NHSScotland Efficiency and Productivity: Framework for SR10

5 Implementation and Governance

5.1 Implementation

Quality and efficiency is everyone's job within the NHS, regardless of grade or profession. The Framework cuts across all NHS Boards (both territorial and specials) and all Health Directorates within the Scottish Government.

The process for taking this forward is as follows:

• Scoping for each workstream and whole systems approach will be undertaken to understand the current landscape and to provide a financial baseline to identify the areas that will provide productive opportunities in the short, medium and long term.
• Service buy-in and leadership is critical. To ensure ownership by the service, each workstream will be lead by a Chief Executive, Chief Operating Officer or key expert in the field, and supported by a Director or Deputy Director from within SGHD.
• Workstreams will challenge and support existing projects and sponsor new and innovative projects that will drive quality and cost savings. Reducing demand on outpatients will be a key focus for the primary and community care workstream, while enhanced recovery will be strongly promoted in the acute flow workstream.
• An integrated approach. Vertical and horizontal integration will be pursued through the whole systems approach to unwarranted variation in high cost, high volume services. The whole systems approach cuts across all workstreams and will feed directly into the service redesign, transformation and innovation workstream.

5.2 QEST Portfolio Office

A QEST Portfolio Office will be established to commission work, monitor progress, ensure spread and sustainability and provide national reporting. This will replace the existing Efficiency and Productivity Programme and the work that has been undertaken to date will continue within the QEST Portfolio Office. The portfolio office will engage with all stakeholders, acting as a central point for advice and coordination of efficiency and productivity activities and challenging variation in the adoption and sustainability of good practice.

The Portfolio Office will work within the framework of P30® ( OGC Guidance on Portfolio, Programme and Project Offices) to provide robust principles to underpin the delivery of the Framework.

5.3 Commissioning the National Workstreams

Commissioning of the required work will be supportive, with no duplication and as close to the front line as possible. The commissioning function will operate along the following principles:

• We will maximise activities that can be driven by NHS Boards and regional groups for national benefit.
• We will work closely with HIS to support their alignment to the twin priorities of quality and efficiency.
• We will commission advice from the new Quality Improvement Hub and HIS where we assess it is best placed to deliver these to the specification and timescales required.
• QEST will deliver directly where we assess this necessary and where other options will not deliver to the specification or timescale required by NHS Boards.

5.4 Governance and Benefits Reporting

The existing local delivery plan process will ensure that monitoring of NHS Boards' efficiency plans is robust. Further guidance and challenge to Boards on areas for improvement will be a key role for SGHD. Figure 5 provides the proposed structure and reporting lines.

Figure 5: Governance Structure

Within the local delivery plan process, efficiency savings will be categorised under the following headings: clinical productivity, workforce, drugs and prescribing, procurement, estates and facilities and support services. Further discussion will be undertaken between NHS Boards and the Scottish Government on the efficiency schemes that feed into the overall total for each category, providing limited bureaucracy and increased flexibility locally.

Monthly performance management oversight within SGHD has been established to include HEAT performance (including efficiency targets), finance, quality (using the early warning scorecard) and workforce information.

The Framework has been subject to a robust equality and diversity impact assessment which will be circulated to all NHS Boards for information.