papers for the stp programme board meeting 23 january 2018 · papers for the stp programme board...
TRANSCRIPT
Papers for the STP Programme Board meeting 23 January 2018 The papers from this meeting follow: Agenda
Page 2
Item 2 – Minutes of the meeting on 31 October 2017
Page 3
Item 3 – Sussex integrated urgent care transformation
Page 7
Item 4 – Digital workstream update
Page 17
Item 5 –Clinical board update
Page 35
Item 6 – Finance update
Page 38
Sussex&EastSurreySustainability&TransformationPartnership
Page 1 of 1
Sustainability&TransformationPartnershipProgrammeBoard
AGENDATuesday23January2018
CrawleyTownFootballClubStadium17:00–19:00
Time ItemDescriptionAttachments
Presenter
1. 17:00WelcomeandIntroductions• STPupdate
BobAlexander
2. 17:10Actionnotes• MattersArising
Enc2
BobAlexander
3. 17:15 SussexIntegratedUrgentCareTransformation Enc3 MaggieKeating
4. 17:30 Digitalworkstreamupdate Enc4 AdrianBull
5. 17:45 ClinicalBoardUpdateEnc5
MineshPatel
6. 18:05 FinanceUpdateEnc6
PaulSimpson
7. 18:25
PlaceBasedPlans• EastSussexBetterTogether(ESBT)• CoastalCare• CentralSussexandSurreyEastAlliance(CSESA)South• CentralSussexandSurreyEastAlliance(CSESA)North
VerbalKeithHinkleyRalphMcCormackWendyCarberry
8. 18:55AOB• NHSContinuingHealthcare
Sussex&EastSurreySustainability&TransformationPartnership
1
Sustainability&TransformationProgrammeBoardACTIONNOTES
Thursday31stOctober201717:45-19.30
Jury’sInn,BrightonPresent:BobAlexander,CEOSTP AdrianBull,CEOESHTDenaMarshall,HWLHCCG AdamDoyle,BHCCGRickFraser,SPFT RichardBoyce,NHSImprovementKeithHinkley,ESCCandESBT PaulSimpson,SASHSamAllen,SPFT MarkWatson,HWLHCCGWendyCarberry,STPSRO&AO,HWLHCCG SallyDartnell,HealthwatchWSxCarolineHuff,STP,HWLHCCG RichardBrown,S&SLMC’sMaggieKeating,HWLHCCG MineshPatel,HMSCCGSamanthaStanbridge,ESCCG AmandaPhilpott,EHSCCGandH&RCCGTrudyMills,FCHC AlistairHill(onbehalfofRobPersey),BHCCPeteCarpenter,KSSAHSN SteveJenkin,CEOQVHGeraldineHoban,HMSCCG PennieFord,NHSEnglandDavidMcKenzie,HMSCCG AlisonNuttall,WSCCMarianneGriffiths,BSUH,WSHT DavidLiley,Healthwatch,BrightonandHoveKatieArmstrong,CWSCCG BenRichardson,CarnallFarrerSiobhanMelia,SCFT MayLi,CarnallFarrerDominicFord,SPFT YvonneTaylor,IC24SallyFlint,SPFT JaynePhoenix,SECambRichardBrown,S&SLMC’s Apologies:DanWood,HuseinOozeerally,OliverPhilips,RobPersey,SadieLeack,SarahBilliard,StephenIngram,ElangoVijaykumar,GeorgeFindlay,MichaelWilson,HelenAtkinson, Item Bywhom
Bywhen
1. Welcome&introductionsDenaMarshallwelcomedeveryonetothemeetingandintroducedBobAlexander.BobintroducedhimselftothegroupandpraisedtheBoardandtheSTPforamarkedimprovementinrecentmonths,offeringhissupport,commitmentanddeterminationtomakeimprovementsinthisSTP.Bobadvisedthegroupthatthereisaninductionprogrammeinplaceforeveryonetomeethimona1:1basisinthecomingmonths
2. ActionnotesTheactionnoteson19thSeptemberwereagreedasacorrectrecord.NoMattersArisingFluUpdate–MaggieKeating• Ithasbeenagreedacrosstheboardthatthefluvaccinationis
Sussex&EastSurreySustainability&TransformationPartnership
2
criticaltothesuccessofthewinterplansandmessagestopromotethishavebeenconsistentacrossallformsofmediaandpartners.
• KatieArmstrongrequestedeveryonetoactivelypushforthehighestleveloffluvaccinationsthiswinter.
• TargetshavebeenadheredsofarandtheperceptionisthatthisSTPisinamuchstrongerpositionthanlastyear.
3. InformationGovernance:AdrianBull/MarkWatson/CarnallFarrar
CarnallFarrerpresentedtheIGreport(Enc4),explainingthekeytargetistogetallproviders(GPpractices)tosigntheDataSharingagreement.Thiswillbealengthyprocessbutistheonlywaytogotobringaboutmajorimprovementsinplacebasedplansandidentifywhichgroupshavethemostpressingmedicalneeds.MineshcommentedthatisrighttobelookingforcontinuitynotdisruptionandalsolearnfromotherSTP’swhoalreadyhaveIGinplace.Healsonotedthatinhisexperience,thiswilltakealongtimetoembedandbringaboutchanges.PublicEngagement–willbebuiltintotheplanNextsteps–BobstressedthatthekeytosuccesswillbetomaximisesupportandendorsementfortheDataSharingagreementassoonaspossible.
4. MentalHealthupdate:WendyCarberry/SamAllen• WendyhighlightedhowthestatisticsuncoveredintheMental
HealthreviewhavehighlightedsomedisturbingfactsinthisSTPwhich,ifnotaddressedwillresultina£24millionMentalHealthdeficitby2020.
• Variationsacrossthepatchareakeyconcern.• Twoareashavebeenidentifiedwhichwouldhavethehighest
impactforquickimprovements:- Addressfragmentationacrosstheareas- Digitalenablement–integratedcareneeded(especiallywithinplacebasedDementiacare)
• Actiontakenintheareasidentifiedwillreleaseresourcesacrossthesystem,whichcouldleadtoa40%reductioninA&Erequests
• ChangesinMHlegislationon1stDecwillexacerbatetheissuessoit’scrucialtotakeaction,repurposesomeoftheresourceandimproveoutcomeswhichwillsavemoney
• Implementationhasalreadycommencedinsomeareas-namelySpecialistPlacementWorkstreams,StrategicCommissioningWorkstreamsandnewCaremodels.
• Nextsteps–developthedeliveryframeworkensuringpartnersareconsulted,ensurealignmentatSTPandplacebasedlevelwithoutdisengagingpartners
• QuestionswereaskedaroundwhetheralltheearlyinterventionpartnersarefullyinvolvedintheprocessincludinggroupssuchasSubstanceabuse.
• Therewasalsodiscussionaroundensuringtherightgovernanceisinplaceastheframeworkmovestodeliveryphase-SamAllen
3
assuredthegroupthatplansareinplacetoensuretheSteeringGroupincludestherightExeclevelpeoplewhocansignoffondecisions
ActionWendyandSamtopresentthedeliveryframeworkatthenextProgrammeBoardmeeting
WC/SA
12December
5. UpdatefromSTPClinicalBoard:MineshPatel• TheClinicalBoardhastwomainareasoffocus:
- UnwarrantedVariation- Service/OrganisationInterfacing
• Theintentionistoaddvalueintoworkingcollectively,bringprideintothewayprojectsarecarriedoutandfindwaystotapintoresourcesbetter
• ProjectsthattheClinicalBoardhasbecomeinvolvedininclude:GIRFT,RightCare,MedsOptimisation,EndofLifeCare(placebased),Repatriation,AHSN,thenewMentalHealthstrategy
• ThedraftClinicalCaseforChangedocument(v7)willbepresentedatthenextClinicalBoardmeeting
• Concernswereraisedabouttheprioritisationoftheworkandcareshouldbetakennotto‘over-commit’.Membersoftheboardcalledforaclearbudgetandplanforresourcingofalltheidentifiedpiecesofwork.
• Pointswerealsoraisedabouttheneedforimplementationnowthatmanyprojectshavebeenidentifiedasofkeyimportance
• ClarityneededtoagreeanSTPbudgetandwhetherthereisfundingavailablefromNHSE/NHSI
6. Financeupdate:PaulSimpsonPaulSimpsonexplainedthatheisnotyetinapositiontodeclaretheFinancialoutturnpositionashadoriginallybeenthepurposeofthisupdate,neitherisheabletoprovideafullpictureoftheRiskfiguresasitremainsachangingpictureacrosstheCCG’s,butthingsareworkingwellandmuchprogresshasbeenmade.PaulremindedthegroupthatlastyeartheSTPsystemhadclosedwithac.£150mdeficitandthatthestartingpositionfor2017/18hadbeenac£50mcontroltotaldeficitbut,duetosignificantdeteriorationastheyearhasprogressed(forprovidersandcommissioners),theworkingfigureisnow£88mdeficit.Paulalsoremindedthegroupthatthe‘DoNothing’scenario(ifnoplansareintroducedtomakesubstantialsavings)wouldresultina£1billiondeficit,soitisclearthatthe5yearFinancialModelmustberobustandimpactfultomakesignificantcostreductions.Paulexplainedthe4keyareasembeddedintothe5yearplanfortransformationarealignedtodiscussionsthatarealreadyunderway:- ClinicalCommissioningcoststhroughreductionofUnwarranted
Variation- TransformingCarethroughtheMentalHealthTransformation
Plan
4
- RightCare–Lookingatconsolidationofprogrammesthatwillchallengethecurrentproceduresandreducecosts
- DeliveringasimplemethodologyforallCCG’stoimplementthatwillgivemoredetailedanalysisaroundtheimpactofactivityreductionandprovidemoreinformativereportingoptions
8. AOB
Nofurtherbusiness.
Date&timeofnextmeeting:12thDecember2017,1745–1930,JurysInn,Brighton,EastSussexACTIONLOG31October2017 Action ByWhom ByWhen
1. MentalHealthStrategicFramework–re-presentto
ProgrammeBoardSamAllen 12December
20172. UpdateonClinicallyEffectiveCommissioning
GeraldineHoban/KatieArmstrong
19September2017
3. OversightworkshopnotestobesharedwiththeProgrammeBoard
DenaMarshall 31stOctober2017
4. Furtherinformationtobeprovidedtostakeholdersthroughcirculatinganadditionalpresentation
NicolaFriend 31stOctober2017
5. PStobringbacktotheSTPExecutiveGroupadetailedupdateofthelikelyoutturnposition
PaulSimpson 31stOctober2017
6. MaggieKeating,CarolineHuffandDanWoodtojointlyexplorehowtheClinicalBoardmightsupportaSTPwideCommsandEngagementcampaignrethefluvaccination
MaggieKeating/CarolineHuff/DanWood
31stOctober2017
7. ColinSimmonstoprovideanupdateontheSussexIntegratedUrgentCareTransformationatthenextProgrammeBoard
ColinSimmons January2018
8. ItwasagreedthatallProgrammeBoardmemberstoreadtheSTPupdateforHOSCChairspresentation
31stOctober2017
Sussex&EastSurrey Sustainability&TransformationPartnership
UrgentandEmergencyCare
STPProgrammeBoardUpdate
Tuesday23rdJanuary2018
Sussex&EastSurrey Sustainability&TransformationPartnership
TheSussexNetworkedModelofUrgentCare
Sussex&EastSurrey Sustainability&TransformationPartnership
• NHS111IUCProcurement:– NHS111CallHandling
– SussexClinicalAssessmentService
– GPOoH(Hear&Treat)
– GPOoHHomeVisitingService(Excl.Coastal)
• LocalProcurement:– GPExtendedhours(18:30-20:00minimum)
– UTCservicestostandard(12hours24/7minimum)
– OoH‘basevisit’/urgentappointmentatastaticbasewilltypicallybeco-locatedwithUTCsites&/orGP
ExtendedHours‘bases’
– Sharedresourceandofferingeconomiesofscale
– Supportingappointmentsandwalk-inservicestothestandard12hours;and
– OoHbasevisitservicesbyappointmentalignedtopatientdemographics
• ProcurementProcess:– AsimultaneousPreQualificationQuestionnaire(PQQ)andInvitationToTender(ITT)Procurementprocess
hasbeenadopted
• ContractLength:– Followingthefeedbackfromourfirstsoftmarkettestingeventweareproposingalongercontractoption
thanisnormallyconsideredi.e.5+2years
– Ithasbeenagreedtoconsiderhowthecommitmentforthefull7yearscanbeconfirmedatanearlier
pointinthecontracttoaffordtheprovidergreaterflexibilitytoinnovate
• Cost:ThefullserviceprovisionincludingF2FOoHisapprox.£17to£19millionperannumforthewholeofSussex.
– OoHBasevisitsbeingprocuredlocallyreducingtheenvelopeby£5.4m
– OoHhomevisitingserviceremainsinscope
– PotentialCoastalvarianceinOoHhomevisiting(£1.4m)
SussexIUCProcurementModel
Sussex&EastSurrey Sustainability&TransformationPartnership
SussexIUCProcurementModel
Sussex&EastSurrey Sustainability&TransformationPartnership
NHS111IUCProcurementTimeline
• NHSECheckpoint/assuranceprocessunderway
• Procurementprocesslaunchw/c24thJanuary–runningthroughtothe
endofMarch
• Evaluationtrainingw/b16thMarch
• Intendopen3rdApriltoreviewsubmissions
• Procurementcompletetheirinitialelements
• Tocommissionersandfinanceon9thApril
• Responseback16thApril–PQQcompleteby20
thApril
• 23rdAprilITTresponsesissued
– NickyStemp=LeadCommissioner
– VickieBeattie=LeadClinician• 4-11June–sitereferencevisittotop2bidders
• July–GoverningBodiestoapproveawardoncontracts
Sussex&EastSurrey Sustainability&TransformationPartnership
NHSEAssuranceCheckpoint:KeyMessages
• Comfortabletechnicalprocurementstepsareallinplace
• Nervousaboutthevarianceinthemodelbeingproposed
– Addedcomplexity
– Varianceinpatientaccessandpathway– Relianceonproviderbehavioursacrosscontractualboundaries
• Needassurancearoundbasevisitvolumes/timeofday/
flow:
– Howwillthenewmodel(s)supportdemandandensurethere
arenogapsintheservicesbeingprovided
– Howdoesthisplaybackintermsoffinances,workforceand
contractualcomplexity
– Assurancerequiredthatsystemisfullycoveredtosupport
patientpopulation
Sussex&EastSurrey Sustainability&TransformationPartnership
NHS111IUCSystemDependencies
Todeliverafullynetworkedmodelforurgentcare,systemwill:• ProvideafacilitytosupportOoHfacetofaceGPled
consultationsatastaticbasethat111canbookdirect
appointmentsinto(orensurealternativeprotocolsarein
place).
• Ensurethattheseprovisionsareavailable18:30-08:00andatweekends(hoursoutsideofGPinhoursservices):
– Whatarethehoursandlocationofthese‘staticbase’services
– Whataretheprotocols/patientpathwaysforfacetoface
outsideofthesetimes
• Provideabase/facilitiesforOoHhomevisitingserviceproviderswhererequired
Sussex&EastSurrey Sustainability&TransformationPartnership
TheSESFacetoFaceUrgentCareModel
Sussex&EastSurrey Sustainability&TransformationPartnership
UTCSiteDesignations
Sussex&EastSurrey Sustainability&TransformationPartnership
UrgentCare-TheDigitalAskandEnablers
• AccesstoappropriatePatientInformation
– TransformationFundawarded-£518kacross3STPs
– Focussedonincreasingcareplanvolumes,qualityandaccessibility
• Callhandlingtoolsandinformation
– DirectoryofServices&TransformationFund(MiDoS)
• DirectBookingintoappropriatesettings
– UTCsandGPOoHBases
• Remoteaccessandvirtualworking
– Supporting‘virtual’elementsoftheCAS
– IncludedinNHS111IUCspecification
• OnlineServices
– NHS111Online(UEC5YFV)
• SymptomsandServices
• ClinicalReferrals(totheCAS)
– OnlineConsultations(GP5YFV)
– ConsultantConnect(Admissionsavoidance)
• UrgentCareMDS
– Managingdemandandmeasuringoutcomes
– IncludedinNHS111IUCspecification(leadprovider)
Sussex&EastSurreyDigital
DrAdrianBullMarkWatson
WhatisDigital?
“Digitalmeansapplyingtheculture,practices,processesandtechnologiesoftheinterneteratorespondtopeople’sraisedexpectations.”
• TomLoosemore
DigitalVision
DigitalVision
To work with citizens, communities, clinicians and professionals to re-design their health and care system, seizing the opportunities and practices of the digital era.
ThisisaDigitalProgramme
• aDigitalProgrammethatis:
DesignLead–enablingredesignfromthecitizenandpatientperspective
DataLead–growingtheculture,communityandcommonservicesforevidencebaseddesign
DevelopmentLead–enablingcommondevelopmentservices&continuousimprovement
ProgrammeApproach
• AgileDesignLeadProgramme–
• Embednewdigitalcapabilitiesandroles
Oversight&
Prioritisation
Assurance&
Engagement
Escalation&
Direction
Delivery&
Change
DigitalProgramme
Board
STPExecutive/Programme
Board
STPFinanceGroup
PlaceBasedPlans
CoreDigitalTeam
DigitalDesign
Authority
STPClinicalBoard
GovernanceDiagram
ProblemAreas
• Complextechnologylandscape
• Mixedmaturitypicture–internalandsupplier
• Capability&workforcegaps–Userresearch,Design,Analytics/DataScience,Digital
development,EnterpriseArchitecture,
• Untappedassets–UniversitiesandSMEs
• Systemconditions–PBR,Sharedbusiness
models,history,investmentplanning
KeyAims
• Createhead-roominthesystemthroughchannelshifttodigital
• Developdigitalrelationshipsandco-designbetweenpatientsandprofessionals
• Increasecitizenandcommunityself-management
• Developsustainabledatacapabilitiesandworkforce
• Defineandagree“scale”ofcapabilities–local,place,STP,regional,national
• Embedproduct&platformmanagement
KeyPriorities-Culture
• Removethebarrierstodelivery
• BuildcredibilityofSESDigitalasacommunity
throughdelivery,clarityandlistening
• Developacultureofcollaboration(digital,clinicalandpartners)andagility
• Definethescale(local,placebased,STPwide,Regional,National)whichcapabilitiesshould
bedeliveredat
DigitalMaturity-Provider
DigitalMaturity-Provider
2016Theme 2017Theme
Provider Readiness Capabilities
Enabling
Infrastructure Readiness Capabilities
Enabling
Infrastructure
BrightonAndSussexUniversityHospitalsNHSTrust 61 44 80 46 48 78
QueenVictoriaHospitalNHSFoundationTrust 51 23 43 74 39 61
SouthEastCoastAmbulanceServiceNHSFoundationTrust 85 40 80 90 35 88
Surrey&SussexHealthcareNHSTrust 89 49 84 86 43 81
SussexCommunityNHSFoundationTrust 61 20 39 81 32 59
SussexPartnershipNHSFoundationTrust 67 27 84 92 42 97
WesternSussexHospitalsNHSFoundationTrust 89 67 93 90 71 89
EastSussexHealthcareNHSTrust 69 33 66 75 36 56
DigitalMaturity–Commissioner2016
OverallCompliance
CoreGPIT&CentrallyMandated
Requirements
EnhancedPrimaryCareIT
TransformationinPrimaryCare
NHSBrighton&HoveCCG 74.26 81 37.5 33.33 NHSEastbourneHailshamand
SeafordCCG 94.1 94.1 0 0
NHSCoastalWestSussexCCG 73.47 76.75 62.5 33.33
NHSCrawleyCCG 73.48 76.74 62.5 33.33
NHSEastSurreyCCG 81.87 87.71 55.55 33.33
NHSHastings&RotherCCG 54.8 58.99 31.25 33.33 NHSHorshamandMidSussex
CCG 72.07 75.1 62.5 33.33 NHSHighWealdLewesHavens
CCG 64.48 68.99 33.33 66.66
InitialWorkstreams
• InformationSharing&Analytics
– STP-wideInformationSharingFramework
– Directcareinformationsharing–ROCIapi
– SharedLinkedDataInformationAnalytics
– AnalyticsCommunityDevelopment
InitialWorkstreams
• IntegratedUrgent&EmergencyCare
– Supporting111recommissioning
– 111Online– CarePlanSolutions
InitialWorkstreams
• Citizen&PatientExperience– Patient/CitizenSharedRecord–learningfromexistingpositiveexamplesSASHIBD,BSUHVirtualFractureClinic
– Patientcommunications–testingPHRbusinessmodel
– Integratingpatient/citizenrecords–ROCIapiinacutes
– DigitalRedesign–redesignofservicesfromcitizen/patientperspective
InitialWorkstreams
• LocalMaternitySystem– Supportingdigitalvisionandprojects
• ConnectingProfessionals– SEClinicalSenatereviewofPrimaryand
SecondaryCareCommunications
– SkypeforBusiness–Federatingacrossorganisationsandsectors
Questions?
Sussex & East Surrey Sustainability & Transformation Partnership
SussexandEastSurrey
Sustainabilityand
TransformationPartnership
STPCLINICALBOARDUPDATE
STPProgrammeBoardupdatebyCarolineHuff23-01-2018
Keyworkstreams• Review,adviseandmakerecommendationstotheSTPonreducingun-
warrentedvariation(ClinicallyEffectiveCommissioning,RightcareandGIRFT).Pathwayredesignandpatientoptimisation
Ø Circulation(Diabetes,Hypertension,AF,angina)Ø MSK(Hips,knees)Ø MedicinesØ ReviewallGettingitRightFirstTime(GIRFT)reportstoagreenexttranchein
preparationforresources• ImprovingaccesstoSpecialistadvice
• Overseethedevelopmentoftheclinicalstrategy:Developthecaseforchangetoengagewidelyonwithpublic,stakeholders,professions
• Provideclinicalandcareprofessionaloversight,andsupportto,allSTPworkstreams(LocalMaternitySystem,TraumaNetwork,UrgentandEmergencyCare,Cancer)
2
Sussex & East Surrey Sustainability & Transformation Partnership
STPExecutiveGroupsupporttoaddresssomeoftheemergingchallenges
• Overseethedevelopmentoftheclinicalstrategy
Ø InconsistentinformationacrossthePlaceBasedPlansandSTPreviewsmakingitdifficulttoestablishaSTP-widepicture
Ø Gapsininformationinkeyareassuchaschildren,primarycare,acutecareØ STPseenasanaddeddemandonhighlypressurisedstaffØ Lackofdedicatedresourcetofillinthegaps,enableobjective
prioritisationandshiftthefocusfromplanningtodelivery• Delayedprojectsupporttoimplementemergingopportunities
• ConsistentClinicalBoardmembership
• Inconsistentcommunicationflows
• SROforkeyworkstreams
3
Sussex & East Surrey Sustainability & Transformation Partnership
Sustainability & Transformation PartnershipSussex & East Surrey
STP Programme Board –Finance Update
Tuesday, 23rd January 2018
Sustainability & Transformation PartnershipSussex & East Surrey
Contents
2
1. Update on 5 Year Model� Overview of modelling work� Scaling factors approach
2. Estates and Capital Strategy
Sustainability & Transformation PartnershipSussex & East Surrey
Component Status
SES STP 5 Year Financial Model
STP Workstreams –Financial Modelling
All STP workstreams has been reflected in the modelling with data validation outstanding for a minority of workstreams.
Mental Health Strategy
Some further information required to complete reflection of the Mental Health strategy in model.
Acute Provider Costs
Model built and scrutinised by working group. Requires fully developed activity plans as an input.
CommunityProvider Costs
Model built and final review by working group underway.
SECAmb Costs Illustrative model complete and being reviewed by trust.
1.1 Update on 5 Year Model – Overview of modelling work
The 5 Year STP Financial Model is being developed in several ways
3
� The SES STP 5 Year Model is being updated to reflect all STP workstreams and to more accurately forecast costs for the 4 different provider types.
� Next steps include developing activity plans, which will be used as inputs for provider cost modelling.
Common methodology based around scaling factors
Sustainability & Transformation PartnershipSussex & East Surrey
1.2 Update on 5 Year Model – Scaling factors approach
Provider cost modelling is based around theuse of scaling factors linking activity changes to cost changes
4
� A scaling factors approach is being used for modelling the costs of acute, community and ambulance trusts. Scaling factors show the marginal cost of doing extra activity on a site for a particular service.
� Our hypothesis is (% change in expenditure) = (scaling factor) x (% change in activity)
� The methodology has been scrutinised by a group of deputy directors of finance.
� Outputs are a good approximation that is useful and appropriate for strategic modelling.
� The approach was developed over several years for acute reconfiguration, and followed 8 stages.
# Summary Description
1. Activity group totals Scaling factors for activity group totals were calculated from Reference Costs activity and actual costs using regression analysis. These were used to calibrate scaling factors for expenditure lines.
2. Regression analysis Regression analysis of size of unit against medical WTEs from NHS Workforce Census data was performed for activity groups with significant on-call rotas.
3. Strict staffing ratios Strict midwife-to-mother ratios necessitate the use of nursing scaling factors of 100% in Obstetrics and Neonates.
4. Bottom-up estimates Interviews and assessment of cost line items within pathology and radiology were used to form estimates that were more bottom-up in nature than those used elsewhere.
5. Low economies of scale Only modest economies of scale were assumed in elective services for clinical staff.
6. No economies of scale
Cost lines where there is no rationale for assuming economies of scale were assigned a 100% scaling factor.
7. No link to activity Where activity is not a good predictor of expenditure, growth is excluded and will require separate modelling in the future. For example, premises costs and depreciation.
8. Case by case The remaining scaling factors were agreed on a case-by-case basis.
Sustainability & Transformation PartnershipSussex & East Surrey
1.2 Update on 5 Year Model – Scaling factors approach
8 stages were used to build up a complete set of scaling factors
5
A&E
Emergency
Medicine
Emergency
Surgery
Obstetrics & N
eonates
Emergency
Paediatrics
Elective Paediatrics
Elective Medicine
Elective Surgery
Adult critical careStaff- Medical 73% 80% 80% 80% 50% 90% 90% 90% 80%Staff- Nursing 70% 70% 70% 100% 75% 90% 90% 90% 70%Staff - other clinical 70% 70% 70% 70% 75% 90% 90% 90% 70%Staff- Non-clinical 10% 10% 10% 10% 10% 10% 10% 10% 10%Clinical service and supplies including drugs (but not PBR excluded drugs) 100% 100% 100% 100% 100% 100% 100% 100% 100%PBR Excluded Drugs 100% 100% 100% 100% 100% 100% 100% 100% 100%Non-clinical services 50% 50% 50% 50% 50% 50% 50% 50% 50%Corporate services 35% 35% 35% 35% 35% 35% 35% 35% 35%Premises costs 0% 0% 0% 0% 0% 0% 0% 0% 0%Depreciation and amortisation 0% 0% 0% 0% 0% 0% 0% 0% 0%Pathology 50% 50% 50% 50% 50% 50% 50% 50% 50%Radiology 80% 80% 80% 80% 80% 80% 80% 80% 80%Other shared clinical services 75% 75% 75% 75% 75% 75% 75% 75% 75%Other costs - operating 75% 75% 75% 75% 75% 75% 75% 75% 75%Other costs - financing and other 0% 0% 0% 0% 0% 0% 0% 0% 0%Outsourced clinical activity 100% 100% 100% 100% 100% 100% 100% 100% 100%Litigation 0% 0% 0% 0% 0% 0% 0% 0% 0%Total
Legend
1. Activity group totals
2. Regression analysis
3. Strict staffing ratios
4. Bottom-up estimates
5. Low economies of scale
6. No economies of scale
7. No link to activity
8. Case by case
Sustainability & Transformation PartnershipSussex & East Surrey
Estimated Duration
3 weeks 1 month 1 month
Key activities � T&F Group� Gather and upload SHAPE asset data
returns� Update disposal schedule� Confirm and complete capital template� Update STP strategy themes
�Analyse data returns�Generate summary slides�Review estates progress against
STP strategies�Review key STP and estates
projects�Agree implementation priorities and
critical decisions
�Summarise transformation by sectors�Summary slides and ppt QA�Review and signoff by Exec, place
bases, SEP function�Submit return
Key meetings
�Finance Group: 12 Jan�T&F Group: date tbc�Estates group: 18 Jan�Finance Group: 26 Jan
�T&F Group: dates tbc�Finance Group: 9 Feb�Capital Group: 19 Feb tbc�Finance Group: 23 Feb
�Exec: 6 Mar�Exec: 20 Mar�Place bases: tbc�SEP function: tbc
End products
�Uploaded SHAPE returns�Updated disposal schedule�Completed capital templates�Updated STP strategy themes and
enabling implications
�Data returns analysis�Updated estates and STP prioritised
projects
�Approved submission of Estates workbook
6
An updated STP Estates Strategy will be complete by the end of March
Data gatheringData analysis,
STP Investment,Project Priorities
Presentation and signoff
February MarchJanuary
2.1 Estates and Capital Strategy� Release of capital from NHSE is contingent on the submission of an up-to-date Estates Strategy, taking
the form of a workbook, by 31st March 2018.
� We have the following process in place to ensure delivery of the Strategy.