Fiona Dalton, CEO

Chief executive's blog - 10 February 2014

In my personal blog, I will keep you up to date on what is happening at the Trust, sharing what I think we are doing well and what we can improve.

Fiona Dalton, chief executive  

Spring  is the time of year when we set budgets for the next financial year (April 2014 to March 2015), and this is always a difficult job. It’s tough because every year the tariff (that is, the amount of money that we get paid for each patient admission, operation or outpatient appointment) is reduced. This is how the government drives every hospital to be more efficient. From April this year most of our tariffs are going down by between 1.2% and 1.5% so for instance, we currently get paid £9,254 for a complex hip operation, but from 1 April we will only be paid £9,151.

But of course everyone who works for the hospital is not being paid less. We don't yet know what the national pay agreement will be, but we anticipate it will be a 1% pay rise. And the cost of the consumables, such as drugs and all the other non-pay items that we need, will also tend to go up by inflation.

To remain financially sustainable the Trust needs to deliver a surplus of approximately 1.5% of its income. However, given the reduced tariff and increased costs, if we do nothing we will spend more than we earn, and a gap will rapidly grow between our income and our costs. The first impact would be on our capital programme – we would no longer have the money to invest in upgrading our estate and facilities, including the new buildings and equipment that we need – and the hospital would go bankrupt.

To avoid this, we have to have a savings programme every year. But of course the last thing that we want to do is to simply reduce the quality of care that we provide. So we have to be cleverer: every year we have to think how we can spend our money in a more intelligent way, how we can focus money on the things that add value to patients and reduce the waste that happens in every hospital.

There is increasing international evidence that high quality care is often also very cost-effective. If we can save the costs of re-doing things that weren't done right the first time, of looking after patients whilst they wait for us to do something, of processes that don’t add value to patients -  then we can improve our quality of care at the same time as saving money.

We cannot pretend that this will be easy, but this is our challenge, and I know that if we all work together we can achieve this.

On a different subject, last week I had my first lunch with a group of patients, all of whom had been treated by our cardiac teams. It was good to see how pleased they were to have the opportunity to talk about their experience and offer their suggestions on what we can do differently. They certainly had lots of ideas - in particular we talked about the food and how we could improve this, and also how we could discharge patients more smoothly and efficiently. They also had some very simple suggestions that they felt would make a real difference to patients – for instance, that we should give or sell eye masks as well as ear plugs to patients to help them sleep in busy wards.

But most importantly all the patients and their partners recognised the very high standard of clinical care that they had received. This quote from one of the patients was typical:

“the standard of care I received from the doctors and nurses was of the highest standard, I would like to mention nurse Jess on ward E4, her cheerful smile and time she took to talk to all the patients was marvellous, on a personal note I would like to thank nurse Rodriguez who was my one to one nurse when I was in HDU, nothing was too much trouble and her constant encouragement when my lung collapsed got me through a difficult time".

Fiona Dalton


We welcome your comments on this blog.

If you have any specific concerns or need advice about the care you have received at our hospitals, please contact our patient support services on 023 8120 6325 or

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