Healthcare quality and efficiency support team: annual report 2013

Shared Services

NHS Borders: Local Forensic Learning Disability Service

Background/Context

A number of clients were being cared for out of area which meant that significant resources were being spent external to Borders to provide a service for them. Clients were therefore placed out of area, away from their families in expensive care settings.

Problem

High cost service with limited access to Borders services, friends and relatives, and difficulty in assessing the quality of the services provided.

Aim

To provide a local and easily accessible service for clients with direct access to Borders health and social care staff in a more clinically appropriate environment. To repatriate clients to their local area with access to relatives and friends.

Action Taken

Working in partnership with social services, a tendering exercise identified a third sector partner to whom NHS Borders sold one of its excess properties to allow it to be refurbished to meet the needs of the clients.

From the resources saved NHS Borders established a local forensic team to meet the needs of the repatriated clients as well as others in the Borders area, providing a quality community based service.

Results

Clients are now cared for within the area, with closer access to family and friends. This has allowed clients to live more independently and confidently.

This project has embraced partnership working, led by the Borders joint health and social care learning disability service who have worked in partnership with the third sector.

Efficiency Savings and Productive Gains

The redesign has allowed costs to be reduced by repatriating clients back to the Borders, reinvestment of some of these resources in the establishment of a local team, and has allowed resources that were being spent outwith Borders to be invested in the local economy as well as contributing to recurring savings of £169,000.

Sustainability

Resource and accommodation has been secured on a recurring basis which gives future sustainability for the service.

Lessons Learned

Through the productivity and benchmarking process and work with South East and Tayside (SEAT), NHS Borders is continually looking to reduce commissioning costs by repatriating patients back to the area and providing services locally. This working example is key to moving forward and providing more shared services with the local authority and the third sector.

NHS Orkney: Contracting Out Payroll Services

Background/Context

NHSScotland's Shared Support Services (SSS) Programme has led on the vision, development and implementation of efficiencies in supporting functions, often through commonality of various systems and processes.

Problem

The SSS benchmarking exercise indicated that NHS Orkney's payroll function was significantly more expensive than the national average at £73 per employee compared to £44 per employee on average. A review of the statistics provided by the SSS programme had identified the payroll function as a potential area where significant savings could be made.

There was also a high dependency on two WTEs (three individuals) for the delivery of the in-house payroll service. A review of the services provided by payroll suggested that significant service continuity risks are associated with dependencies on a restricted staff resource. Furthermore, with limited scope to safely reduce staffing, scope for further targeted efficiencies, as targeted through the new ePayroll system, was limited.

Aim

The project aimed to:

• reduce payroll cost per employee
• move to at least average on benchmarking
• have more robust service continuity
• be able to see future efficiency savings as the new ePayroll system was rolled out

Action Taken

The following actions were undertaken:

• reviewed payroll and finance department structure
• evaluated use of remote contractor, then subsequently contracted payroll services to NHS Grampian from April 1, 2012
• redeployed displaced staff within NHS Orkney

Results

The following results were achieved:

• efficiency savings of £23,500 per annum
• ability to exploit further savings derived from national move to ePayroll (time records are picked up remotely via the SSTS system)
• move to electronic files

Efficiency Savings and Productive Gains

The following were achieved:

• moved from a cost of £6.08 per payslip to £3.81 per payslip
• expertise and resources of contractor's larger team who managed transitions to new national ePayroll system

Sustainability

Payroll is now provided by a larger team at NHS Grampian. This ensures expertise and timeous payments and conformity with statutory and legislative requirements. In addition, there is expertise and capacity to manage payroll implications of eESS implementation.

In addition to the existing ATOS disaster recovery of systems, the payroll service provision for Orkney is now incorporated into NHS Grampian's disaster recovery and continuity plans.

Lessons Learned

The efficiency was delivered by linking the contracting out of the payroll service to a wider reorganisation in NHS Orkney of more than just the affected (payroll) department. This enabled successful and productive redeployment of affected staff, delivering real cash saving with implementation.