Five Year Plan Five Year Plan 2018 - 23 C li Colin Sinclair Si - - PowerPoint PPT Presentation

NHS N ti l NHS National Services Scotland

Five Year Plan Five Year Plan 2018 - 23

C li Si l i Colin Sinclair

Chief Executive 2 Feb 18

Areas for today

• Context
• Vision and strategic direction
• Consequences and plan
• Finance and workforce
• Conclusions

The challenge remains g

Needs/demands increasing whilst money gets tighter

Poor relative health Inequalities

Need for Scotland’s health to

+

=

health

improve

+

=

Increasing service demand Ageing population Complex care needs demand

+

=

Increasing demand Budget deficits Financial pressures demand deficits p

Delivering the Health and Social Care g Delivery Plan

F j Health and social Public health improvement Four major programmes: care integration

“Optimising and joining up balanced health and care

p

“Create a clear set of national public health priorities for Scotland as a whole and t li th tl l tt d services, whether provided by NHS Scotland, local government or the third and independent sectors” streamline the currently cluttered public health landscape” independent sectors

The National Cli i l St t NHS Board review

“Review the functions of existing national NHS Boards to explore

Clinical Strategy

“Strengthen primary and community care; improve secondary and acute care; national NHS Boards to explore the scope for more effective and consistent delivery of national services and the support provided secondary and acute care; focus on realistic medicine” to local health and social care system for service delivery at regional level”

Why we are here y

“To improve the health and llb i f th l f wellbeing of the people of Scotland, we provide solutions to support and solutions to support and deliver public services.”

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 p SS 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.

Our vision

Where we want to be

8 9 3 To enable the t f ti f h lth To underpin a t i bl d To assist other public t i ti 8 9 3 transformation of health and social care to help improve the health and wellbeing of the people sustainable and resilient NHSScotland by providing excellent support services and sector organisations where there is value in doing so and without compromising our health wellbeing of the people

• f Scotland.

support services and expertise. 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.

Our market

Where we want to operate

HEALTH AND SOCIAL CARE

SCOTTISH GOVERNMENT (HEALTH AND SOCIAL HEALTH (REGIONAL, TERRITORIAL, CARE DIRECTORATE) NATIONAL)

NATIONAL SERVICES

| WIDER PUBLIC PUBLIC HEALTH (3 DOMAINS: SOCIAL CARE (LOCAL AUTHORITY

SCOTLAND

SECTOR Health Protection, Health Improvement, Quality Improvement) (LOCAL AUTHORITY, THIRD SECTOR, PRIVATE)

Our market

What is needed

HEALTH AND

SCOTTISH GOVERNMENT HEALTH

SOCIAL CARE

• Support and enable

transformation

• Support delivery of health &

financial targets

• Enable National, Regional and

Territorial service planning

• Support for local

transformation g

• Deliver services & expertise

more widely

• Excellent and efficient support

services

| WIDER PUBLIC

NATIONAL SERVICES

PUBLIC HEALTH

• Support creation of PHB
• Provide corporate shared

i HR Fi C SOCIAL CARE

• Good understanding of local

priorities S l i t ti f l l

SECTOR

SCOTLAND

services, e.g. HR, Fin, Comms

• Ensure SLAs in place to

underpin cross sharing of data and intelligence

• Seamless integration of local

care offering

• Specialist advice and

transformation support To assist other public sector organisations where there is value in doing so and without compromising our health and care focus

Transformation

Our focus on the need NSS will play an important role in supporting the transformational change needed to deliver the Health and S i l C D li Pl Social Care Delivery Plan.

Once for Scotland Digital Delivery Clinical & Business Enablement Public Health National Boards Collaborations

SBU visions and priorities

E t l t t i f

Area Vision Priorities SNBTS Transforming health through integrated transfusion,

• Blood system safety and sustainability

External strategic focus

tissue and cell therapy products, services and solutions

• Embracing new treatment opportunities.

P&CFS A 100% digitally enabled Primary Care support service. To be the leading counter fraud agency in the public

• Digital transformation of primary care transactions
• Supporting new primary care delivery of care models

To be the leading counter fraud agency in the public sector PHI Robust Health Protection function to protect the health and wellbeing for the people of Scotland. Joined up public service data and intelligence to bl

• 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 C ti i t f di it l i t d i t i bl enable:

• The public to make informed decisions
• Professionals to drive improved outcomes
• Public bodies to deliver service value
• Continuous improvement of digital 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

pp g p through leading clinical and commercial solutions g p q g p g 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

CLO CLO to be the recognised provider of choice for selected legal services in support of Health and available to the wider public service in Scotland

• Continued high level of satisfaction from NHS clients and this remains

a priority.

• Fully digital CLO.

IT To be valued as a trusted, integral and strategic IT / Digital services partner to the Health & Care Sector in

• Digital transformation and other technology / methods shifts will drive

need for considerable re-skilling of IT workforce. Scotland

• Need to address resilience and sustainability of national applications

and networks over next few years. Increased focus on security.

SBU visions and priorities

I t l t t i f

Area Vision Priorities

Business Services To deliver excellence in strategic financial

• Reposition PgMS as Transformation Services, providing

Internal strategic focus

Business Services To deliver excellence in strategic financial management and governance enabled by efficient and effective finance shared services To enable public service reform by providing valued service transformation capability and Reposition PgMS as Transformation Services, providing capability to support the delivery of the Health & Social Care Delivery Plan

• Lead the design and implementation of digitally enabled

shared services for the new Public Health Body and a new Finance operating model for National Boards

• Embed Digital Transformation through agile methodology to

valued service transformation capability and trusted delivery expertise to NHS Scotland and the wider public sector

• Embed Digital Transformation through agile methodology to

support new ways of working CEAD To drive engagement, understanding and value for NSS customers and stakeholders

• 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 To ensure Scotland’s health and social care needs are being met through successful and innovative NSS services and solutions

• 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 professional and clinical leadership to influence, inform and support HR Providing innovative people solutions and leadership to enable NSS and our partners to improve the health and wellbeing of the people

• HR is a key enabler to support NSS deliver transformational

change and build capability through :- People and Cultural Change

• f Scotland

Service Redesign Digital Transformation Programme

12

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

2 2 / 2 3 Transform ation culturally em bedded

• True collaboration with National Boards
• Recognition (by others) of where we can

help

• Ability to influence across a broad

stakeholder base

Actions in 2 0 2 2 / 2 3

New Nationals business model delivering effective support services Collaborative working intrinsic 2 1 / 2 2 Supporting transform ation Current Situation

• Well positioned
• Strong reputation
• Strengthened customer

relationships

• Embedded as an intrinsic partner in transformation activities
• Continued to deliver high quality services to an integrated health and

care system

Actions in 2 0 2 1 / 2 2

• Continue digital enablement across health and social care
• Implement Nationals’ collaborative working
• Continue support for service transformation
• Refresh National IT infrastructure

Actions in 2 0 2 0 / 2 1

2 0 / 2 1 Transform ation underpinned by digitisation

Actions in 2 0 1 9 / 2 0 :

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 1 9 / 2 0 Digitised Services

Actions in 2 0 1 8 / 1 9 :

• 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

Continue to support the establishment of the new public health body 1 8 / 1 9 Effective support for transform ation 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

Overview - last year’s steps

Progress against 2017-18 Actions

Action Outcome

Modernise blood service

• JCC Occupied and move of manufacturing ongoing

Support NHSScotland transformational change,

• Pursuing collaboration with national boards including co-

authoring the nationals’ delivery plan developing solutions and progress shared services

• 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

Shared services continue to progress Continue implementation of digital transformation

• Digital programme continues to progress as planned
• Recent RAM process identified customer needs and

corresponding digital requirements corresponding digital requirements

• Digital Transformation Roadmap being implemented

Deliver operational excellence, focusing on what we do and

• All areas pursuing and measuring progress against

‘Improve the way we do things’ g doing it well to meet needs p y g

• Operational excellence embedded and underpinning all

activity Continued focus on staff

• Staff Governance Action Plan in place

development

• Staff Excellence awards scheme refocused
• Workforce planning continues in all areas
• Succession planning progressing beyond executive cohort

SWOT analysis

St th W k Strengths

• Track record of delivery
• Size, breadth and scale
• Willingness to help others

Weaknesses

• Authority and investment
• Financial constraints
• Lack of public visibility / interest
• Willingness to help others
• Lack of public visibility / interest
• Limited influence

Opportunities

• Once for Scotland
• Digital transformation

N i l b d ’ ll b i

Threats

• Cultural resistance and pace of

change M i d f ‘ k’ b i

• National boards’ collaboration
• Clinical engagement
• Magnitude of ‘ask’ but uncertain

future environment

• Imbalance between national,

i l d l l t f ti regional and local transformation

High level actions

Increase our services impact Customer at the heart

g

Digital transformation Customer/stakeholder engagement ‘Once for Scotland’ Implementation of public health body

Great place to work

Staff development

Improving the way we do things

NSS Shared services ‘Once for Staff development Staff feedback NSS Shared services Once for NSS’ NSS Sustainable service programme

Our Key Enablers

programme Innovation Empowerment Operational excellence

Our Key Enablers

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 & well- High Low Health Protection Maintain being 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

17

Fraud prevention Maintain Quality service Low High Programme Management Invest Transformation Medium High

National board collaboration

Opportunities and challenges

External Services External Services

• Focused outcome based deliverables that are more than sum of

parts – Digital – Workforce Transformations Support – Transformations Support – Efficiency and Financial Improvement Internal Efficiency

• Vision for new operating model required to meet on going financial

challenge C t ll b ti h h i li it d i t

• Current collaborative approach having limited impact

Public health body

Programme

• New body to be established by April 2019

y y p

• 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
• 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

p g y p g

• pportunity to demonstrate a model for shared services with wider applicability

Risk

• Risk to the delivery to NSS services due to interdependencies

y p

• 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
• PHI services may be impacted due to perceived misalignment

Local Delivery Plan

Local, Regional and National Planning

T it i l B d f d d li i i l l b M h 18

• Territorial Boards now focused on delivering 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

l ti t thi relation to this

Developing the NSS LDP

• Pending revised guidance we continue to work to existing direction

g g g

• The NSS LDP is expected to be aligned, if not included, within the National Boards’

Delivery Plan – February 2018 - Performance and Finance Committee to sign off final draft February 2018 Performance and Finance Committee to sign off final draft – March 2018 - Comments from SG – April 2018 - NSS LDP finalised and signed off by April Board.

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 2017 18
• Current forecasts indicate a deficit of c£80m for NHS Scotland in 2017-18.
• Non-recurring measures underpinning finances this year must be saved on a

recurring basis from 2018-19 onwards. Funding for NHS Reform will increase by £175m to £303m in 2018-19:

• Transformational Change Fund £126m
• Primary Care £110m

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 g primary, community and social care.

Financial planning assumptions

Baseline Resource increases

• Territorial Boards will receive a cash uplift of 1 5%
• 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
• Other National Boards, including NSS, will receive a flat cash settlement
• NSD will however receive an uplift of 1.5%

Efficiency Targets Efficiency Targets

• The National Boards savings target of £15m in 2017-18 will be made

recurring from 2018-19 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

Scale of financial challenge ahead

Years 3-5 will present a significant challenge

• Whilst 2018-19 and 2019-20 look manageable years 3-5 will present a

Whilst 2018 19 and 2019 20 look manageable years 3 5 will present a real challenge to breakeven

• We must plan to leverage Digital and deliver our services differently

2017‐18

NSS Trading Position ‐ Five Year Plan

£5 £0 £5

Projection 2018‐19 2019‐20 2020‐21 2021‐22 2022‐23

Millions ‐£20 ‐£15 ‐£10 ‐£5 ‐£30 ‐£25

SBTS CLO IT P&CFS PCF PHI Support

Scale of financial challenge ahead

Our support services model is no longer sustainable

• 2018-19 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

2017‐18 Projection 2018‐19 2019‐20 2020‐21 2021‐22 2022‐23

NSS Support Services ‐ Five Year Plan body provide drivers for change

‐£500 £0 £500 2017 18 Projection 2018 19 2019 20 2020 21 2021 22 2022 23 ‐£2,000 ‐£1,500 ‐£1,000 ‐£3,000 ‐£2,500 BS CD CEaD S&G HR

Savings required in 2018-19

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

• Some figures are subject to confirmation

Baseline

• 16,492

22,822 15,993 18,276 40,039 16,780 130,402 5% CRES 868 1 201 842 978 2 107 884 6 880 5% CRES

• 868

1,201 842 978 2,107 884 6,880 Cost Pressures Pay Increase 200 442 279 540 760 700 381 3,302 Incremental Drift 28 25 26 442 260 145 248 1,174 Non Pay inflation 11 2,100 80

• 273

1,216 3,680 Non Pay inflation 11 2,100 80 273 1,216 3,680 CRES relief applied

• 463
• 1,057
• 1,520

Total Savings Target 239 2 972 1 586 1 824 1 998 3 225 1 672 13 516 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%

Reserves position 2018-19

Reserves are used to fund corporate costs and service developments p p

• 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: I t f 0% lift 1 514 Impact of 0% uplift 1,514 NSS Internal change programme delivery 1,000 CRES relief rent and rates 1,057 CRES relief rent and rates 1,057 Apprenticeship levy 170 In year movements - Planned Developments 204 Reserves position RAM 2 1819 3,945

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

Digital Business Critical Business Discretionary Mandatory / Regulatory Other Total Bids

p g y pg

• BS Developments includes £1m Transformation Fund for Internal Demand already

in plan

Digital Critical Discretionary Regulatory Other Total Bids BS £350,000 £1,160,000 £150,000 £1,660,000 CEAD £794,000 £794,000 Clinical £50,000 £450,000 £500,000 CLO £0 £0 HR £72,000 £72,000 IT £1,150,000 £700,000 £120,000 £1,970,000 P&CFS £155 000 £850 224 £105 000 £1 110 224 P&CFS £155,000 £850,224 £105,000 £1,110,224 PCF £1,830,000 £250,000 £2,080,000 PHI £2,251,000 £1,474,000 £125,000 £775,000 £4,625,000 S&G £10,000 £65,000 £75,000 , , , SNBTS £323,202 £1,695,000 £142,500 £2,160,702 NSS TOTAL £3,955,202 £8,209,224 £1,330,000 £65,000 £1,487,500 £15,046,926

Planning scenarios 2018-19

There may be some flexibility in our assumptions

• Development requests of circa £10m

Current Scenario 1 Scenario 2

• Available resources (including programme delivery £3.6m
• Potential consequentials for pay award in year - £1.9m

Current Plan £000s Scenario 1 £000s Scenario 2 £000s SBU Trading position

• 1 385

SBU Trading position

• 1,385

Reserves 3,945 Funds available for Developments 2,643 Underlying assumptions within Reserves: National Boards Collaboration Share 7,500 6,500 5,500 Contingency 2,000 1,000 Additional Resources for Developments 2,000 4,000

Sustainable Workforce Sustainable Workforce

NSS FY18 Forecast FY19 FY20 FY21 FY22 FY23 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) 74 42 47 57 67 79 A b d £4 £1 £2 £2 £3 £3 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 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%

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

q redeployee figures.

• Workforce plans are being developed which describe the future

workforce requirement and also meet the budget deficit q g

• 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

Opportunities and risks pp

Opportunities Risks

Once for Scotland

• Inform and shape policy implementation
• Innovative service delivery

Improve resilience for clinical shared

Political Commitment

• Reliance on collaboration to deliver
• utcomes

Structural financial position weakened:

• Improve resilience for clinical shared

services

• Improved transformation funding
• Structural financial position weakened:
• No contingency gives significant

exposure

• Accessing transformation funding

National Boards’ Collaboration

• Driving synergy and efficiency across

shared services g g

Public Sector Reform

• Challenging relationships between

H lth d L l A th iti

• Supporting primary care transformation
• Life sciences

Improving Health

Health and Local Authorities

• Local and Regional diversity
• Greater distance from the public

health agenda

Improving Health

• Clinical leadership / engagement
• Supporting primary care transformation
• Life sciences and personalised medicine

g

Workforce

• Skills and capabilities

p Digitisation – within and beyond NSS

Summary

Enable Transformation through:

• Once for Scotland approach, National Boards’ Collaboration and Digital

y

pp g 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
• 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
• Where there is value in doing so and without compromising our health and care

focus

Financially challenging: Financially challenging:

• No uplift, little or no contingency and added pressure from Nationals

Collaboration requirement

People:

• Motivated and engaged with focus on digital skills

Questions? Questions?