We reduced the month-end process by four days at an NHS trust and introduced new process to streamline payments and bring the month-end timetable forward.

Background

Blackpool Teaching Hospital Foundation Trust’s (BTHFT) finance team were investigating ways to align month-end reporting to the newly created Lancashire and South Cumbria Integrated Care System (ICS) reporting schedule.

NHS Midlands and Lancashire (NHS ML) was approached to support their initial journey to reduce the time it took to close month-end from 8-9 to 4-5 working days, to align with ICS reporting intentions.

Our finance team, alongside with our Improvement Unit, worked closely with the BTHFT teams throughout March, April and May to assist and advise in the review of their month-end priorities.

Action

We worked as independent advisors and facilitators, alongside BTHFT’s Closedown Group, to identify and agree on amendments to the month-end process. The criteria was based on the potential release of capacity within the finance structure or current areas of concern within the finance function.

Following a thorough engagement process to understand the service change priorities, we delivered bespoke solutions built on our experience of public sector finance.

The areas of focus were:

• A detailed analysis of the month-end timetable with an agreed understanding of the feasibility of the suggested changes to deliver earlier achievement of income and non pay accruals
• A full review of low value, high volume recharges posted by BTHFT, to release capacity
• A focus on the large amount of time, about 175 hours per month, delivering Medical, Nursing and AHP agency accruals across the finance team; and
• The identification of future capacity and time savings and further priority areas.

To ensure that the positive changes delivered as part of this project were sustainable, NHS ML promoted an open approach to issue identification and reflection through the delivery of several targeted workshops.  These were used to encourage internal ownership and engagement for future changes.

Impact

As a result of the work delivered as part of this project:

• BTHFT finance team month-end close was achieved on working day 5 in reporting months 1 and 2 of 2022/23
• A new process was developed for recharges to remove the posting of low value, high volume non-pay recharges. This has freed up about 11 hours every month of the team’s month-end time
• Since 175 hours per month were utilised on agency postings, it was a system priority to concentrate on agency accruals. We delivered a series of workshops and we suggested an automated process which was adopted by BTHFT over the subsequent months. Upon implementation, this would save an estimated 35 hours per month
• Several elements of the month-end timetable recording and accruing income and non pay areas were brought forward in time.