hasn’t.  In percentage terms we might not have had the scale of financial challenges Councils are facing, but we still have to make considerable financial efficiencies year on year.

In 2010, Sir David Nicholson set the Nicholson Challenge against a backdrop of the UK economy in upheaval. He tasked NHS leaders with finding £20 billion of savings, whilst improving quality.

Yesterday the new Chief Executive for NHS England, Simon Stevens, took his new start as a moment to speak frankly.  He said the NHS is facing its biggest sustained budget crunch in years and that success in the coming years will require "a team effort – involving the biggest team in the biggest effort the NHS has ever seen..."  which we are all a part of.

What does it mean for Pennine Care?

I’ll try to explain Pennine Care’s funding challenge as simply as possible (it’s the only way I can understand it!).

Each year we negotiate our contracts with commissioners which include quality and performance requirements, and the price they will pay for services. The price paid is the amount of money we have to run the Trust in that year, to pay wages, pay employers pension contributions and national insurance contributions, rent costs, heat buildings, transport, medicines etc...

The amount we receive this year is less than last year. This is due to a reduction of 1.5% on the prices paid by commissioners across the NHS. The commissioners are required to do this by the government (as part of the overall drive for savings in the NHS). So immediately we have less money than we had last year. We have less money to spend, but the costs are actually going up.  The cost of the 1% wage rise (admittedly only for some following the pay award) isn’t a part of our contract settlement, the Trust has to find money to cover these costs, and each year other costs increase as well. Utilities always go up, cost of medicines always go up and there are many other cost increases -  all have to be met from within that contract value, which is already 1.5% less than the year before.

Then the financial rules we are governed by (from Monitor our regulator) mean that we must generate a surplus, which means putting funds aside to pay for keeping our buildings and equipment in good order, and also to pay for large projects such as capital investment in improving wards or in our new IT systems. A small surplus also gives our commissioners, patients and staff confidence that we are strong enough financially to continue operating even if something unexpected came along. (Remember Woolworths?)

So we have to do better than just break even and the surplus we have to generate is around £2 million.

So in summary, we know the cost of providing our services is around £273 million based on the current financial year but we sign a series of contracts for 1.5% less than this because of a reduction imposed nationally, then from that reduced amount we have to pay increased costs and still generate a surplus. This leaves us short of money and the figure that amounts to is about £8 million, which has to be found through making savings across the Trust.

Is anybody still reading this? Stay with me!

So what does £8m savings mean?

Pennine Care has been successful at meeting savings targets year on year, with minimal job losses.  But it is getting more difficult to find the money.  The £8 million we need to find this year represents the equivalent cost of 218 jobs at band 6.  And that’s why I wanted to start the blog with a post on money, to explain where proposals for redesign and cases for change come from.

When members of Pennine Care's Trust Board spend time with services, there is one consistent theme staff raise, job security. I understand that and I want staff to feel as certain and secure as possible. There is inevitably change required when finding large sums of money to save, but I want to assure our staff we are working really hard to retain staff and keep redundancies to an absolute minimum. 

And that is the reason why we need to be open and transparent.  Nobody wants to be faced with the financial challenge, but it’s a reality we all must face together.  We try incredibly hard to not disrupt patient care and support staff through the changes.  We also ensure we involve staff and patients in the decisions we make.

But making financial savings is now an integral part of the world in which we work, and so unlike when I was a student nurse, we all have to be aware of it.

I’d like to acknowledge and thank staff for continuing to work so hard, so positively and delivering excellent care, despite the financial challenges we face. I continue to be impressed and proud of the enthusiasm, commitment and professional behaviour of staff.

As Chief Executive I don’t underestimate how challenging it is working in the NHS in the current economic climate. Despite these challenges I want the Trust to be a great place to work, a rewarding employer and a supportive organisation. I know that where we achieve that we get the best care.

Next blog I’ll discuss how the financial challenges are creating positive opportunities to improve patient care.


Twitter: @MichaelMcCourt1


  1. This has been really useful, thank you.

  2. Thank you for taking the time and trouble to write a weekly blog - this week's has been particulalry informative

  3. It seems to me that nobody is challenging the government about the cuts. This government is selling the nhs off to private companies and everyone is keeping quiet about it. NHS England have appeared from nowhere as another tier of top management to do the governments bidding whilst hiding in plain view. The important issues are not being talked about. Please address the bigger questions.

  4. Hi You mention in this blog that the 8 million savings represents the equivalent of 218 jobs at Band 6. Is the intention to reduce Band 6 posts and if so do where the reductions will be made?

    1. No that's not the intention, the figure was provided as an example to help staff understand the scale of the value.

  5. HI, thank you for writing a blog and keeping it updated from time to time. I find it interesting. I have been thinking about the structures in our organisation and the loss of clinical talent to management structures and thought how could this be improved. It struck me that consultants who have management duties manage clinical loads. Mr Trodden is undertaking a clinic once a fortnight (I think). Henry Ticehurst did a clinic for a while as MD. I think it would be a thought to encourage and then to expect all managers possibly excluding EDs to have clinical input. This has a number of benefits;
    1. Keep all senior managers in touch with the front line and patient care and perhaps this should also be part of the "Principles of Care - continuing patient contact at all levels of the Trust". This should NOT include any bank/locum work they do - should be job planned and made sacrosanct.
    2. Keep highly trained clinicians in clinical practice perhaps even in supervision of others - use of their services enabling other managers to be redeployed (this is not meant as a cost saving exercise)
    3. Any management service changes will be experienced from their own front line practice - what they change will affect them personally (at least in part). Make relevant service changes and redesign fit for purpose.
    4. Increase respect and willingness of clinicians to engage with management as a combined group as opposed to a seperate groups as at present
    5. Open up transparency and remove the notion that poor clinicians will somehow make better managers - i.e. promoted out of their competency zone. This I have witnessed leads to stress and work related poor behaviours which damage the organisation in the longer run.
    6. It has the potential to remove meetings and lets face it, fewer meetings may be a good thing!
    Thanks for letting me suggest this to you.