Devolving our central income to specialities to help facilitate the understanding and link between income and activity

Great Western Hospitals NHS Foundation Trust, South West, Acute

The problem

The Finance team at Great Western Hospital NHS Foundation Trust needed to move from centrally reporting clinical income and instead devolve this earned income to each division and specialty within the Trust. This change aimed to assist operational divisions in establishing a connection between overall financial performance and activity performance.

The challenges

How might we allocate income to specific specialties to facilitate a better understanding and connection between income and activity?

How can we provide operational staff with improved information regarding the financial impact of their delivered or undelivered activities, in comparison to their planned and budgeted activities? This approach aims to offer specialties a more comprehensive overview of financial performance, to help address the current financial recovery situation.

By providing them with a more comprehensive understanding of their financial performance, how can we empower them to make more informed decisions in the future?

What were/are the outputs?

 Specialty managers now have an income target within their Statement of Comprehensive Income (I&E) that is aligned with the activity plans they have agreed upon as part of the Trust’s annual business planning process. Specialty managers now receive monthly detailed performance reports concerning the financial value of the activity they have carried out, compared with the plan they have signed off.

Another outcome of this initiative was supporting Excel based data to interrogate for more detailed query analysis. We developed an FAQs package that outlines crucial answers regarding the undertaken process and its implications for our users. To assist managers in comprehending and interpreting the information and divisional income data that they now have access to, we have also created a training package for staff.

What were/are the outcomes?

 There is now a significant benefit for our Finance Business Partners within the organisation. They now possess clearer information, enabling them to compile a comprehensive analysis of their division’s financial performance, encompassing income performance, rather than solely reporting on an expenditure budget.

This project provides considerable benefits for the Trust, particularly given its current challenging financial position. On a monthly basis, we are now equipped to gain a better understanding of our financial position, enhancing our forecasting capabilities. This, in turn, facilitates our progress toward improved financial sustainability, with a comprehensive grasp of our income being a crucial component of this.

Specialty managers also now have a better understanding about how their activity performance can drive the organisation’s income performance, with it being linked to the aligned payment incentive rules.


The Innovation

Read the full innovation on the devolving central income to specialties

All the documents and resources relating to this innovation can be found in the downloads section at the bottom of the page.

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What the peer-reviewers said

“Can see how this would be useful for clinicians/ divisions – and help drive out efficiency.”

“Drives greater financial awareness and understanding of impacts from actions amongst services gives services greater autonomy.”

“Provides finance information for divisions which helps focus on the financial impact of potentially failing to meet activity target in their specific area rather than just at Trust level.”

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Here are all of the documents and resources related to this innovation

Innovation B6 – Trust Devolved Income Exercise