Development of Lothian Hospitals Plan
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Development of Lothian Hospitals Plan Edinburgh Integrated Joint Board 11th March 2016 1 Agenda • Why a Lothian Hospitals Plan? • Architecture • Workstreams • The relationship between IJBs and “retained services” • Timescales and process 2 Why a Hospitals Plan? 3 Why a Hospitals Plan? • To set out how NHS Lothian’s specialist hospital services will respond to; – Changes in clinical treatment – Changes in demography – Financial challenges (£50m+in acute) – Workforce challenges – Estate challenges – Patient safety and quality improvement agenda 4 Why a Hospitals Plan? • Required – Integrated Joint Board schemes of establishment – Legislation – Our Health, Our Care, Our Future – NHS Scotland Clinical Strategy 5 Why a Hospitals Plan? • Good practice – Respond to IJB Strategic Plans and Directions – Capital and Revenue Planning – Workforce Planning – Organisational focus – make good decisions 6 Why a Hospitals Plan? • Changes to Scottish Capital Investment Manual – Requires the story to be told up-front with a strategic assessment – New national prioritisation tool 7 Principles • As discussed at SPC 10th December 2015 – All directions must be specific, measurable, achievable, realistic, and time-limited/defined; – All directions must have a clear focus on the outcomes to be achieved for citizens; – All directions must include clear evidence of how they deliver best value for the public; – All directions should consider how best to reduce variation across the current health board area; – Directions which have implications for acute hospital services should be explicitly referenced in the NHS Lothian Hospitals Plan. 8 Scope • Functions delegated to IJBs and delivered in NHSL hospitals – In the form of a delivery plan for IJB Directions • Specialist and tertiary acute hospital services – RIE, WGH, SJH, RHSC/DCN – Royal Edinburgh Hospital – Specialised Learning Disabilities Services 9 Architecture and process 10 Architecture NHSL Lothian Hospitals Plan Hospital Workstream plan Site Options Plan Quality Efficiency plan focussed Clinical Horizon Timetable for Improvement DCAQ Capital plan on optimal performance Scan implementation Workstream Plan 11 What will the outcome be? • Proposed site plans for each of our 4 sites – For consultation with IJBs and the public – Likely with options for each site • Capital, revenue, and workforce plans for each site (and hence the acute sector) • Clarity about how we will shift the balance of care • Clear response to IJB Strategic Plans 12 What will the outcome be? • Granular, robust, effectively-argued, consulted-upon and agreed plan for our acute and specialist services 13 Components • For each workstream • Conceptualization of the problem • Identification of objectives • Horizon scan for new technologies • Workforce profiling • Demand, Capacity, Activity, Queue • Benchmarking and understanding of optimal performance, best value • Patient safety consideration 14 Key milestones • Outline document to Board Development Day March 2016 • Reorganisation of Strategic Planning resource to support March 2016 • Workplan for each site – end May • Options development for each workstream to end November 16 • Site options developed December 16 • Consultation January-March 17 15 Process • Update to SPC at each meeting • Formal consultation will be undertaken on the draft Lothian plan • Annual cycle put in place to revise and update 16 Workstreams 17 Workstream stages Work to be Finalising the Moving to Complete done case implementation Implementing 18 Implementing • “We are in the implementation phase – plans clear and agreed, bricks and mortar, recruitment” • Royal Infirmary Campus and Bioquarter – RHSC/DCN • Royal Edinburgh Hospital – Phase 1 – Learning disability redesign • St John’s Hospital – Ward 20 additional capacity 19 Moving to implementation • “Intent is clear, options are being finalised, case is understood, but to be completed” • Royal Infirmary Campus and Bioquarter – Princess Alexandra Eye Pavilion – Major Trauma Centre – Elective Orthopaedics – Labs automation – Integrated Stroke Unit • Western General Hospital 20 – Linear Accelerator Capacity Finalising the case • “We have a rough idea of what we would like to do, but need to make sure the options are right” • Royal Infirmary Campus and Bioquarter – Liberton Hospital – Outpatients Building – Reprovision of mortuary • Western General Hospital – Critical Care expansion – Robotic Laprascopic surgery • St John’s Hospital – Expansion of theatre capacity 21 Finalising the case • All sites – How can we deliver a quantum improvement in delayed discharge performance and close inpatient beds as a result? – How can we reduce inpatient requirement generally? 22 Work to be done (1) • “We really should do something about that...” • Across RIE and WGH – Medical specialties distribution • Front door • Transitional care and rehabilitation, • quantum improvement in management of delayed discharges – Options appraisals for elective general surgery, urology, gynaecology • Western General Hospital – Regional Infectious Diseases Unit – Edinburgh Cancer Centre 23 Work to be done (2) • Across RIE, WGH, SJH – Elective centres concept – Frailty pathways • All sites – Bed bases – Financial plans – Quality improvement 24 As at end March 2016 Work to be Finalising the Moving to Implementing Complete done case implementation Medical Liberton PAEP RHSC/DCN specialties Elective Outpatients Major Trauma REH 1 and 2 options Building Elective Mortuary Elective Ortho Learning centres Disability Redesign Regional WGH Critical Labs automation SJH Ward 20 Infectious Care Diseases Unit Edinburgh Robotics Linear RIE Stroke Cancer Centre Accelerator Unit Capacity Individual SJH 25 Hospital Plans Theatres As at end March 2017 Work to be done Finalising the case Moving to Implementing Complete implementation (new projects) ECC Elective centres PAEP RHSC/DCN (including SJH capacity) RIDU Elective options Major Trauma REH phase 1 Mortuary Elective ortho SJH Ward 20 WGH Critical Care Linear Accelerator RIE Stroke Unit Capacity Labs Individual Hospital Plans LD Redesign Liberton Lothian Hospitals Plan OP Building Medical Specialties Robotics REH phase 2 26 The relationship between IJBs and “Retained Services”... 27 Relationship between IJBs and “retained services” • IJB expectations of NHSL will be contained in Directions • “Retained services” will also have expectations of IJBs... 28 Interdependency – the IJB perspective... •Key relationship between IJBs RIE/WGH •Edinburgh Cancer Centre and Acute – unscheduled care, •RIDU delayed discharges, older •SJH Elective Centre people, chronic disease •Workforce •Et cetera •What is the IP configuration? •Capital builds •What do IJB Strategic Plans •Revenue and directions indicate? •Space created/used Medical WGH and specialties SJH IJB directs NHSL NHSL Responds directs 29 “Retained” expectations of IJBs... • Delivery of 72-hour DD standard • Reduction in ED attendances • Reduction in UC admissions • Improvements in length of stay • Improvement in DNA rate • Supporting Realistic Medicine approach • ....amongst others... • ...are these clearly enough signalled in Strategic Plans? 30 Key questions? • Is the approach clear? • What is missing? • Is the plan ambitious – aggressive? – enough? • How will the Board manage the interdependency between IJBs and retained services? 31 Discussion 32 .