West of Scotland Regional Planning Agenda item: 13

Creating a Regional Delivery Plan for the West of Scotland

1. Output

• Initial outline Regional Delivery Plan by September 2017• First Regional Delivery Plan by March 2018• A planning and delivery framework which will support an effective and iterative strategic

planning and delivery process• An accepted requirement to collaborate which lays the foundation for close team working

across the whole system (Health and Social Care partnerships and primary care, AcuteServices and NHS Boards) within the region to develop and deliver the regional plan

2. Developing the Regional Delivery Plan

• Describe population health needs and the regional profile of the West of Scotland,including mapping the current provision and starting point.....build on the West ofScotland Collated Strategic Position and supporting Board and IJB strategic plans

• Describe the overarching position for the region within the regional delivery plan• Creating a shared vision... .all proposals and plans, both at local and regional levels,

support the delivery of the vision• Collaborative priorities at a regional planning level and at local IJB and Board planning

levels with the regional delivery plan supported by and supporting of the local deliveryplans

• Delivered through collective leadership supported by guiding principles• Aim to achieve the best outcome for people

3. Requirement of the Plan

Develop the Regional Delivery Plan to deliver the Health and Social Care Plan,National Clinical Strategy, Maternity Framework, Mental Health Strategy, CancerStrategy and Getting it Right for Every Child based on the following key aims:

• Improving health and wellbeing• Increasing care and quality• Delivering the finance and efficiency• Better workplace with a focus on staff

The Regional Delivery Plan should:

• Describe the Key Strategic Service Change ProgrammeThis will consider what changes are planned and deliberate and likely to be dramatic andirreversible in nature. Estates master planning to understand opportunities in terms ofbuildings and capital infrastructure

Demonstrate Best Value InitiativesThis will consider thresholds for intervention, efficient models e.g. lab testing, LVprocedures − adopting a consistent approach across the region! ScotlandProgress Collaborative WorkingWorking across Board boundaries, delivering services between boards, sharing staffing,joined up models/ services, estates master planning to understand opportunitiesbetween agencies, boards

4. Connecting the Regional Plans

It will be important to ensure that there is read across of the Delivery Plans for the 3 regionssupporting the delivery ambitions of the Health and Social Care Plan. It is proposed thatthere is a standardised approach across the 3 regions on:• Planning assumptions• Population demographics I public health input

• DCAQ data• Engagement approach• Staff side involvement• It will also be important to understand and include the work of the National Boards as

they impact on Regional Delivery Plans

5. Developing the Regional Delivery Plan:

To shape the work programme to achieve the Regional Delivery Plan it is important that wedefine and understand what we think success looks like for the 2 key requirements:

• The outline plan by end of September 2017• First Regional Delivery Plan by March 2018

Appendix 1 sets out an outline of the proposed chapters for the plan in March 2018 whichwill be concluded through discussion within the regional groups and across the 3 regions.

Appendix 2a sets out the potential workstreams and appendix 2b the details to support thedelivery of the suggested work streams, the work required and who might be involved. Thisis a complex group of work streams, illustrative at this point, with significant overlap andinter−relationships between the sections. The idea here is to link these together withnarrative, as work progresses, to tell the story for the West of Scotland and where we wantto be, with the underpinning evidence as we have it, or can gather together in the next fewmonths. As the existing evidence is considered during the coming months, specific detailedprojects will emerge as priorities, made up from existing work, and potentially, additionalpriorities. Long term strategic regional planning will develop as a result of the underpinningwork carried out over the coming months and will then be supported as an ongoing anditerative process.

Based on this the proposed outputs to support the September draft plans are set out below.

September 2017 Draft RDP

Conclusion of chapter 1 − setting out the context of the plan

Conclusion of chapter 2 − understanding the West of Scotland population.

Draft of Chapter 3

• Our approach to developing the Regional Delivery Plan• Principles underpinning the plan• Construct of the plan

• Overarching plan• Setting the regional Case for Change and Defining the Gap• Identifying the risks and opportunities

• Shaping plans for each part of the system• Key workstream to develop and deliver the plan• Our priorities and key enablers

• Setting out the Gap Analysis and information available by September which will informthe later chapters and be summarised in the final report

• Workforce context which will inform Chapter 5• Facts and figures

• Issues influencing / informing the need for change to support the case for changeto inform the March 2018 position

• Finance context which will inform chapter 6• Set out the financial position across the region for 2017/18

• Our assumptions• Define as far as possible the expected financial position for the region over

the next 5 years• Review the expected funding, potential growth and savings required• Identify the investment required to:

•S

• support change• expected activity challenges• Essential growth in technology driven change to service provision and

treatment options if no changes to the models of service deliveryApproach to bridging the gap − for completion for March 2018Define opportunities and impact of efficiency and productivity work in terms offinance − for completion for March 2018

• Set out the framework for Chapter 8 on Estates and Capital Planning• Set out estates position and infrastructure• Capital Investment plans − giving a context and supporting position for potential

IA' Outline business cases such as Monklands and GJNH

Selling out the framework for Chapter 4

• Describing the approach and high level position as far as we can• Setting a framework to hang the detailed work with an indication of what the risks and

opportunities are that will be addressed in the March plan based on the gap analysis andcovering the following areas

• Emergency care• Elective care• Primary care/ acute care continuum• Shared Care and Support services

• Examples of regional working will be use to exemplify approach and what will becomplete. This work is closely linked to the work set out in section 6, which willprovide the detailed position in the full plan.

Other Key deliverables for September to inform the plan and work streams

• Undertake the DCAQ work to inform the clinical service models and reshaping ofcare

• Understanding the current demand for services including variation and potentialchanges to demand

• Understanding the likely future demand for services due to population changes andhorizon scanning changes to service delivery. This work will consider the viewsof the Scottish Health Technology Committee and the National MedicalWorkforce Group

• Take account of the public health work and work on variation including the work ofthe Glasgow Centre for Population Health

• Agree the approach to undertaking an equalities impact assessment to reviewservice changes proposed

6. Service Models and supporting Care Pathways

There are a number of specialties which may require change either to deliver a moresustainable model or where the service model requires to be reviewed to support the futureservice demand. A number of these will require to be considered regionally; working throughwhat should be delivered locally and regionally along with the supporting pathways to ensureall patients have equitable access to the level of specialist care they need even where it isnot provided locally. The criteria which need to be considered in determining what priorityareas would be best considered regionally are:

• Work together as need the critical mass beyond local population level to achieve bestoutcomes

• Work together to reduce variation and share best practice• Work together to achieve greater benefits and outcomes for people overall

Table 1: An example for the West of Scotland

Work together as need the critical mass Cancer ServicesUrgent and emergency careSpecialist servicesStroke (hyper−acute and acute rehab)

Work together to reduce variation and share Standardisation of commissioning policiesbest practice Acute Collaboration

Primary and community servicesWork together to achieve greater benefits Mental Health

Prevention at scale

Previous work within the region, reviewing the service provision through a range of lensesincluding:

• Population changes• Workforce challenges• Capacity pressures• Critical mass /numbers for clinical competence/ super specialist areas• Challenged Service delivery models• Technology changes• Vulnerable services identified a number of areas for review regionally.

Specialties identified in red under review or due to be reviewed

Table 2: Specialties to be reviewed in West of Scotland

Major trauma [Urology

Orthopaedics OphthalmologyInterventional radiology

−Radiblogy

Surgical Sübspecialties ENT/OMFS[Stroke Rehabilitation for traumaticand

acquired brain injuryLaboratories

Part of the work to look at the service models should consider the patient outcomes to beachieved and the key standards required both in terms of performance but also in terms ofthe clinical standards to drive improvements in the quality of care and health outcomes.

It will also be important that consideration is given to how the different services models arereviewed using an equality impact assessment.

7. Governance Framework and Arrangements

In order to deliver the required regional plan it is proposed that the current Regional PlanningGroup role and remit is evolved to meet the new requirements of regional planning and anew forum, the West of Scotland Health and Social Care Delivery Programme Board isbeing established.

The Regional Lead Chief Executive will be the Chair and Lead Executive Officer for RegionalPlanning within the West of Scotland and will work with the Chief Executives and Chairs ofthe Boards along with the Director of Regional Planning to review current regional workingarrangements and consider the requirements of the region to determine the futurearrangements within the region. This group will meet monthly and the core membership willbe the Chief Executives of the Boards within the region. It is proposed that the ChiefExecutives provide the overarching leadership to the key workstreams. It suggested that thecore membership should be relatively tight and should include members who are leading theprincipal work streams rather than 'representing' professional groupings.

Recognising the importance of the Chairs' roles in relation to governance it is proposed thatthe Board Chairs form a Scrutiny and Assurance group to provide external scrutiny of theprogramme to guide this regional programme and support the alignment of the local andregional governance arrangements. Board Vice Chairs and IJB chairs involvement inthe Scrutiny and Assurance Group should be considered as well as the option tohave external scrutiny of the plan from outwith the West of Scotland Service.

The emerging programme structure is set out below.

West of ScotlandHealth Boards

(HBs) Chairs Scrutiny and Assurance Group

WoS Health and Social Care Delivery Group

LEAD CHIEF EXECUTIVE

Planned &Cancer Care

CEO Lead

Urology

PLANNING SUPPORT − DIRECTOR OF REGIONAL PLANNING LEAD

Unscheduled Care

CEO! CO Joint Lead

Primary,Community and

Social CareCEO/CO Joint Lead

Integrated Joint Boards

(IJBs)

Support /SharedServices

CEO Lead

STRATEGIC LEAD

Supported by

Medical Leadership

Analyst . Admin

Examples of Existing

SERVICE PLANNINGGROUPS

(TASK AND FINISH)

Major Trauma Procurement

Ophthalmology E−Health

FINANCE AND EFFICIENCY AND PRODUCTIVTY − DIRECTOR OF FINANCE LEAD

WORKFORCE (TRAINING AND DEVELOPMENT) − DIRECTOR OF HUMAN RESOURCES LEAD

ESTATES AND CAPITAL− DIRECTOR OF FACILITIES LEAD

INFORMATION AND EHEALTH − EHEALTH LEAD

The West of Scotland Health and Social Care Delivery Programme Board it is proposed thatwill be responsible for the delivery of the national H&SC Delivery Plan through the RegionalH&SC Delivery Plan. All of the workstreams leads will report directly to the ProgrammeBoard. Once the programme and the workstream leads have been identified we can assesswhether there are any major gaps in membership.

To support that Delivery Board and co−production of the Regional Delivery Plan a number ofcontributions and processes will be required which will see a step change in how we worktogether. Chief Executives and Executive teams will closely inform the development of theplan and have responsibility for subsequent implementation, and in order to do this we willneed some structure and agreed governance to underpin the Regional Delivery ProgrammeBoard.

This arrangement is currently evolving and has yet to be defined clearly what the preciserole, responsibility, accountability and authority the new regional arrangements will have. Asupporting governance model will be prepared setting out NHS Boards retain responsibilityfor delivery within their Board are however legislation already requires NHS Boards to workacross boundaries, allowing one board to carry out functions on behalf of another Board.HSCPs have scope for similar co−operation. HSCPs have scope for similar co−operation.

To ensure read across for the whole system it is expected that the regional plan will supportlocal plans and that it has the support of NHS Boards in planning and in delivery.Recognising Integration Authorities are responsible for designing, commissioning andproviding direction to Boards and LAS for delivery of services in new and sustainable ways,linked to locality plans and robust financial plans to meet needs of their population it will beimportant that regional planning is cognisant of the lJBs roles and is clear about howregional planning will work together and support IJBs, acknowledging this in the developingthe regional plan and clarifying the planning landscape.

To support the new ways of working across the region a Governance Structure & Frameworkwill be developed covering:

• Scheme of Delegation• Terms of Reference• Statement of Expected Standards of Corporate Governance and Internal Control• Repository of control documents and operating procedures

This new way of working will require dedicated time to ensure close working andengagement with the planning process and implementation. It is proposed that a coreexecutive team lead on development of the Regional Plan, reporting to the Lead ChiefExecutive. This core team will guide the writing of the plan and be responsible for collatingcontributions from the various perspectives suggested below in Table 3. Work from thisgroup will feed into the Regional Delivery Board where the CEOs sit as the collaborativedecision making body.

Table 3. Delivery Plan WorkstreamsDelivery Plan Workstream LeadOverall structure and organisation of plan Director of Regional Planningincluding policy context and writing the Supported by core team from belowplanPopulation Context Director of Public Health / Director of

PlanningPrimary, Community and Social Care Chief Executive Lead

Supported by HSCP Director andBetter Health and Prevention Medical /Clinical Directors

Public HealthUnscheduled Care Chief Executive Lead

Supported by Chief OfficerMedical /Clinical Directors

Planned Care and Cancer Services Chief Executive LeadSupported by Chief OfficerMedical /Clinical Directors

Support Services Chief Executive LeadEstates and Capital Supported byeHealth Director of PlanningDiagnostics Director / Head of FacilitiesPharmacy Head of eHealth

Director of DiagnosticsDirector of Pharmacy

Finance, Revenue, Capital and Savings Director of FinanceWorkforce Director of HR

Other supporting workstreams include

Delivery Plan Supporting Workstreams LeadQuality Improvement Director of Planning I Director of NursingCommunications Head of CommunicationsStaff Engagement I Transformational Head of OD I External input potentiallyChangeSystematic analysis of data Head of Health Intelligence I Senior(DCAQ, best value etc) Analyst

Consideration also needs to be given to how the both the Maternity and Mental HealthStrategy workstreams also play in to the regional delivery plan.

8. Organising the Regional Planning and Delivery landscape

In order to build on existing planning and delivery models we will need to be clear aboutwhat is done by whom and at what level. Central to this will be a level of agreement aroundhow each element will fit together.

Planning − In future it may help to consider long term strategic planning as primarily thedomain of the Regional H&SC delivery Board, with local I board service planning interpretingthat long term approach to suit local circumstances. In addition strategic planning must beinformed directly by H&SC partnerships and link directly with whole system planning ofservices.

Delivery − It seems likely that there will be an increasing number of regional services orelements of services which will require a new way of working. The primary issues here willbe governance and organisation of these services and could include a number of proposalsaround integrated or hosted services, including aspects of services or services in theirentirety (delivery of certain specific or all procedures, financial, recruitment, procurement,planning, management etc). These collaborative initiatives could build on existing networksand services moving towards a robust regional governance model including new financialarrangements to support the new ways of working, centred around the Regional H&SCDelivery Board as the assurance mechanism to boards.

A methodology to consider each area of work and systematically consider which levels bestsuit each, for both planning and delivery of services, will need to be established. A number ofcombinations could be considered, as outlined in Figure 1. Further detail is provided inappendix 4.

9. Delivering the Regional Plan − Resource Requirements

Given the expectations of the Regional H&SC Delivery Board to have a first draft of theregional delivery plan by September 2017 with a final version by March 2018, by which timewe are required to have plans around all acute specialties, it is important to determine whatthe resource requirements are to achieve this, particularly the September deadline.

In considering the resource implications there are a number of principles/ assumptions whichneed to be considered:

• Boards will support each workstream with the appropriate level of leadership/support, consistent involvement required

• Senior clinical sign up from project initiation onwards is required• Early wider clinical and operational engagement is essential• All boards release senior staff to support the regional work and this will be reflected

in their individual objectives and appraisal process

Other considerations include:

Figure 1

• Any national data analysis will be done 'Once for Scotland'− regions will commissionnational organisations to deliver required data and analysis

• Factor in patient transport/SAS at earliest opportunity• Need to create opportunity/space for discussion and collaboration − what we need to

do and how we will do it (link with OD work)• Project management support and expertise is essential

Regional Planning Team Role

• Supporting the Regional Chief Executive in driving the strategic planning and delivery ofthe Regional Delivery Plan.

• The team will continue to deliver on current agreed priorities for the West of Scotland.

• Managing and maintaining the managerial and clinical relationships across the region,across the pan Scotland linkages and with SG. Acting on behalf of West of ScotlandRegion in influencing national planning and developments.

• Linking with non clinical national boards (SAS, NHS24, and GJNH) to ensure they arerepresented and there is strategic fit.

• Ensuring regional governance arrangements are in place and maintained.

• Oversee the programme and manage the Programme Office.

There will be a significant call on staffing resources in terms of time to carry out analyticsand research on some of the key issues and in terms of providing appropriate support to thedifferent workstreams. To support the existing regional team we have scoped some of theresources required to carry out this work and the staff required:

• Senior Planner / Programme Manager• Senior Project Administrator• Project Administrator• Senior Data Analyst• Finance officer• Workforce planning officer• Health Economic Input

Clinical Leadership is a crucial element of the work therefore it is envisaged that timeneeds to be identified to ensure strong clinical leadership for the programme is in place toensure effective clinical involvement and engagement

• Medical Director lead• Clinical lead sessions

It is anticipated that these staff will be recruited to the work on the basis of openadvertisement for secondment opportunities at current salary levels. In the case of clinicalstaff, sessional input will be sought to join the work and in all cases it is anticipated that thefunding will be used to backfill roles vacated by those participating in the regional planningprocess.

In the short term we recognise that there is a need to fill some of these roles in theimmediate term and regional Board CE's are asked to consider what short term and fixedterm support they can offer to kick start key elements of the programme.The general roles to be carried out by these posts are referenced in appendix 2b to thisdocument and specific job profiles are currently being finished and will be formally advertised

when approval is granted at SG level to the funding requested by the regional planninggroup for project support.

It is assumed that boards will support the development of the Plan through release of seniorstaff in executive, operational and functional roles. Where there is already work underwayand resource has been identified then this will continue. Once the workstreams have beendefined further resource requirements can be determined, including the mix of what theBoards contributions will be and what back fill should be sought from the ScottishGovernment Transformation Fund. Indicative requirements for the teams to support theclinical workstreams are set out below for consideration:

• Managerial Lead• Clinical Lead (1−2 sessions)• Senior Planner• Data analyst support• Board managerial and clinical representatives x 5/6• Finance, HR and eHealth support as required

Each workstream will be responsible for delivery of the agreed priorities for their givenspecialty. This will involve scoping current services and agreeing optimal service modelgiven regional workforce, financial, demand, etc. This work will be undertaken in line with theongoing work on urology and ophthalmology. Once any future service model is agreed theywill be responsible for implementing the agreed service changes and delivering the agreedbenefits. Leadership of each workstream will be through joint leadership from Managerialand Clinical Leads.

Other support costs are likely to be required such as IT costs to provide hardware andsoftware to support the programme office, video and teleconferencing costs and travel costs.

10. Delivering the Regional Plan − Risks

There are a number of risks identified around this work which requires consideration and arisk matrix developed setting out the mitigation. Table 4 below sets out the risks currentlybeing flagged as the planning process is being evolved.

Table 4. Identified Risks

RISKS1. The timelines set for delivery of a significant amount of planning are challenging,

particularly coupled with the existing pressures on boards to deliver both the clinicaland financial targets.

2. Managerial capacity to support this programme, particularly from small boards givenbreadth of work required for the regional plan.

3. Clinical time and finding backfill for services already under pressure and at risk.4 Keeping the existing local and regional work going.5. OD agenda is significant, particularly given the recent changes with IJBs and ongoing

work to bed these new working arrangements in.6. Important that there is mandate for the HSCP to be part and contribute to this work.7. Political position and announcements at odds with the messages emerging about the

level of transformational change required.8. Public unprepared for the position that may emerge from the regions.9. Engagement and consultation processes constrain the requirement for transformational

change.

Appendix I

I . Chapter 1: Setting the Context

High level policy context − summary of policy and implications for future service planning fordelivery

What we are aiming to achieve

Narrative around change − past, present and future reflection

Need to reform our services

Chapter 2: Understanding the West of Scotland Population

Background facts and figures of the region

High level description of population served, considering deprivation levels links to healthinequalities and outcomes.

Population distribution both in terms of age and geography, considering the variation ofpopulation served; considering disease prevalence and incidence within the region

Review of populations' current use of services to ascertain variation

Population health outcomes

Health in its wider context

Understand the estimated/ expected impact of health improvement work in changingdemand over the generational timescale as well as the scale of the public health workimplicit in the reduction

Chapter 3: Developing and delivering the plan

Our approach to developing the Regional Delivery Plan

Principles underpinning the plan

Construct of the plan• Overarching plan• Defining the Gap• Shaping plans for each part of the system• Key workstream to develop and deliver the plan• Our priorities and key enablers

Gap Analysis Summary• High level service changes required• Increasing demand• Pathways requiring specialist• Workforce: Overall high level regional workforce position reflecting the whole workforce• Finance: high level financial context

Synthesis of Evidence

• High level summary piece − linked to external document on supporting evidence used

Chapter 4: Clinical Context

Rethinking and Reshaping Health and Social Care

Better Health: Putting prevention at the heart of what we do

Population health context and public health challenges to consider the new preventionagenda and avoidance of unnecessary admission

• Better Health I prevention policy context and outcomes to be delivered

• Investment in prevention services to address health inequalities

• Describe the shift to the future vision for improved health, wellbeing and responsibility forown health

• Define key priorities − inequalities, improved health, link to education, housing

This work and the population position and needs assessment above should also belinked to inform the local planning

Reshaping primary and community based care

Interface between primary and secondary care

Acute Hospital Care

• Emergency Care• Elective Care• Tertiary Care• Standardising hospital care• Reducing variation• Key areas of focus

e.g. trauma; stroke; GI bleeding; Cancer surgery; Radiology; IR; Urology,orthopaedics, ophthalmology; Head and Neck; smaller medical and surgicalspecialties

Equality Impact Assessment of the Future Models

Chapter 5: The Workforce of the Future

Consideration to be given to regional models for sustainability, workforce challenges ofrecruitment and retention with a focus on the opportunities from

• Collegiate regional models• Regional contracts• New models of care• Skill mix changes etc

Chapter 6: Financial Resources

The financial challenge

Set out the financial position across the region for 2017118

Our assumptions

Define as far as possible the expected financial position for the region over the next 5 years

Review the expected funding, potential growth and savings required

Identify the investment required to:

• support change• expected activity challenges

Essential growth in technology driven change to service provision and treatment options if nochanges to the models of service delivery

Bridging the gap

Define opportunities and impact of efficiency and productivity work in terms offinance

Chapter 7: Cross Cutting Services

Enablers to support care

Pharmacy

eHealth and Digital Technologies

Transport

Chapter 8: Facilities and Estate

Estates and infrastructure

Capital Investment plans

Chapter 9: Implementation Plan and Timeline

• High level implementation plan for 2018119 with links to local delivery plans / IJBplans

• Medium term (2−5years)• Long term strategic planning (dynamic process)• Next Steps etc

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