1. Context for Next Stage of Integration Professor Tony WellsGerry Marr Chief ExecutiveChief Operating OfficerNHS Tayside

2. Our Vision & Values NHS Tayside: working with you for better health and better care

3. Looking Back: Achievements HEAT Targets and Waiting Times delivered Patient Safety Programme into 3 rd year Key clinical strategies agreed, e.g. older people, Long Term Conditions Financial Balance Significant infrastructure investment in primary and secondary care

4. Looking Forward: Key Challenges Diminishing financial growth Higher and more stretching efficiency and productivity targets, e.g. new cancer waiting times Evidence to support that Shifting the Balance of Care and Resources is occurring over time Implementation of a range of National and local Improvement Programmes e.g. LTC, 18RTT, Mental health Improved HAI outcomes Recruitment and retention of a skilled workforce

5. Looking Forward: Strategic Improvement Challenge Understand the complex care system we work within Determine the performance of the system over time A culture that supports tests of change and a continuous learning approach to improvement Aggregation of improvement and learning across a variety of conditions

6. Our Blueprint: The IOM’s Six Aims Safe – no needless deaths Effective – no needless pain or suffering Patient-Centered – no helplessness in those served or serving Timely – no unwanted waiting Efficient – no waste Equitable – for all

7. Managed Clinical Networks Citizens/Self Help Locality/Natural Community National District/Local Authority Regional/Supra Regional

8. Next Steps for Integration Provision of more integrated clinical services across NHS Tayside Focus on shared clinical outcomes across primary and secondary care Increased capacity and capability in the healthcare system to drive service improvement Improvement methodology which supports clinical productivity and efficiency Improved management of variation, waste and harm Provision of measurable evidence of shifting the balance of care and resources Improved access to services

9. Accident & Emergency Acute Medicine Medicine for the Elderly Integrated Child Health Service Long Term Conditions Medicine Directorate Surgery & Oncology Critical Care Orthopaedics Head and Neck ENT Neurosciences Oral / Maxillofacial Plastics Dermatology Surgery Directorate Laboratories Radiology and Imaging Dental Hospital & Community Dentistry Infection Control Business Support Unit Referral Management Service Waiting Times Management Information and Analytical Services Access Directorate

11. NHST Executive Team Delivery Unit Executive Team Access General Manager Associate Medical Director Associate Director of Nursing Surgery General Manager Associate Medical Director Associate Director of Nursing Medicine General Manager Associate Medical Director Associate Director of Nursing Angus CHP General Manager Clinical Director Lead Nurse Dundee CHP General Manager Clinical Director Lead Nurse Perth CHP General Manager Clinical Director Lead Nurse Operations Director

12. NHST Executive Team Access Joint Clinical Board Delivery Unit Executive Team Chief Operating Officer Director of Finance Director of Nursing Director of Operations Associate Director Workforce NHST Board CHP General Manager x 3 Director of Change & Innovation Assoc Director of Change & Innovation AHP Professional Lead Divisional General Manager x3 Associate Medical Directors x 3 Surgical Division Joint Clinical Board Medicine Joint Clinical Board Surgery

13. …….. Adding Value to what exists Patient Safety Modernisation & Development Clinical Skills Post & Undergraduate Education Clinical Governance Highly Integrated Improvement Alliance Clear measures CLEAR STRATEGIC DIRECTION Build Capacity – Establish Facilities Develop Profound Knowledge - Resource faculties Develop Measures – Improvement, Safety, Shifting the balance of care Build Capacity 2 – Spread Test Measures / Demonstrate Spread Shift the Balance – Triple Aim Measures Consolidate Investment Prepare for Self Reliance Evaluate Publish results Year 3 Specific Aims Demonstrate Shift Publish Year 2 Specific Aims Publish Year 1 Match Funding High level Goals Year 2 Year 1 Recurring