1. OUR HEALTH, OUR CARE, OUR FUTURE

2. Why do we need a strategic plan?
To set out a shared direction and the things we need to do:
To maintain and raise quality standards
To meet the needs of a changing population
To change our relationship with patients and their carers – putting patients at the centre
To work more closely with other public services
To work more efficiently.

3. What are the challenges we face?
Demography, inequalities and ill health
Multiple and chronic illnesses (Multimorbidity)
Health service demand and rising expectations
Tighter finances

4. What will success look like?
Improving the quality of care through:
Increasing the role of primary and community care
Integrating health and social care
Focus on anticipatory care, self –management support
Improving unscheduled and emergency care
Improving our approach to multiple and chronic illnesses
Involving people in their care and in service improvements.

5. What will success look like?
Improving health of the population by focusing on:
Early years
Underlying causes of health inequalities
Preventative measures on alcohol, tobacco, dental health, physical activity
Early detection of cancer.

6. What will success look like?
Better value and financial sustainability, by:
Adapting the workforce
Innovating to raise quality and reduce costs
Raising efficiency and productivity
Designing care pathways delivering what matters to patients.
Identifying areas for disinvestment – where there is no contribution to the health of the population. 6

7. What will success look like?
Previous System
Future System
Geared towards acute / single condition
Designed around people with multiple conditions
Hospital centred
Located in local communities and their assets
Doctor dependent
Multiprofessional and team based care
Episodic care
Continuous care and support when needed
Disjointed care
Coordinated and integrated health and care
Reactive care
Preventative and anticipatory care
Patient as passive recipient
Informed, empowered patients and clients
Self-care infrequent
Self-management/self directed support
Carers undervalued
Cares are supported as full partners
Low tech
Technology enables choice and control 7

8. What we are going to do – the headlines
Patient-centred, whole-system, pathways approach
Scottish Patient Safety Programme
Improve the care for older people
Multimorbidity action plan
Enable joint working- healthcare, social care, 3rd sector
Improve access to primary care & community teams
Reduce and eventually eliminate delays in patients’ discharge

9. What we are going to do – the headlines (continued)
Develop a new East Lothian Community Hospital
Adapt the use of Midlothian Community Hospital
Develop community mental health services and redevelop the Royal Edinburgh Hospital
Revise emergency care at the Western General Hospital
Expand acute receiving and assessment capacity at the Royal Infirmary of Edinburgh
Focus major hospital care on 4 sites: RIE, WGH, St Johns & new REH

10. What we are going to do – the headlines (continued)
New configuration of acute inpatient services at RIE, WGH and SJH
Do more on a day case basis
Review outpatient services
Develop sustainable in-house capacity for elective care
Improve children’s services, open new children’s hospital
Redesign cancer pathways, build a new Regional Cancer Centre

11. How are we going to do it…….?
By putting patients at the centre of our plans.
Focus on the patients’ journey and experience, with four names to represent four groups of patients.

12. How are we going to do it…….?
Different working arrangements for clinical and other staff
Work with patients, staff, GPs, social care colleagues to design a better way of doing things
Integrating health and social care systems
Organisational development
Adapting the workforce
Better use of information
eHealth
Innovation
Managing the finances

13. Priority Workstreams ACUTE PRIMARY CARE/ COMMUNITY Stroke redesign
Unscheduled flow – all 3 sites
Orthopaedic DCAQ
Ortho rehab ( then gen. rehab)
Ophthalmology DCAQ/ accom.
Out-patient redesign
Day surgery/ ambulatory care
Gynaecology
Maternity
Cancer and ECC
Plastic surgery
Laboratories
PRIMARY CARE/ COMMUNITY
GP practice capacity
Primary care capability
LUCS review
Care village/ older people’s care models x4
Draft integration plans x4
Year 1 H&SC priorities x4
WHOLE SYSTEM PRIORITIES/ ENABLERS
Inequalities and prevention Workforce
Information and technologies Patient pathways
Disinvestment/ hard choices

14. Next Steps 2 April 2014 – Draft plan approved by NHS Lothian Board
21 April “Our Health, Our Care, Our Future” consultation launched
May, June, July meetings with staff, patients groups, third sector organisations, carers, community groups, local authorities, Scottish Government and other stakeholders to analyse patent pathways, consider options and develop specific proposals;
8th August 2014 – Consultation closes
1st October 2014 – NHS Lothian Board receive definitive Strategic Plan for approval. 14

15. How to get involved Discuss with your colleagues
Respond to the consultation questions:
- Does this plan address the most important issues?
- Have we missed anything really significant? If so what?
- Is there anything else you would like to tell us before finalising the plan?
Comment on the proposed criteria for making decisions
Comment on the NHS Lothian Health Inequalities Plan
Comment on the NHS Lothian Strategy for Cancer 15

16. How to get involved
Complete the on-line questionnaire at:
Respond to the consultation questions – us at
Write to: Professor Alex McMahon, Director of Strategic Planning, NHS Lothian, Waverley Gate, 2-4 Waterloo Place Edinburgh EH1 3EG