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Case Study: Acute Healthcare


Healthcare Services Provider 2

Appointed Turnaround Director and Interim CEO working alongside a Kingsgate led PMO team


  • The Trust served a population of 258,000 and had undergone very little change over a number of years. The Trust had however suffered from a high turnover of CEOs
  • The Trust operated from its original 1960’s building site and had built a new wing in 2006, the layout of which has caused operational issues in the Emergency Department
  • The Trust had one of the highest outpatient clinic cancellation rates in the NHS (32%) and a high average length of stay
  • In 2010/11, the Trust delivered only 63% of its planned cost improvement programme and missed its A&E four-hour wait, 18-week to treatment and 6-week diagnostic targets – all key performance measures
  • In 2011, the Trust published its financial accounts highlighting the need to find £17m of efficiencies in the following year, almost all of which had to be delivered in less than one year. These in-year savings were in addition to the further year on year savings highlighted in the cost improvement plan of £12m in 12/13 and £10m in 13/14 and the lack of any future development plans for the Trust

Key issues and requirements


  • One of the crucial factors in the Trust’s turnaround was the need to drive through the change in an extremely short period of time.
  • Many of the financial targets could only be achieved with a change in the way the Trust operated.
  • The first action was to establish a broader Transformation Plan supported by a structured communications strategy.
  • The Cost Improvement Plan (CIP) was key to the Transformation Plan.  It detailed the key actions the Trust needed to deliver to complete the initial turnaround in the first twelve months.

Kingsgate’s strategy

Delivery & Moving towards Sustainability

Phase I – Stabilisation

  • Reviewing the skillset of the Chairman, entire Trust Board and senior management team
  • Improving the delivery of clinical care, meeting key targets and realising related efficiencies
  • Planning for £17m efficiencies, with £13m delivered within 12 months
  • Phasing bed reductions, reduced length of stay and 500 outpatient clinics across the Trust
  • Reducing elective activity
  • Improving the efficiency of the Operating Theatres Department, which suffered 9% cancelled lists
  • Maximising savings in non-clinical staff spend, including medical secretary restructure
  • Putting in place controls for long-term reductions in bank and agency staff spend at the Trust

Phase 2 – Moving towards sustainability

  • Renegotiating aspects of the commissioners’ contracts not reflecting expected or actual activity
  • Repatriating business and realisation of unattributed activity and renegotiating supplier contracts
  • Developing a five-year clinical strategic, building on the Transformation Plan to ensure a robust future for the Trust, including achieving Foundation Trust status by 2014
  • Improving staff morale and engagement across the Trust

Results and achievements

  • Achieved the largest cost improvement programme in the East of England NHS and one of the largest in the country
  • Achieved a financial surplus
  • Established a new Executive Team in place with the skills to take the organisation forward
  • The Trust implemented a permanent clinically led quality impact assessment process to ensure quality of care was maintained
  • Serious Untoward Incidents across the Trust fell
  • The Trust reduced 500 outpatient clinics run by the Trust annually
  • Increased discharges from increased from 116 per week to an average of 129; the average length of stay reduced in pilot wards
  • Over the year, the Trust permanently reduced 66 inpatient beds
  • A new Ambulatory Care Service was launched, helping over 12,000 patients avoid being admitted
  • Over £500,000 was realised having renegotiated contracts with commissioners through the year
  • Over £600,000 was realised from repatriated business and unattributed activity