RECOVERY AND SUSTAINABILITY: WASTE, HARM & VARIATION

PERFORMANCE & FINANCE COMMITTEE

Professor Hamish Laing

18th July 2018

Workforce Delivery

Employee Health &

Wellbeing

Premium Cost

Rostering (inc Junior doctors)

Workforce Scrutiny &

Control

Workforce Redesign

Clinical Support Services

Nurse Staffing

Junior Doctors

Service Remodelling

Service Redesign - Frail Older

People

Service Redesign - Mental Health

Service Redesign - Learning Disability

Back office & estates

Financial Sustainability

Procurement

QVC Tier 1 and 2

Income Generation

Unit 'Cost down' monitoring

Ringfenced Funding

Review of Mental Health

Quality Priorities

Health Care Acquired Infections

Service Delivery

Unscheduled Care

Planned Care

Cancer

Stroke

Service Optimisation

Outpatients

Theatres

Patient Flow

Clinical Variation

Medicines Management

Biosimilars

Home Care

Enhanced Turnaround Cont ro ls and R isks Page 4

Savings Delivery Assessment

Sav ings De l i ve ry Conf idence and De lo i t te Assessment Page 3

18/19 18/19 18/19

EstimateDelivery Assessment Shortfall

£m £m £m

Workstream Savings :

Waste Harm & Variation 2.0 0 2.0

• There is delivery challenge with workstream as there has been insufficient allocation of resource to it in Q1 and Q2

• Potential savings (£1M) from INNU and NICE DnDs have been grossly overstated

• Potential benefits are being attributed to other corporate and unit workstreams / plans

• It is recognised that there are significant risks of workstream savings delivery shortfalls in 2018/19. These were also identified by Deloitte

• There remains purpose in adopting a VBHcapproach in the Health Board

Deloitte Assessment

“…It is recommended that the Health Board go further and faster in driving these projects harder, and also consider expanding the size of its programme, if it wishes to deliver substantial savings.”

“The team appears under-resourced to deliver the eight different projects included in the programme currently, let alone the expanded programme recommended in this report. It is suggested that if the Health Board wishes to pursue this agenda effectively and use it to deliver financial savings, that it ensures that the team delivering the programme has sufficient project manager and financial and data analysis capacity, with appropriate senior responsible officers who are

accountable for the delivery of projects”.

PERFORMANCE & FINANCE COMMITTEE

CLINICAL VARIATION DASHBOARDS

• Tackling unwarranted variation by developing agreed pathways is essential to create a “higher reliability” (safer and more efficient) organisation which will contribute to transformation and sustainability plans

• Adopting the principles of Value Based Healthcare across ABMU and regionally through a series of programmes will, if properly resourced and organised, deliver significant benefits and create an environment where resource can be directed increasingly to where it best meets patients need at highest value.

• Programme Budgetting Marginal Analysis (PBMA) and Time-Driven Activity Based Costing (TDABC) are useful technical tools but are resource intensive and take time to complete

• These benefits will support savings in other programmes and be important for other reasons but are unlikely to deliver significant savings over and above those captured elsewhere.

• Depending on significant savings from INNU and DNDs in ABMU is unwise unless new tranches of exclusions are introduced.

• Recruitment to a VBHc central and regional team and procurement of a platform to collect PROMs are essential precursors to delivering benefits

• The workstream should be retitled (Value Based Healthcare) and the unique savings attributed to it revised to nil in 2018-9. Reporting within and outside ABMU should reflect the activity delivered positively.

Act ions : Conc lus ions Page 24