CRN East Midlands Budget allocation approach 2021/22
2020/21 has been, and remains, a challenging year for the CRN and Partner Organisations. The Covid-19 pandemic has impacted upon both our delivery of business as usual, and our priorities. Urgent Public Health and Covid-19 vaccine studies have become the highest priority for the NIHR, with the usual performance metrics not having the current focus. The CRN was mindful that setting the Partners Delivery budget for 2021/22 would be different.
It is important not to disadvantage any partner because of the pandemic situation, but equally time needs to be used efficiently and not wasted by redesigning the whole funding approach and model. This matter was discussed at the Partnership Group on the 23rd June 2020, where it was acknowledged that, despite the uncertainty around the national, and thus regional budget expectations, it would be important to have stability going into next year as early as possible.
It was agreed by the Partnership Group to convene a small working group, to:
○ Consider options and suggest approaches
○ Options appraisal of potential models
○ Bring back to the next Partnership Group for discussion and agreement
Through the Partnership Group, representatives stepped forward to become members of that small budget planning group. During the first few meetings it was recognised that an approach was needed to allow equal representation from partner organisations. To aid this, it was decided to survey all Partner A organisations, seeking views in relation to the regional budget planning for 2021/22. This is an approach that had been used successfully by the West Midlands CRN.
An email was sent out to all Category A Partner Organisations on 23 September 2020, with a deadline of 6 October 2020, further extended for a week in order to increase the response rate. The questionnaire was sent to Medical Directors, R&D Directors and R&D Managers.
Summary of PO Budget Questionnaire Responses
We received responses from 15 out of our 19 Category A Partner Organisations:
Chesterfield Royal Hospital NHS Foundation Trust
Derbyshire Healthcare NHS Foundation Trust
Kettering General Hospital NHS Foundation Trust
Leicestershire Partnership NHS Trust
Lincolnshire Community Health Services NHS Trust
Lincolnshire Partnership NHS Foundation Trust
Northampton General Hospital NHS Trust
Nottingham University Hospitals NHS Trust
Nottinghamshire Healthcare NHS Foundation Trust
Sherwood Forest Hospitals NHS Foundation Trust
United Lincolnshire Hospitals NHS Trust
University Hospitals of Derby and Burton NHS Foundation Trust
University Hospitals of Leicester NHS Trust
Albany House Medical Centre
Lakeside Healthcare Group
Should the budget model we follow for next year include any type of centrally managed element(s) at the start of the year for in-year distribution?
- 79% of respondents said that they would support Vaccines/Urgent Public Health targeted distribution in-year, with 21% disagreeing
- 43% of respondents said that they would support Strategic fund/green shoots type scheme, with 57% disagreeing
Are there any other types of centrally managed element(s) that should be included in the model? Comments received:
- Yes, backfill to cover local governance process and set-up of studies needed for UPH and non-UPH when staff have been redeployed elsewhere.
- The funding needs to support activity. In this time of pandemic, the greatest workload is being shouldered by the acute Trusts.
- Funding should be allocated to, and managed by, those Partner Organisations where the demand is greatest – those who are making outstanding efforts to support UPH studies and now are stretching their limited resources to re-start non-UPH studies, antibody-testing studies such as SIREN and support the opening of vaccine trials. As things stand at present, it is highly likely that, with rising numbers of patients with Covid 19 infection being admitted to acute Trusts, the majority of demand for resource will be there. The complexity of this activity including the added physical & psychological demands on the staff of working in this environment needs to be taken into account when allocating funding for the next financial year. Indeed, given the increase in Covid-19 cases now, at the start of the winter season, I would also suggest that additional resource for those Trusts in 2020-21 should be explored.
- So far as is possible, centrally managed elements should be only for those functions that are best delivered centrally. The RST is a prime example of a great concept but needs to have greater depth including the potential for the development of the next generation of PIs by allowing for secondments into the RST as a development opportunity, where specific research demands specific skills. In some areas, the "plug-in" model of RST deployment cannot be wholly effective without a firm grounding in the clinical area. In this way, the RST model becomes not just a delivery enhancement, but a vehicle for enhancing the infrastructure in POs as these staff return to their substantive roles. In my personal view, centrally managed elements tend to favour an accretion of resources in those organisations that have the time and capacity to make effective bids.
- Small contingency budget for emergencies and opportunities that arise in year. Any strategic green shoots funding should only be available to organisations below a minimum infrastructure threshold. Other organisations with higher income thresholds should be encouraged to look at cost improvement that enables them to re-invest into new areas rather than receive additional funding. Clear central statement that experienced Research Workforce should focus on UPH/Vaccine trials across organisational boundaries rather than be redeployed into clinical roles.
Moving to the main budget modelling, we highlighted a number of options, which might be adopted, and requested an indication of preference.
Use the current budget model in the same way as this year: activity driven (using 2019/20 data), performance premium for time to target and set up times, with cap and collar to manage fluctuations: 15.4%.
Make slight amendments to the current budget model (as outlined in a. above), to introduce a performance element to recognise increased in-year activity (2019/20, in comparison to 2018/19): 30.8%.
To allocate partner budgets (Primary care as a whole is considered as a single partner for budget purposes) using a flat budget pass-through model (with/without strategic fund, depending on above consensus) in line with 2020/21 (-/+ any central uplift/reduction) applied across all budget elements: 53.8%.
The surveys collected further comments and suggestions (not reported here), which were also considered in developing the budget proposal.
Proposal for partner budget
The data from the questionnaire has been considered by the budget planning group and we are bringing this proposal, based on the partner feedback, for the 2021/22 PO Delivery budget for discussion and to seek approval.
We would like to propose, in line with the majority PO preference:
To allocate partner budgets (Primary care as a whole is considered as a single partner for budget purposes) using a flat budget pass-through model in line with 2020/21. If the overall regional budget is increased or decreased, that variance will be applied equally for each partner on a consistent percentage basis.
With regard to the Strategic Fund, in line with majority PO consensus, the budget model will not include a Strategic Fund for 2021/22.
There will be included a centrally managed element which is to be focussed on supporting the delivery of the highest priority studies, currently those defined as Urgent Public Health (UPH), including Covid-19 Vaccine studies. The restarting of the NIHR portfolio will also be considered in the allocation approach. This will be described as the High Priority fund.
As we are planning a pass-through flat budget, this fund will be comprised of the 2020/21 Strategic Funding allocation (£420,000), along with any savings which can be made within the central budget. It is anticipated that savings will be made due to the loss of some central posts in 2020/21 which have not been replaced, some forecast reductions to the Service Support Costs required for Primary Care (due to portfolio changes), along with savings associated with reduced travel expenses and face to face events. This element of the budget is currently being planned.
In order to ensure maximum opportunity to impact, we intend to distribute around 60-70% of the total High Priority fund at the beginning of the year, with the remaining fund allocated later in the year.
During this work, a clear steer was provided that a bidding/application style approach is discouraged, not least due to the amount of time spent by all on this activity. We suggest that this fund could be allocated based on a number of factors:
- The pipeline of UPH studies (incl. Covid-19 Vaccine studies, although noting associated commercial income) planned within the PO
- Past activity delivered through UPH studies
- Consideration of the cases of Covid-19 per 100,000 population
- Particular local need around restart
- Other factors to be considered
The above budget proposal was approved following further review and consideration by partner organisations at the Partnership Group meeting on 11 November 2020 and Finance Engagement event on 8 December 2020.