Homerton Healthcare NHS Foundation Trust – Delivery Unit Impact

Having ended 2022/23 with a small deficit, 2023/24 was set to be even harder and Homerton University Hospital NHS Foundation Trust had set a challenging 5% Cost Improvement Programme (CIP) target.  This needed to focus on reducing spend and required a culture change as the organisation had historically delivered financial performance through a growth in income. CF were commissioned to establish a delivery unit to provide dedicated support for divisional and trust-wide workstreams in their efforts to meet their CIP target. Workstreams were assisted in scoping and development of opportunities, in driving the pace and scale of delivery, performance and outcomes of the programme and building capabilities across the Trust.

Our collaborative approach

CF delivered a programme of work encompassing designing, setting up and mobilising the delivery unit. This included supporting leadership in reviewing existing plans, identifying other opportunities and effectively integrating the delivery unit in their ways of working:

  • Establishing the delivery unit architecture
    • Clear accountabilities and governance established for the Delivery Group with the Trust’s leadership team, clinical and operational leads
    • A two-week engagement rhythm with the focus on idea generation and development one week, and data driven conversations using the delivery dashboard to understand the rationale behind recent performance for the alternate week
    • Support with team design, job descriptions, shortlisting, team establishment and training
  • Supporting development of improvement plans for divisions and priority areas
    • Assisting workstream leads in developing plans for each of their initiatives and drawing on existing work to support identification of new schemes
    • Calculating the financial benefits of the identified schemes and opportunities through data analysis and benchmarking
    • Supporting clinical and operational groups in troubleshooting issues and generating practical solutions
  • Financial reporting and monitoring of schemes
    • Developing a finance and activity dashboard to support workstream leads in tracking progress of schemes
    • Feeding back the status of identified schemes to the delivery group and escalating any challenges in quantifying or further progressing schemes
    • Supporting with identification and implementation of mitigations to address slippage

What was the impact?

Homerton has not only been able to deliver their challenging target, they have exceeded their £1.25m deficit plan and delivered breakeven outturn for 2023/24.

Homerton had not identified any of the CIP target when we began this work; by conclusion of our support they had found 60%, with plans in place to meet the remaining 40%. They have since gone on to use the opportunities and approach we developed with them to identify the full savings requirement, with their own 6-point financial recovery plan and implement.  The establishment of the delivery unit provided confidence in plans resulting in increased productivity with higher throughput, reduced bank and agency spend and optimised use of medicines:

  • Agency spend has reduced from 11.2% in 2021/22 to just over 5% of substantive pay spend and staff have increased from 4,308 to 4,546 to support this and driving additional quality improvement
  • First to follow up outpatient ratio has increased by 13%
  • Monthly theatre utilisation has increased by 10% January 2023 to March 2024 as a result of more efficient theatre processes and resource utilisation
  • Occupancy of General & Acute (G&A) beds has declined together with a 10% reduction in patients with no criteria to reside has enabled them to avoid opening additional capacity
  • Through their medicines optimisation programme, they have reduced usage and expenditure on high cost drugs; pharmacy spend on secondary care has remained below peer median. February 2024 showed £30,000 less expenditure than January 2023

New capabilities have been established which endure long term changes in the Trust’s operational approach, driving sustainable improvements in efficiency and financial performance:

  • The delivery unit architecture effectively supported the Trust in developing cost improvement plans and realising savings in year and has driven a change in culture. The CEO now chairs the monthly Delivery Group with regular meetings between to track progress with divisional ownership of schemes and delivery
  • New programmes of work were identified, focussed on areas with large opportunities such as patient flow, temporary staffing and community estate usage
  • The delivery dashboard uses realistic metrics and targets to support action focussed conversations on scheme delivery, inform decision making and enable escalation of risks

Key factors for success

  • Ensuring accountabilities across trust-wide and divisional workstreams were clear and that each opportunity had someone responsible for driving actions and improvements
  • Maintaining a fortnightly working cycle in which one week would be spent on supporting workstream leads with idea generation and development, and the other on supporting leads in interpreting data from the delivery dashboard to provide a clear narrative for the delivery group

Client Testimonial

“We commissioned Carnall Farrar (CF) to support us in the development of a recovery plan.  The CF team brought relevant expertise and integrated well with our staff. They identified challenges and practical solutions based on knowledge of how the system works and best practice to effect change…. I thought you’d like to know that we are going to exceed our £1.25M deficit plan and break even. Thanks so much to your team who helped us at the beginning of a very tough journey!”

Louise Ashley – CEO

Homerton NHS Foundation Trust

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