NHS Wales Shared Services Partnership IMTP Update

Transcription

1 Agenda Item 8.1 Title of the Paper NHS Wales Shared Services Partnership IMTP Update Executive Lead: Neil Frow, Managing Director Authors: Sharon Lloyd, Marie-Claire Griffiths & Andy Butler Contact Details for further information: Martha Catterson on Date 15th June 2017 Purpose of the Paper The purpose of this paper is to provide the Department of Health and Social Services Executive Team with an overview and update on: 1. Progress against the areas set out in NWSSP s IMTP 2016/17 2. IMTP for 2017/18 areas of focus for the next 12 months 3. The strategic intent NWSSP s longer term intentions and how these will be achieved. The paper also highlights the key issues and challenges being faced by the NHS Wales Shared Services Partnership. Background NHS Wales Shared Services Partnership (NWSSP) provides a range of high quality, customer-focussed professional, technical and administrative services to NHS Wales. The NWSSP was created to: Allow health boards and trusts to focus on the delivery of front line services. 1

2 Agenda Item 8.1 Provide a greater focus on transactional functions and the development of high quality professional services. NWSSP has been up and running for over six years and during that time it has matured with significant progress being made in consolidating, transforming and modernising across the service divisions. This has been facilitated through increased automation, investment in technology, process review, improved performance information systems and the consolidation of the estate as part of an ambitious accommodation strategy. Original Services Transactional Payroll Pensions E-Expenses Recruitment non medical Patient Registration Payments to Primary Care Contractors Supply Chain Accounts Payable Professional /Technical Legal Services Welsh Risk Pool Procurement Sourcing (Central and Local) Counter Fraud Wales Specialist Estates Services Workforce Information Systems Internal Audit Contractor Management Additional Services Workforce Planning Student Awards Services Educational Commissioning Oracle Central Team e- Learning Lease car salary sacrifice scheme 2

3 Agenda Item 8.1 GPSTR (Lead Employer) Primary Medical Care Advisory Team Finance Academy (host) Health Courier Service Surgical Medical Testing Laboratory Commercial Law Service 3

4 Agenda Item 8.1 NWSSP has made excellent progress in delivering both financial and qualitative benefits to NHS Wales since Some of the financial benefits delivered by NWSSP since m internally generated cash savings 16m distributed to health boards, trusts and Welsh Government 500m + estimated annual professional influence savings 8.4m annual cost avoidance due to reduced average recruitment time 74m Cumulative cost avoidance compared to NHS England for training nursing and midwifery staff. Due to negotiating lower fee per health students (Nursing, Midwifery and Allied Health Professional) in NHS Wales and managing lower attrition rates 4m annual cost reduction through property management advice, management of leases, scrutiny of business cases, construction framework and GP rental valuation service 1m savings for NHS Wales through Salary Sacrifice Lease Car Scheme providing over 1,500 energy efficient cars for staff Some of the qualitative benefits delivered by NWSSP Improved patient safety Improved Safer and quicker Better Delivery Supporting Efficiency Quality through good risk management and sharing of lessons learnt through the Welsh Risk Pool and improved procurement processes investment decision-making through the application of professional expertise in the scrutiny of business cases. recruitment process and systems through standardisation and all-wales approach to support prudent healthcare principles recruitment and retention through lead employer arrangements for GPStR and providing Single Point of Contact for national recruitment campaigns for doctors and nurses of consistently high quality legal advice and litigation services to support and help customers improve their services through lessons to be learned prudent healthcare principles through standardised Welsh Risk Pool financial processes and introducing a more sophisticated risk sharing agreement with emphasis on changing behaviours and learning lessons through the single point of contact for Medical and Dental Trainees relocation expenses of services recognised through quality initiatives and a number of highly prestigious national awards 4

5 Agenda Item 8.1 Efficiency 75% of NHS staff now have access to Employee Self Service supported by the e Solutions workforce team. Point 1: Progress against the areas set out in NWSSP s IMTP 2016/ /17 was another year of progress, challenge and transformation on our journey to deliver world class services. We continued to take on board key messages through our ongoing engagement with our partners placing their needs at the centre of what we do. Our IMTP for 2016/17 had 61 main priorities within nine overarching goals.the performance against these priorities is detailed below and summarised as follows. Progress made against our main IMTP priorities Number Achieved 50 Partially achieved 9 Limited progress 2 Total 61 Goal 1 - We have a balanced financial plan and will use our resources effectively to address additional service pressures and demand Exceeded financial targets m additional savings achieved Exceeded procurement savings target m achieved against a target of 20m Annual saving of 9.6m on tuition fees and bursaries when compared to performance across English HEI Achieved cost efficiencies across Hire to Retire transactional services Applied allocative efficiency principles by investing in value added services in particular procurement services, employment and legal services to deliver further savings and meet increased demand Reduction in annual budget of 18% (recurring) by primary care service, whilst expanding services and improving transactional accuracy rates Significant progress has been made in addressing staff sickness and the target of 3.3% was narrowly missed Goal 2 -We will continuously enhance and improve the quality of all of our services Centrally undertaken the Certificate of Sponsorship management for NHS Wales reducing risk and costs Introduced new service delivery models including providing 24 Hour cover within HCS and expanding Blue Light Non Patient Emergency Transport 5

6 Agenda Item 8.1 Implementation of TRAC has decreased the average Wales vacancy approval time from 45 days to 12 days Statutory and Mandatory training has consistently been above 90% higher than compliance target of 85% Appointed Welsh Language Officer and 50 members of staff attended Welsh language courses Introduced annual staff recognition awards and linked pay progression to innovation and compliance with core values PSPP improvement needed more focus to deliver at pace More pace and progress needed in standardisation of processes and investment in technology to deliver savings Introduced workshops and focus groups to help in the standardisation of processes and obtain agreement to take forward initiatives to deliver savings and improve quality of service Goal 3 - We will maximise efficiency, effectiveness and value for money, providing system leadership in applying the lessons from the Lord Carter Report and driving forward the benefits of the Future Generations Act Provided approximate savings 600k p.a. based on internal auditor day rates of 350 in comparison to commercial audit day rates of 500 Undertook a series of engagement presentations with NHS bodies so they understand how they can benefit from Value Based Procurment Achieved an 80% efficiency increase within pricing and payments compared to the existing manual process Legal advice on over 1bn worth of contracts including LINAACS, Design 4 Life, Health Education, Stoma Care and Clinical Waste Rebates and recoveries of nearly 4m and savings of over 9m in withdrawn commercial legal claims in the past year Goal 4 - We will ensure business continuity as we further develop new and transferred service areas Successful transfer of the Surgical Medical Testing Laboratory Improved patient care through the enhancement and expansion of EMRTS logistical support on an all-wales basis Successful roll out of TRAC with no detrimental impact or loss of service Integration of Primary Care Services transport within NWSSP whilst maintaining HCS service Improved PADR compliance (consistently above 70%) despite the implementation of the pay progression policy IT issues leading to some delay in implementing Cleric system for HCS Systems supplier delay in releasing ESR enhanced functionality Recruitment and retention of some staff within our professional services due to market influences 6

7 7 Agenda Item 8.1 Goal 5 - We will help NHS Wales achieve clinical improvement and service change through lessons learnt, spreading good practice and innovation underpinned by clinical evidence and business intelligence Improved patient safety through good risk management and sharing of lessons learnt through the WRP and improved procurement processes Continued focus by our Audit and Assurance services on sharing lessons learnt and good practice across organisations Delivered training for Independent Members on governance and risk matters Introduced a Revised School Vaccination Support Programme, releasing Nurse/Clinician Time (Cardiff & Vale UHB) Delay in appointment to finalise Welsh Risk Pool management structure Goal 6 - We will add value and use our skills and expertise to help NHS Wales tackle key issues such as agency costs and rising clinical negligence claims Continued project management support to the Temporary Nurse Staffing Capacity Steering Group and the underpinning workstreams Took the lead in developing clerical bank portability so the lessons could be learned for nursing staff Doubled the number of nurses returning to practice over the past 3 years 9M in respect of agency nursing fees due to contract legal advice Worked with the Wales Deanery to develop proposals for medical post graduate training the first time this has been achieved for over 10 years Offered a straightforward route to access legal services as and when they are needed Shared learnt lessons from Welsh Risk Pool audits Pace of initial recommendations from the All-Wales Medical Device and Consumables Strategy Group Goal 7 - We will help NHS Wales deliver key strategic objectives, including prudent healthcare and primary care agenda, and the Healthcare Professional Education Investment Review Unlocked capacity of GP Practice Managers by managing all employment processes Established a single point of contact that current and future primary care medical staffing can utilise for training and employment opportunities. Introduced a One Wales Primary Care Rebate Scheme to include a new IT platform 11 LIFT placement opportunities including 4 employability programmes Developed new resources HCSW career Framework Removal of variation and waste through deployment of ESR and interfacing technologies Welsh Universities successfully filled 98.4% of all its commissioned places

8 Agenda Item 8.1 Offer a high quality employment experience for GP trainees Privatisation of NHS England Primary Care services and the impact of this on NHAIS system replacement Goal 8 - We will continue to improve communication, partnerships and engagement with service users and stakeholders to ensure we address their priorities and needs Chair and Director met all NHS bodies Boards during year Regular meetings with health bodies Executive Teams Attendance at some, but not all all-wales peer group meetings Regular feedback obtained through service questionnaires and telephone interviews Improved ratings for Wales Quality Centre and Customer Service Excellence reviews Goal 9 - We will develop partnerships and provide services with other public sector organisations to provide mutual benefit Development of the Store and Scan on Demand service within Primary Care Services reducing pressures on GP Practices estates Enhanced the e-learning solution to enable accessibility to over 300 courses for NHS Wales and the wider public sector including Local Authorities and Welsh Government Work in partnership with Universities to ensure that Wales maintains a low attrition rate and ensure 80% of graduates work in NHS Wales Substantially increased advertising vacancies for Primary Care sector Provide Internal Audit to a Housing Association Areas of less progress were monitored and reviewed throughout the year to understand the causes and identify in-year and longer term actions, with updated plans developed as part of our 2017/18 IMTP. Details of the actions being taken are set out on page 9. Key Performance Indicators 2016/17 In facilitating achievement of the IMTP goals and priorities, NWSSP uses Key Performance Indicators (KPIs) to measure performance and drive progress against key targets. The performance against the high level key performance indicators for 2016/17 are summarised below, with some additional analysis across NHS organisations provided in Appendix 1. KPIs are reported monthly within NWSSP and on a regular basis to Partnership Committee and to individual health boards and trusts. High Level KPIs 2016/17 8

9 9 Agenda Item 8.1 High Level KPIs 2016/17 Financial and Workforce Indicators Financial Position actual outturn Break even 11k surplus Capital financial position Within CRL Achieved Planned Distribution of savings 0.75m 2m + 1.2m brokerage Professional Influence Savings 50m 130m Staff Sickness (Cumulative) 3.3% 3.43% PADR Compliance >85% 77.51% Statutory and Mandatory Training >85% 93.07% Procurement Services Procurement savings 20m 37.2m All Wales PSPP 95% 94.47% Employment Services Payroll accuracy rate 99% 99.78% Recruitment activities undertaken within HBs/Trusts Time to Approve Vacancies 10 days 11.1 days Time to Shortlist by Managers 3 Days 7.2 days Time to notify Recruitment of Interview Outcome 2 Days 5 days Recruitment activities undertaken by NWSSP team Time to Place Adverts 2 days 1.7 days Time to Send Applications to Manager 2 days 1.1 days Time to send Conditional Offer Letter 5 days 3.1 days Primary Care Services Payments made accurately and to timescale 100% 100% Prescription - keying accuracy rates 99% 99.46% Internal Audit Audits reported as a % of planned audits 95% 78% Report turnaround health board and trust 80% 65%

10 Agenda Item 8.1 High Level KPIs 2016/17 management response to Draft Report Report turnaround draft response to final reporting 80% 96% Legal and Risk Timeliness of advice acknowledgement - within 24 hours Timeliness of advice response within 3 days or agreed timescale 90% 100% 90% 100% Welsh Risk Pool Acknowledgement of receipt of claim 100% 100% Valid claims received within deadline processed in time for next WRP committee 100% 100% Workforce Education and Development Services % of Contracts Agreed in principle 100% 100% Contract, Performance and Operational meetings booked and undertaken on a timely basis 95% 100% Actions being taken to address areas that are below target are as follows: Sickness / PADRs performance against targets is reviewed at each Directorate s quarterly performance review and each monthly Senior Management Team meeting. Action is being taken to achieve the minimum of 85% PADR compliance by 31 st July 2017, and an integrated programme to help stress in the workplace will be developed by the 30 th September All Wales P2P the performance has improved during the year (94.47% cumulative) as a result of actions by Accounts Payable including working in partnership with health boards and trusts through local Performance Improvement Groups. In addition, the Finance Academy has established a P2P Work Stream which has focused on PSPP improvement. All Wales Time to Approve Vacancies / All Wales Time to Shortlist by Managers / All Wales Time to notify Recruitment of Interview Outcome - these KPIs relate to actions in health boards and trusts are being addressed through: o Trac reporting functionality improved to allow monitoring and reporting of extended recruitment timeline, o Communication and action plan developed for health boards and trusts to facilitate consistent application, o Meetings taking place with those health boards and trusts who have identified resource to facilitate this work with NWSSP, 10

11 Agenda Item 8.1 o The student streamlining project will drive further efficiencies in this area. Internal Audits reported delays to draft reports by health boards and trusts impacts on ability to fully report audits; this is being addressed with local Audit Committees and the Board Secretaries All-Wales Peer Group. 2016/17 Governance matters NWSSP operates robust governance arrangements as illustrated below. Internal Audit Opinion The Head of Internal Audit opinion for 2016/2017 was that the Partnership Committee can take Reasonable Assurance that arrangements to secure governance, risk management and internal control, within those areas under review, were suitably designed and applied effectively: RATING INDICATOR DEFINITION Reasonable assurance - + Yellow The Committee can take reasonable assurance that arrangements to secure governance, risk management and internal control, within those areas under review, are suitably designed and applied effectively. Some matters require management attention in control design or compliance with low to moderate impact on residual risk exposure until resolved. In reaching this overarching opinion the Head of Internal Audit has identified that the assurance domains relevant to NWSSP have all been assessed as providing reasonable assurance. Internal Audit review of Corporate Governance Internal Audit undertook a review of Corporate Governance in 2016/2017 to assess the control environment including management of the new Health and Care Standards Framework self-assessment process and the assurance framework including the Annual Governance Statement. This audit provides assurance to the Audit Committee of Velindre NHS Trust that risks material to the achievement of system objectives are managed appropriately. Internal Audit concluded that the level of assurance given as to the effectiveness of the system of internal control in place to manage the risk associated with Corporate Governance was Substantial Assurance. 11

12 Substantial assurance - + Green Agenda Item 8.1 The Committee can take substantial assurance that arrangements to secure governance, risk management and internal control, within those areas under review, are suitably designed and applied effectively. Few matters require attention and are compliance or advisory in nature with low impact on residual risk exposure. 12

13 Agenda Item 8.1 Point 2: IMTP for 2017/18 Areas of Focus for the next 12 months The key areas of focus for NWSPP for 2017/18 are set out below, against our five strategic objectives. These have developed in consultation with the Partnership Committee, key stakeholders, staff and our customers. 1 Value for Money To develop a highly efficient and effective shared service organisation which delivers real terms savings and service quality benefits to its customers. 2 Customers To develop an open and transparent customer focused culture that supports the delivery of high quality services. 3 Excellence To develop an organisation that delivers process excellence through a focus on continuous service improvement, automation and the use of technology. 4 Staff 5 Service development To develop and extend the range of high quality services provided to NHS Wales and the wider Welsh Public Sector. To have an appropriately skilled, productive, engaged and healthy workforce. 1. VALUE FOR MONEY To develop a highly efficient and effective shared services organisation which delivers real term savings and service quality benefits to its customers. Delivering a sustainable shared support service which allow greater opportunities for service development Improve the quality and efficiency of service through greater use of benchmarking Deliver professional influence savings and benefits > 100m Operate within a balanced budget and secure 2.3m capital funding for technology, systems and infrastructure Develop capacity to deliver stakeholder requirements, including investing in: Project management skills development IT technologies, paperless solutions and robotic process automation Establishing a data analysis function Delivering our accommodation strategy System developments by investing in PCS, Employment services and procurement Improved data analysis and making better use of information maintained 13

14 Agenda Item 8.1 by NWSSP to identify areas for further savings Deliver process efficiency and driving down costs by working with our partners and maximise the synergy between NWSSP services Continue the focused effort to ensure cost containment and prevent cost growth and also identify opportunities to support Health bodies to deliver on their own IMTP requirements Provide cost effective solutions to help resolve Health Board issues eg Laundry, All Wales Bank 2. CUSTOMERS To develop an open and transparent customer focused culture that supports the delivery of high quality services. Ensure we provide an excellent customer experience in all we do Strengthen our relationships with our customers so we are recognised as trusted partners Develop engagement and co-production to improve quality and user experience Work with our customers to remove inappropriate variation Turn our data into intelligent information to support the NHS Wales quality and safety agenda Support customers in the delivery of their plans Support our partners significant service change whilst leading and facilitating NHS Wales s priorities including: Learning lessons from efficiency agenda and sharing best prcatice Shift to Primary Care Welsh Language Data Driven System Major capital programmes Improvement programmes 3. STAFF To have an appropriately skilled, productive, engaged and healthy workforce resourced to meet service needs. Improve recruitment, retention and succession planning ensuring we have a workforce that meets our customer needs Grow our professional staff to counteract the competitive employment market Develop leadership, innovation and people skills; harnessing creativity and ideas supporting staff with the right skills Support staff to live the values of NWSSP Continue to refocus the culture of the organisation around continuous improvement and customer service Further develop the emotional wellbeing support programme Develop and implement an action plan based on the 2016 national staff survey 14

15 outcomes 15 Agenda Item 8.1 Ensure staff are supported through change management working with our Local Partnership Forum and trade union colleagues Continue the rollout of a robust performance management and appraisal system Working with local universities to develop innovative solutions develop our talent pipeline 4. EXCELLENCE To develop an organisation that delivers process excellence through a focus on continuous service improvement, automation and the use of technology. Strive for organisational excellence Ongoing standardisation, modernisation and automation through the Once for Wales principles Continue refinement of Key Performance Indicators and benchmarking tools in partnership with customers Use our All Wales performance data to highlight improvement opportunities Work in partnership with Directors of Finance and Workforce to drive excellence in systems and procedures: initial priorities to improve further performance in our processes are: Purchase to Pay Hire to Retire Record to Report Continue our investment in technology driving efficiency and quality improvements, including: e-workforce solutions Service user contact management systems Cleric (HCS delivery tracking) Intelligent document scanning Temperature controlled boxes Improved legal case management system Robotic Process Automation Take full advantage of larger regional centres of excellence for resilience, efficiency, standardisation and collaboration 5. SERVICE DEVELOPMENT To develop and extend the range of high quality services provided to NHS Wales and the wider public sector. Engage with customers to define needs for new service areas; foster best practice and innovation Provide new shared services to NHS Wales and the wider public sector; possible areas include: Laundry Welsh language hub

16 Putting things right Single lead employer Occupational Health National Clinical Assessment Service Agenda Item 8.1 Extend our services support and enable sustainable systems in the Primary Care sector, examples of service areas include: PMCAT Patient medication record service Payroll Recruitment Procurement Act as an enabler for NHS Wales and support the implementation of the recommendations of the Jenkins review of the NHS Wales workforce and Reforming Local Government: Resilient and Renewed and any National Improvement programmes (see below) National Improvement Programme NWSSP is also committed to supporting the Chief Executive Management Team (CEMT) National Improvement Programme for While NWSSP is not a Peer Group as identified in the Improvement Programme, it is uniquely placed to help support health boards and trusts by working with organisations and Peer Groups in both the identification and delivery of the identified improvement initiatives. The full response from NWSSP to CEMT is attached at Appendix 2, and summarised below: Additional Services - NWSSP has been exploring the feasibility of establishing a number of All Wales functions through a shared service model. Possible options include: o All Wales Bank - to improve quality of patient care and reduce agency costs o Job Evaluation Collaborative to provide quicker, better and more consistent job descriptions o All Wales ESR Help Desk to support health boards and trusts maximise benefits of ESR o All Wales Workforce Queries Help Desk to provide support for routine and generic HR queries o Laundry services to provide high quality service with economies of scale Procurement Services - supporting Health boards and trusts local procurement plans through: o Influence-able Spend & Spend analysis identifying what can be reduced by procurement intervention o Benchmarking using PPIB Tool (Purchase Price Index and Benchmarking) to deliver savings through greater transparency 16

17 Agenda Item 8.1 o Looking at missed opportunities, opportunities not fully exploited and potential new opportunities o All Wales Medical Consumables and Devices Strategy group - driving the standardisation of variation in medical consumables and devices o Value Based Procurement innovative programme using patient experience and outcome to determine value Employment Services - opportunities to reduce recruitment timelines and to streamline the process of recruitment with key opportunities in: o Reduction in Agency costs o Reduction in administrative costs o Faster recruitment o Supporting the revised bursary offer o Supporting the Train, work, live campaign Specialist Estates Services improving efficiency and cost effectiveness of estates and facilities through: o Benchmarking across organisations o Reducing proportion of non-patient areas and of un-occupied space o LED lighting Primary Care Services o Consideration of a single Medical Performers list for Wales. In addition, a very constructive and helpful workshop was held with Partnership Committee on the 22 nd June to consider potential additional services. A report will be prepared for the all-wales Finance Directors meeting in July. What we need from our partners Our future success and central to being an enabling trusted partner is the requirement for organisations to adopt the once for Wales systems and processes we put in place to drive efficiency. Without the cooperation of our partners we can t truly implement a continuous improvement through a unified approach. If systems and processes are not adopted in a consistent manner and different organisations require variations the full benefits can t be realised across Wales. See Appendix 3 for more details in relation to specific service developments. 17

18 Point 3: The strategic intent NWSSP s longer term intentions and how these will be achieved This section summarises NWSSP s strategic intent as: Years 2 and 3 of the current IMTP, Options for the longer term Year 2 and 3 of current IMPT The key intentions for NWSSP over next 2 years are set out below. These have developed in consultation with the Partnership Committee, key stakeholders, staff and our customers. OVERARCHING GOAL We will support NHS Wales to improve quality of patient care and the quality of the employment experience through continuous improvement and innovation We will add value as exemplars of good practice and use our skills and expertise to help NHS Wales tackle key issues We will continue to develop and strengthen communication, partnerships and engagement with our staff and our partners to ensure we address their priorities and needs We will maximise efficiency, effectiveness and value for money through system leadership and a Once for Wales approach ACHIEVED THROUGH Review opportunities to maximise the benefits of shared services Full use of ESR Hire to Retire ESR functionality including 3 rd party interfaces Legal / clinical lessons learned audits integrated into Service to ensure risks are mitigated and lessons learned are implemented Mature arrangements for the link between effective use of financial and clinical resources to add value to patient safety and resources World Class Hire to Retire performance benchmarking The Single Point of Contact to be fully established as the central portal in enhancing clinical, nursing and allied health professional recruitment across Wales Enhance customer services through further investment in technology and streamlined processes. Providing our customer group with a quality service offering a timely single point of contact and transparent monitoring of all customer transactional activity NHS Wales transformation programme fully embedded Procurement Strategy for Wales which maximises value and contributes to NHS financial sustainability 18

19 We will help NHS Wales deliver their key strategic objectives and continue to support health bodies in the delivery of their efficiency programme to maximise value We will ensure business continuity offering a consistency of service across Wales as we further develop existing and additional service areas and our staff We will develop partnerships and provide services with other public sector organisations to provide mutual benefit We will continue to enhance and improve the quality of all of our services, driving forward the benefits and principles of prudent healthcare We will use our resources effectively to address additional service pressures and demand whilst maintaining a balanced financial plan NWSSP Services provided at cluster / confederation level. Full integration of online bursary application system, NWSSP payroll and expenses system. An embedded trusted partnership relation across NHS Wales Develop our all Wales service following the review of current arrangements potential areas could include Occupational Health and Laundry Integrated working with Health Education Wales for whole GP workforce Provide holistic legal advice service across the public sector in Wales One workforce & OD system integrated across NHS Wales and Primary Care Paperless workforce processes fully embraced across NHS Wales Delivery of overall financial targets A well established, financially stable business model with future benefits and growth identified and the longer term NWSSP has been on a journey since April 2011 when the organisation was first set up. One of the founding fundamental principles for setting up shared services was to allow local health boards and trusts to focus on frontline service delivery and this still holds true today. Various options were considered for shared services in the original NHS Wales Shared Services National Business Case (2010) but it was considered a more realistic and achievable option to minimise any associated risk by narrowing the initial portfolio of operation. Over time NWSSP has grown, evolved and matured with a number of additional services being added to the original portfolio. This has been achieved on a gradual basis and in many respects taking the opportunities as they have presented themselves to help solve immediate problems. Six years on, NWSSP is a mature, stable organisation with an established and experienced management team. As demonstrated in this report, we have a proven track record in: Achieving significant financial savings and professional influence benefits Implementing strong systems and controls Driving quality and improvement Bedding in and enhancing new and additional services. 19

20 NWSSP has firm foundations in place and has now reached a point where a decision needs to be made about future direction of travel. The options as we see them are as follows: Do Minimum NWSSP can continue to improve and enhance its existing services and to bring in additional services on an incremental basis. This will include planned and potential additional services already identified in our IMTP and the Partnership Committee workshop in June 2017, as well as responding to other opportunities as they present. The main advantage of this option is that it can be achieved within the current NWSSP framework and governance arrangements. The main disadvantage of this option is that is does not achieve the full potential for all Shared Services across NHS Wales in the immediate future. The intermediate scope Originally included in the original business case, this option looks at undergoing a significant step change to maximise opportunities within NHS Wales. It includes using NWSSP as a collaborative vehicle to take forward a number of more clinical support services as well as other services traditionally associated with a shared services, for example IT and finance. Discounted for the initial phase, the 2010 business case proposed re-considering this option in the medium term subject to the successful delivery of the Shared Services concept. Some of the proposed services on the original list have already been brought into NWSSP through the incremental approach or are no longer valid proposals; however there are other services that, subject to further investigation and agreement with key stakeholders, could be considered. Potential services include: o o o o o o o o o Pathology services Pharmacy All Wales Medical Strategy Group Welsh Medical Resources Centre NHS Wales Centre for Equality and Human Rights All-Wales Medicine Strategy Group Programme Management Unit IT and informatics Financial Services The main advantage of this option is that it maximises opportunities within NHS Wales including some standalone clinical services in addition to common business and professional functions. 20

21 The main disadvantage of this option is need for substantial support and buy-in from key stakeholders. It would also necessitate additional project support and professional advice, and considerable managerial oversight, although the extent of this would be linked to the scope, scale and speed of the stepped change. Maximum scope This option looks at extending the scope of NWSSP to wider public services in Wales. This was also included in the original National Business case, and acknowledged as a possible longer term option. The main advantage of this option is that over time it maximises the potential scope for efficiencies and savings in Wales and meets the full potential for Shared Services. The main disadvantage lies with the attendant risks, which would involve considerable change and disruption to services in the short term, and could impact on NWSSP s ability to maintain a high quality service to NHS Wales. This could be mitigated by pilot projects and a phased approach of select service areas. Governance arrangements The legal framework and governance arrangements that underpin NWSSP have evolved over time and it is important that these do not hinder the opportunity to take advantage of future opportunities and different ways of working that will be required going forward, including: NWSSP s definition within the Establishment Order (statutory and legal framework) will require amendment to allow it to provide wider services. Shared Services Partnership Committee Governance - when NWSSP was established the Shared Services Partnership Committee was set up to act as the decision body on behalf of NHS Wales and to provide strategic leadership and direction. The organisation has significantly matured and now represents 74% of the expenditure of Velindre and potentially outgrown many of the benefits from being a hosted organisation. The current arrangements may in fact be a barrier to taking us to the next phase of the journey, and it may be appropriate to consider whether the governance arrangements being put in place for HEW would be more appropriate for NWSSP. We would welcome the opportunity to discuss these options, and subsequent governance arrangements, in more detail. 21

22 Appendix 1 All Health Organisation KPIs March 2017 KPIs Mar 2017 ABMU AB BCU C&V CT HD PHW POW VEL WAST Financial Information Distribution of Direct Savings Professional Influence Savings 93k 249k 74k 197k 90k 240k 79k 210k 52k 139k 58k 155k 7k 17k 15k 39k 9k 23k 10k 26k m m m m 7.754m m 1.067m 6.421m 1.942m 6.718m Employment Services Payroll services Payroll accuracy rate prior to Supplementary Payroll accuracy rate post Supplementary 99% 99.20% 99.03% 99.54% 99.49% 99.64% 99.62% 99.38% 99.44% 99.70% 99.79% 99% 99.60% 99.51% 99.77% 99.74% 99.82% 99.81% 99.69% 99.72% 99.85% 99.90% Recruitment - activities undertaken within HBs / Trusts Time to Approve Vacancies 10 days 15.3 days 12.9 days 14.4 days 11.3 days 12.3 days 11.9 days 7.6 days 16 days 5 days 6.1 days Time to Shortlist by Managers Time to notify Recruitment of Interview Outcome 3 days 7.9 days 9.6 days 8 days 10.1 days 7.2 days 10.7 days 4.4 days 8.1 days 5 days 4.2 days 2 days 4.2 days 4.7 days 4.7 days 8.5 days 3.4 days 5.6 days 1.8 days 5.7 days 9.3 days 4.2 days Recruitment - activities undertaken by NWSSP Time to Place Adverts 2 days 1.4 days 2 days 1.9 days 1.9 days 2 days 1.2 days 1.4 days 1.8 days 1.8 days 1.2 days Time to Send Applications to Manager 2 days 1 days 1.5 days 1 days 1.2 days 1.1 days 1.0 days 1.0 days 1.2 days 1 days 1 days Time to send Conditional Offer Letter 5 days 2.8 days 3.6 days 3.5 days 3.1 days 3.4 days 2.9 days 2.9 days 3.5 days 0.6 days 2.9 days 22

23 Appendix 1 KPIs Mar 2017 ABMU AB BCU C&V CT HD PHW POW VEL WAST Procurement Services Procurement savings Volume of Invoices paid against a PO (PO invoices) 20m 37m 3.281m 5.707m 3.730m m 3.702m 5.971m 3.343m 6.366m 1.644m 3.561m 1.783m 3.606m 0.158m 0.182m 0.352m 0.287m 0.502m 0.413m 0.577m 0.436m 80% 88.4% 96% 83.2% 93.3% 85.8% 91% 84% 80.20% 87.6% 50.2% E Enablement invoices 80% 81.8% 74% 61.1% 94.5% 90.8% 87.4% 89.8% 21.5% 86.7% 15.1% PSPP Compliance non NHS (Adj) cumulative 95% 96% 96% 97% 94% 89% 89% 96% 94% 94% 99% Internal audit Audits reported as a % of planned audits Report turnaround (15 days) management response to Draft report Report turnaround (10 days) draft response-final 91% 82% 88% 82% 100% 88% 88% 81% 91% 91% 74% 68% 79% 64% 86% 79% 92% 83% 80% 47% 86% 68% 58% 77% 68% 100% 58% 67% 79% 80% 90% 100% 100% 91% 100% 100% 100% 100% 100% 93% 89% 83% Primary Care Services Primary Care payments accurate and to time Patient assignments actioned within 24 hours Medical record transfers to/from GPs & other PC agencies within 6 weeks Urgent medical record transfers within 2 working days Cascade Alerts issued within timescale 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 95% 96% 98% 96% 97% 97% 89% 95% 89% 95% 95% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 23

24 Appendix 2 NHS WALES CHIEF EXECUTIVE MANAGEMENT TEAM (CEMT) NATIONAL IMPROVEMENT PROGRAMME NIP.doc 24

25 Appendix 3 What we need from our partners NWSSP Service Developments Embedding of recruitment system Full deployment of ESR and e- workforce solutions NHAIS replacement Development of Oracle functionality Value based procurement Purpose Ensure NHS Wales is utilising Trac data to drive internal efficiencies in the Recruitment timeline To provide easily accessible and interactive workforce solutions that automate and streamline processes whilst removing duplication and waste Replacement of the patient registration and primary care payment system due to NHS England privatisation of primary care services Ongoing modernisation to improve service quality and standardisation processes Reduce unwarranted variation ensuring the purchase of medical consumables and devices that provide optimum patient outcomes What we need from our partners Organisations to take advantage of the Trac data to ensure all internal stakeholders meet agreed KPI s Utilise Trac functionality such as talent pool management to fast track suitable applicants (will need NWSSP support) Full engagement and support to deploy ESR and workforce solutions in line with defined standards and Hire to Retire project timescales Consistent application of the changes and ongoing communication through deployment Continued engagement about functionality requirements. Ongoing communication through deployment Clinical decision making and input into the ongoing work programme Organisations to adopt and extensively communicate the recommendations of the all Wales Medical Consumables and Devices Strategy Group Student Streamlining Recruitment Process A Once for Wales approach to the recruitment and preemployment checks of healthcare students in partnership with Universities 25 Organisations to agree to one procedure that can be adopted with Universities to place students in vacancies Consistent application of the process in a Once for Wales

26 Ongoing development of paper-lite payroll processes Electronic Transfer of Claims in Primary Care Storage and Scan on demand in Primary Care Reduce the reliance on paper within local payroll processes Reduce the reliance on paper and increase efficiencies within Primary Care Free up the Primary Care estate through the electronic storage of records approach Ongoing communication throughout implementation Appendix 3 Organisations to sign up to the implementation of online payslips and stop the distribution of paper payslips Consistent application of the process in a Once for Wales approach Organisations to buy into the process supporting their primary care clusters to be able to take advantage of the service 26