Efficiency Technical Notes

Efficiency Technical Notes - March 2006

9. Heal th

1. Portfolio/Number/Name:H/C1 NHS Procurement
2. Programme/Activity: As part of NHSScotland's agenda for Modernising Support Services, SEHD launched Phase 2 of BPI (Best Procurement Implementation) in NHSScotland at the end of August 2003. This has now evolved to become National Procurement, a division of NHS National Services Scotland. Process & Technology - co-ordinating the rollout of the eProcurement Scotl@nd service to NHSScotland ( NHS boards and Special Health Boards); Strategic Sourcing - developing commodity strategies for key procurement activity resulting in 'best value' pricing for NHSS; Logistics - implementing best practice supply chain management in NHSScotland and securing the procurement benefit opportunities identified in Phase 1; Change Management and Communication - supporting the changes driven by the Strategic Sourcing and Process & Technology streams with a comprehensive communications programme and a focus on managing the stakeholders through supporting and championing the Programme. This activity relates to cash releasing efficiency savings arising from the Process and Technology and Strategic Sourcing workstreams. National Procurement aims to stimulate collaborative buying and thereby deliver sustainable cost reductions of £60 million per annum.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	33	50	60
			Time
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	33	40	50
			Time
	3.3 Explanation for difference		The original target for 2006-07 and 2007-08 has been revised upwards to reflect increased achievements made in negotiating national contracts. Savings are dependent on NHS Boards fully implementing new national contracts.
4. Accountable Officer for delivery				Dr Kevin Woods
5. Project Manager				Mr Ross Scott
6. EGDD Portfolio Manager				Ms Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? Savings will be made through the use of technology (e-procurement), purchasing through reverse electronic auctions, and the number of national contracts negotiated. As at February 2005, NHSScotland had participated in 3 reverse electronic auctions (two for IT and one for non sterile gloves) and several others were planned; national contracts had been negotiated for 14 commodities and were in place with a further 7 due to come on stream by April 2005. A total of 140 commodities has been identified although it is anticipated that some commodity bundling will occur. All NHS Chairmen and Chief Executives have formally signed up to the objective of ensuring that their Board participates actively in the National Procurement agenda. Furthermore, each Board has given an Executive Director specific responsibility for BPI.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? The action required is that the technology is rolled out by National Procurement; national contracts are negotiated by the Strategic Sourcing team; and that NHS Board Chief Executives and Heads of Procurement ensure that the contracts are used within their Boards. NP is a business change programme and success is tied to the degree to which structure and practice changes. There is, therefore, a key dependency on NHSScotland participating in the programme and taking responsibility for implementing business change in that environment. The Change Management and Communication activity within NP is important in this respect. The need to recruit an additional 85 staff was recognised to deliver the cash releasing efficiency savings. Of this figure 16 are required to make up a current staffing shortfall and 27 will be on fixed term contracts primarily concentrating on implementation. This means a net addition of 42 permanent people to provide ongoing leadership, strategic sourcing, systems management/development expertise. This recruitment exercise is now essentially complete with a fully staffed organisation being in place.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? The recurring saving is £33m pa and rises to £60m in 2007-08. This saving is net of the costs of additional staff referred to above.
9. Measurement		9.1 What are the inputs that will be measured? The unit cost of the identified commodity lines are monitored (to ensure the planned reduction in cost is taking place) and benefits published on a monthly basis.
		9.2 What are the outputs that will be measured? The volume of purchases made (in those specific commodity lines) will be recorded and published on a monthly basis.
		9.3 What is the baseline for inputs and outputs? The input and outputs for the identified commodity lines will be compared with existing commodity expenditure 2004/05 baselines to determine the level of savings delivered through NP.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? The expectation is a positive impact on quality. Through technology and national contracts better purchasing at better prices will be delivered. Better working practices will be developed and administrative savings will be delivered through the reduction in the number of paper documents (eg purchase orders, goods received notes, invoices, etc) that will need to be processed. Key Performance Indicators are managed by NP on a monthly basis.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? Monthly reporting of procurement data is prepared by the NP based upon returns from NHS Boards and extracts from NHSS financial systems.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? Responsibility for reporting to SEHD and the Project Board lies with the Director of National Procurement.
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. Savings are not dependant on legislation. Savings are dependent on the roll-out of technology to NHS Boards and the identification of commodities and the development and implementation of national contracts.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards will not assume these efficiency savings. The cash releasing efficiency savings will be retained by NHS Boards and used for developing and/or delivering local patient services.

1. Portfolio/Number/Name:H/C2 NHS Support Service Reform
2. Programme/Activity: Shared Support Services for NHS Financial Processing & Reporting and NHS Payroll Services. Model is based around a virtual model with two Hubs (Finance and Payroll) and twelve Spokes. Shared Support Services is an organisational design involving the standardisation and consolidation of dispersed common activities whilst harnessing available technology. Full sign up of CEOs to the project releases a conservative £10m per annum recurring saving from 2007/08.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	10
			Time	n/a	n/a	n/a
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	10
			Time	n/a	n/a	n/a
	3.3 Explanation for difference		There has been no amendment to the original target
4. Accountable Officer for delivery				Kevin Woods
5. Project Manager				Alex Smith
6. EGDD Portfolio Manager				Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? Savings are primarily centred around a reduction in staff numbers (604 WTEs). Savings are also anticipated in relation to a common system. A phased implementation originally planned for April 2006 is now expected to commence in October 2006 (Wave 1 migration). Once completed, the net overall revenue savings to NHSScotland is £10.122m on a recurring basis.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? Delivery is dependent on individual NHSScotland cooperation. It is also imperative that the necessary IT infrastructure is in place to accommodate the process at a local level. The project is being managed by NHS National Services Scotland with the Chief Executive as the Accountable Officer.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? The project investment costs contained within the approved Outline Business Case ( OBC) are: £13.789m Capital & £12.359m Revenue giving a total investment of £26.148m. The 604 establishment posts are to be released from 23 NHS Scotland bodies with no compulsory redundancies; it is to be achieved through redeployment and early retirement arrangements, for example. The net overall revenue savings to NHSScotland is £10.122m on a recurring basis commencing 2007-08: Gross Recurrent Savings - £17.15m Running Costs (Shared Services) - £ 7.03m Net Recurrent Saving - s£10.12m
9. Measurement		9.1 What are the inputs that will be measured? The support service costs, which are classified as Non-Clinical Service Costs in NHS Boards, will be measured.
		9.2 What are the outputs that will be measured? Benchmarking exercises will be conducted to ensure the range of benefits anticipated is being achieved in terms of quality and quantity expectations (which will be detailed in the Full Business Case in due course).
		9.3 What is the baseline for inputs and outputs? The baseline for inputs is the costs of those services in each NHS Board in 2004/05. In respect of outputs, Financial and HR information will be utilised for measuring performance. This will be initiated by the project team. NHSScotland Health Boards will independently provide information on the impact of the project and the validity of information. Details of finalised savings will be detailed as part of the Full Business Case.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? Benchmarking exercises will be conducted to ensure the range of benefits anticipated is being achieved in terms of quality and quantity expectations (which will be detailed in the Full Business Case in due course). The quality of the service will improve despite the reduced cost of running this model of delivery. Advances in technology are to be harnessed as part of the anticipated positive improvements. This project aims to make efficiency savings within NHSScotland, whilst at the same time making a general improvement in the quality of financial/management information.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? Monitoring arrangements will be agreed as the project evolves. Individual organisations will be considered during the implementation stage and compared to original expectations. As part of the business case process, a post project evaluation will also be completed.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? The project team will be responsible for information relating to savings and quality improvements and submitting this to the Health Department quarterly.
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. The savings are dependent on major structural changes within the NHS finance community in terms of technology utilised, ways of working and major reduction in staff numbers.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards (Revenue Resource Limits) did not assume these efficiency savings. The cash releasing efficiency savings will be retained by NHS Boards and used for reinvestment in frontline services.

1. Portfolio/Number/Name:H/C 3 NHS Logistics Reform
2. Programme/Activity: As part of NHSScotland's agenda for Modernising Support Services, SEHD launched the Logistics Project at the end of August 2003.The project is centred around implementing best practice logistics process and infrastructure across the entire NHSScotland supply chain in order to secure significant economic and service benefits. Key project activities include : Process & Change Management - developing the work processes for the Logistics service and co-ordinating the rollout of the Logistics Strategy implementation across NHSScotland ( NHS Boards and Special Health Boards); Contracting and Supplier Management - positioning the supplier base to deliver service and cost benefits driven by in bound supply chain modernisation. Infrastructure development - ensuring that required physical and human resources are in place to support the delivery of best in class supply chain activity at both local and national level. IT Systems Management - supporting the supply chain change management process through the availability of best of breed IT functionality. Stakeholder Management - ensuring that an effective communications programme is in place and that focus is given to managing key stakeholders through the change via supporting and championing the project. The logistics strategy which received FBC approval in December 2005 will enable NHSScotland to gain control over the supply chain for consumable products covering circa £600 million annual expenditure allowing NHSScotland to exert leverage on suppliers as to how goods are procured and delivered to meet the needs of the NHSScotland at least cost. In addition non-cash releasing savings will be achieved through release of clinical staff time from product ordering activity and through release of space at Hospital level. This is estimated at 215,000 staff hours p.a. equating to a cost of £2.15 million and £ 1.2 million p.a. from space release.
3. Savings	3.1 Current target saving £m		2005-06	2006-07	2007-08
		Cash	0	2.5	7.5
		Time	0	0	0
	3.2 Previous target saving £m		2005-06	2006-07	2007-08
		Cash	0	5	10
		Time	0	0	0
	3.3 Explanation for difference	Targets revised to reflect increased recurring expenditure as per the Logistics FBC, which was approved December 2005.
4. Accountable Officer for delivery			Dr Kevin Woods
5. Project Manager			Mr Ross Scott
6. EGDD Portfolio Manager			Ms Gillian Woolman
7. Description of efficiency and actions to be taken	7.1 What is the efficiency improvement? How will the saving be made? Savings are in the main dependent on the acquisition and development of a (single) NHSScotland National Distribution Centre ( NDC) located in Lanarkshire. The logistics infrastructure proposed is common best practice associated with the private sector as evidenced by Tesco, Morrisons and Asda. Perhaps more relevant, is Boots distribution centre based at Bellshill supplying all outlets in Scotland from Wick to Dumfries with a range of products not dissimilar to that used by NHSScotland. The main savings will be derived from centralised purchasing delivering better product prices from the improved logistics infrastructure and through right sizing NHSScotland physical and human logistics infrastructure.
	7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? The action required is that the NDC is acquired and commissioned by the logistics team and operated effectively and efficiently using best practice processes supported by appropriate IT. It is also important that local infrastructure and process changes are implemented by NHS Board Chief Executives and Heads of Procurement to ensure that the efficiency improvements are maximised. There is, therefore, a key dependency on NHSScotland participating in this project and taking responsibility for implementing business change at both a local and national level. Good change management and communication activity is important in this respect. NHS Chief Executives have formally endorsed the Logistics FBC as have staff / partnership representatives.
8. Associated costs	8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? There are no development or redundancy costs associated with this project This project will result in potentially significant opportunities for staff, with new posts being created, redeployment and training within the new logistics infrastructure and in other areas within each Health Service organisation. The gross recurring saving is approx £18m pa with gross recurring expenditure of approx £10.5m.
9. Measurement	9.1 What are the inputs that will be measured? The current costs associated with Logistics activity have been captured within the Logistics FBC as have the projected future costs and future service level performance metrics. A range of Key Performance Indicators ( KPI's) have been developed which will track cost and service performance against the metrics detailed within the FBC. The high level KPI's relate to Customers / Suppliers and Operational activity.
	9.2 What are the outputs that will be measured? The main outputs are savings achieved against plan. These predominately relate to product price reduction / headcount reduction and change to local infrastructure. Additionally service performance will be measured against published standards which are embedded in Service Level Agreements ( SLA's) with the customer Health Boards.
	9.3 What is the baseline for inputs and outputs? The baseline is 2004/05 expenditure on distribution and 2004/05 volume transported.
10. Quality cross-check	10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? Service levels performance metrics will be published and embedded within customer SLA's. Monitoring of performance will be ongoing and reported continuously against agreed KPI's which reflect the performance metrics. The head line target is to achieve a 98% first time, on time, in full delivery of product requested. Freeing up the time of front line staff spent on ordering and processing goods at ward level, and the reduction of inventory (and possible waste) within hospitals, will additionally be monitored.
11. Monitoring	11.1 What are the arrangements for monitoring the delivery of efficiency savings? Monthly Management Accounts and via KPI monitoring arrangements.
12. Reporting	12.1 What are the arrangements for reporting the delivery of efficiency savings? Savings will be formally reported at NHSScotland and customer level on a quarterly basis.
13. Dependencies	13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. Savings are not dependant on legislation. Savings are dependent on the acquisition and operation of the ( NDC) and on the implementation of local infrastructure and process change at local level.
14. Use of savings	14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards will not assume these efficiency savings. The cash releasing efficiency savings will be retained by NHS Boards and used for developing and/or delivering local patient services.

1. Portfolio/Number/Name:H/C 4 Improved prescribing of drugs
2. Programme/Activity: The plan is to deliver £20 million savings through improvements in prescribing, by adopting best practice and reducing inappropriate prescribing. A national co-ordinating plan was issued on February 28, 2005 requiring Health Boards to develop local plans which draw on existing guidance, and which are capable of monitoring to identify progress against the national targets.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	5	10	20
			Time	0	0	0
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	5	10	20
			Time	0	0	0
	3.3 Explanation for difference		There has been no amendment to the original target.
4. Accountable Officer for delivery				Dr Kevin Woods
5. Project Manager				Mr Chris Naldrett
6. EGDD Portfolio Manager				Ms Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? By adoption of local plans featuring, but not exclusive to, areas identified in the national co-ordinating plan issued in February 2005, NHS Boards will release cash due to improved prescribing. The plan identified for each Board the target saving and approaches to achieve the target is built upon best clinical practice, possible areas for savings identified by SEHD, and included reference to existing external guidance such as the Audit Scotland June 2003 report on GP prescribing. Local plans have been submitted to SEHD . It will be for Boards to consider whether further staff are required to augment existing prescribing advisory staff to help achieve local plans. Savings are achieved by a reduction in the quantities of certain prescribed drugs/items being replaced, offset in some cases by increases in prescriptions of other, usually cheaper, drugs/items.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? Local plans, as mandated by the national co-ordinating plan, in which local stakeholders accepted realistic targets for prescribing quality improvements. Plans signed off by Board Chairs/Chief Executives and prescriber representatives as locally appropriate, and were completed in Summer 2005. The action managers are the 4,250 + clinicians with prescribing rights, and ultimately the clinical discretion to prescribe for their patient what is most appropriate. It is, therefore, crucial that clinicians be satisfied that local plans aspire to improve quality in prescribing and clinical benefits for patients and are not crude cost savings targets. They are supported by an existing network of prescribing advisers in Health Boards, for which each HB has to determine the appropriate complement and decide if staff augmentation would improve the likelihood of a successful outcome.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? There are no development or redundancy costs. No change in staff complement is planned.
9. Measurement		9.1 What are the inputs that will be measured? The spend on drugs will be monitored. The gross target is a reduction in expenditure of £20m by 2007/08.
		9.2 What are the outputs that will be measured? National aggregation of local plans will establish local benchmarks in the light of the headings provided in the national co-ordinating plan.
		9.3 What is the baseline for inputs and outputs? 2004/05 provides the baseline for drugs volume and expenditure.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? The programme is quality based and drawn on quality indicators detailed in the Audit Scotland Report of June 2003.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? Monitoring will be done in the SEHD, based on NSSISD aggregation. There is extensive data available from NHSNSS Information Services Division to GP practices and Health Board prescribing advisers to allow their prescribing behaviour to be monitored. Availability however lags prescribing by 3-4 months. Monitoring will be quarterly, after availability of data, by each Health Board and will be aggregated centrally by NHSNSS. This will be used by NHSNSSISD to provide tailored reports for each Health Board, but in a format that is capable of aggregation to allow SEHD to monitor national progress.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? SEHD will agree with NHSNSSISD the form of a national monitoring report to track overall progress.
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. No legislative changes are required. The achievement of targets will involve changes in the clinical practice of 4,250 General Practitioners and other independent prescribers, for whom the prime driver is improving the quality of prescribing for the benefit of their patients. To some degree it will also depend on the success of planned nationally co-ordinated initiatives, as foreshadowed in the national co-ordinating plan, to support the efficient prescribing of non drug prescription items, such as dressings and nutritional products. More cost effective prescribing in rural areas may need to go hand in hand with revisions to dispensing doctor contract arrangements to avoid destabilisation of the aggregate funding packages available to particular practices. Critically, continuing development of area wide formularies, jointly by Health Boards and stakeholders including both clinicians and the industry, which will stimulate progress towards greater national consistency in prescribing practice. We will review again whether mandating generic dispensing through Regulations is necessary and desirable to realise the last remaining latent savings from comprehensive generic prescribing.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? This efficiency saving was assumed as part of the allocation made by the Scottish Executive to NHS Boards. This freed up resources for Ministers to allocate to their priorities through NHS Boards.

1. Portfolio/Number/Name:H/C7 NHS Efficiency Savings
2. Programme/Activity: A recurring 1% Efficiency Saving from NHSScotland. NHS Chief Executive Officers have signed up to deliver 1% recurring efficiency savings. Information has been submitted from each NHS Board summarising the schemes and the level of savings expected from each one. A wide range of efficiency schemes have been identified across the NHS Boards, including contracting, commissioning, estates and facilities, service redesign, workforce arrangements, transport services, and local initiatives on prescribing/drugs and support services (over and above national ones). Plans covering to the end of 2007-08 have been received.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	88	134	208
			Time	0	0	0
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	88	134	208
			Time	0	0	0
	3.3 Explanation for difference
4. Accountable Officer for delivery				Dr Kevin Woods
5. Project Manager				Mr Alex Smith
6. EGDD Portfolio Manager				Ms Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? How the 1% efficiency saving is being made by each Board is very much a local decision. Information on specific schemes has been received by the Health Department for each individual body. This information enables the monitoring of progress against the targets set for each NHS Board.. Savings are and will be made by improving productivity and use of existing resources through reductions in cycle times, process times and efficiencies, and better use of existing capacity. Specific examples include service redesign, appropriate staffing considerations and review of catering arrangements. A broad and diverse range of projects have been considered as part of this exercise.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? NHSScotland Health Board Chief Executives and Directors of Finance have given their full commitment to the process and the delivery of the savings. The achievement of savings will be monitored using the financial monitoring templates already in use. NHS Boards have built agreed savings into their 5 year plans.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? It is unlikely that there will be offsetting recurring expenditure to underpin any of the savings generated.
9. Measurement		9.1 What are the inputs that will be measured? The level of expenditure spent on a particular service will be measured, taking one year with another. Budget savings will fall against Clinical/Non-Clinical Service Costs. The expected efficiency benefits will be measured purely on a financial basis. These savings will be detailed in financial returns made throughout the monitoring period..
		9.2 What are the outputs that will be measured? The level of activity will be measured, taking one year with another.
		9.3 What is the baseline for inputs and outputs? The level of expenditure and the level of activity in 2004/05 are the baselines.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? These savings will not impact on the quality of service provision and this will be assured through established performance assessment arrangements.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? This process has been aligned with current reporting/monitoring information, ie monthly basis commencing month 3 of any given fiscal year. Lead responsibility for monitoring is Directors of Finance in conjunction with Chief Executive Officers. In practise this is the completion of a monitoring schedule by individual NHSScotland Health Boards/Special Health Boards.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? Once received, the monitoring information is collated and forwarded to the Health Department Management Board. Financial information is used to measure progress. Detailed information has been available since 31 March 2005 and will continue to be assessed and updated routinely. Full Ministerial involvement will include these savings as part of the annual review process of Performance Management. Validation will be part of the normal financial monitoring process (including meetings with key NHSScotland staff) and ultimately feeding into an audited set of annual accounts. Ministers will ultimately hold NHSScotland Health Boards and Special Health Boards to account for the delivery of these savings.
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. These savings are expected to be locally based initiatives and not dependant on any legislative or structural influences.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? This 1% efficiency saving was assumed as part of the allocation made by the SEHD to NHS Boards and consequently was built into the budget. However there has been no diminution in the overall funding to Boards because the gross annual uplift is considerably more than 1% There is no direct link between the amount saved and a specific new initiative; the resources released are to be reinvested in NHS priorities . The objective is to achieve more or better services for the same money. The process encourages a culture of continuous improvement and re-examination of services and service delivery.

1. Portfolio/Number/Name:H/C 8 Facilities Management System ( FMS) in NHSScotland
2. Programme/Activity: With the move by NHSScotland Bodies towards single system working Directors/leads of Facilities have created a forum in which they can discuss how best they can improve service efficiency and effectiveness. This group has identified a major gap in the support systems available to Facilities Managers and this proposal seeks to rectify that situation. Current working arrangements are characterised: management information for a range of key support services which is limited, unconnected and retrospective, systems which provide limited understanding of capacity or productivity, systems which provide only limited scope for true performance management and development, the provision of services which are more process dominated than outcome focussed, delivery of sub-optimal use of scarce resources. The proposed Facilities Management System ( FMS) will be a universal system which will deliver detailed information to support managers in the delivery of key support services such as cleaning, laundry, transport, telecommunications etc. For the first time NHSScotland will have a common system for monitoring, managing information and control conducive to on-going service efficiency, effectiveness and value for money. The key benefits include: delivery of a universal management system; performance focus based on up-to-date information which will lead to evidence-based decisions; potential to reduce revenue and contribute to Boards' financial management systems; ability to drive continuing improvement through benchmarking and sharing of best practice; potential to be extended into the wider public sector.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	0.1	0.4	0.8
			Time	0	0	0
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	0.1	0.4	0.8
			Time	0	0	0
	3.3 Explanation for difference
4. Accountable Officer for delivery				Dr Kevin Woods
5. Project Manager				Project Sponsor: Mr David Hastie Project Manager: Mr Paul Kingsmore
6. EGDD Portfolio Manager				Ms Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? The savings will derive from managers having access to improved information not only for the services delivered in their own facilities but by their ability to benchmark against other similar service delivery across NHSScotland. The over-riding benefits from the introduction of the FM System will be the ability of mangers to provide significantly improved services by delivering relevant, focussed information. This will enable true performance management to be undertaken for the first time across the entire range of Facilities Management services in NHSScotland.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? The first action is the active support of SEHD in promoting policies which will require Boards to implement the proposed system. This can be achieved and is similar to the mandatory requirement in place whereby Boards must use the newly developed Property Management System. It will also require the active support of the strategic leads for Facilities Management and the newly constituted group representing these managers is fully supportive of this proposal. Finally the NHSScotland Property and Environment Forum will commit resources to this project and support it once the system has been rolled out to the service.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? There are no redundancy costs associated with delivery of this saving. Development costs related to the Pilot Study in NHS Tayside amount to £250,000. Change will be achieved through greater efficiencies and altered working practices.
9. Measurement		9.1 What are the inputs that will be measured? Inputs are the level of resource spent in this area. These inputs cover the whole range of services included in the Facilities agenda. The inputs will include all staff, operational, risk and user focus costs in the facilities management categories of laundry, catering ,sterile services, domestic, portering, security, procurement, estates, telecommunications, transport, capital projects, waste management and car parking.
		9.2 What are the outputs that will be measured? NHSScotland Boards will monitor the outcomes as part of their governance arrangements. As this project will result in improved service delivery Boards will be required to introduce new monitoring and evaluation systems. By benchmarking against other NHSScotland Boards. By a "balanced scorecard" approach with monthly and cumulative outcomes assessed against targets including previous years. The outputs will specific to each facilities management service as per 9.1 above. The generic outputs will be: financial - staff and non-staff costs; operational - absenteeism, overtime, headcount, turnover, vacancy levels risk - e.g. downtime on equipment user focus - complaints, condemned items etc.
		9.3 What is the baseline for inputs and outputs? 2004/05 levels of expenditure and levels of service provide the baseline against which to measure inputs and outputs.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? By producing sets of KPIs management will be able to benchmark performance across a range of sites both within individual healthcare systems and nationally. By improving the quality of information available to key management staff we can empower these managers to make more effective decisions regarding the provision of vital support services which will result in the delivery of more patient focussed, value-for-money care. By enabling managers to effectively benchmark the services provided they can ensure that improved performance and therefore ongoing service improvement.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? Cost for delivery across a wide range of services will be monitored over time and also benchmarked against similar services provided elsewhere within NHSScotland.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? By exception reporting using a traffic light system.
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. The savings are not dependent on legislative changes. This proposal is dependent on its implementation by all NHSScotland Boards and this can be achieved through existing Property Management and other Scottish Executive policies.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards did not assume these efficiency savings. Any savings are for retention by NHS Boards for reinvestment in local priorities.

1. Portfolio/Number/Name:H/C 9 Drugs pricing
2. Programme/Activity: This programme relates to supply side activities to improve value for money in national arrangements for the pricing of drugs by NHSScotland.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	42	42	42
			Time	0	0	0
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	42	42	42
			Time	0	0	0
	3.3 Explanation for difference
4. Accountable Officer for delivery				Dr Kevin Woods
5. Project Manager				Mr Chris Naldrett
6. EGDD Portfolio Manager				Ms Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? The saving will be made, in the main, by implementation of a revised Pharmaceutical Prices Regulation Scheme negotiated on a UK basis with the industry. These impact on the prices of 'branded' products used in Primary Care, i.e. drugs still protected by licence. These account for around 2/3rds of Primary Care drug costs. Opportunities for savings in other areas will continue to be pursued. No changes are expected in the short term. The gross target of £42m is derived by applying an average 7% discount across all branded drugs.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? PPRS arrangements are now largely in place, with only one small element, where the financial impact is marginal, relating to so called standard branded generics is still to be clarified. SEHD representative in negotiations on PPRS has been Prof. Scott, CPO. We are still waiting on DH to decide on Standard Branded Services.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? There are no development or redundancy costs associated with this saving.
9. Measurement		9.1 What are the inputs that will be measured? The cost per unit of relevant branded drugs will be measured. There is extensive and reliable data available from NHSNSS Information Services to allow the costs of Primary Care prescribing to be monitored. Availability however lags prescribing by 3-4 months.
		9.2 What are the outputs that will be measured? To monitor the effects of the PPRS target 7% price cut across all branded drugs purchased in Primary Care.
		9.3 What is the baseline for inputs and outputs? The baselines are 2004/05 costs per unit and volume levels.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? The immediate impact on quality of service provision is likely to be neutral.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? Monitoring will be quarterly - after availability of data - and will be by NHSNSS.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? Quarterly reports are being produced by NHS: NSS: ISD three months in arrears to reflect times to process prescriptions.
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. There are no legislative implications. Reimbursement prices for drugs are set by Directions through the Scottish Drug Tariff which itself is enabled by the Pharmaceutical Services Regulations (Scotland) 1995.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? This efficiency savings was assumed as part of the allocation made by the Scottish Executive to NHS Boards. This freed up resources for Ministers to allocate to their priorities through NHS Boards.

1. Portfolio/Number/Name:H/C 10 Efficiency savings in the Care Commission
2. Programme/Activity: Regulation of care services defined in the Regulation of Care (Scotland) Act 2001 The Care Commission is an NDPB responsible for the regulation of a wide range of care services under the Regulation of Care (Scotland) Act 2001. The Commission will be responsible for delivering these savings. Jacquie Roberts, Chief Executive and David Wiseman, Director of Operations at the Care Commission, are the key action managers. The £1m cash savings in 2005-06 and subsequent years relate to efficiency savings in the regulation of early years services.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	1.0	1.6	1.6
			Time	0	0	0
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	1	1	1
			Time	0	0	0
	3.3 Explanation for difference		The increase in efficiency in 2005-06 has been made as part of the budget negotiations described at 7.1 below. In 2006-07 we expect a further £600k of efficiencies (mainly due to the reduced time now required to regulate care home services).
4. Accountable Officer for delivery				Dr Kevin Woods
5. Project Manager				Ms Linda Gregson, SEHD Care Standards and Sponsorship Branch and Care Commission Director of Operations
6. EGDD Portfolio Manager				Ms Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? £1m of the savings have been made through the streamlining of the Commission's joint inspection arrangements for early years services with HMIE. For example, it has been agreed with HMIE that in a year when a joint inspection is due then for smaller services that inspection will be carried out by one inspector. The Commission has also revised the activity time needed to inspect childminders in light of discussions with the Department. A saving of £160k a year from 2005-06 also has been achieved as a result of the Care Commission's Organisational Structure Review approved by Ministers. The savings are a result of a net reduction of 8 middle management posts. This will not affect the quality or quantity of the Care Commission's output. In 2005-06 the Care Commission also funded increase in non-staff prices (around £250k) from efficiency savings elsewhere in its budget We are currently negotiating the Care Commission's budget for 2006-07. Efficiencies of a further £600k are embedded in the Commission's draft budget.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? The Care Commission's inspection processes take account of the efficiencies in practice set out at 7.1 above. The amount of inspector time required now to deliver the new arrangements is less than before and this has been reflected in the Care Commission's staffing requirements.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? The efficiencies impact on staffing levels. It is difficult to be specific about numbers. Recent work by the Care Commission in relation to fee levels sets out the activity required to regulate all care services for which it is responsible. That work takes account of the new arrangements described above and is reflected in the Care Commission's gross budget.. The £1m efficiency saving is recurrent. The saving has not resulted in any redundancies. The reduction in staff time required to regulate early years services as above has been achieved through a combination of re-deploying staff into the regulation of services that have not been previously regulated ( e.g. housing support) and by not filling vacant posts.
9. Measurement		9.1 What are the inputs that will be measured? The £1m efficiency is in the Care Commission's gross budget and subsequently in the grant-in-aid required from the Department. We expect the Care Commission's gross expenditure (which is agreed by the Department) to continue to reflect the efficient practice in the regulation of these and other services. The Care Commission will be required to keep its cost down. We will be monitoring expenditure against the Care Commission's gross budget to ensure both that there is no overspend and that no additional grant-in-aid is required.
		9.2 What are the outputs that will be measured? The outputs are the targets set out in the Care Commission's Corporate Plan.
		9.3 What is the baseline for inputs and outputs? The baselines are 2004/05 costs per unit and target levels achieved.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? We do not expect the savings to affect the Care Commission's statutory inspection requirements or the quality of inspections being carried out. Through established performance monitoring returns to the Department we will receive assurance that there has been no deterioration in performance.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? Care Commission provide monthly reports on outturn against budget and quarterly reports showing outturn against key corporate plan targets and statutory requirements.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? Care Commission provide monthly reports on outturn against budget and quarterly reports showing outturn against key corporate plan targets and statutory requirements.
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. The efficiencies at the level agreed are not dependant on legislation. The delivery of further efficiencies is, however, constrained by the requirement in the Regulation of Care (Scotland) Act 2001 for services to be inspected at least once a year (and twice in the case of services where overnight accommodation is a part of the service e.g. care homes). Ministers now have, through the Smoking Health and Social Care (Scotland) Act 2005), the power to vary the minimum frequency of inspections. They are currently considering for which of the services regulated by the Commission there is a case for consulting on the use of that power..
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? The Care Commission has reduced its gross budget for 2005-06 by the £1m agreed as part of the discussions on Early Years' efficiencies. This efficiency savings was assumed as part of the allocation made by the Scottish Executive to the Care Commission. This freed up resources for Ministers to allocate to their priorities.

1. Portfolio/Number/Name:H/T 1 Reduction in sickness absence
2. Programme/Activity: Each health board will have developed local plans to achieve the target of 4% sickness absence in their area by 31 March 2008. Achievement of these local targets will be expected to deliver 4% sickness absence levels across NHSS as a whole by 31 March 2008. Therefore, health boards which already have sickness absence rates lower than the NHSScotland average will be expected to reduce down to 4% as soon as possible, or, once they have maintained or improved upon this position, to continue the cycle of improvement and strive to minimise sickness absence by effective management in line with staff governance principles. The target will be most challenging for health boards with high levels of sickness absence as they may need to reduce their sickness absence substantially by 2008. The approach used here continues to be to support those health boards which are already working to achieve reduced sickness absence and challenge those boards where more focused management attention is required. The underlying principle builds on previous initiatives in that effective management in line with staff governance principles should reduce sickness absence and be of benefit to employees, employers and patients. Board-by-board data on sickness absence has been collected through the new NHS workforce information repository since autumn 2005. part of the Scottish Workforce Information Standard System project.. This lead to changes in reported sickness absence rates due to greater accuracy, better coverage of all NHS systems, and new methodologies for collection of data. This may mean that a technical adjustment to the percentage target may need to be made, but this will not affect the level of time releasing savings which are planned.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	16.3	34.5	54.8
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	16.3	34.5	54.8
	3.3 Explanation for difference		The Department advises that due to significant changes in relation to the new collection system and methodologies for collection we are unable to ascertain if the time releasing saving of £16.3m has been achieved in year 1. With the new collection process and NHS Board action plans now in place we will be able to monitor progress accurately over the next 2 years.
4. Accountable Officer for delivery				Mr Paul Martin, Interim Director of Human Resources, SHE
5. Project Manager				Mr John Turner/ Diane Murray
6. EGDD Portfolio Manager				Ms Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? The efficiency improvement is increased attendance levels as a result of more pro-active absence management. Savings will be achieved by using existing staff more effectively and by employing less complimentary or temporary staff.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? The delivery of these time releasing savings are dependent on: 1. Board Chief Executives recognising the importance of this agenda and delivering on time 2. The support of Partnership colleagues 3. The continued delivery by SWISS to agreed time scales and accuracy.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? There are no redundancy costs associated with this saving. Development costs have been incurred, and recurrent operational costs will be incurred on the SWISS project but as it was not embarked upon on efficiency grounds alone those costs will not be netted of the time releasing saving.
9. Measurement		9.1 What are the inputs that will be measured? Payroll costs will be recorded.
		9.2 What are the outputs that will be measured? The associated output is the level of attendance secured by that expenditure on staff (pay). By monitoring sickness absence rates by health board and staff group,, efficiency benefits will emerge by staff group, ie. by evaluating the reduction in sickness absence by different 'groups' of unit labour cost. Sickness absence data will be available from SWISS quarterly as from January 2006
		9.3 What is the baseline for inputs and outputs? The baseline is the level of sickness absence in 2004/05. There is a possibility that the renewed focus on sickness absence reporting will result in improved reporting of sickness absence, which in itself is positive, but may result in sickness absence levels appearing to increase. As the SWISS data becomes available, there may be a need to make a technical adjustment, reset the baseline and adjust the target accordingly, whilst not affecting the level of time releasing savings. This will be the result of the transfer of data collection from one system to another. The new SWISS system is more accurate, therefore, we will review and possibly adjust the time releasing savings baseline and target by August 2006.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? By reducing sickness absence, health boards will increase the number of days contributed, by its workforce, to the delivery of health care and therefore should impact directly on the delivery of care to the public by frontline staff. Reliance on temporary staffing will also be reduced and should result in further savings. The overall impact should lead to a more consistent approach to care delivery as the public should see more NHS staff at the frontline and less staff employed by agencies. We have begun to explore the use of clinical quality indicators to demonstrate improved quality in areas where sickness absence rates are lower.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? The "Scottish Workforce Information Standard System" ( SWISS) aims to provide information on staff in a consistent and accurate format. The project was set up to develop a national database that collects, holds and reports information on all NHS Scotland staff. The monitoring and reportin fits into agreed performance arrangements. SWISS will provide the data on a real time basis, the database will be updated weekly however absence data will be monitored on a quarterly basis initially.. The information provided by SWISS will be monitored by the Workforce Modernisation Division of SEHD The lead responsibility for ensuring the validity of the data rests with ISD and SWISS. The data is also collected as part of the Staff Governance arrangements and for the NHS Board Local Delivery Plans. Health boards are required to ensure that the data they input is of high quality. The quality of existing data, which forms the baseline, may not be accurate. The focus on this target has already resulted in better data quality. The recording of absence for some staff groups has been shown to be poor, therefore, with improved recording it is likely that sickness absence rates will increase, We will review the baseline and recommend any necessary adjustment in August 2006. Better reporting gives the opportunity for sickness absence to be better managed locally, therefore, health boards who improve their reporting, but as a consequence, demonstrate an increase in sickness absence will be supported to continue to strive for improved data quality and effective management of sickness absence.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? The Workforce Modernisation Division will give 3 monthly updates on sickness absence rates and 6 monthly updates on the progress of action plans to address the issue.
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. No legislative dependencies Effective reduction of sickness absence is dependent on effective local management in line with staff governance principles and PIN guidelines and the delivery of an effective Occupational Health Service. The monitoring of progress has been enhanced by the SWISS Project delivering its agenda on time. All health boards are now using SWISS and are contributing to the Workforce Information Repository ( WIR) following its introduction during 2005. Good quality data has been available from January 2006.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards did not assume an increase in attendance levels. Any time released from this project will contribute directly to the delivery of local service priorities

1. Portfolio/Number/Name:H/T 2 Increasing Consultant Productivity
2. Programme/Activity: NHS health boards are expected to demonstrate an increase in consultant productivity by 1% per annum over a 3 year period from 1 April 2005 to 31 March 2008.. Service redesign and the application of the leverage of pay modernisation will be key to health boards achieving this. It is acknowledged that an increase in consultant productivity will impact on a number of other roles and departments and therefore, an increase in productivity is expected to be delivered by other staff groups.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	21.1	45.6	73.0
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	21.1	45.6	73.0
	3.3 Explanation for difference
4. Accountable Officer for delivery				Mr Paul Martin, Interim Director of Human Resources, SEHD
5. Project Manager				Mr John Turner
6. EGDD Portfolio Manager				Ms Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? It is expected that by increasing the overall productivity of consultant teams there will be increased output for the same level of input. This may equate to more numbers of patients or an increasing complexity of patients being treated.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? 1. the delivery of timely and reliable data - ISD 2. the identification of further, specific productivity measures - this work is currently being lead by the Scottish Association of Medical Directors and the National Workforce Performance and Effectiveness Group 3. the leadership of health board Chief Executives is key to the delivery of this saving 4. support & co-operation from other staff groups
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? There are no redundancy costs associated with this saving. Development costs have been incurred, and recurrent operational costs will be incurred on the SWISS project but as it was not embarked upon on efficiency grounds alone those costs will not be netted off the time releasing saving.
9. Measurement		9.1 What are the inputs that will be measured? Input is pay costs of consultants. Arrangements will be put in place to monitor that input levels.
		9.2 What are the outputs that will be measured? Output is the number and complexity of patient treatments. Activity and workforce numbers will be measured.
		9.3 What is the baseline for inputs and outputs? The baseline is the number of consultants and their respective case numbers and mix in 2004/05. Increasing consultant productivity may result in more patients being treated and therefore would have a positive impact on waiting times; however, it may well confirm that the case mix of patients being treated is becoming increasingly complex so that consultants are becoming more productive by consistently treating a more complex group of patients. Either an increase in numbers of patients treated, or an increasing complexity of patients being treated will demonstrate positive changes in consultant productivity. A change in the complexity of patients may be the result of a number of factors: for example a) other professionals are increasingly delivering some workload that was previously delivered by consultants and b) more care is increasingly being delivered outside of the hospital setting, for example, in primary care facilities. Both of these examples are in line with government priorities. A focus on increasing consultant productivity will enable health boards to understand how consultants and clinical teams are working, and how service redesign and improvement can increase consultant productivity, with the aim of improving overall patient care.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? We have begun to explore the development and use of clinical quality indicators. Appropriate quality indicators should demonstrate maintenance and or improved quality in areas where changes have been made to the delivery of care by the consultant team to increase productivity in terms of throughput or complexity of cases conducted.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? 1. SWISS will provide the workforce data. The new system that will help NHS Scotland collect, store and report information about its 150,000 staff more efficiently commenced phased introduction in 2005. The "Scottish Workforce Information Standard System" ( SWISS) aims to provide information on staff in a consistent and accurate format. The project's first phase involved setting up a national database that will hold information on NHS Scotland staff. The national database will be updated weekly; however, it is likely that consultant productivity data will be monitored less frequently. 2. ISD will deliver the activity data using existing data collections which is updated monthly. 3. The monitoring and reporting will fit into performance arrangements. 4. ISD will be responsible for monitoring the data collection process. Challenges in interpreting the data: Consultant productivity will be impacted on by a number of variables, for example, patient case mix, location of services, number of junior staff supporting consultants, GP referral patterns. This list is not exhaustive. Therefore, benchmarking of data against peer groups will inform interpretation. Interpretation of the data in isolation from the context may be unhelpful and misleading. Changes to consultant productivity may impact negatively on the workload of other staff if not planned and managed appropriately. A large increase in the number of consultants employed, following, for example, recruitment drives, will impact on productivity ratios and therefore the interpretation of data should be viewed in context. Changes to the way that data is captured, for example, a move away from recording Finished Consultant Episodes to Spells, may result in a need to review and reset the baseline. The NHS is introducing pay reform across all members of the workforce. As staff change the way they work, there may be an impact on the productivity of consultants. It should be noted that Modernising Medical Careers, which commences in 2005, and which changes the way in which doctors are trained, will, over time, change how consultants and other members of staff work and will therefore impact on productivity data and trends in the future.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? Efficiency savings will be reported via the mechanisms mentioned above. Pay modernisation benefits realisation plans will also provide evidence of improved quality of service provision. These will be monitored on a 6 monthly basis by SEHD
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. There are no legislative dependencies The monitoring of progress will be enhanced by the SWISS Project continuing to deliver its agenda on time. All health boards are using SWISS and have been contributing to the Workforce Information Repository ( WIR) since its introduction in 2005. Good quality data will be available from January 2006 onwards.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards did not assume an increase in consultant workloads. Any time released from this project is for reinvestment in local service priorities.

1. Portfolio/Number/Name:H/T 3 Scottish Primary Care Collaborative
2. Programme/Activity: The Collaborative Approach is a tried and tested method, developed in the USA, which has been applied to a range of management challenges including healthcare systems in the USA, Sweden and England. This year Australia and Canada will also be using the improvement methodology. The goal of the programme is to assist primary care organisations to develop their capability to deliver rapid , sustainable and systematic improvements to the care they provide to their communities through a sound understanding and effective application of quality improvement methods and skills. The aims are: To ensure that 90% of patients can access their primary health care routinely within one working day. Through proactively improving GP Practice appointment systems and developing robust contingency plans for GP holidays and absences, the number of DNAs (missed appointments) can be reduced and the number of days using a locum can also be reduced.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	6.52	6.52	6.52
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	6.52	6.52	6.52
	3.3 Explanation for difference		It is too early to change forecasts given the early stage of data collection for these purposes.
4. Accountable Officer for delivery				Kevin Woods
5. Project Manager				Stephen Gallagher
6. EGDD Portfolio Manager				Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? More patients will be seen by practice staff thus reducing dependency on locums. The number of GP hours lost from missed appointments ( DNAs) will be reduced. Consequently there is an increase in the number of patient contacts (output) relative to input.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? To secure the delivery of the efficiency improvement the commitment of participating GP practices is required to work through the Collaborative Improvement Methodology and to develop proactive models of care which involves developing call and recall systems for patients with Long Term Conditions e.g CHD, Diabetes.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? This project was embarked upon to secure better patient access and was not embarked upon on efficiency grounds alone. Consequently any development costs will not be netted off the time releasing saving.
9. Measurement		9.1 What are the inputs that will be measured? The number of locum days a GP practice, who are participating in the SPCC, uses before and after implementing changes to its practice systems will be measured. The number of GPDNAs a practice, who are participating in the SPCC, experiences before and after implementing changes to its practice systems will be measured.
		9.2 What are the outputs that will be measured? The savings achieved from the reduced number of locum sessions used by GP Practices as a direct result of the contingency planning that they have implemented since joining the programme. The savings achieved from the reduced number of DNAs experienced by GP Practices as a direct result of the patient access improvements they have made since joining the programme.
		9.3 What is the baseline for inputs and outputs? The baselines are: the number of locums and respective cost in 2004/05, and the number of DNAs in 2004/05.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? Quality of the service will improve as waiting will decrease and practices will have the capacity to direct patients to the most appropriate member of the health care staff in a more efficient and effective manner. Local practices undertake patient satisfaction surveys routinely
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? The information on DNAs and Locums will be provided by participating GP Practices on a monthly basis via an online reporting system, which they would be using to monitor their progress in improving patients access to services and improvements in the management of care for people with long term conditions. Agreed procedures for recording the information in every practice would be used to ensure consistency and accuracy of the data recorded. Accuracy could be compromised if practices did not follow guidance on recording the data.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? The efficiency savings will be reported by calculating the savings from the data submitted by the GP practices as detailed above (11. Monitoring) on a monthly basis. This will then be entered into the quarterly Monitoring Returns
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. There are no legislative dependencies Improving practice systems is the basis of the method. Practices are assisted in this by a project manager in order to identify alternative ways of providing care to patients. eg telephone consultations, Practice Nurse led clinics.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards for primary care did not assume an increase in the number of patient contacts. Due to the nature of the project there is not time released, but time more productively applied.

1. Portfolio/Number/Name:H/T 4 Outpatient Programme/Specialty Redesign Projects
2. Programme/Activity: The redesign of orthopaedics, ENT and dermatology, will pilot services that help bring the demand, capacity and activity of services closer into balance. In many projects service redesign includes training alternative staff such as nurses, physiotherapists, podiatrists and GPs to diagnose and treat patients traditionally seen by a consultant.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	0.897	0.897	0.897
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	0.897	0.897	0.897
	3.3 Explanation for difference		Data capture too early to revise forecasts.
4. Accountable Officer for delivery				Kevin Woods
5. Project Manager				Stephen Gallagher
6. EGDD Portfolio Manager				Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? By training other staff to appropriately take on some clinical tasks previously conducted by consultants this frees consultants to provide the specialist services that they are trained for. In some circumstances care being provided by an alternative practitioner such as a nurse will mean that that service is provided at less expense. For example a consultant appointment costs approximately £65 where an appointment cost at a clinic run by another health professional is approximately £31. The Centre for Change and Innovation ( CCI) projects are piloting 27 Allied Health Professional( AHP) and nurse led clinics. If each of these new services do only 2 clinics a week for 42 weeks this would save £771,120 on the cost of the equivalent numbers of patients being seen by a consultant. 10 GP with Special Interest clinics are also being piloted. At one clinic a week this will save £126,000 over the course of a year based on the cost of a GP appointment of £35 per appointment (based on 10 appointments per week in a 42 week year). Where review or follow up patients are seen by alternative staff this will allow consultants to see more new patients in the same amount of clinics.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? NHS Boards need to be fundamentally signed up to supporting and developing their staff to explore new roles and different ways of working.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? This project was embarked upon to secure better patient access and was not embarked upon on efficiency grounds alone. Consequently any development costs will not be netted off the time releasing saving.
9. Measurement		9.1 What are the inputs that will be measured? The inputs measured are the number of patients referred to a given specialty. Because the NHS does not work "just in time" these patients are selected from waiting lists. Data collected throughout these projects will include numbers of patients seen by alternative practitioners and referral rates. We will incorporate financial saving into the final review.
		9.2 What are the outputs that will be measured? The outputs are the number of patients seen by an alternative health professional other than a consultant as would previously been the case.
		9.3 What is the baseline for inputs and outputs? The Outpatients' Programme established specific projects to test and implement new roles in its redesign of long wait specialties and community outpatient services projects. The baseline in 2004/5 is zero contacts and projects came on stream incrementally throughout 2005/2006.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? Local NHS Boards will be leading on the evaluation and the audit of local services. The quality of the services involved is expected to increase as the patient will see the most appropriate clinician to their needs. Waiting times will also be reduced in many areas.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? These projects were not set up to demonstrate cost savings however we will cover this in the final evaluation. Data to be collated is collected monthly to Programme closure in 2006 and where possible is collected from data already collated by the Health Board. The majority of data is quantitative. Due to the poor nature of some of the outpatients data currently collected and the fact that data on patients seen by anyone other than a consultant not yet collected there are some risks to collection and accuracy.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? Local Project Managers report data to Outpatient Programme data analyst
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. There are no legislative dependencies.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards for outpatient services did not assume an increase in the number of patient contacts. Due to the nature of the project there is no time released, but time is more productively applied.

1. Portfolio/Number/Name:H/T 5 Outpatient Programme: Patient Focussed Booking
2. Programme/Activity: Patient focussed booking is being introduced for appropriate new patients across Scotland and for return patients also in some areas. Patient focussed booking allows patients to have some input into the day and time of their appointment. Before this project was initiated the vast majority of patient appointments were offered fixed appointments where no choice was given. It also assists in managing the waiting list by ensuring that all routine patients are seen in chronological order. This was difficult previously as often clinics would be cancelled and re-booked or patients were moved forward in the queue.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	2.59	2.59	2.59
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	2.59	2.59	2.59
	3.3 Explanation for difference
4. Accountable Officer for delivery				Kevin Woods
5. Project Manager				Stephen Gallagher
6. EGDD Portfolio Manager				Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? With patient focussed booking, there is greater likelihood of the patient making their appointment and a greater likelihood of clinics running as planned. This will result in: Decreased patient cancellation rates which result in non attendance ( DNA) rates to 5% or less in the 30 plus participating sites; Booking patients chronologically increases queuing efficiency and reduces initiatives to manage the longest waiters. We know that patients have not been booked in strict chronological order in the past due to different vetting timescales, patient pressure and the ability of clinicians to pull certain patients forward. Hospital driven cancellations also leads to "churn" of the lists; Decreased hospital cancellation rates.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? The efficiency improvement requires: Delivery of appropriate computer software packages (particularly for return appointments); Robust policies on clinic cancellation, consultants leave, DNAs. Changes in working practice within medical records
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? This project was embarked upon to secure better patient access and was not embarked upon on efficiency grounds alone. Consequently any development costs will not be netted off the time releasing saving.
9. Measurement		9.1 What are the inputs that will be measured? This project is not established on measuring cost savings but data collection is in place, which will allow for extrapolation and further analysis. The inputs being measured are the number of clinics taking up the new Patient Focussed Booking approach during the lifetime of the CCI Outpatients Programme.
		9.2 What are the outputs that will be measured? The outputs that will be measured are the spread of PFB implementation for the duration of the outpatients programme (to March 2006), hospital cancellation rates and 'did not attend' rates. Patient satisfaction has also been determined through a survey of patients in Dermatology clinics throughout Scotland in 2005. Sites are measuring DNA rates, cancellation rates and waiting times. Audit Scotland calculate DNA rate of 1 in 7 (14%) DNAs cost £20m per annum (Audit Scotland 2003) PFB should reduce DNA rates to 5% or less Audit Scotland calculate that there is a total of 10 million OP attendances. Acute Hospitals see 6.5 million patients; 31% of appointments are first appointments All Acute Hospitals are implementing PFB for first appointments (6.5/10 of £20m) (£13m x 31%) (9/14 improvement of £4.03m) This gives a time releasing saving of £2.59m on Did Not Attends. National definitions and metrics do not yet exist for hospital cancellations and so no value is yet attributed to these expected improvements. However, Audit Scotland estimated that 1% of clinics are cancelled which may be as many as 100,000 appointments of which 65,000 would be in hospitals. Where possible, PFB utilises existing data reporting systems e.g.MMI data, which is reported to the National Waiting Times Unit. Due to the requirement for timely reporting, this data is not fully validated. In addition to the above, due to the poor nature of some of the outpatients data currently collected and the fact that data on patients seen by anyone other than a consultant not yet collected there are some risks to collection and accuracy. Quantitative data is collected monthly, where possible, using existing data reporting processes e.g.MMI (monthly management information) data. Qualitative data (in the form of staff and patient satisfaction surveys) is collected locally and fed into Centre for Change and Innovation ( CCI).
		9.3 What is the baseline for inputs and outputs? The baselines in 2004/05 are: No patients were booked through Patient Focussed Booking prior to the project launch in November 2003. Switching to the new approach began incrementally during 2004/5 and data for 2005/2006 represents the build up of implementation that is continuing.
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? Improved quality for patients through: choice over date and time of appointment; continued validation of the need for an appointment; less time spent waiting in clinics; reduced DNA rates (target of 5% or less by December 2005). A sample survey of patients attending dermatology clinics in 2005 highlighted 98% of patients felt happy to telephone to arrange an appointment 89% of patients felt that they were given choice over their appointment 97% of patients were happy with the appointment they received 10% of patients had difficulty getting through to appointment centres.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? Monthly monitoring and reporting of: DNA rates; Clinic cancellation rates; Outpatients waiting over 26 weeks; Longest outpatient waiting time by specialty; Implementation of PFB across specialties.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? PFB Project Managers at each site are responsible for reporting to the National PFB Project Manager.
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. There are no legislative dependencies More dedicated outpatient and queue management.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards for outpatient services did not assume an increase in the number of patient contacts. Due to the nature of the project there is no time released, but time is more productively applied, resulting in increased throughput.

1. Portfolio/Number/Name:H/T 6 Electronic transmission of lab results to GPs
2. Programme/Activity: Implementing a national IT system and service in all hospitals to give access from clinical areas to blood, radiology report and pathology test results. The NHSScotland IT Strategy sets out a vision in which patient information is shared electronically between different parts of the local healthcare community to deliver improved patient care. NHSScotland GPs order some 24 million laboratory tests for their patients per annum. Although computers within hospital lab services are used to prepare the results of these tests, for many years the method of reporting back to GPs was only to post the individual pieces of paper back to the relevant GP practice. More recent IT strategy has been to directly link each laboratory computer system to a common electronic database known as SCI Store. A programme of work, now completing, was then undertaken to give GPs and key staff in each GP practice the ability to 'dial in' and look up the patient's test results. This has proven to be useful in situations where immediate access to results are required - no delays through posting and filing - and where results go amiss. 100% of GP practices linked to NHSScotland's telecommunications network now have this facility installed. Note however that the paper flow has not yet been 'switched off' since GPs still need to look at each and every result which comes in and action them as necessary. The next strategic goal, which is the subject of this Technical Note, is to 'push' the electronic results down to the GP practice so that they can be incorporated directly into the patient's existing IT-based record. This is made possible having taken the earlier steps. However before being able to switch off paper there needs in addition to be an on-screen workflow facility for GPs to be able to review and action the test results. In addition to release of time there will be a positive impact on quality due to a number of benefits being realised, for example … immediate availability of results at point of patient care as soon as lab test complete rather than in days, improved access to results - via a terminal rather than wherever the paper happens to be, removes transcription errors from phoned results, reduces the risk of clinicians missing important patients results, clear audit trail provided of whether results have been viewed, enhanced security of access compared to paper alternatives, ability to view results on screen during a patient consultation supports the opportunity to discuss the results and future treatment options with the patient, having the test results assists the practice perform audit, ability to manipulate the laboratory results electronically allows graphical display and prepares for inclusion of electronic decision support.
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	4	8	12
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	4	8	12
	3.3 Explanation for difference
4. Accountable Officer for delivery				Kevin Woods, SEHD Chief Executive
5. Project Manager				Charlie Knox, SEHD Head of Computing & IT Strategy Division
6. EGDD Portfolio Manager				Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? The initiative promotes efficient and effective practice management, for example … removes the need to sort and file results in the Casenotes reduced time to trace and pull together results reduced time searching for results, ie. telephoning The nature of the saving is therefore time to be spent on other tasks.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? National programme commissioned by SEHD for NHS National Services Scotland ( NHSNSS) to develop and roll-out the initiative. Key action manager within NHSNSS is Ron Anderson, Head of National IT Programmes. Roll-out project and resource plans agreed and monitored with each NHS Board, under responsibility of Directors of General Medical Services. The partnership working extends to NHSScotland's commercial IT Services supplier, Atos Origin, who maintain the SCI Store IT system and the various GPIT system suppliers.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? This project was embarked upon to secure better access to patient information and was not embarked upon on efficiency grounds alone. Consequently any development costs will not be netted off the time releasing saving.
9. Measurement		9.1 What are the inputs that will be measured? Number of test results sent electronically to GP practices.
		9.2 What are the outputs that will be measured? Extensive before-and-after timings have been conducted on paper-based versus electronic test results based on n = 600,000. Although in the hospital setting, the workflow processes and benefits to be gained are the same. Only those savings attributable to secretarial and administration staff have been included as they represent the most reliable contribution. Savings for each administrative staff category have been quantified and converted into w.t.e. The cash equivalent, £293,567, has been derived by applying appropriate salary rates. It is not proposed to devote the significant effort to undertake this level of study in each hospital and GP practice. Instead, a figure has been calculated for savings per test. Based on 600K tests this equates to £0.50 per test. The total number of tests ordered by GPs per annum is known - 24M p.a. - hence when full implementation is achieved over the three year period the annual saving will be £12M. Statistics for these analyses will be taken from extracts from the SCI Store systems are considered to be accurate.
		9.3 What is the baseline for inputs and outputs? The baselines in 2004/05 is 20,000 test results electronically transmitted and incorporated into GP practice IT systems. The total/ target is the 24 million lab tests p.a. transmitted to 1041 GP practices
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? Due to the nature of the service improvement it is not considered that quality checks over time are required. Hence once the software has been designed and tested the data continues to flow into the patient record. What will be monitored however is the 'live time' of the service, as part of routinely collected statistics for contract performance.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? Measurement of progress toward full implementation will be derived from 6 monthly returns from each NHS Board, collated by the NHSNSS project team and submitted to SEHD (Charlie Knox, SEHD Head of Computing & IT Strategy Division). SEHD will apply the necessary conversion to £ equivalent using the formula described above and submit to EG Project Manager. To add to the above, extract analyses on number of test results being transmitted to each GP practice are obtained from SCI Store. Monitoring the reduction of paper flows/ filing in GP practices will be undertaken by NHS Board project teams and collated by NHSNSS.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? Quarterly reporting using existing 'Red-Amber-Green' forms to the eHealth Programme Board
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. No legislation or structural changes required.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards for primary care did not assume time savings. Due to the nature of the project there is no time released, but time is more productively applied.

1. Portfolio/Number/Name:H/T 9 Digital X-rays / Picture Archive Computer System ( PACS)
2. Programme/Activity: PACS is a computer system that captures, stores, distributes and displays digitised images. Images can be relayed to any destination capable of receiving them, and can be reviewed in different destinations simultaneously. Improving the imaging of patients in healthcare will inevitably increase the efficiency of the healthcare system as a whole. The introduction of PACS in NHSScotland opens up potential to deliver a range of benefits to patients. Clinicians will be able to access images taken at stages along pathways and readily access relevant patient records. This will streamline care and speed up diagnosis and treatment. PACS offers the opportunity for radiology reporting to be done remotely, utilising telemedicine and potentially facilitating much more flexible working of radiologists who will be able to access images on a 24-hour, seven day a week basis. It challenges traditional radiology reporting structures and encourages organisational review and reconfiguration of imaging services across health communities for maximum efficiency. As part of the national eHealth Strategy, SEHD has identified national funds to implement PACS throughout NHSScotland over the period of this Efficient Government Programme. A procurement exercise for a PACS system and supplier has recently been completed.. In addition to time saving, positive impact on quality can be anticipated due to a number of benefits. These can be grouped under two main headings: Improving the quality of overall patient care and reducing clinical risk Increased numbers of reported images and so reduced clinical risk and better service to GPs Quicker diagnosis and more timely clinical decisions - including for GPs Fewer clinical procedures repeated (including, but not restricted to, radiology) because of lost/mislaid images Fewer rejects, resulting in fewer retakes and so reduced radiation exposure for the patient Less unauthorised access to images through security functions within PACS Fewer instances of suboptimal clinical decisions being made in absence of access to image (inc previous images) Reduced risk of clinical errors resulting from use of hard copy where patient not identified clearly on image Avoid losing old images through destroying hard copy for reasons of lack of space Improving the working environment and facilities for staff Contribute to reduced staff turnover and improved morale through the introduction of modern PACS technology Reduced health & safety risks associated with the manual handling of hard copy images Better working practices for clinicians beyond Radiology (inc easier image manipulation and ability to prepare behind the scenes) Patients no longer have to carry their films around with them Enhanced teaching and research through ready access to PACS images
3. Savings	3.1 Current target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	3.25	13.4	23.5
	3.2 Previous target saving £m			2005-06	2006-07	2007-08
			Cash	0	0	0
			Time	3.25	13.4	23.5
	3.3 Explanation for difference
4. Accountable Officer for delivery				Kevin Woods, SEHD Chief Executive
5. Project Manager				Charlie Knox, SEHD Head of Computing & IT Strategy Division
6. EGDD Portfolio Manager				Gillian Woolman
7. Description of efficiency and actions to be taken		7.1 What is the efficiency improvement? How will the saving be made? There are various ways in which staff time will be released, thereby improving operational effectiveness and the patient experience: Less staff time spent handling hard copy images, inc routine handling plus finding lost/missing images Less wasted staff time associated with clinic appointments aborted due to not having images to hand Fewer rejects, resulting in fewer retakes and so less wasted staff time Fewer unnecessary admissions and patient events on the patient journey caused through not having access to all the images Reduce overall patient waiting on the ward, in A&E etc. by obtaining faster radiological reporting Eliminate patients being asked their name, address etc. multiple times by staff within Radiology Freeing up of clinician time ( e.g. for consultation with GPs) through remote access to images enabling remote reporting and 'virtual' multidisciplinary team meetings Reduced length of stay duration resulting from cumulative effect of above benefits The method of deriving the savings figures is as follows … Extensive before-and-after timings have been conducted on traditional versus digital X-ray services in a typical hospital. The time savings vary across a range of staff, from filing clerks to consultant radiologists. Savings for each staff category have been quantified and converted into w.t.e. The cash equivalent has been derived by applying appropriate salary rates. Hence in the hospital studied there are 238,000 X-Ray investigations per annum and calculated time releasing savings of £2,364,000 p.a. It is therefore not proposed to devote the significant effort to undertake this level of study in each hospital. Instead, a formula has been devised to give a cash saving figure per X-ray investigation: £9.93. The number of investigations carried out in each NHS Board without a PACS has been baselined, hence when PACS is fully implemented in the particular NHS Board the time savings can be calculated using this formula. The number of X-Ray investigations undertaken per annum in NHSScotland which are currently not digital, ie. traditional rather than PACS, is 2,374,050. This number and the significant associated time savings explain the significant planned savings.
		7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? A national procurement exercise of a PACS supplier and service has recently been completed. There will now be a managed roll-out programme over the course of this Efficient Government Programme. Supported by national funds and including local facilitation, the programme has been commissioned by SEHD to NHS National Services Scotland ( NHSNSS). Key action manager within NHSNSS is Ron Anderson, Head of National IT Programmes. Roll-out project and resource plans will be agreed and monitored with each NHS Board. The project will be directed by a Project Board chaired by Charlie Knox (Action Officer mentioned above) and supported by a reference group of radiologists. The partnership working extends to NHSScotland's commercial IT Services supplier, Atos Origin, who will work with the PACS supplier to deliver a managed central service for the system.
8. Associated costs		8.1 Are there any development or redundancy costs associated with the delivery of this efficiency saving? This project was embarked upon to secure better access to patient information and was not embarked upon on efficiency grounds alone. Consequently any development costs will not be netted off the time releasing saving.
9. Measurement		9.1 What are the inputs that will be measured? The key data required is number of X-Ray investigations held within the PACS system, which can then be compared with the known total X-Rays taken. The PACS system is readily able to run off extract reports and analyses.
		9.2 What are the outputs that will be measured? Statistics will be taken as analysis extracts direct from the PACS systems on number of images captured/ stored, and these will be compared to total expected numbers. Since the PACS system is readily able to run off extract reports and analyses, the information is not subject to error.
		9.3 What is the baseline for inputs and outputs? In 2004-5 some 22% of X-Rays in NHSScotland were digital/ PACS
10. Quality cross-check		10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? Due to the nature of the service improvement it is not considered that quality checks over time are required. Hence once the software has been designed and tested the data continues to flow into the patient record. What will be monitored however is the 'live time' of the service, as part of routinely collected statistics for contract performance.
11. Monitoring		11.1 What are the arrangements for monitoring the delivery of efficiency savings? Measurement of progress toward full implementation will be built in to project reporting to the national PACS Project Board. In addition to monthly highlight reports there will be 6 monthly updates on progress toward the targets.
12. Reporting		12.1 What are the arrangements for reporting the delivery of efficiency savings? Measurement of progress toward full implementation will be built in to project reporting to the national PACS Project Board. In addition to monthly highlight reports there will be 6 monthly updates on progress toward the targets.
13. Dependencies		13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. No legislation or structural changes required.
14. Use of savings		14.1 How are the efficiency savings released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards for primary care did not assume time savings. Due to the nature of the project there is no time released, but time is more productively applied.

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Efficiency Technical Notes - March 2006

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Efficiency Technical Notes - March 2006

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