Stepping into the role of Clinical Director brings with it a unique vantage point — one where clinical priorities and financial realities converge. This year, I’ve been tasked with helping deliver quite a significant savings target within my directorate. It’s a formidable challenge, but also an opportunity to rethink how we deliver care, manage resources, and lead change.
Understanding CPIPs: More Than Just Numbers
The Cost and Productivity Improvement Programme (CPIP) isn’t just a financial exercise. It’s a strategic framework that asks us to identify efficiencies, reduce waste, and optimise delivery — all while maintaining safety and quality. In surgery, this means looking at everything from workforce models and procurement choices to theatre utilisation and pathway redesign.
What I’ve learned is that CPIPs work best when they’re grounded in clinical insight. The most impactful schemes aren’t imposed from above — they’re built from the ground up, shaped by those who understand the nuances of service delivery.
Finding Savings Without Compromising Care
One of the most powerful examples of this has been our review of surgical prep solutions. By switching from a high-cost branded product to a clinically equivalent alternative, we identified significant annual savings. What this highlighted was that small changes can have huge impacts and I’ve already managed to find significant savings when working with procurement just by consolidating and rationalising what we use. The best thing is that it hasn’t disadvantaged my colleagues at all. In fact I don’t think any of them realised that there had been any change because they are are still using what they always used as needed to deliver the best care. Just going through this exercise has saved just under 10% of what the savings target is.
Similarly, we’ve begun to scrutinise our use of temporary staffing. Bank and agency spend, particularly in middle-grade rotas, represents a significant cost pressure. By reviewing job plans, improving recruitment, and exploring flexible working arrangements, we’re aiming to reduce reliance on premium staffing models. Some of what I am looking at is how to optimise rostering by changing how we evaluate the job plans and rotas, not necessarily changing them. The aim is to minimise the disruption in work patterns for permanent and fixed term rotational staff. Other elements are to looking how the service needs to develop and what activity is needed to fulfil the needs of our community. Thus far I’ve managed to do a fair bit without too much disruption.
The Role of Data and Dialogue
Financial recovery isn’t just about spreadsheets — it’s about storytelling. In our recent deep dives, we’ve used tariff modelling to show the income potential of different surgical lists. By stratifying case mix and projecting delivery trajectories, we’ve built a narrative that links clinical activity to financial outcomes
This kind of data-driven dialogue has helped us engage stakeholders, secure support, and align our plans with broader trust priorities. It’s also helped us identify where operational barriers — like pre-op bottlenecks or scheduling constraints — are limiting our ability to deliver.
Leading with Transparency and Trust
Perhaps the biggest lesson has been the importance of transparency. As Clinical Director, I’ve had to navigate difficult conversations — about job planning, resource allocation, and service redesign. But by being open about the challenges and clear about the rationale, I’ve found that teams are more willing to engage, adapt, and innovate.
We’ve also made space for feedback, recognising that no plan is perfect and that frontline insight is essential. Whether it’s a consultant raising concerns about tax implications of LLPs or a matron flagging staffing gaps, these voices shape our approach and strengthen our solutions
Looking Ahead: From Savings to Sustainability
Delivering what I’m expected to in savings is a steep climb, but it’s not the summit. The real goal is to build a surgical service that’s financially sustainable, clinically excellent, and operationally resilient. That means embedding CPIP thinking into everyday practice — not just as a response to pressure, but as a culture of continuous improvement.
As we move forward, I’m committed to leading with purpose, listening with intent, and learning from every step. Because in the end, financial stewardship isn’t just about balancing budgets — it’s about enabling better care for every patient we serve.