The project was to develop a transformation programme to include workstreams linked to Lord Carter’s recommendations for acute productivity improvement. Early into the assignment it was agreed that some initial short-term focus was required on improving the current in-year improvement programme which needed further development in terms of project development and planning. This involved a strengthening of the existing management processes, removing the need to create new structures and working patterns (when the priority was delivery); tightened monthly reporting between the PMO, operating divisions and the finance team, and set up a Productivity Board, chaired by the CEO. Some Divisions had fallen behind in their savings development, so facilitated workshop sessions were established to generate further schemes and close the gaps. A project structure for all major projects was established with clear structure templates, project documentation and highlight reporting.

A specific set of projects was established for agency/temporary staffing improvement – this delivered a reduction of 33% on previous year spending. The same principles applied to waiting list initiatives, where expenditure was forecast to fall by 50% compared to the previous year. To provide time to further develop CIP plans, a programme of short term actions was instigated with tightened expenditure controls around discretionary spending; including daily scrutiny of non-stock requisitions, establishment of a vacancy panel (this was limited to non-clinical and clinical posts above Band 7 to avoid delays on recruiting to key clinical posts), senior sign-off of legal advice, IT kit and routine maintenance.

Working with the Communications Team a series of staff communications was developed to help all staff understand the challenges and, more importantly, the role they can play individually to support cost control. All major contracts were reviewed which led to a task and finish group to review all variations to the PFI contracts.

Building on in-year improvement plans a programme for future work was developed building on the Carter recommendations and incorporating the Sustainability and Transformation Plans of the local health economy. Further workshops were completed with clinical areas to identify local, standalone plans – these sessions involved management and clinical leaders. The Carter Report recommendations were the basis for a series of ‘trustwide’ themes, established with project structures, covering elective flow optimisation (OP, Theatres, Cath Lab, Endoscopy), Bed Productivity, Temporary Staffing, Clinical Administration, Back Office as well as a specification for the review of commercial opportunities including the development of a case for the redevelopment of an existing café in a combined modern café/Subway® as a joint venture between a commercial provider and the Royal Voluntary Service.