Driving operational efficiencies within the Social care sector: survey and round-table event, June 2019

Tuesday 25th June 2019
Driving operational
efficiencies within Social Care
Practical insights from your peers and sector specialists
Survey and follow-up round-table event

© Ad Alta Advisory Ltd. and Sayer Vincent, 2019 1
Roundtable attendee organisations

Key event insights: Back-office transformation
Key points
• Optimise staff mix and ensure that the right activities are in the right place/roles: Consider staff mix, current
tasks/activities and how they could be re-allocated to new roles with appropriate level of allocation to seniority + skills
required
• Reduce central admin. burden on operational teams: What adds value? What reporting do we need to do? What do
end-users think takes the most time? How could processes be simplified or automated?
• Challenge demand everywhere: What are we doing as a Head Office / central teams? Do we need to do it (what is
contractual and what is an internal decision)? Do local / operational teams value-it? Ask internal users what they think
adds value / wastes time from central teams e.g. reporting. Consider lean thinking to remove unnecessary demand
• Address procurement ‘quick wins’: Re-tender all central / commodity procurement contracts (and consider both demand
/ spec. + supply-side costs) and use brokers / independent specialists where appropriate for subject-matter expertise and
supplier knowledge (often on a shared savings basis)
– Mobile phones
– Utilities
– Insurance
– Data / wifi
– Etc.
Practical insights / case studies
• Significant savings from centralising tasks into central Finance Team, relieving pressure from local teams/ care homes
• Procurement of insurance, mobile phones and utilities contracts (energy consultants) as ‘quick wins’
• Mergers as a catalyst for back-office savings

Key event insights: Front-line staff efficiency + service re-design
Key points
• Consider activity-based costing: What is the margin contribution / true cost of certain services e.g. care packages or
contracts? What are the fixed vs. variable cost-drivers?
– What could we then re-negotiate with commissioners; and/or
– What elements should we focus on / go after that make the biggest difference?
• Think about "outcomes" and "effectiveness“ vs. solely efficiency (inputs):
– Consider 'working smarter' not harder as the key, to make working lives easier and free-up valuable time / expertise
• Re-think roles and competencies: The competencies of some roles can be almost impossible to expect people to deliver
on, as expect multiple experts to be in one role/person, so consider whether roles could be fundamentally re-assessed
– What are the various tasks / responsibilities
– Which ones are specialist vs. generalist?
– What is the lowest-level of skill that is required for a specific task?
– How could new/revised roles be created based on a more logical grouping of skills to have the right activities in the
right place/role at the lowest possible level?
• Focus on changing delivery models, doing things differently; fewer staff better paid, more empowered; focus on people
we serve; think creatively to unlock government grants e.g. already available for building new houses but not generally
known about
• How to upskill senior careers to take on tasks from nurses?
• Ensuring there is enough management time for front line managers / team leaders, not just focus on doing and delivering
services themselves

Key event insights: Data, tools and technology
Key points
• Consider core / generic processes that could be automated: what core processes are there (particularly if paper-based /
manual) where document + process management tools could be rapidly introduced and deliver a clear RoI e.g. finance
invoice processing / purchase to pay
• Be careful about ‘off the shelf’ tools: Finding tools that are 'off the shelf’ and meet the specific needs / business
requirements of individual organisations’ operational ways of working is very difficult
• Consider scope boundaries of core vs. bespoke add-on tools: Define what any core system should cover, and then
consider what ‘best in class’ / specific or bespoke tools would be appropriate e.g. Ad Alta has created a whole range of
bespoke XLS+VBA toolkits to cover gaps in core tools/processes, but as they have been designed around improving
existing ways of working and clear gaps in core systems (but making them much more efficient), there is always much
less change resistance then forcing an inappropriate system onto non-standard internal processes
• Don’t under-estimate the work involved in implementing e-Rostering / rota management tools: While there is no doubt
that they could/should make a significant positive difference, they typically expose gaps in existing processes and systems
and so can require a lot of pre-work e.g. standardising employment contracts, terms and conditions etc.
• Change management, as ever, is critical: Take the time to clearly define "what's in it for me" (WIIFM) for all the different
groups of stakeholders (some might be directly threatened by a new tool taking away existing activities/responsibilities),
set a clear vision, get visible executive support, take the time to get it right 1st time e.g. via pilots and staged rollouts, and
provide mostly carrot vs. stick incentives and proactively track and take action based on rollout data
• A new document management solution made a huge difference to filling gaps in shifts from permanent and bank staff
• 5 years ago invested in more HR automation, also for safeguarding checks (however, £40m payroll still managed on
spreadsheets!)

Key event insights: Agency use
Key points
• There is no panacea / its ‘horses for courses’
• Often a 1 size fits all might not be the best approach vs. a region-specific one, taking into account local demand,
suppliers and candidates
• Consider what barriers could be put in place to minimise agency use e.g. having to formally justify agency staff requests
• Consider apprenticeships (again if/where appropriate)
• Look at data and trends to identify where to focus e.g. what drives retention (for example if after 6 months most
employees typically stay for 3+ years etc. how can we get them through the initial 6 month period?)
• Consider bonuses / incentives for budget holders to reduce agency use
• Focus management attention and have standard KPIs on agency use each and every week
• Use staff bank to re-use temporary staff who are happy to work directly (and so avoid agency fees)
• Work with your procurement team to un-bundle agency costs e.g. pay-rates vs. charge-rates
• Idea of giving bonus e.g. 1 day of holiday for getting a new hire through their induction / probation period
• Management focus to minimise agency / make it difficult for staff to use agency > only 14% staff turnover; just lost a
whole team to a new Aldi which opened nearby; moved away from neutral vendor for agency management; use of
apprentices in back office (central) but not yet front line
• Agency use an issue in 3 care homes out of 10, mainly down to poor management and leadership and location
• Good example from local team in Cambridgeshire, which significantly improved local recruitment; leavers are generally in
the first 12 weeks, otherwise they stay for years, so focused on support to retain staff through the initial probation period

About us
• We are an award-winning firm of chartered accountants with a clear focus on
charities and social enterprises. We support a number of clients operating in
the health and social care sector
• We are also an ethical firm that bases all its decisions and the way it operates
on the fundamental principle that people are more important than money.
Our goals are to deliver excellent services, and to treat clients and staff well
• We are innovative and dynamic operational transformation specialists with a
proven track-record of delivering hands-on and sustainable transformation. We
focus primarily on health + care, and more recently, the not-for-profit sector
• Over the last 10 years, we have delivered millions of pounds of tangible
financial benefits for our clients, as well as significantly improving the quality
of service, and dramatically enhancing the working lives of operational front-
line staff. We also receive consistently excellent client feedback

Getting in touch
Michael Seymour
Managing Director
M: 07957 344 188
michael.seymour@adaltaconsulting.co.uk
Please don’t hesitate to get in touch – we would be delighted to have the opportunity to:
Jonathan Orchard
Partner
T: 020 7841 6360
jonathan.orchard@sayervincent.co.uk
Fleur Holden
Partner
M: 07805 529 437
fleur.holden@sayervincent.co.uk
• Learn more about you and your
organisation and your current
challenges
• Answer any further questions
you may have
• Confidentially share experience
and case studies
• Discuss where and how we
might be able to help you

Survey responses

Roles of survey respondents
• Of the 8 responses, we had a mix of executive roles, with 50% from within the Finance function and the
rest across other leadership positions (CEO, Trustee, Transformation Director)
4/8 (50%) of the
respondents were
from the Finance
function

Income of survey organisations
• Over half of the responses were related to organisations with income of £50m+ p.a. We also had 1
response from an organisation of £25-50m of annual income, 2 from organisations with £15-25m of annual
income and 1 with <£15m of annual income

FTEs of survey organisations
• There were 3 organisations with between 500-1,000 full-time equivalent employees, and 2 each with
1,500-2,000 and 2,500+ FTEs (and one organisation with <500 FTEs)

Sustainability drivers / challenges
• The top 2 drivers of sustainability / challenges were:
1. “Having access to sufficient quantity and quality of staff”, arguably followed by
2. “Driving efficiencies and cost base optimisation”
1
2
3
4

Progress to-date against sustainability challenges
• While there was ‘good’ or ‘very good’ progress against many of the areas (an average of 31%), nearly 2/3
of all the responses rated overall progress as either ‘adequate’ (43%) or ‘poor’ (19%)
• … however, we are going to focus today on progress against efficiency improvement and staffing
The most positive (+)
areas of progress
were around
‘developing scale’
(43% ‘very good’ or
‘good’) and ‘driving
efficiencies’ (50%
‘good’)

Annual cost / efficiency improvement targets (2019/20)
• The most frequent cost / efficiency improvement target range was 1.0-2.5% (38% of responses),
followed by 2.5-5.0% (25% of responses). 2 organisations didn’t have one and 1 organisation had a CIP
target of > 10.0%

Confidence in achieving cost / efficiency targets (2019/2020)
• Interestingly, the level of confidence in achieving cost improvement / efficiency targets was only either
‘Somewhat confident’ (75%) or ‘Not so confident’ (25%). No one rated it ‘very’ or ‘extremely’ confident
(or indeed ‘not at all confident’)

Future cost / efficiency improvement focus areas
• There was no obvious clear ‘winner’ in terms of how to achieve cost / efficiency targets, with all being
rated ‘fundamental’ by at least ½ of all respondents. Only a handful were perceived as ‘not very
important’ (reducing non-pay / 3rd party costs – 21%) and front-line efficiency improvement – 15%)

Progress to-date against CIP target focus areas (overall)
• While there was ‘good’ progress against many of the areas (30% of responses) - particularly ‘back-office
efficiency’ at 50% - most were rated as ‘adequate’ (48%)

Topic areas
1. Operational efficiency improvement
– Front-line staff efficiency
– Internal service re-design and innovation
– Back office efficiency
2. Data, tools and technology
3. Minimising temporary staff costs

• All 3x areas of ‘back-office efficiency’,
‘front-line staff efficiency’ and
‘internal service re-design’ were seen
as ‘fundamentally’ important (55-
60% of respondents)
• While progress was seen as ‘good’
against ‘back-office efficiency’ by ½
of respondents, there was
significantly less perceived progress
against front-line staff efficiency’
(50% ‘adequate’ or ‘poor’) and
‘internal service re-design (60% just
‘adequate’)

Key insights / notes: Back-office transformation
Key points
• Optimise staff mix and ensure that the right activities are in the right place/roles: Consider staff mix, current
tasks/activities and how they could be re-allocated to new roles with appropriate level of allocation to seniority + skills
required
• Reduce central admin. burden on operational teams: What adds value? What reporting do we need to do? What do
end-users think takes the most time? How could processes be simplified or automated?
• Challenge demand everywhere: What are we doing as a Head Office / central teams? Do we need to do it (what is
contractual and what is an internal decision)? Do local / operational teams value-it? Ask internal users what they think
adds value / wastes time from central teams e.g. reporting. Consider lean thinking to remove unnecessary demand
• Address procurement ‘quick wins’: Re-tender all central / commodity procurement contracts (and consider both demand
/ spec. + supply-side costs) and use brokers / independent specialists where appropriate for subject-matter expertise and
supplier knowledge (often on a shared savings basis)
– Mobile phones
– Utilities
– Insurance
– Data / wifi
– Etc.
• Significant savings from centralising tasks into central Finance Team, relieving pressure from local teams/ care homes
• Procurement of insurance, mobile phones and utilities contracts (energy consultants) as ‘quick wins’
• Mergers as a catalyst for back-office savings

Key insights / notes: Front-line staff efficiency + service re-design
Key points
• Consider activity-based costing: What is the margin contribution / true cost of certain services e.g. care packages or
contracts? What are the fixed vs. variable cost-drivers?
– What could we then re-negotiate with commissioners; and/or
– What elements should we focus on / go after that make the biggest difference?
• Think about "outcomes" and "effectiveness“ vs. solely efficiency (inputs):
– Consider 'working smarter' not harder as the key, to make working lives easier and free-up valuable time / expertise
• Re-think roles and competencies: The competencies of some roles can be almost impossible to expect people to deliver
on, as expect multiple experts to be in one role/person, so consider whether roles could be fundamentally re-assessed
– What are the various tasks / responsibilities
– Which ones are specialist vs. generalist?
– What is the lowest-level of skill that is required for a specific task?
– How could new/revised roles be created based on a more logical grouping of skills to have the right activities in the
right place/role at the lowest possible level?
• Focus on changing delivery models, doing things differently; fewer staff better paid, more empowered; focus on people
we serve; think creatively to unlock government grants e.g. already available for building new houses but not generally
known about
• How to upskill senior careers to take on tasks from nurses?
• Ensuring there is enough management time for front line managers / team leaders, not just focus on doing and delivering
services themselves

Topic areas

2: Use of data, digital tools and technology
• While ‘better use of data, digital tools and technology’ was seen as ‘critical’ or ‘very important’ by ~80%
of respondents, progress was rated as just ‘adequate’ or ‘poor’ by ~85% of respondents

Key insights / notes: Data, tools and technology
Key points
• Consider core / generic processes that could be automated: what core processes are there (particularly if paper-based /
manual) where document + process management tools could be rapidly introduced and deliver a clear RoI e.g. finance
invoice processing / purchase to pay
• Be careful about ‘off the shelf’ tools: Finding tools that are 'off the shelf’ and meet the specific needs / business
requirements of individual organisations’ operational ways of working is very difficult
• Consider scope boundaries of core vs. bespoke add-on tools: Define what any core system should cover, and then
consider what ‘best in class’ / specific or bespoke tools would be appropriate e.g. Ad Alta has created a whole range of
bespoke XLS+VBA toolkits to cover gaps in core tools/processes, but as they have been designed around improving
existing ways of working and clear gaps in core systems (but making them much more efficient), there is always much
less change resistance then forcing an inappropriate system onto non-standard internal processes
• Don’t under-estimate the work involved in implementing e-Rostering / rota management tools: While there is no doubt
that they could/should make a significant positive difference, they typically expose gaps in existing processes and systems
and so can require a lot of pre-work e.g. standardising employment contracts, terms and conditions etc.
• Change management, as ever, is critical: Take the time to clearly define "what's in it for me" (WIIFM) for all the different
groups of stakeholders (some might be directly threatened by a new tool taking away existing activities/responsibilities),
set a clear vision, get visible executive support, take the time to get it right 1st time e.g. via pilots and staged rollouts, and
provide mostly carrot vs. stick incentives and proactively track and take action based on rollout data
• A new document management solution made a huge difference to filling gaps in shifts from permanent and bank staff
• 5 years ago invested in more HR automation, also for safeguarding checks (however, £40m payroll still managed on
spreadsheets!)

Topic areas

3. Minimising temporary staff (agency) costs
• While ‘minimising temporary staff (agency) costs’ was seen as ‘critical’ or ‘very important’ by ~85% of
respondents, progress was rated as just ‘adequate’ or ‘poor’ by nearly ¾ (72%) of respondents

Barriers to retaining staff from the UK (and/or overseas)
• The greatest barriers to retaining staff from the UK (and/or overseas) were
1. ‘An ability to pay attractive hourly rates or salaries’ (38%); and
2. ‘Competition for staff from temporary agencies’ (31%)

Key insights / notes: Agency use
Key points
• There is no panacea / its ‘horses for courses’
• Often a 1 size fits all might not be the best approach vs. a region-specific one, taking into account local demand,
suppliers and candidates
• Consider what barriers could be put in place to minimise agency use e.g. having to formally justify agency staff requests
• Consider apprenticeships (again if/where appropriate)
• Look at data and trends to identify where to focus e.g. what drives retention (for example if after 6 months most
employees typically stay for 3+ years etc. how can we get them through the initial 6 month period?)
• Consider bonuses / incentives for budget holders to reduce agency use
• Focus management attention and have standard KPIs on agency use each and every week
• Use staff bank to re-use temporary staff who are happy to work directly (and so avoid agency fees)
• Work with your procurement team to un-bundle agency costs e.g. pay-rates vs. charge-rates
• Idea of giving bonus e.g. 1 day of holiday for getting a new hire through their induction / probation period
• Management focus to minimise agency / make it difficult for staff to use agency > only 14% staff turnover; just lost a
whole team to a new Aldi which opened nearby; moved away from neutral vendor for agency management; use of
apprentices in back office (central) but not yet front line
• Agency use an issue in 3 care homes out of 10, mainly down to poor management and leadership and location
• Good example from local team in Cambridgeshire, which significantly improved local recruitment; leavers are generally in
the first 12 weeks, otherwise they stay for years, so focused on support to retain staff through the initial probation period

Appendix

Options to drive scale
• The most important option in developing scale was by far and away ‘organic growth’ (63% ranking it
‘most important’), followed by ‘partnerships and alliances’. At the other end of the scale, the least
preferred option was a merger with a different type of organisation e.g. Healthcare providers

Barriers to closer collaboration with local Healthcare organisations
• The greatest barriers to increased collaboration with the Healthcare sector identified were ‘different
cultures’ and ‘mis-aligned values, with the other barriers equally important (except for having ‘separate
budgets’ which was seen as less of an issue

Getting in touch
Michael Seymour
Managing Director
M: 07957 344 188
michael.seymour@adaltaconsulting.co.uk
Please don’t hesitate to get in touch – we would be delighted to have the opportunity to:
Jonathan Orchard
Partner
T: 020 7841 6360
jonathan.orchard@sayervincent.co.uk
Fleur Holden
Partner
M: 07805 529 437
fleur.holden@sayervincent.co.uk
• Learn more about you and your
organisation and your current
challenges
• Answer any further questions
you may have
• Confidentially share experience
and case studies
• Discuss where and how we
might be able to help you

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