1. Shared Laboratory Services
IBMS
Right test
Right place
Right time
Laboratory
Services
Efficient
Effective
Equitable
Resilient
Affordable

4. 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

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

6. Realising the Potential
Once for Scotland?
Best for
Scotland?

7. 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

8. 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

9. 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

10. BIG RED SHED?

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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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.

18. 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

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

20. Laboratory medicine underpins healthcare delivery
“ %* 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

21. 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

22. 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.

24. 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)”

25. 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

26. 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

27. Too Difficult?
Challenging Scottish Geography

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

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

30. 1st Workshop 15th Sept

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

32. 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