APPENDIX 3
Achieving Excellence – Completion of the Healthcare Strategy and
Moving to Implementation
1. Introduction
The NHS Board, meeting on 14th July 2016, agreed that the proposals contained
within the draft Healthcare Strategy Achieving Excellence should be shared with the
wider public and other stakeholders through a three month formal consultation
process. The consultation was launched on 2nd August and was concluded on 2nd
November 2016. The NHS Lanarkshire report on the outcomes from the consultation
process, and the Scottish Health Council’s review of the process itself are attached as
Appendix 1 and Appendix 2 respectively.
This paper sets out for the NHS Board these aspects of the stakeholder feedback from
the consultation which will be incorporated in a final version of Achieving
Excellence. From this, the process for the implementation of the healthcare strategy
is described beside some of the specific changes we can expect to be delivered from
the implementation phase.
2. Consultation Outcomes
The key themes which were reflected in the consultation were:
Shifting the balance of care
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Support for a continued shift in the balance of care from acute hospitals to
community services
Support for the continued integration of health and social care, which as seen
as key to shifting the balance of care
The right services must be in place in community to support this effectively
The discharge and transition process for patients needs to work well
Make more use of the third sector
Improving primary care
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Support for new ways of working to improve primary care services
Address the availability of GPs and difficulties in accessing GP appointments
Support for more 24/7 services, but concerns about how this can be achieved
Support for self-management and preventative approaches. Patient education
and support is required to implement this.
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Realistic medicine
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Support for treatment which is minimally disruptive and based on realistic
outcomes
Realistic medicine is important in order to successfully implement the strategy
Public information and education is required to support the introduction of
realistic medicine
More work needs to be done to review and monitor patients’ medication and
ensure patients have realistic expectations about prescribing.
Redevelopment of Monklands Hospital
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Strong support for the redevelopment of Monklands Hospital with a clear
consensus that investment is required
Mixed response on best option for redevelopment
Transport/accessibility, minimising disruption and cost were the key issues
raised in selecting the best option.
Centres of Excellence
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Strong support for the principle of centres of excellence
Some concern about what this means for the availability of services in people’s
local hospital
Support for the NHS Lanarkshire’s commitment to retaining three acute
hospitals that deliver emergency care
Transport is a key consideration when creating a centre of excellence.
Trauma and orthopaedic surgery
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Overall support for creating centres of excellence for both trauma (emergency)
surgery and elective (planned) orthopaedic surgery
Support for locating the centre of excellence for trauma surgery at Wishaw
General Hospital.
A mixed response on the best location for the centre of excellence for elective
orthopaedic surgery with most expressing no preference or indicating
Monklands Hospital as the best option.
Carers
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The strategy is the right direction of travel for unpaid carers, but should have
more focus and detail on their needs and how to support them.
Mental health and learning disabilities
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Support for the vision for mental health set out in Achieving Excellence
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Good community-based provision across North and South Lanarkshire is
important along with a focus on prevention
There should be mental health provision on all three acute sites
There should be more in the strategy about plans for learning disabilities
services.
eHealth
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Support for making improvements in eHealth including the introduction of a
single patient record
Support for providing more health services online and through telehealth
Consideration needs to be given to people who do not have the technology or
knowledge to use online services
Online services should be an addition to, not a replacement for face-to-face
healthcare.
Travel and transport
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Travel and transport need to be properly reviewed and assessed when
planning health services
Specific issues raised in relation to traveling to services included journey time,
affordability, parking and public transport provision
NHS Lanarkshire should work with Strathclyde Partnership for Transport,
Scottish Ambulance Service and community transport providers to improve
transport to health services.
Workforce
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Concerns about the availability and capacity of staff to support the
implementation of the strategy given funding, recruitment and retention
challenges
Training, development and support are important to attract staff and ensure
new models of care can be successfully introduced.
The conclusions from the consultation will be used to prepare a final version of
Achieving Excellence in December 2016 which will form the starting point for the
whole-system service improvement implementation plans.
3. Service Redesign
The implementation agenda will follow from the revised priority areas described in
the “what will success look like?” sections and summary section 7 in Achieving
Excellence.
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This will include (but is not limited to) the following:
 Building further the skills and capacity in community and primary care
services, including the sustainability of community hospitals and mitigating
immediate GP workforce issues through building primary care team.
 Making the necessary changes to adult functional and organic mental health
services with a split between North and South Lanarkshire provision. Also,
adapting the service models for medium and low secure mental health services
to reflect changes on a regional and local basis.
 Continuing the reshaping of older peoples services including a move away
from contracted beds, continuation of the 10 year reshaping care of older
people programme, and investment in service improvement through the
Intermediate Care Fund.
 Planning and delivering Centres of Excellence including:
o major trauma, at Wishaw General
o elective orthopaedics, which will be subject to option appraisal between
Hairmyres and Monklands
o systemic anti-cancer therapy and cancer services at Monklands
o gastro/upper GI surgery, which requires further, detailed planning and
engagement.
 Working with regional partners in improved urology, maxillofacial surgery,
neurology, and aseptic pharmacy
 Meeting the stretch aims for improved children’s services as set out in the
early years Collaborative
 Working through the overarching future service configuration on each DGH in
over the coming ten years, making the optimal use of the PFI sites combined
with investment in new facilities at Monklands
 Implementing a transport Hub to improve access to ambulance, public and
community transport
Over and above this we will deliver service improvements in 2017 such as the
expansion of the emergency department and same-day surgery facilities in
Monklands, the expansion of ophthalmology in Hairmyres and a new short-stay
ward and upgraded neonatal unit at Wishaw. The eHealth improvement programme
will continue to enable change.
4. Monklands Replacement/Refurbishment Programme Impact on
Timescales
The first formal step in the business case process is the preparation of an Initial
Agreement document. The NHS Board will be asked to note the draft initial
Agreement (IA) on 30th November. The Initial Agreement cover paper describes the
business case development and approvals process.
In autumn 2017 we will need a very clear understanding of the range of services to be
delivered in the new/refurbished Monklands development as stated in 3.3, above.
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Through the whole-system planning framework we will agree the key planning
assumptions on shifting the balance of care, which will be one of the main drivers for
the Monklands service model for 2025. This, alongside a final decision on the
disposition of acute specialties (particularly orthopaedics), will allow us to complete
the outline business case in mid-2018. The completion date for the new development
will also emerge in 2017 when the full appraisal on the 4 options is completed.
5. Whole-System Planning & Delivery
NHS Lanarkshire, South Lanarkshire Health and Social Care Partnership and Health
and Social Care North Lanarkshire now have the necessary ambition and information
to continue the process of service improvement described in Achieving Excellence.
This will be a whole-system process with the following objectives:
 Prepare robust plans based on the future 10-year health and social care needs
of the population that deliver the “what will success look like?” sections in
Achieving Excellence;
 Create and implement these plans as an integrated and coordinated health
and social care system;
 Build on earlier and on-going work across Lanarkshire, regional and national
agendas;
 Use the emerging detail on service models to prepare the New Monklands
business case in keeping with the requirements set out in the Scottish Capital
Investment Manual.
The Strategic Planning Group and the Corporate Management Team have conducted
a series of meetings to determine the best and most efficient means of meeting these
objectives. Their conclusions are that a revised governance and planning structure
will be required to achieve this based on a Programme Delivery Board, Delivery
Team and service specific workstreams with set membership, remit and priorities.
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SOUTH
IJB
NHS
BOARD
NORTH
IJB
STRATEGIC
DELIVERY
BOARD
STRATEGIC DELIVERY TEAM
WORKSTREAM 1
WORKSTREAM 2
WORKSTREAM 3
WORKSTREAM 4
WORKSTREAM 5
WORKSTREAM 6
5.1 Strategic Delivery Board
A Strategic Delivery Board be established which will adopt a project management
approach to deliver service improvement. This Delivery Board will be co-chaired by
the Chief Executive and the HSCP Chief Officers and will consist of the Corporate
Management Team plus a small number of other senior officers from the HSCPs,
acute and corporate divisions including clinical staff and staff side representatives.
The Delivery Board’s tasks will be:
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Setting the overall objectives and agenda for the implementation phase over
10 years
Performance management of the Delivery Team (below) and respective
workstreams –receiving reports and escalation/intervention as necessary
Whole-system sign off of agreed service changes (appropriate to other
statutory requirements and agreed delegation limits)
Receiving direction from, and providing reports to, the NHS Board, and the
Integration Joint Boards (and their committees)
Evaluate and mitigate risks to the programme.
5.2 The Delivery Team
A Forecasting, Capacity Planning and Strategic Delivery Team will be established
which will provide the “engine room” of the implementation phase of Achieving
Excellence. This Delivery Team will be co-chaired by Deputy Chief Executive and the
Heads of Health (North and South) and will consist of the current Strategy Planning
Group (which is a large group the CMT, senior officers and clinicians from HSCPs
and acute, heads of function and other specialists as the agenda dictates). Their tasks
will include:
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Forecasting and capacity planning on a whole-system basis
Coordinating the outputs from the workstreams (below) to reduce duplication
and avoid omission
Compile whole-system change plans
Agree priorities, programming and resources
Provide performance monitoring information to the programme board.
5.3 The Workstreams
The planning on a detailed level will be taken forward by a series of workstreams.
This is similar in approach to the preparation of Achieving Excellence during
2015/16, but the focus will now change towards the detailed consideration of how
and when we will deliver the ambitions set out in section 7 of Achieving Excellence
(taking into account revisions brought about through the consultation process).
The workstreams will be led by a senior clinician or manager working on behalf of
the whole of the Lanarkshire health and social care system, reporting on the
progression of the work to the Delivery Team. Each workstream will be facilitated by
one or more experienced project manager(s), dependent on the scale of the task.
The specific workstream tasks will be to:
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Articulate detailed proposals for the changes to clinical and service models,
and the assumptions which underpin these;
Prepare demand/capacity/activity plans for these services up to 10 years
ahead;
Prepare supporting workforce, infrastructure and finance plans to deliver the
new service models;
Provide appropriate information on service model(s), including balance of
what elements of treatment and care can be delivered in community settings,
and what requires acute hospital provision. This information will be crucial in
shaping the Centres of Excellence in the configuration of acute hospitals. This
will also provide the detail required to finalise the outline business case for
“New Monklands” project.
They will work in a manner which:
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Builds on earlier and on-going work, incorporating inputs from regional and
national agendas
Identifies and prioritises the workload to meet deadlines set by the Delivery
Board
Consider the roles of health promotion/prevention, quality and realistic
medicine in their planning
Include appropriate stakeholder engagement and communication as an
integral element of planning the future.
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Underpinning this work will be the principles of the Lanarkshire Quality Approach
and Realistic Medicine.
The Strategic Planning Group will continue to develop the detailed aspects of this
framework at their meetings on the 24th November and 22nd December 2016. This
will finalise leadership, resourcing and the specific scope and remit for the individual
workstreams. The initial meeting of the Delivery Team will take place on 26th
January 2017, meeting monthly thereafter.
6. Conclusions
The process and governance to allow the implementation of the aims of Achieving
Excellence will be fully in place in January 2017. This will be conducted on a wholesystem basis between HSCPs, acute and corporate functions.
Work will proceed at least the next two years in final planning and implementation
for delivering “what will success look like?” albeit the timescale for implementation
of some elements of this will be either dependent on, or affected by, the process to
replace/refurbish Monklands Hospital.
CRL
18th November 2016
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