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1 Nhs Lothian Draft Strategic Plan 2014-2024 Our Health

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1 Nhs Lothian Draft Strategic Plan 2014-2024 Our Health West Lothian 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 Scotland. 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 Edinburgh, West Lothian, Midlothian 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
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