Postal and communication strategies within the NHS. A White Paper from Neopost Cut Costs Improve Productivity Communicate more effectively Manage the mail process

©2013 Neopost

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Postal and communication strategies within the NHS | White Paper

Introduction Postal and communications strategies within the NHS is the latest in a series of Neopost white papers that seeks to throw light on postal strategies within the public sector as it endeavours to save money and make existing operations more efficient. The NHS may be protected from the budget cuts faced by other public sector organisations, but the combination of a growing and ageing population and the need to raise productivity and the quality of care means that it, too, is having to reduce waste and unnecessary expenditure. The ‘Nicholson Challenge’ targets the NHS to make £15-20 billion of efficiency savings between 2011 and 2014.

Jeremy Hunt’s vision of a paperless NHS by 2018 has a direct impact on communications strategies...

Currently the largest public sector contributor to climate change in Europe, the NHS is also under pressure to shrink its carbon footprint in line with a wider, legally binding commitment by the Government to cut greenhouse gas emissions by 80% (from 1990 levels) by 2050. This involves a 10% reduction in carbon emissions by 2015 and a 34% reduction by 2020. The scale of the financial and carbon savings facing the NHS has forced managers to re-assess all aspects of their operations, including postal communications, an area already undergoing significant change due to the rise of electronic messaging. Jeremy Hunt’s vision of a paperless NHS by 2018 has a direct impact on communications strategies by promoting the replacement of hard copy documents with digital ones that can be accessed online and distributed electronically. For now, physical mail is still a significant area of expenditure and source of carbon emissions: the Government Procurement Service (GPS) has calculated that the NHS spends £79 million each year on postage and postal services and that smarter procurement could cut these costs by between 9% and 30%. Using mailing equipment and software to make mailing processes more efficient and less wasteful can clearly help public sector organisations with their cost- and carbon-cutting agenda. But to what extent is investment in the post room being integrated with these wider aims?

Postal & Communications Strategies Surveys 2012 To help find out, Neopost commissioned the Government Policy Hub (GPH) to carry out a series of iGov surveys into postal communications within the public sector. Postal and communications strategies within the NHS is based on a survey of NHS professionals carried out by GPH in November 2012. Other Neopost white papers in the series include Postal and communication strategies within local authorities, Postal and communication strategies within higher education and Postal and communications strategies within central government.

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©2013 Neopost

Postal and communication strategies within the NHS | White Paper

Postal & Communications Strategies Survey 2012 Executive Summary The NHS is made up of numerous organisations, including 211 clinical commissioning groups, 161 acute trusts, 56 mental health trusts, 36 community providers, 10 ambulance services, 7,600 GP practices and 2,300 hospitals. It employs 1.358 million people and sees one million patients every 36 hours. For an organisation of this size, efficient, effective and secure communications is essential. The importance of postal communications to the NHS is demonstrated by the fact that two thirds of organisations have a postal communications strategy in place. Almost all strategies have been produced within the last three years and should therefore reflect the imperatives to cut costs and reduce carbon emissions. However, just one in four respondents says their communications strategy is either fully aligned with waste and carbon reduction targets or in the advanced planning stage. Mail digitisation The vast majority of respondents expect incoming and outgoing mail volumes – and mailing budgets – to decline in the next 18 months. This is consistent with national trends and also reflects the investment NHS organisations are making in integrated messaging solutions. More than four out of 10 respondents who expressed a view said their organisation had completed, or was on the way to completing, the integration of physical and digital mail in a unified workflow; the figure for the digitisation of incoming mails is 29%. Almost half who expressed an opinion said that their organisations were still gaining an insight into both solutions.

The survey also reveals low levels of engagement with mailing solution suppliers...

Nonetheless, physical mail remains an important means of communication, on a par with email and the telephone and well ahead of text messaging and webbased interactions. Sources of advice On the evidence of this survey, the NHS is more advanced than central government, local government and higher education bodies in the e-substitution of physical mail with digital communications. NHS organisations are also more likely than other public sector bodies to have a postal communications strategy in place. Even so, they could still be missing out on opportunities to improve mailing efficiency. Fewer than one in five organisations have used or intend to use external expertise in the development of a communications strategy. As a result, these strategies are perhaps not as comprehensive as they could be. The survey also reveals low levels of engagement with mailing solution suppliers, indicating that NHS organisations are failing to take full advantage of advice offered by industry specialists.

©2013 Neopost

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Postal and communication strategies within the NHS | White Paper

Postal Communications Strategies The importance of postal communications to the NHS is reflected in a higher than average adoption of mailing strategies. Two thirds of organisations surveyed have already developed a postal communications strategy, compared to one in 10 who haven’t. This is higher than many other public sector organisations: for example just 20% of higher education bodies and 17% of local authorities have developed a postal communications strategy. Such a high incidence is to be expected considering the importance and sensitivity of much of the material sent by healthcare organisations. The fact that three quarters of such strategies have been developed in the last three years suggests that their prevalence might have just as much to do with developments in digital communications and the pressure on healthcare organisations to reduce paper consumption. In most cases, strategies are developed in house, with fewer than one in five (18%) respondents using or expecting to use external expertise when devising a strategy. Q. H  as your organisation/department developed a communications strategy? Don’t know: 68 (21%)

Yes: 228 (68%) No: 38 (11%)

Q. If yes, when was it written?

Don’t know: 37 (17%) 1-3 years ago: 164 (75%) Over 3 years ago: 18 (8%)

Q. H  as or will your organisation/department use external expertise to develop your communications strategy?

Don’t know: 103 (40%)

Yes: 47 (18%)

No: 106 (41%)

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©2013 Neopost

Postal and communication strategies within the NHS | White Paper

Postal Services Budgets Despite the prevalence of postal communications strategies, managers in healthcare organisations have little knowledge of postal budgets or expenditure. Less than half of respondents know whether their postal budgets have changed in the last 18 months or how they are likely to change in the next 18 months. Amongst those who are aware of such matters, there is clear evidence of costcutting: 70% say that budgets have fallen in the last 18 months; and 80% expect them to fall further in the next 18 months. These findings are consistent with surveys of other public sector bodies under pressure to save money and increase efficiency. They also reflect the transition to digital communication channels. Q. What has been the effect on postal budgets over the last 18 months? Our organisation is working with a reduced postal services budget: 87 (34%) Don’t know: 133 (52%) Our organisational postal services budget has remained stable: 36 (14%)

Q. What are your plans for postal budgets over the next 18 months? I plan to reduce my postal services budget: 100 (39%) Don’t know: 132 (52%) I do not plan to reduce my postal services budget: 24 (9%)

©2013 Neopost

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Postal and communication strategies within the NHS | White Paper

Digital & Physical Communications Healthcare organisations are big communicators. More than one in five respondents who are able to estimate volumes of digital and postal communications say that their department/organisation sends more than one million items annually. A similar number (18%) say they receive more than 500,000 items each year. More than half say they send more than 200,000 items annually. Digital communications make up the majority of inbound and outbound messages in three out of four organisations (excluding Don’t Knows). Even so, physical mail remains an important means of communication, on a par with email and the telephone and well ahead of text messaging and web-based interactions. Q. A  pproximately how many items of outgoing communications does your organisation/department send annually? Less than 10,000: 17 (8%) 10,001 – 50,000: 16 (8%) 50,001 – 100,000: 4 (2%) 100,001 – 200,000: 5 (2%) 200,001 – 500,000: 15 (7%) 500,001 – 1 million: 16 (8%) 1 million & above: 22 (10%) Don’t know: 118 (55%) 0

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Q. H  ow many items of inbound mail does your organisation/ department receive annually? Less than 5,000: 21 (11%) 5,000 – 25,000: 18 (9%) 25,000 – 50,000: 11 (6%) 50,000 – 100,000: 4 (2%) 100,000 – 250,000: 8 (4%) 500,000 & above: 13 (7%) Don't know: 121 (62%) 0

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Q. W  hat types of inbound and outbound communication do you mainly send and receive? Letter: 150 (22%) Email: 191 (29%) SMS: 64 (10%) Web-hosted: 81 (12%) Telephone: 168 (25%) Don’t know: 14 (2%)

0 15 20 25 30 Q. R  oughly speaking, what would you5say is10 the proportion of physical, as opposed to digital items?

Less than 25% is physical mail: 72 (37%) 26 – 50% is physical mail: 36 (18%) 51 – 75% is physical mail: 25 (13%) Over 75% is physical mail: 11 (6%) Don’t know: 52 (27%)

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Postal and communication strategies within the NHS | White Paper

Mail Volumes Despite the continued importance of postal communications, there is clear evidence that mail volumes are falling in healthcare organisations, just as they are in other sectors. Nine times as many respondents expect mail volumes to go down as up over the next 12 months. Almost seven times more respondents expect their incoming mail volumes to shrink rather than grow. These trends are reflected in declining postal budgets in the NHS. Even so, the number of respondents who expect mail volumes to decline is greater than the number who intend to reduce their postal services budget. This may be indicative of rising postal costs. Q. D  oes your organisation/department plan to increase or decrease outgoing mail over the next 12 months?

Don’t know: 75 (38%) Decrease: 109 (56%)

Increase: 12 (6%)

Q. D  oes your organisation/department plan to increase or decrease incoming mail over the next 12 months?

Decrease: 63 (33%) Don't know: 121 (62%)

Increase: 10 (5%)

Postal communications & the environment Much of the impetus to reduce mail volumes in both public and private sector organisations comes from a desire to cut paper use and associated waste and carbon emissions. However, few NHS organisations have yet aligned their communications strategy to targets for waste and carbon reduction. More than three quarters of respondents say that their organisation/department is exploring ways to reduce controllable waste. Yet, so far just one in four says their communications strategy is either fully aligned or in the advanced planning stage. Almost one in three respondents says that they need more planning or are still gaining an insight.

©2013 Neopost

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Postal and communication strategies within the NHS | White Paper

Q. T  o what extent has your communications strategy been aligned to targets concerning waste and carbon reduction? Fully aligned: 22 (12%) In advanced planning: 25 (14%) More planning needed: 39 (22%) Gaining insight: 17 (9%) Not yet: 15 (8%) Don’t know: 62 (34%)

0 5 10 ways 15 20reduce 25 Q. I  s your organisation/department exploring to controllable waste further?

Yes: 138 (77%)

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Don’t know: 39 (22%)

No: 3 (2%)

Mail & digital communications NHS organisations have a clear expectation that mail volumes will decrease and are already making use of technology to support the transition from paperbased to digital communications. Of those able to give an answer (i.e. excluding Don't Knows), more than 40% have already completed, or are in the process of completing, the centralisation of physical and digital mail so that they can automatically route communications via electronic or hard copy means as part of an integrated workflow. A further 44% are gaining an insight into the subject. Adoption rates are only slightly lower for the digitisation and electronic routing of incoming mail. Excluding Don’t Knows, 29% are in the process of completing, or have already completed, mail digitisation, with 52% still gaining an insight into the topic. Q. H  as your organisation/department completed, or is it investigating, the centralisation of physical and digital mail? Yes, completed: 15 (9%) In the process of centralising: 21 (12%) Gaining insight: 38 (22%) No, will not centralise: 13 (7%) Don’t know: 89 (51%)

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©2013 Neopost

Postal and communication strategies within the NHS | White Paper

Q. H  as your organisation/department completed, or is it investigating, the digitisation of mail? Yes, completed: 13 (8%) In the process of completing: 17 (10%) Gaining insight: 54 (32%) No, probably not: 19 (11%) Don’t know: 63 (39%)

Challenges & Priorities The NHS is subject to many of the same pressures as other public sector organisations, from shrinking budgets to carbon reduction targets. They also face more specific challenges relating to Government plans for a paperless NHS and online access to patient medical records. Due to the sensitive nature of much NHS material, the need for data security is paramount. Such considerations are at the forefront of respondents' minds, with almost six out of 10 claiming to be concerned or very concerned about data security. The same number are investigating or already implementing a plan to deliver a paperless NHS. These findings highlight the value of modern communication solutions that can improve mailing accuracy and manage the interplay between physical and digital messaging. . Q. H  ow concerned are you about data security and inaccurate patient details? Very concerned: 57 (33%) Concerned: 44 (25%) Slightly concerned: 31 (18%) Not concerned: 26 (15%) Don’t know: 63 (39%)

Q. A  re you aware of Jeremy Hunt’s vision of a paperless NHS, outlined in his Digitalisation of the NHS: The New Imperative speech, and are you implementing a plan to this end? Implementing: 18 (11%) Gaining insight: 78 (46%) Not implementing: 13 (8%) Don’t know: 63 (39%)

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Postal and communication strategies within the NHS | White Paper

Q. A  pproximately how many missed appointments do you suffer annually? 0 – 100: 18 (11%) 101 – 250: 1 (1%) 251 – 500: 2 (2%) 501 – 1,000: 5 (3%) 1,001 – 2,500: 5 (3%) 2,501 – 5,000: 5 (3%) 5,001 – 10,000: 5 (3%) 10,000+: 7 (4%) Don't know: 120 (71%) 0

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Procurement Framework agreements are the preferred method of procuring mailing equipment and services. However, overall awareness of public sector buying organisations is low suggesting that organisations in the NHS might be missing out on the best deals. The Government Procurement Service (GPS) is the best known buying organisation, but only one third of respondents who recognise the GPS are aware of the GPS – Hybrid Mail framework agreement. Knowledge of other public sector buying organisations is even lower. Both the Pro5 and ESPO procurement groups are recognised by just 7% of respondents. Q. Please select all the framework agreements your organisation/ department is aware of. Government Procurement Service: 94 (37%) Government Procurement Service (Hybrid Mail): 32 (13%) Pro5: 18 (7%) ESPO: 18 (7%) None of the above: 10 (4%) Don’t know: 79 (32%)

0 5 10 15your 20 preferred 25 30 Q. W  here available, are framework agreements procurement route?

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Yes: 77 (41%)

Don’t know: 94 (51%)

No: 15 (8%)

What Next? To help organisations in the NHS identify how they can improve their mailing process, Neopost offers free, no obligation audits from which we are able to develop bespoke communications solutions and strategies. For more information, please contact Antony Paul on 01708 714576 or email [email protected]. Page 10

©2013 Neopost

Postal and communication strategies within the NHS | White Paper

Mailing technology Modern mailing solutions have a big role to play in helping the NHS meet broader cost cutting and efficiency targets and manage the transition to paperless communications. Respondents’ investment choices for the next 18 months reflect these priorities, with digitisation of incoming mail, secure email and centralisation of physical and digital mail generating the greatest interest amongst purchasers. A high ranking for franking machines shows that physical mail will continue to be an important part of the communications mix. While many organisations in the NHS are investing in new technologies to improve communications, low levels of engagement with suppliers suggest that they are failing to make the most of the advice available to them. Q. W  hich providers has your organisation talked to with regard to innovations in communication? Synertec: 18 (8%) Royal Mail: 36 (15%) TNT Post: 27 (11%) Pitney Bowes: 16 (7%) Neopost: 19 (8%) FP Mailing: 7 (5%) Don’t know: 113 (46%)

Q. W  hich solution/areas your organisation/department will be looking at over the next eighteen months. Digitisation: 54 (16%)

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Centralised solutions: 40 (12%) Mail scanners: 21 (6%) Secure email: 40 (12%) Address data verification: 15 (4%) Franking machines: 33 (10%) Shredders: 27 (8%) Inserting & envelope systems: 11 (3%) Letter openers: 4 (1%) Address printers: 8 (2%) Don’t know: 82 (26%)

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About Neopost Neopost is the UK’s and Europe’s Number One supplier of mailing solutions. Our products and services are sold in more than 90 countries and in 2011 we recorded sales of more than 1 billion euros. With expertise in traditional and digital communications, Neopost supplies the most technologically advanced solutions for franking, folding/inserting, addressing, logistics management and traceability, plus a full range of services including consultancy, maintenance and financing solutions. We are the only manufacturer from the postal solutions industry to have served local authority purchasing consortia, central government and the wider public sector on successive framework agreements for over 15 consecutive years. Neopost is an approved supplier to the National Franking Machine Agreement (NFMA), which gives higher and further education institutions across the UK access to Neopost’s extensive range of franking machines, consumables, maintenance and associated products at competitive rates.

©2013 Neopost

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Postal and communication strategies within the NHS | White Paper

Survey Participants Neopost and Government Policy Hub (GPH) would like to thank the following organisations for taking part in the Postal & Communications Strategies Survey 2012: National Health Service, with special thanks to those who took the time to offer further insight through additional comments and observations. 5 Boroughs Partnership NHS Foundation Trust Ashford & St Peter's Hospitals NHS Foundation Trust Ashford and St Peter's Hospital NHS Foundation Trust Barking, Havering and Redbridge University Hospitals NHS Trust Barnet and Chase Farm Hospitals NHS Trust Barnet Enfield Haringey Mental Health NHS Trust Barts Health NHS Trust Bedford Hospital NHS Trust Birmingham Childrens Hospital Bradford Teaching Hospitals NHS Foundation Trust Brighton and Sussex University Hospitals NHS Trust Cambridge University Hospitals NHS Foundation Trust Cambridge University Hospitals NHS Trust Care Plus Group Central and North West London NHS Foundation Trust Central London Community Healthcare NHS Trust Chesterfield Royal Hospital NHS Foundation Trust Commissioning Board Cornwall Partnership NHS Foundation Trust County Durham and Darlington NHS Foundation Trust CPFT CUH Cumbria Partnership NHS Foundation Trust Derby Hospitals NHS Foundation Trust Derbyshire Healthcare NHS Foundation Trust Dorset County Hospital NHS Foundation Trust Dudley and Walsall Mental Health Partnership NHS Trust East Cheshire NHS Trust East Coast Community Healthcare CIC East Dunbartonshire Community Health Partners hip East Lancashire Hospitals NHS Trust East London NHS Foundation Trust

Neopost House South Street Romford Essex RM1 2AR

East Midlands Ambulance Service NHS Trust East Midlands LETB Epsom and St Helier University Hospitals NHS Trust First Community Health & Care CIC Frimley Park Hospital Gloucestershire Hospitals NHS Foundation Trust GP Practice Great Western Hospitals NHS FT Health Education Wessex Health Education Yorkshire and the Humber Healthcare Improvement Scotland Healthcare Improvement Scotland Heart of England NHS Foundation Trust HSMC Humber NHS Foundation Trust Ingenium IDS Inverclyde Community Health Partnership Kings College Hospital NHS Foundation Trust Kingston Hospital NHS Trust Leeds and York Partnership NHS Foundation Trust Leeds Teaching Hospitals Trust Leicestershire Partnership NHS Trust MCHFT Mersey Care NHS Trust Mid Cheshire Hospitals NHS Foundation Trust Mid Essex Hospital Services NHS Trust Mid Staffordshire NHS Foundation Trust Midlands and East Specialised Commissioning Cluster National Institute for Health and Clinical Excellence NBT NHS Ashton, Leigh and Wigan NHS Ayrshire & Arran NHS Bassetlaw NHS Bradford and Airedale NHS Bristol NHS Calderdale NHS Cheshire and Merseyside CSU NHS Commercial Procurement Collaborative NHS Cornwall and Isles Of Scilly NHS Diabetes and Kidney Care

NHS Direct NHS England NHS Fife NHS Great Yarmouth and Waveney NHS Greater Glasgow and Clyde NHS Greater Manchester CSU NHS Health Scotland NHS Hertfordshire NHS Highland NHS Islington NHS Lanarkshire NHS Leeds NHS Leicestershire County and Rutland NHS Litigation Authority NHS Midlands and East NHS National Services Scotland NHS Norfolk NHS Norfolk and Waveney CSU NHS North Central London NHS North East Essex NHS North East London and the City NHS North Somerset NHS Nottinghamshire County NHS Oldham NHS Portsmouth NHS Primary Care Commissioning NHS Sheffield NHS Somerset NHS South East London NHS South West London NHS Stoke On Trent NHS Sussex NHS Sustainable Development Unit NHS Tameside and Glossop NHS West & South Yorkshire and Bassetlaw Commissioning Support Unit NHS Western Isles NHS Worcestershire nhsp Norfolk Community Health and Care NHS Trust North East Ambulance Service NHS Foundation Trust North West Ambulance Service NHS Foundation Trust North Staffordshire Combined Healthcare NHS Trust North West Collaborative Commercial Agency North Western Deanery North Yorkshire and Humber CSU Northampton General Hospital NHS Trust Northumbria Healthcare Northumbria Healthcare NHS Foundation Trust Nottinghamshire Healthcare NHS Trust Oxford Health NHS Foundation Trust Pennine Acute NHS Trust Pennine Acute Trust Peterborough and Stamford Hospitals NHS Foundation Trust Peterborough Community Services Portsmouth CCG Portsmouth Hospitals NHS Trust RCHT Rotherham Doncaster and South Humber NHS Foundation Trust Royal Brompton & Harefield NHS Foundation Trust

Royal Free London NHS Foundation Trust Royal Wolverhampton Hospitals NHS Trust Severn Deanery Sheffield Health & Social Care NHS Foundation Trust South Central Ambulance Service NHS Foundation Trust South East Coast Ambulance Service NHS Foundation Trust South Essex Partnership University NHS Foundation Trust South London Healthcare NHS Trust South Staffordshire and Shropshire Healthcare NHS Foundation Trust South Staffordshire PCT South Tees Hospitals NHS Foundation Trust South Tyneside NHS Foundation Trust South West London and St George' s Mental Health NHS Trust South West Yorkshire Partnership NHS Foundation Trust South Western Ambulance Services NHS Foundation Trust Southern Health NHS Foundation Trust Southport and Ormskirk Hospital NHS Trust St George' s Healthcare NHS Trust State Hospitals Board for Scotland Stockport NHS Foundation Trust Surrey and Borders Partnership NHS Foundation Trust Sussex Partnership NHS Foundation Trust Taunton and Somerset NHS Foundation Trust The East of England NHS Collaborative Procurement Hub The Health Informatics Service NHS The Ipswich Hospital NHS Trust The Princess Alexandra Hospital NHS Trust The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust The Shrewsbury and Telford Hospital NHS Trust The Tavistock and Portman NHS Foundation Trust University Hospitals Coventry and Warwickshire NHS Trust University Hospitals of Leicester NHS Trust Warrington and Halton Hospitals NHS Foundation Trust West London Mental Health NHS Trust West London Mental Health Trust West Middlesex Hospital West Middlesex University Hospital NHS Trust West Suffolk NHS Foundation Trust WHACT Whittington Hospital Wye Valley NHS Trust Yorkshire Ambulance Service NHS Trust

Tel: 0800 731 1334 Fax: 01708 726361 www.neopost.co.uk.

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