HFMA Awards 2019: clinician
12 December 2019
Western Sussex Hospitals NHS Foundation Trust chief nurse Maggie Davies has a determination to ensure good-quality care and best use of NHS resources. It resulted in her leading a range of initiatives that reduced nursing spending, which has seen her acknowledged as the HFMA Working with finance – Clinician of the Year 2019.
The award acknowledges the importance of clinical engagement in financial management and recognises a clinician who has taken financial responsibility for their services, led efficiency or improvement programmes or provided an example for other clinicians by engaging with the financial agenda.
In 2015/16, the trust spent £9m on agency nursing, equal to 9% of its total nursing expenditure. It recognised this was unsustainable and set about identifying and implementing a range of interventions to reduce its reliance on temporary staffing and the rates it paid to hire agency workers.
Ms Davies (pictured) worked closely with corporate colleagues and frontline clinical staff to balance agency spending reductions with safe staffing and engage a large and diverse workforce. Over three years, she was able to reduce agency spending to £3m, despite rising emergency workload and high patient acuity – the trust serves a population with a higher proportion of older people than the national average.
The programme was implemented as NHS Improvement introduced measures to curb agency costs, including by making framework agreements with suppliers. One in 10 nurses were from agencies and the main agency was not on the framework.
Working with finance, HR and performance management colleagues, Ms Davies’ initial step was to reduce the reliance on temporary staff with targeted domestic and international recruitment. Clear costing underpinned each stage of the recruitment process to provide best value for money. She also led steps to increase the trust’s supply of bank staff, restructuring a financial incentive scheme to pay a bonus for additional shifts to its nurses.
Finally, she worked with directors of finance and HR to target recruitment of registered nurses from above-cap agencies to trust contracts, and hold a firm line on the rates the trust paid – moving to cap rates. The trust now has a substantive nursing workforce with a better than national cost per WAU (weighted activity unit), below peer usage of temporary workforce and below peer and national agency cost per shift.
‘I’m speechless,’ Ms Davies said on receiving the award. ‘It’s a huge honour and it shows what can be achieved if you work as a team.’
Working with finance colleagues was not daunting, she added – they were open and welcoming. Asked why she had tackled the issue, she said: ‘This was about quality for me and about changing the market from high-cost agency nursing to rewarding our own staff, who have been loyal to the organisation.’
The judges were impressed by her work and collaboration with the finance team.
‘They approached the common “wicked problem” of spending on agency staff with thought, skill and tenacity,’ they said.
‘By interpreting financial data and using this with a wide range of budget holders to pinpoint staffing needs and renegotiate agency contracts, Maggie and her team reduced agency spending, improved staff satisfaction and earned an outstanding CQC assessment for patient care.’
Download our HFMA Awards 2019 supplement here
Jacqueline Andrews, Leeds Teaching Hospitals NHS Trust’s director of research, has put financial management at the heart of her ‘clear and ambitious’ vision for research. The trust’s research income is about £21m a year and Dr Andrews believes value for money, waste reduction and financial sustainability are as relevant to research as to other business segments. With the finance team, she’s introduced a management model that has finance as an integral element to deliver greater transparency, benefits for patient services and cost improvements.
Liz Kay, Leeds’ clinical director for medicines management and pharmacy services, has delivered big savings through local, regional and national initiatives to improve patient care and create system-wide efficiencies. Under her leadership, the West Yorkshire Association of Acute Trusts regional supply chain collaboration is on track to save £1.5m, saving on drugs spending (77%) and workforce efficiencies (23%). She chairs the Leeds trust’s medicines finance group, where clinical and finance staff have an overview of medicine spending.
Mojgan Sani, North Tees and Hartlepool NHS Foundation Trust, has worked with finance, operational managers and commissioners to increase the cost efficiency of medicines spending. The chief pharmacist and director for medicines optimisation was appointed in March, but she and her team quickly engaged with finance and senior clinical colleagues to get best value from medicines. In the first quarter, savings reached £500,000 and the forecast outturn for the year is £2.2m.