The Evolution of Scaled Shared Services

The NHS is currently facing significant challenges, including workforce shortages, budget constraints, and lengthy waiting lists, all while still being expected to maintain the same high-quality care for the public. To match these expectations and address the cost, efficiency, and productivity challenges prevalent across the service, the NHS should build on its current approach to shared services delivery. Shared Services concepts are not new to the NHS with the establishment of NHS Shared Business Services (SBS) and regional models since 2005, but the NHS is yet to fully align with the Cabinet Office’s ambition of pursuing a Global Business Services (GBS) model for central government departments. This blog post will discuss the critical role that GBS can play in overcoming the challenges facing the NHS and improving the service's resilience and flexibility in the future.

The evolution of shared services: from back-office to the ‘Centre Office’ GBS model

Traditional shared service models involve moving manual, high-volume, low-value processes from business functions to a centralised unit. This allows business functions to concentrate on their core competencies, while the organisation benefits from improved service efficiency, delivery, and cost savings through economies of scale. Although these shared service models are still widely adopted, they often lead to functional silos and unnecessary handoffs between business functions, resulting in duplicated work, ‘shadow’ organisations, and process inefficiency.

Global Business Services (GBS) confronts these challenges by bringing together multiple functions into one streamlined service delivery model to optimise processes and break down siloed working while prioritising customer satisfaction and user experience during design and decision-making processes.

Typical characteristics of a GBS model include:

• End-to-end processes or value-chains managed by a Global Process Owner (GPO) responsible for designing and managing a process;
• Delivery of value adding capabilities (e.g. continuous improvement, data, reporting and analytics) to business functions not usually seen in more traditional shared service models;
• A shared infrastructure and governance that provides business support services across different locations, departments, functions, and processes – be that global in a geographic or an organisational sense at system regional or national level; and
  
• A laser focus on having the customer at the forefront of the design and decision making processes

It’s this focus on ensuring customer experience across the NHS workforce is at the forefront of critical decision making; end-to-end process design and delivery; and offering capabilities-as-a-service that separates the latest thinking in GBS shared services design, the ‘Centre Office’ model, from previous iterations.

Central government is currently following this path with the Central Government ‘Shared Services Strategy for Government’. Through the development of 5 GBS ‘Clusters’, they are pursuing the objectives of better experience for all users, efficiency through standardised end-to-end processes and offering capabilities as a service for respective departments.

The Centre Office GBS Model – the next stage in NHS scaled shared services?

The Deloitte white paper ‘Welcome to the Centre Office’, defines the ‘Centre Office’ by four key characteristics:

1. Customer Experience: putting all the users’ priorities at the heart of design and delivery of services
2. End-to-End Services: reliable and consistent transactional services, underpinned by well-designed and efficient processes
3. Capabilities-as-a-Service (CaaS): capabilities, such as project management and process automation, offered back to business functions as a service
4. Enablers of the Centre Office: supporting foundations to allow for a scalable and agile operation (e.g. real estate and facilities; talent management)

Diagram 1 – The Centre Office Model, including examples of what would typically be housed under each of the 4 focus areas

While there is no one-size-fits-all ‘Centre Office’ model for all organisations, Diagram 1 provides a framework for how each organisation, group of organisations or system could define their own vision. This vision will ultimately be shaped by leaders' ambitions, the value proposition of shared services in the organisations involved, and the commitment leaders have to this journey.

1. Customer Experience

Technological advancements in our personal lives have raised expectations for customised, seamless experiences in our professional lives, driving the ‘Centre Office’ approach to customer experience. This approach prioritises user-centric services and engagement strategies that address customer needs and pain points, measure and report on customer-centric metrics, and establish proactive feedback loops to achieve shared objectives.

A customer experience strategy would have front line healthcare workers heavily involved in the development of digital tools and services, such as feedback on submitting expenses claims, booking holiday / leave or ease of accessing tests and diagnostic data on patients, reducing the administrative burden, or co-creation of new specific patient-centred processes to ensure a more coordinated and efficient patient journey.

2. End-to-end services

An end-to-end service operates across the value chain, breaking down silos between traditional functions by housing relevant sub-process areas in one Shared Service Centre (SSC). The end-to-end process is overseen by a GPO who holds the responsibility for defining the blueprint and vision, as well as transforming the process to align with strategic objectives and requirements of the organisation.

If we take the ‘Procure to Pay’ process as an example, the sub process areas traditionally cut across both Procurement and Finance functions, with typical pitfalls being a lack of adherence to a ‘No PO/No Pay’ policy leading to uncontrolled spending, inaccurate financial reporting, and potential vendor disputes. By having these sub process areas housed within a single SSC, with the design and delivery of this process managed by a GPO as an end-to-end process, it becomes significantly easier to drive efficiencies, deliver greater value for the organisation, and improve customer experience. Delivering this kind of end-to-end value chain at a Group or even Integrated Care System (ICS) level in the NHS would drive significant transformation and user satisfaction, with examples being front line workers able to order equipment via their mobile, or finance business partners time freed up to work closer with clinical and non-clinical teams to identify cost saving opportunities or managing budgets.

3. Capabilities as-a-service

The Centre Office model aims to consolidate and provide specialised capabilities across the entire organisation(s), rather than individual business units, departments, or Trusts within a group or ICS independently developing and maintaining their own capabilities (such as project management or continuous improvement). Consolidating and delivering capabilities from an SSC offers greater consistency and standardisation, driving productivity and cost savings through service consolidation and economies of scale. This approach also offers a wider range of capabilities for customers of the GBS and becomes a natural repository to host and scale future capabilities, such as Artificial Intelligence, and offer them as a service to the organisation across geography, business unit or divisional boundaries.

If AI was offered as a capability as a service across an ICS, this could support an HR function through deployment of AI chatbots to promptly retrieve HR policies and engage in intelligent conversations with front line employees. These chatbots would provide customised guidance and result in significant time savings for HR personnel while ensuring accuracy and consistency in ensuring HR policies are followed. Similarly, for Finance, an AI capability could play a critical role in identifying fraudulent activities, improving regulatory and oversight analysis, and proactively identifying financial productivity opportunities.

4. Enablers

Enabling functions like Estates, IT, Legal, and Talent Management are crucial for delivering enhanced end-to-end services and exceptional customer experiences. By designing services, managing performance, and collaborating with partner ecosystems, these functions optimise cost and service levels. Having central oversight of systems, applications, and asset management further boosts IT efficiency, security, and compliance.

If we consider talent management, a GBS organisation could offer recruitment and onboarding assistance to HR functions across an ICS as well as providing customised learning and development programs for clinical and non-clinical staff. This would help to attract and retain top talent, while ensuring that staff have the necessary skills to provide high-quality care. Additionally, the GBS organisation could assist with succession planning for critical leadership roles in an ICB or Trust, ensuring continuity of leadership and effective decision-making.

Conclusion
 

The 'Centre Office' GBS model provides a comprehensive solution to address the NHS's most critical challenges, driving productivity and efficiency while also embedding resilience and agility to better tackle future unforeseen events. The Covid-19 pandemic demonstrated the NHS's ability to swiftly transform, digitise, and align its back office, supply chain, and frontline to serve the public. However, as highlighted in the government's 2022 'plan for digital health and social care', the NHS still grapples with disparate systems and outdated paper processes, diverting time from value-adding activities, particularly for frontline staff who struggle to trust presented data sources. The 'Centre Office' GBS model offers a proven blueprint to address the NHS's crucial productivity, efficiency, and cost challenges, with the potential to ultimately improve patient outcomes, maximise collaboration across the NHS workforce and enhance the overall sustainability of our healthcare system.

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Authors:
 

Charles Stubbs – Manager
Jack McGourty - Consultant
Stephania Robbins - Analyst
Luke Abrams – Analyst