Services Scotland Chief Executive 2 Feb 18

Transcription

1 NHS National Services Scotland Five Year Plan C li Si l i Colin Sinclair Chief Executive 2 Feb 18

2 Areas for today Context Vision and strategic direction Consequences and plan Finance and workforce Conclusions

3 The challenge remains Needs/demands increasing whilst money gets tighter Poor relative health + Inequalities = Need for Scotland s health to improve Ageing population Complex + = care needs Increasing service demand Increasing + Budget = Financial demand deficits pressures

4 Delivering the Health and Social Care Delivery Plan Four major programmes: Health and social care integration Optimising and joining up balanced health and care services, whether provided by NHS Scotland, local government or the third and independent sectors The National Clinical i l Strategyt Strengthen primary and community care; improve secondary and acute care; focus on realistic medicine Public health improvement Create a clear set of national public health priorities for Scotland as a whole and streamline the currently cluttered public health landscape NHS Board review Review the functions of existing national NHS Boards to explore the scope for more effective and consistent delivery of national services and the support provided to local health and social care system for service delivery at regional level

5 Why we are here To improve the health and wellbeing of the people of Scotland, we provide solutions to support and deliver public services.

6 Our vision Where we want to be Supporting the transformation of health and social care NSS, working with others, will enable the transformation of health and social care to help improve the health and wellbeing of the people of Scotland. We will continue to underpin a sustainable and resilient NHSScotland by providing excellent support services and expertise. We will assist other public sector organisations where there is value We will assist other public sector organisations where there is value in doing so and without compromising our health and care focus.

7 Our vision Where we want to be To enable the transformation ti of health and social care to help improve the health and wellbeing of the people of Scotland. To underpin a sustainable and resilient NHSScotland by providing excellent support services and expertise. To assist other public sector organisations where there is value in doing so and without compromising our health and care focus It s not about doing all three all of the time we adapt the areas we focus on at any given time It s not about doing all three all of the time, we adapt the areas we focus on at any given time to meet the evolving needs of our partners, stakeholders and customers. Individual services will also place emphasis on each area to differing levels.

8 Our market Where we want to operate HEALTH AND SOCIAL CARE SCOTTISH GOVERNMENT (HEALTH AND SOCIAL CARE DIRECTORATE) SOCIAL CARE (LOCAL AUTHORITY, THIRD SECTOR, PRIVATE) HEALTH (REGIONAL, TERRITORIAL, NATIONAL) WIDER PUBLIC SECTOR NATIONAL SERVICES SCOTLAND PUBLIC HEALTH (3 DOMAINS: Health Protection, Health Improvement, Quality Improvement)

9 Our market What is needed SCOTTISH GOVERNMENT HEALTH Support and enable Enable National, Regional and transformation Territorial service planning Support delivery of health & Support for local financial targets transformation Deliver services & expertise Excellent and efficient support more widely services NATIONAL SERVICES SCOTLAND SOCIAL CARE PUBLIC HEALTH Good understanding of local Support creation of PHB priorities Provide corporate shared Seamless integration ti of local l care offering Specialist advice and transformation support services, e.g. HR, Fin, Comms Ensure SLAs in place to underpin cross sharing of data and intelligence HEALTH AND SOCIAL CARE WIDER PUBLIC SECTOR To assist other public sector organisations where there is value in doing so and without compromising our health and care focus

10 Transformation Our focus on the need NSS will play an important role in supporting the transformational change needed to deliver the Health and Social Care Delivery Plan. Once for Scotland National Boards Collaborations Digital Delivery Clinical & Business Enablement Public Health

11 SBU visions and priorities External strategic t focus Area Vision Priorities SNBTS Transforming health through integrated transfusion, Blood system safety and sustainability tissue and cell therapy products, services and Embracing new treatment opportunities. solutions P&CFS PHI A 100% digitally enabled Primary Care support service. To be the leading counter fraud agency in the public sector Robust Health Protection function to protect the health and wellbeing for the people of Scotland. Joined up public service data and intelligence to enable: The public to make informed decisions Professionals to drive improved outcomes Public bodies to deliver service value Digital transformation of primary care transactions Supporting new primary care delivery of care models Protecting the health of the people of Scotland Supporting public health reform including the development of public health priorities and establishment of the new body Continuous improvement of digital it services to underpin sustainable and resilient services Responding to all workstreams of the Health and Social Care Delivery Plan PCF Supporting the development of new models of care Increasing response to the requirements of regional service planning through leading clinical and commercial solutions and emergence of national planning requirement Improve the Quality Assurance of our commissioned population screening services and build the clinical support provided to health boards. Increasing levels of governance in operating environment CLO CLO to be the recognised provider of choice for Continued high level of satisfaction from NHS clients and this remains selected legal services in support of Health and a priority. available to the wider public service in Scotland Fully digital CLO. IT To be valued as a trusted, integral and strategic IT / Digital services partner to the Health & Care Sector in Scotland Digital transformation and other technology / methods shifts will drive need for considerable re-skilling of IT workforce. Need to address resilience and sustainability of national applications and networks over next few years. Increased focus on security.

12 SBU visions and priorities Internal strategic t focus Area Vision Priorities Business Services To deliver excellence in strategic financial Reposition PgMS as Transformation Services, providing management and governance enabled by capability to support the delivery of the Health & Social Care efficient and effective finance shared services Delivery Plan Lead the design and implementation of digitally enabled shared services for the new Public Health Body and a new To enable public service reform by providing Finance operating model for National Boards CEAD valued service transformation capability and trusted delivery expertise to NHS Scotland and the wider public sector To drive engagement, understanding and value for NSS customers and stakeholders Embed Digital Transformation through agile methodology to support new ways of working Drive understanding and adoption of NSS Transform how NSS engages with stakeholders Strategy and Governance Driving best in class strategy, governance and performance management Continuous improvement in all areas. Collaboration on business shared services for NSS and with special boards Clinical HR To ensure Scotland s health and social care needs are being met through successful and innovative NSS services and solutions Providing innovative people solutions and leadership to enable NSS and our partners to improve the health and wellbeing of the people of Scotland Strengthening awareness and partnering with the clinical community of NHSScotland Influencing the Scottish health and care agenda through professional and clinical leadership to influence, inform and support HR is a key enabler to support NSS deliver transformational change and build capability through :- People and Cultural Change Service Redesign Digital Transformation Programme 12

13 Overview - 5 Year Strategy Vision: Supporting transformation of health and social care GAP Analysis People skilled for digital service delivery True collaboration with National Boards Recognition (by others) of where we can help Ability to influence across a broad stakeholder base Current Situation Well positioned Strong reputation Strengthened customer relationships 21/22 Supporting transformation 22/23 Transformation culturally embedded Actions in 2022/23 New Nationals business model delivering effective support services Collaborative working intrinsic Actions in 2021/22 Embedded as an intrinsic partner in transformation activities Continued to deliver high quality services to an integrated health and care system 18 / 19 Effective support for transformation 19 / 20 Digitised Services 20 / 21 Transformation underpinned by digitisation Actions in 2020/21 Continue digital enablement across health and social care Implement Nationals collaborative working Continue support for service transformation Refresh National IT infrastructure Actions in 2019/20: NSS services digitised and digital approach embedded Implement Once For Scotland shared services offer Implement new business models National Boards supporting national, regional and local transformation Continue to support the establishment of the new public health body Actions in 2018/19: Support the creation of new public health body Develop the transformation support service Increased collaboration at operational and strategic levels with other National Boards; delivering the National Boards Delivery Plan Deliver further phase of digital transformation Deliver staff development and leadership programme Develop new business models to support delivery within tight financial settlement

14 Overview - last year s steps Progress against Actions Action Modernise blood service Support NHSScotland transformational change, developing solutions and progress shared services Continue implementation of digital transformation Deliver operational excellence, focusing on what we do and doing it well to meet needs Continued focus on staff development Outcome JCC Occupied and move of manufacturing ongoing Pursuing collaboration with national boards including coauthoring the nationals delivery plan LIST working with health and social care partnerships, supporting NHS benchmarking through Discovery. PgMS supporting health and social care delivery. Shared services continue to progress Digital programme continues to progress as planned Recent RAM process identified customer needs and corresponding digital requirements Digital Transformation Roadmap being implemented All areas pursuing and measuring progress against Improve the way we do things Operational excellence embedded and underpinning all activity Staff Governance Action Plan in place Staff Excellence awards scheme refocused Workforce planning continues in all areas Succession planning progressing beyond executive cohort

15 SWOT analysis Strengthsth Weaknesses Track record of delivery Authority and investment Size, breadth and scale Financial constraints Willingness to help others Lack of public visibility / interest Limited influence Opportunities Once for Scotland Digital transformation National boards collaboration Clinical engagement Threats Cultural resistance and pace of change Magnitude of ask k but uncertain future environment Imbalance between national, regional and local l transformation ti

16 High level actions Customer at the heart Customer/stakeholder engagement Implementation of public health body Increase our services impact Digital transformation Once for Scotland Improving the way we do things NSS Shared services Once for NSS NSS Sustainable service programme Great place to work Staff development Staff feedback Our Key Enablers Innovation Empowerment Operational excellence

17 Service delivery planning Services NSS s Strategic Intention Rationale Potential to Increase HI Potential to Increase FI Blood, Tissues & Cells Disinvest Modernisation Medium Medium Information & Intelligence Invest Transformation High Medium Health Protection Maintain Health & wellbeing High Low Information Technology Invest Digitisation Medium High Legal Maintain Quality service Low Medium Procurement Maintain Efficiency & flexibility Medium High Logistics Maintain Efficiency Low Medium Specialist Healthcare Commissioning Invest National planning High Medium Facilities Invest National planning Low Medium Primary Care -Support Invest Transformation Medium Medium Primary Care - Payments Divest Modernisation Low Medium Fraud prevention Maintain Quality service Low High Programme Management Invest Transformation Medium High 17

18 National board collaboration Opportunities and challenges External Services Focused outcome based deliverables that are more than sum of parts Digital Workforce Transformations Support Efficiency and Financial Improvement Internal Efficiency Vision for new operating model required to meet on going financial challenge Current collaborative approach having limited it impact

19 Public health body Programme New body to be established by April 2019 Chief Executive on national Public Health Reform Oversight Board Internal programme board established with Mary Morgan as SRO Programme Director appointed and starting end of February Impact Most or all of PHI (ISD & HPS) will move to new body PHI makes up 20% of NSS staff and 5% of the total revenue spend Opportunity NSS to develop and deliver a shared services offering to the new body; presenting an opportunity to demonstrate a model for shared services with wider applicability Risk Risk to the delivery to NSS services due to interdependencies Funding allocations may be insufficient to deliver the programme Timescales may be too short for delivery PHI services may be impacted due to perceived misalignment

20 Local Delivery Plan Local, Regional and National Planning Territorial i Boards now focused on delivering i regional plans by March 18 NSS joined up with National Boards to develop a collaborative plan over the same timescale We will continue to underpin local, regional and national needs with solutions and deliver actions to support the Health and Social Care Delivery Plan We will support the creation of a new Public Health Body and the move of staff in relation to this Developing the NSS LDP Pending revised guidance we continue to work to existing direction The NSS LDP is expected to be aligned, if not included, within the National Boards Delivery Plan February Performance and Finance Committee to sign off final draft March Comments from SG April NSS LDP finalised and signed off by April Board.

21 Financial planning context The financial challenges facing NHS Scotland are significant and growing. Current forecasts indicate a deficit of c 80m for NHS Scotland in Non-recurring measures underpinning finances this year must be saved on a recurring basis from onwards. Funding for NHS Reform will increase by 175m to 303m in : Transformational Change Fund 126m Primary Care 110m Mental Health 47m Trauma Networks 10m Cancer 10m This distribution of resources is designed to support a further shift in the share of the frontline NHS budget dedicated to mental health and to primary, community and social care.

22 Financial planning assumptions Baseline Resource increases Territorial Boards will receive a cash uplift of 1.5% The 4 patient facing National Boards will each receive a cash uplift of 1.0% Other National Boards, including NSS, will receive a flat cash settlement NSD will however receive an uplift of 1.5% Efficiency Targets The National Boards savings target of 15m in will be made recurring from onwards Addressing the Pay Cap: Scottish Government Pay Policy applied: 3% Increase for staff earning 30,000 or less 2% Increase for staff earning above 30,000, capped at 1,600 for those earning more than 80,000

23 Scale of financial challenge ahead Years 3-5 will present a significant challenge Whilst and look manageable years 3-5 will present a real challenge to breakeven We must plan to leverage Digital and deliver our services differently Millions NSS Trading Position Five Year Plan Projection SBTS CLO IT P&CFS PCF PHI Support

24 Scale of financial challenge ahead Our support services model is no longer sustainable breakeven is non-recurring A new operating model which embraces digital delivery and shared services is essential Once for NSS and National Boards Collaboration new public health body provide drivers for change 500 NSS Support Services Five Year Plan Projection ,000 1,500 2,000 2,500 3,000 BS CD CEaD S&G HR

25 Savings required in SBUs have been asked to deliver 5% CRES and contain cost pressures Trading position currently - 1,385m Some figures are subject to confirmation CLO 000s IT 000s P&CFS 000s PCF 000s PHI 000s SNBTS 000s Support 000s Total 000s Baseline - 16,492 22,822 15,993 18,276 40,039 16, ,402 5% CRES , , ,880 Cost Pressures Pay Increase ,302 Incremental Drift ,174 Non Pay inflation 11 2, ,216 3,680 CRES relief applied ,057-1,520 Total Savings Target 239 2,972 1,586 1,824 1,998 3,225 1,672 13,516 As a of Baseline n/a 18% 7% 11% 11% 8% 10% 10%

26 Reserves position Reserves are used to fund corporate costs and service developments Position shown reflects un-allocated resources available to meet in year pressures and any essential developments National Boards Contributions and Contingency are provided for 2018/19 000s Reserves position per prior plan 7,912 Movements: Impact of 0% uplift 1,514 NSS Internal change programme delivery 1,000 CRES relief rent and rates 1,057 Apprenticeship levy 170 In year movements - Planned Developments 204 Reserves position RAM ,945

27 Development funding bids Essential development requests will be subject to prioritisation Requests are both revenue and capital in nature Full reconciliation of digital demand underway (includes 1.8m from PHI) CLO digital investment will be self funded PCF Developments include NDC Warehouse Management System Upgrade 1m BS Developments includes 1m Transformation Fund for Internal Demand already in plan Business Business Mandatory / Digital Critical Discretionary Regulatory Other Total Bids BS 350,000 1,160, ,000 1,660,000 CEAD 794, ,000 Clinical 50, , ,000 CLO 0 0 HR 72,000 72,000 IT 1,150, , ,000 1,970,000 P&CFS 155, , , ,110, PCF 1,830, ,000 2,080,000 PHI 2,251,000 1,474, , ,000 4,625,000 S&G 10,000 65,000 75,000 SNBTS 323,202 1,695, ,500 2,160,702 NSS TOTAL 3,955,202 8,209,224 1,330,000 65,000 1,487,500 15,046,926

28 Planning scenarios There may be some flexibility in our assumptions Development requests of circa 10m Available resources (including programme delivery 3.6m Potential consequentials for pay award in year - 1.9m SBU Trading position -1,385 Reserves 3,945 Funds available for Developments 2,643 Current Scenario 1 Scenario 2 Plan 000s 000s 000s Underlying assumptions within Reserves: National Boards Collaboration Share 7,500 6,500 5,500 Contingency 2,000 1,000 0 Additional Resources for Developments 0 2,000 4,000

29 Sustainable Workforce FY18 NSS Forecast FY19 FY20 FY21 FY22 FY23 Workforce numbers (WTE) 3,332 3,405 2,683 2,628 2,645 2,664 Paybill 145m 149m 117m 118m 119m 121m Agency Staffing (WTE) Agency budget 4m 1m 2m 2m 3m 3m % of Agency Staffing (WTE) 2.2% 1.2% 1.4% 1.7% 2.0% 2.4% Total NSS Workforce Numbers (WTE) 3,405 3,448 2,730 2,685 2,712 2,743 Total Paybill 149m 150m 119m 120m 122m 124m % Movement on Total WTE 1.2% -20.8% -1.6% -1.0% 1.1% % Movement of Total Paybill 1.1% -20.9% 0.8% 1.9% 1.9%

30 Sustainable workforce Key issues RAM process has provided clarity around financial deficits in each SBU which will result in service redesign in a number of areas. Predicted staff reductions require more clarification to establish accurate redeployee figures. Workforce plans are being developed which describe the future workforce requirement and also meet the budget deficit An assumption has been made with the formation of the new Public Health Body from 19/20 onwards (approx 700 WTE) transferring out of NSS. Agency costs mainly relate to IT, PCF and Finance & Business Services with the main driver being 10% year on year increase from PgMS

31 Opportunities and risks Opportunities Once for Scotland Inform and shape policy implementation Innovative service delivery Improve resilience for clinical shared services Improved transformation funding National Boards Collaboration Driving synergy and efficiency across shared services Supporting primary care transformation Life sciences Improving Health Clinical leadership / engagement Supporting primary care transformation Life sciences and personalised medicine Risks Political Commitment Reliance on collaboration to deliver outcomes Structural financial position weakened: No contingency gives significant exposure Accessing transformation funding Public Sector Reform Challenging relationships between Health and Local Authorities Local and Regional diversity Greater distance from the public health agenda Workforce Skills and capabilities Digitisation within and beyond NSS

32 Summary Enable Transformation through: Once for Scotland approach, National Boards Collaboration and Digital transformation Creating the Public Health Body Underpin core services by: Understanding and engaging with our customers / stakeholders Develop services and solutions that match changing demand Assist wider Public Bodies: Where there is value in doing so and without compromising our health and care focus Financially challenging: No uplift, little or no contingency and added pressure from Nationals Collaboration requirement People: Motivated and engaged with focus on digital skills

33 Questions?