Rosier Bailey

Name: St George's University Hospitals NHS Foundation Trust


Scale: Cost base c£800m, 9000 staff

Reach: South London

St George’s is an acute service provider to a population of 1.3m in South London with specialist provision to some 3.5m across the South East. It is one of the country’s principal teaching hospitals.


Support the turnaround engagement of KPMG by Monitor. Specifically to provide a robust forecast for the current year due to identified limitations in the existing budget and significant issues with actual performance.



Working closely with two of the four Clinical Divisions:


CWDT – Children’s, Women’s, Diagnostics, Therapies and Critical Care. The division includes specialist paediatric services, medicine and neonatal intensive care, all complex obstetric and gynaecological services, and seven ITU facilities. Diagnostics services encompasses all forms of radiology and imaging, UK leading breast imaging, and clinical genetics including leading research projects. Therapies covers all aspects of inpatient, outpatient and home therapies. The division also operates all the Outpatients clinics and performs pharmacy operations for the whole of the main hospital site.


Community Services Division (CSD). This division incorporates all local treatment on behalf of CCGs and local authorities. Includes schools, health centres, in home therapies, local outpatients, community adult health, offender healthcare and community sexual health.


  • Design of templates to reference both recent actual performance and budget, but force a detailed bottom-up forecast encompassing all areas through income to pay and non pay costs. This process identified significant issues with cost centre alignment between budget, ongoing reporting and the on-the-ground reality. Detailed work undertaken in conjunction with General Managers (GM’s) and supporting staff to ensure the reality was correctly incorporated into the forecasts.
  • Process put in place to realign reporting.
  • High level of buy-in achieved with all levels in the divisions aided by the desire to understand and correct the existing issues.
  • Incorporation and alignment of CIPs and business cases to provide a full picture of expected performance.
  • Detailed data consolidated and further reviewed with GMs and staff. Worked closely with the Divisional Directors of Operations and Divisional Clinical Directors to ensure overview, balance and directional validation.
  • Providing significant challenge throughout the process of both existing and forecast activities.


Forecast presented to Board and onwards to Monitor.

Roll-forward with further validation and incorporation of business cases undertaken to form the forecast for the following year.

Monitoring the initial two months of the forecast against the actual results and incorporating learnings into the forecast for the following year.


Guidance of trust staff and focus on key drivers through the process with a high level of active participation.