Diagnostics and Therapies Division

Agenda Item 7

Diagnostics and Therapies Division

Financeand Vacancy Position Month 6

1Introduction

Following a report to the August Trust Board the Division was tasked with providing a fuller report to TOG and then to the Trust October Board meeting.

Specifically the Division was asked to

1.1Undertake an urgent analysis of all posts that have been vacant for 3 months or more to identify the underlying reasons. This would include removing posts from establishment that have been inactive for 6 months or more, to use elsewhere in the Division or assist with cash releasing efficiency savings.

1.2Review the Divisions readiness for the 18 week targets.

1.3Consider the conversion of pay underspend into capital to improve operational effectiveness.

1.4Review the vacancy control process.

1.5Review the discrepancy between the apparent vacancy levels in the Radiology Service and the budgetary overspend.

2Methodology and Progress

2.1The Division has undertaken a comprehensive review of budgets and vacancies in order to identify underlying reasons for vacancies and remove or reallocate posts that have been vacant for more than 6 months (section 3)

2.2The Division has reviewed its position with respect to 18 weeks(section4)

2.3The Division has considered the conversion of pay underspend to capital (section 5)

2.4The Division has reviewed the vacancy control process (section 6)

2.5The Division has conducted a review of Radiology vacancies, although this has to be seen in the context of broader changes underway(section7)

3Vacancies

3.1The Division’s vacancy level below shows a decrease between August and September.

This reduction in the vacancy level is ‘work in progress’, using the following methodology;

• Identifying the current vacancies in each service and which of these have been vacant for more than six months
• Discussing the findings with Heads of Service to establish underlying reasons

To date (17 October) we have covered Medical Physics, Laboratory Medicine, Radiology and Pharmacy. Discussions are yet to be held with the remaining D&T services.

3.2 We have found a number of reasons for vacancies lying vacant for more than six months:

• Skill mixes have taken place but have not been reflected in the budget statements due to delays in Finance and Payroll
• Agenda for change assimilations have not yet been reflected in budget statements due to delays in Finance and Payroll
• Vacancies or parts of vacancies have been held open for maternity returners or for further skill mixes
• Vacancies have been hard to fill because of local or national workforce shortages
• Turnover in some services has led to a constant vacancy level because posts have been left vacant while recruitment has been taking place.This effect has been heightened where vacancies have also been hard to fill.

Interim results of our analysis are shown in the table below (month 6)

* Of the remaining three vacancies above, two have been removed non-recurrently for CRES, one from Laboratory Medicine and one from Pharmacy (see section 6)

3.3The table above does not reflect the recruitment activity which is high due to turnover and the seasonal nature of its recruitment of newly-qualified staff in (e.g.) Pharmacy, Radiologyand Physiotherapy. The graph below shows the Division’s monthly turnover exceeding the Trust figure in June 07. Newly-qualified posts are then largely vacant until August/ September.

3.4As a result of our analysis to date we have

• Embarked on an urgent re-alignment of budgets to ensure that establishments reflect the true picture

• Removed 7.27 posts across the Division non-recurringly for CRES 2006/07, where they have been vacant for longer than 6 months
• Agreed some long-term principles for managing pay budgets that involve a more innovative approach to establishments to reflect individual service turnover rates and seasonality and/or difficulties in recruitment. The Vacancy Control Panel will be key to this process.

4 18 week Initiatives
Representation both from Diagnostics and Therapy clinical leads on the 18 week project group and recent formal cross Divisional meetings have enabled us to identify key areas to focus our input to achieve the 18 week targets. All services have now identified schemes, which, following scrutiny by the core management team, have been fully funded and are in the implementation phase. Risks to schemes are in the main ability to recruit and in these cases agency staffing will be considered. For information, schemes range from Saturday working in Radiology to support outpatient clinics, Pharmacy support and education to wards with regard to medicines management, additional support for ear nose and throat clinics from Audiology and an 8 week Occupational Therapy service trial of Saturday morning working on Care of the Elderly wards.

Improved processes, pathways and efficiency initiatives across Diagnostic services within the Division are delivering achievement of the 18 week pathway milestones. One stop clinics and Direct to Test initiatives are examples of this work. We are confident in our plans to meet future 18 week milestones.

5Capital

It was decided that the Division should part fund the Ultrasound Modernisation scheme from existing pay reserves. The scheme is deemed an important part of modernisation and is required to deliver and maintain progress towards achieving 18 week targets, reducing diagnostics waiting times to less than two weeks and maintaining that improvement. It involves refurbishing three current scanning rooms and creating a fourth dedicated to in patient (emergency) and interventional ultrasound. It was felt that in light of turnover rates, LDP investment was taking time to convert into posts and the Division was subsequently accumulating a pay underspend. £200k was transferred in Month 5 to support funding of the modernisation scheme.

6Vacancy Control Process

The core management group has reviewed the vacancy control process. The process is not cumbersome and does not introduce delay, but it does facilitate an essential Divisional overview of recruitment activity. Given the removal of the vacancy factor from Divisional budgets, turnover rates, seasonal recruitment and the high ratio of pay to non pay in the majority of its services, the Division’s approach to recruitment will in future take all these factors into account when agreeing new appointments. It must be noted that for many specialist professions within the Division there is very limited availability of suitably qualified bank or agency staffing.The Division is agreed that where turnover is predictable then recruitment will allow for this. This will enableoptimum staffing across the Division to support all the Division’s patient pathways.

7Radiology
As at month 6 Radiology is overspent by £270k and underspent on pay by £73k. The analysis undertaken (section 3) has revealed that 17.9 of the 25.5 vacancies are not being actively recruited to. We are working with the Head of Service to rectify these significant anomalies in the budget statements. The Radiology service is currently undergoing changes in its management structure, which will lead to a requirement for further work to re-align budgets to the new management structure. The Division has decided that whilst anomalies need to be rectified where possible, it should delay any major re-adjustment of budgets until the shape of the new structure is finalised within the next four to five months.

8Finance

The Division has removed 7.27 long standing vacancies (non-recurrently) where there is no active recruitment plan and used these to support the delivery of cash releasing efficiency savings. The Division is actively identifying and actioning additional schemes to support recurrent achievement, and is confident that the 5 year plan is deliverable.

9Conclusions

9.1The Division has removed long standing vacancies where there was no active recruitment plan, and used these to support our cash releasing efficiency savings.

9.2Following cross-Trust, Divisional discussions, the Division has formulated, funded and implementeda robust 18 week action plan across all services.

9.3The Division has achieved 18 week pathway Diagnostic milestones acrossall services.

9.4A proportion of Divisional pay underspend has been converted to capital to improve operational effectiveness within Radiology

9.5The Division has an agreed strategy in relation to recruitment and turnover.

9.6Significant further work has begun and will continue to adjust Radiology establishments

9.7The Divisional cash releasing efficiency saving plan is being delivered to date

Written by:

Sue Taylor, Acting Divisional Manager - Diagnostics and Therapies

Philippa Finch Divisional Human Resource Manager

Tom Harley Divisional Financial Manager

Amy Robinson Senior Management Accountant

17th October 2007