Shared Laboratory Services IBMS 26-11-16 Right test Right place Right time Laboratory Services Efficient Effective Equitable Resilient Affordable

Technology & Innovation Service Sustainability Drivers of change Once for Scotland New models of care Increasing Demand Rising Expectations Technology & Innovation Service Sustainability Quality & Safety Health & Social Care integration The Big Conversation: Beyond 2020 Health & Social Care Integration Resource constraints: Financial and Workforce Resource Constraints: Financial and Workforce

Scotland in Numbers 1 Nation 5.25 million People 14 Territorial Boards 7 Special Boards 32 Local Authorities 31 Integration Joint Boards

Realising the Potential Once for Scotland? Best for Scotland?

Defining the future landscape Shared Services Strategic direction 2020 and beyond Doing what is right & doing it safely! “coherent, comprehensive and sustainable high quality services” Increased 1° care focus Value, waste, variation outcomes, innovation

SHARED SERVICES Services in Scope Business Intelligence Finance HR Laboratories Procurement eHealth Fleet & Logistics Public Health Aseptic Dispensing Radiology Medical Physics Hard FM Soft FM Capital Planning Sterile Services

EXECUTIVE LEADERSHIP SUPPORT Chief Executives have agreed: To secure buy-in and support participation and engagement at Board level To support the development of an ambitious future vision for Shared Services which explores the potential to develop national, integrated solutions Ambitious solutions should be developed as part of an options appraisal against agreed guiding principles and presented in a business case which demonstrates both the costs and benefits of each option All existing programmes will migrate to the new governance structure, reconfiguring existing governance and reporting arrangements To make resources available to support the work of the portfolio going forward

BIG RED SHED?

SHARED SERVICES Expectations Improved efficiency Savings Cost avoidance Sustainability Reduced variation Enhanced quality Reduced Inequity

There is ambition to do more in all areas Lagging Leading Public Health eHealth Procurement Soft FM HR Hard FM Fleet Mgmt Pharmacy Business Int Finance Labs Radiology Where are you Where does your programme go Where should you be 2 3

There is ambition to do more in all areas Lagging Leading Public Health 1 eHealth Procurement Soft FM HR Hard FM Fleet Mgmt Pharmacy Business Int Finance Labs Radiology Where are you Where does your programme go Where should you be 2 3

There is ambition to do more in all areas Lagging Leading Public Health 3 1 eHealth Procurement Soft FM HR Hard FM Fleet Mgmt Pharmacy Business Int Finance Labs Radiology Where are you Where does your programme go Where should you be 2 3

There is ambition to do more in all areas Lagging Leading Public Health 3 1 2 eHealth Procurement Soft FM HR Hard FM Fleet Mgmt Pharmacy Business Int Finance Labs Radiology Where are you Where does your programme go Where should you be 2 3

There is ambition to do more in all areas Lagging Leading Public Health eHealth Procurement Soft FM HR Hard FM Fleet Mgmt Pharmacy 3 1 2 Business Int Finance Labs Radiology Where are you Where does your programme go Where should you be 2 3

Making the future happen Far greater opportunities exist for systems that want to be ambitious There is scope for new approaches that consider the whole pathway together with Laboratory medicine Systematic collaboration between sites will deliver greater benefits than consolidation far greater opportunities exist for systems that want to be ambitious there is scope for new approaches that consider the whole pathway together with Laboratory medicine systematic collaboration between sites will deliver greater benefits than consolidation investing in developing models of care that take advantage of what is available need for better supported IT that is interoperable so patients and other institutions can easily access data (the ability to store, retrieve and analyse data will become increasingly important) None of these changes can be delivered without a highly skilled and effective workforce.

SHARED SERVICES Planning & Performance Framework The primary focus for planning and service delivery is at Board level Boards are held to account for the achievement of local service delivery targets A national or regional approach tends to be focussed on small highly-specialised services – often where services are no longer sustainable locally The relationship between the Scottish Government and Boards needs to change to drive the development of shared services in a proactive rather than reactive way The performance framework needs to incentivise a “Once for Scotland” approach? National Regional Multi-Board BOARD Hospital Community Patient

Business Case Approach Strategic Outline Case, Laboratories Full Business Case Implementation Talk to Claire about this slide We are here

Laboratory medicine underpins healthcare delivery “70 - 80%* of clinical medicine decision making is predicated upon, or confirmed by, or documented by medical laboratory test results” Impacts of diagnostic services are whole system, therefore our thinking about these services and consequences of change to them should be whole system! *Report of the Review of NHS Pathology Services in England Chaired by Lord Carter of Coles Pathology Quality Assurance Review. Chaired by I Barnes Report 2014 Dighe, A. S. Medicolegal liability in laboratory medicine, Semin Diagn Pathol, 2007;24:98-107 22

Future state? Users Provider Interface and infrastructure that: - delivers what is needed by the users supports efficient, appropriate and effective use and delivery of diagnostics hides from the user the organisational complexity of the provider Clinical services Efficient Effective Equitable Resilient Affordable Laboratory services Efficient Effective Equitable Resilient Affordable Users Provider

Present state Users Providers Users Interface Diagnostics \Providers Users Providers Users Complex environment with many drivers for change. Patient/pathway focussed. Variation in practice Changing user base accessing complex services Silos Providers 20 ologies! Highly complex with many silos. Massive capabilities. Rapidly evolving technologies. Analytical Information, data and knowledge management. Demand led. Many pressures on services. Seen as cost centres rather than value centres.

Towards a future state: shared services More than just centralisation or consolidation of similar activities in one location Right test Right place Right time The convergence and streamlining of an organisation or organisations functions to ensure that they deliver the services required of them as effectively as possible. More than just centralisation or consolidation of similar activities in one location, Shared Services mean delivering services to customers at a cost, of a quality and timeliness that is competitive with alternatives.’ (Scottish Government Shared Services Guidance, 2011)”

Key Drivers Robust & future proof Lean process driven Safe accurate effective Correct distribution of service Cross discipline working Knowledge & skills utilisation Address silos Position future needs/growth of service and reasons. Opportunity for a total modernisation and transformation of the pathology service. New Solution to be Innovative and Affordable Key Drivers: Robust, Future Proof, LEAN process driven, Centralised service, Cross discipline working, skills re-profiling, Remove silos NHS Tayside challenged the marketplace wanting a pioneering solution Want the lab to be a colleague to the doctors and GPs it serves. Want the lab staff to be liaison not just testers, but offering help and advice to the client base. 27

Labs in Scotland PHI Map 1 Nation 5.25 million People 14 Territorial Boards 7 Special Boards 32 Local Authorities 31 Integration Joint Boards Slide to be replaced wih PHI slide

Too Difficult? Challenging Scottish Geography

Towards a better design Laboratory Services Efficient Effective Equitable Resilient Affordable Improved impact. Form follows function Future Local Board Regional National? Current

“If you always do what you always did, you will always get what you always got.” (A. Einstein). Time for some thinking!

1st Workshop 15th Sept

Towards a better design Shared Laboratory Services Efficient Effective Equitable Resilient Affordable Right test Right place Right time Future Board Regional National Current

Sustainable & Resilient Current Future Reduction of variation, waste and harm Equitable, effective with high impact, sustainable Equitable Efficient Effective & Safe Sustainable & Resilient Current Future Reduction of variation, waste and harm Equitable, effective with high impact, sustainable Spectrum of Development Across the Boards