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TRANSCRIPT
Shared Services: Towards
a distributed service model
for delivery of
NHSScotland’s laboratory
services.
Dr Bill Bartlett
21st June 2018
http://www.sharedservices.scot.nhs.uk/health-portfolio/programmes/laboratories/
Present State
14 Territorial Boards 2 Special Boards 32 Local Authorities 31 Integration Joint Boards
1 Nation 5.3 million People
Organisational Complexity
NHSScotland in Numbers
Health Services Cost Book 2014 to 2015 R130: - 22 locations 13 boards: -
Labs in Scotland PHI Map
Speciality Specimens
Microbiology 5 Million
Histopathology 2 Million
Haematology 11 Million
Tests
Biochemistry 82 Million
National
Regional
Multi-Board
BOARD
Hospital
Community
Patient
Laboratory services
• Current service:
• 27 laboratory locations, 87 laboratories:
• 21 Medical Micro
• 26 Biochemistry
• 26 Haematology
• 10 Histopathology
• 4 Immunology
• Covering 16 Boards (14 territorial and 2 special)
• 19 Specialities
• Approximately 3759 FTE staff
• Annual costs estimated at £251.6m
• £178.9m staffing costs
• £72.7m non-staffing costs
Once for Scotland
New models of care
Increasing Demand
Rising Expectations
Technology & Innovation
Service Sustainability
Quality & Safety
He
alth &
Social C
are In
tegratio
n
Th
e B
ig C
on
vers
atio
n:
Beyo
nd
2020
Drivers of change applying to NHS services
Resource constraints: Financial and Workforce
By working differently, Shared Services will deliver new ways of working which are flexible and responsive to the changing needs of NHSScotland for 2020 and beyond
Transformation service to meet needs.
Once for Scotland
www.sharedservices.scot.nhs.uk
2014: NHSScotland Shared Services
Health
Business
Operational
Laboratories
Clinical Engineering
Pharmacy
Public Health
Radiology
Shared Services
Strategy & Policy Context
MDN Paper to DSG Nov 2015
Shared Services Lab Team 2016
Workshops
Position Paper to CEs Sept 2016: Distributed Service Model
Strategic case for DSM CEs August 2017: Guiding Principles
Shared Services
Business case for the DSM
Positioning Paper
Strategic Paper
Business Case
Implementation
MANDATE
Data
IT
Innovation
Standardisation
Distributed Service Model Design Group
Guiding Principles Blueprint
Workstreams
Future State:
Distributed Services Model
Triple Aim Focus:
What is the Vision?
Patient centric,
outcome focussed,
whole system wise
Scotland wide access to
state of the art services
through a distributed service
-Right test
-Right place
-Right time
Delivery through a Distributed Service Model
What are we trying to achieve
with a DSM?
Investment objectives Why is change required?
To put in place a scalable configuration of
facilities that can meet future demand for
Laboratory services
Existing configuration is
unable to meet increasing
demand and new models of
care
To enhance service resilience through
minimising variation and enabling cross border
working
Risk of failure as the current
service model is not resilient
To provide a sustainable, resilient, adaptable
workforce lined to a credible workforce plan
Current workforce is not
sustainable
To provide improved and equitable outcomes
for patients
To refresh outdated
technology/ageing
infrastructure and increase
best practice
To deliver value for money Shrinking budgets and
competing demand for
revenue
Shared Services
A Distributed Service
“Functional distribution of laboratory resource that
enables equitable delivery of high quality health
care independent of location.”
Functional distribution NOT centralisation
Right test
Right place
Right time
Laboratory services
Efficient
Effective
Equitable Resilient
Affordable
Blod Sciences
Blood Transfusion
Bacteriology
Virology
Histopathology
Immunology
Genetics
Shared Services
National Laboratories Pie
Triple Aim Focus: Better Care, Better Experience of Care, Cost per Capita
Blod Sciences
Blood Transfusion
Bacteriology
Virology
Histopathology
Immunology
Genetics
National Pie
Functional distribution of service to Boards
Triple Aim Focus: Better Care, Better Experience of Care, Cost per Capita
Region 1
Region 3 Region 2
Governance: National Laboratory Oversight Board
Regional service
Supra-Regional service
• sustainability through a scalable, flexible, innovative service configuration.
• resilience through efficient and effective use of
– workforce knowledge and skills
– estate and physical resources
• equity of service across the country
• access to latest technologies at enabled centres accessible to all Boards.
• increased efficiency and effectiveness to either realise cost savings/containment or increase capacity through reduced waste and economies of scale.
Distributed service compliant with the
shared service agenda will deliver : -
-Right test
-Right place
-Right time
Design, Business Case & Implementation
Vision
Design
Incremental change
Incremental Approach to Change Distributed Service Model proposed
to CEs - August 2017
? Blood Sciences
Blood Transfusion
Bacteriology
Virology
Histopathology
Immunology
Genetics
Business Case
Data Group
IT Group
DSM Design Group Laboratories DSM Blueprint
Proposed Governance Framework
Data solution: National Labs Data Mart
IT Connectivity Solution: NPEx
High Level Specification for LIMS
Business
Case
£6.6M
BC Approved CE Meeting April 10th
2018
1.
2.
3. which will provide an (almost) real time
4.
1. A new governance framework: to facilitate the design and development of the Distributed Service Model and the delivery of the National Laboratories Blueprint.
2. IT Connectivity solution: which will enable laboratory to laboratory electronic communication and the management of work flow across NHSScotland Boards.
3. A National Laboratories Data Mart: which will provide an (almost) real time data set for multiple purposes e.g. clinical and business intelligence.
4. A high level technical specification: for the future procurement of Laboratory Information Management Systems.
Guiding Principles, Blueprint & Governance Structure
1. Enables national planning of services while enabling a focus on local needs
(right testing, right place, and right time).
2. Is aligned with the National Clinical Strategy, supporting health care improvement with a Triple Aim focus.
3. Employs a Once for Scotland approach through an appropriate governance structure.
4. Enables national workforce planning.
5. Allows the free flow of materials, information, data, knowledge and skills across organisations.
6. Enables optimised demand on services locally and nationally via appropriate interfaces with users and planners.
………………………………16
DSM Guiding Principles
http://www.sharedservices.scot.nhs.uk/media/1482/2018-02-06-laboratories-blueprint-final-version.pdfs
Organisation Technology Information
The Blueprint & Guiding Principle
Current model not optimised to deliver sustainable services to underpin current and future NHSScotland
requirements
National distributed service model (DSM) with unified vision configured to enable consistent delivery of
national, regional and local plans/ priorities enabling equity of access to servics..
Sta
rtIn
teri
mE
nd
Baseline and activity map of service use and project requirements.
Design and incrementally deliver a distributed service to meet current and emerging demands
Compliance of Boards/Regions with guiding principles, development of shared priorities, sharing of
outputs from processes such as procurement exercises
Region 1
Region 3 Region 2
Laboratories Services Oversight Board Regional delivery
Regional service
Supra-Regional service
New Governance Framework
Laboratory Services Oversight Board
Blueprint
Consistency
Blue Skies
Opportunity
Delivering Value
Guiding Principles
Enabling the Wider System
Triple Aim
Sharing
National Context
Connectivity and Data
IT Connectivity solution
• National funding for the procurement and
implementation of NPEx across Scotland
National Laboratories Data Mart (NLDM) solution
• National funding for the development and
implementation of a National Data Mart for
laboratories
Essential Infrastructure
Solving the IT/Data problems
Data Requiring Domains
Data Requiring Domains Data mart
development with prioritised
functionality
Fully developed Data Marts designed to
meet the needs of a DSM for labs.
• Vision
Laboratories DSM Blueprint
• Delivery of the vision
• Enables and supports regionalisation
Proposed Governance Framework
• Delivery & adds value
• Drives standardisation
Data Sharing: National Labs Mart Data
• Enables the evolution
• Connection of new and old systems
Lab to Lab Connectivity: NPEx
• Assures consistency
High Level Specification for LIMS
What are the Benefits?
Southern
Ireland
Carter
STP
Hub & Spoke
Shared Services
DSM
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
• need for better supported IT that is
interoperable so patients and other
institutions can easily access data
• Reinvestment of efficiency savings.
“We cannot solve our problems with the same thinking we used when we created them”
(A. Einstein)
Laboratory services
Efficient
Effective
Equitable Resilient
Affordable