Carnall Farrar with University Hospitals Plymouth NHS Trust

Plymouth Hospitals NHS Trust had narrowly avoided financial special measures and was under pressure to deliver a Cost Improvement Programme (CIP) that was significantly more ambitious than anything delivered before. The CIP target was £40m, of which £10m was unidentified. This needed to be achieved at a time that the performance and experience of clinical leadership was mixed, and so the Trust needed reassurance that financial improvements would not impact adversely on quality or safety.

The NHS Improvement ‘Model Hospital’ had shown that overall the Trust pay costs were in line with benchmarks. However, within this, it highlighted opportunities for improvements in medical workforce productivity. The Trust was also grappling with how to make its sub-scale services more sustainable.

In this context Carnall Farrar (CF) was appointed to help the Trust find financial improvements and to develop an approach to release these savings, without disempowering clinical directorates who were just starting to take on their responsibilities as part of their role as managerial leaders of the Trust.

Our approach was to work collaboratively with Trust executive and clinical leaders. We helped the executive team lead the Clinical Directors to accept that significant savings could be delivered without a negative impact on clinical service delivery, and then to take on responsibility for the delivery of the improvements.

Our most significant achievement was that the Trust implemented the improvements themselves to achieve £10m savings, without the need for additional consultancy support. The Trust believed in the assessment CF undertook, felt equipped and empowered to take on the challenge of implementation and then delivered the improvements, leading to the achievement of their Control Total. The emphasis placed on clinical engagement and support meant that the recommendations were owned by the executive and Clinical Directorates, and recognised as interventions that would materially improve the clinical and financial performance of the Trust.

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