Finance

1) The plan must show how organisations return to financial balance.

In line with the aspirations in long term plan, providers within the system should be in balance during 2020/21, with the whole system being in balance in 2023/24.

2) Providers must deliver 1.1% cash releasing efficiency, unless they are in deficit (1.6% applies).

NHS organisations within Suffolk and North East Essex are aiming to deliver minimum levels of efficiency as follows:

• Organisations in recurrent balance – 1.1% plus 0.5% to contribute to the regional reserve (minimum 1.6%)
• Organisations in deficit – as above plus an additional 0.5% to move towards balance (minimum 2.1%)

3) Plans must include measures to maximise efficiencies and support appropriate reductions in the growth in demand for care.

System financial plans reflect the developments noted throughout this strategic plan, including measures to moderate the growth in non-elective activity. Our ICS non-elective admission/A+E attendance rate growth is currently 2.1%/0.4% respectively below the regional average.

4) Reduced variation across the system (quality, access and outcomes).

The efficiency element of the plan draws on local and national benchmarking work to show where further efficiencies are available through reducing variation on quality, access and outcomes.

Over the period of the long term plan, we will be making progress on the implementation of population health management which will be a key enabler for this work, assisting with effective decision making.

5) Make better use of capital investments, with a baseline of investments and a prioritised list of discretionary expenditure items.

There is a well developed ICS estates strategy and supporting workbook which set out the current baseline of assets and the prioritised list of future developments. In addition to this work, which focusses largely on NHS assets, our local alliances will be looking at the wider public sector estate with the aim of maximising efficiency and effectiveness.

As a system we are committed to using our resources in the most efficient way to deliver all our priorities including those in the NHS Long Term Plan. We aim to develop sustainable solutions that will enable us to maintain a high standard of service delivery whilst continuing to transform local services.

Although we have been able to make significant efficiencies by working as our constituent parts, we know that generating further savings year on year becomes increasingly challenging. We also know we need to do more to meet the challenges of continued increasing demand for services and the increasing health inequalities caused by local deprivation. Local government also continues to face huge financial pressures, and our system can learn from the successful strategies that have enabled our local councils to continue providing high quality services despite major cuts in funding in recent years. Our workforce is our most important resource, and we must ensure the skill mix of staff meets peoples’ needs, fill vacancies and reduce reliance on agency staff, improve staff experience and reduce sickness rates. Going forward, we know we need a whole system approach to integration and transformation that takes into account these challenges and builds on our strengths.

We have agreed the following principles that will underpin our approach to achieving system efficiency:

• We will differentiate between areas where activity directly drives costs from opportunities to release costs, and we will tailor our approach to system efficiency accordingly.
• We will avoid shifting activity and costs from one area of the system to another – instead identify and support a range of different options to achieve savings.
• We will seek to avoid making the mistake of spending new money in ‘old ways’ – we will instead explore ways to use money differently in the future.
• We will listen to the ideas of frontline staff, test out their ideas and scale up what works.
• We will help frontline staff to better understand how what they do impacts on budgets and resources.
• We will use technology to operate more efficiently and effectively.
• We will use buildings more effectively, sharing spaces and resources.
• We will take a regional approach where appropriate, achieving alignment and consistency across borders.

The turnover of different agency staff can affect continuity of care and result in a people having a poorer experience of care, can impact on the health and wellbeing of other staff and compromise effective team working, and can result in inefficient practices through lack of in-depth knowledge of the care already given or the person’s needs. We can achieve this by:

• Collaborating at a regional level to align our approaches to agency staffing and drive up standards, building on best practice locally and elsewhere.
• Exploring in more detail where agency spend is highest and develop the workforce in these areas to reduce the need for agency staff.
• Ensuring all partners adhere to agreed standard agency payment rates.
• Developing consistent and efficient approaches to flexible working and a shared bank to attract staff to take up these options.
• Exploring annualised rostering to ensure gaps are filled and to improve consistency for staff and service providers

These measures can enable us to improve activity and efficiency; lower vacancy rates and spend on agency staff; achieve consistency in the agency offer and payment rates; align our approach locally and regionally; and provide a stepping-stone to permanent work for our staff.

We know there are opportunities to share estates and support services in health and care across our system, that could generate better value and achieve financial savings. We can achieve this by:

• Making better use of space in buildings, in particular for administrative staff, by stocktaking to identify gaps and opportunities both now and as contracts expire, building on One Public Estate initiatives.
• Making better use and spreading the costs of providing core hours or 24/7 coverage in, for example, maintenance, estates, HR, finance, or legal specialist services.
• Reducing duplication in governance areas such as serious incidents and complaints.
• Joining up areas such as procurement and contracts, and approach the market as an ICS where possible, to ensure we do things only once.
• Joining up business intelligence teams to improve quality and consistency of data.
• Reducing waiting times for patients by identifying gaps and opportunities across the system and joining up on clinical outsourcing.
• Review how services are paid for by CCGs, including the needs of our Primary Care Networks.
• Compare data on waiting times across specialities in the ICS to find opportunities for efficiencies.

In this way we can share resources more effectively, make better use of the resources we have, and improve consistency and quality of care for people using services. .

Recruitment in health and care can be challenging, and we know that some staff who train locally move out of area to further their careers. The process of recruitment can also be lengthy, with organisations having to use agency staff to cover shortfalls in the interim. We need to attract staff to our system, and the ICS provides us with a valuable opportunity to progress our plans together. We can achieve this by:

• Using data to review the gaps across the system, understand the causes, challenge issues of concern, and share best practice in recruitment and staff skill mix.
• Continuous advertising, promoting our area as a good place to work with a positive culture and good health and wellbeing, effective leadership and best use of technology
• Working with higher education to ensure pre- and post-qualification learning meets employers’ needs.
• Considering an ICS-wide recruitment hub, and make the bank a more attractive option.
• Taking a consistent approach to using recruitment incentives across our area, and reviewing opportunities for bursaries to attract staff.
• Proactively attracting newly qualified professionals back into our area, and taking a consistent approach to international recruitment.
• Developing a workforce passport that can be used across the ICS area to simplify and speed up recruitment.

These measures can improve system-wide collaboration and integration; increase workforce supply; achieve ‘one’ system-wide workforce where partners trust each other’s training and standards; create an agile workforce; increase the attractiveness of substantive positions and retention of staff; reduce workloads through better skill mix; and reduce agency spend.

We have a number of strategies in place to support people to avoid having to be admitted to hospital when their condition deteriorates, to be discharged as soon as they are well enough so they can recover in their own homes. However, we face increased demand for urgent and emergency services in the future, and need to ensure that our services respond in the most efficient way, to ensure people receive the right care in the right place and in a timely way. We can achieve this by:

• Ensuring that people are directed to the right place and type of care for their needs; ambulances should take fewer people to emergency departments, as more people’s needs can be met within the community. Enabling ambulance services to access mental health care records will support this strategy.
• Creating a less risk-averse culture in care settings and in primary care, by training and supporting staff to recognise better when and where people need care and treatment. Reducing reliance on agency staff in care settings will mean staff know the people they care for better, helping them to make the right decisions for their needs.
• Achieving a common approach across the ICS to providing integrated support when patients return home from hospital that builds on existing best practice.
• Reviewing the functions and available space in community hospitals, to maximise the opportunities to use their resources effectively.
• Developing seven-day therapy services to better support people in the community and avoid hospital admissions.
• Explore creative opportunities to reduce ‘stranded’ patients, for example extra voluntary sector support, or short-term accommodation where people can wait for adaptations to their own home.
• Explore why care homes can be reluctant to admit new residents over weekends, and ensure the right resources are available to support homes in the first days of the person’s stay.

These strategies can enable us to achieve better health outcomes for patients, reduce the need for hospital stays, cut agency staff costs, and reduce the risks of cancelling elective surgery due to high demand for unplanned care.

achieve this by:

• Triaging referrals from GPs at a central point to reduce inappropriate demand for outpatients.
• Improving access to online consultations and virtual clinics.
• Simplifying care pathways by centralising outpatients, providing a one-stop diagnostic hub to reduce the need for people to travel to multiple appointments.
• Improving systems for cancelling appointments to reduce the number of non-attendances.
• Reducing the need for locum doctors and agency staff, so that people experience more continuity of care and more efficient support.
• Moving further to paperless recording systems to reduce costs of transferring paper records to online.

In this way we can improve patients’ experiences, reduce costs travel costs for staff and patients, make optimum use of available resources and reduce unnecessary follow- up appointments