MONITOR BUSINESS CASE APPROVAL FORM

MONITOR BUSINESS CASE APPROVAL FORM Title Reference information Agency Intensive Support Team BC Reference M-767 Strategic Plan Reference 2.4 – ...
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MONITOR BUSINESS CASE APPROVAL FORM

Title

Reference information Agency Intensive Support Team

BC Reference

M-767

Strategic Plan Reference

2.4 – Assess the size of the financial gap 2015/2016 and beyond. Consider what this means for the sector and work with partners to mitigate the consequences.

TBC Provider Sustainability

Approvals Required (please tick ) Directorate Governance Controls Committee

Budget Holder X

Department for Health

X X Expenditure type (please tick ) X Extension to Business Case

New Business Case Resourcing Permanent role filled by secondment/day rate contractor Temporary role filled by internal transfer or fixed term contract Temporary role filled by secondment/day rate contractor

Budget Holder Team/ Directorate

Professional Services Consultancy project

Other Project Spend ICT

Comms



X



Consultancy advice

New appointment

X

Research

Extension to existing appointment

X

Capacity / Implementation

Facilities / Estates

Other (Specify)

Role / Project information Agency spend is having a serious impact on trust finances - temporary staffing Description / Background/ Business spend in the NHS increased by 29% to £2.4bn in FY 2013-14. In 2014 – 15 this trend has accelerated. Increased agency spend has therefore been a Requirements major area of focus for the Joint DH-Monitor 15/16 Spending Review Challenge Board. In a related activity Monitor has been working closely with DH, TDA and the Cabinet office to review and recommend solutions to limit and decrease agency spend in the sector. Amongst the recommendations was a requirement that Monitor / TDA establish implementation support teams. There was also a requirement that Monitor do more to facilitate greater collaboration and sharing of best practice between trusts. Ministers have endorsed both these recommendations. The focus of these teams will initially be agency spend on nursing but will be expanded once further work from the Cabinet Office has been completed.

MONITOR BUSINESS CASE APPROVAL FORM

This business case supports the initial development and implementation of an Agency Intensive Support Team (AIST) in Monitor which gives effect to these recommendations. The AIST would form part of the new Provider Sustainability Directorate (Operational Improvement Team). Following initial implementation in the first three months (if successful) Monitor would anticipate increasing the size of the team through permanent recruitment in order to upscale delivery of the support package to Trusts. Objectives, Desired Outcomes & Skills

The set up of an Agency Intensive Support Team (AIST) is modelled on the existing Emergency Care Intensive Support Team (ECIST) currently operated by DH. The outputs of the AIST in the initial six months will be to: 

Trial a draft diagnostic tool

Based on Monitor / PMIU research an initial stakeholder input Monitor has prepared a draft diagnostic tool to support trusts in identifying what they can do to move towards best practice. Monitor will trial this diagnostic in a number of foundation trusts in the first six months. Support for objective Monitor / TDA / PMIU conclude there are 5 broad areas trusts need to do well in order to effectively manage agency spend. Although a diagnostic has been developed in house to analyse trust performance in these areas it has yet to be tested. We have already commenced initial conversations with and hope to commence testing in mid-April. A tested diagnostic will provide greater assurance that we are providing the correct tool to the sector as a basis for action and cost improvement planning. 

Intensive Support packages for up to 3 trusts

Monitor will facilitate use of the diagnostic tool, action planning and ongoing programme management oversight at a number of foundation trusts. Action planning will be linked to setting targets and the development of a cost improvement plan with the foundation trust. Support for Objective DH / Monitor intend to write to s42 trusts seeking targeted cost reductions against agency spend. The proposed trial using the diagnostic tool would allow Monitor to do this in detail at up to 3 foundations trusts in the first six months. 

Facilitating support across the foundation trust sector

Monitor is working closely with the TDA and the NHS Collaborative Procurement Partnership to deliver a series of Board and Practitioner workshops in May and June this year. The focus of the workshops is to;   

introduce the diagnostic tool; set out a process for trust self assessment and reporting to TDA / Monitor; and set out expectations regarding trust action and cost improvement

MONITOR BUSINESS CASE APPROVAL FORM

planning. Support for the objective DH / Monitor intend to write to s42 trusts seeking targeted cost reductions. The proposed trial would allow Monitor to do this in detail at up to 3 foundations trusts in the first six months. Monitor will be in a stronger position to target intensive support at foundation trusts as a result of the activity and will be able to provide small scale assistance, sign-posting and advice to trusts. Potential Longer Term Implications This business case covers the provision of interim resource to set up the AIST and commence initial delivery. However, if the initial trial is successful we would anticipate upscaling activity necessitating the permanent recruitment of resource. This could commence as early as July / August. We would expect a permanent resource of up to 10. This would include: -

permanent resource to replace the interims in place for the initial trial (2); and

-

additional positions (up to 8) to delivery a more comprehensive programme in the longer term.

The 10 positions would include five subject matter experts to deliver diagnostic support to trusts and to help and shape and prepare delivery plans. The remaining 5 post would focus on ‘delivery science’, overseeing activity as delivery plans unfold. This would amount to approximately a £1.3 million pound requirement each financial year (assuming level 2.1 / 2.2 equivalents).

Procurement/recruitment route [As agreed with Procurement / HR](please tick ) Framework Competitive Competitive Direct Recruitment X (Insert tender quotes (10k award which one) (above £30k) up to £30k) Single tender action Outsourcing rationale (if applicable) Insufficient in-house resource If this is a case for outsourcing activity, please select the rationale from Insufficient in-house expertise one or more the following options (please tick the relevant boxes): One off project Other (please explain below) KIM confirmation (if applicable) If the case will create an analytical tool, model or other software, please confirm that KIM have been consulted on the case. Specifically, that the tool is compatible with Monitor’s IT infrastructure and that any ongoing support requirement is manageable. Temporary staff confirmation (if applicable) If this is a case for an off-payroll engagement (i.e. a position filled by an individual not on Monitor’s payroll), please confirm that the appropriate contract will contain the required clauses regarding tax compliance. This will require confirmation from Finance and/or HR.

MONITOR BUSINESS CASE APPROVAL FORM

The new posts will be sourced through IMAS and then procured through an agency (anticipating a reduced fee). We have approach who may procure the candidates on a direct engagement basis in order that we expedite the process and negate agency fees. Finance have confirmed this approach is possible and that we can reimburse a foundation trust for that expenditure. The contract extension will be managed through Veredus.

Value For Money Assurance / Business Benefits 2 new positions (220 days) It is likely we will source the two positions through IMAS although in this case Monitor will need to directly engage the candidates through an agency rather than an IMAS secondment.

Extension of Existing Position (63 days)

Impact If Business Case Not Approved Monitor would have to reprioritise activity and possible not be in a position to deliver. Monitor will not be in a position to provide a targeted support package. In the context of the 15/16 challenge and the priorities being set by the Department of Health this will delay Monitors ability to set targets and cost improvement plans at trusts and limit our ability to reduce agency spending in 15/16.

Financial case Opex

Capex

Product, Role(s) and Grade(s) (or equivalent) Policy Lead Clinical Lead Improvement Lead

Unit Cost

Agency Fee (if approp)

Discount agreed -

Units Required

FY Expenditure Due 14/15 15/16

Sub Total

63 tbd tbd

66 110

Up to £10,000 for travel and accommodation expenses over the 6 month period.

Contingency (if required) Expenses VAT (20%) Total

209,112

MONITOR BUSINESS CASE APPROVAL FORM

Budget Confirmation Budget availability How expenditure is to be funded confirmed by Request from the central projects fund Delegated authority confirmation Confirmation from Finance that this business case is within Monitor’s delegated No authority to approve (see note below) Budget Code (from Finance)

Budget Approver

Audit For completion by project team: Date created Submitted by (name and role) Signed off by (name and role) Approved by Budget Holder For completion by Secretariat Date approved by Directorate Governance Date approved by Controls Committee Date approved by Department for Health

8 April 2015 James Mackay, SPA Suzie Bailey, Director Improvement Toby Lambert, Director Pricing

Note on delegated authority: DH has granted Monitor earned autonomy from its main spending controls. A key condition of this autonomy is that all requirements are included in a forecast signed off by DH; cases outside of this may be subject to the full DH approval process. Finance can confirm if the case is within our delegated authority. Specific thresholds which require additional approval, such as from DH Ministers, Cabinet Office and/or Treasury approval:    

 

 

Temporary staff on a day rate of £900 plus VAT or above (DH Ministerial approval required) Consultancy projects above £200,000 plus VAT require (DH Ministerial approval required) Any proposal to extend a consultancy agreement beyond 9 months or 3rd renewal at the 9 month stage (Cabinet Office approval required) Legal services contracts over £20,000 plus VAT and over 9 months (with the exception of legal advisory services provided by counsel (barristers); legal services relating to civil or criminal litigation legal disputes (including disciplinary, regulatory or tribunal matters); and inquiries or any matter of a contentious nature) Any new or renewed salaried substantive posts with salaries over £100,000 must be authorised through a separate process via Organisation Transformation (DH/HMT approval required) Comms Marketing and Advertising spend greater than £20k (DH approval required), or over £100k (Cabinet Office approval required) or single recruitment advertising spend greater than £40k (specific DH approval required) ICT with whole life costs greater than £5m or admin support systems greater than £1m (Cabinet Office approval required) All new leases, renewals of existing leases, the non-exercise of lease break options, new property acquisitions, new build developments, sale and leaseback and freehold sales. (Specific DH approval required)

MONITOR BUSINESS CASE APPROVAL FORM

Business case format last updated: January 2015