Review of the IQRA Programme 2022/2023 for Board of Directors
The review of the IQRA Programme 2022/2023 presented to the Board of Directors by Matt Edwards, Director of Clinical Workforce Transformation, highlighted a focus on providing a caring, safe, and excellent environment. The analysis encompassed agency spending variances, performance against targets, and reduction goals, demonstrating a commitment to efficiency and quality in healthcare provision.
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Caring, safe and excellent IQRA Programme 2022/2023 review to Board of Directors 24thMay 2023 Matt Edwards Director of Clinical Workforce Transformation
Caring, safe and excellent Agency End of Year Position - 2022/2023 Variance FY22- Staff Group FY22 Total FY22 Apr-Mar FY23 YTD FY23 Medical Agency 8,319,634.69 8,319,634.69 13,260,861.00 4,941,226.31 Nursing Agency 29,318,072.74 29,318,072.74 24,105,093.00 - 5,212,979.74 AHP/HSS 3,076,362.82 3,076,362.82 3,092,699.00 16,336.18 Admin & Clerical 1,875,294.94 1,875,294.94 1,485,851.00 - 389,443.94 Estates 569,459.77 569,459.77 414,879.00 - 154,580.77 Total 43,158,824.96 43,158,824.96 42,359,383.00 - 799,441.96 VC's 23,950,000.00 23,950,000.00 8,767,351.36 - 15,182,648.64 Total + VC's 67,108,824.96 67,108,824.96 51,126,734.36 - 15,982,090.60 2021/22 Agency Spend Actual (FOT) 2022/23 Agency Final Plan (June 2022) Provider Berkshire Healthcare Buckinghamshire Healthcare Oxford Health Oxford University Hospitals Royal Berkshire Total 5,987 21,785 63,156 9,251 11,641 111,820 4,469 18,000 40,517 8,064 1,193 72,243 Current trajectory from forecast: Mass vaccinations: Trajectory exc mass vaccinations: 50,544 -10,293 40,251
Caring, safe and excellent Agency Monthly Run Rate Agency spend is 42.33m which is 826k less than FY22. Nursing spend is - 5.2m less than FY22. Medical spend remains high it is 4.9m higher than FY22. A&C has seen a saving of 389k in FY22. End of year position 22/23 is 1.8m above NHSEI target (4.48%). Spend vs Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total FY21 3,315,486.66 3,485,139.72 3,593,584.58 3,541,903.84 3,350,342.27 3,416,427.10 3,491,780.64 3,603,373.90 3,473,842.79 3,738,341.40 3,678,702.34 4,469,899.7243,158,824.96 FY22 3,539,973.22 3,546,835.66 3,481,069.22 3,646,572.19 3,710,208.61 3,401,875.35 3,351,537.64 3,505,663.07 3,480,000.02 3,346,487.61 3,490,266.00 3,832,340.0042,332,828.59 Variance 224,486.56 61,695.94 -112,515.36 104,668.35 359,866.34 -14,551.75 -140,243.00 -97,710.83 6,157.23 -391,853.79 -188,436.34 -637,559.72 -825,996.37 Targeted Forecast 3,376,416.00 3,376,416.00 3,376,416.00 3,376,416.00 3,376,416.00 3,376,416.00 3,376,416.00 3,376,416.00 3,376,416.00 3,376,416.00 3,376,416.00 3,376,416.0040,516,992.00 Performance vs Target 163,557.22 170,419.66 104,653.22 270,156.19 333,792.61 25,459.35 -24,878.36 129,247.07 103,584.02 -29,928.39 113,850.00 455,924.00 1,815,836.59
Caring, safe and excellent Agency Spend Reduction Target vs Actual Performance Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Total Planned Total delivered Variance Target performance rate reduction Actual performance rate reduction -20,136.90 -54,582.55 -99,936.76 -169,351.12 -249,745.83 -331,374.27 -438,481.25 -553,350.73 -680,758.79 -805,004.14 -949,931.18 -1,127,102.82 -1,127,102.82 -60,373.91 -142,775.66 -212,159.29 -282,215.07 -346,504.46 -418,979.22 -516,757.86 -616,359.38 -683,503.55 -732,543.63 -838,268.97 -959,263.62 -959,263.62 167,839.20 Target performance recruitment -34,000.00 -102,000.00 -204,000.00 -338,083.33 -504,250.00 -702,500.00 -934,083.33 -1,199,000.00 -1,497,250.00 -1,826,916.67 -2,188,000.00 -2,580,500.00 -2,580,500.00 Actual performance recruitment* -15,000.00 -62,000.00 -139,000.00 -238,500.00 -375,750.00 -558,500.00 -783,000.00 -1,043,500.00 -1,334,250.00 -1,659,000.00 -2,023,500.00 -2,403,000.00 -2,403,000.00 177,500.00 Target performance retention -14,583.33 -51,250.00 -113,750.00 -199,176.67 -311,280.00 -442,560.00 -608,016.67 -792,650.00 -1,011,460.00 -1,253,196.67 -1,517,860.00 -1,799,750.00 -1,799,750.00 Actual performance retention* 11,632.50 10,717.50 35,852.50 67,690.00 111,527.50 188,515.00 228,825.00 253,502.50 241,430.00 229,657.50 97,705.00 144,522.50 144,522.50 1,944,272.50 Target performance peri team -12,487.50 -37,462.50 -74,925.00 -124,875.00 -187,312.50 -262,237.50 -349,650.00 -449,550.00 -561,937.50 -686,812.50 -824,175.00 -974,025.00 -974,025.00 Actual performance peri team -15,000.00 -30,000.00 -45,000.00 -82,500.00 -127,500.00 -172,500.00 -221,250.00 -273,750.00 -337,500.00 -431,250.00 -528,750.00 -630,000.00 -630,000.00 344,025.00 Target performance international recruitment -139,020.00 -278,040.00 -417,060.00 -556,080.00 -769,244.00 -1,033,382.00 -1,297,520.00 -1,575,560.00 -1,862,868.00 -2,154,810.00 -2,456,020.00 -2,761,864.00 -2,761,864.00 Actual performance international recruitment -139,020.00 -278,040.00 -417,060.00 -556,080.00 -769,244.00 -1,033,382.00 -1,297,520.00 -1,575,560.00 -1,862,868.00 -2,154,810.00 -2,456,020.00 -2,761,864.00 -2,761,864.00 0 Target performance bank N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Actual performance bank N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Target performance medical Staffing Actual performance medical staffing Total N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A -9,243,241.82 -6,609,605.12 2,633,636.70
Caring, safe and excellent Recruitment & Retention Activity 2022/2023 Support Staff Achieved Moving to NA Role Planned Starting 2 Year Top Up Achieved Starting 2 Year Top Up Planned Moving to TNA role Achieved Moving to TNA Role Planned Moving to NA Role Service Community Hospitals Adult & Older Adult Inpatient CAMHS & ED Inpatient Forensic Inpatient Total Planned Recruitment Achieved Recruitment 28 50 18 50 146 8.8 14.53 29.91 8.32 23.8 76.56 8 8 8 2 6.84 12.83 3.42 4.28 27.37 6 9 4 4 5.32 14 2.58 6.08 27.98 5 5 1 5 20.57 18.27 18.27 65.91 26 23 16 Registered Nurses Planned International Recruitment Achieved International Recruitment Planned Domestic Recruitment Achieved Domestic Recruitment Service Community Hospitals Adult & Older Adult Inpatient CAMHS & ED Inpatient Forensic Inpatient Total Comments 5.77 5 of which were student nurses 16 All Student Nurses 5.04 All Student Nurses 4 All Student Nurses 30.81 5 10 12 5 16 43 5 11 0 10 26 15 10 10 40 Retention
Caring, safe and excellent Key Achievements Arrival of 107 Internationally Educated Nurses (IENs), 77 of which are undertaking NMC registered nursing roles. Agency cost avoidance achieved to date is 2,45M. The recruitment KPI achieved cost avoidance of 2,023,500.00 which is 92.48 % of target. For inpatient services this was predominately achieved through the recruitment of student nurses in 2022/23. Agency spend is 42.33M, which is 826K less than this time last year. This is inclusive of an extra 4.9M on medical spend against last year. Nursing agency spend is 5.2M less than this time last year, this is due to the Trust s need for accessing qualified and unqualified nursing shifts has been reduced by 20% due to the interventions. Development and procurement of 5 external contracts has been achieved within 2022/2023. NHSP bank contract went live 13th February (significant challenges through implementation). Master Vendor Contract for Nursing, AHP and Admin & Clerical with ID Medical went live 13th February. Guaranteed Volume Contract with TFS Healthcare for Littlemore site had a soft launch 30th January. Internal medical bank partnership with Patchwork, implementation plan currently being scoped, target date is 26th June 2023. Master Vendor contract and direct engagement model for Medical Workforce contract awarded 23rd March, target date for implementation end of June 2023.
Caring, safe and excellent Unrealised Benefits Recruitment activity for registered nurses within inpatient units, from the total nurses recruited for inpatient teams only 0.77 ETW was attributed to domestic recruitment. 26 of the target 40 peripatetic team workers recruited, missed agency cost avoidance of 295,425. Improvement in turnover figures, the Trust were unable to deliver any reductions in staff turnover in registered and unregistered roles. Medical agency spend has continued to increase throughout 2022/2023, although the workstream was set up in August there has been a number of delays across the identified workplan.
Caring, safe and excellent Agency Contracts NHSP KPIs - 1-28 March 2023 April Total Demand Hours April Total Bank Fill Hours Baseline Bank Hours % March April KPI-Bank % Actual Fill KPI-Bank % Actual Fill % Admin & Clerical Man (Band 7 -9) Admin & Clerical Non Man (Band 1 - 6) Allied Health Professionals Health Care Scientists Nursing Qualified Nursing Unqualified Support TOTAL 36% 70% 51% 52% 25% 72% 69% 36% 70% 51% 52% 40% 72% 69% 56% 70% 87% 43% 95% 36% 68% 82% 55% 50% 90% 55% 60% 50% 75% 70% 63% 50% 90% 42% 90% 37% 78% 86% 60% 1,474 11,701 5,579 1,646 53,606 46,178 4,437 129,076 742 10,539 2,359 1,479 20,066 36,048 3,820 77,055 Qualified nursing shifts in April were 37% which is 13% behind target, however, this represents a 12% improvement on the baseline hours pre-transfer. Admin shifts have seen a 20% shift fill improvement since the beginning of the contract. ID Medical cost effective replacements Feb March Avg Rate Reduction Avg Rate Reduction Shifts Est Savings Shifts 2,978.50 6,037.50 Est Savings Band 2&3 Band 5 37 7.00 5.00 104 207 7.00 5.00 8,372.00 11,902.50 105 Cost Effective Replacement Savings Feb Mar 9,016.00 20,274.50 Proactive engagement with agency supply chain has identified alternative supplies/new workforce to provide shifts at a reduced charge rate.
