Financial improvement programme

The NHS is currently facing significant challenges, both in terms of meeting rising demand and the money available to it. 

For us, this mainly relates to capacity issues and decisions we have made to increase capacity to deliver a safe service to patients, issues which have been building for a number of years as the gap between funded capacity and demand has grown. Most years this has been bridged through one-off funding, stripping back office services and funding through patient-facing vacancies. We have actively been recruiting to these vacancies, reducing attrition and streamlining support services which resulted in less financial resource to put towards the capacity gap. In 2016 and going into 2017, we faced with a rapid increase in demand and the acuity of 999 patients.

Given the position of the NHS, NHS Improvement (NHSI) has introduced a financial Improvement Programme (FIP) where trusts are invited to join to address their financial challenges and where NHSI have confidence that this support can reduce a financial challenge. Given our deficit position, NHSI invited us to join the programme - as part of that, we get the support of a financial improvement team to analyse the effectiveness and efficiency of the Trust and then come up with potential solutions to improve the service to patients and our financial position. We are pleased to report that this FIP team have confirmed that the size of our support services are leaner than what is expected in the NHS generally.

The FIP team comes to us from an organisation called SSG, who have been carrying out analysis since December 2016.

While this is not a formal report to the Trust and the conclusions have not been validated by us, the FIP team have kindly agreed to allow us to publish their initial findings prior to detailed analysis, to assist in the wider understanding of the financial challenge and in the interests of transparency and openness.

The SSG have identified six areas where they believe we can make improvements to both the service, its efficiency and finances. It is important to note, that SSG are only paid if the required savings are delivered.

Financial improvement schemes

Patient Transport Service (PTS)

We are reviewing how we can operate these contracts in a more financially sustainable way. The service is a core part of our work and we believe we’re best placed to run it for patients across the region. This is a difficult market place, predominantly driven by cost, and with lots of competition. We want to deliver quality services to patients and this can’t always be done at the lowest cost. This means we’re looking at how quality services can be delivered more efficiently: are there savings to make that don’t impact on quality, can processes be more streamlined and could contracts be managed with our commissioners better? This will help bring PTS back into budget and make it a viable and sustainable business for us which is good news for our staff, volunteers and patients.

Non-pay spend and spending on contracts

We are reviewing all non-pay spend i.e. all spending on items or services that are not critical right now, with every order being reviewed. We’re also reviewing our existing contracts with suppliers to ensure maximum value for money.

Private Ambulance Service (PAS) contract management

We are reviewing how to get best value for money and maximise our use of PAS.


A large part of our capacity gap is driven by people needing time off to complete education and learning. Therefore, we’re looking at how we can improve and modernise our education processes – moving from a traditional approach to a more modern, interactive way of learning by utilising technology such as e-learning platforms.

We're pleased to say that our sickness rate is steady and lowering overall, and our sickness policy is being reviewed so staff who are unwell can be better supported and helped in their return to work.

Emergency Operation Centres (EOC) protocols and processes

These host the teams handling decisions about our responses to the calls coming in, and  have many protocols and processes in place.  We’re looking at all of these to see if they can be made more effective and help us provide a better response and service to patients.

Operational trials

We have two trials taking place looking at issues such as vehicle mix, tail and surge activity, unit hour production, out of service, welfare and so on.  Staff and managers will be involved in developing these trials.