Parallel Session 2.7 Working Collectively to Make Best Use of Our Resources Across NHSScotland

Working collectively to make best use of our resources across the NHS in Scotland.John Burns

Michael Cambridge Gordon Beattie

Brendan Faulds Lynn Marsland

East of Scotland Procurement Consortium (ESPC)

Partners

• NHS Borders• NHS Fife• NHS Forth Valley• NHS Grampian• NHS Highland• NHS Lothian• NHS Orkney• NHS Tayside• National Procurement/SG

Heavy use of Video and Teleconferencing

Aims

• Productive opportunities of sharing services• Test change• Build a consortium business model• Provide lessons learned for similar projects• Contractual economies are a given• Create value as well as savings• Shift from a ‘club’ to a disciplined consortium• Reduce fixed costs

Ensure we buy the “right thing” for the patient as well as buy in the “right way”

What’s it got to do with me?

• Integrates with overall improvement/quality plan• Reinvesting savings in direct patient care• Ensuring fit for purpose products• Capturing end users clinical knowledge • Refining Commodity Advisory Panel reps• Pooling Clinical Procurement Specialist knowledge• Effective Supply Chain reduces waste and saves you

time – Closing the Gap, RTC, Productive Ward, 6S• Continuous quality by contract/supplier management• Corporate Governance and Legal risks • Back office - but vital back office

Defining Drivers

• Clinical Need• Clinical Pathways• Risk Management• Financial constraints• Policies• Procurement Strategies and Innovation• Competitive Tender requirements• Legal requirements (incl. E&D)• Logistics

Measures

• PCA score of 90% or more • Price savings on aggregated contracting• Reduced operating costs • Savings are formally tracked • Dashboards for budget control and predictive

modelling • Customer Surveys

Changes

• Re-model/share resources to excel for all • Save time by using a “bottom-up approach” • Share and spread local innovation and success • Bank organic economies and cash efficiencies• Longer term – redesign?• What needs to be done x 8…?• TUGs/CAPs

Changes – Q’s

• Processes fit for purpose from a user's stance? RTC…• More freedom of product choice rather than less? • Regionalise supplier markets through MCNs - ie. endoscopy?• Do controls on waste and variation = negative impact on care?• Do controls on waste and variation really save money? • Can we incentivise clinical staff to change?• Horizon scanning - do our systems stifle new technology?• Clinical Procurement Specialists embedded?• Can we influence how suppliers influence clinicians?• Ageing population - are we forecasting demand impacts?• Too much bureaucracy? Will less bring clinical improvement ?

Examples of Improvement – non cashAREA OF IMPROVEMENT

EXAMPLE OF ACTIVITY

Enhancing patient experience

Discrete supply chain for IV needles; incontinence products, which respect patient sensitivities, with delivery to home rather than public collection at HC or hospital

Improving flow Stock management system trials that build confidence to avoid both shortages and “just-in –case” ordering

Improving patient safety

Sharing of product safety info and equipment specifications; common Hazard/Alert systems and comms; Common HAI action plans

Non Cash Benefits

• Consistent reporting and systems• Enhanced and sustainable capability• Effective MI dashboards• Increased non-pay spend influence• Shared templates and T’s & C’s• Shared specifications• Shared learning and innovation• Better access for SMEs and Third Sector• Fosters wider public sector partnering• Improved compliance and governance• Reduced carbon footprint

Cash Benefits

• Lower Operating Costs• Cost avoidance• Regional savings

Increased supplier and market leverage

Increased market influence

Reduced duplication

Improved affordability/VfM

Reduced IT Systems support

Single instance catalogue management

Joint Supplier and Contract Management

Kotter’s 8 steps for successful change

• Increase urgency• Build a guiding team• Get the vision right• Communicate for buy-in• Empower action• Create short-term wins• Don’t let up• Make change stick

Working Collectively to Make Best Use of Our Resources Across NHSScotland

TECHNICAL USER GROUPS – HARNESSING EXPERT OPINION

Technical User Groups (TUGS)

Back Ground:

• New West of Scotland Project.• 5 HB’s working collectively.• Need to make effective decisions not just advise.• Geographically spread.• Different Organisations• No existing regional decision making forums.• Need to harness the expert knowledge of local product

users

Technical User Groups (TUGS)

Creation of TUGS:

• Populated by expert users from each Health Board.• Experts formally appointed to TUG.• Each have DELEGATED AUTORITY OF CEO.• Decisions made once covering all 5 HB’s.• Expert Users of the services to take primary responsibility

for the selection of the supplier of the products/services • Product decisions catalogued and loaded onto local

PECOS /Cedar system.• TUG experts maintain ‘formulary control’ and review.

Online

User

SupplierTUGProcurement Team

eProcurement System

Agree a Deal + Product Range.

Add to PECOS Catalogue

Goods Issued Supplier Paid

Feedback

Paper Indent

TUG : Continence Products

• West of Scotland Health Boards spend around £7m per year • Supplied to Primary & Secondary care environments.• TUG of senior Continence Advisors, Service Managers and

Procurement Specialists. • National multi –supplier framework let Dec 11.• Mini Competition specification focused on service delivery and cost

Outcome• Technical Users across the region worked closely together to

establish the benefits of a regional approach. • This collective approach delivered improved patient services while

delivering enhanced savings through economies of scale and standardisation.

• The WoS regional approach to the implementation of this National Framework has also delivered saving of around £1.5M to the five Health Boards.

Question

Think about the people issues around change in Procurement and HR.

What are the main people issues you see?

How do we best bridge the gap between early adopters and those who are less keen to change?

Engaging Stakeholders to get Better Value through Procurement

National Procurement – who are we?

• We are NHSScotland’s Centre of Procurement Expertise, set up in response to the McClelland Review of Public Procurement in Scotland (2006)

• We provide goods, services and procurement expertise to NHSScotland’s 14 Regional Health Boards and 8 Special Health Boards

• We are a Division of National Services Scotland and work closely with the Scottish Government’s Health and Procurement Directorates

• We strive towards procurement best practice and delivery of new, innovative ways of working that deliver significant financial and service efficiencies across NHSScotland

NHSScotland ProcurementSupporting the Health and Wellbeing of the People of Scotland

Our Key Aims

• Become effective supply chain partner by working collaboratively with NHSS to identify and implement joint efficiency solutions

• Provide a total customer service package including Logistics, Procurement, Systems, Improvement and Development Services

• Be innovative and forward looking by assessing and implementing more effective ways of working through processes, systems and technology

• Add value to Health Boards via improvement programmes to identify and deliver real solutions in support of our customers’ challenges


Health Expenditure 2010/11

• Non-Pay Spend in 2010-11 was £2.559bn in NHS Scotland

• Trade supply spend = £2.017bn


So that’s the opportunity…..

How do we engage to exploit it?


Intensive Improvement Activity

• A short, sharp consultancy engagement • Provides a focus and creates momentum for change• We guarantee to borrow your watch and tell you the time!• There will be very little in the way of surprises• You well get out of it what you put into it• Delivers detailed and specific recommendations

recognising Risks, Challenges, Constraints and first steps to implementation

• Planning & Preparation are PARAMOUNT• Needs executive engagement and organisational

commitment to take responsibility to follow it through


How it has been received..

Robert Stewart said, “We are really keen to move on

and tackle these recommendations and although resource is

always a challenge the IIA has helped all of us

understand more about the benefits of better

procurement and was well worth the effort involved.”

Calum Campbell said “Having seen and heard of the success of IIAs in other

Boards and recognising NP’s role our Centre of

Expertise for Procurement, I saw this as something that could help me identify the

maximum amount of savings from procurement

in as short a time as possible”.

. Laura Ace commented, “This exercise raised the focus on procurement throughout the organisation, increasing the

visibility of what we were spending on and bringing together all the strands of

procurement within a common framework. It coincided well

with a growing awareness on the ground that we needed to standardise, collaborate and

follow best practice to get best value and I am confident

savings will flow as a result.”

Nick Kenton said “We clearly recognised the need to

improve and the benefits that would accrue when we

did. It was an easy sell to the Board members and we

quickly gained cross Board support to proceed.”

. Pamela McLauchlan summarised, “A good exercise at a good time for the organisation.

It will help us maintain our continuous improvement in this area and will result in an additional £100k of savings in the next year.”

Caroline Lamb said “We have been looking for the right

solution to getting the most from procurement for some time

….the focus that the NP team brought has helped me make

some key decisions. I am confident NES will really benefit

from the IIA experience.”

• The IIA is a structured rapid improvement style event focused on an individual health board – sponsored by a Health Board Senior Executive

• Tailored “consultancy-style” event

• Within a structured process– Identification, Definition,

Delivery, Closure– Generate energy, awareness,

visibility, momentum, action plans and owners


Success so far….• 16 IIAs delivered since January 2010• 2 recent events targeted purely on identifying additional

savings– £2.2M identified on top of existing projects– Equates to approx 1%-1.5% of targeted Trade Spend

• Funding being sought to take this approach to remaining 20 Health Board organisations– Using a conservative 1% estimate this would equate

to £20M in additional savings

• Beyond investment, it just needs engagement and a common purpose to realise the benefits!


Thank You!


Question

Think about the people issues around change in Procurement and HR.

What are the main people issues you see?

How do we best bridge the gap between early adopters and those who are less keen to change?

HR Shared Services

Overarching Objectives

• Born out of Efficiency and Productivity agenda• 1 of 3 strands to Shared Services

- Finance- HR- Facilities

• Balanced “scorecard” of benefits- Quality of service (governance)- Delivery of service (productivity)- Cost (efficiency)- People (value-add, career progression)

• Identify, quantify and realise benefits from eESS• Support revised national Workforce Development Strategy

IMPLIFY

TANDARDISE

HARE

Scope

if it sits in HR anywhere – its in!!

Programme Principles• Openness and transparency: key stakeholders indentified and all

documentation is made accessible• Partnership: with formal Partnership representatives, NHS staff and external partners • Robust benchmarking and data analysis: establishing a baseline of current

internal data as well as comparisons with external best practice• Engagement: involving groups of HR staff from across NHS Scotland to ensure

ownership for implementing the models developed• Based on a future model where services are most appropriately delivered either locally,

regionally or nationally• Service and process redesign methodology: lean best practice and

programme management disciplines

Risks and Interdependencies

• Implementation and functionality of eESS • Leadership from HRDS, other Directors “in scope” and

other HR staff• Effective partnership working• PIN policies• Health and Social Care integration• e-Payroll, e-Rostering etc• Our “customers”

Workstreams and Timescales

Phase 1 – April 2012 to March 2013• Employee Services• Medical Staffing• Recruitment• Payroll and Benefits Advice

Phase 2 – April 2013 to March 2014• Organisation Development• Learning, Development and Education• Workforce Planning, Workforce Information etc• Occupational Health and Safety

What’s happening now ..

• HRD lead for Phase 1 workstreams- Ian Reid: Recruitment

- Kenny Small: Medical Staffing

- Jacqui Jones: Employee Services

- Annie Ingram: Payroll and Advice

• Baseline for current staffing levels etc• HR “Customer” survey baseline• Understand benefits from eESS implementation• Engage! – Communicate! – Change!

Any questions or comments?

Parallel Session 2.7 Working Collectively to Make Best Use of Our Resources Across NHSScotland

Business

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