Finance team takes charge of sitreps (#DoingOurBit)

by Steve Brown

30 April 2020

Alex Dallos, head of financial planning at Sussex Community NHS Foundation Trust, has dropped his technical accounting and financial role to help the trust meet demands for status reports on key aspects of the trust’s response to Covid-19.

He says when the call came for trusts to start delivering daily updates on everything from number of deaths and delivered tests to occupancy levels, staff absences and levels of personal protective equipment, he was the obvious candidate to get involved.

‘We are a finance and performance department,’ he says. ‘However, the performance team have a full workload. And, at the time, it didn’t have the spare capacity to pick up the significant extra work – with very short timelines – without standing down existing reporting functions.’Alex Dallos p

Mr Dallos’s normal work involved supporting a number of medium to long-term projects. The trust is planning a new hospital and Mr Dallos (pictured) has been providing the financial analysis to support the outline business case. He also line manages the trust’s cost accountant with the trust on the verge of choosing a new system to support patient-level costing. And he has been providing financial support to the development of some primary care services.

‘All of my projects had a longer-term focus, so I stepped in,’ he says.

It has been a steep learning curve with around 10 national situation reports (sitreps) required to be uploaded – most of them on a daily basis, seven days a week. These sitreps cover a range of information – some of which is reported at the daily government press briefings. The 11am sitrep is arguably the most extensive and most demanding – covering staff absence by categories of staff groups and providing an analysis of the numbers of tested Covid-19 patients being treated and the treatment they are receiving.

Information demands from the centre can also change at the last minute – as central bodies and ministers need a more nuanced view of the data.

‘We’ve had change requests emailed to us on a Friday night, with information needed for the Saturday morning sitrep. For example, alongside a breakdown of Covid and non-Covid patients with an age split, we were suddenly also asked to provide details of the numbers of patients on an end-of-life care pathway. There was a recognition that this would not be easy on a Saturday – and it is arguably not a simple judgment – but it was something we still had to deliver.’

As a community trust, Sussex has played a major role in helping acute providers discharge patients in anticipation of needing increased capacity for Covid-19 patients. But it also has its own patients with Covid-19 – albeit on a smaller scale compared with acute neighbours. Currently it has around 40-50 Covid-19 patients daily across its 326 beds, with overall occupancy levels down compared to usual. This means between 10% and 20% of its current inpatients have been tested positive for the virus.

However, collecting data is not straightforward. The trust has 13 wards arranged in three areas covering the south and west of West Sussex , central and north of West Sussex, and parts of East Sussex .

Each area collates the daily information for its wards before passing it on to Mr Dallos and his team.

‘We are used to providing performance information, but not as frequently and not condition specific,’ says Mr Dallos. ‘The systems we had didn’t work in the time frame and the processes weren’t established.’ This meant the trust had to build manual processes, often relying on spreadsheets and email to collate the required data. He points out that normal information governance rules apply, adding that ‘we just have to apply them more quickly’.

Initially, Mr Dallos was meeting the sitrep demands with support from a couple of people in broader performance governance roles. While some of the submissions had previously been established by emergency planning colleagues, they did not have the capacity to meet the increasing demands. And establishing the new data requirements, templates and processes and turning around the actual submissions was very much his responsibility.

There are now seven people involved in the data collection within the finance and performance team – not including the senior managers who are needed to sign-off the different sitreps. ‘We’ve very rapidly turned from a five-day-a-week to a seven-day service in finance and performance – with a rota in place to cover the whole week.’rebecca.Anderson - p

A key member of the team supporting Mr Dallos is Rebecca Anderson (pictured), a finance trainee on the national financial management training scheme. Ms Anderson has been with the trust for six months – her second rotation on the scheme. She has recently moved over from her management accounting role to share responsibility with Mr Dallos for the sitrep submissions.

While not a traditional part of the training scheme, Ms Anderson says she is enjoying the different work, which involves a strict daily routine, and being part of the trust’s response to the Covid-19 outbreak. It has also provided an opportunity to develop other skills and attributes by interacting with the area teams responsible for the various data submissions.  ‘It’s improving skills such as communication and management – for example we are training a member of the contracts team to help support the operation,’ she says.

She acknowledges that activity data is crucial to management information – for example underpinning robust cost data – and so greater familiarity with activity issues and collection is useful.