The Royal Wolverhampton NHS Trust

Transcription

1 The Royal Wolverhampton NHS Trust Meeting Date: 27 th April 2015 Trust Board Report Title: Executive Summary: Action Requested: Transformation Programme 2014/15 End of Year Review The Transformation Programme was established to deliver the Transformation schemes for 2014/15. This report highlights progress during 2014/15 and identifies the minor changes to the reporting systems for 2015/16. To note: current progress Report of: Author: Contact Details: Director of Planning and Contracting Head of Performance Resource Implications: Public or Private: (with reasons if private) References: (e.g. from/to other committees) Appendices/ References/ Background Reading NHS Constitution: (How it impacts on any decision-making) None Public Session Monthly Reporting to Finance and Performance Committee Transformation Programme Individual Scheme Details. In determining this matter, the Board should have regard to the Core principles contained in the Constitution of: Equality of treatment and access to services High standards of excellence and professionalism Service user preferences Cross community working Best Value Accountability through local influence and scrutiny Page 1 of 7

2 1.0 Background In 2014/15 the Trust recognised the need to look to a transformational based approach to contribute towards CIP as well as the more conventional transactional schemes. This followed an efficiency opportunity review that was conducted by external consultants. The review detailed that additional savings were possible. However, the findings suggested that savings were only realisable if the trust looked at larger change programmes that impacted across a number of areas and disciplines. To support this approach, the Trust introduced the Transformation Programme Group (TPG) to provide greater scrutiny and oversight for the larger trust wide transformation schemes. 1.1 The remit of the TPG is to provide oversight for all of the schemes that are categorised within the transformation programme. In 2015/16, the majority of schemes are based on the original externally commissioned work and are categorised within four programmes of work: - Programme A Ways of working - Programme B Care Pathways - Programme C Commissioning and Partnerships - Programme D Human Resources 1.2 Virtually all of the schemes that have an operational impact are delivered through Programmes A and B, to support this, there are four subgroups that contribute to these workstreams, they are: Elective Chaired by Deputy Chief Operating Officer Non-elective Chaired by Deputy Chief Operating Officer Outpatients Chaired by Head of Patient Access Community Chaired by Group Manager Community /15 Programme Initial work during 2014/15 focused on validating the original report and identifying additional schemes to underpin the Transformation Programme, this has resulted in a programme of work that focuses on reducing waste and inefficiency, service redesign and increased Income generation. 2.1 As the year has progressed Programme A (Ways of Working) and Programme B (Care Pathways) have naturally merged into one Programme and is now known as the Clinical Transformation Programme. Programme C remains in place although Programme D has been fully worked through and formally closed down. Page 2 of 7

3 Work has commenced on all projects with varying degrees of success. It is reasonable to suggest that for the majority of schemes that have either failed to deliver, or have not delivered their full values, that the initial savings values and assumptions behind the savings were either incorrectly calculated or based on assumptions that have not been deliverable. Examples can be seen in the Terms and Conditions project and the Staffing Review Project. At the end of the year the Transformation Programme has delivered 42% of the initial plan in-year and 47% recurrently. Transformational Target In-Year Actual Recurrent Actual Corporate 725,972 39, ,605 Division 1 4,246,441 1,423,235 1,610,302 Division 2 4,003,052 2,207,868 2,395,397 Estates & Facilities 156, , ,672 Total 9,132,207 3,868,566 4,324,976 42% 47% 2.4 For a full breakdown of the values delivered by programme and by scheme please see appendix The Transformation team has worked closely with Matrons, Directorate Managers and department leads however it was recognised that there was a need to engage with staff at all levels to encourage ideas. As a result the team developed the Bright Ideas initiative. The idea behind the scheme was to ask staff for their opinions and ideas as to how the trust could look to reduce waste and inefficiency. Since its launch in February 2015, nearly 200 s have been received through the Bright Ideas address. Whilst the majority of the ideas have been shared with relevant departments and managers to follow-up, two major projects have been identified and are being developed by the Transformation Team in partnership with operational leads: - Print Strategy - Recycling Project - Reduce costs associated with land fill waste / income generation attached to recyclable materials Both projects are currently being developed and will report through to the Transformation Programme Group. Page 3 of 7

4 /16 Programme Given the partial success within 2014/15, it is clear that there is still value in continuing with the Transformation programme and indeed looking to broaden the scope where possible. Details of the progress of all the schemes contained within the programme for 2015/16 will be presented to Finance and Performance committee during April. 3.1 Changes to the existing reporting system have been proposed which could see the subgroups within the Clinical Transformation Group merge and the development of one new group This will have a number of immediate benefits. Firstly, it would have the obvious benefit of reducing the number of meetings that most staff are required to attend. Secondly, all project developments would be shared across a wider group of staff allowing for better engagement and finally, schemes that have shown real benefit could be shared and rolled-out more quickly and with less difficulty as all schemes would be known and understood 3.2 The Transformation Programme Group remains with the following remit: - Set the agenda for the Transformation programme for 2015/16 - To scrutinise and challenge the monthly update reports from the three groups identified: Clinical Transformation Group Commissioning and Partnerships Programme Manager Monthly Update report - Head of Procurement - Approve all new schemes and developments presented from the Programme Leads/Group - Authorise the bids from the small value investment fund 3.3 The outputs from this group will continue to report through the Finance and performance committee for scrutiny and assurance. 4.0 Recommendations The Board is asked to note the progress made during 2014/15. Page 4 of 7

5 Appendix 1 Transformation Programme 2014/15 Scheme Title Project Summary 2014/15 Target Achieved Programme Group A - Ways of Working Clinical Admin Review of productive community services Initial report based their target on the principles of streamlining clinical administration across the Trust. This will enable significant headcount reduction, as well as enhancing the service offering to customers. projects in development include 1. Outsourcing of Medical Health Records Library - Decision re way forward - May Reconfiguration of OPD Service - The Transformation Team have identified that we currently deliver OPD services out of 17 different locations. The team are currently scoping the benefits of reducing 17 departments to 6 - streamlining clinical admin workforce, opportunities to review nursing skill mix enhanced environment for patients and staff increased for specialties to procedure rooms / consulting rooms thus reducing the need for out of hours clinics and provide opportunities to transfer Day case work to OPD 750,000 - The team have identified significant savings can be achieved through mobile working. These include reduced mileage claims, opportunities to reduce admin posts and increased direct care - approx. 30 mins per day per district nurse - which equates to 10 additional nurses per week - this additional capacity provides opportunities to transfer activity out of the acute setting into the community or review nursing workforce through natural wastage. The team are currently testing devices for specification and functionality and work to develop a the business case for full roll out to all district nurses and community matrons is underway Full Roll Out - December , ,878 Theatres Programme Group A TOTAL Initial report focused on theatre sessions being held outside of scheduled hours and advised that improved utilisation of theatre sessions will negate the requirement for theatre sessions overrunning. Further analysis shows that this did not take into account that lists are stopped during the day due to lack of capacity in recovery as beds have not been identified on wards enabling transfer of patients out of theatres. During the work up stage the project team recognised the need to focus on AVOIDABLE cancellations on the day thus reducing wasted time and resources. work undertaken in Appleby has reduced on the day cancellations by 60% over 3 months - or equivalent of additional income of 10k over 6 months. The pilot has become business as usual with a plan to roll out the process across Beynon during May The team are targeting a similar reduction of 60 % or eqvilent of additional income of 12k per month. Work has also been completed to increase pre admission clinic capacity 103,000-1,186, ,878 Page 5 of 7

6 Scheme Title Project Summary 2014/15 Target Achieved Programme Group B - Care Pathways Consultant Job Planning Length of Stay (elective) Scheme currently being reviewed in-line with new software developments 300,000 - reduction in LoS will free up bed capacity across the Trust. A number of initiatives are in place across the Trust however specific Transformation Projects include - - establishment of C41 Nurse Led Unit - first stage of working towards a medical elective unit - social work / orthopaedic pilot The Team have been working with specific departments to increase access / improve process that will improve inpatient flow thus improving non elective LoS 477, ,000 Specific Projects have included work with Pharmacy, Radiology Length of Stay (non elective) Radiology - improved access through review of allocation of consultant sessions, departmental commitment to carry out diagnostic MRIs etc on discharged patients within 2 working days rather that wait for test before discharge (compliance monitored through daily bed meetings) Pharmacy - review of the ordering of dosset boxes - evaluation of options - May 2015, implementation of improved E-Discharge alert system - April 2015 Outpatients Length of Stay Efficiency Impact Programme Group B TOTAL By reducing DNA rates, first to follow up ratios and clinic cancellations this will increase the efficiency of outpatient services. The OPD Project team have over 2014/15 undertaken a pilot in partial booking systems and scoped opportunities identified through E-Reminder systems. A plan re the way forward will be agreed in April 2015 with a clear objective of reducing specific specialties DNA rates by 25% Working with the operational teams to reduce LoS and look at ways in which efficicincies could be generated across a broad range of specialties 982, ,558 1,000,000 1,000, ,412 2,759,842 2,531,970 Page 6 of 7

7 Scheme Title Project Summary 2014/15 Target Achieved Programme Group C - Commissioning and Partnerships Additional Procurement Schemes 247Time - Med Locums, FP10 Dressings Project, Hybrid Pressure Mattress Roll Out, Overall Review and Evaluation of Managed Print options across the Trust, Regional Standardisation on one Supplier for Hearing Aids & Batteries, Standardise on One Supplier for all CRM activity, Standardise on One Supplier for all orthopaedic activity and Synergy - Drapes & Gowns. 2,268, ,452 Pathology Expansion Progressing - still working with commissioners and other organisations to commence new work. 650,000 3,683 Renegotiation of Existing SLAs for Services Provided to Other Review of current SLAs and implement price increase, not fully realiseable as many organisations have a similar "matching" arrangement in place which has negated the impact. 176,769 1,097 Other Back Office Workforce in development 500,000 - Centralised Switchboard across Undertake Black Country review of services to provide centralised solution. This scheme was identified as 'red' and no longer viewed as deliverable. Trusts in the Black Country 30,000 - Centralised Choose and Book Undertake Black Country review of services to provide centralised solution. This scheme was identified as 'red' and no longer viewed as deliverable. and Appointments across Black 30,000 - Development of New Business from NHS Telford and Wrekin Work has commenced and clincis are being delivered however not at the rate of activity anticipated and the level of CIP predicted is not being delivered. 80,532 - Programme Group C TOTAL 3,735, ,232 Scheme Title Project Summary 2014/15 Target Achieved Programme Group D - HR Departmental Staffing Reviews Various projects delivered to release small savings across a number of areas. - 31,685 Base opportunity of reduction in A&C pay costs of 3%. The objective of the project is to design and implement new ways of working which achieve a Corporate Admin and Clerical reduction in corporate Admin and Clerical operating costs, whilst some of this work has been completed most of the savings have been taken at a Review transactional level and appear within relevant budgets 100,000 - Terms and Conditions Management Skill Mix Staffing Review Programme Group D TOTAL The project has been completed and a number of options presented to the Trust Board for consideration. Only those agreed have been implemented and the savings delivered has been reduced. This scheme was identified as 'red' and no longer viewed as deliverable. MARS V2 was implemented and had very little take up, the savings identified refelct in-year values and the recurrent savings are larger. 250,000 88, ,000-1,000,000 40,801 1,450, ,486 Page 7 of 7