Financial improvement programme update

EEAST RRVs and amb on scene

Over the last couple of months EEAST has been working closely with the financial improvement programme (FIP) team to identify how we can deliver a better service to patients, better support staff and deliver efficiencies at the same time. 

It has become clear that we can actually develop our services for staff and patients whilst working more efficiently – efficiencies that deliver either cost savings or productivity gains. Productivity gains mean we increase the availability of our resources, and the more of these we make available, the less reliance we will have on private ambulance services.

Here is the latest update on the seven schemes we have been running.

Discretionary spend and contract management

We have been reviewing all discretionary spend, i.e. all spend on items or services that are not essential right now, to decrease Trust expenditure.  We have put in place a check and challenge process, which reviews all orders to ensure that they are required by the Trust and that the spending could not be deferred or postponed. By being stricter on what we spend, we can release quick savings that support our financial recovery. This is something that we can all assist with – please only put in an order if it is absolutely essential.

We have also been carrying out stock audits across the region to get a better understanding of the quantity of stock we have at stations and depots.  From this information, we will be setting consistent required stock holding levels in each area so that we reduce the amount of stock we have at any one time. The initial results have shown that some areas hold much more stock than others, which is not an optimal way of managing our supplies.

Through this work we have also identified that there is significant variation in the level of spend per unit response across the Trust, ranging from £3.16 per response through to £5.19 – a 64% cost difference. We will be working with local management teams to understand why this variation exists, gather best practice and develop a plan for future standardisation.

At the same time we have been reviewing the contracts we have in place with suppliers to ensure we are getting the most value for money out of them. One of the contracts we have been looking at is our occupational health contract and how we can improve the service to staff whilst staying within the set budget.  We are recruiting a fleet cost controller to help us to better manage our fleet maintenance contracts and drive better value for money, as this is an area where we spend more than £2m every year.

Private ambulance services contract management

Over the past few years we have used a number of private ambulance service (PAS) providers to help boost our capacity to respond to patients. This has also ensured that we could release student paramedics so they can continue with their training and education.

Given the significant investment we have made in securing these services, we have been looking at how we can better use our PAS resources, both in terms of using them more productively and how we manage the contracts. To help develop better relationship with our partners, we held a stakeholder event for PAS companies this month where we shared our plans for the year ahead, and discussed our joint expectations and requirements.  We had a really good turnout for the event and received a number of suggestions around how we could help unblock some barriers and improve productivity.

We have coped well with a reduced deployment of PAS, although this has coincided with a reduction in demand. The PAS contract management group has re-engineered how we procure, deploy and manage the use of PAS, and financially we are well on track to deliver more than £1 million savings from this work.


We all know that we have a capacity gap, i.e. the gap between the number of staff we are funded for and what we actually need. We are working hard to address this gap with commissioners and regulators. However, a large part of this gap is driven by staff being abstracted from patient-facing duties. Whilst we finalise this year’s clinical and non-clinical training plan, we are also seeing how we can deliver this in a more modern and interactive way.  Last year we introduced a new e-learning system (Learn Zone), where staff csn complete some of their mandatory training on line.  We are looking at how we can utilise technology better to help us improve how we deliver education and training to staff, whilst decreasing physical abstractions.

We have also been reviewing our sickness policy so we can better support staff who are unwell, and help them return to work both quicker and in a more supportive way. Before rolling this out, we are developing management training on how to use this new policy and process to support staff and promote workplace wellbeing, which we aim to deliver in April.

EOC protocols and processes

We have set up a joint working group looking at the staff support desk and how we can deliver these functions in the future – functions that help us better support staff whilst improving our response to patients. We are developing some staff welfare indicators as part of this.

Operational trials

We have put in place two operational trials – one in the east and one in the west. The trial in the west went live on 1st March and is looking at how we reduce handover delays and improve turnaround times for our ambulance crews at Watford General Hospital. We are now in the sixth week of this 12-week programme and the initial results look very positive. Watford handover is already much improved, and lots of learning has come out. We have identified some patient flow and alternative pathway issues which we have raised with the hospital, and this will form the next phases of the project. The team leading this is made up of staff from EEAST and the hospital, with support from NHS Improvement.

The trial in the east is looking at out-of-service, in terms of how we can manage it better whilst providing more support. We are running this trial in a number of phases, the first of which appeared to have a significant impact. As part of this we have also visited London Ambulance Service to understand how they manage out-of-service and offer support to staff.  In west Norfolk we are trialling a new vehicle daily inspection (VDI) process, that covers operational readiness needs and delivers the highest levels of compliance to give us quality and safety assurance.

The Trust remains focused on supporting staff in resolving challenges they face during the day, getting breaks and getting off on time, whilst working in a supportive environment – an essential element of the FIP programme.

Patient transport services (PTS)

Patient transport services is a core part of the work EEAST delivers to patients. These services are a lifeline to patients in the community who need to get to regular hospital appointments. As part of this we have been reviewing how we can make PTS sustainable for us and ensure we deliver these services within the budget available, so that we can grow the service and increase PTS activity across the region. We have been looking at how we can operate more efficiently whilst delivering a quality service.

We have also started developing our objectives for PTS for the next year. The PTS team presented to the executive leadership board last week, highlighting the good work to date and how we are delivering a more efficient service.

Published 30th March, 2017

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