NHSScotland Shared Services Health Facilities Scotland Conference Crieff Hydro 5 th November 2015 Once for Scotland

Drivers of change Once for Scotland New models of care Increasing Demand Rising Expectations Technology & Innovation Service Sustainability Quality & Safety Health & Social Care integration The Big Conversation: Beyond 2020 Resource constraints: Financial and Workforce Health & Social Care integration The Big Conversation: Beyond 2020 Resource constraints: Financial and Workforce

The journey to date Autumn 2014: Guiding Coalition identified Shared Services as a key enabler of quality, safe and financially sustainable clinical services January 2015: NSS tasked by Chief Executives with establishing a portfolio approach to drive Shared Services forward February 2015: Approach and governance arrangements proposed March 2015: Position statements on each programme established, facilitated discussions to explore progress to date March 2015: Initial phase of work commissioned June 2015: Presented findings of initial work to Chief Executives – Directive given in support of Shared Services, communications published July 2015: NHSS Shared Services Portfolio Board held first meeting August 2015: Governance meeting –programme governance agreed September 2015: Chief Executives committed to release resources October 2015: Design Authority held first meeting

Services in Scope Business Intelligence Finance HR Laboratories ProcurementeHealth Fleet & Logistics Public Health Pharmacy Radiology Medical Physics Hard FM Soft FM Capital Planning Sterile Services

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 Pharmacy Business Int Finance Labs Radiology LeadingLagging There is ambition to do more in all areas

Fully ArticulatedNot Articulated Extent to which future delivery model has been defined Public Health 1 eHealth 1 Procuremen t 1 Soft FM HR 1 Hard FM Fleet Mgmt 1 Pharmacy 1 Business Int 1 Finance 1 Labs 1 Radiology 1 Work needed to define “art of the possible”

Quote source descriptor: This is dummy text ​ Key themes from feedback: More direction is needed from the leadership of NHSScotland and from the Scottish Government. Shared Services must be driven from the top by Chief Executives. Any changes must be future-proof to make the most of the hard work involved in driving improvements Significant communications and engagement effort is needed to ensure that managers take a positive view of shared services and don’t just look for reasons not to proceed Strong leadership is essential for success

A NEW NARRATIVE A bold vision… 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 support 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

Increased efficiencyIncreased effectiveness Leading practice processes Economies of scale Service standardisation Flexibility & scalability Increased automation, enabling maximum value-adding output from people Enhanced customer service Optimise value from technology investment Drive consistent process quality standards More effective use of workforce Consistent and effective application of internal controls Longer-term sustainability Improved resilience Sharing scarce specialist resources across boundaries Sharing enabling technology investment costs and developing a consistent platform Meet increasing demand with reducing financial resources Quality improvement & innovation (using continuous improvement) Allowing boards to focus on core health outcomes Better and wider talent management and development opportunities A NEW NARRATIVE Genuine ambition….

A NEW NARRATIVE and an explicit set of financial objectives Driving financial sustainability and best value Deliver reductions in operating expenditure through sharing which are greater than CRES targets Return on investment within 5 years Deliver ongoing efficiency and productivity improvements over the longer term Most programmes are currently silent on the financial implications of their proposals There is a reluctance to commit to delivering savings within business cases Shared services must deliver more than just cost savings BUT when the sustainability of frontline services are in doubt »Support functions must be challenged to deliver more for less

REFRESHED GOVERNANCE Clarity of purpose and effective decisions

Supporting Delivery Governance Enabling Environment The role of the portfolio Tackling barriers to change: a workforce transition plan, developed in partnership, to define workforce issues arising from Shared Services will be addressed. The financial rules which will govern how the cost of change will be financed and how benefits are measured, realised and shared across NHSScotland. a portfolio wide strategy for IT investment required to support any shared services initiatives going forward.

Leadership, Communication & Engagement Leadership Role of Portfolio Board as advocates and ambassadors Health & Social Care Management Board and Chief Executives Engagement Customer Reference Group Working in Partnership : Staff-side engagement Design Authority – engagement with existing governance fora Communications Strategy and approach Effective channels

Any questions?

BUSINESS SUPPORT Defining next steps ProgrammeKey FindingsRecommendations FinanceLong standing programme with good models for engagement Delivered circa £50m since 2005 Lacks ambition -focus on consensual continuous improvement Develop New Narrative for Integrated Business Services Re-align governance, ensuring supporting IT governance is aligned Develop SOC for Integrated Business Services, incorporating other business services activities where appropriate Consider role of e-Health and Business Intelligence as providers of shared services as part of Integrated Business Services Model Consider how e-Health and Business Intelligence services will enable wider Integrated Business Services delivery. HRProposals for Medical Trainees and Recruitment to be progressed More ambitious vision required for HR services as a whole which embraces cross functional working Need to re-establish governance, programme resources. e-HealthAlready being delivered nationally, and pan public sector model emerging. Both an enabler and a provider of shared services. Business Intelligence Emerging programme. Both an enabler and a provider of shared services.

OPERATIONAL SUPPORT Defining next steps ProgrammeKey FindingsRecommendations ProcurementNational Procurement shared service well established. Procurement review identified targeted changes to existing arrangements Opportunities to widen scope should be explored. Develop business case to develop optimal delivery model for procurement to support NHS Scotland Consider how transactional aspects of procurement should align and interact with an Integrated Business Services model. Hard FM: Capital Planning Sterile Services, Fleet Management and Logistics More challenging ambition and vision required. In particular, the benefits of cross boundary working need to be explored Governance arrangements require rationalisation. Consider how best practices from mature work streams are embedded in future models. Logistics SOC to be developed which will be a key enabler to support an ambitious vision for the delivery of operational services for NHS Scotland. Thereafter Business Cases for individual operational services will define appropriate delivery models for each component service. Soft FM: Laundry, Catering, Portering, Retail Services

HEALTH SUPPORT Defining next steps ProgrammeKey FindingsRecommendations Aseptic PharmacyEmerging programme Challenges relating to resilience and capital investment Develop an SOC to define future operating model to improve resilience, efficiency and effectiveness of services. Diagnostic Services: Laboratories, Radiology and Medical Physics Emerging Programme Considerable appetite for ambitious review to reduce un-necessary variation and ensure equity of access. Develop an SOC to define future operating model to improve resilience, efficiency and effectiveness of services. Public HealthEmerging programme Subject to Public Health Review Programme of work to be established to deliver findings of review with Shared Services impact.