Case Studies

Turning around the NHS's second largest deficit

Added 17/12/2007


Sustain’s private sector expertise played a critical role in helping a primary care trust (PCT) with an annual budget of £1bn to overcome the second largest deficit in the NHS and achieve financial balance.
The PCT had been formed by amalgamating five organisation, but pre-planning for the merger had been limited. As a result, an interim chief executive and chair were the only senior posts which had been filled by the time Sustain was drafted in.
As well as resolving issues within the organisation, Sustain was tasked with satisfying national requirements by developing a formal turnaround plan and process and deliver weekly reporting within the organisation and through to the DoH national programme office.

Key challenges
For six months, the organisation was operating in the absence of large swathes of its management structures – and their associated key skills. To overcome this, Sustain used a variety of tested management techniques to engage with those involved and drive progress.
Constant staff changes brought with it additional pressures. A finance team was gradually put in place and uncovered historic issues which further impacted on the deficit, while projects had to be regularly reviewed as new individuals came into post. Coupled with this came a change at the top, with the interim chief executive replaced after just four months. At this stage, two critical director posts also remained unfilled.

Main actions

Our priority was to produce a robust turnaround plan which would help the PCT achieve a firm financial basis from which to build for the future. To keep the plan firmly on track, we liaised closely with workstream directors and managed regular communication with the regional turnaround director.
Senior finance staff were seconded to the project office to make sure all plans had firm financial basis and validity, while Sustain played a key role throughout, attending workstream meetings and holding weekly executive meetings to maintain focus and continue to drive progress.
Working as a team, we helped the PCT’s directors to develop their commercial awareness whilst equipping them with the necessary skills to manage a £1bn operation.

Outcomes and achievements
Sustain’s valuable input helped up-skill the PCT’s staff while also returning the organisation to financial balance within just 12 months, placing it on a sound financial footing to face future challenges.
Our approach we adopted was widely recognised by the Department of Health, while the programme also achieved respect from local GPs.
The project management tools and methods introduced by Sustain were embedded into the PCT, giving it an increased awareness of the steps required to run a large organisation within a set budget, in turn ensuring its long-term sustainability.

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