Annual Report 2014 - Reporting on the Quality and Efficiency Support Team

Part 12: HR Shared Services

ABOUT THE PROGRAMME

Linda Semple
t: 0131 244 2297
e: linda.semple@nhs.net

drivers

'We will respond to the needs of the people we care for, adapt to new, improved ways of working, and work seamlessly with colleagues and partner organisations. We will continue to modernise the way we work and embrace technology. We will do this in a way that lives up to our core values. Together, we will create a great place to work and deliver a high quality healthcare service which is among the best in the world.' (Everyone Matters: 2020 Workforce Vision).

NHSScotland is a people-focused organisation, employing more than 150,000 colleagues across Scotland who account for approximately 75 per cent of the overall NHSScotland budget. NHSScotland faces the challenges of public sector reform, integration of health and social care, financial sustainability, demography of the population and technological advances. Within the Route Map to the 2020 Vision for Health and Social Care the Scottish Government has identified 12 priority areas for action, one of which is workforce. Everyone Matters: 2020 Workforce Vision has emerged as the workforce strategy to address this.

The future of NHSScotland is dependent upon sustaining a highly skilled, multi-disciplinary, professional, caring workforce and Human Resources (HR) needs to transform to ensure it can continue to deliver and enhance the unique value-add it brings. The purpose of the HR Shared Services Programme is to demonstrate where the introduction of shared services can support this requirement, enhance the role of HR and deliver further benefits.

The underpinning ethos of the shared services agenda is:

• Simplify: processes and procedures are as 'lean' as possible, minimising inappropriate waste
• Standardise: variation between NHS Board areas and individual users is minimised or removed
• Share: where there are benefits in doing so, processes are delivered from fewer locations or once for the whole of Scotland

aims

The Programme has been established with the high-level objectives of ensuring that the appropriate development of HR Shared Services:

• Improves the quality and efficiency of HR services delivered to customers
• Improves the governance of HR and workforce-related services and activities
• Improves the resilience and sustainability of HR services
• Delivers redesigned HR service processes which are effective, efficient and productive
• Ensures the maximisation of business systems integration opportunities (e.g. eESS, e-payroll)

workstream

Phase one of the HR Shared Services Programme has focused on the following areas:

• Recruitment
• Employee Services
• Medical and Other Trainees

These three areas cover approximately 50 per cent of HR activity in NHSScotland.

achievements 2014

• Visible ownership of the programme by HR directors who have developed a paper Creating the Vision for Transforming the HR Operating Framework in NHSScotland, of which shared services is a part
• Completion of the option appraisal process for future operating models in February 2014 building on the activity scoping work previously undertaken
• Significant engagement with users and providers of HR services within the 11 NHS Boards represented on the Programme Board through completion of a customer insight exercise
• Augmenting the HR activity baselining exercise undertaken in 2013, further data capture of volumetric activity across all NHS Boards has been completed to enable reduction in variation and identification of areas of good practice
• Increased senior staff understanding of the potential of shared services gained through visits to other organisations which have implemented models of shared service and an HR Shared Services Showcase Event held in December 2013

priorities 2015

• Completion of a Case for Change by January 2015 to enable consultation with stakeholders
• Engaging in a series of tests of change with NHS Boards which are developing innovative approaches to the development of HR services
• Continued close working with the eESS project team in relation to the roll out of the single national HR system.

http://www.qihub.scot.nhs.uk/quality-and-efficiency/shared-services/hr-shared- services.aspx

Programme Case Study

HR Shared Services

Background and context

Shared Services is one of a number of workstreams that support the Efficiency and Productivity Framework across the NHS in Scotland. Considerable work has taken place within Financial Shared Services and there are further opportunities which will be progressed over the next few years. The Director General of the NHS in Scotland, along with the Chairs and Chief Executives, has committed to supporting a wider review of organisational "support" services, common to all Heath Boards, where there is potential to adopt a shared services approach. A process mapping exercise in 2011 identified Human Resources (HR) as a second wave Shared Services work programme.

The underpinning ethos of the Shared Services agenda is:

• Simplify: processes and procedures are as "lean" as possible minimising inappropriate waste
• Standardise: variation between Health Board areas and individual users is removed
• Share: where there are benefits in doing so processes are delivered from a single (or limited number of) location(s).

Problem

A number of issues have been identified across HR services in Scotland (although not all of the issues are universal as some HR teams are already working towards solutions).

• There is a need for further standardisation and consistency in approach as well as a sharing of resources.
• HR issues are often complex and span across organisations.
• There is a great deal of duplication in a number of processes and workstreams.
• Some teams, particularly the smaller teams struggle with resilience and sustainability.
• Customer feedback with regard to the quality of service provision is not as good as it could be.

The drive therefore is to improve quality, while reducing costs and recycling savings back into the Boards.

Aim

The scoping and review of potential HR Shared Services delivery for NHSScotland, including:

• Establishing the need for investment,
• Appraising the main options for service delivery, and
• Providing management with a recommended or preferred way forward for further analysis.

- epitomized in the submission of a Compelling Case for Change document; to put in place the basis for delivery of the programme.

Action taken

A programme board was established to oversee the initiation and implementation of an approach to HR Shared Services. The programme has been established with the high level objectives of ensuring that the appropriate development of HR Shared Services:

• Improves the quality and efficiency of HR services delivered to customers
• Improves the governance of HR and workforce related services and activities
• Improves the resilience and sustainability of HR services
• Delivers redesigned HR service processes which are effective, efficient and productive, and
• Ensures the maximisation of business systems integration opportunities (e.g. eESS, e-payroll etc)

The programme was split into three workstreams, namely:

• Recruitment
• Employee Services
• Medical and other Trainees

Each workstream is led by an HR Director, each with its own Steering group. A sub-group was set up by the HR Directors to ensure that outcomes from the programme are shared with HR Directors and that the HR Directors have a forum through which they can input to the programme.

Scoping and review of the workstreams was undertaken with a focus on stakeholder engagement. Several high profile scoping workshops were held in 2013.

Data gathering was undertaken, establishing a baseline for the programme.

The programme board agreed that it would be beneficial to understand what customers of HR felt about the current HR services they receive and where a move to shared services might add value or detriment existing quality.

The Customer Insights Exercise totaled 20 1-to-1 sessions (CEO and HR Directors in ten Boards), 84 people in focus groups (HR teams, a operational customers and staffside representatives) and 355 completed e-surveys (broad group of HR staff and operational customers). A further 110 staff in NHS Greater Glasgow & Clyde had contributed opinions to the review.

95% of those from the 1-to-1s and focus groups agreed that there was a need to change; with 81% of those in the e-survey also agreeing the need to change.

A series of options appraisals for each of the workstreams was undertaken between January and May 2014.

Information from the scoping and engagement workshops, workstream work, customer engagement exercise and options appraisals was then triangulated and presented in the CCfC document in December 2014.

Results

The compiling of the Compelling Case for Change will enable the implementation and delivery of HR Shared Services across NHSS.

The report presents the findings of the scoping and review of potential HR Shared Services delivery. In the CCfC the following has been established:

• The scope for each of the workstreams
• Potential management and governance structure
• Benefits, risks, dependencies, constraints
• Critical success factors
• High-level benefits scorecard; measurement of benefits will take place in terms of the four quartiles: Quality, Cost, Service Delivery and People
• Strategy and programme investment aims
• Potential model(s) of service delivery for each of the workstreams
• Programme delivery milestones until 2016/17 and the basis for an implementation plan
• The programme costs
• Recommendations for each of the workstreams

Patient experience

The following patient benefits are anticipated:

• Savings will be realised which can be reinvested in patient care.

Staff experience

Whilst it is too early to have evidence of staff benefits, it is anticipated that the following benefits will be realised:

• The new model will ensure that specialist HR activity can be raised to ensure that HR specialists have a greater influence on the strategic and value added issues facing NHSScotland Boards.
• Greater job satisfaction of HR staff through:
  • Better communication and sharing of knowledge
  • Alignment and rationalising of processes and policies
  • HR staff knowledgeable about local and national issues
  • Capabilities/competencies set for HR professionals; staff will know better what is expected from them
  • HR professionals focused on added value tasks
  • The future model of HR will require more emphasis on understanding and optimising the unique value HR brings to the organisation, requiring HR to develop skill sets that will result in an improved approach to recognising and anticipating the factors which will have a strategic impact on Boards; be clearer on the potential impacts these will have; and play a greater part in shaping and implementing the resulting organisational changes (transformational activity).
• Improved experience for HR customers:
  • Consistent, accurate, timely delivery of HR service
  • Customer-focused service using simplified, standardised processes

The following dis-benefit was identified as part the CCfC:

• Staff may be remote from the cases they are likely to be dealing with

Efficiency savings and productive gains

Whilst it is too early to have evidence of improved efficiency, HR Shared Services would be expected to deliver, as a minimum, the following benefits:

• The new model will ensure that administrative and support activities will be provided consistently, efficiently and effectively with a potential to achieve economies of scale.
• Investment in new models of delivery for the three workstream is estimated to result in significant savings after 5 years of delivery.

Sustainability

The delivery of the HR Shared Services programme will ensure that the service is fit for the future.

Lessons learned

• On a programme with a large scope, stakeholder engagement is more complex and time consuming than originally anticipated.
• To ensure support for a large and complex programme like this, sufficient programme resourcing is essential.

Next steps

• The programme will move to the delivery phase of HR Shared Services.

NHS Board Case Study

NHS 24

Unscheduled Care: Changing the Frontline Delivery Model in NHS 24

Background and context

The development of the unscheduled care workforce plan within NHS 24 is a collaborative process, aligning HR, service and financial planning in partnership. This integrated approach aims to proactively define the workforce requirements for a 12 month period, ensuring that all parties involved are fully engaged in the planning process.

Part of the service improvement methodology is to identify key workforce issues that support future models of service delivery so that NHS 24 will ensure the highest quality of service for the Scottish public and patients.

Problem

Some of the key challenges and problems that NHS 24 faces in relation to the unscheduled care workforce are:

• service change
• population demographics
• age demographics
• population diversity
• the impact of remote and rural living
• technology changes

In addition, internally, the following challenges have to be taken into account:

• predicting call volumes and demand for service in the short, medium and long-term
• building rotas which best meet the needs of the service
• resourcing special days such as public holidays and protected learning times (for GPs), exceptional periods such as festive and Easter
• predicting performance and identifying shortfalls - endeavouring to cover any gaps
• Against this backdrop, NHS 24 must identify efficiency savings of 3 per cent which is increasingly challenging to achieve and where cost pressures continue to grow as budgets level off. There is also limited flexibility to alter the overall staffing profile due to the current NHSScotland policy of no compulsory redundancies.

Aim

The first step was to identify a preferred workforce model to support the achievement of wider corporate goals and objectives.

The goals and benefits of change, the context of how services will be delivered in future, and the options for future service delivery and the drivers and constraints were considered.

These steps outlined the workforce required to meet the predicted service needs and all of the key issues, local and national, which impact on workforce design and deployment.

The workforce model was costed so that the level of cash releasing efficiency savings could be estimated and recognised against the previous model.

Action taken

The unscheduled care service remains NHS 24's key focus and priority, delivering a safe and effective service to the people of Scotland.

Based upon current modelling, the changes to the workforce for this service in recent years are detailed as follows:

• A reduction in whole time equivalent nursing numbers from 212 to 192 (-20) and a headcount reduction from 366 to 329 (-37).
• A reduction in team leader numbers from 90 to 69 (-21) and a headcount reduction from 89 to 77 (-12). This reduction is due to the change in the model of management in local and remote centres. In addition, team leaders no longer manage Health Information Advisors, Breathing Space and the Scottish Emergency Dental Service as these staffing groups have their own management structures. The introduction of the senior call handler role, has also reduced the demand on the team leader role.
• The other significant workforce group is call handlers where there has been a whole time equivalent increase from 252 to 353 (+101) and a headcount increase from 450 to 563 (+113).
• The ratio of nurses to call handlers was 1 : 1 and the current position is now 0.7 : 1.
• In recent years, the mitigating effect of the introduction of protocol based call handler advise and discharge processes need to be taken into account - these include exclusion of nurse interventions in, e.g. sore throat (over 5s), medication enquiries, bony injuries, death notification, minor ailments, suspected stroke, urinary tract infections, burns scalds and bites, earache and sunburn.
• The percentage of calls closed by call handlers has increased from 13.7 per cent to 26 per cent, an increase of 12.3 per cent.
• In recent years, there have been a number of 'new' roles introduced that would have reduced the need for trained nurses including the introduction of pharmacists, physiotherapists, dental nurses, breathing space advisors, mental health nurses and cognitive behavioural therapy (CBT) counsellors.
• Whilst the above have been introduced at varying stages, there is a clear justification in the reduced staffing ratios due to reduced nursing workload.

Results

The move towards a higher proportion of the service being delivered by call handlers during the 2013-14 financial year was delivered. The move to this model of delivery was based on the experience gained over many years and consideration by management of the best, most efficient and appropriate way to deliver the service in future years.

Patient experience

Patient service levels are aligned to key performance indicators (KPIs) in terms of the desired performance for time taken to answer calls and to deal with the needs of the patient within appropriate timeframes based on clinical priority. The performance targets are factored in to the workforce plan to deliver a highly responsive and effective service:

• Access Service Level - 90 per cent of all calls answered within 30 seconds
• Clinical Calls - 100 per cent of calls commenced consultation in three hours

Staff experience

There has been a positive impact on staff experience with opportunities for staff to take on different roles and gain new experience as a result of the restructure of frontline services.

Efficiency savings and productive gains

During the 2013-14 financial year, NHS 24 was able to recognise a recurring cash releasing efficiency saving of £1.955 million.

Sustainability

NHS 24 continues to look at frontline delivery models to ensure that these support the clinical presentation of the calls received to the service on an on-going basis. The frontline workforce is modelled against changes in demand and takes account of the annual workforce and financial planning exercises. It is subject to scrutiny and review throughout the year.

Lessons learned

The full impact of the presentation of calls has to be taken into account and the impact of this on the culture of the organisation. Whilst time was spent with staff when the new models were being put into place, there is always scope for further discussions to take place with staff which would have been better for staff engagement.

The last year has taught NHS 24 that the model introduced was quite well fitted to changing demand and NHS 24 has continued to meet its KPIs.

Much of the work used to introduce the new frontline delivery model was able to be utilised again during the planning for the introduction of the 111 free phone number.