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Business Plan 2011/12

Delivering the Best

NHS Wales Shared Services Partnership Business Plan

Shared Service Partnership

2011/12 Business Plan 2

NHS Wales Shared Services

Partnership

Mission Statement

To enable the delivery of World Class Public Services in Wales

through customer –focus, collaboration and innovation


Shared Service Partnership 2011/12 Business Plan - draft

Contents

1) Introduction to the Business Plan 4 Director’s Introduction 4

2) Context of Shared Services for NHS Wales 5 a) Purpose 5

b) NHS Wales Shared Services Partnership 5

c) Developing the Shared Service Business Plan 6

3) Vision and Values 8

4) Corporate Objectives for 2011/12 9 5) Key Issues 11 6) Supporting the Business Plan 12 a) Managing Performance 12

b) Benchmarking 12

c) Customer Relationship Management 13

d) Communication 13

e) Risk Management 14

f) Sustainability 15

g) Estates 15

h) Information Governance 15

7) The Financial Plan 17 a) Financial Baseline 17

b) Savings 21

c) Funding Flows 22

d) Budget Finalisation 23

8) Service Improvement Overview 24 a) Procurement Services 24

b) Employment Services 25

c) Welsh Risk Pool Services 29

d) Facilities Services 30

e) Legal and Risk Services 32

f) Contractor Services 35

g) Audit & Assurance Services 37

h) Prescribing Services 41

9) Conclusion 46

10) Appendices 47 1) Origin of Services Provided 48

2) The Structure of the Organisation 49

3) Funding Flow Analysis 50

4) Benefits Register 52




1) Introduction to the Business Plan

Director’s Introduction The challenging economic climate means that new and innovative approaches are required in all areas of public service. The NHS Wales Shared Services Partnership will allow health organisations to focus on health care whilst it focuses on innovation and efficiency within the support services.

NHS Wales is facing huge challenges, not just in delivering the Annual Quality

Framework within financial balance but also significant changes that will require

services to be delivered differently. In the longer term the increase in the elderly

population means that consumption of NHS services is set to double by 2030 and

the lower proportion of the population in the younger “wealth generating group”

means that there will be even more pressures on public finances.

How we respond to the financial and demographic challenges now will determine

whether NHS Wales will meet its commitment to the health of its nation. It is not

possible to provide quality healthcare services by “doing the same things” the

“same way” with significantly less money. Efficiency savings alone will not be

enough and significant transformational change will be required. NHS Wales must:

• Tackle clinical sustainability issues;

• Maximise workforce contribution;

• Lift productivity whilst ensuring quality and safety;

• Work with partner organisations ( both public and third sector ) to maximise

resources;

• Engage the population in managing wellness;

• Ensure individuals can care for themselves at, or closer to, home;

• Use technology to deliver services differently to meet cost and volume

issues;

• Best organise resources - buildings, workforce and equipment; and

• Work across the public sector to maximise the best use of resources.

NHS Wales will require high quality business and professional support functions to

tackle this challenging agenda and NWSSP and other support organisations will have

a key role to play.

Neil Frow Director of NHS Wales Shared Services Partnership 28th March 2011




2) Context of Shared Services for NHS Wales

a) Purpose The purpose of this paper is to present the inaugural NHS Wales Shared Services

Partnership (NWSSP) Business Plan for 2011/12. The plan seeks to build on the

foundations laid down by the NHS Wales Shared Services Programme and sets out

the initial proposals for NWSSP to deliver more effective and efficient business and

services to NHS Wales.

b) NHS Wales Shared Services Partnership

Background

The NHS Wales Shared Services Partnership is a new way to deliver support services

to NHS Wales Organisations. It is believed that this approach will result in

significant efficiency savings and qualitative benefits for health organisations.

The journey to a national Shared Services was initially proposed in the 2008

consultation paper “Proposals to Change the Structure of the NHS in Wales”. In

2009 a research study was commissioned by WG from Bath University to review best

practice models for Shared Services. In November 2009, the Health & Social

Services Directorate (HSSD) Chief Executives’ Group agreed a Shared Services

concept and the proposed programme approach for the development and

implementation of shared services. The shared services business case was

completed in September 2010 and the Minister for Health and Social Services

announced that the Shared Services Programme would be implemented with the

shadow running period starting on 1st November 2010 and becoming operational on

1 April 2011.

Arrangements

NWSSP is not a statutory body or a hosted organisation but a “virtual organisation”

with over 1300 staff and an overall net budget of nearly £50m. NWSSP staff are

employed by LHBs and Trusts but are ultimately accountable to the Director of

Shared Service and his Senior Management Team (Appendix 2)

The Shared Services Partnership Committee is responsible for the setting of

NWSSP’s policy and strategy and monitoring delivery. The Committee is a

subcommittee of the Health & Social Services Directorate General’s National

Delivery Group and comprises representatives from LHBs, Trusts, WG and staff

side.




NWSSP provides a range of business and professional services as follows;

• Procurement Services

• Employment Services

• Contractor Services

• Prescribing Service

• Facilities Services

• Legal and Risk Services

• Risk Pool Services

• Internal Audit

Phased Development of Shared Services

It is proposed that shared services will develop in 3 main phases:

• Phase 1 – establishment and consolidation of services;

• Phase 2 – transformation and modernisation; and

• Phase 3 – Growth and development.

Inevitably 2011/12 will very much focus on Phase 1 however NWSSP will also aim to

make some progress on phases 2 and 3. There is a real need to develop and

improve certain services by investing in technology and adopting a professional

approach whilst also continuing to develop a customer service approach and an

excellent reputation for quality and delivery. The required level of service will only

be possible by developing a highly motivated and appropriately skilled workforce.

Mechanisms will need to be developed to consider the individual cases and benefits

to be gained from transferring new services to NWSSP. All proposals will need to be

signed off and agreed by the Shared Services Partnership Committee

c) Developing the Shared Services Business Plan This business plan sets out how the NWSSP will strive to achieve a high degree of

consistency and standardisation across all its services in NHS Wales whilst

recognising the need to tailor services on a local basis where appropriate. The plan

also provides details of the main functions of NWSSP and summarises the strategic

objectives, main initiatives and focus that it will take during the forthcoming

financial year.

The Business Plan has been developed in a number of stages.

• The Visions and Values have been produced by the Chair and Senior Management team – Section 3;

• Functional area work streams were set up by the Shared Service Programme Board and they developed detailed Service Improvement plans during the shadow running phase;




• The Senior Management team of NWSSP have reviewed these plans and have developed Service Improvement Plan Summaries that are highlighted in Section 8; and

• These have now been underpinned by the Corporate Objectives (See Section 4) that have been developed based on an assessment of organisational needs.

It is recognised that the business planning process will need to be refined, developed and become more sophisticated during 2011/12 and work is already ongoing to address this.




3) Vision and Values

NWSSP developed its Vision and values during the Senior Management development day in April 2011. Our corporate mission is:

“To enable the delivery of world class Public Services in

Wales through customer-focus, collaboration and innovation”

Our corporate vision is:

“By 2015 we shall be recognised as a world class Shared

Services through the excellence of our people, our services and our processes”

The implication is that to be the best at what we do we need to be consistently DELIVERING THE BEST. Core Values The Chair and Senior Management Team have identified the following Core Values that will form the basis of NWSSP conduct. Further work is ongoing with stakeholders, staff and customers to embed and develop our values.

LISTENING AND LEARNING (to constantly improve the quality, effectiveness and efficiency of all we do)

• To include Patience, Tolerance, Understanding, Responsiveness, Respect.

WORKING TOGETHER (with colleagues, customers and suppliers)

• To include Trust, Teamwork, Honesty, Loyalty, Openness, Humour, Co-operation, Embracing Diversity, Empowerment, Valuing Others.

TAKING RESPONSIBILITY (for decisions and making things happen)

• To include Commitment, Focus, Dependability, Professionalism, Integrity, Delivery, Quality, Fairness, Leadership.

INNOVATING (to encourage continuous improvement)

• To include Courage, Freedom, Support, Creativity, Risk Awareness, Vision and Challenge.




The business plan has been developed around a set of initial key overall objectives that provide the basis for NWSSP as a whole. These objectives will be refined and developed as NWSSP moves from phase 1 into phases 2 and 3. Key Objective 1

To set up and create a new effective shared services organisation that is fit for purpose, ensures business continuity and delivers significant benefits to NHS Wales from year 1

As a new organisation NWSSP will need to develop an identity, establish an effective partnership with its service users and implement robust governance arrangements in a virtual environment. Key objectives include:

• Achieving financial and performance targets and operating within budget

• Developing and implementing a sophisticated corporate performance management system;

• Ensuring business continuity and a seamless transfer of services to NWSSP;

• Appointing and creating a highly motivated senior management team;

• Introducing robust controls and procedures and operating within sound principles of governance;

• Developing and embedding integrated and effective Risk Management processes and systems;

• Delivering the financial and qualitative benefits identified in the benefits register;

• Assessing current Quality and Customer Service accreditations and rolling out throughout NWSSP as appropriate; and

• Developing and implementing an Estates strategy to maximise the efficiency and effectiveness of the NWSSP estate.

Key Objective 2

To develop a highly efficient and effective corporate, customer focused approach that adheres to the principles of continuous service improvement and provides high standards of service provision and performance

Improving the customer experience and providing a consistent high quality service is a key requirement for NWSSP. This will require close working with customers and the development of a culture of continuous service improvement that delivers efficiencies and improved quality. Key objectives include:

• Developing and implementing a Customer Service Strategy and client relationship management arrangements;

4) Corporate Objectives for 2011/12




• Producing robust service Improvement Plans for each service and managing performance on a regular basis;

• Process mapping and evaluating existing transaction based services to identify efficiencies and to standardise and modernise systems and provide common consistent patterns of service;

• Continually seeking to improve services through standardisation and/ or rationalisation;

• Developing VFM services and evidencing this through the effective use of benchmarking;

• Developing a programme to provide staff with skills in service improvement techniques; and

• Utilising IT solutions to automate manual systems and procedures e.g. intelligent scanning and E expenses.

Key Objective 3

To have an appropriately skilled, healthy, productive and engaged workforce

Our 1300 staff represents our major asset and their continued development will be key to the success of NWSSP. Key objectives include:

• Developing and implementing an organisational development plan;

• Ensuring that all staff are subject to performance and development reviews;

• Implementing effective, regular and innovative methods of communication with staff;

• Developing a local partnership forum;

• Promoting and participating within the Corporate Health Standard; and

• Developing systems to measure and improve staff satisfaction and morale.

Key Objective 4

To develop the medium and longer term strategy for shared services

NWSSP will work with WG and NHS Wales to identify the most appropriate way forward in terms of the strategic development of shared services across Wales. Key objectives are:

• Securing benefits from the synergies to be gained from existing services within NWSSP;

• Transforming, modernising and rationalising existing NWSSP services; and

• Identifying potential further services to be included in NWSSP




The key issues impacting on the NWSSP are:

• Business continuity of some transactional services – in particular the payroll services transferred from two LHBs are significantly under resourced and have required immediate support from the wider payroll resource to deliver the core service;

• Shortfalls in senior managerial resources - LHBs have transferred direct staff to NWSSP however certain senior management within LHBs and Trusts (with NWSSP services as part of their previous responsibilities) have not transferred;

• Financial resources transferred from LHBs and trusts – in a number of cases the budgets transferred from LHBs do not fully reflect the current costs of running the service, as a result some services will be starting off in a deficit position. The underlying deficit is being finalised and falls within a range of £0.4m to £1m. Further work is necessary to determine the baseline and sign off budgets with Directors of Finance;

• Baseline staffing information – data quality issues with the information held in ESR has had a significant impact on the time taken to draw accurate information for development of the business plan;

• Insufficient designated finance and corporate resources – Whilst there are potential synergies to be gained from shared services, there is a gap in the resources available to cover corporate areas. Whilst significant support is currently being provided by NLIAH, this area needs to be formalised;

• Communication - effective communication will be key to successful staff engagement but requires innovate solutions in a virtual organisation;

• Staffing – the recruitment and retention of staff will be a vital part of NWSSP’s ability to deliver the services required by LHBs and other clients, especially as we enter a period of financial constraint and significant change. As a key service principle it is essential that NWSSP is in a position to provide sufficient training to its staff, so as to enable them to be fully competent and qualified to carry out tasks in an effective and efficient manner. Failure to do this may result in delays in driving forward service and savings plans.

• Managing the introduction of new / enhanced systems – the changes envisaged over the next few years represent a considerable challenge to NWSSP and NHS Wales. Proposals when developed will need to be based on realistic and robust assumptions progressed within a tight project management framework to ensure business goals are delivered on time and within approved budgets.

5) Key issues




6) Supporting the Business Plan

Introduction The business plan will need to be supported by a range of activities across NWSSP addressing issues of efficiency, governance and infrastructure. A major challenge for 2011/12 will be to establish the NWSSP arrangements and develop the culture and behaviours to support partnership working with service recipients. The arrangements for implementing the plan will need to be developed, including project planning, timetabling, key milestones and monitoring. The main initiatives that will be undertaken are outlined in the remainder of this section

a) Managing Performance We will develop a comprehensive performance dashboard which assists in driving the NWSSP’s performance. The dashboard will be interrogated at various levels and provides performance data on the following:

• Financial performance;

• Specific service level operating performance;

• Project performance;

• Key performance indicators (KPIs);

• Customer satisfaction;

• Benchmarking of operational processes and industry standard services; and

• Employ engagement and satisfaction.

During the year, the system will evolve to include client satisfaction measurements. The KPIs used by NWSSP will measure performance of our services at the highest level and at local level. Many of the KPIs are already in place however other KPIs will need to be developed over time.

b) Benchmarking We will undertake a benchmarking exercise of our services and use the resulting data to highlight areas where driving performance towards the market’s highest performers will bring customer, operation and financial benefits.




c) Customer Relationship management

NWSSP understands the importance of Customer Service in the delivery of services

to individuals and groups. A draft strategy has been developed to help create and

develop a positive approach to Customer Service in which we strive to consistently

exceed the expectations of our customers. We aim to create an environment within

which 'Customer Service' is seen as essential to the management and delivery of

services.

The aim of this strategy is to ensure that all users of NWSSP services including our

staff are treated as valued customers. The strategy focuses on creating the overall

conditions under which excellent service delivery can be achieved. In particular:

• The Shared Services Committee will have representatives from each health organisation in Wales;

• Each health organisation will have a nominated Management Contact who will ensure regular review meetings are held with that organisation to cover key developments and issues;

• Service User Groups will be established for functional areas e.g. Payroll, Recruitment and Accounts Payable to ensure engagement in service development; and

• An issue and complaints process will be developed to ensure that problems are resolved and lessons learnt.

We will regularly conduct structured customer satisfaction surveys. These will provide valuable feedback to enable action plans to be created to improve our customer’s experiences. The areas surveyed will mirror our KPIs but also include an overall customer satisfaction result based on customers being asked to consider all aspects of the service they currently receive.

d) Communication NWSSP recognises the importance of effective communication in a brand new virtual organisation with over 1300 staff and a wide range of stakeholders. NWSSP is committed to producing a communication strategy which will cover both internal and external communication. An initial communication plan was developed by the Shared Service Programme Board. This now needs to be refined and developed to cover internal and external communication and will build on existing best practices within the NWSSP services organisation and from a review of other approaches.




Significant operating risks

Significant contractual

risks

Business plan

risks

Significant

project risks

Significant directorate

risks

External

Strategic risks

Corporate

Risk Register

e) Risk Management The effective Management of Risk is vital to the success of NWSSP. It will inherit a number of risks from the project phase and these will need to be effectively managed during the early phases of operation. A corporate risk register will be developed as part of the overall risk management framework, structured around the sources of risk and the following themes:

This structure will provide clarity of risks across the organisation; it will highlight all significant sources of risk and allows action plans to be tailored to the classification of risk. The corporate risk register will be supported by risk management arrangements through the organisation and a corporate risk management group that ensures the Shared Services Committee is aware of risks emerging in the business. The corporate risk register will be reviewed regularly by the Senior Management team.




f) Sustainability NWSSP is fully committed to long term sustainable development and will strive to promote awareness of, and engagement in, sustainable development across all business activities. We will:

• Implement a sustainable development action plan

• Promote continuous improvement in sustainable development practices

• Continuously review best practice in sustainability issues

• Engage with key stakeholders and business partners on relevant aspects of sustainable development

• Maintain an environmental management system to measure, manage and report performance

• Incorporate sustainability into strategic plans, business plans and business cases

• Embed sustainability into operational activities

• Provide appropriate training and guidance materials for our people, contractors and other stakeholders in sustainability and environmental issues.

To retain the focus on sustainability and ensure sustainable development remains high on our agenda, a sustainable development action plan will be developed. This will be reviewed on an annual basis and highlight the key actions that will be undertaken to minimise our impact on the environment.

g) Estates An estates strategy will be developed to support the business by ensuring our property portfolio is fit for purpose and suitable buildings are available in the most appropriate location to help us achieve services excellence and value for money. The Strategy will focus on continuously reviewing our property needs to actively manage the property portfolio when business events, and to lesser extent, market conditions, dictate.

h) Information Governance Information governance is concerned with the way in which we handle all organisation information including sensitive and personal data. Each LHB and Trust will have arrangements for managing information governance in accordance with the requirements set up in NHS Wales. NWSSP will introduce similar arrangements which will dovetail into existing policies. Effective and responsible management of such information will be a very high priority for NWSSP.




Currently NHS Wales LHBs and Trusts internal policies and procedures will be used to provide the framework for handling data. During the first year NWSSP will focus on the following areas;

• Information Governance Management;

• The Confidentiality NHS Code of Practice;

• Data Protection Act;

• Information Security;

• Information Quality;

• Records Management; and

• Freedom of Information Act




7) The Financial Plan

a) Financial Baseline once figureceived

2011/12 Financial Baseline £000 £000

2010-11 Budgets for services transferred to NWSSP

• Pay 37,513

• Non Pay 9,655

Budget available to NWSSP 47,168

Funding to be transferred re budget deficit 577

NWSSP running Costs: Pay 355

NWSSP Running Costs: Non Pay 175

2011/12 Recurrent Baseline before cost pressures 48,275 Cost pressures

Pay

• Pay Award / National Insurance impact 625

• Incremental Drift 325

• Assistant Director - Internal audit appointment 100

Non Pay:

• Inflation general 409

• General Contingency reserve 250

1,709

2011/12 Recurrent baseline prior to savings 49,984 Additional budget requirement 2,816

Funded by Shared Services Business case savings 1,622 Additional cost savings / income 737 Money to be confirmed 577 2,936 Direct savings for distribution to WG, LHBs and Trusts 120

The budget can be analysed over services as follows:




Financial Plan There are 2 distinct elements to the NWSSP budget:

1. Services undertaken on an All Wales basis – Facilities, Legal and Risk Services, Risk Pool Services, Contractor Services and the former element of Welsh Health Supplies Procurement Services and Prescribing Services; and

2. Services previously undertaken within LHBs and Trusts - Accounts payable, Procurement, Employment Services and Internal Audit.

Services undertaken on an All Wales Basis Approximately 60% of the budget is associated with services that have traditionally been provided on an All Wales basis. The respective budgets are relatively self contained and the funding in respect of the All Wales services have all been agreed on a timely basis. Services previously undertaken within LHBs and Trusts The identification of the budgets associated with services previously undertaken within LHBs and Trusts has been challenging. A significant amount of work was undertaken by the Shared Services Finance Work stream and subsequently by NWSSP in conjunction with LHBs and Trusts to identify the baseline budgets for 2011/12. During June and July NWSSP has been provided with detailed budget reports and staffing information from LHBs and Trusts which have been reviewed and analysed in detail. This work has identified differences in the way that budgets have been determined in individual LHBs and key differences in some of the principles applied eg local cost improvement targets have been set in some LHBs. As a result of the inconsistencies the following principles were discussed and agreed at the All Wales Director of Finance meeting on 15th July 2011. Key principles Shared Services is a ministerial priority supported by a business case and was established to improve service levels and quality within Wales and to bring about financial benefits through maximising the opportunities of scale. In order to achieve this it is essential that it is established with a solid financial baseline that is clearly understood. The overriding principle agreed is Shared Services should not be set up to fail and it is imperative that NWSSP is set up with a balanced budget.

The overriding principle is supported by the following underpinning principles:

1. The resources should be consistent and based upon the financial declarations produced by the Shared Services Finance Workstream in March/April 2011.




The 2010/11 budget should be used as the financial baseline for 2011/12 subject to consideration being made for any overspend that arose in 2010/11.

2. The 2011/12 in year cost pressures will be met through efficiencies and savings made by NWSSP. Local CIP programmes will not be applied to NWSSP related budgets, however the overall level of direct savings required from NWSSP will be determined and set by the NHS Wales Shared Services Partnership Committee.

3. The liability for any inherited deficits will remain with the relevant LHB or Trust.

4. The agreed financial baseline for each LHB and Trust should be formally signed off. The accountability and therefore the liability for any inherited deficits remains with the LHB or Trust. However there is a shared responsibility to deliver the business case benefits.

In order to discharge the above principles and objectives the following key operating principles have been agreed:

1. Existing SLA agreements between NWSSP and LHBs and Trusts for hosting arrangements eg Procurement Services, Risk Pool will remain at 2010/11 levels. Similarly charges levied on LHBs and Trusts for All Wales Services provided by NWSSP eg Materials Management SLA will remain at 2010/11 levels.

2. The overall control of the budget for Shared Services has been delegated to the Director of NWSSP through NHS directions and amendments to standing orders and financial instructions that have been agreed by each Board. Further delegation where appropriate for the management of Service budgets being made to members of the NWSSP Senior Management Team.

3. Budgets for NWSSP services will remain in the financial ledgers of NHS Wales Organisations and will be reported as part of the overall financial position of individual LHBs and Trusts.

4. LHBs and Trusts will provide NWSSP with relevant staffing and financial information by the 7th working day of each month.

5. There are differences in the manner which non staff budgets are reflected within LHBs. In some LHBs such budget and expenditure is allocated to individual cost centres, in others elements are maintained centrally. Where historically expenditure has not been separately identified NWSSP staff will continue to have the same level of access to central budgets as in prior years eg training.




Agreement on financial baselines Good progress has been made and overall agreement in principle has been reached in all meetings held. The detailed analysis of budget reports has identified a large number of relatively small issues in some organisations that could cumulatively prove significant. These matters are being resolved with LHBs and Trusts. In addition, staff in post and vacancy information has now been received to enable the costing exercise to be completed for comparison to baseline pay budgets. The findings are broadly consistent with the Month 4 information. Overall agreement in principle has been reached in the meetings to date and subject to the satisfactory completion of the staff reconciliation the budgets will be signed off in September 2011. The main outstanding matters are:

• Hywel Dda – the LHB is forecasting an outturn deficit of approx £200,000 on employment and procurement services. This represents an improvement on the declaration outturn position where an overspend of £257,000 was identified. There are also pressures on the Capital and PFI audit budget. NWSSP are working with the Hywel Dda Finance Director to resolve the issues.

• Betsi Cadwaladr – at month 4 there is a large YTD overspend identified which equates to a forecast outturn deficit of £300,000 - £350,000. The declaration position for 2010/11 identified a deficit of £317,000.

NWSSP will work with Hywel Dda and BCU to reduce the deficits during 2011/12 however any remaining deficit will remain in the respective LHB accounts and will need to be funded in the event of NWSSP becoming a hosted organisation. Summary of Budgetary Pressures The Budget Pressures outlined in the table above includes a general contingency reserve to cover unexpected cost pressures that may arise eg VERs. In the event that this is not required it will be distributed to organisations. There are also a number of significant financial risks including:

• Business continuity of some transactional services – in particular the payroll services transferred from tow LHBs are significantly under resourced and have required immediate support from the wider payroll resource to deliver the core service. Additional short term support from Aneurin Bevan has also been obtained to cover the ongoing absence of the Head of Employment Services. The ability to generate financial savings in the short term is challenging and action is being taken to stabilise the situation ;

• Shortfalls in senior managerial resources - LHBs have transferred direct staff to NWSSP however certain senior management within LHBs and Trusts (with NWSSP services as part of their previous responsibilities) have not transferred; and




• Staffing – the recent appointment of the Assistant Director–Audit & Assurance from outside the existing internal audit staff has resulted in an additional cost pressure.

b) Savings The Business Case highlighted a range of potential savings both qualitative and quantitative. Direct savings achieved from Shared Service operations will be shared in accordance with the benefit distribution methodology agreed with DoFs in May 2011. It should however be noted that direct savings on WG funded services will be redistributed to WG. The Shared Services Business case identified the need to generate direct savings of £1,622k in 2011/12 and this is supported by a detailed benefits register. Further work is ongoing within NWSSP to finalise plans to secure the additional savings of £737k required above. The total direct savings equate to 5% of the budget in 2011/12.

Service Savings £000

Employment Services 684 Procurement Services 160 Internal Audit Services 0 Legal and Risk Services 154 Risk Pool Services 0 Facilities Services 203 Contractor Services 241 Prescribing Services 180 Total 1,622

As well as direct savings arising in Shared Services there are also significant financial savings that will arise within Local Health Boards and Trusts as a result of the professional influence of Shared Services e.g. Procurement – over £30 million see appendix 4 for further details. Distribution of Savings Application of the key principles should result in the types of savings and benefits distribution as follows:

Types of Savings* Approach to Distribution

e.g. Source of Savings

Transactional Savings – Local Initiative

Local Saving retained net of any recharges

Payroll & Recruitment Services and P2P Services (e.g. transfer of work between sites due to standardisation and streamlining of processes)




Types of Savings* Approach to Distribution

e.g. Source of Savings

Transactional Savings – National Initiative

Shared pro rata to 2010/11 costs Share agreed in advance

Payroll & Recruitment Services and P2P Services (e.g. New IT systems reducing manual workload).

Regional Collaboration

Shared between those organisations affected on a pro-rata basis

Sharing 1 post between 2 organisations when a vacancy occurs

Intelligent Client Role

Local saving Legal Services; Internal Audit Services; Capital Project Management (e.g. in-house and not contracted-in work)

Reduced running costs of an existing all Wales service

Shared pro rata to 2010/11 costs/ contributions

Contractor Services (e.g. restructuring of management arrangements)

Economies of Scale Shared pro rata to 2010/11 costs

Payroll & Recruitment Services (e.g. reduced costs of ESR fees)

*Available savings after the funding of any I2S requirements or additional marginal running costs. **Benefits will only be distributed to individual LHBs once any underlying deficit has been eliminated

C) Funding Flows The principles for funding flows are as follows:

• The process must be simple and transparent;

• Administration must be kept to a minimum and transactions minimised;

• The way in which the benefits are distributed must act as a positive lever for

change;

• The process should ensure that the NHS Wales Shared Service Committee (and

Management Team) has clarity of existing relevant spend and its associated

activity;

• The opportunity to re invest savings to produce enhanced savings must exist if

Shared Services are to deliver its full potential savings; and

• The proposed approach should ensure and develop organisational commitment

to NWSSP.

Whilst the Funds Flow for many areas remains unchanged a number of specific changes are proposed for the reasons outlined below (detailed analysis is shown in Appendix 3):




• Internal Audit - The budget will still be held in the ledger of each Health

Organisation but will be managed by and be the responsibility of NHS Wales

Shared Services. The savings made through the shared service changes will

be reflected in the ledger of each organisation;

• Contractor Services - It is proposed to amend the funding to reduce the level

of recharges and therefore the associated administration of this process.

This meets with the legal advice received and is also in line with the

principles of the project in terms of reduced administration. This will leave

the head of service time to focus on key activities linked to gaining best

value for NHS Wales;

• Accounts Payable and Procurement - The budget will still be held in the

ledger of each Health Organisation but will be managed by and be the

responsibility of NHS Wales Shared Services. The savings made through the

shared service changes will be reflected in the ledger of each organisation;

• Payroll and Recruitment - The budget will still be held in the ledger of each

Health Organisation but will be managed by and be the responsibility of NHS

Wales Shared Services. The savings made through the shared service

changes will be reflected in the ledger of each organisation; and

• ESR Payroll Fee – to minimise recharging and recirculation of funds this fee

will be paid to one organisation and expenditure due will be settled directly

with WG.

Any savings achieved from Shared Service operations will be shared in accordance with the benefit distribution methodology.

d) Budget Finalisation A considerable amount of work has been undertaken by the Shared Services Finance Workstream to identify the resources to be transferred to NWSSP. The work is substantially complete however:

• SLAs with WG for All-Wales service budgets are still in the process of being

finalised; and

• Resources for services previously provided by LHBs and Trusts require final

sign off with Directors of Finance.

The budget will be updated to reflect the outcome of the above.




8) Service Improvement Overview

Introduction Over the last few months several Shared Service Programme workstream meetings have been held in conjunction with LHB, Trust and WG colleagues to start to develop Service Development Plans (SDPs). Further work will be carried out during the early part of 2011/2012 to further refine SDPs, through more meaningful engagement with customers and stakeholders including the development of robust Key Performance Indicators (KPIs) which will aid the measurement of the continued improvement of services provided across the Health Communities in Wales. As part of this process the NWSSP aims to achieve a higher degree of consistency and standardisation across all services in Wales. That said it is recognised that “one size” does not always fit all and it is important that the local focus is not lost.

a) Procurement Services Challenges Faced Procurement Services as a function has been established out of the wider reorganisation of services within NHS Wales and more specifically the Shared Services project. Procurement Services is an NHS Procurement organisation providing a Sourcing, Purchasing, Materials Management, Payments and Equipping service to NHS Trusts and Boards in Wales. The next few years will undoubtedly be characterised by large scale, complex change. Key Improvements / Changes Change Benefit

Deliver £20 million plus figure of cash realising savings.

Supports the delivery of individual Boards/Trusts overall CIP target. This helps deliver more benefit to frontline services as efficiencies are made.

Deliver an end to end Supply Chain solution with full electronic ordering & reporting.

Will help deliver a more efficient and effective service. It will reduce overall cost, eliminate unnecessary waste and reduce non added value activity. It will provide a consistent level of system and service across Wales.

Develop a Sourcing function that manages the entire Sourcing Strategy for NHS Wales, including Capital Equipping.

Standardise on recognised Procurement Best Practice for all processes, and contracting once for Wales. This will help deliver a common way of working which will reflect current Best Practice. This allows more of a flexible approach




Change Benefit

to moving work around and consistent approaches. It should reduce errors and the need for “re-work”. Helps in developing and training of staff.

Develop an integrated Purchase to Pay function for Wales which is utilising the best available technology

Deliver transaction savings from all processes particularly invoice payments. Deliver a more efficient and effective system and reduce cost. It will provide a modern way of working and offer benefits for suppliers.

Develop staff to deliver to their full potential. Building staff capabilities to deliver benefits and realise new opportunities.

We need a skilled, focused and inspired workforce. They need to have the skills to “do the job” and to rise to the challenges of change that we will work through.

Support Needed

• The availability of IT and systems is critical and this is particularly key in the Delivery of the Accounts Payable process savings;

• Board and Trust support on the delivery of savings is key particularly with clinical reference

• Most importantly will be the support of the staff going forward;

• Stakeholder “buy in“ and support for the principles; and

• The support of our partners

Success Criteria The overall plan details a number of KPIs that will be important at a number of levels.

b) Employment Services Challenges Faced

Challenge Solution Obtaining buy in from staff to support the required changes.

• Involve staff in developing proposed solutions to change working practices.

• Train and develop staff including the acquisition of new skills such as service improvement techniques.

• Openness, honesty and transparency throughout.

• Work in partnership with staff from the outset.




Challenge Solution Obtaining support from staff side representatives for the required changes.

• Work in partnership with staff side from the outset.

• Openness, honesty and transparency.

• Enable representatives to participate in the change.

• Ensure representatives have a thorough understanding of what a shared service means.

Ensuring service recipients are engaged with the service and support the change management process.

• Effective customer service links are developed.

• Develop the customer/provider relationship to ensure a common understanding.

• Engage key individuals in developing new ways of working.

Development of relevant and appropriate technological solutions.

• Ensure key Business and Systems support staff are involved in all stages of the procurement process.

• Learn from others who have experienced the process and the consequent changes.

• Network with relevant colleagues in shared services.

Ensuring the service is up to date and future proof.

• Strong networking and benchmarking.

• Robust development plans are in place.

• Learn from others.

Current services are inconsistent in relation to scope, quality, size and resource.

• Scope the services and quantify resources required.

• Engage with staff and service recipients in developing plans to standardise services.

Key Improvements / Changes Change Benefit Safe transfer and stabilisation of existing services a) Transfer recruitment teams as per

the agreed phased implementation plan and financial framework.

b) Assess the service provision against

resources transferred.

a) Reduced risk of service failure.

b) identify any shortfalls in service provision against individual legacy statements.




Change Benefit c) Implement agreed governance

arrangements for the services. d) Review business continuity plans

and develop standardised plan for the services.

c) Reduce risk and ensures compliance.

d) Reduce risk of service failure

Procedures & protocols Internal i) Standardisation of internal

procedures & protocols.

a) Reduced costs and increased efficiency through standardisation of processes and use of best practice.

b) Improved ESR data quality through correct and timely data being entered onto the system.

c) Reduced overpayments due to improved working practices.

Management information Standardised internal management information systems (i.e. Recruitment management database; Errors and overpayments reporting database; risks, issues & complaints logs).

• Production of relevant KPIs.

• Standardised method for calculating cost per payslip.

• Evidence based information.

• Improved customer service.

Electronic solutions a) Implementing year 1 e-Expenses

project plan. b) Prepare strategy for implementing

Web ADI. c) Implement project plan for the

new NHS Jobs system.

• Improved efficiency and reduced costs.

Service model and supporting management structure a) Review interim structure put in

place for 1 April 2011 and implement appropriate changes as required until implementation of the final service model and management structure.

b) Develop and agree future service model based upon the strategic vision for shared services.

• Improved governance.

• Clarity of vision and strategic direction.

• Effective management arrangements in place.




Change Benefit c) Develop future management

structure based on agreed service model.

d) Develop critical areas such as Business Management and Project Support, Service improvement, customer services.

e) Develop HR systems team to support service delivery and the provision of critical management information.

• Improved operational performance.

Support Needed

• Assessment of the expectations of service recipients to establish the future direction of travel.

• Service recipients must be engaged with the service and support the change management processes;

• Flexible use of financial resources and significant business systems and IT support;

• Capital investment through Invest to Save and other relevant schemes.

• Staff side buy-in and shared services staff support;

• Freedom to develop services within agreed parameters; and

• Investment in project management, service improvement, staff training and development and customer services.

Success Criteria Safe transfer and stabilisation of existing services

a. Transfer plan implemented successfully;

b. All shortfalls identified and either level of service adjusted or additional resources secured;

c. Governance arrangements operating effectively; and

d. Business continuity plans in place and understood.

Procedures & protocols

e. Standard internal procedures rolled out across Wales;

f. ESR data quality input by the service meets agreed minimum criteria;

g. Overpayments protocol fully implemented in all NHS organisations; and

h. Staff understand procedures and protocols and have been provided with the relevant training.




Management information

i. A consistent and comparable set of performance indicators for payroll and recruitment services is provided to relevant individuals within service recipient organisations; and

j. Targets are agreed and progress towards them is identified.

Electronic solutions

k. Target levels of implementation plans achieved;

l. Savings targets delivered; and

m. Customer satisfaction increased.

Service model and supporting management structure n. Future service model delivered;

o. Effective management structure in place;

p. Staff understand agreed reporting arrangements; and

q. Shared services customer services framework implemented.

c) Welsh Risk Pool Challenges Faced

• Lack of clarity regarding assessment role in 2011/2012;

• Need to agree to broaden assessments to include higher level governance issues around the Emergency Dept, Maternity and Surgical front line areas; and;

• Finance support for Welsh Risk Pool and Legal & Risk

Key Improvements / Changes

Change Benefit Re-introduction of financial incentivisation scheme for improved practice.

Broader ownership of risk management issues and their implications.

Work with Internal Audit. Reduce opportunity for duplication in gaining assurance for non-financial issues.

Make more use of joint L&Rs/WRP database to inform and educate NHS Wales.

Increase awareness/broaden lessons learned.

Expansion of current training and education role in risk management eg MSc, tailored training.

Improvement in practical knowledge of how to evaluate and control risk and improve practice.




Change Benefit Themed initiatives around high risk areas.

Lead development and adoption of national initiatives in identified risk areas.

Success Criteria

• Agreement and roll out of incentivisation system;

• Working arrangement with Internal Audit;

• Continue with current networking arrangements; use of data as part of education and training provision;

• Successful completion/qualification by students; and

• Identification of national risk issues and solutions.

d) Facilities Services Challenges Faced The NHS Estate is a critical component in the delivery of safe, effective and efficient healthcare services and patient surveys consistently demonstrate that the standard of healthcare buildings and facilities management services have a huge impact on the patient experience. NHS Wales has an interest in over 500 properties, occupying 1.8 million m2 and incurring revenue costs of £330 million per annum. In 2010/11 over £400 million was invested in capital procurement, of which the majority was in respect of building projects. Property generally is an expensive asset but healthcare property is particularly costly and the more we can rationalise the NHS Estate, the more resource can be redirected to front line services. Good work has been done by NHS Wales in recent years in this regard but further progress is now needed as the financial pressure of reduced funding starts to take effect. Key Improvements / Changes Change Benefit

• Implement a national property management service utilising the e-PIMS database.

• This initiative will require NWSSP-FS to provide all professional services in respect of NHS Wales’ property management needs

• Will assist Health Boards/Trusts in the more efficient and effective management of property and better utilisation of the NHS Estate.




Change Benefit Develop a more robust approach to the management of capital projects. This initiative has 3 aspects;

a) Streamlining the business case process;

b) Improving the Designed for Life Building for Wales Framework; and

c) Introducing in-house construction project management services.

• Will contribute to a more efficient and effective management of capital delivering better value for money.

• Develop estate management solutions for those NHS organisations currently lacking the critical mass to fulfil this function.

• It is proposed that work is undertaken to explore the possibility of the smaller NHS organisations being managed as a single entity from an estates management perspective with NWSSP-FS overseeing and supporting the arrangement or alternatively for one of the Health Bodies to fulfil this function.

• Better use of existing estate management resources and the control of estate risks.

Support Needed NWSSP - Facilities Services is fully funded by the Welsh Government to provide advice and support to the Welsh Government’s Health Department on all matters of asset management and to provide specialist services to NHS Wales. To implement any changes requires the support of both the Welsh Government and NHS Wales and NWSSP-FS always engages its key stakeholders in all of its change programmes. This applies to all aspects of the Service Improvement Plan. Property Management – NWSSP-FS are currently working on the premise that the delivery of a national property management service can be absorbed within its existing establishment. This is based on the assumption that approximately 250-300 new leases will be identified by Health Boards/Trusts. Whilst NWSSP-FS will provide all professional services in respect of the NHS Wales’ property management requirements, a local contact liaison officer will be required at each Health Board/Trust. Capital Projects – Good progress has already been made with improving the business case process and NWSSP-FS is currently procuring a new Regional




Framework for 2011/12 with a replacement National Framework to follow next year. To develop a construction project management service NWSSP-FS will require additional funding from Welsh Government to recruit a small team of project managers to fulfil this role. NWSSP-FS are currently in discussion with the Welsh Government regarding this funding. Estate Management – A number of the smaller Health Boards/Trusts do not have the critical mass to support the full range of resources needed to manage their estate. To explore opportunities for further collaboration will obviously require the support of those organisations directly effected. Success Criteria

• If a property rationalisation programme could achieve a 5% reduction in space, revenue savings of £15million+ would be delivered. In addition the very significant backlog maintenance investment needed in those assets that should be rationalised, estimated at £23 million, could be redirected to assets with a greater strategic significance for NHS Wales. A national property management service would also cost less than the current disaggregated arrangements;

• Even after the capital budget reductions planned for the next 3 years, capital expenditure across NHS Wales will be well in excess of £200million per annum. A 5% efficiency improvement would indicate a £10million+ saving per annum. A national construction project management service will also cost less than the current arrangements and offer more scope to deliver the efficiencies require; and

• The potential financial savings in establishing sustainable estate management arrangements are more difficult to estimate than those associated with property management and construction procurement. This initiative is more directed to improving the effective management of estate risks which can yield substantial operational benefits.

e) Legal and Risk Services Challenges Faced Challenge Solution

• Obtaining buy in from LHBs to utilise effectively an ‘in house’ legal service, and ensure effective use of the services available under the legal services framework contract.

• Involve Board Secretaries and relevant Governance staff in developing proposed solutions to change working practices to avoid ‘scatter gun’ purchase of legal advice.

• Ensure staff receptive to changes.

• Raise awareness of process of obtaining legal advice at Board level.

• Work in partnership with client LHBs from the outset.




Challenge Solution

• Obtaining support from ‘in house’ staff to respond to broader legal issues.

• Training and personal development of staff in additional specialties.

• Offer opportunities to alter work profile.

• Recruit appropriate specialists where appropriate.

• Ensure staff and customers have a thorough understanding of ‘in house’ legal service.

• Ensuring customers are engaged with the service and support the need to provide more information about external legal expenditure.

• Request information about expenditure in tender process.

• Effective customer service links are developed.

• Develop the customer/provider relationship to ensure a common understanding.

• Understanding of current legal expenditure.

• Collate information received during tender process.

• Ensuring the legal service is competitive on cost and exceeds customer expectation.

• Efficient processes

• Robust training and development

• Continuation of Lexcel.

Key Improvements / Changes Change Benefit

• Centralisation of requests for legal advice.

• Reduction of reliance upon external legal providers under the new contracts.

• Improve cost and compensation data capture.

• Grow ‘in house’ expertise over all relevant healthcare advice.

• Better integrated working with WRP on risk management and implementation of risk management strategies.

• Early notification of risk areas arising out of compensation claims.

• Reduction of duplication, consistency of advice, reduction of expenditure.

• Raise awareness at all levels within NHS currently insufficiently recognised.

• Reduce costs of legal advice.

• Reduce risk and ensure compliance.

• Reduce risk of service failure

• Improve outcome for patients.




Change Benefit Procedures & protocols

• Increase use of database reports to provide service with comprehensive information on areas of risk and trends.

• Reporting of risks identified in claims in a structured manner involving Risk Managers and Governance teams.

• Develop streamlined payments system.

• Improve risk management and harm to patients.

• Reduce cost of payments to external providers of advice.

Staff Development Opportunities

• Training and development in areas not currently undertaken.

• Improved staff retention and job satisfaction.

Electronic solutions

• Move towards paperless office-scanning and greater use of IT.


Support Needed

• Acceptance and cooperation of Board Secretaries /Governance managers with responsibility for legal expenditure;

• Recognition and promotion of ‘in house’ legal expertise by Director and National Committee;

• Utilisation of ‘in house service by Shared Service Partners;

• Service recipients must be engaged with the service and support the change;

• Significant IT support;

• Freedom to develop services within agreed parameters; and

• Investment in service improvement, staff training and development and customer services.

Success Criteria

• Increased level of legal instructions on non litigation matters;

• Customer satisfaction with all legal assistance;

• Appreciable reduction in legal expenditure;

• Continued accreditation –Lexcel; and

• Compliance with KPIs.




f) Contractor Services Challenges Faced Contractor Services was previously an established department within the Business Services Centre providing shared service support to LHBs and independent contractors on an all-Wales basis. With the creation of the NHS Wales Shared Service Partnership from 1 April 2011, there will be a continuing emphasis on support with a view to providing a high quality service on a cost effective basis. In order to respond to the current economic position affecting the NHS in Wales, there will be a need to review both pay and non-pay budgets in order to address cost efficiency targets. This will involve reviewing accommodation costs, lease arrangements and various support contracts, together with a full review of management and staffing arrangements across Wales. This will be against a backdrop of introducing new technology and changes in the way Contractor Services operate as well as undertaking benchmarking exercises with similar organisations in other parts of the UK in the further development of best practice. There will undoubtedly be clear expectations from Health Boards that there will be savings from NWSSP and it will be important to identify early ‘wins’ that can eliminate the doubts regarding the creation of a shared serve organisation. Key Improvements/Changes Change Benefit

• Review Senior Management Arrangements:

a) Management will need to be appropriate for new organisational needs.

b) Release of both financial and human

resources.

c) Improved standardisation of working

processes/procedures.

d) More focussed service delivery.

e) Improved operational performance

• Review of other Management Posts. a) Reduced costs and increased efficiency through removal of




Change Benefit duplication and introduction of best practice.

b) Standardisation of working. c) Improved customer service. d) Improved corporate governance.

• Review of Systems/Procedures – Modernisation

a) Undertake consistency reviews across each of the regional offices in each of the 5 functional areas of:

▪ Contracts Management ▪ Payments Authorisation ▪ Registration ▪ Business Support ▪ Post Payment Verification

a) Review all systems/processes with a view to maximum standardisation.

c) Discuss with customers changes that might be required to SLAs. d) In-sourcing of work currently delivered through external contracts

Review of Office Locations a)Reduction in number of sites. b)Reduction in lease costs. c)Reduction in pay costs

Review of all internal and external contracts

d) Work with procurement team to identify more cost effective contracts.

b) In-sourcing of contracts

Support Needed Engage Health Boards in supporting shared service principles by providing clear examples of benefits arising from the new arrangements. Ensure that staff are fully involved in any staffing or service changes that are planned. Site rationalisation is a major risk which should not be underestimated. The support of NWIS is vital not only to support existing IM&T arrangements in Contractor Services, but also to support key developments such as Performers Lists. It is likely that there will be an increased requirement for this support as the service changes and possibly expands.




Capital investment will be required if service is centralised and located on one (or two) sites. It will be important to ensure that trade unions are kept fully informed of all potential changes and that HR advice is available at all times. Clear communications strategy to be developed that seeks to ensure that all stakeholders, patients and other organisations are kept fully informed of the development and delivery of shared services. Development of training plans with support from OD and external training sources. Success Criteria

• Ensuring ‘business as usual’ and that changes, particularly in respect of reductions in senior management do not de-stabilise the service;

• Budgets are kept under control and identified savings are achieved;

• Key improvements are achieved within budget;

• Key Performance indicators are continually achieved;

• Electronic solutions replace paper based systems;

• New management arrangements are introduced;

• Staff respond to and support changes;

• Customers receive a high quality service and are involved in shaping shared services; and

• Significant savings achieved without loss of quality of service.

g) Audit & Assurance Services Challenges Faced

Challenge Solution Obtaining buy in from key stakeholders • Presentations to Audit Committees

and professional group meetings (eg, Board Secretaries, Directors of Finance);

• Key stakeholder representation and input to the shared service internal audit model and the resultant Service Improvement Plan;

• Work with other internal and external review and inspection agencies to develop the vision for the shared service internal audit model; and




Challenge Solution

• Respective Heads of Internal Audit in regular two-way communication with their Boards and Audit Committees.

Deliver high quality service to all organisations

• Developing an all Wales needs assessment and audit planning tool;

• Developing an all Wales Standardised and computerised audit methodology and approach;

• Developing a standardised and robust quality control process for audit products;

• Adoption of the NHS Wales Internal Audit Standards; and

• Developing a standardised set of key performance indicators for Audit Committees and Boards to assess internal audit performance.

Address the inconsistency in internal audit days across NHS Wales organisations

• Developing an all Wales needs assessment and audit planning tool;

• Discussing with Boards and Audit Committees their existing sources of assurance; and

• Discussions with external audit and inspection agencies to help identify optimum internal audit resources per organisation.

Mechanism to provide organisations with “choice” of audit teams / personnel

• Developing an all Wales staffing model which includes flexibility of resource utilisation based on knowledge, skills and experience;

• Developing a standardised and robust quality control process to identify problems in service delivery (including rotation of staff if desired); and

• Associate Director of Audit and Assurance to meet regularly with Boards and Audit Committee Chairs to review performance, identify issues and initiate remedial action.




Challenge Solution Move quickly – outsourced provision due to expire

• Utilisation of shared service audit resource at Powys LHB with interim Chief Internal Auditor in place;

• Hand over discussions underway with other outsource providers whose contracts expire in April 2012; and

• Staffing model and gap analysis to be undertaken to identify possible recruitment needs.

Staff recruitment and retention for in-sourced contracts

• Ongoing and frequent communications with staff on shared services implementation progress;

• Developing a staffing model based upon career development and opportunities offered by the shared services model; and

• Gap analysis to be undertaken to identify potential resources and skills gap to inform recruitment decisions.

Develop effective liaison arrangements with the Wales Audit Office

• Schedule quarterly meetings with Wales Audit Office Engagement Partner with lead for Shared Service

Key Improvements / Changes Change Benefit Seamless transfer of service to the Shared Services Partnership

• Maintenance of robust and appropriate level of assurance for Boards and Audit Committees;

• Continuing reliance on internal audit work by external audit and other external review agencies; and

• Mitigation of risk of service failure.

An independent all Wales service led by the Associate Director Audit and Assurance

• Reduced costs and increased efficiency through standardisation of processes and adoption of best practice;

• Delivery of a consistent and high quality audit service based on a standard methodology and quality control process;




Change Benefit

• Availability of a breadth of skills to meet specific needs; and

• Single point of interface for stronger liaison with other internal and external review agencies to ensure optimum use of audit and inspection resources.

Utilisation of all Wales skills and resources

• Improved flexibility and speed of response;

• All Wales audit methodology includes in built flexibility to recognise organisation specific needs;

• Delivering a local service with significant national resource covering all of Wales; and

• Access to a broad talent pool with wider skills and experiences.

Standardised, computer based audit approach and methodology


• Standard and robust quality control and review procedures.

• Facilitates a consistent opinion in support of the statement of internal control.

• Improved technical audit effectiveness and compliance with documentation standards

All Wales reviews, value for money studies and advisory service

• Sharing relevant best practice of ‘lessons learnt’ in other NHS Wales organisations;

• An ability to retain and develop specialisms to match the future requirements of the NHS Wales organisations; and

• Proactive contribution to the service improvement agenda.




Support Needed

• Investment of approximately £40k required to upgrade and standardise IT and communications resources to enable development and implementation of a standardised and efficient audit methodology;

• Engagement from all organisations in an all Wales needs assessment to address the differences in resource provision and identify recruitment, training and development needs; and

• Development of the potential framework contract for private sector providers to address any specialist skills gaps.

Success Criteria

• Realisation of significant cash releasing savings in line with the business case;

• Delivery of a service which exceeds NHS Internal Audit standards and supports Audit Committees and Boards with pragmatic and innovative recommendations and advice;

• An appropriately skilled and respected inclusive model of service has been attained;

• Internal Audit established at the core of the NHS Wales integrated assurance framework and co-ordination with other internal and external review and inspection agencies;

• Internal Audit becomes an enabler to assist clients achieve savings and improved value for money;

• Elimination of variation in provision and assurance through the delivery of a standardised, in-house service; and

• Improved technical audit effectiveness and compliance with documentation standards .

h) Prescribing Services Challenges Faced Prescribing Services initiated an internal modernisation programme over 5 years ago and the momentum gained during this time has allowed the organisation to achieve a number of goals. This has included the automation of many of its processes through the workflow improvement programme which has enabled the unit to implement a near paperless pricing process. In implementing Key From Image (KFI) systems the unit has utilised technology to improve both individual processor performance and is now looking to re-engineer a number of its administration functions. The programme has been built with a strong staff engagement and acceptance of continuous change within the organisation and this will now require strong leadership acumen in order for the cultural change that has transpired to be maintained during the next phase of the programme.




Over the next couple of years the environment within prescribing services will be totally transformed as the business adopts an approach to automation. A multitude of prescription claims will be made on the organisation from manual written forms, through to computer generated and bar coded submissions and for the first time the receipt of electronic claims messages. Similarly to the WIP was launched the unit must put in place the environment now to be able to deliver a seamless service in the future, based on staff involvement in order to assure all stakeholders that quality and productivity remains at the heart of service provision. The other challenge will be in terms of Organisation Development in integrating within the NWSSP and to be able to learn and share experiences with other areas of shared services and to support the director in contributing to achieving the future expectations that will undoubtedly grow in terms of delivering efficiencies to NHS Wales. Key Improvements / Changes Change Benefits

Automatic data capture and pricing from 2DRx

• Improve the accuracy of reading barcodes up to 99% of all prescriptions;

• Reduce the use of Intelligent Character Recognition (ICR);

• Pre-populate information to pricing member of staff; and

• Need to develop automated ‘Rules’ engine, and maintenance as per any changes that occur in drug tariff.

• Less manual intervention needed on correcting information included in barcode;

• Improves quality of information needed to be manually entered where ICR can not pick up data;

• Throughput increased as well as improvement in quality; and

• Faster and more accurate throughput of pricing reducing manual resources.

Electronic Returns system

• To move from a paper based returns system improving services to the contractor;

• Allows PSU to improve it’s internal process of returns in terms of manual effort required to print prescriptions, double stuff envelopes and manage the returned items through the

• Allows contractors to make amendments and return changes within the same pricing month and being paid for the queried item in month;

• Reduce manual intervention and potential mistakes in sending forms through post. Critically it also reduces the risk of patient information being lost in the post,




Change Benefits

normal monthly declaration process; and

• Reduce postage charges to the unit.

together with the medicines prescribed to that patient; and

• Reduce non staff costs

Scanner replacement

• Sign off new scanners as part of the acceptance testing process;

• Install first scanner into production by the second week in April 2011 and to integrate this solution with the current PSU registration process environment; and

• Install second scanner into production by the second week in June 2011 and to also integrate this solution with the current PSU registration process environment.

• Allows for the planning of installation of the new solutions;

• Improves throughput of the images to the holding area and onward transport to the production environment; and

• As above, once installed the new solution will allow for improved barcode reading on the fly (up to 99% accuracy in contract) and provide the necessary capacity to scan more images from other areas of PSU, Shared Service or the wider NHS in Wales.

Implementation of DES claims service

• To implement the software and provide secure access for the contractor to make an e-claim for EHC;

• Provide automated system at an agreed date every month so that payments are generated based on e-claims made;

• Provide a payment file each month to BSC contractor Services to make actual payment to contractor; and

• Development of reporting information on a national basis.

• Provides a solution on the same platform as current information services;

• Reduce the need for a contractor to pass claims to the HB and then onto the BSC for payments to be made;

• Reduces transcription errors, lost forms and a seamless interface with current BSC payment system; and

• Provide rudimentary public health information at various levels of reporting from National, LHB, and locality to individual contractor for the purposes of planning. Also provides PPV information for scrutiny.




Change Benefits

Automatic data capture and pricing from ETC

• Need to incrementally increase the automated ‘Rules’ engine as required for the introduction of ETC and for the first time the automated transfer of both prescribing and dispensing information;

• To manage the transition of all production services currently provided by PSU where a mixed claims process is available to all service recipients within NHS Wales;

• Introduction of ETC will increase the throughput and improve quality of pricing information through automatically pricing information from electronic messages;

• This faster and more accurate throughput of pricing will considerably reduce manual resources; and

• The development of a completely new service delivery model will totally transform the current environment where resources will be able to be released for redeployment through Shared Services or the wider NHS in Wales.

Development of NHS Wales Medicines Management system and service requirements

• At present the Head of PSU allocates resources for developing systems and services within NHS Wales utilising the requirements gathered from the various bodies outlined above. After discussions with the new CPO, proposals are to be put forward to merge the 2 main user groups (Prescribing Services UG and Dispensing Services UG) and to create a committee to undertake the prioritisation of service improvements from a national perspective.

• Bearing in mind the scarce resources available to NHS Wales it will be imperative that these are allocated on a national basis in line with emerging policy and statutory requirements; and

• As the current software development staff inside PSU will remain within NWIS after transfer to NWSSP it is felt that formal performance management of these resources between NWSSP and NWIS will be important in delivering timely and efficient services to NHS Wales.

Support Needed Over a number of years support for Prescribing Services has mainly come from within the unit itself, especially in terms of service development through process re-engineering of functions within the unit and delivering improved quality and efficiency through automation. As a mainly self contained and unique service




within NHS Wales prescribing services has engaged with the stakeholder community in order for them to shape their requirements and to prioritise them accordingly based on legislative change and overall service improvement in supporting commissioners and providers alike. This should not be affected by the new arrangements under NWSSP however as a major element of the unit, namely the software development team, was transferred to NWIS then robust service level management will need to be adopted. Early indications suggest this will be a seamless mechanism that will allow full access to these resources as previously received under HSW. In taking forward the unit into the next phase of transition support will need to be gained from the NWSSP director in order that platforms can be put in place now in order to be proactive in shaping future service provision for prescribing services in Wales. Furthermore this can be a 2 way process where prescribing services can also contribute to the strategy for service improvement in terms of the wider shared service agenda. Finally it is imperative that the cultural change that has been shaped in prescribing services is maintained and this will be done with full on engagement with the staff and staff representative bodies. Success Criteria The overall success of prescribing services will be the acknowledgement of the service recipient organisations that continuous service improvement/development has been achieved in enabling them to deliver improved outcomes for NHS Wales. These will include improved services to patients, improved efficiencies within their organisations in delivering these services and ultimately doing ‘more’ with ‘less’. From a volumetric perspective each operational service provided and each development objective undertaken by prescribing services will need to be measured in the form of performance delivery and continuous improvement. These will be measured through key performance indicators at both organisation level and from an individual perspective through performance management and appraisal. Meeting service levels will be the responsibility of everyone involved in the organisation as will service improvement. This will be measured through a number of criteria including stakeholder engagement and feedback forums and from an internal viewpoint through criteria that includes improved productivity, quality and general management techniques to reduce/maintain levels of sickness absence as a key enabler to motivating the workforce.




9) Conclusion

The business planning process has identified many service improvements and developments from all the services but a recurring theme has been the need to standardise across a range of systems, policies and procedures. These differences in operational working practices, an inevitable consequence following the merger of different departments, are seen to be an opportunity to further improve the efficiency of service.

The detailed business objectives from the individual services have been formulated in order to improve services so that the NWSPP can provide, to LHBs, Trusts and other clients, a improved, cost effective, modern and efficient business and professional support services.




Appendices

1 The Origins of Services Provided 2 The Structure of the Organisation 3 Funding flows analysis 4 Benefits Register


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Appendix 1 - The Origin of Services Provided The services to be included within NHS Wales Shared Services with effect from the 1st April 2011 are as follows:

NHS Wales Shared Services [Overall Circa Value £50m with 1300 WTE (Mainly direct running costs for services)]

Business Services Professional Services

• Procurement Services:

o Purchase to Pay (formerly elements of Procurement & Accounts Payable from NHS Wales organisations).

o Sourcing* (formerly elements of Procurement from NHS Wales organisations).

o Supply Chain* (formerly Welsh Health Supplies)

• Payroll (from NHS Wales organisations)

• Recruitment (from NHS Wales organisations)

• Contractor Services (hosted by Powys tHB)

• Prescribing Services Unit (hosted by Velindre NHS Trust as part of NHS Wales Informatics Services)

* These services have both business & professional elements.

• Welsh Health Estates (hosted by Cwm Taf HB)

• Welsh Health Legal Services** (hosted by BCU HB)

• Welsh Risk Pool (hosted by BCU HB)

• Internal Audit** (from NHS Wales organisations) **Estimated outsourced values included.

This is the initial phase and it is intended to assess what other services can be most effectively delivered through a shared services approach during the next year.


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Appendix 2 - The Structure of The Organisation

NHS Wales Shared

Services Committee

Chair

Director of Shared

Services

Assistant Director NWSSP

(Finance & Corporate Services)


(Facilities Services)

Assistant Director

NWSSP (Legal & Risk

Services)

Head of Welsh Risk

Pool Services Head of

Contractor Services


(Employment Services)

Shared Services

Committee Secretariat

(NDG)

Shared Services Support Manager

Head of Prescribing

Services Assistant Director NWSSP

(Procurement Services)

Assistant Director

NWSSP (Audit & Assurance

Services)


of 84

Appendix 3 - Funding Flows Analysis. A review of funding flow has identified the current arrangements and planned changes which are outlined below.

Service Area Current Funds Flow Planned Funds Flow Prescription Services Unit

Prescribing Support

Funding provided direct from WG to the host organisation - Velindre

No Change

Pharmacy Support

Funded by recharge to Health Boards

No Change

Contractor Services

All Services Funding Allocated by WG to Health Organisations. Health Organisations are recharged by Host (Powys) by Invoices for services provided by Contractor Services

WG funding to be paid directly to Host (Powys)

Welsh Health Legal Services

Legal Liability - Health

Funding provided direct from WG to the host organisation – BCU

No Change

Other Legal Services

Provided on request and invoice issued

No Change

Welsh Health Estates

All Services Funding provided direct from WG to the host organisation – Cwm Taf

No Change

Welsh Risk Pool

All Services Funding provided direct from WG to the host organisation – BCU

No Change

Internal Audit Audit Services Funding provided by WG to Health Organisations who either provide this service internally or purchase externally.

Funding to be held by Health Organisations but managed by Shared Service Organisation to meet service obligations.

Capital Audit Recharges to Health Organisations for the work conducted.

No Change

Procurement Services

Accounts Payable

Funding provided by WG to Health Organisations who either provide this

Funding to be held by Health Organisations but




Service Area Current Funds Flow Planned Funds Flow service internally or purchase externally.

managed by Shared Service Organisation to meet service obligations.

Procurement Funding provided by WG to Health Organisations who either provide this service internally or purchase externally.


Welsh Health Supplies

Funding provided direct from WG to the host organisation - ABMU

No Change

Recruitment Funding provided by WG to Health Organisations who either provide this service internally or purchase externally.


Payroll Payroll Services

Funding provided by WG to Health Organisations who either provide this service internally or purchase externally.


ESR Payroll Fee

Currently the £100k ESR Payroll Fee is included within the funding for Health Organisations from WG and Recharged for the 7 payroll functions. This funding is received by WG and is in part used to Provide support to ESR (£140k)

The funding should be paid directly by WG to 1 Health Organisation which will hold it on behalf of Shared Services who will pay £240k to WG for the payroll fee and ESR Support. The balance will be a saving which will be used to fund Shared Service activities.


of 84

Appendix 4 - NHS Wales Shared Services Indicative Benefits Regi ster

Financial

Benefits in 1

Year £000

Cumulative

Financial Benefits to

year 5 £000

Total No of

Benefits

Audit & Assurance 0 645 10

Facilities Services 203 2,520 16

Legal and Risk

Services

154 2,310 20

Contractor Services 241 2,882 11

Prescribing Services 180 1080 16

Procurement Services 160 3,410 28

Employment Services 684 4,708 19

Total 1,622 17,555 120




Audit & Assurance Services – Indicative Benefits Regi ster

Benefit Type Ref Benefits Identified

Benefit s in Year

1 £000

Benefit over 5 years £000

Key Measurements Position as at 30 th June 2011 Owner Realisation

Date

Cash Releasing Economies of Scale

IA1 Insourcing internal audit

work that is currently outsourced

0 425 Comparison of cost of

insourced audits that were previously outsourced

HOIA 31.3.2016


IA2 Improved productivity through economies of

scale NIL 220

Cost of overall internal audit service compared with

baseline cost HOIA 31.3.2016

Cash Releasing Professional Influence

IA3 Sharing of best practice

and VFM savings across all LHBs

NIL NIL

Identification of VFM savings implemented throughout NHS Wales. Register maintained by

Internal Audit

HOIA 31.3.2016

Qualitative IA4

Opportunity to develop more beneficial

relationships with other internal and external assurance functions delivering optimum

value to organisations from their assurance

and inspection agencies

N/A N/A

Feedback returns from Audit Committees and external

review agencies. Reduced inspection burden

HOIA 31.3.2016

Qualitative IA5

Improved level of confidence and

standardisation of the level of assurance

mitigating risk across all organisations

N/A N/A Statement of internal control. WAO comments in Annual

Audit letter HOIA 31.3.2016




Benefit Type Ref Benefits Identified

Benefit s in Year

1 £000


Key Measurements Position as at 30 th June 2011 Owner Realisation

Date

Qualitative IA6

Risk based allocation of audit resources across all business areas, not

purely finance

N/A N/A

Sign off of risk assessment and resultant audit plan by

respective audit committees. Higher proportion of audits undertaken in non finance

audits

HOIA 31.3.2016

Qualitative IA7

The catalyst and driver to promote integrated

assurance across NHS Wales

N/A N/A Statement of internal control HOIA 31.3.2016

Qualitative IA8

Delivery of high quality standardised, IT

enabled and quality assured audit approach

which, through its managed use, will

strengthen its remit and approach which,

through its mandated use, will strengthen its

remit and independence

N/A N/A

All Wales standardised methodology and approach. Full reliance on internal audit

work by external review/ inspection agencies

HOIA 31.3.2016

Qualitative IA9

Output focussed on delivering a better

service with greater value

N/A N/A Stakeholder feedback and peer review

HOIA 31.3.2016

Qualitative IA10 Flexibility and speed of

response N/A N/A

Stakeholder feedback and peer review.

HOIA 31.3.2016




Facilities Services – Indicative Benefits Register

Benefit Type Ref Benefit Identified

Benefit in Year 1 £000


Key Measurement

Position as at 30 th June 2011 Owner

Realisation Date


WHE1

Utilising staff resource gained from declining activity, previously outsourced . Benefits to be realised within LHB’s

Review progress in redeployment of staff across NHS Wales

Some property management activity that was previously outsourced is now being delivered through NWSSP-FS

ND

31.3.16

Cash Releasing Economies of Scale WHE2

Property Management: lease negotiations/rent reviews etc. 200 1720

Review of all new lease/rental agreements

All property management services are now being delivered by NWSSP-FS. 8 leases management cases have been completed, generating £460,000 of savings.

ND

31.3.16

Cash Releasing Economies of Scale WHE3

GMS funding

Review of all new GMS funding agreements

All GMS funding agreements are being reviewed by NWSSP-FS

ND

31.3.16

Cash Releasing Capital In-Sourcing

WHE4

Train and redeploy staff to fulfil activity currently out-sourced e.g. project management

3

800

Monitor cost of project management service against current benchmark

A paper has been presented to Planning Directors and comments received. No Health Board or Trust has identified any staff for redeployment. A separate exercise is currently underway to re-tender existing project management commissions. An initial assessment indicates significant savings

ND

31.3.16







Key Measurement


Realisation Date

being delivered.

Non Cash Releasing Opportunity Benefits

WHE5

Simplified Contractor/Consultant procurement

Nil

Nil

Ensure a network of appropriate framework agreements are established

New regional frameworks are currently being procured to commence in October 2011. The OJEU notice for the new national framework will be issued later this year.

ND

31.3.16


WHE6

Standard documentation

Nil

Nil

Ensure portfolio of standard documentation is available and disseminated

Standard documentation is being developed for all framework activity.

ND

31.3.16


WHE7

Provision of specialist estates and engineering support

Nil

Nil

Monitor usage of specialists services

Records indicate that NWSSP-FS specialist engineering services are utilised throughout NHS Wales

ND

31.3.16

Non Cash Releasing Cost Avoidance

WHE8

Asset/construction procurement

Nil

Nil

Review life cycle cost data from new projects against current benchmarks

There is still a limited amount of life cycle data available from the new buildings constructed through the framework but data is being collected through the EFPMS

ND

31.3.16







Key Measurement


Realisation Date

Non Cash Releasing Cost Avoidance

WHE9

Management risk and the reduction of errors buy adhering to National Publication Programme, Hazard Notices, AEDET, BREEAM, Fire safety audits

Nil

Nil

Ensure consistent and timely delivery/intervention through on going audit of management systems

NWSSP-FS continues to manage the national publications programme disseminating best practice guidance. NWSSP-FS also continues to administer all estates and facilities Hazard Notices.

ND

31.3.16

Qualitative

WHE10

Harmonised method of delivery for support improves consistency of support

N/A

N/A

Agree detailed work specifications and ensure consistent service quality supported by ISO 9001

NWSSP-FS has recently been successful in maintaining its ISO 9001 accreditation. The review of ISO 14001 is due shortly.

ND

31.3.16

Qualitative

WHE11

Standardisation of best practice improves standards and quality of customer service

N/A

N/A

Monitor development of best practice guidance and review implementation

A number of the processes and systems required by the guidance are monitored through NWSSP-FS specialists, particularly the Authorising Engineers.

ND

31.3.16

Qualitative

WHE12

Better utilisation of staff skills

N/A

N/A

Undertake skills audit

A paper has been presented to the Director NWSSP for discussion at the Shared Services Committee that will require a national estates

ND

31.3.16







Key Measurement


Realisation Date

skills audit

Qualitative

WHE 13

Greater job satisfaction and career opportunities for staff

N/A

N/A

Staff surveys and feedback

Staff surveys have not been undertaken to date

ND

31.3.16

Qualitative

WHE14

Improved business resilience through better recruitment and retention

N/A

N/A

Monitor staff turnover and review market response to recruitment opportunities

There is no staff turnover recorded for 2011/12 and no vacancies have been advertised.

ND

31.3.16

Qualitative

WHE15

Improved governance, transparency and financial control

N/A

N/A

Business plans reviewed by Shared Services Committee

The NWSSP Business Plan has been approved by the Shared Services Committee

ND

31.3.16

Qualitative

WHE16

Improved staff and public confidence through strong team NHS corporate identity

N/A

N/A

Staff surveys and feedback

Staff surveys have not been undertaken to date

ND

31.3.16




Legal & Risk Services – Indicative Benefits Register




Key Measurement


Realisation Date

Cash Releasing

Transactional

LR1 Increased capacity (better utilisation of staff skills) through elimination of

duplication

154 2310 Review type and volume of

outsourced work

Not started ALF 31.3.2016

Cash Releasing

Economies of Scale

LR2 Gatekeepers for outsourced legal contracts controlling

legal spend

0 0 As above Not started ALF 31.3.2016

Cash Releasing

Economies of Scale

LR3 Home based staff working-reduction of office expenses

0 0 Monitor staff numbers

Compare budget outturn

Some home working ALF 31.3.2016

Cash Releasing

Economies of Scale

LR4 Dictation software- reduction in band four secretaries

0 0 No redundancies but no recruitment

No reduction in staff ALF 31.3.2016

Cash Releasing

Economies of Scale

LR5 WHLS video link 0 0 Monitor Travel expense budget for

set off against purchase price

installed ALF 31.3.2016

Cash Releasing

Economies of Scale

LR6 Reduction in travel expenses and travel time

0 0 As above Yet to be ascertained, video unreliable

ALF 31.3.2016







Key Measurement


Realisation Date

Cash Releasing

Economies of Scale

LR7 Direct payment for external agency fees - reduction in

administrative time, postage and sundries

0 0 Keep record of payments for

comparison for transactions

Not started ALF/JB 31.3.2016

Cash Releasing

Economies of Scale

LR8 Renegotiated or better deal, In-sourcing not outsourcing,

Improved productivity, Specialisation.

0 0 Review call off contracts 6 monthly

Not started ALF 31.3.2016

Cash Releasing

Professional Influence

LR9 Provision of legal advice to Shared Services partners

0 0 Monitor incidence of requests

No instructions from SS partners

ALF 31.3.2016

Non Cash Releasing Opportunity

Benefits

LR10 Closer collaboration with shared service partners e.g. fees payment through P2P. Estate advice re-commercial

property debt recovery advice to Supplies P2P

N/A N/A As above no ALF 31.3.2016


Benefits

LR11 Development opportunities for legal staff

N/A N/A Longer term aim Not started ALF 31.3.2016


Benefits

LR12 Development/redeployment for secretarial support staff

N/A N/A no ALF 31.3.2016

Non Cash Releasing

Cost Avoidance

LR13 Reduce numbers of successful claims by

increased proactive and reactive work to improve

N/A N/A Much too soon ALF/JB 31.3.2016







Key Measurement


Realisation Date

management of risk

Non Cash Releasing

Cost Avoidance

LR14 Enable better use of existing information and data

collected by other review bodies and regulators by

collation and monitoring of action plans. Use this and

own information as criteria to inform incentivisation system

N/A N/A No data JB 31.3.2016

Qualitative LR15 Robust comprehensive in-house service responsive to

health clients needs

N/A N/A As before Not started ALF/JB 31.3.2016

Qualitative LR16 Closer collaboration with Shared Service partners

N/A N/A ‘’ ALF 31.3.2016

Qualitative LR17 Consistency of advice across service

N/A N/A ‘’ ALF 31.3.2016

Qualitative LR18 Channel for lessons learned across diverse areas including employment

practice e.g. bullying and harassment

N/A N/A ‘’ ALF/JB 31.3.2016

Qualitative LR19 Develop opportunities for all WHLS staff

N/A N/A This is a possibility not a probability

ALF/JB 31.3.2016







Key Measurement


Realisation Date

Qualitative LR20 Reduction of risk of overspend on legal services

with the opportunity to control and direct private sector

suppliers

N/A N/A Annual monitoring of work undertaken

against cost

ALF/JB 31.3.2016




Contractor Services – Indicative Benefits Register

Benefit Type Ref Benefit

Identified



Key Measurement

Position as at 30 th June 2011 Owner Realisation

Date

Cash Releasing

Transactional Savings

CS1

Automation of Processes

16 237 Six monthly review of target ophthalmic and pharmaceutical outlets being automated.

Programme of connectivity progressed

GP/VP 31.3.2016

Cash Releasing

Economies of Scale

CS2

Senior Management re-structuring

225

1,525

Implementation of revised senior management structure. Subject to VERS

On going - The division is focussing on achieving at least 435k recurrent savings in the current financial year

GP/VP 31.3.2016

Cash Releasing

Economies of Scale

CS3

Restructuring within management levels

Nil 1,120 Implementation of revised management structure.

On going GP/VP 31.3.2016

Cash Releasing

Professional Influence

CS4

Standardisation of Working Practices Across Wales

Nil Nil Review of Working Practices across Wales.



Benefits

CS5

Greater business resilience

N/A N/A Review business resilience across Shared Service organisation.

Business continuity, strategy and plans produced

GP/VP 31.3.2016

Qualitative

CS6

Development of a PCS Helpdesk dealing with queries from patients, Health Boards and others

N/A N/A Implementation of Primary Care Services Helpdesk.






Identified



Key Measurement


Date

Qualitative

CS7

Strategic Intent looking at implication of forthcoming changes to independent contractor contracts, Evaluation of work within Health Boards that is capable of being transferred to shared services. Potential re-configuration of PCS to respond to new working arrangements. Development of communication and modernisation plans. Improved staff morale through further career opportunities and job satisfaction. Review HB functions that could be transferred to the NHS Shared Service Programme

N/A N/A Review of opportunities to transfer work areas from Health Boards to the NHS Shared Services organisation. Continued liaison with WG regarding potential for new primary care contracts.

Issue raised with all 7 Health Boards – under continuous review

GP/VP 31.3.2016

Qualitative

CS8

Greater opportunities to explore synergies that exist with other shared service providers

N/A N/A Review opportunities to explore synergies that exist within Shared Services organisation.






Identified



Key Measurement


Date

Qualitative

CS9 Possible basis to develop services for a broader public service

N/A N/A Working with the Shared Services Director begin liaison with Local Authorities to explore business opportunities.


Qualitative

CS10 Facilitate improved access to management information and better able to make available to stakeholders (WG to mandate), which could also improve service planning and contract negotiation

N/A N/A Review management information available within Primary Care Services and opportunities to share same with Health Boards and other stakeholders.


Qualitative

CS11 Within PCS there is a huge amount of data/information that could be more effectively used in health planning. Future plans would be to allow greater access to this information by WG in particular to assist them with overall service planning.

N/A N/A Review management information which could be made available to WG.





Prescribing Services – Indicative Benefits Register




Key Measurement


Realisation Date

Cash Releasing Transactional

PSU01

Rollout of Key from Image systems into the pricing

processes and impact of early re-engineering of systems at

Cardiff and Caerphilly operations

Ability to release expected resources from within the P2

pricing process Completed DH 31.3.2016


PSU02

Rollout of automatic capture of prescribing items from the 2D barcode, applying the Drug Tariff rules to a set of items that allow automatic data capture and pricing into the P2 pricing processes at both Cardiff and Caerphilly operations 180

900

Ability to release expected resources incrementally from

within the P2 pricing process based on the quality and volume of

2D bar coded prescriptions being received Estimates releasing around 8

WTEs

Completed 2010/11, as per prediction 8 staff

have not been replaced as they have left to

move to other areas of NWIS/Velindre NHST DH 31.3.2016


PSU03

Deployment of new scanner technology which will improve on the ability to read 2D bar

codes automatically at time of scanning process making

intervention by use of Intelligent Character

Recognition and thereafter operator intervention

redundant in this process 0 100

To ensure the new scanners will be able

to read 99% of the scanned bar

Estimates releasing between

1 - 2 WTEs codes automatically in a one pass process. This is

part of the specification laid out in the ITT process

Partially completed, the new scanners are now

in place and we are able to read around 93% to

95% barcodes in comparison to around

73% with the old scanners. Resources

released 1 on VER and the other WTE is

earmarked for the P2P project DH 31.3.2016







Key Measurement


Realisation Date


PSU04

To engage with community pharmacy to develop an

electronic returns process for queries on monthly

submissions and the return of correct information. Nil

80

Reduction in resource

requirements within the BST section and savings on postage of approx £4K pa

Estimates releasing 2 WTEs

and reduction in postage costs

Piloting the proposed solution in 5 community

pharmacies – likely rollout will start in the

new year. Some resources are likely to

be re-allocated to provide different

functions during the re-organisation of the BST team. 1 VER as been

agreed and will be released at the end of

2011/12. DH 31.3.2016


PSU05

Total Service transformation of PSU to a mixed processing environment (for community

pharmacy) where hand written prescriptions, 2D bar coded prescriptions and Electronic Transferred Claims (ETC)

messages are received within PSU. This will also improve the quality of the pricing process

as items are automatically processed Nil

Likely benefits are based on the rollout of the ETC into NHS

Wales and the phased

implementation of the new PSU

environment and development of rules based technology to

process 2D bar coded and ETC

messages automatically. Initial estimates suggest

resources reallocated across unit with a net reduction of approx

40 WTEs

No progress in the rollout of ETC has been

made by the national programme. Initial

estimates suggested that full deployment of

ETC would deliver benefits in 2012/13 financial year. At

present the programme is approximately 18

months behind. DH 31.3.2016







Key Measurement


Realisation Date


PSU06

Completion of automation of processing of Multi Vaccine

claims Nil

Full deployment of automatic claims

system within all GP practices in NHS Wales (currently

approximately 75% usage) with Reduction in

resource requirements within

the PF process Estimates releasing

around 1 WTE

The automatic claims service for multi

vaccines is now being used by around 86% of

the GP practices in Wales. We are

continuing to encourage those practices not

using the system to sign up. DH 31.3.2016


PSU07

Electronic receipt of Dispensing Doctors prescription claims


requirements within the P2 process. Initial

estimates suggest resources reallocated across unit with a net reduction of approx 5

WTEs

Early dialogue has taken place with GPC Wales

and we are about to trial new submission

systems around the prescribing message on the 2DRx. There are no

plans to at a national level to include the

dispensing practices in an ETC service at this

time. DH 31.3.2016


PSU08

Electronic receipt of Appliance Contractor prescription claims


requirements within the PF process Initial

estimates suggest resources reallocated across unit with a net reduction of approx 2

WTEs

There are no plans to at a national level to

include the appliance contractors in an ETC service at this time. DH 31.3.2016







Key Measurement


Realisation Date


PSU09

Review of PSU estate requirements in conjunction

with Head of WHE and Velindre NHS Trust

Success of modernisation

process will be able to determine

requirements at both Cardiff and Caerphilly

operations

In dialogue with the NWSSP – FS unit on

the strategy for reduction in office space

as part of the overall NWSSP organisation

estate strategy development. DH 31.3.2016

Cash releasing Total 200 1,080

Non Cash Releasing Service Enabling

PSU10

Rollout of Formulary System for NHS Wales, enabling LHBs

to performance manage the national drugs budget in terms

of conformance. Nil Nil

Product available for service deployment

as part of management of medicines within

NHS Wales.

Product development now passed into NWIS

development team. However as a customer

this product will be invaluable to PS in

supporting the performance

management systems development on behalf

of the NMMPB and LHBs DH 31.3.2016

Non Cash Releasing Service Enabling

PSU11

Administration of national Directly Enhanced Services

claims systems Nil Nil

National tariff accepted and service

deployed

Initial service for EHC deployed and reporting

systems developed. This development will

form the basis of all new electronic claims

systems DH 31.3.2016 Non Cash Releasing Service

PSU12

Delivery the service improvements as deemed necessary by the Medicines Management Programme, and Nil Nil

Delivery of financial and clinical

performance tools in relation to managing

Provided high level prescribing and

dispensing dashboard and prescribing DH 31.3.2016







Key Measurement


Realisation Date

Enabling Prescribing and Dispensing User Groups.

NHS Wales Drugs. indicators for LHBs and Trusts


PSU13

Strategic alignment of unit to the ongoing agenda of the Medicines Management Programme and the potential need to offer independent professional pharmacy services and differential pricing for NHS Wales as part of a national drug tariff. Nil Nil

Keeping a watching brief on being able to employ

a professional pharmacist as part of

the current re-structure of PS which will also

incorporate the successor planning for the present processing

manager.


PSU14

Opportunities to develop joint service modernisation

strategies with other shared service providers Nil Nil

Working in collaboration with the P2P project and

early moves to review synergies between

Contractor Services and PS underway. DH 31.3.2016


PSU15

Opportunities to develop joint service modernisation

strategies with other the wider public sector in Wales Nil Nil No progress DH 31.3.2016

Cash Enabling Service Development

PSU16

Increased partnership working with external NHS Wales

stakeholders (pharmaceutical organisations, community

pharmacy) and development of income generating information

services Nil Nil

Limited progress in opening dialogue with community pharmacy representative bodies. DH 31.3.2016




Procurement Services – Indicative Benefits Register




Key Measurement


Realisation Date

Cash Releasing Transactional Savings PTP1

Harmonisation - Increased capacity

better utilisation of staff skills through elimination

of duplication

*160

Note automation is key for

these benefits to be realised

*3,410

Note automation is key for

these benefits to be realised

Head Count Reduction, or

transfer of resources- reduced staff requirement

through automation of supplier invoices.

Although we desperately need

automation in order to deliver the existing

service as recruitment

restrictions and staff shortages are being

felt by every organisation.

Scanning Project ongoing, at this stage it is doubtful whether this on its own will deliver the totality of the year one savings, however, there is good progress being made with the

Xchange Wales programme which will

help to achieve the target. SS 31.3.2016

Cash Releasing Economies of Scale PTP2

Regeneration or better deal ↓ ↓

£5,958,429 achieved in the first two months of

the year. SS 31.3.2016

Cash Releasing Economies of Scale PTP3

In-sourcing not outsourcing ↓ ↓

Negotiation with Prescription Pricing for scanning services will be looking to reduce costs of invoices processed. To be determined

Agreement reached with PPS and reflected within

the Scanning Project, this is a low cost

solution. SS 31.3.2016







Key Measurement


Realisation Date

Cash Releasing Economies of Scale PTP4 Improved productivity ↓ ↓

Cost per Invoice delivering to best in class. To be determined SS 31.3.2016

Cash Releasing Economies of Scale PTP5 Specialisation ↓ ↓

Procurement Managers Planning element. SS 31.3.2016

Cash Releasing Professional Influence PTP6

Savings accruing to NHS Wales from Shared

Service advice e.g. Procurement advice ↓ ↓


Non Cash Releasing Opportunity Benefits PTP7

To review the current expenditure which is not

co-ordinated via the FMS system Nil Nil



Achieving economies of scale and efficiencies

thus reducing the cost of services, systems and equipment Xchange

Wales and or more e-enablement will drive

efficiency and throughput of Invoices Nil Nil

Possibility of utilisation of existing capacity elsewhere in other organisations creating savings. This is linked to the scanning solution only. SS 31.3.2016







Key Measurement


Realisation Date


Fewer systems support costs Nil Nil

Oracle R12 Upgrade could facilitate changes across a number of disciplines. SS 31.3.2016


Cost Avoidance Actions that prevent

increasing current costs; or prevents costs that would otherwise have

been incurred Nil Nil SS 31.3.2016

Qualitative PTP11

Improved staff and public confidence

through strong corporate identity for "Team NHS Wales" - A view that we

have a joined up professional Procure to

Pay service that supports front line staff N/A N/A

As we do not have a corporate identity as yet if at all under the virtual structure it is doubtful if this benefit will be delivered for either staff or the public SS 31.3.2016

Qualitative PTP12

A view from business that they have one point

to contact to discuss potential or indeed real

NHS business N/A N/A

This is very doubtful under a virtual structure without and corporate identity and the same multi points of contact SS 31.3.2016







Key Measurement


Realisation Date

Qualitative PTP13

To be seen as an employer of choice

within the Welsh public sector N/A N/A

The virtual structure impacts on this as we do not have one employer SS 31.3.2016

Qualitative PTP14 Opportunity to work with

DE&T on SMEs N/A N/A SS 31.3.2016

Qualitative PTP15

Greater job satisfaction and career opportunities

for staff - A greater sense of working for

Wales for the benefit of the patient and wider public sector. More opportunities to train and develop and gain

experience across different commodity

areas. Harmonised pay and grades and better

recruitment and retention. N/A N/A

This will still be a key aim but again the virtual structure impacts on this . We will still have issues around training and the A4C issues on pay. SS 31.3.2016







Key Measurement


Realisation Date

Qualitative PTP16

Improved business resilience through better

recruitment and retention - The

resilience of the system and protection of data

should be covered through an appropriate

standard ISO 27001 Information Security Standard. This also picks up business

resilience and with more than one location

supports the delivery of the service from other

locations in the event of an incident. N/A N/A

This will depend on a number of factors not least of which is the IT infrastructure that we adopt and with the virtual structure the resilience issues are still very closely linked to the HB/Trusts positions SS 31.3.2016

Qualitative PTP17

Improved governance, transparency and

financial control - It is clear now that the 50%+

of non coordinated expenditure is in many

instances non compliant with standing

orders/SFIs but also in many cases also with

EU Procurement legislation. N/A N/A

This remains to be seen in light of the discussions around Governance in the revised structure SS 31.3.2016

Qualitative PTP18

Harmonised method of delivery for services,

improves consistency of support - A single N/A N/A SS 31.3.2016







Key Measurement


Realisation Date

approach but within a flexible framework that

is stakeholder responsive within a

corporate team structure. At a detailed

level support the treatment of patients in

a consistent manner and supports the clinical risk

agenda.

Qualitative PTP19

Single audit processes and guidance. One set

of policies and procedures is ISO 9001/2000/18001 N/A N/A SS 31.3.2016

Qualitative PTP20

Standardisation of best practice improves

standards and quality of customer service - to implement a standard way of working which reflects current best

practice. This will utilise the same IT system with

standard forms and templates. It should all

be against an appropriate ISO Quality standard. Helps protect against legal claims for

non compliance N/A N/A

Still a key aim depends on how the IT works out SS 31.3.2016







Key Measurement


Realisation Date

Qualitative PTP21

Increased capacity - Should be realised from

some of the areas of duplication but it needs to be balanced with the fact that doing the job properly takes more time than paying lip

service to it N/A N/A SS 31.3.2016

Qualitative PTP22

All Wales Oracle & technological

development Team N/A N/A SS 31.3.2016

Qualitative PTP23

Xchange Wales. Oracle COM2

N/A N/A SS 31.3.2016

Qualitative PTP24

More focused attention on improving systems and processes, data quality and control

N/A N/A SS 31.3.2016

Qualitative PTP25

Oracle Technological Support Staff - All Wales

Central Team etc. N/A N/A SS 31.3.2016

Qualitative PTP26

Learning and sharing best practice, Shared

training and development of staff N/A N/A SS 31.3.2016







Key Measurement


Realisation Date

Qualitative PTP27

Common process and common ways of

working enable real improvement to be

made throughput and efficiency N/A N/A SS 31.3.2016

Qualitative PTP28

Creation of expert pool which is better able to

support cohesively especially in times of

shortage N/A N/A SS 31.3.2016




Employment Services – Indicative Benefits Register


Benefit in Year 1

£000


Key Measurement


Realisation Date

Cash Releasing Transactional Savings E1

Reduction in cost per recruitment application process Nil Nil

Limited information available. Under

development IRJ 31.3.2016

Cash Releasing Transactional Savings E2 Bulk CRB costs Nil Nil

Anticipate that e-CRB will be included in new NHS jobs. Benefits will

then be measured IRJ 31.3.2016

Cash Releasing Economies of Scale E3 40 200 Clarification required IRJ 31.3.2016

Qualitative E4

Standardisation of processes/forms - Standardisation across the payroll service is a critical pillar in the future strategy N/A N/A

On-going part of service improvement plan linked to WfIS IRJ 31.3.2016

Qualitative E5 Links to WfIS project N/A N/A On going IRJ 31.3.2016





Benefit in Year 1

£000


Key Measurement


Realisation Date

Qualitative E6

Links between the activity undertaken in the Payroll and Recruitment Project and the work to be carried out by the WfIS Team have already been acknowledged. The activities of both programmes must run in parallel. It has been agreed that representatives of each project will attend the respective boards and teams to ensure consistency of approach and the most appropriate use of valuable resources. N/A N/A LC 31.3.2016

Cash Releasing Transactional Savings E7

Reduction in cost per payslip 184 2,208 TBC

No progress – cost per payslip not yet agreed IRJ 31.3.2016

Cash Releasing Transactional Savings E8 Weekly to Monthly Pay Nil Nil

TBC

No agreement to move weekly paid staff to

monthly IJ/SJ 31.3.2016

Cash Releasing Economies of Scale E9 Payroll Department Levy 460 2,300

TBC

Clarification required as to what this is IRJ 31.3.2016





Benefit in Year 1

£000


Key Measurement


Realisation Date

Cash Releasing Professional Influence E10

A strategy on agreeing an all Wales process dealing with web based expenses, Web ADI and E Rostering will need to be agreed Nil Nil

TBC Strategy being

developed for e-Expenses but nothing

for Web ADI or e-rostering IRJ 31.3.2016

Non Cash Releasing Opportunity Benefits E11

Developing a protocol dealing with overpayments Nil Nil

TBC Health Boards to agree standard protocol. Local

protocols and policies in place IRJ 31.3.2016

Qualitative E12

Standardisation of processes/forms - Standardisation across the payroll service is a critical pillar in the future strategy Nil Nil

TBC

On-going part of service improvement plan linked to WfIS IRJ 31.3.2016

Qualitative E13

Overpayment/underpayments - "Overpayment Protocol" and a "Right First Time and On Time Protocol" Nil Nil

TBC

On-going part of service improvement

plan IRJ 31.3.2016





Benefit in Year 1

£000


Key Measurement


Realisation Date

Qualitative E14

Pensions service - A separate Task and Finish Group will be set up to analyse the current service across all the pension departments to review existing systems and processes. Anecdotally, there would appear to be a difference in how the services are provided and agreement needs to be reached across Wales on the Service Level Agreement. Nil Nil

TBC

Sub-group of Pensions leads to be set up in September to look at

the transactional processes. Part of

service improvement plan. IRJ 31.3.2016

Qualitative E15

ESR data - The accuracy of data within ESR is one of the most important issues on the agendas of Workforce and OD Directors. Through the WfiS Team, the quality of ESR data will be analysed, but without doubt the payroll and recruitment services will have a significant part to play in the input of accurate data in to ESR and the interface with other systems such as NHS Jobs. Nil Nil

TBC

Significant progress has been made on this with agreement of the minimum data set with WfIS and ESR Data

monitoring systems in place. Om-going piece

of work IRJ 31.3.2016





Benefit in Year 1

£000


Key Measurement


Realisation Date

Qualitative E16

A critical area will be the development of Assurance Statements from BPS to partner organisations in respect of the quality of the data input by the shared service and the associated KPIs to measure this activity. This is critical as Workforce and OD Directors are accountable to their Boards for the quality of the data within ESR Nil Nil

TBC

On-going part of service improvement

plan IRJ 31.3.2016

Qualitative E17 Links to WfIS project Nil Nil TBC On-going work and

strong links in place IRJ 31.3.2016

Qualitative E18

Links between the activity undertaken in the Payroll and Recruitment Project and the work to be carried out by the WfIS Team have already been acknowledged. The activities of both programmes must run in parallel. It has been agreed that representatives of each project will attend the respective boards and teams to ensure Nil Nil

TBC

On-going IRJ 31.3.2016





Benefit in Year 1

£000


Key Measurement


Realisation Date

consistency of approach and the most appropriate use of valuable resources.

Qualitative E19

Project Team and WfIS Team colleagues have already set up networks to share data and ideas and such networks will considerably enhance the potential for realising future benefits Nil Nil

TBC

On-going IJ/SJ 31.3.2016

business plan 2011/12 - nhs wales · possible to provide quality healthcare services by “doing...

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