Establishment Control using ESR A case study by Derby Teaching Hospitals NHS Foundation Trust Background Derby Teaching Hospitals NHS Foundation Trust has an annual budget of 500 million and is one of the largest employers in the region with more than 8,000 staff. It provides both acute hospital and community based health services, serving a population of over 600,000 people in and around Southern Derbyshire. The Trust runs two hospitals: the Royal Derby Hospital, which incorporates the Derbyshire Children s Hospital, is a busy acute teaching hospital and London Road is the Trust s Community Hospital. The Trust treats a million patients each year and more than 6,000 babies are born in its maternity unit annually, an average of 17 births every day. 72,000 elective operations take place every year in the hospital s suite of 35 modern operating theatres, an average of more than 280 operations per day. The Project The main aim of the project was to enable accurate reporting on establishment from ESR. This meant that we would need to ensure all staff establishment data was entered into ESR so that we could identify notional vacancy gaps and over-establishments. This was driven by a requirement to accurately report staffing utilisation at business unit level in Trust Board Reports. Before work on updating the current ESR data commenced, our Finance team worked with our ESR team to develop a joint process for new starters including creating new positions in ESR when necessary. The Finance team would complete a New Position form for the ESR team, identifying the position details (Including Job Title, Band, Cost Centre & subjective code and Staff Group), along with the funded establishment against the position. The ESR Team would then create any new positions identified in ESR, and record the funded establishment. Once this process was in place, we began to update the existing position data in ESR.
Firstly the ESR team ran the Position Analysis report, identifying all current positions in ESR. The Finance team used this to match each position in ESR against the details held in the General Ledger. ESR differs to the General Ledger in that there can be several similar positions in a single Cost Centre, all of the same band, but which Finance would just identify as a single budget line/subjective Code. In order to minimise data maintenance it was locally determined that the establishment would be recorded against a single position in that organisation, rather than against each position. This would mean that some positions showed as over established and some under established, but when reporting at the organisational (Cost Centre) level or by band, the total establishment matched the ledger at that level. For example All the ESR positions below are in the same Organisation, but from a Finance perspective, the Ledger simply has one line for Consultant with an establishment of 69.84. By recording the 69.84 in ESR against only one position, all the other positions show as under-established, but when aggregated at Organisation (Cost Centre) level, it can be seen there is an under-establishment of 17.44 The reason there are so many ESR positions in this Cost Centre, is due to the fact they are all on differing Pay-scales (Due to Level of Seniority as can be seen by the Grade column below).
Once the Finance team had completed this work, the data was returned to the ESR team, who then entered each of the identified establishments against the ESR positions. When ESR had been updated, we agreed and embedded a new process: When any budgetary change is made by the Finance team, which changes an established position, they access ESR and amend the establishment to maintain a match with the General Ledger. A monthly control report is run which the Finance team use to ensure the ESR details reconcile with the General Ledger details. As well as enabling accurate reporting, having the establishment recorded against each position means ESR advises if the entry being made takes a position over its established total -see the screenshot below. This then leads to a question as to whether this over-establishment is expected. Due to the process that our Trust has implemented, recording establishment against selected positions (rather than all) we do receive the above message for most amendments made in the system, so our workaround is to ignore them. The messages would be of benefit however, if recording the establishment against individual posts. Key Benefits The main benefit of embedding the ESR Establishment Control process is the ease at which reports can be run, clearly identifying over and under establishments.
Example Oracle Business Intelligence Report: Recommendation 12 of the Carter Report stated that: NHS Improvement should develop the Model Hospital and the underlying metrics, to identify what good looks like, so that there is one source of data, benchmarks and good practice. One of the Key items identified for trusts was: Trust boards ensuring that the Electronic Staff Record (ESR) is reconciled to the financial ledger on a weekly basis, with a minimum reconciliation of 95% from October. Having the Establishment Control process in place in ESR enables us to meet this requirement, and our quarterly validation checks between the finance ledger and ESR ensures that the establishment remains in line. Monthly meetings with Finance Managers ensure Cost Improvement Programme s (CPI) and any changes to establishment are mapped accordingly. This has enabled us to submit more accurate returns, and in particular has been beneficial for providing the monthly Monitor staff information, and providing detailed staff and vacancy information for the Sustainability and Transformation Plans (STPs) has given us a clearer understanding when reviewing staff details in relation to the Carter metrics.
Close working between our ESR and Finance teams over a number of years has given us a much better understanding of the true level of vacancy in the organisation. There are still differences between the two systems with regards to Maternity leave and other absences, and also with the treatment of CIP/vacancy factor in the Ledger the difference now is that we understand these areas. The joint working has also allowed ESR Occupation Codes to be fed into the General Ledger to make the reporting of cost and WTE by staff types easier in the many returns now required by the Trusts regulators. Scott Jarvis, Director of Operational Finance. Lessons Learned The implementation of an Establishment Control process does take time, and does require a very close working between your Finance and ESR teams. It is vital that the maintenance of the establishment data in ESR is kept up-to-date with changes made in the General Ledger. If they are not, this will lead to a further reconciliation exercise being required to realign the two data sets. Further Information If you want more information about the Establishment Control project at Derby Teaching Hospitals, please contact Greg Chambers, Workforce Systems Manager 01332 258141, greg.chambers@nhs.net or Chris Broadhurst, Head of Finance Systems - 01332 789531, chris.broadhurst1@nhs.net directly. For information about ESR Establishment Control functionality and best practice please contact your NHS ESR Functional Advisor or Account Manager or access the HR Best Practice guide on Kbase. Log in and click the following link: https://www.electronicstaffrecord.nhs.uk/kbase/afile/223/6215/