Shared Services in the age of integrated care systems – friend or foe?
The introduction of integrated care systems (ICSs) gives the NHS a once-in-a-generation opportunity to streamline, standardise and level up care across an area – coordinating services and planning in a way that improves population health and reduces inequalities, writes Jordon Beevers, Director of ICS Solutions, NHS Shared Business Services.
While much has been made of the importance of provider collaboratives and the need to reach beyond the NHS, relatively little attention has been paid to the opportunities presented by back-office integration, with a lack of actionable insight causing some ICSs to put it on the ‘too difficult’ pile.
NHS England 2023/24 Priorities and Operational Planning Guidance stipulates that Integrated Care Boards (ICBs) and providers should work together to:
- Develop robust plans that deliver specific efficiency savings and raise productivity consistent with the goals set out in this guidance to increase activity and improve outcomes within allocated resources.
- Put in place strong oversight and governance arrangements to drive delivery, supported by clear financial control and monitoring processes.
Plans, it says, should also set out measures to:
- Reduce corporate running costs with a focus on consolidation, standardisation and automation to deliver services at scale across ICS footprints.
- Reduce procurement and supply chain costs by realising the opportunities for specific products and services.
- Improve staff experience and retention.
- Use forthcoming digital maturity assessments to measure progress towards the core capabilities set out in What Good Looks Like – the framework that sets out to enable healthcare leaders to digitise, connect and transform services safely – and identify the areas that need to be prioritised in the development of plans.
When it comes to corporate services, however, the problem for the diverse range of organisations coming together to work as one system is in knowing what’s already working well, and what needs improvement.
Using insight diagnostics to provide system-wide data and intelligence can aid decision-making across corporate services
By taking an agnostic and independent view, it’s possible to co-create a holistic, joined-up roadmap for organisations to drive collaboration and best value across ICSs.
Data and benchmarking can help ICSs to transform the back office. Detailed analysis can help identify what’s working well, areas of inconsistency within and across an ICS, where the greatest improvements opportunities lie – and how investments can be best targeted – to support better and more informed decision-making across multiple organisations and identify potential savings.
In this vein, an insight diagnostic exercise we ran with a leading pathfinder ICS highlighted not only the potential for system-wide service improvements, but also significant savings of £7.3 million (26 per cent) on operational expenditure over the next ten years, including cash releasing savings of almost £4 million.
Shared Corporate Services for the digital age – the shared service ecosystem
It is now more than 20 years since the concept of shared services for NHS business support functions came into existence.
Philip Hewitson was acting Chief Executive at Northwick Park & St Marks Hospitals in North London when he was asked to lead the Department of Health’s national programme to develop shared service arrangements for NHS business support functions.
In Hewitson’s view, shared services provide the best of both worlds. They enable the operational and strategic levels of an NHS organisation to concentrate on what they need to without having to worry about managing back-office systems as well.
This frees up NHS Trusts, commissioners – and now ICSs – to concentrate on and develop the job they must do in delivering healthcare, planning, and commissioning health services. There’s less duplication and access to high levels of automation from sophisticated systems that talk to each other. This, in his view, can only improve management and therefore, patient care.
As he puts it, “there’s a whole suite of benefits. Shared services are applicable in so many areas. When skills are so scarce and when money is so tight, why wouldn’t you look to things that already exist?”
John Yarnold, another original proponent of shared services was Finance Director at Plymouth Hospitals NHS Trust when he took up the post of Project Director of the programme.
He points out that to successfully manage the health component of the ICS, the ICB will need transparent financial activity information consolidated at system level, but able to be interrogated at transactional level.
“If I were directing this nationally, I’d make it mandatory for all NHS organisations within an ICS to go with shared corporate services. From a finance and accounting perspective, have one common chart of accounts, one set of common processes, and then introduce enhanced systems to enable consolidation of the accounts at a national or regional level. Then, the ability to extract data from different sources and combine it with financial information. Data that’s available to all partners within an ICS to inform and improve decision-making. That’s what we need.”
Creating a shared services ecosystem of Finance, HR and Procurement services can empower healthcare leaders, giving them control to improve outcomes for their patients, staff and suppliers by reimagining shared corporate services for the digital age.
At NHS Shared Business Services, we’ve crunched the numbers and estimate shared services have the potential to deliver £400 million in operating savings across ICSs, can enable them to realise £726m+ of Procurement savings opportunities and attain 25 per cent in operational savings.
With numbers like these at stake, and ICSs reportedly likely to post a combined deficit of £600 million for the current financial year, we simply cannot afford to let a lack of insight relegate these savings to the ‘too difficult’ pile.