Draft 2017/18 savings targets

(1)

Draft 2017/18 savings targets

16/17 CRES shortfalls and target reduction for Recurring overspends 16/17 recurrent surpluses Improved controls and cost

reduction Net income generation Staffing models, workforce management, recruitment & retention Efficiency and productivity Value; Pathways; Referral and treatment thresholds; Clinical decision making Service reconfiguration & premises rationalisation

Contingency Total Basis for target Basis of attribution to directorates

£k £k £k £k £k £k £k £k £k £k

Planned care

Theatre utilisation and productivity 253 227 480

As set out in theatres theme. Equates to around 5% of theatre staffing + anaesthetist + surgeon time. High level opportunity analysis indicates circa 15% max

opportunity

Principles of attribution to directorates to be

finalised

Theatre utilisation and productivity- ACT 66 34 100

As set out in theatres theme. Equates to around 5% of theatre staffing + anaesthetist + surgeon time. High level opportunity analysis indicates circa 15% max

opportunity

finalised

Planned care pathway optimisation specifically in specialties coming within the National Planned Care Programme - ENT, Urology, T&O, Oph

100 100

Impact of "best" more streamlined pathways in the 4 specs in national

project.

To be allocated equally over Ophthalmology, ENT, Urology and T&O

Outpatient pathways - reduced follow up rate 200 200

Change in practice/culture. Target based on a 4% reduction in the average follow rate @ c £15 per follow up avoided. This equates to

moving around 1/2 of the way to UQ performance

Proportionate to distance from UQ performance

Minor procedures moved to outpatient or

other non theatre settings tba tba 0

Hysteroscopies and flexible cystoscopies at PCH key areas.

Staffing required lower in outpatient settings gives cost savings for each session moved. Also cases/session can be greater in alternative setting. Opportunity

opened up by use of GUM procedure rooms at RGH

TBA

Alternatives to surgery tba 0

Patients not benefitting from operations currently; potential for

greater balance on alternative interventions (eg weight

management)

TBA

Endoscopy utilisation and productivity 100 0 100 2016/17 target not delivered Acute medicine

Outpatient productivity - in the room 137 313 450

Outpatient "technical" efficiency - DNA rates from text and remind

and partial booking, utilisation, session length, reducing variation,

alternatives to medical staff

finalised

Referral criteria/thresholds tba 0

Target areas of inappropriate referral or high referral. Every 1%

reduced demand equates to approx £70k at £70 per new and

£40 per follow avoided

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Unachieved CRES / Targeted Overspends -RTT

extra thetare sessions 99 99

Recover 2015/16 unachieved plans / overspends

As per directortae forecasts Unachieved CRES / Targeted Overspends -A&C

and specialist nurses 258 258

As per directortae forecasts

Patient care administration

Outpatient admin and chaparoning outside the

clinic room 66 34 100

Current self check in functionality +

moving on to outcoming in clinics ACT

Medical records - booking processes 67 33 100

Reduced waste from cancellations. Moving to 100% e referral and

electronic communication of outpatient letters. Bigger opportunity in subsequent years

ACT

Resources released in directorate admin from

records centralisation 28 172 200

Direct impact of reduced notes required to be pulled by directorates (estimated value of

redirected work = c £300k pa). Bigger opportunity in later years,

including from digitisation

Pro rata to medical records estimates of cost of notes pulling avoided by centralised

model

Unscheduled care, frailty and long term conditions

Improved management of elective and

non-elective patient flow enabling reduced beds 1000 1000

Multiple enablers for flow improvement including IARS, acute

medicine, increased day surgery rates, and others. Total improvement assumed is 50 bed

equivalent out of a total opportunity of c 150 bed equivalents. 25 of these beds assumed to be retained to improve USC and planned care performance and 25 beds released for savings, equating the £1m cost reduction opportunity. These assumption will

be tested through the bed modelling commission currently

underway.

Not to be allocated pending conclusion of

bed modelling work commissioned from external consultants

Improved value in the management of long term conditions

Respiratory 0 TBA

Diabetes 0 TBA

CHD 0 TBA

Clinical support services

Radiology 52 200 tba 252

2% of pay budget for productivity. We also need to look at appropriateness of demand

Radiology

Therapies 280 tba 280

Therapies "Value" based review of current

service configurations/patterns and their use of resources and outcomes. Limited in year expectation ? Build plans for

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Pathology 169 200 tba 369

Pathology

Facilities

Housekeeping 409 0 409 Based on original plan not yet

implemented Facilities

Patient catering 250 250

G&K and NHS Wales benchmarking indicates minimum £500k opportunity. £250k is assumed to

be part year effect 17/18

Facilities

Restaurants and Bar Baristas 100 100 Improving on RGH + new model

PCH and YCC Facilities

Portering 100 100 200

G&K and NHS Wales benchmarking indicates minimum £200k

opportunity.

Facilities

Laundry 100 100

Broad estimate of laundry rationalisation savings across South

Wales is £250k for CT. This is part year effect. Dependent on agreed

action with other HBs

Facilities

New Switch Board 120 120 Savings from introduction of new

switchboard Facilities

Management and admin 100 100 Minimum opportunity based on

G&K benchmarking Facilities

Residences tba 0 Assess opportunities Facilities

NEPT 100 0 0 100

Better management of demand and reduced private ambulance use. Review potential for in house

dedicated discharge vehicle(s)

Facilities

Premises rationalisation/reduction 50 50

Potential knock on effect to Facilities of premises

rationalisation

Facilities 0

Estates 0

Utilities 150 150 Partly enabled by 16/17 investment

(LED & VO) Estates

Building maintenance 50 50 Efficiency target(aprox 1%-2%) Estates

Premises rationalisation/reduction 150 150 Potential knock on effect to Estates

of premises rationalisation Estates

Estates Opportunities from 2016/17 36 36 Forecast recurring surplus from

16/17

Corporate directorates 186 250 436

2016/17 target largely not achieved. Assume re-instating

16/17 target is the minimum

£186k as per directorate forecasts. New £250k target allocated based

on pay expenditure 0

Contracting and commissioning 0

Further service repatriation 100 100 Rough initial target tba

Review of Community Dental 200 200 Rough initial target Contracting and

Commissioning

Contracting Opportunties from 2016/17 517 517 Forecast recurring surplus from

16/17

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Primary care and community services

CHC 14 250 750 1014

£1m target in context of £1.5m growth funding. Enablers include

the latest collaborative commissioning programme and the

cross cutting theme on CHC

Initial allocation based on CHC expenditure.

Primary care prescribing 500 1000 1500 £1.5m target in context of £3m

growth funding (as 16/17) Medicines Management

Localities productivity 200 200 Circa 2% Localities

Stop overspends from managed practices or

absorb within primary care growth monies 270 0 270

As per directortae forecasts Impact of new cluster models in reducing

demand on secondary care tba 0

Mental health services

Rationalisation of crisis services 300 300 2016/17 target not delivered in

16/17 Adult Mental Health

OPMH Phase 2 500 500

Iniital estimate of net saving from further bed reductions offset by

some community investment

Adult Mental Health

Unachieved CRES / Targeted Overspends -

Pinewood Repatriation 113 113

Community productivity 90 90 Recover 2015/16 unachieved plans

/ overspends

CAMHS 50 100 150

2% target - new clinical models and better utilisation of Tier 4

capacity

CAMHS

CAMHS 50 50 Efficiency to offset NFA shortfall on

other HB comm Services CAMHS Unachieved CRES / Targeted Overspends - T4

Income 75 75

Ward nursing 1966 0 1966

Target is to reduce forecast £4m overspend from 16/17 by 50%. Achievement would depend on combination of enablers including recruitment and retention but also

new specialling models.

Medical staff management 1441 0 1441

Target is to reduce forecast £2.8m overspend from 16/17 by 50%. There are enablers being put into

place in 16/17 such as improved recruitment, medical e rostering implementation, shared rota management service. £2m is high risk target. Needs to have higher

focus.

As per directortae forecasts. Further work needed to align savings

targets with opportunity.

Non-pay 24 750 250 1024

Same target as 16/17 but will need greater contribution from clinical

practice change (procuring for value) to achieve

As advised by Procurement Team

Unachieved CRES / Targeted Overspends

-Nursing 73 73

As per directortae forecasts Unachieved CRES / Targeted Overspends -

Other 368 368

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Not yet allocated by service area

Travel Expenses tba 0 tba

Retire & Return tba 0 tba

Salary Sacrifice Schemes tba 0 tba

Skills escalator and associated nursing

workforce model tba 0 tba

Acute prescribing - bio-similars 160 160 High level target. Opportunities

through DEFINE benchmarking.

To be advised by Medicines Management

Acute prescribing - other 160 160 High level target. Opportunities

through DEFINE benchmarking.

To be advised by Medicines Management Reconfiguration to rationalise service provision

to a single site or reduced sites 200 200 Initial high level target TBA

0

Contingency -3310 -3310

Total 6424 553 2050 150 1823 1790 2720 1300 -3310 13500