LEEDS TEACHING HOSPITALS NHS TRUST Division of Diagnostic and Therapeutic Services

WRITING A BUSINESS CASE FOR AN IR SERVICE BRIAN GODFREY DIVISIONAL GENERAL MANAGER DIAGNOSTIC & THERAPEUTICS DIVISION

LEEDS TEACHING HOSPITALS NHS TRUST  2,200 Beds  Two Large Acute Hospitals  3 Peripheral Hospitals  Range of Off-Site Facilities  260k Inpatients and Day Cases Per Year

DIAGNOSTICS & THERAPUETICS DIVISION Pathology 850 Radiology 500 Pharmacy 500 Medical Illustration 30 Infection Prevention 20 1,900 wte Annual Budget£100M

Radiology Directorate Full Range of Imaging Modalities inc PET-CT 5 Sites - 11 Locations 500 wte 56 Consultants 11Vascular / Neuro Interventionists 24/7 Intervention Service 2 Main acute sites

Background  Two former Trusts competing for services in one city  Duplication of services  Merger  Strategy of centralisation of clinical services. SOC withdrawn  Emergence of two complimentary acute hospitals  Trauma established at LGI  Vascular at LGI

Drivers for Change  Clinical Reconfiguration Strategy  Ageing equipment  Serious Untoward Incidents  Technological advances in interventional devices – neuro coiling  Medicines & Healthcare Products Regulatory Agency  Reduce vascular surgery “open” procedures

Drivers for Change  Abdominal Aortic Aneurysm Screening Programme  Vascular Services Review – Y&H SHA  Potential for new income streams  Patient Choice  Need to plan diagnostic services to support the Clinical Reconfiguration

Interventional Radiology  Full range of diagnostic and treatment procedures  Business cases concerned with Neuro and Vascular Intervention  11 specialised consultants – working city –wide on-call on two sites  Trained radiographers and nurses

Planning the Development  Involve the Experts – Clinical Lead  Structured Planning Programme  Dedicated Planner  Multi – Discipline Approach inc Surgery  Understand the Pathway  Recognise joint MDT, M&M and Clinics  Scope the activity – Acutes / Electives

Benefits  Minimal Invasive Therapies - reduce infection rates - reduce recovery time - shorter LOS  Alternative to open procedures - Patient choice  Safety – Compliance with guidance etc  Develop Service  Robust Equipment

Contents of the Business Case  Background  Strategic Fit  Impact on Activity and Case for Demand  Patient Pathway and Risk Management  Finance -Capital Ancillary Equipment Revenue Risk and Return on Investment

Contents of the Business Case  Current Performance of the Directorate  Other Impacts of the Case  Summary of Options  Preferred Option  Risks  Deliver Method  Recommendation

Design  Consulting Rooms  Waiting Area – booking in etc  Theatre Quality  Anaesthetic Rooms  Compliance with NHRA, SHA  Recovery Area / Day Case  Changing Accommodation

Lessons Learned  Understand the Pathway  Responsibility for the Pathway  Involvement of surgeons and bed holding specialties, Radiographers and Nurses  Junior Doctor support  Co-location of services  Agree Income Streams  Stent 10k  Coil 7k  Return on investment  Patience – Two phase approach  Governance - Joint MDTs with surgeons - Audit and Joint M&M meetings

Lessons Learned  Plan for both Acute and Elective cases  Dedicated Planner  Networks  Comprehensive 24hr service  Compliance with statutory agencies etc.

And Finally  The case for investment should reflect the service need  ‘Prepare the Ground’  TeamWork  Viability  Review and Audit