OUR HEALTH, OUR CARE, OUR FUTURE Your chance to help shape healthcare in Lothian

NHS LOTHIAN’S DRAFT STRATEGIC PLAN FOR 2014-2024 SUMMARY CONSULTATION Our Health, Our Care, Our Future 1 We want to hear as many views as possible on how NHS Lothian should evolve.

INTRODUCTION NHS Lothian works experience patients have to help people live of our services. This will WE NEED A STRATEGIC healthier, longer lives – take planning and change. PLAN TO: no matter who they are Our 10-year strategic • Provide high quality or where in the region plan gives us guidance care at all times they live. Much progress to ensure that services • Adapt to a growing and has been made, but are developed in the best ageing population significant challenges and way for patients, and that opportunities lie ahead. the approach we take is • Make patients and carers efficient and cost-effective. our partners Healthcare is advancing • Work more closely with at great speed. At the We will work with patients, our other partners, including same time, our population carers and everyone local authorities and is growing and ageing, else with an interest in voluntary organisations and we are caring for Lothian’s health service • Be more efficient many more people with to get our direction and complex needs. The tough priorities right. economic climate also means we have to make This summary outlines our savings of £40 million a aims and issues and shows year, savings that we will what success could look reinvest into providing like. It is also an invitation new and expanded to get involved – we want services for patients. to hear as many views as possible to help shape our By preparing for the plans to deliver our health, challenges, and embracing our care and our future. the opportunities, NHS Lothian can bring tremendous improvements Tim Davison in care, and in the Chief Executive

2 Our Health, Our Care, Our Future We want everyone to enjoy longer and healthier lives at home, or somewhere homely.

OUR VISION We want everyone to enjoy longer and healthier lives at home, or somewhere homely. For this to happen, health and social care services must be fully joined up and work smoothly for patients.

Care must be of the highest quality and patients have to be involved in decisions that affect them. Patients and carers must be our partners in care. We need to do more, together, to prevent illness, anticipating patients’ changing needs and helping them to manage their own conditions.

Most care should be delivered at home, or as close to home as possible. When someone needs hospital treatment this will normally be for a day. Where a longer spell in hospital is needed, we will get patients home, or somewhere homely, as soon as they are ready.

NHS Lothian also needs the right technology, buildings, equipment and skilled staff. Our systems must be reliable, sustainable and efficient, supporting patients on a care pathway that is timely, safe, evidence-based and ensures they have the most positive experience possible.

Our Health, Our Care, Our Future 3 CHALLENGES Our NHS has to adapt to early on. Cancer and LOTHIAN’S POPULATION the needs of a population dementia are on the rise, that is larger, older as are serious health 2010 and has more complex problems like type 2 conditions than ever. diabetes. We must tackle 836,711 the causes of ill health The older we get the more like obesity, poor diet long-term conditions we and limited physical 2025 tend to have. For over 65s activity, smoking and 965,007 the average is two, and over excessive alcohol. INCREASE 75s it’s three plus. Older people also tend to be Money is also a great 15% admitted to hospital more challenge. Right now we often and for longer. We have to find £40 million need to do more to prevent in savings a year to AGED OVER 65 avoidable admissions and to reinvest in our services, rehabilitate patients quickly. then find more money 2010 for some of the more 124,313 People who are poor or expensive investments disadvantaged often have proposed in our plan. This poorer health. Tackling will mean we have to stop 2025 health inequalities is a doing some things, and 175,631 fundamental challenge. do other things differently We need to find ways to make sure we use our INCREASE to reduce ill health and resources where they provide effective help deliver greatest benefit. 30%

EFFICIENCY SAVINGS – HELPING TO BALANCE THE BUDGET 65-74 74-84 85+ 9.2% 6.2% 2.8%

SPENDING Prevention UPLIFT INCOME UPLIFT Pay costs £16.7m Medicines £17.7m Budget uplift £31.6M Increased capacity £17.6m Efficiency savings Developments £9.4m £37.3M Other £7.5m

TOTAL £68.9M TOTAL £68.9M Obesity, poor diet and limited physical activity, smoking and excessive alcohol NHS Lothian base budget £1,141m

4 Our Health, Our Care, Our Future Our strategy needs to be based on a clear vision and everything needs to be measurable. This is what we think success should look like:

OPPORTUNITIES More GP and community-based care We have tremendous opportunities to improve health and reduce costs by preventing illness and providing care at an Integrated health early stage and in the community. Services can and social care be redesigned, putting the patient first. This will be part of wider change that sees NHS professionals, local authorities, the voluntary Greater safety in all healthcare environments sector, patients and carers as partners in care.

Different groups within the NHS often work in an isolated way – much can be achieved by getting Better emergency care everyone with a role in a patient’s care working much more closely together. The way staff work, and the skills they have, is of huge importance. Improved approach to There are opportunities to make sure services multiple and chronic illness are available more flexibly to meet needs. Some services that are currently only available in Involving people in their hospital can also be provided in the community care to improve services or at home.

Some buildings are old and no longer fit for Adapting purpose. This gives us the chance to create the workforce new, purpose-built specialist centres on some sites and to dispose of others. IT and web-based Innovating to raise quality technologies can speed up services, making them and spend money where more accessible and cutting administration. it can deliver the greatest benefit to patients

NHS Lothian will encourage its values of quality, Higher efficiency dignity and respect, care and compassion, and productivity openness, honesty, responsibility and teamwork in all it does. We will also encourage staff to be Care pathways (a patient’s innovators and believe there are opportunities care journey through the to improve leadership, ensuring that staff at all NHS) that deliver what levels are clear about their responsibilities to matters to patients patients and colleagues.

Our Health, Our Care, Our Future 5 People in Lothian’s wealthiest areas can expect to live 21 years longer than those in the most deprived communities.

LIFELONG CARE The NHS is here to provide care at all stages of life. Our draft plan outlines how we will do this.

Children and young people: Services for children and young people are to be improved. More health visitors and school nurses will be recruited and we will implement the Children’s Bill so there is a named person responsible for every child aged 0-5.

Preventing illness: We aim to help prevent or delay the onset of illness by tackling the underlying causes, such as smoking, obesity and overuse of alcohol. This will be done by strengthening healthy lifestyle initiatives and working with the most vulnerable.

Health inequality: Your chances of becoming ill are closely linked to factors such as levels of deprivation, race, disability and gender. We will work with local authorities and other partners to reduce poverty, improve education and employment, and improve health and wellbeing. We will target and tailor clinical services to those most in need.

6 Our Health, Our Care, Our Future Frail older people: Continuing care for older people needs to change so they can move smoothly between home, residential home and, when necessary, hospital. We propose a wider range of community services so fewer older people will need to go into our acute hospitals. This can be offered in residential homes, community hospitals or with support at home.

End of life care: When people near the end of their lives we want them to be in the place they wish to be cared for and, when practical, to die where they choose. Part of this involves making sure CARE CLOSE TO HOME that the care is available to avoid unnecessary emergency Some of our most far- Right care, right time: hospital admissions and we are reaching ideas involve Patients need to be sure developing plans to provide increasing the role and of a timely consultation better community-based capacity of GP and with an appropriate health palliative care. community services – care professional. They moving care away from should wait no more than hospitals and closer 48 hours for a non-urgent to home. appointment with a GP or practice nurse. Patients and More care at home: carers must also be involved By strengthening GP and in decision-making. community teams and involving patients more GP services: in the management of A review is needed of GP their own health, we can and practice staff numbers deal with problems earlier and whether their premises and reduce the need are suitable and located for hospital admissions. appropriately. There needs This can be especially to be an expansion in valuable for improving primary care premises and services for patients with workforce. More services conditions like diabetes should be available to and dementia. patients closer to home.

Our Health, Our Care, Our Future 7 Out of hours care: The Lothian Unscheduled Care Service (LUCS) will be reviewed as demands have increased Each year, there dramatically. LUCS provides care services ‘out of are over five million hours’, when GP practices are closed: overnight, at weekends and on public holidays. contacts with general practices... Care villages: We need new and better ways to offer residential care for older people that maximises their ...1.5 million with community independence and supports their needs. services and 136,000 with our out-of-hours general Dental health: medical service. We propose to improve dental and oral health by registering more children aged two years There are 127 GP practices in and under. Patients also need better access to Lothian supported by a total specialist dentistry. of 1,601 general practitioners.

5M GENERAL PRACTICE

1.5M COMMUNITY SERVICES

136,000 OUT-OF-HOURS GENERAL MEDICAL SERVICE

8 Our Health, Our Care, Our Future CARING FOR DIFFERENT NEEDS Chronic and long-term Learning disabilities: conditions: We aim to improve care Growing numbers of people for people with learning are living with one or more disabilities, autistic spectrum chronic long-term condition. disorders, and challenging Our goal is to help them to behaviour, by working with manage their own conditions local authorities to create a and to anticipate changes. community and residential This reduces the chances of support service. Together things going wrong, provides we plan to provide more care closer to home and cuts supported community care avoidable hospital admissions. and modernise residential care facilities for those who Ways we can do this include need them. joining up services for people with long term conditions such as chronic obstructive pulmonary disease (COPD). We are looking to develop combined telehealth and telecare solutions to support people to live as independently as possible and to involve and work with the voluntary sector.

Mental health services: Lothian’s mental health services are being transformed through the development of community and intensive home treatment teams which reduce the need for hospitalisation. Future work will further enhance community mental health facilities while modernising acute mental health facilities at the Royal Edinburgh Hospital.

Our Health, Our Care, Our Future 9 We are looking at the best locations for providing hospital services and how to ensure we have the right staff, capacity and facilities.

Artist’s impression of new RHSC and DCN, to open in 2017.

OUR HOSPITALS

We are looking at the best Royal Hospital for Sick Children locations for providing hospital (RHSC): services and how to ensure we A new, replacement, children’s have the right staff and facilities. hospital is being built at the RIE We will cut waiting times and site and will open in 2017 review outpatient services and acute inpatient services. Royal Infirmary of Edinburgh (RIE): A great deal of change is planned, Expanded acute receiving with the development of many sites and assessment capacity and and the disposal of those that are a specialist centre for clinical underused, unoccupied or in the neurosciences wrong place. Western General Hospital (WGH): A new regional cancer centre and Key proposals include: improvements to emergency care Royal Edinburgh Hospital (REH): Phased redevelopment with St John’s Hospital, Livingston purpose-built facilities for mental (SJH): health care Increase day surgery capacity.

10 Our Health, Our Care, Our Future Our Health, Our Care, Our Future 10 We will also: • Review the model for dermatology services EACH YEAR: • Concentrate inpatient orthopaedics and trauma at RIE • Focus stroke services at either the RIE or WGH and SJH • Redevelop ophthalmology services at RIE, WGH, SJH or Lauriston Building • Create more day surgery facilities at WGH and/or SJH 1M • Develop more convenient, safe and innovative OUTPATIENTS alternatives to routine outpatient attendance and follow-up.

We also plan: • A new East Lothian Community Hospital. More residents could be treated locally along with purpose-designed care for older people, to prevent inappropriate admission to, and allow earlier discharge from, acute hospitals in Edinburgh. • To adapt Midlothian Community Hospital to 240,000 ATTEND A&E better serve the local population. This will include purpose-designed care for older people.

Hospital stays: Most hospital care, to access the specialist assessment and treatment which only acute hospitals can provide, should be on an outpatient or day patient basis. For those patients requiring longer stays, we want to speed up assessments and diagnostic tests so that more than 80% can leave within 48 hours. 100,000 INPATIENTS Too many patients still have to remain in hospital because there is nowhere else suitable for them to go. We want to reduce these delayed discharges to a maximum of two weeks by April 2015 and then to eliminate them completely.

Emergency care: Our emergency care system is under pressure, with very large numbers of patients arriving in our emergency departments. Many people are waiting 100,000 too long. Change is needed so that emergency PLANNED SURGICAL departments can provide quality care for those with INTERVENTIONS life-threatening conditions and so that other patients are treated in a more appropriate setting.

Our Health, Our Care, Our Future 11 PUTTING Some of the main ways we • Integrated care and support PATIENTS FIRST will improve the patient’s that promote independence, experience are: and wellbeing The needs of patients • Making it easier to access • Whole system pathways must come first. We are community care and GP teams which recognise people’s redesigning services so • Ensuring health and social multiple conditions the priority is on the care professionals work • Reducing health inequalities patient’s journey of together care through the NHS through specific health actions and social care services, • Greater safety, for example and supporting wider actions ensuring quality of care by helping prevent falls with community planning and giving them the and with better medicines partners most positive experience. management • Using research and innovation • Giving people more control to improve care for people over their conditions with multiple conditions.

2014 2024 CURRENT SYSTEM FUTURE SYSTEM

 GEARED TOWARDS ACUTE DESIGNED AROUND PEOPLE WITH / SINGLE CONDITION MULTIPLE CONDITIONS

HOSPITAL-CENTRED LOCATED IN LOCAL COMMUNITIES AND THEIR ASSETS

DOCTOR DEPENDENT MULTI-PROFESSIONAL AND TEAM-BASED CARE

EPISODIC CARE CONTINUOUS CARE AND SUPPORT WHEN NEEDED

DISJOINTED CARE COORDINATED AND INTEGRATED HEALTH AND CARE

REACTIVE CARE PREVENTIVE AND ANTICIPATORY CARE

PATIENT AS PASSIVE RECIPIENT INFORMED, EMPOWERED PATIENTS AND CLIENTS

SELF-CARE INFREQUENT SELF-MANAGEMENT / SELF-DIRECTED SUPPORT

CARERS UNDERVALUED CARERS ARE SUPPORTED AS FULL PARTNERS

LOW TECH TECHNOLOGY ENABLES CHOICE AND CONTROL

12 Our Health, Our Care, Our Future MAKING SERVICES WORK FOR YOU Four names will become very familiar to NHS Lothian staff and partners as we redesign services to put patients first. Callum, Hannah, Scott and Sophie represent patients of different ages, lifestyles and backgrounds with all the same healthcare needs as the rest of us. One way we put patients first is by planning service changes on the basis of how it would benefit each of them.

Callum Scott Adult patient between Patient aged 16 to 55 years of age Hannah over 74 Adult patient aged between 16 and 74

Sophie Child patient aged under 16

Frail Anxiety Long term Diabetes conditions Depression COPD Not specific Alcohol or May have a long Heart Failure diagnosis Drug misuse term condition

49% 7% 5% 11% OF PEOPLE IN LOTHIAN ARE OF PEOPLE IN LOTHIAN ARE OF PEOPLE IN LOTHIAN ARE OF PEOPLE IN LOTHIAN ARE IN THIS PATIENT GROUP IN THIS PATIENT GROUP IN THIS PATIENT GROUP IN THIS PATIENT GROUP = = = USES PRIMARY CARE AND SPECIALIST COMMUNITY 11% CARE SERVICES, MAY ATTEND 56% 33% A&E AND RECEIVE A RANGE OF THE A&E ADULT PATIENTS OF THE A&E ADULT PATIENTS OF THE A&E ADULT PATIENTS OF LOCAL AUTHORITY AND ADMISSION EACH YEAR. ADMISSION EACH YEAR. ADMISSION EACH YEAR. VOLUNTARY SECTOR SERVICES.

Our Health, Our Care, Our Future 13 BRINGING CHANGE The people who care for you: We need to ensure that the with all who need it – Our workforce is changing right services are available including patients. to better meet the needs of seven days of the week and patients. Many healthcare at all times of day. We will New partnerships: professionals are learning work with staff to find ways Better healthcare means extra skills – this breaks down of changing and extending working in partnership. barriers and allows the most working hours, and increasing By April 2015 we will have specialised staff to concentrate productivity, while being a Health and Social Care on the most complex work. family-friendly employer. Partnerships fully up and running for Edinburgh, West In future we want more Respect and compassion Lothian, Midlothian and East specialists who are normally for patients and colleagues Lothian. These will bring based in hospital going out is fundamental. Our draft together NHS Lothian with into the community. We can strategic plan highlights local authorities, communities also make consultations easier the need for all staff to be and other stakeholders to with telehealth and telecare. clear about the values and provide or commission the behaviour expected of them. services needed in their areas. It is increasingly difficult Equally, NHS Lothian will make to recruit enough doctors sure that staff are included in Finance: in certain areas, such as decisions that affect them. We need to create £400 emergency medicine, million in efficiency savings paediatrics and smaller Better IT: over the next 10 years while surgical specialities and some We need to improve the way pushing care standards specialised services are too we use IT systems to speed up and meeting growing small to provide the best up service and improve safety. demand. Investment choices outcomes for patients. Where We must become “paper will be based on healthcare this happens we will assure light” so information is needs, safe and seamless the highest standards by shared electronically, securely, service models, and our concentrating them together. accurately and immediately ability to raise productivity.

14 Our Health, Our Care, Our Future Artist’s impression of new REH.

We must become “paper Efficiency and our decision-making, innovation must be assessing plans to ensure light” so information is core building blocks for they are safe, effective, shared electronically, a sustainable financial person-centred, timely, future. We will become effective and efficient. securely, accurately and more efficient by: immediately with all who • Benchmarking services Property: need it – including patients. by comparing with the Our strategy has best and striving for been to determine improvement how best to use our • Reducing unnecessary largest hospital sites variation in clinical by commissioning practice and outcomes masterplans to • Using any major shape their future change to improve development. Some cost effectiveness of our smaller older sites will no longer be • Encouraging the needed, while others public to become are proposed for involved in their redevelopment with our health care decisions local authority partners and help reduce to provide innovative avoidable demand. new facilities for older We have identified people and others with proposed criteria for longer term care needs.

Our Health, Our Care, Our Future 15 OUR QUESTIONS TO YOU

This consultation is all about getting as many views as What next possible on our draft strategic plan. These will all be taken into account before the plan is finally agreed. MAY TO AUGUST 2014 Below are some questions we would particularly like Meetings with patient people to consider. groups, staff, independent contractors, partnerships, • Does this plan address the most important issues? Councils, Scottish • Have we missed anything really significant? If so what? Government and other • Is there anything else you would like to tell us before stakeholders to analyse finalising our Strategic Plan? patient pathways, consider options and develop You are not limited to answering these questions, specific proposals. so please feel free to raise any points you feel are important about the Strategic Plan. AUGUST TO SEPTEMBER Feedback from the Further information consultation is incorporated If you would like fuller details on our thinking and our into the plan. proposals you will find the full draft Strategic Plan on our website www.nhslothian.scot.nhs.uk OCTOBER NHS Lothian Board to Many parts of our draft are developed from other NHS approve final Strategic Plan. Lothian, or Scottish Government plans and strategies. These are detailed in the full draft strategy and are also available on our website should you wish to read them. TO GET THIS BOOKLET To request a paper copy please contact 0131 465 5548 IN ANOTHER LANGUAGE or e-mail [email protected] OR FORMAT

Having your say e.g. large print, please To take part in this consultation you can complete call the Interpretation and the on-line questionnaire at www.nhslothian.scot.nhs.uk Translation Service (ITS) on /OurOrganisation/OurHealthOurCareOurFuture 0131 242 8181 and quote reference number 14-0042 e-mail us at: [email protected] or write to: Professor Alex McMahon Director of Strategic Planning, Performance Reporting and Information, NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG.

The consultation period runs until 8th August 2014.

16 Our Health, Our Care, Our Future