Community Health and Care Partnership

NHS LOTHIAN DRAFT STRATEGIC PLAN 2014-2024 Meeting of OUR HEALTH, OUR CARE, OUR FUTURE 25 March 2014

REPORT BY HEAD OF HEALTH SERVICES Agenda Item [10]

SUMMARY

There have been many significant improvements in healthcare in NHS Lothian in recent times and NHS Lothian is committed to continuous improvement across all of its services. The Strategic Plan has been developed to describe what NHS Lothian proposes to do over the coming decade to address the challenges presented by the growing and ageing population living with increasing complex co-morbidities, recognising our workforce and financial resources are limited. Health and Care Partnerships are key vehicles for changing the way we deliver health and care, in line with the Scottish Government’s 2020 vision, and ensuring that systems of working and service delivery are fundamentally redesigned to improve population health, tackle health inequality, improve the quality of care and secure value and financial stability – the Triple Aim.

RECOMMENDATION

Board is recommended to: 1. Consider the context, challenges planning approach and propositions within NHS Lothian’s draft strategic plan, and the implications for the West Lothian Health and Care Partnerships Strategic Plan. 2. Advise on and support the process for engagement and consultation on the strategic direction and specific propositions so that the communication and engagement plan can maximise the contribution of individuals and organisations in West Lothian.

BACKGROUND 1. The purpose of this report is to advise the Community Health and Care Partnership of the development of the above strategic plan and provide an opportunity for partners to comment in advance of its consideration by NHS Lothian Board in April 2014.

1.1. Following the agreement of NHS Lothian’s Strategic Clinical Framework “our health our future” in February 2013 it was agreed that a comprehensive strategic plan for the delivery of health and healthcare in Lothian should be developed setting out the challenges to be addressed and the plans and propositions which are needed to achieve the aims of 1 the Strategic Clinical Framework.

The Framework and the developing strategic plan are consistent with the Government’s strategic narrative and vision for achieving sustainable quality in the delivery of healthcare services across . The vision is that by 2020:- x everyone is able to live longer, healthier lives at home, or in a homely setting x we will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self- management x when hospital treatment is required and cannot be provided in a community setting, day case treatment will be the norm x whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions x there will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

Aligned to the development of this plan will be the four integration plans describing how NHS Lothian will work with its four Council partners. These will be consulted on during 2014/15, with a view to the new Partnerships becoming operational in 2015.

These changes, which are expected to fully integrate primary care and community services with social care services are being progressed with the prime purpose of delivering improved health and care through changed ways of working at a pan Lothian, partnership, locality and neighbourhood level.

Integration therefore is an essential enabler, which will generate new dynamic creating different and exciting opportunities for NHS Lothian and its partners to realise their joint outcomes.

1.2 Today’s and tomorrow’s challenges Unless we fundamentally change the ways we currently work and organise our services, we will not be able to deliver high quality care and we will fail the population we are here to serve.

The strategic plan has been developed to recognise and address the principal challenges which must be addressed over the next 10 years. These include: x an overall population growth in Lothian of 15% from 2010 to 2025 (12.3% from 172,080 to 193,345 in West Lothian) 2010 GRO estimates x increasing incidence and prevalence of certain diseases, including diabetes, dementia, cancer

2 x lower rates of health improvement in our poorer communities where people continue to die younger and live less healthy lives resulting in a continuing health inequalities gap x increasing number of people living with more than one long term condition, and many with complex co-morbidities x Our aging workforce, limited availability of some staff groups and skill sets , and the need to develop staff skills more effectively within a more integrated health and social care workforce x Limited public resources with the expectation that real terms growth in public spending will not return to 2009/10 levels until at least 2025, coupled with need to rebalance investment from hospital to community services and consider areas for disinvestment.

1.3 Transforming our Services –Putting Patients at the Centre of Our Plans For a long time we have planned the way we deliver health and care services separately in different parts of our system (primary care, acute care, local councils). We have also tended to plan around buildings, or around individual services.

What is proposed is a radical shift away from this ‘traditional’ approach to a patient-centred, whole-system approach, focussing much more explicitly on the needs of people who use NHS Lothian’s services.

This plan is predicated on the need for radical redesign to deliver sustainable improvements in health and care services in Lothian. A central tenet of service redesign is to focus on the patients’ journey and experience, to help identify where service improvements are necessary and to involve a wide range of service users and providers in analysing and redesigning improved patient pathways.

Using intelligence and evidence, we have identified representative patients with varying degrees of care needs: we have called these patients Callum, Hannah, Scott and Sophie. We will use these patients as examples to illustrate their pathways of care, understand their care needs, how their care needs are currently being met and agree how these can be met more effectively and efficiently in radically different ways. This is being conducted through a designed and managed process of engagement during 2014 and will inform large and significant parts of the final plan.

Urgent service redesign work is currently required, some is ongoing and will continue, in order to allow us to meet the most pressing and immediate challenges that we face. However, alongside that, patient focused workstreams will be initiated with the aim of redesigning healthcare across whole pathways during 2014.

1.4 Lothian’s Vision for the Future 3 Current System Future System Geared towards acute / single Designed around people with 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 The plan will describe what NHS Lothian intends to do over the coming decade to address these challenges and provide a high quality and sustainable healthcare system for its citizens. It will do this through new ways of working by its staff, as well as by working differently with its key partners through the four councils, the third sector and with patients and carers.

A wide range of propositions has been developed and will be debated and firmed up through consultation and engagement over the coming months; many of these are essential in order to deliver the 2020 Vision, including the following: x a radical shift away from a traditional, incremental approach to development based on services and specialties to a patient-centred, whole-system, pathways approach, focussing much more explicitly on the needs and experiences of people who use NHS Lothian’s services; x pursue the ten safety essentials and nine point of care priorities in the Scottish Patient Safety Programme, across primary care, mental health, maternity and acute care x improving services for the significant, and growing, number of people with multiple conditions, by developing and delivering Lothian’s multimorbidity action plan, in concert with the national programme 4 x integrating care delivery around the needs of patients, through closer interdependence and integration of community and hospital based services and across the public sector, through the establishment of Health and Social Care Partnerships in 2015 for , West Lothian, and East Lothian, in accordance with Government legislation; x improving access to primary care, through an increase in the number and capacity of general practices and community teams to meet increased demand arising from the population growth, extended life expectancy and the consequent increase in multi-morbidities; develop primary care premises, wherever possible, as integral parts of multipurpose facilities providing health, social care, voluntary and other community-based services; develop a Lothian-wide approach to sharing and benchmarking of primary care information at general practice and partnership level; x urgently reduce to a maximum of 2 weeks by April 2015 and eventually eliminate altogether delays in patients’ discharge from hospitals; x improving the care for older people by adapting and modernising the role of all current continuing care provision across Lothian to create a seamless spectrum of care from Hospital Based Complex Clinical Care through to residential home care; x improving arrangements for the residential care of older people, including assessment of the potential for the creation of a new ‘care village’ concept on the Royal Victoria Hospital and sites, replacing old and out of date non-acute hospital facilities with new purpose-built facilities; x developing a new East Lothian Community Hospital and adapting the use of Midlothian Community Hospital, to provide ‘step up’ and ‘step down’ care for older people, to prevent inappropriate admission to acute hospitals in Edinburgh and to provide a wide range of community services for people closer to home; x continuing to develop community mental health services to better support people at home, and to modernise acute mental health services by redeveloping the , with phase one expected to be complete by 2016; x delivering a wide range of improvements in children’s services, including the construction of a new Royal Hospital for Sick Children on the Royal Infirmary of Edinburgh campus, with completion expected by 2017; x Developing new facilities for the Regional Cancer Centre, fit for the 21st century, at the , and integrating within a patient pathway designed to keep patients as close to home for treatment as possible; x revising the model of emergency care at the Western General Hospital to improve the quality of service and the experience for patients and

5 staff, and which is sustainable; to expand acute receiving and assessment capacity at the Royal Infirmary of Edinburgh to meet the growing demand for more generalist services that can respond to the needs of older, frailer patients, the quality and sustainability of specialist hospital services, through a new configuration often with multiple conditions and many with dementia;

x improving acute inpatient services at the Royal Infirmary of Edinburgh, Western General Hospital and St John’s Hospital, Livingston, including the development of a specialist clinical neurosciences centre at RIE and consideration of development of facilities to ensure quality, efficiency and sustainability of service provision, recognising the need for sufficient capacity to meet current and future demand within access targets. Dermatology in-patients, acute stroke in Edinburgh and day case surgery for high volume specialties e.g. ophthalmology and orthopaedics are specific areas.

x improving patient services by widening the scope and scale of operative procedures undertaken on a day case basis and designing day surgery facilities for construction at WGH and/or SJH;

x radically reviewing the future requirement for outpatient services and introducing more convenient, safe and appropriate alternatives to routine outpatient attendance and follow-up. 1.5 Specialty Configuration and Site ‘Masterplanning’ NHS Lothian has too many hospital buildings which are not fit for purpose and we need to review the future use of all our sites, ensuring that those retained are fit for purpose and, together with any new developments, are able to meet future demand and deliver high quality healthcare in the 21st century.

We remain committed to retaining our four acute sites: the Royal Infirmary of Edinburgh, the Western General Hospital, St John’s Hospital and the Royal Edinburgh Hospital. Work is well advanced to reprovide the Royal Hospital for Sick Children and dept of clinical neurosciences adjacent to RIE by 2017.

We will be exploring options to improve the quality and safety of hospital facilities by reproviding complex care beds from Hospital and in upgraded accommodation at the Royal Victoria Hospital in the short term. With Edinburgh Council we will explore the future role of the Royal Victoria Hospital and of Liberton Hospital to meet the care needs of older people.

1.6 Making it Happen: Delivering the Changes Our culture, how we work together, making best use of the health and care workforce, and developing our organisational ability to redesign and innovate, including using technology will be crucial to achieving our objectives. Our financial assumptions include the generation of circa £40m of efficiency savings each year to fund the changes we need to make. Other specific actions include:

6 x Modernise and train the workforce, reflecting efficient and innovative use of knowledge and skills and challenging outmoded systems of working. x Consider with partner service providers and education providers how to develop how to develop the health and care workforce we need x Identify and deliver a minimum of 3% efficiency savings over each of the next 10 years to allow investment in the new service models and fit for purpose facilities. x Work with partners to identify and drive forward opportunities for more efficient delivery of corporate services through a shared service approach. x Create specific initiatives to develop medical and other clinical leadership arrangements that facilitate the engagement of frontline staff in the processes of managing change x Make optimum use of managed clinical networks and other organisations to engage with citizens and to focus attention of services on patient-centred priorities and pathway redesign x Make full use of new technologies e.g. telehealth/telecare and other digital systems such as paperless processes to enable service modernisation and efficiency improvements. x Drive forward the innovation agenda by developing a culture of innovation across the whole organisation focus on delivering against our key challenges to improve quality, efficiency and productivity. x Implement NHS Lothian’s values and use these as the cornerstone of our organisational development plan to drive the positive culture changes we need.

2. Consultations The NHS Lothian Strategic Plan sets out the intended direction of travel for the redesign and transformation of health, healthcare and care more generally in the Lothian area. Public consultation on specific proposals will take place in accordance with NHS Lothian’s duty to involve, engage and consult on service change. A wide public and stakeholder communication and engagement process is planned following formal approval of the consultation draft. Many propositions will also have implications for staff and staff partnership input to the development of the strategic plan has been essential.

3. Conclusions The final version of this strategic plan will be presented to NHS Lothian Board for approval on 2 April 2014. The further development of the components of the plan will take place during 2014, alongside the drafting of strategic commissioning plans by the Health and Social Care partnerships which are expected to be established by statute in Spring 7 2015. It will be essential that the strategic ambitions of NHS Lothian and that of statutory and other community planning partners are aligned if the required shift to a whole system, person centred approach to health and healthcare is to be achieved and the national 2020 vision delivered for the population of Lothian.

PREVIOUS CONSIDERATION BY THE BOARD

None.

IMPLICATIONS

The Health and Social Care partnership through the Joint Director has been involved in the development of the plan. The partnership has a key role in the consultation and engagement on the plan, and in designing and delivering the changes needed to achieve its outcomes.

Equality/Health The NHS Lothian draft health inequalities plan will be issued for consultation along with the Strategic Plan.

Financial/Resource Make best use of limited NHS, Council and other agencies resources.

Legal Public Bodies (Joint Working Scotland) Act.

REFERENCES

None.

APPENDICES

None.

CONTACT/DATE OF REPORT

Libby Tait, Associate Director, Modernisation, NHS Lothian [email protected]

25 March 2014

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