Survey Partner: Efficiency Challenges in the NHS Healthcare Sector Survey 2015

Transcription

1 Survey Partner: Efficiency Challenges in the NHS Healthcare Sector Survey 2015

2 Contents The Survey 2 Survey Methodology and Respondents Profile 3 Key Findings 4 Conclusion 10 Efficiency Challenges in the NHS 2015

3 The Survey NHS England s Five Year Forward View has identified a gap between the resources they have available and increasing patients needs which will reach 30 billion a year by 2020/21. As part of the overall plan to address this funding gap, NHS England have set the challenging target of generating efficiency and demand savings of between 2-3% each year for the rest of the decade. Achieving this will mean taking action on prevention initiatives, investing in new care models and, as highlighted in the Dalton Review, seeing a bigger share of the efficiency savings coming from sharing back office services. In light of this, igov, in partnership with Serco, have recently conducted an online survey, which examines the potential readiness and barriers organisations across the NHS are experiencing as they strive to meet their new efficiency targets. It considered the ways in which organisations were already creating efficiency savings, and how they look to build upon this in the future. Efficiency Challenges in the NHS 2015

4 Survey Methodology and Respondents Profile The survey was conducted online by igov Survey between the 9th April and the 5th May. The survey respondents represent a broad cross-section of managers, head of department, directors and c-suite executives from organisations across the NHS. 297 individuals from 205 unique organisations participated in the survey. Organisations included those from Acute Trusts, Mental Health and Community Trusts, Ambulance Services, Clinical Commissioning Groups and Commissioning Support Units. The following diagrams show a breakdown of results by trust types and seniority. 8% 3% BREAKDOWN OF RESPONDENTS BY TRUST TYPE 17% 2% 40% Acute Mental Health/Community Ambulance CCG CSU Other 30% 27% 21% 8% 10% 23% BREAKDOWN OF RESPONDENTS BY SENIORITY Chair Chief Executive Director Head Manager Other 11% Efficiency Challenges in the NHS 2015

5 Key Findings The vast majority of survey respondents (86%) were aware of the NHS Five Year Forward View In the context of this report, a further 76% told us they had a plan in place to generate efficiency savings, and of those who didn t, over half (61%) were considering implementing a plan within the next year. 14% ARE YOU AWARE OF THE NHS FIVE YEAR FORWARD VIEW REPORT AND ITS IMPLICATIONS IN REGARDS TO EFFICIENCY CHALLENGES FOR YOUR ORGANISATION? Yes No 86% Of those who had an efficiency savings plan in place, 55% of survey respondents stated they anticipated a year-on-year efficiency saving of between 2 and 6%. 4% 7% 24% 10% 26% IN THE CONTEXT OF THIS REPORT, WHAT IS YOUR ANTICIPATED YEAR ON YEAR EFFICIENCY TARGET FOR YOUR PARTICULAR ORGANISATION? 0-2% 2-4% 4-6% 6-8% 8%+ Don't know 29% Efficiency Challenges in the NHS 2015

6 Improving the patient journey (74%) and Delivering integrated care models (73%) were voted as the top priorities for dealing with future organisational challenges A further 42% believed that Business Support Services is a high priority, and has an important role to pay in the delivery of future challenges. Moreover, this was followed by another 42% who highlighted this area as a medium priority. Other important areas were also highlighted as delivering clinical improvement plans (50%) and freeing up clinicians to deliver care (45%). PLEASE RANK THE FOLLOWING IN ORDER OF PRIORITY TO DEALING WITH FUTURE ORGANISATIONAL CHALLENGES High priority Medium priority Low priority No priority Integrated care models Business support services efficiency Improving patient journey Freeing up clinicians Clinical improvement plans Sharing information Efficiency Challenges in the NHS 2015

7 Just under half (41%) believed outsourcing and sharing services contributed toward achieving their efficiency targets Moreover, there is a significant increase in respondents (62%) who believe outsourcing and sharing services will make an important contribution to successful delivery of the efficiency plan over the next five years. TO WHAT EXTENT HAS OUTSOURCING AND SHARING SERVICES CONTRIBUTED TO ACHIEVING SAVINGS/EFFICIENCY IN THE LAST TWELVE MONTHS? PLEASE RANK FROM 1 TO 5, WHERE 1 = NO CONTRIBUTION AND 5 = STRONG CONTRIBUTION 26% 12% 3% 32% 1 = No contribution = Strong contribution 27% WHAT CONTRIBUTIONS WILL OUTSOURCING AND SHARING SERVICES HAVE ON THE SUCCESSFUL DELIVERY OF YOUR EFFICIENCY SAVINGS PLAN OVER THE NEXT 5 YEARS? PLEASE RANK FROM 1 TO 5, WHERE 1 = NO CONTRIBUTION AND 5 = STRONG CONTRIBUTION 9% 13% 18% 25% 1 = No contribution = Strong contribution 35% Efficiency Challenges in the NHS 2015

8 Procurement was highlighted as the business support area that could create the largest efficiency improvements (54%) This was closely followed by estates and property management (42%) and ICT services (40%). Moreover, procurement was also highlighted as the area in which the quickest efficiency savings could be made (45%), followed by estates and property management (28%) and ICT services (34%). WITHIN THE FOLLOWING BUSINESS SUPPORT SERVICE AREAS, WHERE WOULD YOU EXPECT TO SEE THE LARGEST EFFICIENCY IMPROVEMENT? PLEASE RANK FROM 1 TO 5, WHERE 1 = NO CONTRIBUTION AND 5 = STRONG CONTRIBUTION Estates and property management ICT services Financial services Employment services Procurement Patient admin services Catering services Occupational health services Information management Efficiency Challenges in the NHS 2015

9 Renegotiating contracts was highlighted as the most common factor that will facilitate the successful delivery of efficiency savings over the next five years (69%) Other factors that participants thought would contribute significantly to efficiency savings included rationalising estates (58%) and outsourcing and sharing services (45%). However, participants also highlighted concerns over service levels and availability as the result the challenge to deliver efficiency savings. Almost a third of participants (32%) were concerned about reduced service levels, whilst a further 28% were concerned about the reduction of service availability. WHAT ARE THE CONTRIBUTIONS THAT WILL FACILITATE SUCCESSFUL DELIVERY OF YOUR EFFICIENCY SAVINGS PLAN OVER THE NEXT 5 YEARS? PLEASE RANK FROM 1 TO 5, WHERE 1 = NO CONTRIBUTION AND 5 = STRONG CONTRIBUTION 23% 15% 5% 20% RENEGOTIATING CONTRACTS 1 = No contribution = Strong contribution 37% 13% 22% 7% 31% REDUCED SERVICE LEVELS 1 = No contribution = Strong contribution 27% Efficiency Challenges in the NHS 2015

10 Risk of Service disruption was ranked as the most common barrier organisations are facing as they strive to meet the efficiency challenge (59%) This was closely followed by over half who believed a perceived lack of relevant skills (52%) could be a significant barrier to achieving their efficiency challenge. Other barriers cited included the perceived cost of new ways of working (41%) and being locked into legacy contracts (37%). WHAT ARE THE MAIN BARRIERS THAT YOU FORESEE FOR YOUR ORGANISATION TO DELIVER THE EFFICIENCY CHALLENGE? PLEASE RANK FROM 1 TO 5, WHERE 1 = NO CONTRIBUTION AND 5 = STRONG CONTRIBUTION Lack of management buy-in Risk of service disruption Perceived cost of new ways of working Lack of relevent skills Locked into legacy contracts Efficiency Challenges in the NHS 2015

11 Conclusion by Dominic Durose, Business Development Manager at Serco Generating annual efficiency savings of between 2-3% over the next five years is a challenging target for NHS organisations. It's that much more challenging when you consider the importance of protecting front-line health care on the one hand and the pressures of demographic change on the other. With three out of every four NHS organisations already rising to the challenge, this survey shows that progress is being made. Securing immediate savings in the first year, however, is just the first and, arguably, easiest - step to take. Most respondents agree that it's quite another matter to establish sustainable savings without risking service disruption or impacting adversely on service levels and availability. Respondents have echoed the widely held beliefs that integrated care models represent the way forward, with nearly half believing that outsourcing and sharing services will be important in achieving efficiency targets and delivering guaranteed year-on-year savings. More specifically, the survey shows that renegotiating contracts, rationalising the estate portfolio and the risks posed by new ways of working feature as some of the key considerations when addressing efficiency challenges. Evidently, it's in these areas where the opportunities and real obstacles to organisational change lie. The success already achieved by Serco ASP s NHS partnership demonstrates the real value of working with a like-minded partner to deliver high quality shared services and ongoing savings while also protecting frontline resources by investing in new service developments and operational efficiencies. To find out more please contact me on or visit Efficiency Challenges in the NHS 2015

12 Acknowledgements The survey team at igov Survey would like to take this opportunity to thank all of those who were kind enough to take part - and especially to those who found the time to offer additional insight through their extra comments. We would also like to thank our partner, Serco, for their assistance in compiling the survey questions, scrutinising the responses and analysing the results. Efficiency Challenges in the NHS 2015 copyright Unless explicitly stated otherwise, all rights including those in copyright in the content of this publication are owned by or controlled for these purposes by igov Survey. Except as otherwise expressly permitted under copyright law or igov Survey s Terms of Use, the content of this publication are owned by or controlled may not be copied, reproduced, republished, downloaded, posted, broadcast or transmitted in any way without first obtaining igov Survey s written permission or that of the copyright owner. To contact the igov Survey team: dcross@ingenium-ids.org Tel: Address: FAO David Cross, Ingenium IDS Ltd, Mansion House, Wellington Road South, Stockport, Cheshire, SK1 3UA Efficiency Challenges in the NHS 2015

13 Efficiency Challenges in the NHS 2015 Quest ion: Are you aware of t he NHS Five Year Forward View report and it s implicat ions in regards t o efficiency challenges for your organisation? Yes % No % Question: In the context of this report, what is your anticipated year-on-year efficiency target for your part icular organisat ion? 0-2% % 2-4% % 4-6% % 6-8% % 8% % Don't know % Quest ion: Do you current ly have a plan in place t o generat e ef f iciency savings? Yes % No % Don't know % Question: Is this something you are considering implementing in the next 6-12 months? Yes % No % Don't know % Grid: Please rank t he f ollowing in order of priorit y t o dealing wit h f ut ure organisat ional challenges: Quest ion: Delivering int egrat ed care models High priority % Medium priority % Low priority % No priority at all %

14 Quest ion: Business support services ef f iciency/ Cost avoidance High priority % Medium priority % Low priority % No priority at all 2 1 % Quest ion: Improving t he pat ient journey High priority % Medium priority % Low priority % No priority at all 2 1 % Quest ion: Freeing up clinicians t o deliver care High priority % Medium priority % Low priority % No priority at all % Quest ion: Delivering clinical improvement plans High priority % Medium priority % Low priority % No priority at all % Quest ion: Improving sharing of pat ient inf ormat ion High priority % Medium priority % Low priority % No priority at all %

15 Quest ion: Providing a paperless working environment (ie. 'going digit al') High priority % Medium priority % Low priority % No priority at all % Grid: To what extent do you agree or disagree with the following statement?: Quest ion: We have made our planned ef f iciency savings during t he last t welve mont hs and met our budget challenges Strongly agree % Agree % Neutral % Disagree % Strongly disagree % Grid: To what extent have each of these following actions contributed to achieving savings/ef f iciency in t he last t welve mont hs? Please rank where 1 = no cont ribut ion and 5 = st rong cont ribut ion. Quest ion: Reducing service availabilit y % % % % % Quest ion: Renegot iat ing cont ract s % % % % %

16 Question: Reduce service levels % % % % % Quest ion: Out sourcing and sharing services % % % % % Quest ion: Rat ionalising est at es % % % % % Quest ion: Management rest ruct ure % % % % % Quest ion: New t echnology invest ment % % % % %

17 Grid: Wit hin t he f ollowing business support service areas, where would you expect t o see t he largest ef f iciency improvement? Please rank where 1 = no cont ribut ion and 5 = st rong cont ribut ion Quest ion: Est at es and Propert y Management % % % % % Quest ion: ICT services % % % % % Question: Financial services % % % % % Quest ion: Employment services (such as payroll, HR, recruit ment) % % % % %

18 Question: Procurement % % % % % Quest ion: Pat ient Administ rat ion Services % % % % % Quest ion: Cat ering services (pat ient meals) % % % % % Question: Occupational Health Services % % % % % Quest ion: Inf ormat ion management % % % % %

19 Grid: Of t he same list, which areas would you expect t o see t he quickest improvement in ef f iciency? Please rank where 1 = no contribution and 5 = strong contribution. Quest ion: Est at es and Propert y Management % % % % % Quest ion: ICT services % % % % % Question: Financial services % % % % % Quest ion: Employment services (such as payroll, HR, recruit ment) % % % % %

20 Question: Procurement % % % % % Quest ion: Pat ient Administ rat ion Services % % % % % Quest ion: Cat ering services (pat ient meals) % % % % % Question: Occupational Health Services % % % % % Quest ion: Inf ormat ion management % % % % %

21 Grid: What are t he cont ribut ions t hat will f acilit at e successf ul delivery of your ef f iciency savings plan over t he next 5 years? Please rank where 1 = no cont ribut ion and 5 = st rong cont ribut ion. Quest ion: Reducing service availabilit y % % % % % Quest ion: Renegot iat ing cont ract s % % % % % Question: Reduce service levels % % % % % Quest ion: Out sourcing and sharing services % % % % %

22 Quest ion: Rat ionalising est at es % % % % % Quest ion: Management rest ruct ure % % % % % Grid: What are t he main barriers t hat you f oresee f or your organisat ion t o deliver t he ef f iciency challenge? Please rank where 1 = no cont ribut ion and 5 = st rong cont ribut ion. Quest ion: Lack of management buy-in % % % % % Quest ion: Risk of service disrupt ion % % % % %

23 Quest ion: Perceived cost of new ways of working % % % % % Quest ion: Lack of relevant skills wit hin t he organisat ion % % % % % Question: Locked into legacy contracts % % % % % Grid: To what extent do you agree with the following statements?: Question: My organisation prioritises short term efficiency savings (6-12 months) rather than sustained savings over a 2-3 year period Strongly agree % Agree % Neutral % Disagree % Strongly disagree %

24 Question: My organisation has a fixed strategy in place to create efficiency savings in both the short and long term Strongly agree % Agree % Neutral % Disagree % Strongly disagree % Quest ion: Redesigning our business support services will be t he largest cont ribut or t o delivering our ef f iciency savings Strongly agree % Agree % Neutral % Disagree % Strongly disagree % Grid: T hinking about your operat ion model f or business support services, rank in order of import ance t he levers which will deliver ef f iciency savings and improved service qualit y: Please rank where 1 = not at all important and 6 = very important Question: Investing in new ICT systems and tools % % % % % % Quest ion: Simplif ied processes and f rameworks % % % % % %

25 Quest ion: Flexible/mobile working pract ices % % % % % % Quest ion: Sharing services wit h ot her organisat ions % % % % % % Quest ion: Rat ionalising propert y/est at es % % % % % % Quest ion: Improving employee self-serve capabilit y % % % % % %

26 Quest ion: Are you int erest ed in hearing more about increasing ef f iciency gains in t he f ollowing areas? Please t ick all t hat apply Estates and Property Management % ICT services % Financial services % Employment services (such as payroll, HR, recruitment) % Procurement % Patient Administration Services % Catering services (such as patient meals) % Occupational Health Services % Information Management % Other - please specify %

27 Results Breakdown Job Funct ions Job Function Count Percent Job Function: Administration % Job Function: Audit % Job Function: Board Secretary % Job Function: Business Development 9 2 % Job Function: Business Management % Job Function: Catering % Job Function: Chief Executive/Deputy % Job Function: Childrens Services % Job Function: Clinical % Job Function: Commissioning % Job Function: Community Health % Job Function: Contract Services % Job Function: Corporate Services % Job Function: Customer Services % Job Function: Education % Job Function: Emergency Planning % Job Function: Energy % Job Function: Engineer % Job Function: Environment % Job Function: Facilities & Estates % Job Function: Finance Management % Job Function: Fire % Job Function: General Manager % Job Function: General Practitioner % Job Function: Governance % Job Function: Governor % Job Function: Health & Safety % Job Function: Hotel Services % Job Function: Human Resources % Job Function: Information % Job Function: Information Governance % Job Function: IT Management 14 3 % Job Function: Legal Services % Job Function: Marketing Communications % Job Function: Medical Director % Job Function: NHS Planning % Job Function: Nursing Director %

28 Job Function: Occupational Health % Job Function: Operations % Job Function: Organisational Planning % Job Function: PA % Job Function: Performance % Job Function: Pharmacy % Job Function: Planning % Job Function: Primary Care % Job Function: Procurement/Purchasing % Job Function: Programme Management % Job Function: Project % Job Function: Quality Assurance % Job Function: Records Management % Job Function: Regulatory % Job Function: Research % Job Function: Risk % Job Function: Sales % Job Function: Senior Manager % Job Function: Service Delivery % Job Function: Social Services % Job Function: Strategy % Job Function: Sustainability % Job Function: Sustainable Communities % Job Function: T elecoms % Job Function: T raining % Job Function: T ransformation/change Management % Job Function: T ransport/fleet % Sect ors Sector Count Percent Clinical Commissioning Groups % NHS % Organisat ions 2gether NHS Foundation Trus t Aintree Univers ity Hos pitals NHS Foundation Trus t As hford and St Peter' s Hos pitals NHS Foundation Trus t Barnet, Enfield and Haringey Mental Health NHS Trus t Bedford Hos pital NHS Trus t Birm ingham and Solihull Mental Health NHS Foundation Trus t Bradford Dis trict Care Trus t Brighton and Sus s ex Univers ity Hos pitals NHS Trus t Buckingham s hire Healthcare NHS Trus t Calders tones Partners hip NHS Foundation Trus t Care Plus Group Central London Com m unity Healthcare NHS Trus t City Health Care Partners hip CIC Com m unity Health Partners hips Countes s Of Ches ter Hos pital NHS Foundation Trus t Croydon Health Services NHS Trus t Dartford and Graves ham NHS Trus t Derbys hire Healthcare NHS Foundation Trus t Dors et HealthCare Univers ity NHS Foundation Trus t Eas t London NHS Foundation Trus t 5 Boroughs Partners hip NHS Foundation Trus t Airedale NHS Foundation Trus t Avon and Wilts hire Mental Health Partners hip NHS Trus t Barts Health NHS Trus t Berks hire Healthcare NHS Foundation Trus t Bolton NHS Foundation Trus t Bradford Teaching Hos pitals NHS Foundation Trus t Bris tol Com m unity Health Calderdale and Hudders field NHS Foundation Trus t Cam den and Is lington NHS Foundation Trus t Central and North Wes t London NHS Foundation Trus t Ches terfield Royal Hos pital NHS Foundation Trus t City Hos pitals Sunderland NHS Foundation Trus t Cornwall Partners hip NHS Foundation Trus t Coventry and Warwicks hire NHS Partners hip Trus t Cum bria Partners hip NHS Foundation Trus t Derby Hos pitals NHS Foundation Trus t Dors et County Hos pital NHS Foundation Trus t Eas t Lancas hire Hos pitals NHS Trus t Eps om and St Helier Univers ity Hos pitals NHS Trus t

29 Eas t London NHS Foundation Trus t Firs t Com m unity Health & Care Glouces ters hire Care Services NHS Trus t Great Orm ond Street Hos pital for Children NHS Foundation Trus t Health Education Eas t Midlands Health Education Wes t Midlands Hertfords hire Com m unity NHS Trus t Hom erton Univers ity Hos pital NHS Foundation Trus t Hull and Eas t Yorks hire Hos pitals NHS Trus t Is le of Wight NHS Trus t Kent, Surrey and Sus s ex Academ ic Health Sciences Network Lancas hire Care NHS Foundation Trus t Leeds Com m unity Healthcare NHS Trus t Lincolns hire Com m unity Health Services NHS Trus t Liverpool Com m unity Health NHS Trus t Maids tone and Tunbridge Wells NHS Trus t Medway NHS Foundation Trus t Mid Ches hire Hos pitals NHS Foundation Trus t Mus grove Park Hos pital NHS Airedale, Wharfedale and Craven CCG NHS Barnet CCG NHS Bexley Clinical Com m is s ioning Group NHS Bolton CCG NHS Brighton and Hove CCG NHS Central London Clinical Com m is s ioning Group NHS Chorley and South Ribble Clinical Com m is s ioning Group NHS Com m ercial Solutions NHS Durham Dales, Eas ington and Sedgefield CCG NHS Eas t Surrey CCG NHS England NHS Ham bleton, Richm onds hire and Whitby CCG NHS Hartlepool and Stockton-on-Tees CCG NHS Hors ham and Mid Sus s ex CCG NHS Im proving Quality NHS Luton CCG NHS North Ham ps hire CCG NHS Nottingham City Clinical Com m is s ioning Group NHS Ports m outh CCG NHS Rus hcliffe CCG NHS South Sefton CCG NHS Southern Derbys hire CCG NHS Trafford CCG NHS Wands worth CCG NHS Wilts hire CCG North Bris tol NHS Trus t North Eas t London NHS Foundation Trus t North Som ers et Com m unity Partners hip North Wes tern Deanery Northern Devon Healthcare NHS Trus t Nottingham s hire Healthcare NHS Foundation Trus t Oxleas NHS Foundation Trus t Penins ula Purchas ing and Supply Alliance Queen Victoria Hos pital NHS Foundation Trus t Royal Berks hire NHS Foundation Trus t Royal Cornwall Hos pitals NHS Trus t Royal United Hos pitals Bath NHS Foundation Trus t Salford Royal NHS Foundation Trus t Sandwell and Wes t Birm ingham Hos pitals NHS Trus t Sheffield Health and Social Care NHS Foundation Trus t Sherwood Fores t Hos pitals NHS Foundation Trus t Solent NHS Trus t South Central Am bulance Service NHS Foundation Trus t South London and Mauds ley NHS Foundation Trus t South Tynes ide NHS Foundation Trus t South Wes t London and St George' s Mental Health NHS Trus t Southport and Orm s kirk Hos pital NHS Trus t Surrey and Borders Partners hip NHS Foundation Trus t Sus s ex Com m unity NHS Trus t Tam es ide Hos pital NHS Foundation Trus t Tham es Valley Prim ary Care Agency The Great Wes tern Hos pitals NHS Foundation Trus t The Mid Yorks hire Hos pitals NHS Trus t The Royal Liverpool and Broadgreen Univers ity Hos pitals NHS Trus t The Sheffield Children' s NHS Foundation Trus t The Walton Centre NHS Foundation Trus t Univers ity College London Hos pitals NHS Foundation Trus t Univers ity Hos pital Southam pton NHS Foundation Trus t Univers ity Hos pitals of Leices ter NHS Trus t Warrington and Halton Hos pitals NHS Foundation Trus t Wes t London Mental Health NHS Trus t Wirral Com m unity NHS Trus t Worces ters hire ICT Services Yeovil Dis trict Hos pital NHS Foundation Trus t Eps om and St Helier Univers ity Hos pitals NHS Trus t Gates head Health NHS Foundation Trus t Glouces ters hire Hos pitals NHS Foundation Trus t Greater Manches ter Wes t Mental Health NHS Foundation Trus t Health Education South Wes t Heart of England NHS Foundation Trus t Hertfords hire Partners hip Univers ity NHS Foundation Trus t Houns low and Richm ond Com m unity Healthcare NHS Trus t Im perial College Healthcare NHS Trus t Kent and Medway NHS and Social Care Partners hip Trus t Kings College Hos pital NHS Foundation Trus t Lancas hire Teaching Hos pitals NHS Foundation Trus t Leices ters hire Partners hip NHS Trus t Lincolns hire Partners hip NHS Foundation Trus t Liverpool Heart and Ches t Hos pital NHS Foundation Trus t Manches ter Mental Health and Social Care Trus t Mers ey Care NHS Trus t Midlands and Lancas hire Com m is s ioning Support Unit National Ins titute for Health and Care Excellence NHS Arden Com m is s ioning Support Unit NHS Bedfords hire CCG NHS Birm ingham South Central CCG NHS Brent CCG NHS Bus ines s Services Authority NHS Central Southern Com m is s ioning Support Unit NHS Coas tal Wes t Sus s ex CCG NHS Cum bria CCG NHS Eas t Lancas hire CCG NHS Enfield CCG NHS Greater Hudders field Clinical Com m is s ioning Group NHS Hardwick CCG NHS Herts Valleys CCG NHS Houns low CCG NHS Kernow CCG NHS North Eas t Lincolns hire CCG NHS North Staffords hire CCG NHS Oldham CCG NHS Profes s ionals Ltd NHS South Kent Coas t CCG NHS South Warwicks hire CCG NHS Supply Chain NHS Wakefield Clinical Com m is s ioning Group NHS Wes t Ham ps hire CCG NHS Wolverham pton Clinical Com m is s ioning Group North Eas t Am bulance Service NHS Foundation Trus t North of England Com m is s ioning Support Unit North Wes t Com m is s ioning Support Unit Northam ptons hire Healthcare NHS Foundation Trus t Nottingham Univers ity Hos pitals NHS Trus t Oxford Univers ity Hos pitals NHS Trus t Penins ula Com m unity Health Plym outh Hos pitals NHS Trus t Rotherham Doncas ter and South Hum ber NHS Foundation Trus t Royal Brom pton & Harefield NHS Foundation Trus t Royal Free London NHS Foundation Trus t Royal Wolverham pton Hos pitals NHS Trus t Salis bury NHS Foundation Trus t SEQOL Sheffield Teaching Hos pitals NHS Foundation Trus t Sirona Care & Health Som ers et Partners hip NHS Foundation Trus t South Devon Healthcare NHS Foundation Trus t South Tees Hos pitals NHS Foundation Trus t South Wes t Com m is s ioning Support Unit South Wes tern Am bulance Service NHS Foundation Trus t Stockport NHS Foundation Trus t Surrey and Sus s ex Healthcare NHS Trus t Sus s ex Partners hip NHS Foundation Trus t Tees, Es k and Wear Valleys NHS Foundation Trus t The Chris tie NHS Foundation Trus t The Leeds Teaching Hos pitals NHS Trus t The Rotherham NHS Foundation Trus t The Royal Mars den NHS Foundation Trus t The Tavis tock and Portm an NHS Foundation Trus t United Lincolns hire Hos pitals NHS Trus t Univers ity Hos pital of South Manches ter NHS Foundation Trus t Univers ity Hos pitals Birm ingham NHS Foundation Trus t Wals all Healthcare NHS Trus t Wes t Hertfords hire Hos pitals NHS Trus t Wes t Midlands Am bulance Service NHS Foundation Trus t Worces ters hire Health and Care NHS Trus t Wrightington,Wigan and Leigh NHS Foundation Trus t Yorks hire and Hum ber Com m is s ioning Support Unit