THE BUSINESS SERVICES ASSOCIATION. Lord Carter Review: BSA Response

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1 THE BUSINESS SERVICES ASSOCIATION Lord Carter Review: BSA Response May 2016

2 ABOUT THE BSA The BSA is a policy and research organisation. It brings together all those who are interested in delivering efficient, flexible and cost effective service and infrastructure projects across the private and public sectors. Research conducted by Oxford Economics, commissioned by the BSA, shows that business service providers make a huge contribution to jobs and prosperity in every part of Britain. The sector accounts for over 9 per cent of gross value added to the economy and provides 3.3 million jobs, equivalent to over 10 per cent of all UK workforce jobs. More than two thirds of business services are provided for the private sector, with the remainder commissioned by the public sector. Introduction BSA healthcare members work on the basis of supporting the NHS through collaboration and partnership. They offer services as diverse as catering, estates management, ICT, transportation, portering, back-office administration and more. We support many of the recommendations put forward in Lord Carter s review. The Business Services Association 2nd Floor 130 Fleet Street London EC4A 2BH We believe that the best way private providers can contribute towards improving NHS efficiency is through further and deeper collaboration with Hospital Trusts and adopting a more integrated approach. Savings targets provide a useful starting point to bring about the cultural and operational changes required to improve hospital efficiency. This note sets out the BSA s response to the review and ideas for how efficiencies can be implemented. The Business Services Association Limited is registered in England No Registered office as above. Designed by Soapbox

3 1 Estates Lord Carter s final report found that space used by Trusts for non-clinical purposes ranged from 12% - 69%. Research from elsewhere suggests the amount of unused and underused floor space in the NHS adds up to the equivalent of 14 Hospital Trusts. This highlights an opportunity for the NHS to explore and adopt more innovative ways of using their estate. Money raised from a more efficient estate can help fund the transformations needed to deliver a Trust s care priorities Currently, individual NHS Trusts cannot retain money generated from the sale of buildings, offering little incentive to dispose of underused assets. Therefore, the BSA recommends the establishment of a ring-fenced fund using money raised by individual Trusts through property sales or leases. This money can help fund the transformation needed to deliver a Trust s care priorities. An additional benefit would be incentivising a commercial approach to estate management. Individual control of estates funding, combined with a commercial approach, would allow Trusts to explore alternative revenue raising ideas, such as the leasing or hiring out of underused buildings. Partnering with private providers can help facilitate a commercial approach by improving access to finance and establishing joint ventures focused on estates management. BSA members are already delivering NHS estate improvements through such ventures. Case study: Kier Construction & NHS Trusts Kier Construction and OR International have worked together to develop a suite of healthcare solutions aimed at improving the operational efficiencies of underused or surplus NHS estate. By reconfiguring the existing estate, they have been able to establish focused and efficient step down units within NHS Trusts. These units provide tailored programmes for the rehabilitation of patients who are medically fit for discharge but need help with mobilisation before final discharge. Initial schemes have seen a reduction in the median lengths of stay in the target patient group by up to 25%, with the potential to reach 40% in the future. Daily costs are also lowered with patients treated in a focused clinical setting leading to operational efficiencies not otherwise achievable in higher acuity general surgical or medical wards.

4 2 ICT and Technology ICT and digitisation offers the NHS a significant opportunity to transform how services are designed and delivered. Enhanced digital technology can allow data to be collated more comprehensively and geared towards reducing unnecessary expense. When harnessed effectively, technology can be used to significantly reduce hospital admissions. Cost-savings associated with practical telehealth options used by patients can offer a better for less scenario. Additionally, mobile technology offers the NHS a chance to improve efficiency and improve patient experience. Simple measures such as allowing patients to order meals on computer tablets can improve their experience and save staff time. Data can also be collected to improve menus and cut down on food waste. When harnessed effectively, technology can be used to significantly reduce admissions Technology can also be harnessed to improve service quality by installing interactive screens at key points in the hospital, allowing patients to review facilities and alert staff to problems. Such a system could allow (where appropriate) patients to rate services they receive, creating a data pool for hospitals to identify areas for improvement. This would provide real time data on patient experience allowing an effective targeting of resources. The Happy Dubai initiative puts this dashboard principle into practice. Using screens placed around the city, authorities better understand how satisfied users are with municipal services. A similar NHS programme would allow patients to feel involved in shaping the type of service they receive. Case study: Capita & Australia s National Online Health Service Capita Healthcare Decisions worked with Healthdirect Australia to help people check symptoms online and receive personalised healthcare advice. With over 80% of Australians seeking health information online Healthdirect Australia recognised the importance of ensuring that the information they are accessing is safe, relevant and trustworthy. In response they developed the Healthdirect Symptom Checker an online tool which allows people to check their symptoms and receive personalised advice on what healthcare action to take next. Healthdirect Australia chose Capita s Decision Management Software (DMS) to power Symptom Checker. The DMS allows the organisation to aggregate its own verified content and present it to consumers online through Capita s Application Programming Interface (API). Capita s DMS and API significantly reduced the time taken to populate the Symptom Checker flows with verified clinical content, and changes and updates required are simple to undertake.

5 3 Administrative NHS administration and back-office costs, as identified by Lord Carter, account for approximately 4.3bn, nearly 4%, of total NHS spending. Carter points out that admin variation across NHS Trusts ranges from 6% to 11%. Strategic partnerships allow providers to introduce a common set of services, processes and standards aimed at reducing variation Strategic partnerships allow providers to introduce a common set of services, processes and standards aimed at reducing variation. By adopting a partnership, rather than transactional approach, NHS organisations can learn from the prior experience, expertise and innovation of commercial providers. Performance improvement, in terms of cost and quality, can best be achieved through transformation of the way patient administration services are provided. This requires, for example, investment in appropriate technologies, including information systems and various forms of automation or self-service; introduction of lean operational processes; investment in workforce training; performance management and service leadership. To improve working practices often requires change throughout the whole system, for example the way consultants vet referrals. To get the most out of digital workflow then the role of paper and even faxes must re-imagined. Case study: Serco & NHS Trusts Serco has worked with two innovative NHS Trusts, one of them multi-site, to identify, quantify and plan to deliver transformational improvements in patient administration and are now working with a third. The core services addressed are typically: appointment booking, capacity scheduling, receptions, switchboard and help desk, post room and patient information (secretarial and medical records), patient experience and ward clerking. Despite concerns that such significant changes would be resisted, Serco found that by creating confidence in the alternative and demonstrating benefits to all parties they encountered enthusiasm for the smart use of technology and the release of time that can be better used, for example, for patient care.

6 4 Workforce E-Rostering offers a practical solution for improving staff efficiency and reducing dependence on agency workers E-rostering offers a practical and readily available solution for achieving Lord Carter s aim of ending inefficient and outdated paper rosters, as well as reducing dependency on agency workers. It is a small change that can ensure workforces are managed more efficiently. Establishing a clear and easy to understand system of electronic staff timetabling will allow managers and staff to quickly see the upcoming work schedule. This in turn has the potential to save man hours which can then be dedicated to the delivery of patient care. A number of BSA members offer and have already implemented e-rostering programmes at NHS Trusts across the country. Case study: Allocate & North Lincolnshire & Goole NHS Trust Allocate, using their software programme, helped improve the e-rostering system used by North Lincolnshire & Goole NHS Foundation Trust. The Trust had been using e-rostering for a number of years previously, but hadn t been able to effectively embed it into the hospital system. It was an add-on, rather than a replacement, for what roster creators were doing before. Incentives were created to get staff to use the system more effectively, such as moving the booking of requests for annual and study leave onto the system, helping influence when staff were able to take time off. Additionally, roster-managers were encouraged to use the autoroster feature, significantly improving the efficiency of allocating frontline staff to the correct shifts. Regarding the improvements in e-rostering, Marcus Hassall from the Trust said Across 10 wards we could evidence savings averaging 60,000 per ward. But we have also improved patient care by using our restricted resources better. Procurement It is important procurement is conducted in an open and trusting manner from the start It is important procurement is conducted in an open and trusting manner from the start. Too often the relationship between commissioners and providers can become rigid. A flexible relationship is essential to ensuring efficiency gains are made through strategic partnerships. Such flexibility will help both parties to adapt when circumstances change. Additionally, straightforward measures such as the introduction of a suitably responsible point person on both sides of a contract, coupled with regular meetings, will help to improve contract management. Other practices, such as a proper handover when relevant people move jobs, should be conducted as standard and contribute towards reducing inefficiency.

7 5 Private providers can also play a key role in achieving Lord Carter s aim of reorganising NHS Trusts procurement models. BSA members have experience of becoming part of a Trust s procurement teams, combining their staff with NHS staff and working together as one unit for streamlining purchasing procedures. Innovative contracts, such as ones where the Trust retains all associated savings, offer an incentive to explore options for revamping procurement. The BSA also recognises that the e-procurement has the potential to achieve efficiency and cost savings in services as well as products. Case study: Serco Group & District General Hospitals Serco worked with two NHS Trusts, both mid-sized DGHs of over 1,000 and 800 beds respectively, tasked with redesigning the Trust procurement functions in order to deliver multi m cost savings. The two contracts provided full service provisions of procurement, logistics and associated financial processes and had commitments baked into the commercial structure of contracts to deliver a long term reduction in the Trust s non-pay spend from the start. Flexible and mobile Serco category management and sourcing experts were inserted into the client s existing team to create a single team managed by Serco, leveraging shared support services to maximise procurement savings. We reviewed supply chains for all goods which may deliver efficiencies in customers existing materials management activities. Serco used the TUPE transfer of existing staff to bring them into our procurement team. The additional resources, staff training, clear personal objectives, introduction of new procurement systems and access to shared service category management experts were vital to driving cost savings. Pathology Transformation requires investment and expertise to deliver an efficient model on time and on budget There is an evident need to reduce the number of inefficient laboratories, as outlined by Lord Carter s report. This can be achieved by moving to networked pathology models known as hubs and spokes to improve quality of testing and cost effectiveness. There are examples of the private sector already successfully delivering pathology services across the country in partnership with the NHS. Such partnerships have demonstrated the potential for service improvement and efficiency savings to be made. Transformation requires investment and expertise to deliver an efficient model on time and on budget. Hub and spoke models in the UK and Europe have demonstrated improved quality and speed by separating urgent testing, which continues to be delivered close to patients on site at hospitals, from routine testing which is delivered from state-of-the-art, highly automated hub laboratories.

8 6 Hub laboratories handle tests from primary care, as well as tests from hospitals that require same or next day turnaround. These large scale hub laboratories can handle testing volumes from many hospitals and also offer the service to general practice which can compete with NHS hospital labs to offer a faster, more cost effective service with improved quality. In order to realise the savings potential a hub and spoke model offers, investment is needed to design and build new laboratories, restructure existing processes and working practices and deliver new equipment. Guidance for hospital labs looking to calculate whether or not they are meeting the targets set out in Lord Carter s reports is crucial for ensuring improvement. Many labs will not include the full costs of delivering pathology such as the hospital overheads and central costs which favourably skews the costs of pathology. The BSA recommends that a template is produced so that all hospital labs can be compared on a like-for-like basis to be able to fairly assess which are efficient and which require significant improvement to meet the deadline set by Lord Carter of April Case study: Integrated Pathology Partnerships & Somerset Pathology Services Pathology services in Somerset were transformed with all routine work, apart from histopathology, being delivered by a new state of the art, off-site, Hub laboratory. The hospital based laboratories were remodelled into essential service laboratories (ESL) to handle urgent testing requests requiring fast turnaround. This redesign was achieved by the original pathology staff working together with the IPP team to produce a more effective delivery model fit for the local health economy. Previously, GP work had been saturating the hospital laboratories during the early evening. Now, by splitting the hospital in-patient work from the cold work, turnaround times within the hospitals and for GPs has improved. Today, in excess of 95% of GP work is routinely reported by the following morning and there have been reductions of around 25% in average turnaround times for both urgent and routine blood tests within both hospitals. In addition, 95% of tests are now available within 74 and 124 minutes respectively (compared to 133 and 257 minutes previously). Within A&E, turnaround times in specific cases have reduced by 22% for urgent and 29% for non-urgent tests. Variation has also been reduced and the A&E doctors are now confident that they can expect to get critical tests back faster and more often with a positive impact on patient pathways.

9 7 APPENDIX LIST OF BSA MEMBERS Full members Accenture plc AECOM Amey plc ARAMARK Ltd Atos Balfour Beatty plc Bellrock Ltd Berendsen plc Bouygues Energies and Services British Telecommunications plc Capita plc Carillion plc Compass Group plc Costain Group plc Elior UK Ltd ENGIE UK & Ireland Freidman FM G4S plc Ingeus UK Ltd Interserve plc ISS UK Ltd Kier Group plc Maximus UK Ltd Mitie Group plc MYFM Ltd NSL OCS Group UK Ltd Optum Health Solutions UK Ltd PeoplePlus Pinnacle Group Prospects Services Ltd Seetec Group Ltd Serco Group plc Sodexo Ltd Sopra Steria Ltd TerraQuest Solutions Ltd Veolia (UK) Ltd VINCI Facilities Associate members Baachu Barclays Corporate Bevan Brittan LLP Clyde & Co LLP Deloitte DWF LLP ECI Partners Ernst & Young LLP Grant Thornton LLP Interim Partners KPMG LLP Metzger Ltd Nabarro LLP New Street PA Consulting Ltd Pinsent Masons LLP PricewaterhouseCoopers UK Reynolds Porter Chamberlain Royal Bank of Scotland Group Plc Sharpe Pritchard LLP Trowers & Hamlins LLP

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