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

Workstream

Hospital

NHSL Lothian Hospitals Plan

Workstream plan

Efficiency plan focussed on optimal performance

Clinical Horizon Scan

Quality Improvement

Plan DCAQ

Site Options Plan

Capital plan Timetable for

implementation

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 done

Finalising the case

Moving to implementation Implementing Complete

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

– Linear Accelerator Capacity

20

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

done

Finalising the

case

Moving to

implementation

Implementing Complete

Medical

specialties

Liberton PAEP RHSC/DCN

Elective

options

Outpatients

Building

Major Trauma REH 1 and 2

Elective

centres

Mortuary Elective Ortho Learning

Disability

Redesign

Regional

Infectious

Diseases Unit

WGH Critical

Care

Labs automation SJH Ward 20

Edinburgh

Cancer Centre

Robotics Linear

Accelerator

Capacity

RIE Stroke

Unit

Individual

Hospital Plans

SJH

Theatres 25

As at end March 2017

Work to be done Finalising the case Moving to

implementation

Implementing Complete

(new projects) ECC Elective centres

(including SJH

capacity)

PAEP RHSC/DCN

RIDU Elective options Major Trauma REH phase 1

Mortuary Elective ortho SJH Ward 20

WGH Critical Care Linear Accelerator

Capacity

RIE Stroke Unit

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 and Acute – unscheduled care, delayed discharges, older people, chronic disease

•What is the IP configuration?

•What do IJB Strategic Plans and directions indicate?

Medical specialties

•Workforce

•Capital builds

•Revenue

•Space created/used

RIE/WGH •Edinburgh Cancer Centre

•RIDU

•SJH Elective Centre

•Et cetera

WGH and SJH

IJB directs NHSL

Responds

NHSL

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