Cash-strapped NHS Fife outlines major review in bid to make savings of £25m

“This is a really challenging financial position,” Margo McGurk, NHS Fife’s director of finance and strategy, explained to the board on Tuesday.

“It’s our job to respond to situations as effectively as we can, but it’s absolutely clear that some difficult decisions and choices face us if we are to be successful.”

Finance was a critical point of discussion for the board on Tuesday, and members were given an in depth look at the situation.

Looking back over the past year, it failed to fully deliver its ambitious £15 million saving programme, and costs for acute services and external agency staff spiralled.

Looking to the future, the picture is not much improved.

NHS Fife will be required to deliver approximately £25 million – or 3% worth - of recurring efficiency savings in the coming year. That expectation has come directly from Holyrood.

To make matters worse, the government has capped future brokerage loans at £5 million - a figure that will reduce further in future years.

Even with a £25 million cost savings programme, NHS Fife is predicting a £30 million deficit by next March. In order to avoid that £30 million chasm, NHS Fife will be forced to make an additional 4% of savings.

With NHS Fife’s financial situation as it currently stands, the Scottish Government has said it cannot approve the current 2024/25 financial plan - leaving the board in a state of limbo. The current plan includes £25 million of cost cutting measures but NHS Fife will need to find an additional 4% worth of savings to get Holyrood’s stamp of approval.

“There are two specific things we absolutely have to do as an organisation,” Ms McGurk explained. “The first is to deliver in full a 3% recurring savings and the second is to work through the details of the additional [steps] necessary to deliver 4% savings as far as possible.”

She continued: “Notwithstanding that, we have to deliver our financial targets, and we have to do all of this safely and at pace.”

>> The Plan

NHS Fife will deliver its financial improvement plan through what it calls a “Reform, Transform and Perform” framework.

This will include immediate changes across the organisation; evolving NHS services, structures; and driving sustainable improvements throughout the organisation.

The health board is looking to make these changes across about 15 areas of medicine.

Continued medicines optimisation - that means effective purchasing, prescribing, supply, administration, and waste reduction.

Aspects of Fife’s unscheduled care bundle - previously managed by the Health and Social Care Partnership - will be re-incorporated into NHS Fife’s Acute Services Division for efficiency and effectiveness.

NHS Fife also hopes to make savings through the major private finance initiative contract review for phase 3 developments at Kirkcaldy’s Victoria hospital

It is also planning to rationalise its estate and infrastructure. Ms McGurk’s report claimed that some of the board’s space is “poor clinically for patients and staff”. There are also £100 million worth of maintenance backlogs across the estate. According to the report, there are opportunities to “consolidate space” on NHS Fife sites or by sharing space with partners such as Fife Council.

The board is also looking at reductions in surge bed capacity - moving beds into alternative parts of Victoria Hospital and reviewing models of care.

Reducing Covid-19 legacy costs

Reducing the amount of spending on supplementary staffing, on external healthcare providers, and examining procurement schemes and contracts for savings opportunities

Beyond those well defined £25 million savings targets, the board will look at making a further 4% of cost savings.

According to the report, these plans “have still to be identified in detail”, but they include: site rationalisation, review overnight urgent and unscheduled care

Re-imagine Victoria Hospital site, same day emergency care, reimagine Queen Margaret Hospital site, review of medical devices, optimise digital enablement

and “right sizing medical workforce.”

It will also review procedures of low clinical value, optimise remote appointments, theatre and medicine usage.