Countess of Chester Hospital NHS Foundation Trust
A Case Study from the Countess of Chester Hospital NHS Foundation Trust
Utilising ESR to support Workforce Strategy & Planning, Trust Assurance and Cost Reduction
The Countess of Chester Hospital NHS Foundation Trust (COCH) has consistently strived to maximise the functionality available in ESR, and we had demonstrated this with our early implementation of Manager Self Service (MSS) and the integration of Oracle Learning Management (OLM) and e-Learning. Building on our ‘model office’ approach to ESR, our focus in 2012/13 moved to understanding how we could utilise ESR to support the Trust in three key project areas:
- Workforce Strategy, analytics & planning;
- And to help identify potential efficiency savings.
Our Director of HR & OD, Susan Young, was working with her Trust Board colleagues to identify ways in which the Trust could manage the key challenges faced not only during 2012/13 but also in the years ahead. There are a wide range of challenges that the Trust, currently faces including:
- Difficult demographics within the patient base of 450,000;
- The significant increase in Emergency Department admissions;
- Increased inpatient referrals;
- The challenging quality and performance budgets;
- Reducing costs by around 5%.
In addition, we were preparing for an NHS Litigation Authority (NHSLA) Level 3 Assessment in February 2013. It is these challenges collectively that gave us a set of clear objectives and the HR Division knew that the data held within ESR was pivotal in supporting the Trust in addressing this tough agenda.
Sponsored by Susan Young and supported by the HR & Wellbeing Business Services team, a shared transactional service supporting the Countess, the project was broken down into three key aspects:
1. The delivery of a workforce information summary booklet, which is routinely used as reference data by the Director of HR, HR Business Partners and other key stakeholders within the Trust;
2. The quality assurance of workforce data to meet the relevant 17 NHSLA standards from a HR perspective in preparation for the Level 3 Assessment;
3. The analysis of workforce and bank & agency data to address agency spend and Emergency Department vacancies.
Sue Hodkinson, Head of HR and Wellbeing Business Services (pictured left) explains: "Susan acknowledges she is data hungry and the starting point was to deliver a readily accessible and updateable workforce information booklet which would enable Susan and the HR Team to answer questions raised by the Chief Executive, the Board of Directors or other staff members whilst they were engaging across the Trust.
The workforce information booklet has developed throughout the year through regular stakeholder & evaluation meetings, led by Susan. It now contains numerical and graphical information and is broken down into 18 areas and is available remotely so Susan can access this on her tablet, whilst also being available in a paper format. It includes historical (e.g. 2007-12) and current data such as staff in post, age profile, turnover, and sickness and it will be evolving further in the future to include quarterly vacancy information, again obtained through ESR & NHS Jobs, in addition to the Business Intelligence analytics that have recently been enhanced within ESR, as Susan is keen for the Trust to fully utilise this functionality going forward".
The Director of Nursing and the Trust’s Risk & Governance Coordinator lead on the delivery of all of the standards for our NHSLA Level 3 Assessment. There are 17 standards which relate to HR and the delivery of these were supported by each month’s workforce information reports being shared across the Trust, outlining each department’s performance relating to compliance with mandatory training, induction and appraisals and absence management data. By using ESR Self Service, managers were encouraged to own their data and it was that sense of empowerment that meant that they were able to ensure that employee records were up to date. Quality assurance was also embedded, with peer reviews being undertaken to ensure appropriate readiness for the assessment across the HR-related standards.
And finally working with the Urgent Care Division, we have utilised ESR, in conjunction with interfaces to other systems, to enable the analysis of the Trust’s bank & agency data. This has identified that the Trust’s spending on agency staff peaks in May or June and again in the winter. Spending on agency staff peaks at certain times of the year. Analysing the data helps us to understand the root causes of the spend; gaps in junior doctors’ rotas, sickness levels and unfilled vacancies. The focus on this element of the project was to support our cost reduction programme, reduce locum spend & improve staffing within the ED Department.
Benefits and Achievements
Under the leadership and direction of Susan Young, the Countess of Chester Hospital NHSFT has achieved significant improvements and financial savings as a result of embedding ESR within the organisation.
Susan explains: “If I can understand our workforce, I know where there’s potential to develop that workforce and make savings”. In addition, quality assurance of the data held in ESR and associated reports enabled the HR team to support the Trust in achieving NHSLA Level 3, whilst also supporting an unannounced Care Quality Commission (CQC) assessment during the same week. Furthermore, the analysis of bank and agency data, delivered through the ESR interface, enabled trends to be identified which resulted in the Trust initiating a successful international recruitment campaign, a fully staffed Emergency Department and reduced locum costs.
1. Workforce Information & Planning
- The Trust has been developing its Workforce Plan and Annual Plan for 2013 onwards and through the use of the booklet and the innovative use of ESR, Susan explains that “this obviously helps me in the development of the workforce strategy and workforce planning because we can look at things like the age profile and try to spot where we might have difficulties in certain professional groups in the future”. In addition, HR Business Partners have been able to carry out more informed workforce planning with the Divisions in conjunction with the use of MSS, managers and HR have the tools available to them to identify trends and potential areas to address.
- Whilst sickness absence is reported monthly to the Board, the booklet has provided the HRBPs with valuable, understandable and easily accessible data, both online and in a paper format, which has enabled them to undertake further analysis and targeted action to address sickness hot spots. This has supported the Trust in reducing sickness absence from 4.5% to less than 4% in 12 months.
- The Trust passed NHSLA Level 3 with a score of 49 out of 50 which resulted in an annual saving of £500,000, an achievement which only 1 in 5 organisations have realised. Susan Young explains: “In the light of the recent Francis report, risk management and safety is an area that every NHS organisation should have a tight grip on. Having board level assurance that you have a competent and safe workforce is of paramount importance, and is the key to improving patient safety and the quality of care you provide. Perhaps this is the best demonstration of the benefits of our whole team approach. The assessors were incredibly impressed with the culture within our organisation and the standard of our documentation. The evidence presented against all of the standards was so thorough that the two day assessment was completed in one day”. In addition, the Pass Report from the Assessment stated that “The organisation demonstrated an extremely thorough and well executed approach, both in terms of risk management and assessment process, resulting in a well-deserved Level 3 award”.
- The reports and information held within ESR are now being developed to provide a single data set to enable Freedom of Information (FOI) requests to be dealt with more quickly and efficiently.
3. Cost Reduction Strategy
- The Trust identified a potential overspend on agency staff of £3 million at the start of 2012/13. However, as Susan recalls, “we spotted the problem, did something about it and by the end of the year our spend was around £2 million. It’s more than we wanted, but it’s not £3 million” and through close working across the Divisions, medical agency spend has reduced significantly. Using the data from the ESR interface, we are able to understand why agency spend has been incurred, how to target it through the recruitment to vacancies and work with the Lead Employer for Junior Doctors to address gaps in rotas.
- In addition, our innovative use of ESR has enabled the Countess of Chester and Wirral University Teaching Hospital NHS Foundation Trust to create a shared HR & Payroll transactional service. Susan says "We have saved £350,000 across both organisations and we are also able to income generate for both of our trusts because we can now provide services to others as well".
Advice for other Trusts
- Senior sponsorship is key: the project has been lead at the highest level by our Director of HR & OD driving the need for relevant data, and having that clear leadership we could understand how the information would support our Board of Directors & Council of Governors.
- Work across divisions & boundaries: Though ESR data reporting and analysis is undertaken within HR, Finance manages the establishment, and managers undertake a significant amount of input through Self Service. We are also investigating workforce analysis across organisational boundaries, including the local Authority & local Trusts.
- Look for trends: The wealth of data held in ESR can identify trends and potential cost reduction opportunities. Though ESR may not have all the answers, by having a senior sponsor and working collectively, this analysis can support the Trust as demonstrated and ultimately, improve patient care.