Setting the Scene Brian Montgomery Health Portfolio Director

14 Territorial Boards 7 Special Boards 32 Local Authorities 31 Integration Joint Boards 1 Nation 5.25 million People Scotland in Numbers

Shared Services Drivers of Change Resource constraints: Financial and Workforce Health & Social Care integration The Big Conversation: Beyond 2020

National Clinical Strategy Quality Strategy Shared Services 7 Day Services 20:20 Vision Shared Services Strategy and Policy Context

Shared Services Realising the Potential Once for Scotland? Best for Scotland? Scotland?

To secure buy-in and support participation and engagement at Board level To support the development of an ambitious future vision for Shared Services which explores the potential to develop national, integrated solutions Ambitious solutions should be developed as part of an options appraisal against agreed guiding principles and presented in a business case which demonstrates both the costs and benefits of each option All existing programmes will migrate to the new governance structure, reconfiguring existing governance and reporting arrangements To make resources available to support the work of the portfolio going forward Executive Leadership Support Chief Executives have agreed

Refreshed Governance Clarity of purpose and effective decisions

Shared Services - Services in Scope

Shared Services Portfolio Board Design Authority Business Portfolio Operational Portfolio Health Portfolio Customer Reference Group Medical Physics Radiology Pharmacy Aseptic Dispensing Laboratories Public Health Portfolio Director Subject Matter Expert Programme Manager Project Manager Project Support Officer Radiology Programme Governance for Radiology Programme

Shared Services Expectations Realistic medicine Enhanced quality Reduced inequity Sustainability Reduced variation Improved efficiency Cost avoidance Savings

Value for Money Health of the Population Experience of the Individual Shared Services The IHI Triple Aim

SAVINGS QUALITY (EQUITY) SUSTAINABILITY Shared Services The Triple Tension

Creating the right environment for Shared Services Challenges unwarranted variation in clinical practice o intrinsic o extrinsic service planning and delivery performance management financial strategy workforce strategy “Winners and Losers”

Variation Clinical practice Demand o Demand optimisation Technology Inequity Atlas of Variation Creating the right environment for Shared Services

The primary focus for planning and service delivery is at Board level Boards are held to account for the achievement of local service delivery targets A national or regional approach tends to be focussed on small highly-specialised services – often where services are no longer sustainable locally. The relationship between the Scottish Government and Boards needs to change to drive the development of shared services in a proactive rather than reactive way The performance framework needs to incentivise a “Once for Scotland” approach? National Regional Multi-Board BOARD Hospital Community Patient Planning and Performance Framework

Requirements Consistency Coordination Collaboration Quality Assurance Infrastructure Logistics Information Technology / e-Health Distributed services Creating the right environment for Shared Services

Requirements Engagement Permission Mandate Ambition Creating the right environment for Shared Services

Where are you Where does your programme go Where should you be 2 3 Public Health eHealth Procurement Soft FM HR Hard FM Fleet Mgmt Pharmacy Business Int Finance Labs Radiology LeadingLagging There is ambition to do more in all areas

Where are you Where does your programme go Where should you be 2 3 Public Health 1 eHealth 1 Procurement 1 Soft FM HR 1 Hard FM Fleet Mgmt 1 Pharmacy 1 Business Int 1 Finance 1 Labs 1 Radiology 1 LeadingLagging There is ambition to do more in all areas

Where are you Where does your programme go Where should you be 2 3 Public Health 31 eHealth 3 1 Procurement 3 1 Soft FM 3 HR 3 1 Hard FM 3 Fleet Mgmt 3 1 Pharmacy 3 1 Business Int 3 1 Finance 3 1 Labs 3 1 Radiology 3 1 LeadingLagging There is ambition to do more in all areas

Where are you Where does your programme go Where should you be 2 3 Public Health 31 2 eHealth Procurement Soft FM 3 2 HR Hard FM 3 2 Fleet Mgmt 312 Pharmacy Business Int Finance Labs Radiology LeadingLagging There is ambition to do more in all areas

Where are you Where does your programme go Where should you be 2 3 Public Health eHealth Procurement Soft FM HR Hard FM Fleet Mgmt Pharmacy Business Int Finance Labs Radiology LeadingLagging There is ambition to do more in all areas

Shared Services will be managed Once for Scotland and delivered in a consistent way where it is appropriate to do so. NHSScotland’s Shared Services will: transform the way services are delivered by integrating services and working across boundaries; support Scotland’s health with a sustainable, consistent and effective service which meets customer’s requirements; be fully accountable to their customers for the quality and effectiveness of their services; exploit economies of scale to increase efficiency, reduce costs and maximise returns from continuous improvement; embed governance to set strategic direction, prioritise service improvements and resolve day to day issues. A New Narrative A bold vision…

Business case approach Strategic Outline Case / Initial Agreement Outline Business Case Full Business Case We are here Implementation Strategic Outline Case Radiology Programme

1 Strategic Case 2 Economic Case 3 Commercial Case 4 Financial Case 5 Management Case The strategic and economic cases are the focus for the Strategic Outline Case Clinical Effectiveness Cost Effectiveness Business case approach Strategic and Economic Cases Radiology Programme