NHSScotland Efficiency and Productivity: Framework for SR10

2 Executive Summary

WHY has the Framework been revised?

• The original NHSScotland Efficiency and Productivity Programme Delivery Framework (June 2009) covered the previous spending review period until March 2011.
• The Healthcare Quality Strategy for NHSScotland (May 2010) provides the vision for NHSScotland as a world leader in healthcare quality.
• The SR10 spending review period outlined UK public spending until 2015. The draft Scottish budget sets out a public sector efficiency target of 3% for 2011/12.
• The budget for NHSScotland has been protected from cuts as a result of the Scottish Government's decision to pass on the consequentials awarded to the Department of Health from the UK 2010 Spending Review. However, inflationary pressures arising from increasing demographic changes, drugs and staff costs will mean that NHS Boards will need to make a minimum of 3% efficiency savings to break even.
• Significant progress has been made against efficiency targets; this report builds on good practice and anticipates future challenges.
• NHSScotland has a duty to the people of Scotland to ensure quality services that are good value for money. Being more efficient and productive is essential to ensure careful use of the public purse.

WHAT is the purpose of the Framework?

The Framework's main purpose is to identify priority areas to improve quality and efficiency. The Framework is a companion to the Quality Strategy and provides a baseline for the changes that will need to be undertaken by the Scottish Government Health Directorates ( SGHD), NHS Boards and other public sector organisations.

The Framework has three overarching themes:

• Support - supporting our workforce.
• Enablers - identifying, sharing and sustaining good practice.
• Cost Reductions - reducing variation, waste and harm.

The Support theme is linked closely to the Quality Strategy and highlights the importance of staff being appropriately skilled to deliver the necessary change. Open communication will continue through close partnership working and our commitment to staff governance.

The Enablers include:

• benchmarking and the right quality, performance and productivity data
• the effective use of technology in the delivery and redesign of healthcare
• the Improvement and Support Team ( IST) will be re-focussed and re-branded to the Quality and Efficiency Support Team ( QEST) to provide support and challenge.

Seven Cost Reduction workstreams, underpinned by the support and enablers, identify where there are further savings and quality improvements to be made:

• evidence based care
• preventative and early intervention
• outpatients, community and primary care
• acute flow and capacity management
• workforce productivity
• prescribing, procurement, support/shared services, and
• service redesign, innovation and transformation.

There will be generic activity across each of the cost-reduction workstreams to identify savings. To ensure vertical and horizontal integration we will also apply a Whole Systems Approach to a number of high-volume, high-cost services. This will be undertaken using a 'task and finish' methodology and underpinned by a framework of supporting and challenging NHS Boards.

HOW will the Framework be delivered?

NHS Boards have already made savings and will be expected to deliver efficiency targets each year for the foreseeable future. To ensure maximum ownership and service delivery, the workstreams will be led and delivered by NHS Boards, with SGHD supporting and enabling the delivery.

The monitoring, evaluation, support and sharing of the outputs across the workstreams will be coordinated by a portfolio office based within the QEST. The first stage of implementation is the details scoping of each workstream to identify and prioritise cost reductions from the long list of potential productive opportunities, the benefits and deliverables, and the timescales and resources required to achieve the desired results. This will provide the basis of the QEST portfolio plan for the SR10 period.

There will be close working with the Scottish Government's four Quality Ambition Delivery Groups supporting the capture of benefits realisation. QEST will also commission or deliver support to NHS Boards where there is scope to test or accelerate the uptake of new approaches to service delivery which improve quality and reduce costs.

WHEN is the Framework expected to start and finish?

Significant work is already underway to establish the Framework, and scoping of the workstreams has commenced. The Framework is designed to cover the spending review period and will be refreshed annually.

WHO is the expected audience for the Framework, WHO will be doing the work and WHO will ensure the deliverables are achieved?

The audience for the Framework is primarily targeted at NHSScotland, but we anticipate that the general public and other public sector organisations will have an interest in the approach we are planning to undertake between 2011 and 2015.

NHS Board senior executives and clinicians will provide strong leadership, taking ownership of the workstreams and specialty redesign. The SGHD will provide central coordination, benefits realisation, challenge and expert support.

The governance of the Framework will continue to be overseen by the Efficiency and Productivity Strategic Oversight Group ( EPSOG), whilst the local delivery plan process will allow NHS Boards and the Scottish Government to monitor progress both against the Quality Strategy (through the Quality Measures) and the Efficiency and Productivity Framework (through the HEAT targets and efficiency plans).