Agenda item: 8.1, Public Board meeting · PDF file · 2016-10-201 of 23 Implementation of NHS Productivity and Efficiency (Lord Carter) recommendations 26 October 2016 Agenda item:

1 of 23 Implementation of NHS Productivity and Efficiency (Lord Carter) recommendations 26 October 2016

Agenda item:

8.1, Public Board meeting

Date: 26 October 2016

Title:

Implementation of NHS Productivity and Efficiency (Lord Carter) recommendations

Prepared by:

Gill Heathcote, Programme Director

Presented by:

Paul Southard, Acting Chief Financial Officer

Responsible Executive:

Paul Southard, Acting Chief Financial Officer

Summary:

This paper provides an outline of the work being carried out by the national NHS Productivity and Efficiency Team, how the RD&E is engaging with this work, progress against key recommendations and actions underway to inform the Trust’s savings plan.

Actions required:

The Board are asked to note the information provided.

Status (*): Decision Approval Discussion Information

x

History:

This paper is the first high level overview on the NHS Productivity and Efficiency programme for the Board of Directors. A Procurement Transformation Plan (PTP) which was a recommendation from the Lord Carter report was received by the Trust Board in September 2016.

Link to strategy/ Assurance framework:

The issues discussed are key to the Trust achieving its strategic objectives.

Monitoring Information Please specify CQC standard numbers

and tick other boxes as appropriate

Care Quality Commission Standards Outcomes

Monitor Finance

Service Development Strategy Performance Management

Local Delivery Plan Business Planning

Assurance Framework Complaints

Equality, diversity, human rights implications assessed

Other (please specify)


1. Purpose of paper

1.1 This paper updates the Board of Directors on the Trust’s progress against recommendations made by Lord Carter of Coles, in his report Operational productivity and performance in English NHS acute hospitals: Unwarranted variations 1 An independent report for the Department of Health by Lord Carter of Coles.

2. Background

2.1 In 2014 Lord Carter of Coles was commissioned by the Secretary of State for Health to carry out a review to identify what could be done to improve efficiency in hospitals. The Royal Devon & Exeter NHS Foundation Trust (RD&E) was in the second cohort of hospitals to work with the NHS Productivity and Efficiency Team at the then Department of Health, who were tasked with the review.

2.2 In late 2015 a data pack was provided to the RD&E which suggested that the Trust had a potential savings opportunity of £28m compared to the national mean. This savings figure was based on an early iteration of data analysis and the NHS Productivity and Efficiency team continue to work to refine the benchmarking information.

2.3 The report published in early 2016 made 15 recommendations, with supplementary actions, a total of 84, with 72 requiring action by the RD&E. Full details of the recommendations and actions are provided on the Board shared drive.

2.4 The NHS Productivity and Efficiency team, now based at NHS Improvement, are working on the following areas:

Model Hospital

Nursing productivity

Allied health professionals productivity

Doctor productivity and Clinical quality and efficiency

Getting it right first time

Pharmacy transformation and medicines optimisation

Estates and facilities

Procurement

Pathology

Services consolidation – Pathology and Back Office

3. Model Hospital

3.1 The aim of the model hospital is to provide a set of metrics that can be used to benchmark hospitals to identify opportunities to improve efficiency and implement good practice. An on-line portal has been created and benchmarking information is currently available on the following:

Nursing and Midwifery (1st draft of dashboard out for comment)

Estates and Facilities

Pharmacy and Medicines

1 Operational productivity and performance in English NHS acute hospitals: Unwarranted variations - An

independent report for the Department of Health by Lord Carter of Coles, February 2016


3.2 An example of the current draft Nursing and Midwifery Dashboard is included below:

3.3 Weighted activity unit (WAU) - The Model Hospital uses a measure of hospital output, a single unit, to measure the total units of activity in a trust where one unit, one WAU, represents a quantity of clinical activity equivalent to the cost of the average elective inpatient stay (£3,500).

The number of WAUs within each trust is calculated by adding together all the different types of activity weighted according to the national average cost of providing that activity. All types of activity counted in reference costs are included, for example non-elective work, outpatients and diagnostic tests as well as elective admissions.

A trust’s output in terms of WAUs can be compared to the amount spent by the trust on providing that quantity of clinical activity, to calculate the total cost per WAU. This is then used as a measure of the efficiency for each trust.

3.4 Information is starting to be published on the dashboard. The relevant lead at the RD&E will then scrutinise it and identify any lines of enquiry and potential opportunities for savings. These will then feed into the overall Trust CIP plan as appropriate.

4. Nursing productivity

4.1 The Trust has been reporting since June 2016 on a monthly basis Care Hours per Patient Day (CHPPD). This metric has been created as a single means of measuring staff deployment and is considered by NHSI to be a productivity tool to be used by Trust’s as one element of a multifaceted methodology for assessing safe staffing. The Trust is also submitting Costs per Care Hour data.

4.2 This metric is included at Trust level in the model hospital nursing and midwifery dashboard. The information available indicates that the Trust is


performing well compared to peers and national average, with the only area of note being the cost per weighted activity unit (WAU) for healthcare support workers. This is related to spend on specialling, and work is underway to address this. This includes the development of an alternative model for specialling, training for band 2 and band 3 nursing staff on mental health and dementia care and a tighter authorisation process.

It is anticipated that the dashboard will become live by the end of the financial year with data inputted up to a quarter in arrears. This will be at Trust and ward level. The dashboard will be included as part of the Trusts Nursing and Midwifery Establishment review once available.

5. Allied health professionals (AHP) productivity

5.1 The national team are testing a data collection template with five Trusts to monitor clinical time provided by AHPs. This will then be implemented for all Trusts to complete in order to create a baseline for a dashboard on the Model Hospital portal. They are also setting up working groups to explore job planning, e-rostering for AHPs, demand and workload measurement, and care hours per patient day. Once this information is available it will make it possible for the Trust to identify variation with other trusts and opportunities to make efficiencies.

6. Doctor productivity and Clinical quality and efficiency

6.1 In June the NHS Productivity and Efficiency Team hosted a conference for all Medical Directors to collaboratively agree how consultant job planning will be developed. They are working with a pilot group of 5 acute trusts’ Medical Directors to complete an updated template which will include more granular detail to help them assess consultant activity specifically around direct clinical care. They will then analyse how effective the template is and decide next steps.

The RD&E has submitted detailed job planning information to the NHS Productivity and Efficiency Team as required in August 2016. There has been no feedback on this to date.

7. Getting It Right First Time

7.1 Following the successful completion of a quality improvement pilot in orthopaedics entitled Getting It Right First Time (GIRFT) the Department of Health has commissioned a programme using similar methodology to look at a number of additional clinical areas in order to support the NHS in delivering productivity and efficiency improvements across England. Lord Carter is leading this agenda, with The National Director of Clinical Quality and Efficiency, Professor Tim Briggs, leading key components of the programme. The ambition is to identify areas of good practice to share across the NHS as well as to identify unexplained variation in clinical practice and/or divergence from good, evidence-based care.

7.2 The GIRFT methodology has two main components:

Clinical leadership of change, where national clinical leaders engage in peer-to-peer discussions with clinicians and hospital managers. The expectation is that this process will enable a clinical team to reflect on the


delivery of its services - what is good and what is poor - with a view to encouraging service-improvement.

The provision of a benchmarking data package, produced by the GIRFT team, which includes a wide range of relevant information about the clinical department and its performance. It is important to recognise that the data pack is not used to ‘performance-manage’ the unit but is expected to provide fresh insights into the way the department functions through the use of comparative data.

7.3 The GIRFT team are focusing on the following ten specialties over a three year period:

Orthopaedics extension to include Spinal

General Surgery

Vascular

Urology

Neurosurgery

Ear, Nose & Throat

Paediatric

Oral & Maxillofacial

Obstetrics & Gynaecology

Ophthalmology

Cardiothoracic

7.4 Mike Hutton, consultant spinal surgeon at the RD&E is the spinal clinical advisor for the national team, reporting to Prof Briggs.

7.5 The RD&E has just received the benchmarking data packs for General Surgery and Urology and these will be reviewed by the specialities to identify opportunities for improvement in efficiency.

7.6 It has been agreed that the Devon Clinical Cabinet, of which the Trust is a member, will review the data packs from member Trusts to facilitate peer challenge at specialty level.

8. Pharmacy transformation and medicines optimisation

8.1 The Trust needs to draft a Hospital Pharmacy Transformation Plan (HPTP) by 31st October 2016 ensuring it increases pharmacist prescribers; implements e-prescribing; delivers accurate digital coding of medicines and consolidates stock-holdings of medicines. This is so that by 2020 pharmacists and clinical pharmacy technicians spend more than 80% of their time on patient-facing medicines optimisation activities rather than supporting infrastructure roles. NHS Improvement will then provide feedback on the plan by December 2016. The Trust should then submit a final board-approved plan by the end of March 2017. A template has been provided and is being completed. The HPTP plan will set out how the trust will transform hospital pharmacy services in the coming years supported with the enabling technology.

8.2 The first edition of the Hospital Pharmacy Medicines Optimisation dashboard is already live on the portal and there are various indicators that benchmark performance against other similar providers in the Trust peer group. Some indicators are still being populated from ESR and national benchmarking data. There are some indicators that show the RD&E have been very quick to adopt new medicines and deliver savings e.g. biosimilar infliximab, or change local


practice to meet Carter guidance e.g. soluble prednisolone.

8.3 There are multiple workstreams underway locally and regionally looking at how Trusts can transform and rationalise pharmacy services. Some of the work will be linked to the STP and Success Regime. There are some indicators where the RD&E is 0% compliant mainly linked to e-prescribing and digital maturity of the organisation. There will be investment required to develop the enabling technologies, especially digital coding of medicines in order to populate a minimum data set, by June 2017, as this is directly linked to commissioner income on high cost drugs.

9. Estates and facilities

9.1 The Estates and Facilities compartment has now gone live and is lit up in green on the Model Hospital portal. This includes metrics taken from trusts’ 2014-15 Dashboard with the only amendment being the movement from adjusted treatment cost (ATC) based metrics to ones using the Weighted Activity Unit (WAU) as explained in Lord Carter’s report.

The compartment contains metrics on Efficiency, Productivity and Quality & Safety to allow users to have an overall and integrated understanding of the state of their estate and facility services. This compartment will be updated with the 2015-16 metrics when the relevant data becomes available later this year. It will also reflect changes to the data collected and the metrics in the Dashboard. Changes under consideration include the provision of site level metrics and PFI metrics.

9.2 The Trust is involved in a Sustainability and Transformation Plan (STP) Estates Working Group and this, together with STP implementation, will inform the Trust’s future estate strategy and savings proposals.

Peninsula wide a review of Estates Return Information Collection (ERIC) submissions and data collection has been completed in order that all local trusts are reporting on the same basis and can be compared. This has been implemented for the ERIC data collection exercise which concluded in July.

Plymouth are taking the lead on liaising with the Carter team regarding estates for Peninsula Trusts.

10. Procurement

10.1 A comprehensive paper on Procurement was provided to the September 2016 Board meeting.

11. Pathology – Model Hospital

11.1 A pathology data collection template has been completed for the national team at the end of September, providing detail on activity and costs. The primary uses of the completed data templates are to ensure that NHSI has an operationally relevant baseline benchmark for future initiatives and to support the draft of a business case on pathology consolidation. The data will also be analysed to start forming the benchmarks, which will be included in the trust-level Pathology compartment on the Model Hospital portal.


11.2 A pathology quality assurance dashboard with key performance metrics has been designed for trusts to use internally in the first instance.

12. Services consolidation – Pathology and Back Office

12.1 Two separate central teams are leading the pathology and back office service consolidation work, although they are liaising closely.

12.2 Services consolidation – Back office: NHS Improvement have required all STPs to consider options for consolidation and sourcing for the following back office services:

Finance

HR and Payroll

IM&T

Procurement

Estates and Facilities

Governance and Risk

Legal Services The purpose is to deliver efficiency savings, establish a platform for sustainability within individual organisations, ensure corporate and administrative costs do not exceed 7% of income by April 2018 and 6% by 2020, and consider the use of the NHS estate to maximise space for clinical services. The options to be considered are:

Hosted shared services – one organization manages services for a number of others

Jointly managed service body – back office services managed within one body governed by all participant organisations

Joint venture with private sector

Outsourced provider NHS Improvement have provided guidance on what elements of the services could be shared and what should be retained by individual organisations.

The first task for the STP was to complete benchmarking information and a case for change document which was submitted in mid-October 2016.

This will be reviewed by the Central team and feedback provided to the STP in the first week of November, and next steps agreed.

12.3 Services consolidation – Pathology:

The STP have been asked to complete a business case by the end of October 2016 on pathology consolidation.

13. NHS Productivity and Efficiency recommendations

13.1 There are a number of recommendations that have either a clear deadline in them for action, or an expected performance metric, either identified within the recommendation or whether the Trust is monitoring progress at Board level . These are collated in table 1 below with current performance identified, progress and any remedial actions being taken.


Table 1 - Trust performance against NHS Productivity and Efficiency recommendations with a deadline or performance metric:

ID Action RD&E performance RAG Green – on track

Amber – issues

Red – off track

Action being taken if amber or red

Recommendation 1 - NHS Improvement should develop a national people strategy and implementation plan by October 2016 that sets a

timetable for simplifying system structures, raising people management capacity, building greater engagement and creates an engaged and

inclusive environment for all colleagues by significantly improving leadership capability from “ward to board”, so that transformational change

can be planned more effectively, managed and sustained in all trusts.

1B Engaging with staff with regular

performance reviews ensuring that

a culture of continuous

improvement is developed

81.5% PDR’s completed in last 12

months (August 2016) in excess of

Trust target of 80%

1C Developing management practices to gain a better understanding of the reasons for high levels of staff attrition

Turnover rate - 13% Stability index - 89.5% Turnover is higher than National Acute Trusts (16/17) 10.8% And the average across the Southwest 12.7%

Turnover is reviewed monthly per staff group and, where it is higher than expected is examined at the relevant Workforce Strategy group. Exit interviews are completed for all leavers which are monitored via monthly workforce KPIs. Deep dives are completed where a rise in turnover starts to happen and actions implemented. Lessons learned are then applied across staff groups if appropriate. Turnover is affected by competition locally for shortage roles e.g. registered nurses and AHP and is expected to be higher in nursing as we employ a larger number of international nurses.



Amber – issues

Red – off track


1E

A reduction in the high rates of

bullying and harassment with a

sustained campaign led personally

by each trust Chief Executive

The RD&E reports in the top 20% best

performing trusts against the bullying

and harassment items in the staff

survey:

KF 25 ‐ Percentage of staff

experiencing harassment, bullying or

abuse from patients, relatives or the

public in last 12 months (19%)

KF 26 ‐ Percentage of staff

experiencing harassment, bullying or

abuse from staff in last 12 months

(20%)

KF 27 ‐ Percentage reporting

experience of bullying etc (43%)

Recommendation 2 - NHS Improvement should develop and implement measures for analysing staff deployment during 2016, including

metrics such as Care Hours Per Patient Day (CHPPD) and consultant job planning analysis, so that the right teams are in the right place at the

right time collaborating to deliver high quality, efficient patient care.

2F All trusts using an e-rostering

system, with the following practices

being implemented: i) An effective

95% - inpatient areas

The Rosterpro Rostering policy has



Amber – issues

Red – off track


approval process by publishing

rosters six weeks in advance

been reviewed in line with the Good

practice Guide on rostering published

by NHSI in June 16, there were no

material gaps identified

2G Trusts implementing the guide on

enhanced care (previously referred

to as ‘specialling’) by October

2016, which will be monitored by

NHS Improvement, using an

approach developed by them as an

improvement priority

Not published yet

Internally an alternative model and

authorisation process for specialling is

being proposed in addition to

educational skills uplift on mental health

and dementia care for band 2 and band

3 nursing staff. This proposal is going to

Care Matters and Joint Professions

Group in November

2J Continuing adherence to the

agency rules set out by NHS

Improvement

The number of breaches reported in the

weekly submission to NHS

Improvement remains stable at an

average of 98 per week.

Year to date at month 5 total spend on

agency £2.4m which is within the NHS

Improvement ceiling of £3.0m

Recommendation 3 - Trusts should, through a Hospital Pharmacy Transformation Programme (HPTP), develop plans by April 2017 to ensure

hospital pharmacies achieve their benchmarks such as increasing pharmacist prescribers, e-prescribing and administration, accurate cost



Amber – issues

Red – off track


coding of medicines and consolidating stockholding by April 2020, in agreement with NHS Improvement and NHS England so that their

pharmacists and clinical pharmacy technicians spend more time on patient facing medicines optimisation activities.

3B Ensuring that more than 80% of

trusts’ pharmacist resource is

utilised for direct medicines

optimisation activities, medicines

governance and safety remits while

at the same time reviewing the

provision of all local infrastructure

services, which could be delivered

collaboratively with another trust or

through a third party provider

50% of pharmacist resource is utilised

for direct medicines optimisation

activities, medicines governance and

safety remits

Locally outpatients dispensing almost

fully outsourced; some discharge

prescriptions also outsourced; homecare

fully utilised where appropriate; aseptic

products outsourced as much as

commercial providers can support as

they are at capacity. Work on-going

across the region looking at all of these

options and possibility of shared

services, but even when services are

outsourced there is still a requirement for

back office support, governance and

financial management. The 80%

expectation is not achievable with the

current definitions of clinical workforce.

3G Consolidating medicines stock-

holding and modernising the supply

chain to aggregate and rationalise

deliveries to reduce stock-holding

days from 20 to 15

Stockholding of 16 days Any further reduction in stock holding will

actually increase the frequency of orders

and delivery. The RD&E also provides

drug supplies to Devon Partnership Trust

locally and for South Devon, plus all

Eastern community hospitals and



Amber – issues

Red – off track


community nursing teams.

3G Consolidating medicines stock-holding and modernising the supply chain to aggregate and rationalise deliveries to reduce deliveries to less than 5 per day

Average deliveries per day – 16.2

With the requirement to outsource

products and provide specialist cancer

drugs every day it is not possible to

reduce deliveries to 5 or less. 4

wholesalers currently deliver twice each

day and cold supply chain (a series of

storage and distribution activities which

maintain a given temperature range),

controlled drugs, bulk IV fluids and

contrast media are delivered separately.

Outsourced chemotherapy is provided by

another delivery. There are no

wholesalers or companies that stock the

range of products required by a Trust of

this size and suppliers, not Trusts,

control how they will deliver their drugs.

The frequency of delivery that is required

to maintain stock at 15 days has already

been reviewed, reduced and

consolidated.

3G Consolidating medicines stock-holding and modernising the supply chain - ensuring 90% of orders are

E-orders are placed where supported

by the supplier, this is currently 53.2%.

Where suppliers support e-orders they

are placed, but many orders are still

transmitted by fax, phone and email.



Amber – issues

Red – off track


sent and processed electronically Regionally work is underway to move

suppliers to e-ordering.

3G Consolidating medicines stock-holding and modernising the supply chain - ensuring 90% of invoices are sent and processed electronically

E-invoicing – 0%

Currently all orders are processed via the

Agresso financial management system

and then matched to the pharmacy stock

control system. The Trust’s IT systems

do not support e-invoicing and so

significant investment in new IT systems

would be required to address this.

Work is underway to streamline current

invoicing processes to ensure as efficient

as possible.

Recommendation 4 - Trusts should ensure their pathology and imaging departments achieve their benchmarks as agreed with NHS

Improvement by April 2017, so that there is a consistent approach to the quality and cost of diagnostic services across the NHS. If benchmarks

for pathology are unlikely to be achieved, trusts should have agreed plans for consolidation with, or outsourcing to, other providers by January

2017.

4A Trusts introducing the Pathology

Quality Assurance Dashboard

(PQAD) by July 2016 to assure

themselves and others that the

pathology service provided to them

is and remains of appropriate

quality and safety, with NHS

Guidance for Trusts to create their own

Pathology Quality Assurance

Dashboard has been disseminated in

September 2016.

The Trust is adapting the

recommended PQAD for use as



Amber – issues

Red – off track


Improvement hosting the

dashboard

suggested by the guidance to ensure

local usefulness.

4B HSCIC publishing a definitive list of

NHS pathology tests and how they

should be counted by October

2016, with NHS Improvement

requiring trusts to adopt the

definitions from April 2017

Not published yet

4C NHS Improvement publishing

guidance notes for forming

collaborative joint ventures and

specifying managed equipment

service contracts for local

adaptation by October 2016

Not published yet

4D NHS Improvement introducing metrics that describe relative imaging departmental productivity related to the use of equipment and workforce activity by December 2016.

Not published yet

Recommendation 5 - All trusts should report their procurement information monthly to NHS Improvement to create an NHS Purchasing Price

Index commencing April 2016, collaborate with other trusts and NHS Supply Chain with immediate effect, and commit to the Department of

Health’s NHS Procurement Transformation Programme (PTP), so that there is an increase in transparency and a reduction of at least 10% in



Amber – issues

Red – off track


non-pay costs is delivered across the NHS by April 2018.

5B NHS Improvement providing a national spend analysis and benchmarking solution from high quality trust spend data to be fully operational by April 2017. This will include a purchasing price index starting with an initial basket of 100 products with immediate effect. NHS Improvement will hold trusts boards to account in performance against the index from October 2016

Trusts advised of the first 12 products

in September - NHS Supply Chain will

procure the best price nationally by

December, for implementation by

March 17

5D Trusts focusing on the

measurement of key procurement

metrics and being responsible for

driving compliance to the following

targets by September 2017: 80%

addressable spend transaction

volume on catalogue, 90%

addressable spend transaction

volume with a purchase order

Catalogue and purchase order - 95%

5D Trusts focusing on the

measurement of key procurement

metrics and being responsible for

Contracting -

85% - procurement spend only

More work needs to be completed in

these areas to establish the level of

contracting which could be established to



Amber – issues

Red – off track


driving compliance to the following

targets by September 2017 - 90%

addressable spend by value under

contract

c76%2 - procurement and other areas

of spend e.g. pre-approved invoices,

estates

achieve over 90% within a year.

5F Trusts embracing the adoption and

promotion of the NHS Standards of

Procurement with the support of

the new Skills Development

Networks, with those that have

already achieved Level 1 achieving

Level 2 of the standards by

October 2018; and those trusts that

are yet to attain Level 1 achieving

that level by October 2017. All

trusts to produce a self-

improvement plan to meet their

target standard by March 2017

Level 1 achieved as an average, but

not for all areas (self assessment)

Further work needs to be undertaken

before peer assessment.

Recommendation 6 - All trusts estates and facilities departments should operate at or above the benchmarks for the operational

management of their estates and facilities functions by April 2017 (as set by NHS Improvement by April 2016); with all trusts (where

appropriate) having a plan to operate with a maximum of 35% of nonclinical floor space and 2.5% of unoccupied or under-used space by April

2017 and delivering this benchmark by April 2020, so that estates and facilities resources are used in a cost effective manner.

2 To be confirmed by 26/10/16



Amber – issues

Red – off track


6A Ensuring every trust has a strategic estates and facilities plan in place, including in the short term, a cost reduction plan for 2016-17 based on the benchmarks, and in the longer term (by April 2017), a plan for investment and reconfiguration where appropriate for their whole estate, taking into account the trust’s future service requirements

Tender process underway for survey

and audit of the estate to provide base

data for estates strategy.

Following submission of ERIC return

the Model hospital dashboard for

estates and facilities is being updated

mid October and will then be reviewed,

to inform further cost reduction plans.

6C Health and Social Care

Information Centre (HSCIC) and

trusts should ensure better data

accuracy by improving the

governance and assurance of the

ERIC data in time for the 2015-16

returns due in July 2016 with trust

Finance Directors ensuring the

financial ledger and ERIC reported

costs are aligned by July 2016

The RD&E has worked with Trusts

across the South West to improve

accuracy of ERIC returns through

workshops resulting in changes in the

questions/criteria provided by the

HSCIC. In addition a representative

from the South West ERIC workshop is

presenting at the DOH/HSCIC national

workshop produce relevant and viable

data submissions for 2017/2018

6D Ensuring estates and facilities

costs are embedded into trusts’

patient costing and service line

reporting systems, which will be

monitored by NHS Improvement

Complete



Amber – issues

Red – off track


Recommendation 7 - All trusts corporate and administration functions should rationalise to ensure their costs do not exceed 7% of their

income by April 2018 and 6% of their income by 2020 (or have plans in place for shared service consolidation with, or outsourcing to, other

providers by January 2017), so that resources are used in a cost effective manner.

7A Testing their existing services against shared service solutions and where comparison highlights savings of 5% or more, these savings should be delivered

This is being picked up in the work

around corporate and admin services

7B Trusts submitting a plan to NHS

Improvement by October 2016 if

their corporate/ administration

workforce costs are above 7% of

their income for the financial year

2015/16, including comparing their

functions and services against a

national set of benchmarks that

NHS Improvement are developing

for July 2016 for the key functions

of HR, Finance, IM&T, and

Procurement with plans to commit

to national shared service models.

Internal analysis of corporate and

administration workforce costs has

been completed. This identifies a gap of

c£7m between current levels and the

7% Carter target. Corporate

benchmarking is currently being

completed through NHS Benchmarking

and this will be used to inform an action

plan to begin closing the gap. To the

Trust’s knowledge the national set of

benchmarks referred to by Carter have

not yet been released for any of the

functions listed above.

A review of business cases that the

Trust wishes to implement that will

impact on administrative staff across

the Trust, mainly E-notes and a new

The STP is prioritising work on the Back

Office review requirements.

Benchmarking information, a case for

change and a high level delivery plan

have been submitted to NHSI.



Amber – issues

Red – off track


PAS system, has indicated that the gap

will reduced down to c£4m.

Past NHS Benchmarking and

comparison to outsourced services has

indicated for the main corporate areas

listed above that the Trust is

competitive. A reason the Trust

appears high compared to this indicator

is that outsourced services are not

included in the calculation; this cost

appears as part of the non-pay

indicator, even though it may cost more

than delivering the service in house.

Recommendation 8 - NHS Improvement and NHS England should establish joint clinical governance by April 2016 to set standards of best

practice for all specialties, which will analyse and produce assessments of clinical variation, so that unwarranted variation is reduced, quality

outcomes improve, the performance of specialist medical teams is assessed according to how well they meet the needs of patients and

efficiency and productivity increase along the entire care pathway.

8D NHS Improvement establishing national registries for all clinical and medical specialties where one does not presently exist by October 2016

Not published yet

8E NHS Improvement bringing all existing clinical registries and data

Not published yet



Amber – issues

Red – off track


source feeds into its new structure in order to establish National and Local dashboards for each clinical specialty, to enable real time assessment of clinical performance, to identify and drive the required changes by July 2016

8G Trust boards being made

accountable and mandated to

review the dashboards for three

clinical or medical specialties each

month, to benchmark themselves

against the established metrics and

best practice, and routinely track

progress by October 2016

Not published yet

Recommendation 12 - NHS Improvement should develop the Model Hospital and the underlying metrics, to identify what good looks like, so

that there is one source of data, benchmarks and good practice.

12E Trust boards ensuring that the Electronic Staff Record (ESR) is reconciled to the financial ledger on a weekly basis, with a minimum reconciliation of 95% from October 2016

The data from ESR is loaded to the

Agresso General Ledger on a monthly

basis.

The payroll data is reconciled on a

monthly basis to the ESR system, using

the Summary report provided by

Payroll, and ensuring that this

Further guidance is required to inform the

calculation, as it is not clear what the

target relates to specifically.



Amber – issues

Red – off track


reconciles to the various ledger

balances.

Recommendation 14 - All acute trusts should make preparations to implement the recommendations of this report by the dates indicated, so

that productivity and efficiency improvement plans for each year until 2020/21 can be expeditiously achieved.

14E Medical directors ensuring that

each consultant has an up to date

accurate job plan

As at 29th September 2016 Trust

Performance is as follows:

• 45% of job plans complete

• 43% of job plans are in the

process of being revised and

agreed

• 12% of job plans are overdue for

review and revision (Consultants

are working to previously agreed

job plans in the interim)

Current performance has dipped below

the usual positive position, however this

is due to some transient operational

changes / challenges within two

divisions.

Performance as at Month 12 in 2015/16

Changes in Medical Leadership, both

temporary and permanent, have

impacted upon current compliance and

plans are now place to ensure the

position is improved and maintained.

A session between the Associate

Medical Directors and the Medical

Director is scheduled in October to agree

a common strategy across the divisions,

to reduce variability.

The Medical Director chairs a quarterly

Job Planning Group at which job

planning status is monitored on an on-

going basis.



Amber – issues

Red – off track


is below:

• 75% of job plans complete

• 19% of job plans in the process of

being revised and agreed

• 6% of job plans overdue for review

and revision (Consultants working

to previously agreed job plans in

the interim)

14I HR directors introducing the nine

management practices that

strengthen organisational

resilience, effectiveness and

productivity

Work is underway on all nine of the

management practice plans


14. Governance

14.1 The governance of the work to support the delivery of the NHS Productivity and

Efficiency recommendations is as follows:

Each workstream and recommendation has an Executive sponsor and an

operational lead. They are coordinating the work through existing structures

and reporting to the Hospital Operations Board and then the Executive

Operations Group as part of the Strategic Deployment Matrix.

15. CIP

15.1 The Model Hospital portal is only partially operational at present and where it is

active not at a sufficient level of granularity to enable effective benchmarking.

This makes it more difficult to identify savings opportunities at this point,

although it is expected in time that the Model Hospital will be very useful.

15.2 Where recommendations have pointed to opportunities for savings these are

being activity explored or implemented, such as agency or procurement spend.

It is likely that elements of the 17/18 CIP plan will incorporate savings schemes

generated from the NHS Productivity and Efficiency work.

16. Proposals

16.1 The Board are asked to note progress against the NHS Productivity and

Improvement recommendations.

Documents

Agenda item: 8.1, Public Board meeting · PDF file · 2016-10-201 of 23 Implementation of NHS Productivity and Efficiency (Lord Carter) recommendations 26 October 2016 Agenda item: