Efficiency Challenges in the NHS - Emap.com...challenging target for NHS organisations. It's that much more challenging when you consider the importance of protecting front-line health

Efficiency Challenges in the NHSHealthcare Sector Survey 2015

Survey Partner:

Contents

The Survey 2

Survey Methodology and Respondents Profile 3

Key Findings 4

Conclusion 10

Efficiency Challenges in the NHS 2015

The Survey NHS England’s Five Year Forward View has identified a gap between the resources they have available and increasing patients needs which will reach £30 billion a year by 2020/21.

As part of the overall plan to address this funding gap, NHS England have set the challenging target of generating efficiency and demand savings of between 2 - 3% each year for the rest of the decade. Achieving this will mean taking action on prevention initiatives, investing in new care models and, as highlighted in the Dalton Review, seeing a bigger share of the efficiency savings coming from sharing back office services.

In light of this, iGov, in partnership with Serco, have recently conducted an online survey, which examines the potential readiness and barriers organisations across the NHS are experiencing as they strive to meet their new efficiency targets. It considered the ways in which organisations were already creating efficiency savings, and how they look to build upon this in the future.


Survey Methodology and Respondents Profile The survey was conducted online by iGov Survey between the 9th April and the 5th May. The survey respondents represent a broad cross-section of managers, head of department, directors and c-suite executives from organisations across the NHS.

297 individuals from 205 unique organisations participated in the survey. Organisations included those from Acute Trusts, Mental Health and Community Trusts, Ambulance Services, Clinical Commissioning Groups and Commissioning Support Units. The following diagrams show a breakdown of results by trust types and seniority.


8%3%

17%

2%

30%

40%AcuteMental Health/CommunityAmbulanceCCGCSUOther

21%

27%

11%

23%

10%8%

ChairChief ExecutiveDirectorHeadManagerOther

BREAKDOWN OF RESPONDENTS BY TRUST TYPE

BREAKDOWN OF RESPONDENTS BY SENIORITY

Key Findings The vast majority of survey respondents (86%) were aware of the NHS Five Year Forward View

In the context of this report, a further 76% told us they had a plan in place to generate efficiency savings, and of those who didn’t, over half (61%) were considering implementing a plan within the next year.

Of those who had an efficiency savings plan in place, 55% of survey respondents stated they anticipated a year-on-year efficiency saving of between 2 and 6%.


14%

86%

YesNo

ARE YOU AWARE OF THE NHS FIVE YEAR FORWARD VIEW REPORT AND ITS IMPLICATIONS IN REGARDS TO EFFICIENCY CHALLENGES FOR YOUR ORGANISATION?

24%

4%7%

29%

26%

10%

0-2%2-4%4-6%6-8%8%+Don't know

IN THE CONTEXT OF THIS REPORT, WHAT IS YOUR ANTICIPATED YEAR ON YEAR EFFICIENCY TARGET FOR YOUR PARTICULAR ORGANISATION?

Improving the patient journey (74%) and Delivering integrated care models (73%) were voted as the top priorities for dealing with future organisational challenges

A further 42% believed that Business Support Services is a high priority, and has an important role to pay in the delivery of future challenges. Moreover, this was followed by another 42% who highlighted this area as a medium priority. Other important areas were also highlighted as delivering clinical improvement plans (50%) and freeing up clinicians to deliver care (45%).


Integrated care models

Business support services efficiency

Improving patient journey

Freeing up clinicians

Clinical improvement plans

Sharing information

0 25 50 75 100

High priority Medium priority Low priority No priority

PLEASE RANK THE FOLLOWING IN ORDER OF PRIORITY TO DEALING WITH FUTURE ORGANISATIONAL CHALLENGES

Just under half (41%) believed outsourcing and sharing services contributed toward achieving their efficiency targets

Moreover, there is a significant increase in respondents (62%) who believe outsourcing and sharing services will make an important contribution to successful delivery of the efficiency plan over the next five years.


TO WHAT EXTENT HAS OUTSOURCING AND SHARING SERVICES CONTRIBUTED TO ACHIEVING SAVINGS/EFFICIENCY IN THE LAST TWELVE MONTHS? PLEASE RANK FROM 1 TO 5, WHERE 1 = NO CONTRIBUTION AND 5 = STRONG CONTRIBUTION

3%12%

26%

27%

32% 1 = No contribution2345 = Strong contribution

WHAT CONTRIBUTIONS WILL OUTSOURCING AND SHARING SERVICES HAVE ON THE SUCCESSFUL DELIVERY OF YOUR EFFICIENCY SAVINGS PLAN OVER THE NEXT 5 YEARS? PLEASE RANK FROM 1 TO 5, WHERE 1 = NO CONTRIBUTION AND 5 = STRONG CONTRIBUTION

9%

18%

35%

25%

13%

1 = No contribution2345 = Strong contribution

Procurement was highlighted as the business support area that could create the largest efficiency improvements (54%)

This was closely followed by estates and property management (42%) and ICT services (40%). Moreover, procurement was also highlighted as the area in which the quickest efficiency savings could be made (45%), followed by estates and property management (28%) and ICT services (34%).


Estates and property management

ICT services

Financial services

Employment services

Procurement

Patient admin services

Catering services

Occupational health services

Information management

0 25 50 75 100

1 2 3 4 5

WITHIN THE FOLLOWING BUSINESS SUPPORT SERVICE AREAS, WHERE WOULD YOU EXPECT TO SEE THE LARGEST EFFICIENCY IMPROVEMENT? PLEASE RANK FROM 1 TO 5, WHERE 1 = NO CONTRIBUTION AND 5 = STRONG CONTRIBUTION

Renegotiating contracts was highlighted as the most common factor that will facilitate the successful delivery of efficiency savings over the next five years (69%)

Other factors that participants thought would contribute significantly to efficiency savings included rationalising estates (58%) and outsourcing and sharing services (45%). However, participants also highlighted concerns over service levels and availability as the result the challenge to deliver efficiency savings. Almost a third of participants (32%) were concerned about reduced service levels, whilst a further 28% were concerned about the reduction of service availability.


WHAT ARE THE CONTRIBUTIONS THAT WILL FACILITATE SUCCESSFUL DELIVERY OF YOUR EFFICIENCY SAVINGS PLAN OVER THE NEXT 5 YEARS? PLEASE RANK FROM 1 TO 5, WHERE 1 = NO CONTRIBUTION AND 5 = STRONG CONTRIBUTION

5%15%

23%

37%

20%1 = No contribution2345 = Strong contribution

RENEGOTIATING CONTRACTS

7%13%

22%

27%

31% 1 = No contribution2345 = Strong contribution

REDUCED SERVICE LEVELS

Risk of Service disruption was ranked as the most common barrier organisations are facing as they strive to meet the efficiency challenge (59%)

This was closely followed by over half who believed a perceived ‘lack of relevant skills’ (52%) could be a significant barrier to achieving their efficiency challenge. Other barriers cited included the ‘perceived cost of new ways of working’ (41%) and being ‘locked into legacy contracts’ (37%).


Lack of management buy-in

Risk of service disruption

Perceived cost of new ways of working

Lack of relevent skills

Locked into legacy contracts

0 25 50 75 100

1 2 3 4 5

WHAT ARE THE MAIN BARRIERS THAT YOU FORESEE FOR YOUR ORGANISATION TO DELIVER THE EFFICIENCY CHALLENGE? PLEASE RANK FROM 1 TO 5, WHERE 1 = NO CONTRIBUTION AND 5 = STRONG CONTRIBUTION

Conclusion

by Dominic Durose, Business Development Manager at Serco

Generating annual efficiency savings of between 2-3% over the next five years is a challenging target for NHS organisations. It's that much more challenging when you consider the importance of protecting front-line health care on the one hand and the pressures of demographic change on the other. With three out of every four NHS organisations already rising to the challenge, this survey shows that progress is being made. Securing immediate savings in the first year, however, is just the first – and, arguably, easiest - step to take. Most respondents agree that it's quite another matter to establish sustainable savings without risking service disruption or impacting adversely on service levels and availability. Respondents have echoed the widely held beliefs that integrated care models represent the way forward, with nearly half believing that outsourcing and sharing services will be important in achieving efficiency targets and delivering guaranteed year-on-year savings. More specifically, the survey shows that renegotiating contracts, rationalising the estate portfolio and the risks posed by new ways of working feature as some of the key considerations when addressing efficiency challenges. Evidently, it's in these areas where the opportunities and real obstacles to organisational change lie. The success already achieved by Serco ASP’s NHS partnership demonstrates the real value of working with a like-minded partner to deliver high quality shared services and ongoing savings – while also protecting frontline resources – by investing in new service developments and operational efficiencies.

To find out more please contact me on 07983 340424 or visit www.sercoasp.com


http://www.sercoasp.com

Acknowledgements

The survey team at iGov Survey would like to take this opportunity to thank all of those who were kind enough to take part - and especially to those who found the time to offer additional insight through their extra comments. We would also like to thank our partner, Serco, for their assistance in compiling the survey questions, scrutinising the responses and analysing the results.

Efficiency Challenges in the NHS 2015 © copyright Unless explicitly stated otherwise, all rights including those in copyright in the content of this publication are owned by or controlled for these purposes by iGov Survey.

Except as otherwise expressly permitted under copyright law or iGov Survey’s Terms of Use, the content of this publication are owned by or controlled may not be copied, reproduced, republished, downloaded, posted, broadcast or transmitted in any way without first obtaining iGov Survey’s written permission or that of the copyright owner.

To contact the iGov Survey team: Email: [email protected] Tel: 0161 482 7890 Address: FAO David Cross, Ingenium IDS Ltd, Mansion House, Wellington Road South, Stockport, Cheshire, SK1 3UA


mailto:[email protected]


Quest ion: Are you aware of the NHS Five Year Forward View report and it s implicat ions in regards toef f iciency challenges for your organisat ion?

Answer Count Percent

Yes 254 85.5 %

No 43 14.5 %

Quest ion: In the context of this report , what is your ant icipated year-on-year ef f iciency target foryour part icular organisat ion?


0 - 2% 29 9.8 %

2 - 4% 78 26.3 %

4 - 6% 87 29.3 %

6 - 8% 19 6.4 %

8%+ 12 4 %

Don't know 72 24.2 %

Quest ion: Do you current ly have a plan in place to generate ef f iciency savings?


Yes 226 76.1 %

No 38 12.8 %

Don't know 33 11.1 %

Quest ion: Is this something you are considering implement ing in the next 6 - 12 months?


Yes 22 61.1 %

No 8 22.2 %

Don't know 6 16.7 %

Grid: Please rank the following in order of priorit y to dealing with future organisat ional challenges:

Quest ion: Delivering integrated care models


High priority 139 72.8 %

Medium priority 39 20.4 %

Low priority 10 5.2 %

No priority at all 3 1.6 %

Quest ion: Business support services ef f iciency/ Cost avoidance





No priority at all 2 1 %

Quest ion: Improving the pat ient journey





No priority at all 2 1 %

Quest ion: Freeing up clinicians to deliver care


High priority 86 45 %




Quest ion: Delivering clinical improvement plans






Quest ion: Improving sharing of pat ient informat ion



Medium priority 84 44 %



Quest ion: Providing a paperless working environment (ie. 'going digital')






Grid: To what extent do you agree or disagree with the following statement?:

Quest ion: We have made our planned ef f iciency savings during the last twelve months and met ourbudget challenges


Strongly agree 46 24.3 %

Agree 58 30.7 %

Neutral 37 19.6 %

Disagree 38 20.1 %

Strongly disagree 10 5.3 %

Grid: To what extent have each of these following act ions cont ributed to achievingsavings/ef f iciency in the last twelve months? Please rank where 1 = no cont ribut ion and 5 = st rongcont ribut ion.

Quest ion: Reducing service availabilit y


1 113 60.1 %

2 36 19.1 %

3 20 10.6 %

4 16 8.5 %

5 3 1.6 %

Quest ion: Renegot iat ing cont racts


1 30 16 %

2 40 21.3 %

3 52 27.7 %

4 40 21.3 %

5 26 13.8 %

Quest ion: Reduce service levels


1 93 49.5 %

2 51 27.1 %

3 24 12.8 %

4 17 9 %

5 3 1.6 %

Quest ion: Outsourcing and sharing services


1 60 31.9 %

2 51 27.1 %

3 50 26.6 %

4 22 11.7 %

5 5 2.7 %

Quest ion: Rat ionalising estates


1 57 30.3 %

2 49 26.1 %

3 41 21.8 %

4 31 16.5 %

5 10 5.3 %

Quest ion: Management rest ructure


1 54 28.7 %

2 44 23.4 %

3 39 20.7 %

4 34 18.1 %

5 17 9 %

Quest ion: New technology investment


1 36 19.1 %

2 49 26.1 %

3 56 29.8 %

4 32 17 %

5 15 8 %

Grid: Within the following business support service areas, where would you expect to see the largestef f iciency improvement? Please rank where 1 = no cont ribut ion and 5 = st rong cont ribut ion

Quest ion: Estates and Property Management


1 26 15.2 %

2 30 17.5 %

3 44 25.7 %

4 40 23.4 %

5 31 18.1 %

Quest ion: ICT services


1 28 16.4 %

2 29 17 %

3 45 26.3 %

4 38 22.2 %

5 31 18.1 %

Quest ion: Financial services


1 23 13.5 %

2 57 33.3 %

3 56 32.7 %

4 29 17 %

5 6 3.5 %

Quest ion: Employment services (such as payroll, HR, recruitment )


1 24 14 %

2 53 31 %

3 38 22.2 %

4 42 24.6 %

5 14 8.2 %

Quest ion: Procurement


1 19 11.1 %

2 19 11.1 %

3 41 24 %

4 63 36.8 %

5 29 17 %

Quest ion: Pat ient Administ rat ion Services


1 45 26.3 %

2 38 22.2 %

3 58 33.9 %

4 26 15.2 %

5 4 2.3 %

Quest ion: Catering services (pat ient meals)


1 72 42.1 %

2 55 32.2 %

3 25 14.6 %

4 16 9.4 %

5 3 1.8 %

Quest ion: Occupat ional Health Services


1 68 39.8 %

2 53 31 %

3 36 21.1 %

4 11 6.4 %

5 3 1.8 %

Quest ion: Informat ion management


1 29 17 %

2 43 25.1 %

3 45 26.3 %

4 40 23.4 %

5 14 8.2 %

Grid: Of the same list , which areas would you expect to see the quickest improvement in ef f iciency?Please rank where 1 = no cont ribut ion and 5 = st rong cont ribut ion.

Quest ion: Estates and Property Management


1 35 20.6 %

2 45 26.5 %

3 42 24.7 %

4 28 16.5 %

5 20 11.8 %

Quest ion: ICT services


1 25 14.7 %

2 40 23.5 %

3 47 27.6 %

4 37 21.8 %

5 21 12.4 %

Quest ion: Financial services


1 32 18.8 %

2 44 25.9 %

3 54 31.8 %

4 32 18.8 %

5 8 4.7 %

Quest ion: Employment services (such as payroll, HR, recruitment )


1 34 20 %

2 48 28.2 %

3 41 24.1 %

4 31 18.2 %

5 16 9.4 %

Quest ion: Procurement


1 23 13.5 %

2 24 14.1 %

3 47 27.6 %

4 46 27.1 %

5 30 17.6 %

Quest ion: Pat ient Administ rat ion Services


1 60 35.3 %

2 37 21.8 %

3 54 31.8 %

4 14 8.2 %

5 5 2.9 %

Quest ion: Catering services (pat ient meals)


1 78 45.9 %

2 43 25.3 %

3 31 18.2 %

4 14 8.2 %

5 4 2.4 %

Quest ion: Occupat ional Health Services


1 72 42.4 %

2 52 30.6 %

3 33 19.4 %

4 7 4.1 %

5 6 3.5 %

Quest ion: Informat ion management


1 26 15.3 %

2 51 30 %

3 58 34.1 %

4 22 12.9 %

5 13 7.6 %

Grid: What are the cont ribut ions that will facilitate successful delivery of your ef f iciency savings planover the next 5 years? Please rank where 1 = no cont ribut ion and 5 = st rong cont ribut ion.

Quest ion: Reducing service availabilit y


1 54 33.1 %

2 50 30.7 %

3 27 16.6 %

4 16 9.8 %

5 16 9.8 %

Quest ion: Renegot iat ing cont racts


1 9 5.5 %

2 24 14.7 %

3 38 23.3 %

4 60 36.8 %

5 32 19.6 %

Quest ion: Reduce service levels


1 50 30.7 %

2 44 27 %

3 36 22.1 %

4 21 12.9 %

5 12 7.4 %

Quest ion: Outsourcing and sharing services


1 21 12.9 %

2 41 25.2 %

3 57 35 %

4 30 18.4 %

5 14 8.6 %

Quest ion: Rat ionalising estates


1 24 14.7 %

2 28 17.2 %

3 34 20.9 %

4 49 30.1 %

5 28 17.2 %

Quest ion: Management rest ructure


1 33 20.2 %

2 40 24.5 %

3 39 23.9 %

4 31 19 %

5 20 12.3 %

Grid: What are the main barriers that you foresee for your organisat ion to deliver the ef f iciencychallenge? Please rank where 1 = no cont ribut ion and 5 = st rong cont ribut ion.

Quest ion: Lack of management buy-in


1 41 25 %

2 38 23.2 %

3 37 22.6 %

4 23 14 %

5 25 15.2 %

Quest ion: Risk of service disrupt ion


1 6 3.7 %

2 25 15.2 %

3 37 22.6 %

4 52 31.7 %

5 44 26.8 %

Quest ion: Perceived cost of new ways of working


1 9 5.5 %

2 32 19.5 %

3 56 34.1 %

4 47 28.7 %

5 20 12.2 %

Quest ion: Lack of relevant skills within the organisat ion


1 8 4.9 %

2 26 15.9 %

3 44 26.8 %

4 56 34.1 %

5 30 18.3 %

Quest ion: Locked into legacy cont racts


1 29 17.7 %

2 32 19.5 %

3 43 26.2 %

4 34 20.7 %

5 26 15.9 %

Grid: To what extent do you agree with the following statements?:

Quest ion: My organisat ion priorit ises short term ef f iciency savings (6 - 12 months) rather thansustained savings over a 2-3 year period



Agree 37 23.6 %

Neutral 31 19.7 %

Disagree 60 38.2 %


Quest ion: My organisat ion has a f ixed st rategy in place to create ef f iciency savings in both the shortand long term



Agree 58 36.9 %

Neutral 48 30.6 %

Disagree 36 22.9 %


Quest ion: Redesigning our business support services will be the largest cont ributor to delivering ouref f iciency savings



Agree 28 17.8 %

Neutral 37 23.6 %

Disagree 54 34.4 %


Grid: Thinking about your operat ion model for business support services, rank in order of importancethe levers which will deliver ef f iciency savings and improved service qualit y:

Please rank where 1 = not at all important and 6 = very important

Quest ion: Invest ing in new ICT systems and tools


1 9 5.7 %

2 13 8.3 %

3 28 17.8 %

4 30 19.1 %

5 37 23.6 %

6 40 25.5 %

Quest ion: Simplif ied processes and f rameworks


1 3 1.9 %

2 8 5.1 %

3 19 12.1 %

4 35 22.3 %

5 44 28 %

6 48 30.6 %

Quest ion: Flexible/mobile working pract ices


1 8 5.1 %

2 11 7 %

3 23 14.6 %

4 35 22.3 %

5 47 29.9 %

6 33 21 %

Quest ion: Sharing services with other organisat ions


1 12 7.6 %

2 14 8.9 %

3 41 26.1 %

4 35 22.3 %

5 37 23.6 %

6 18 11.5 %

Quest ion: Rat ionalising property/estates


1 23 14.6 %

2 20 12.7 %

3 28 17.8 %

4 33 21 %

5 29 18.5 %

6 24 15.3 %

Quest ion: Improving employee self -serve capabilit y


1 28 17.8 %

2 24 15.3 %

3 40 25.5 %

4 35 22.3 %

5 21 13.4 %

6 9 5.7 %

Quest ion: Are you interested in hearing more about increasing ef f iciency gains in the following areas?Please t ick all that apply


Estates and Property Management 45 13 %

ICT services 50 14.4 %

Financial services 30 8.6 %

Employment services (such as payroll, HR, recruitment) 41 11.8 %

Procurement 57 16.4 %

Patient Administration Services 28 8.1 %

Catering services (such as patient meals) 21 6.1 %

Occupational Health Services 24 6.9 %

Information Management 45 13 %

Other - please specify 6 1.7 %

Results Breakdown

Job Funct ions

Job Function Count Percent

Job Function: Administration 6 1.3 %

Job Function: Audit 1 0.2 %

Job Function: Board Secretary 3 0.7 %

Job Function: Business Development 9 2 %

Job Function: Business Management 6 1.3 %

Job Function: Catering 2 0.4 %

Job Function: Chief Executive/Deputy 49 10.6 %

Job Function: Childrens Services 2 0.4 %

Job Function: Clinical 11 2.4 %

Job Function: Commissioning 10 2.2 %

Job Function: Community Health 3 0.7 %

Job Function: Contract Services 13 2.8 %

Job Function: Corporate Services 7 1.5 %

Job Function: Customer Services 4 0.9 %

Job Function: Education 1 0.2 %

Job Function: Emergency Planning 1 0.2 %

Job Function: Energy 3 0.7 %

Job Function: Engineer 2 0.4 %

Job Function: Environment 2 0.4 %

Job Function: Facilities & Estates 21 4.6 %

Job Function: Finance Management 47 10.2 %

Job Function: Fire 1 0.2 %

Job Function: General Manager 5 1.1 %

Job Function: General Practitioner 6 1.3 %

Job Function: Governance 15 3.3 %

Job Function: Governor 1 0.2 %

Job Function: Health & Safety 8 1.7 %

Job Function: Hotel Services 2 0.4 %

Job Function: Human Resources 19 4.1 %

Job Function: Information 6 1.3 %

Job Function: Information Governance 4 0.9 %

Job Function: IT Management 14 3 %

Job Function: Legal Services 2 0.4 %

Job Function: Marketing Communications 5 1.1 %

Job Function: Medical Director 3 0.7 %

Job Function: NHS Planning 2 0.4 %

Job Function: Nursing Director 6 1.3 %

Job Function: Occupational Health 3 0.7 %

Job Function: Operations 16 3.5 %

Job Function: Organisational Planning 4 0.9 %

Job Function: PA 1 0.2 %

Job Function: Performance 11 2.4 %

Job Function: Pharmacy 6 1.3 %

Job Function: Planning 2 0.4 %

Job Function: Primary Care 1 0.2 %

Job Function: Procurement/Purchasing 36 7.8 %

Job Function: Programme Management 4 0.9 %

Job Function: Project 7 1.5 %

Job Function: Quality Assurance 7 1.5 %

Job Function: Records Management 1 0.2 %

Job Function: Regulatory 1 0.2 %

Job Function: Research 1 0.2 %

Job Function: Risk 12 2.6 %

Job Function: Sales 3 0.7 %

Job Function: Senior Manager 7 1.5 %

Job Function: Service Delivery 8 1.7 %

Job Function: Social Services 1 0.2 %

Job Function: Strategy 7 1.5 %

Job Function: Sustainability 1 0.2 %

Job Function: Sustainable Communities 2 0.4 %

Job Function: T elecoms 1 0.2 %

Job Function: T raining 10 2.2 %

Job Function: T ransformation/Change Management 5 1.1 %

Job Function: T ransport/Fleet 1 0.2 %

Sectors

Sector Count Percent

Clinical Commissioning Groups 51 17.3 %

NHS 244 82.7 %

Organisat ions

2gether NHS Foundation Trus t 5 Boroughs Par tners h ip NHS Foundation Trus t

Aintree Univers i ty Hos pi ta ls NHS Foundation Trus t Ai redale NHS Foundation Trus t

As hford and St Peter ' s Hos pi ta ls NHS Foundation Trus t Avon and Wi l ts h i re Menta l Heal th Par tners h ip NHS Trus t

Barnet, Enfie ld and Har ingey Menta l Heal th NHS Trus t Bar ts Heal th NHS Trus t

Bedford Hos pi ta l NHS Trus t Berks hi re Heal thcare NHS Foundation Trus t

Bi rm ingham and Sol ihu l l Menta l Heal th NHS Foundation Trus t Bol ton NHS Foundation Trus t

Bradford Dis tr ict Care Trus t Bradford Teaching Hos pi ta ls NHS Foundation Trus t

Br ighton and Sus s ex Univers i ty Hos pi ta ls NHS Trus t Br is to l Com m uni ty Heal th

Buckingham s hi re Heal thcare NHS Trus t Calderdale and Hudders fie ld NHS Foundation Trus t

Calders tones Par tners h ip NHS Foundation Trus t Cam den and Is l ington NHS Foundation Trus t

Care Plus Group Centra l and Nor th Wes t London NHS Foundation Trus t

Centra l London Com m uni ty Heal thcare NHS Trus t Ches ter fie ld Royal Hos pi ta l NHS Foundation Trus t

Ci ty Heal th Care Par tners h ip CIC Ci ty Hos pi ta ls Sunder land NHS Foundation Trus t

Com m uni ty Heal th Par tners h ips Cornwal l Par tners h ip NHS Foundation Trus t

Countes s Of Ches ter Hos pi ta l NHS Foundation Trus t Coventry and Warwicks hi re NHS Par tners h ip Trus t

Croydon Heal th Services NHS Trus t Cum br ia Par tners h ip NHS Foundation Trus t

Dar tford and Graves ham NHS Trus t Derby Hos pi ta ls NHS Foundation Trus t

Derbys hi re Heal thcare NHS Foundation Trus t Dors et County Hos pi ta l NHS Foundation Trus t

Dors et Heal thCare Univers i ty NHS Foundation Trus t Eas t Lancas hi re Hos pi ta ls NHS Trus t

Eas t London NHS Foundation Trus t Eps om and St Hel ier Univers i ty Hos pi ta ls NHS Trus t

Eas t London NHS Foundation Trus t Eps om and St Hel ier Univers i ty Hos pi ta ls NHS Trus t

Fi rs t Com m uni ty Heal th & Care Gates head Heal th NHS Foundation Trus t

Glouces ters h i re Care Services NHS Trus t Glouces ters h i re Hos pi ta ls NHS Foundation Trus t

Great Orm ond Street Hos pi ta l for Chi ldren NHS Foundation Trus t Greater Manches ter Wes t Menta l Heal th NHS Foundation Trus t

Heal th Education Eas t Mid lands Heal th Education South Wes t

Heal th Education Wes t Mid lands Hear t o f England NHS Foundation Trus t

Her tfords hi re Com m uni ty NHS Trus t Her tfords hi re Par tners h ip Univers i ty NHS Foundation Trus t

Hom erton Univers i ty Hos pi ta l NHS Foundation Trus t Houns low and Richm ond Com m uni ty Heal thcare NHS Trus t

Hul l and Eas t Yorks hi re Hos pi ta ls NHS Trus t Im per ia l Col lege Heal thcare NHS Trus t

Is le o f Wight NHS Trus t Kent and Medway NHS and Socia l Care Par tners h ip Trus t

Kent, Surrey and Sus s ex Academ ic Heal th Sciences Network Kings Col lege Hos pi ta l NHS Foundation Trus t

Lancas hi re Care NHS Foundation Trus t Lancas hi re Teaching Hos pi ta ls NHS Foundation Trus t

Leeds Com m uni ty Heal thcare NHS Trus t Le ices ters h i re Par tners h ip NHS Trus t

Lincolns hi re Com m uni ty Heal th Services NHS Trus t Lincolns hi re Par tners h ip NHS Foundation Trus t

Liverpool Com m uni ty Heal th NHS Trus t Liverpool Hear t and Ches t Hos pi ta l NHS Foundation Trus t

Maids tone and Tunbr idge Wel ls NHS Trus t Manches ter Menta l Heal th and Socia l Care Trus t

Medway NHS Foundation Trus t Mers ey Care NHS Trus t

Mid Ches hi re Hos pi ta ls NHS Foundation Trus t Mid lands and Lancas hi re Com m is s ion ing Suppor t Uni t

Mus grove Park Hos pi ta l National Ins ti tu te for Heal th and Care Excel lence

NHS Ai redale, Whar fedale and Craven CCG NHS Arden Com m is s ion ing Suppor t Uni t

NHS Barnet CCG NHS Bedfords hi re CCG

NHS Bexley Cl in ica l Com m is s ion ing Group NHS Bi rm ingham South Centra l CCG

NHS Bol ton CCG NHS Brent CCG

NHS Br ighton and Hove CCG NHS Bus ines s Services Author i ty

NHS Centra l London Cl in ica l Com m is s ion ing Group NHS Centra l Southern Com m is s ion ing Suppor t Uni t

NHS Chor ley and South Ribb le Cl in ica l Com m is s ion ing Group NHS Coas ta l Wes t Sus s ex CCG

NHS Com m ercia l Solutions NHS Cum br ia CCG

NHS Durham Dales , Eas ington and Sedgefie ld CCG NHS Eas t Lancas hi re CCG

NHS Eas t Surrey CCG NHS Enfie ld CCG

NHS England NHS Greater Hudders fie ld Cl in ica l Com m is s ion ing Group

NHS Ham bleton, Richm onds hi re and Whi tby CCG NHS Hardwick CCG

NHS Har tlepool and Stockton-on-Tees CCG NHS Her ts Val leys CCG

NHS Hors ham and Mid Sus s ex CCG NHS Houns low CCG

NHS Im proving Qual i ty NHS Kernow CCG

NHS Luton CCG NHS Nor th Eas t Linco lns hi re CCG

NHS Nor th Ham ps hi re CCG NHS Nor th Staffords hi re CCG

NHS Nottingham Ci ty Cl in ica l Com m is s ion ing Group NHS Oldham CCG

NHS Por ts m outh CCG NHS Profes s ionals Ltd

NHS Rus hcl i ffe CCG NHS South Kent Coas t CCG

NHS South Sefton CCG NHS South Warwicks hi re CCG

NHS Southern Derbys hi re CCG NHS Supply Chain

NHS Trafford CCG NHS Wakefie ld Cl in ica l Com m is s ion ing Group

NHS Wands wor th CCG NHS Wes t Ham ps hi re CCG

NHS Wi l ts h i re CCG NHS Wolverham pton Cl in ica l Com m is s ion ing Group

Nor th Br is to l NHS Trus t Nor th Eas t Am bulance Service NHS Foundation Trus t

Nor th Eas t London NHS Foundation Trus t Nor th of England Com m is s ion ing Suppor t Uni t

Nor th Som ers et Com m uni ty Par tners h ip Nor th Wes t Com m is s ion ing Suppor t Uni t

Nor th Wes tern Deanery Nor tham ptons hi re Heal thcare NHS Foundation Trus t

Nor thern Devon Heal thcare NHS Trus t Nottingham Univers i ty Hos pi ta ls NHS Trus t

Nottingham s hi re Heal thcare NHS Foundation Trus t Oxford Univers i ty Hos pi ta ls NHS Trus t

Oxleas NHS Foundation Trus t Penins ula Com m uni ty Heal th

Penins ula Purchas ing and Supply Al l iance Plym outh Hos pi ta ls NHS Trus t

Queen Victor ia Hos pi ta l NHS Foundation Trus t Rotherham Doncas ter and South Hum ber NHS Foundation Trus t

Royal Berks hi re NHS Foundation Trus t Royal Brom pton & Harefie ld NHS Foundation Trus t

Royal Cornwal l Hos pi ta ls NHS Trus t Royal Free London NHS Foundation Trus t

Royal Uni ted Hos pi ta ls Bath NHS Foundation Trus t Royal Wolverham pton Hos pi ta ls NHS Trus t

Sal ford Royal NHS Foundation Trus t Sal is bury NHS Foundation Trus t

Sandwel l and Wes t B i rm ingham Hos pi ta ls NHS Trus t SEQOL

Sheffie ld Heal th and Socia l Care NHS Foundation Trus t Sheffie ld Teaching Hos pi ta ls NHS Foundation Trus t

Sherwood Fores t Hos pi ta ls NHS Foundation Trus t Si rona Care & Heal th

Solent NHS Trus t Som ers et Par tners h ip NHS Foundation Trus t

South Centra l Am bulance Service NHS Foundation Trus t South Devon Heal thcare NHS Foundation Trus t

South London and Mauds ley NHS Foundation Trus t South Tees Hos pi ta ls NHS Foundation Trus t

South Tynes ide NHS Foundation Trus t South Wes t Com m is s ion ing Suppor t Uni t

South Wes t London and St George ' s Menta l Heal th NHS Trus t South Wes tern Am bulance Service NHS Foundation Trus t

Southpor t and Orm s ki rk Hos pi ta l NHS Trus t Stockpor t NHS Foundation Trus t

Surrey and Borders Par tners h ip NHS Foundation Trus t Surrey and Sus s ex Heal thcare NHS Trus t

Sus s ex Com m uni ty NHS Trus t Sus s ex Par tners h ip NHS Foundation Trus t

Tam es ide Hos pi ta l NHS Foundation Trus t Tees , Es k and Wear Val leys NHS Foundation Trus t

Tham es Val ley Pr im ary Care Agency The Chr is tie NHS Foundation Trus t

The Great Wes tern Hos pi ta ls NHS Foundation Trus t The Leeds Teaching Hos pi ta ls NHS Trus t

The Mid Yorks hi re Hos pi ta ls NHS Trus t The Rotherham NHS Foundation Trus t

The Royal Liverpool and Broadgreen Univers i ty Hos pi ta ls NHS Trus t The Royal Mars den NHS Foundation Trus t

The Sheffie ld Chi ldren ' s NHS Foundation Trus t The Tavis tock and Por tm an NHS Foundation Trus t

The Wal ton Centre NHS Foundation Trus t Uni ted Lincolns hi re Hos pi ta ls NHS Trus t

Univers i ty Col lege London Hos pi ta ls NHS Foundation Trus t Univers i ty Hos pi ta l o f South Manches ter NHS Foundation Trus t

Univers i ty Hos pi ta l Southam pton NHS Foundation Trus t Univers i ty Hos pi ta ls B i rm ingham NHS Foundation Trus t

Univers i ty Hos pi ta ls o f Le ices ter NHS Trus t Wals a l l Heal thcare NHS Trus t

Warr ington and Hal ton Hos pi ta ls NHS Foundation Trus t Wes t Her tfords hi re Hos pi ta ls NHS Trus t

Wes t London Menta l Heal th NHS Trus t Wes t Mid lands Am bulance Service NHS Foundation Trus t

Wir ra l Com m uni ty NHS Trus t Worces ters h i re Heal th and Care NHS Trus t

Worces ters h i re ICT Services Wrightington,Wigan and Leigh NHS Foundation Trus t

Yeovi l Dis tr ict Hos pi ta l NHS Foundation Trus t Yorks hi re and Hum ber Com m is s ion ing Suppor t Uni t

Documents

Efficiency Challenges in the NHS - Emap.com...challenging target for NHS organisations. It's that much more challenging when you consider the importance of protecting front-line health