Healthcare - Ernst & Young - United Kingdom

In the face of rising patient demand, restricted resources and an expectation of large efficiency gains, improving productivity is key.

We can help you transform your service delivery model by developing a fundamental understanding of your clinical services and challenging their viability in order to shape a proactive and agile new strategy. We can also bring sustained performance improvement to your operating model and help drive your organisation in the most productive and effective way.

We can help management teams facing consistent operational failures, steep financial decline, clinical failures, transformation efforts that fail to make progress.

We help address these challenges by working with the Board and executive teams to establish recovery. We undertake a rapid assessment of an organisation’s issues, develop and execute a recovery plan alongside management, with the aim of stabilising the organisation, maximising current year results and building a strong foundation for future success.

The new landscape for NHS commissioning is putting clinicians at the heart of decision making. Our experience tells us that when clinically-led commissioning decisions are aligned to robust management processes, there is a huge potential for service improvement and greater productivity in health systems.

We improve the capabilities of commissioners through long-term partnerships. Our support teams help with the transition to GP-led commissioning consortia and the realisation of major productivity opportunities and system-wide programmes of service improvement.

We have expertise and experience in all aspects of health and social care integration including:

• Redesign of integrated care pathways
• Early intervention and reablement
• Change management that recognises that historically health and local government have worked in different cultures, to different agendas
• Organisational change including supporting the development of integrated care organisations.

The NHS is facing the biggest financial challenge in its history. Constrained funding and significant projected growth in demand and other cost pressures mean it must deliver approximately £20bn in efficiency savings by 2013/14.

Most organisations will have to make significant changes to meet this challenge. We can help your finance function develop a clear vision and roadmap for the future, enabling delivery of your organisation’s strategy and achieving required cost savings. We also have significant experience of conducting foundation trust assessments for Monitor and can help you prepare for an assessment.

As the NHS is gripped by change, real estate presents constantly evolving challenges.

We advise primary care trusts, acute trusts and foundation trusts on how to make the best use of their estate whilst driving through cost efficiencies and providing fit for purpose space.

Critical to this is our health estate diagnostic review which identifies key estate issues and opportunities to release capital and achieve cost savings. We advise on estate cost reduction and the use of strategic estate partnerships with the private sector to manage an estate. We also develop a low capital building solution that uses private sector expertise and finance to deliver fit for purpose buildings without the need to commit capital or sign a long head lease.

Effective financial management should encompass the pro-active management of taxes.

VAT and payroll taxes represent significant costs, as can corporation tax. We have a team dedicated to helping NHS clients with these issues. We work with trusts to ensure they are compliant with tax regulations and that they maximise available reliefs. We provide a comprehensive tax service, including:

• VAT and payroll tax assurance programmes
• Flexible benefits and the associated tax implications
• Contract review as well as VAT efficient procurement, helping Trusts to utilise available reliefs
• Advice on property transactions, including co-developments with charities, universities etc.
• Restructuring advice, for example primary care trust provider carve out
• Support with HM Revenue and Customs audits.

Liberating the NHS changes the role and function of health regulators, especially Monitor’s role in relation to competition and failure. With our experience in quality and economic regulation we can help both providers and commissioners prepare for the significant challenges ahead.

Doing the right deal right can make your business more competitive and profitable – and help it grow more quickly.

• We provide lead and financial advice on a range of PPP and PFI projects within the NHS.
• We support our clients engaging in competitive or non-competitive acquisition or integration (including transforming community services).
• We advise on a variety of mergers and acquisitions transactions, including bidding to acquire mental health NHS Trusts, mergers of community health services entities, acquisition of acute NHS trust by a foundation trust, and integration of community health services organisations with foundation trusts.
• We also have significant experience ofprivate sector mergers and acquisitions, including advising on healthcare transactions.