Transcript No Slide Title

Whole systems planning
Jane Austin
Future Healthcare Network
[email protected]
January 2003
Summary
• About the Future Healthcare Network
(FHN)
• Context
• Changing the shape of the system
• Changing the organisation of hospitals
• New planning system
• Conclusions
UK FHN Network
Information Authority
DOH Policy Unit
EPR
Impact of IT on design
PPP
Acute Strategy
Maternity/Paeds changes
Royal
Colleges
NatPaCT
Working with private sector
Output specs
Urban regeneration
Future
Healthcare
Network
Acute
Reconfiguration
Modernisation
Agency
Major Contractors Group
Information exchange
Redesign
Changing workforce
Design quality
Building processes
NHS Estates
Streamlining
procurement process
Accommodation
Training implications
Sustainability
Design quality
CABE
Prince’s Foundation
PFU
University
Hospitals
Network
Overseas FHN Network
Australia
New Zealand
Information
Authority
Major
Contractors
Group
DOH Policy
Unit
PPP
Acute Strategy
Maternity/Paeds changes
Royal
Colleges
Modernisation
Agency
EPR
Impact of IT on design
Working with private sector
Output specs
Urban regeneration
Future
Healthcare
Network
Acute
Reconfiguration
Information exchange
Redesign
Changing workforce
Design processes
Design qaulity
NHS Estates
European
property
network
Streamlining
procurement process
Accommodation
Training implications
Sustainability
Design quality
CABE
Prince’s Foundation
PFU
University
Hospitals
Network
USA
Role of the Future Healthcare Network
Innovation
Implementation
Policy
development
Trusts
NHS Confed
Support for changes in the NHS
System
configuration
Environmental
design
Innovation
Re-Design &
clinical pathways
FHN
Implementation
Workforce
change
Policy
development
Finance
Technology
change
Whole system thinking
Modernisation
Agency
DOH
policy unit
PCTs
NPDT
GP Premises and GP contract
Social
care
Best practice
across all PCTs
NHS
Estates
NatPaCT
More care outside hospital.
LIFT, Walk-in Centre,One stop shops, DTCs
PCT
Network
Acute
trusts
Whole system
planning
Policy
Development
New models of care,
Changing workforce, ICT,
Building design
Hospital
Network
Best practice across all
acute trusts
Context
• No major building for 10+ years
• Knowledge base and skills out of date,
fragmented
• Patient safety, staffing pressures
• New political imperatives
• New methods of building and procurement
• New culture
Centralisation of decisions:
historically unbalanced
Affordabilit
y
Workforc
e
Centralisation
Patient
safety
Patient
experience
Decentralisation
… but now rebalancing ...
Workforce
Centralisation
Patient
safety
Affordability
Service
delivery
Patient
experienc
e
Decentralisation
… and influenced by new developments
IT opportunities remote diagnosis
Training flexibility
Role changesWorkforc
e
High tech equipment
Patient
safety
Affordability
Service
delivery
Patient
experienc
e
Clinical networks
Centralisation
Decentralisation
So what is changing?
Organisation inside hospitals
Shape of health
system
Changing the shape
of the health system
Chaotic health
system
GP
Outpatients
Radiology
Lung
function
Mortuary
Home
Endoscopy
Emergency
Dpt
Ward
Theatre
Haematology
Pathology
? Medical
assessment
unit
Components of the health system
Specialist Tertiary hospital
500k pop
District Hospitals
(250k pop)
Local care centre(s)
50- 100k pop
Decentralisation of care
GPs
2-10k pop
Option 1 – Traditional model
Main access
Selected
access
Specialist Tertiary hospital
500k pop
District Hospitals
(250k pop)
emergency care
Local care centre(s)
50- 100k pop
elective care
Social care
Option 2 – Access at all levels
Specialist tertiary
hospital
Specialist access
24/7
Local access
Critical
care
Main access
Local elective care
(ACAD)
Local Care
Centre(s)
Local
Emergency
Local
elective:
Local emergency care
(BeCAD)
?16/7
Social care
Local access
Option 3 - Local access + information highway
Specialist tertiary
hospital
Local
BeCAD
Local
ACAD:
Main access
24/7
Strong
ICT
links
specialist
ambulatory care
ACAD:
Local elective care
Critical
care
Main access
Strong
ICT
links
Local access
Local Care
Centre(s)
BeCAD:
Local emergency care
?16/7
Social care
Changing the shape of the system
Conclusions about redesigning the system
•Different models to fit local needs
•Decentralisation of care
•Seamless communication ICT is vital
•Redesign not relocate services in small hospitals
•Stakeholder (patient and staff) views important
•Move information not patients round the system
•Local access to care & diagnostics
•Local chronic disease management through
clinical networks
Changing the organisation inside
hospitals
Changes in clinical practice + building design
Treatment
• NHS Direct
• Extended GP hours
• Minor injuries etc
Prevention
• intermediate care
(avoiding admission)
A&E &
Acute
Assessment
Assessment
Theatres
Ambulatory
care
Follow ups
Elective
• Specialist GPs
• Direct booking
• Outreach clinics
• Self care
Diagnostics
Critical
care
Specialist care
Step down / rehabilitation
Step down
• networks/links to
specialist or teaching
hospitals
Simple surgery
• intermediate care (speeding discharge)
• at home packages
• nursing homes
• community hospital beds
• Specialist GPs
• Primary care centres
Patient pathway across an organisation
Home
Sick
patient
better
patient
GP
Ambul’
A&E
X-ray
Labs
Ward
Graduated care process
Ambulatory
- 23 hr
investigations
& surgery
Outpatients
Community
+ Primary
Care
Chest Pain
Elderly
A&E
Assessment
Diagnostic
Medical Surgical
areas
Investigation
Critical
Care
Acute
Inpatient
Care
- Generalised
- Specialised
- One Stop
Patient Hotel
Intermediate
Care Facilities
•Rehabilitation
•Low
Dependency
Peri Acute
Care
•Respite
•Shared Care
•Home Care
•Social Care
Primary Care
Community
Community
Care pathway
Primary Care
Inpatient Aggregations
ENT
Maxillo-facial
Burns
Plastic Surgery
Breast Services
Dermatology
Oncology
Haematology
Stroke
GI Medicine
Trauma
Renal Medicine Cardiology Acute Medicine
GI Surgery
Respiratory & medical COE
Neurology
Renal
Surgery
Liver
Medicine
Palliative Care
Vascular
Urology
Neurosurgery
Liver Surgery
Cardiac Surgery Ophthalmology
Pain
Metabolic
Anaesthetics
Rheumatology
Outpatient Aggregations
Oncology
Liver Medicine
ENT
Cardiac Med &
& Radiotherapy
Ophthalmology
Liver Surgery
Maxfac
Surgery
Haematology
Neurosurgery
GI
Vascular
Dermatology
Breast
Neurology
Renal
Respiratory
Burns & Plastics Palliative Care
Urology
Pain
Acute Med &
Neurosurgery
medical COE
Neurology
Rheumatology
Trauma
Metabolic Unit Orthopaedics
A&E
Objective: to create critical mass across which services can be effectively provided. Flexibility to meet demand. Optimisation
through ‘pull’ system Groupings (or aggregation) of patients according to care needs to achieve more homogeneity in terms of
disease path, length of stay, skills and service requirements. New groupings away from traditional specialty based classifications.
Body mapping for focused patient management.
Small scale organisation (NWLHT)
Urgent
Treatment
Step-down
Expert consulting panel
Primary
Care Urgents
Primary Care
Follow-up
Primary Care Chronics
Intermediate
Care
Outpatients
NHS
Direct
Acute
care centre
A&E Minors
Rehab IP
A&E Majors
Step-down IP
Crit Care
Acute IP
Elective Care
Recovery & Theatres
Elective IP
DTC
Conclusions: changing the shape inside hospitals
•Clinical aggregations combining medical + surgical specialties
•ICT is vital to be ready at the same time as building
•Diagnostic front door
•Hot floors
•‘Cellular’ construction round processes
•Increased local outpatients + reduced hospital waiting areas
•Patient focused care – Do we need Radiology departments?
•Staffability: consequences for the workforce
So, we need a new planning system…
Stage1 : Health systems with different starting points & drivers
Building
Maintenance
Dialogue with
Local People
New standards
& guidelines
Workforce
issues
Stage 2: Developing the whole system vision
Hospital-Community/Primary-Social
Stage 3: Defining the limits of the possible
Stage 4: Options for change
Stage 5: Preferred option for whole system
Stage 6: Strategies for organisations and functions
Communications
IT
Building
changes
Stage 7: Outline business case
Workforce
Change
Patient and public involvement throughout the process,
Proposed planning process ( Pre SOC)
Service planning and environmental design
Environmental design getting more detailed>>>>>>>>>>>
Estates strategy
Outline designs
Strategic
overview
Concept designs
Inside/outside
hospital care
Detailed design
Care pathways
Detailed design of
components
New models of care
Clinical aggregations
Service planning scale getting smaller>>>>>>>>>
Life of project >>>>>>>>>>>
Clinical components
Integrated planning
Changing
workforce
New
Clinical
models
Building
design
Impact
of technology
Outside
hospitals
Private public partnerships
procurement
Whole system configuration
Inside
hospitals
Possible impact areas
Changing
roles
EUWTD
Changing
workforce
Patient /staff
environment
E learning
Demography
Efficient
building
layout
New clinical
models
Building
design
Knowledge
management
Access to
scarce skills
EPR
Environmentally
robust
Intelligent
buildings
Impact of
technology
Timescale
year 1
2002/3
year 2
2003/4
year 3
2004/5
year 4
2005/6
year 5
2006/7
29 large PFI projects phase 1
PFI Building process
Projects
DTC development
42 LIFT projects
Primary building process
New procurement process
Technology procurement
Care redesign processes
year 6
2007/8
pilots
pilots
Workforce change
Next
Election?
year 7
2008/9
year 8
2009/10
phase 2
Conclusions
Key issues for the FHN
1.
2.
3.
4.
5.
Ensure that the £value of good design is recognised
More resources to support service planning
Decentralisation of care and ICT – but how
Patient focused infra-structure what does it mean?
Adapt planning processes to new context? Who does
what in the new system
6. Can we afford an increased workforce?
7. Future medical equipment needs
Issues for whole system planning
•
•
•
•
•
•
PFI / LIFT interface
What can be done outside hospitals
Implications for GMS contract
Chronic disease management
Affordability
Timescales