Northern HSC Trust. Savings through Reform And Modernisation 2015/16

Northern HSC Trust Savings through Reform And Modernisation 2015/16 26 th March 2015 1

Table of Contents Introduction... 3 DHSSPS Financial Plan for 2015/16... 3 The Northern Trust Share of Savings Target... 4 Approach to identifying and delivering savings opportunities... 4 Efficiency and service impact savings opportunities... 4 Directorate-led and cross-cutting initiatives... 5 High-level opportunities... 6 High-level savings opportunities... 6 Risk Assessment... 7 Equality Requirements... 7 Engagement and Consultation... 8 Governance arrangements for planning and delivery of the Trust s savings opportunities... 8 Annex 1: 2015/16 Reform plan savings Proposals... 10 2

Introduction The Northern HSC Trust cares for a population of over 450,000. It has an annual spend in excess of 600 million. The Trust in common with the rest of the HSC faces the reductions in public sector funding that are prevalent at this time. This plan sets out the proposals which the Trust has developed from reviewing its operations and costs in order to deliver the savings target. This has been done through applying a long term reform and modernisation approach rather than short term cost reductions. In developing the proposals the Trust aligned them with a number of principles: 1. The prioritisation of services according to need; 2. That risks to patient and client care, and to the safety and quality of such care will be effectively managed and reported within the existing risk management arrangements; 3. In developing the alternative models of care in the proposals, best practice is being applied; 4. In developing the reforms proposed in acute care settings, the Trust has sought to ensure that alternative, effective community and primary care service models will, within the resources available, be directed to minimise the impact of any acute sector reforms; 5. Within the reforms proposed, discretionary spending,management costs and procurement efficiencies have all been targeted ; 6. Savings proposals will be subject to public consultation and equality screening/impacts as appropriate in line with departmental and organisational legislation and guidance. Notwithstanding these principles it is almost inevitable that there will be service impacts across a number of areas, likely resulting in increased waiting times in elective acute services and access to services in the community. The Trust will seek to minimise these impacts through prioritisation of care and will continue to ensure that risks to patients and clients are managed at all times. DHSSPS Financial Plan for 2015/16 The Department of Health, Social Services and Public Safety (DHSSPS) set out its assessment of the Executive s 2015/16 budget for Health and Social Care, Public Health and Public Safety in its paper dated 26 November 2014. Within this paper the DHSSPS set out its plan to deliver financial balance for 2015/16. This plan summarises the funding requirements for 2015/16, which includes an additional 150 million of additional resources compared to 3

2014/15, and hence there is an expectation that Trusts and ALBs will need to achieve significant savings in order to finance existing cost pressures and commitments. This paper reflects the Northern Trust s position within the overarching DHSSPS financial plan. It is worth noting the wider organisational context against which the Trust s 2015/16 plan is set. The Trust is actively moving from a period of Turnaround to one of Transformation through a programme of Reform and Modernisation, underpinned by a model for change that is people-centric. The Financial plan will operate in parallel to this strategic plan; they will be collaboratively connected and mutually supportive in delivery of outcomes. The Northern Trust Share of Savings Target The Northern Trust s share of Trusts savings target for 2015/16 is 17m. This was notified to the Trust in a letter from Mrs V Watt, HSCB, dated 17 December 2014. This target, which represents approximately 3% of the Trust s Revenue Resource Limit (RRL), is extremely challenging as it follows year-on-year cash efficiency/productivity targets of circa 3% per annum since 2008/09. The Trust has not been wholly successful in delivering the required savings targets over this period and efficiency opportunities have become increasingly difficult to identify. In recent years the Trust has had to rely heavily on nonrecurrent sources of savings, for example holding workforce vacancies. In 2014/15 the Trust has also benefited from non-recurrent funding and will have to apply a number of one-off accounting adjustments in order to meet its breakeven target. The Trust will, through the continuation of current workforce scrutiny and approval process seek to maintain the levels of vacancies, net of backfill, held in 2014/15 during 2015/16. Approach to identifying and delivering savings opportunities Efficiency and service impact savings opportunities Over the years the Trust s planning processes for savings opportunities have been guided by the McKinsey review, the HSCB s Indicative Productivity Opportunity Pack (IPOP) and other efficiency benchmarking information. 4

In addition the Trust continues to actively participate in the four system-wide TYC workstreams: Care Pathways, Outpatients Reform, Acute Reform and Reablement. It is hoped that these funded and focused approaches will contribute to the delivery of the Trust s savings initiatives/ productivity gains. As part of the current exercise, the Trust has identified and exploited any remaining efficiencies which exist within its day-to-day operations. The value of these efficiencies does not meet the Trust s required savings target, and will not deliver the statutory duty to breakeven. It is inevitable; therefore, that the Trust must now resort to identifying a number of cost reduction measures which have service implications. In identifying these opportunities the Trust has sought to re-prioritise services on the basis of need, with a focus on the maintenance of safety and quality across all remaining services. The Trust is keen to engage in a collaborative process with commissioners and the DHSSPS, so that there is a clear understanding around the implications of delivering the required savings target, and agreement around service prioritisation, safety and quality. Underpinning this process is the recognition that a number of reviews have indicated that the Northern Trust has insufficient acute medicine and surgery bed capacity in Antrim Hospital. The Trust has achieved the 75 th percentile of length of stay against Northern Ireland Peers and this work shows that there should be a bed complement of around 370 beds as against the current capacity of around 328 beds. This makes it exceptionally difficult to anticipate further efficiency savings from within this area. Directorate-led and cross-cutting initiatives The Trust has identified both Directorate-specific and cross-cutting opportunities to reduce costs. This matrix of opportunities should provide standardisation of approach across the Trust, granularity of initiatives and a level of ownership for enhanced delivery. The Trust is keen to see a regional system-wide approach for a number of the Social Care initiatives proposed within this paper, particularly for those areas which require legal advice, service user and public consultation. The Trust is committed to working collaboratively with the commissioner and other Trusts to achieve this objective. 5

High-level opportunities The opportunities identified within this paper are currently at the high-level scoping stage which will be developed further, both within the Trust and through interactions with the HSCB and DHSSPS. The Trust s Change Initiative Project plans (CIPs) for each initiative will be developed accordingly. Indicative workforce implications Indicative workforce implications of the high-level opportunities identified within this paper have been estimated, and will be refined as opportunities are scoped further, and definitive plans developed. Deployment, productivity and resource planning measures such as vacancy control, redeployment and retraining, absence and performance management will continue to support the delivery of savings measures and transformation as we move forward. More sophisticated planning, use and productivity and efficiency methodologies and Directorate and Division led management of staff cost expenditure will ensure that any savings through staff costs are not done so at the detriment of employee engagement or investment in front line resources. Our experience from recent years has shown that relying on natural wastage in staff turnover and workforce movement to reduce staff costs associated with the proposed changes will go some way to delivering the target cash savings. However, it is expected that access to a voluntary exit scheme will be necessary to support delivery of the savings within the required timeframes. High-level savings opportunities The table below sets out the values attributable to the high-level savings opportunities identified under the four general categories identified by the DHSSPS. High level Category of Reform Savings Opportunities m CYE Acute Reform 1.845 Social Care Reform 3.049 Staff Productivity 2.860 Miscellaneous Productivity 2.346 Total 10.100 Annex 1 sets out the various initiatives identified by each Directorate and the detail around these initiatives which has been subject to review and discussion with the HSCB. 6

This set of proposals leaves the Trust significantly short of the required 17 million and it is envisaged at this stage that further savings without serious service impact are not achievable. The Trust will continue to implement workforce controls in order to reduce this gap. The Trust will manage the workforce implications of the 2015/16 savings initiatives, as plans are developed, in accordance with its Framework on the Management of Change Protocol. Risk Assessment The Trust has reviewed the detailed initiatives which form part of the four overarching workstreams, and carried out a high-level assessment of the deliverability of each of the individual projects/targets within the planned timeframes. These are set out in each of the savings areas in Annex 1 along with a note regarding consultation. It needs to be acknowledged that there are significant challenges in delivering this plan which are out with the control of the Trust, namely political and public opposition to decommissioning of local healthcare facilities, continuing increases in demand for services, cost pressures in the HSC economy, current waiting time targets, Trade union and staff concerns and the limited time within which to achieve the totality of the savings. The Trust does not have the capacity to absorb any potential slippage arising from the impacts outlined as non-recurrent workforce or other contingency savings will have been fully exploited in getting to the 11m savings target. Equality Requirements The Trust will fulfil its statutory equality and good relations duties set out under Section 75 of the Northern Ireland Act 1998 through the application of its revised equality scheme arrangements. 1 In keeping with the commitments of the Trust s Equality Scheme the Trust has carried out a preliminary equality screening of this Plan the outcome of which was the decision to subject the Plan to on-going screening given its strategic nature - which is in line with the Equality Commission for NI Guidelines which state that.. for more detailed strategies or policies that are to be put in place, 1 The Trust welcomes the recent guidance note from the Equality Commission for Northern Ireland (December 2014) which specifically refers to the requirements of Section 75 in relation to budget setting. 7

through a series of stages, a public authority should then consider screening at various times during implementation. As opportunities become proposals, equality considerations will form part of the decision-making process. The Trust will fully screen each proposal to assess its potential for resultant adverse implications, and identify the subsequent action to be undertaken e.g. equality impact assessment or on-going screening. In accordance with its equality scheme, the Trust will prepare and publish the outcomes of its screening exercises on its website. Engagement and Consultation The Trust recognises the value of early engagement and consultation with key stakeholders including service users, staff, professional bodies, Trade Unions and the general public. This is particularly important given the nature of the proposals currently being identified and the projected service implications. The Trust s revised equality scheme sets out the Trust s commitment to consultation and engagement under its statutory duties under Section 75 of the Northern Ireland Act 1998. The scheme also provides a framework for effective implementation of these duties. The Trust is also fully cognisant of its statutory duty of public involvement and consultation and recognises the benefit of Personal and Public Involvement (PPI)/ service user involvement which ensures that service users, patients, clients and carers, including the public, have their say about the way services are planned and delivered. The Trust will engage in formal consultations in accordance with the Trust s Consultation Scheme and good practice guidance. Governance arrangements for planning and delivery of the Trust s savings opportunities Given the timing of the DHSSPS/HSCB s request, and very limited timescales for the development of savings plans, the Trust has not been able to hold detailed discussion with HSCB and Northern LCG on its approach to reducing its cost base to meet its savings target. The Trust will now commence dialogue with commissioners so that there is a clear understanding of the opportunities within this paper. Given the seriousness of the current financial situation it is 8

critical that decisions about the Trust s proposals progress swiftly in order to enable successful implementation within the target timescales. The Trust also welcomes any support which the HSCB may offer to identify further areas which have the potential to release cash savings which have not been reviewed and included in this paper. Robust planning performance and accountability processes are key to the successful delivery of savings proposals within target timeframes. Within the Trust we will plan and performance manage individual savings initiatives under the Trust s reform and modernisation) Programme, and as part of our normal appraisal, accountability and performance management framework. The savings plan governance arrangements are being finalised. 9

Annex 1: 2015/16 Reform plan savings Proposals 10

Acute Reform Proposals The following proposals represent the Trust approach to reforming its Acute Services and delivering more cost effective services for the population served by the Trust. They should not be seen in isolation of the service reform plan as a whole (RAMP) which sets out the overall strategy across all services and blends the acute and social care services changes. Proposal CYE FYE Deliverability R/A/G Public Consultation required Y/N '000 '000 Adjustment to Mid Ulster beds to continue for further year: The Trust adjusted its bed complement in 2014/15 by seven beds and it is proposed that these will remain closed as part of the wider strategy to enhance intermediate care as part of the RAMP plan 408 408 N Whiteabbey MIU temporary closure to continue for further year: As part of its 2014/15 contingency plan to achieve breakeven the Trust closed its MIU at Whiteabbey Hospital on a temporary basis. The Trust would propose to maintain this closure for a further period of time and will consult on a permanent closure. 240 240 Y Whiteabbey/ Mid Ulster OOH adjustment : The Trust has adjusted its out of hours Medical cover and improved its nursing support in Whiteabbey As a result the need for locum medical cover has been reduced and this will be continued. 130 130 N 11

Move to sba volumes in a range of services : The Trust has over delivered on its contracted volumes in a number of specialties/community service areas and is planning to live within the Service and Budget Agreement (SBA) levels set for it in 2014/15. This may impact on staffing levels and on waiting times for services, whilst prioritising patient and client clinical needs. 440 440 N Adjust Medical Model in Mid Ulster and Whiteabbey to suit patient profile: The Trust will introduce a new medical model for the two hospitals which reflects the case mix of patients and will be a suitable model to support the medical needs of patients provided for in these two locations. 125 250 N Centralisation of Acute Outpatients clinics on Acute hospital sites, i.e., Antrim and Causeway. This will be progressed in collaboration with a regional outpatient reform plan Seasonal adjustment in Acute and Community Care: 67 134 Y - The Trust will plan to utilise its current bed stock in a more efficient way by aligning bed availability with demand. This will allow the Trust to reduce the number of beds opened in its hospital sites and in the intermediate care facilities during the summer months when demand tends to be less. This is in keeping with seasonal adjustment for the winter period. Clinical need and demand will be recognised. Total Planned Savings 2015/16 435 1,845 1,602 N 12

Social Care Reform Proposals Proposal CYE FYE Deliverability R/A/G Public Consultation required Y/N '000 '000 Domiciliary Care : There are a number of domiciliary care proposals which have been identified: (a) Cost management initiative in domiciliary care : The Trust will continue to extend its use of Independent Sector supply of Domiciliary Care to its clients, where the capacity of the in-house service is maximised. 250 500 N (b) Reduction in overtime in homecare: The Trust will recruit a number of permanent homecare staff to reduce overtime in the existing workforce 440 440 N (c) Management of Domiciliary Care budgets to contain spend: Trust spend will be managed within the set budgets 149 149 N Learning disability Cash Awards : The Trust currently pays a daily allowance to Learning disability clients in Day/ Adult Centres. The intention is to review this allowance which is no longer considered appropriate. This proposal will be consulted on locally. 60 120 Y 13

Cessation of non-statutory transport: The Trust provides free transport to a number of voluntary organisations and proposes to cease this unfunded activity, while supporting voluntary organisations to seek alternative arrangements. Local consultation will be required. 28 78 Y Review Commissioning of community and Voluntary Sector services: The Trust proposes to review its arrangements with the voluntary sector. This will require those services currently commissioned from these organisations to be redesigned and/or alternatively reprovided. Consultation will be necessary. 1,500 2,000 Y Live within budget for Community Hospitals : The Trust will plan to live within its budgets for intermediate care facilities in 2015/16 and this will require appropriate bed/resource management. The Trust will be working to improve the Length of Stay. 467 467 N Reconfiguration of Supported Living Facilities: This initiative will look at the need for replacement of facility/facilities and will seek to place its current clients in appropriate and/or alternative community settings. Consultation will be required. 155 247 Y Total Planned Savings 2015/16 3,049 3,981 14

Staff Productivity Proposals: The Trust has reviewed all of its staff costs areas and has identified potential for savings in the following areas: Proposal CYE FYE Deliverability Public Consultation R/A/G required Y/N '000 '000 Travel rates reduction: The change in rates of travel in July 2014 have contributed an 80k per month reduction in the cost of staff travel and this will continue in 2015/16. 960 960 N Management and Admin costs reduction: The Trust is carrying out an administrative staff review across its services to identify opportunity for administrative cost reduction through better use of shared resources, review of the management structures and a review of temporary and agency staff requirements. 1,000 1,000 N Reduction in travel mileage (circa 5%): All directorates in the Trust will be tasked to deliver a 5% reduction in travel mileage which will not only reduce the cost of travel but also reduce the time spent travelling by staff. This should provide a productivity gain. 400 400 N Absence Management : Directorates will be set a target for further reducing staff absence 500 500 N Total Planned Savings 2015/16 2,860 2,860 The trust will require access to Voluntary Exit funding to assist towards achieving the reduction in Management and Administrative costs. 15

Miscellaneous Productivity In order to meet the challenge of the savings target the Trust has also reviewed its discretionary spend areas and identified the following: Proposal CYE FYE Deliverability R/A/G '000 '000 Public Consultation required Y/N Nonpay costs management: The Trust will continue its emphasis on managing spend on non-pay discretionary items such as stationery, furniture and equipment, managing choice through better procurement and contract management, and stock review 1,596 1,596 N Capitalisation of Assets The Trust will avail of any opportunities to capitalise assets within existing accounting guidelines 500 - N Review of Estate and Leases: The Trust is carrying out a review of its estate in line with the Trust reform and modernisation plans to align services and estate needs for the future. A review is also under way for opportunity to relinquish lease property and to consolidate on Trust sites. A target has been set to reduce expenditure in this area. 250 250 N Total Planned Savings 2015/16 2,346 1,846 16