Download - Whole systems planning
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Summary
• About the Future Healthcare Network (FHN)
• Context• Changing the shape of the system• Changing the organisation of
hospitals• New planning system• Conclusions
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UK FHN Network
Future Healthcare
Network
Modernisation Agency
Information AuthorityMajor Contractors Group
DOH Policy Unit
PFU
NHS Estates
Royal Colleges
University Hospitals Network
CABEPrince’s Foundation
Information exchangeRedesignChanging workforce
AcuteReconfiguration
PPPAcute Strategy
Maternity/Paeds changes
EPRImpact of IT on design
Working with private sectorOutput specs
Urban regeneration
Streamlining procurement process
AccommodationTraining implications
Design qualityBuilding processes
SustainabilityDesign quality
NatPaCT
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Overseas FHN Network
Future Healthcare
Network
Modernisation Agency
Information Authority Major
Contractors Group
DOH Policy Unit
PFU
NHS Estates
Royal Colleges
University Hospitals Network
CABEPrince’s Foundation
Information exchangeRedesignChanging workforce
AcuteReconfiguration
PPPAcute Strategy
Maternity/Paeds changes
EPRImpact of IT on design Working with private sector
Output specsUrban regeneration
Streamlining procurement process
AccommodationTraining implications
Design processesDesign qaulity
SustainabilityDesign quality
AustraliaNew Zealand
European property network
USA
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Role of the Future Healthcare Network
Innovation
ImplementationPolicy
development
Trusts NHS Confed
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Support for changes in the NHS
Environmental design
Workforce change
Technology change
Re-Design & clinical pathways
Finance
Innovation
ImplementationPolicy
development
FHN
System configuration
Plann
ing
and
PPP
Planning and P
PP
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Whole system thinking
PCTsDOH policy unit
Modernisation Agency
NPDT NatPaCT
NHS Estates
Whole system planning
PCT Network
Hospital Network
Best practice across all PCTs
Best practice across all acute trusts
Policy Developmen
t
Acute trusts
More care outside hospital.LIFT, Walk-in Centre,One stop shops, DTCs
GP Premises and GP contractNew models of care,
Changing workforce, ICT, Building design
Social care
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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
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Centralisation of decisions: historically unbalanced
Centralisation Decentralisation
Workforce
Patient safety Patient
experience
Affordability
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… but now rebalancing ...
Centralisation Decentralisation
Workforce Patient safety
Patient experienc
e
Service delivery
Affordability
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… and influenced by new developments
Centralisation Decentralisation
Patient safety
Patient experie
nce
Service delivery
Training flexibility
IT opportunities - remote diagnosis
High tech equipment
Affordability
Workforce
Clinical networks
Role changes
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So what is changing?
Organisation inside hospitals
Shape of health system
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Changing the shape of the health system
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Theatre
Endoscopy
Pathology
Haematology
Radiology
Home
Emergency DptWard
Outpatients
Lung function
Medical assessment
unit
GP
Mortuary
?
Chaotic health system
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Components of the health system
Specialist Tertiary hospital500k pop
District Hospitals (250k pop)
Local care centre(s)50- 100k pop
GPs2-10k pop
Decentralisation of care
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elective care
Option 1 – Traditional model
Complex cases
Medically fit for discharge
or for convalescence
Medically
fit for
discharg
e
District Hospitals (250k pop)
emergency care
Specialist Tertiary hospital500k pop
Local care centre(s)50- 100k pop
Main access
Social care
Selected access
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Option 2 – Access at all levels
Specialist tertiary hospital
24/7
Local elective care(ACAD)
Local emergency care(BeCAD)
Complex cases+ICT
Medically fit for
discharge
Critic
al
care
Local elective:
Local Emergency
Main access
Specialist access
Local access
?16/7
Local Care Centre(s)
Social care
Local access
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Option 3 - Local access + information highway
Specialist tertiary hospital
24/7
ACAD: Local elective care
BeCAD: Local emergency care
Critic
al
care
Local ACAD:
Local BeCAD
Main access
specialist ambulatory care
Local access
Strong ICT
links
Strong ICT
links
?16/7
Main access
Local Care Centre(s)
Social care
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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
Chan
gin
g t
he s
hap
e o
f th
e
syst
em
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Changing the organisation inside hospitals
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Changes in clinical practice + building design
• intermediate care (avoiding admission)
• NHS Direct• Extended GP hours• Minor injuries etc • Specialist GPs
• Direct booking• Outreach clinics • Self care
• intermediate care (speeding discharge)• at home packages• nursing homes• community hospital beds
Step down / rehabilitation
Theatres
DiagnosticsCritical
care
A&E & Acute
Assess-ment
Elective
Ambulatory care
Prevention
Treatment
Ste
p d
ow
n
Assessment
Follow ups
Simple surgery
• Specialist GPs• Primary care centres
• networks/links to specialist or teaching hospitals
Specialist care
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Patient pathway across an organisation
A&EGP X-rayAmbul’Home Labs WardSick patient
betterpatient
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A&EDiagnostic
Investigation
Critical Care
Acute Inpatient Care Intermediate
Care Facilities
Ambulatory- 23 hr investigations & surgery
Outpatients
- Generalised- Specialised- One Stop
•Rehabilitation•Low Dependency•Respite•Shared Care•Home Care•Social Care
Community
Primary Care
Com
mu
nit
y +
P
rim
ary
C
are
Primary Care
Community
Patient Hotel
Chest Pain Elderly
Assessment
Medical Surgical areas
Peri Acute Care
Graduated care processGraduated care process
Care pathway
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OncologyHaematology
Palliative Care
PainAnaesthetics
Liver Medicine
Liver Surgery
GI MedicineGI Surgery
Renal Medicine
Renal SurgeryUrology
CardiologyRespiratory
VascularCardiac Surgery
Ophthalmology
MetabolicRheumatolog
y
Stroke
Acute Medicine& medical
COE
Neurology
Neurosurgery
Trauma
Inpatient Aggregations
Outpatient Aggregations
Burns
Plastic SurgeryBreast
ServicesDermatology
ENTMaxillo-facial
Cardiac Med Cardiac Med & Surgery& SurgeryVascularVascular
RespiratoryRespiratory
Liver Liver Medicine Medicine
Liver SurgeryLiver SurgeryGIGI
RenalRenalUrologyUrology
ENT ENT MaxfacMaxfac
NeurosurgerNeurosurgeryy
NeurologyNeurology
Acute Med Acute Med & medical COERheumatologRheumatolog
yyDermatologyDermatology
Burns & Burns & PlasticsPlastics
OncologyOncology& &
RadiotherapyRadiotherapyHaematologyHaematology
BreastBreastPalliative Palliative
CareCarePainPain
TraumaTraumaOrthopaedicsOrthopaedics
A&EA&E
OphthalmoloOphthalmologygy
NeurosurgerNeurosurgeryy
NeurologyNeurology
Metabolic Metabolic UnitUnit
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.
.
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NHS Direct
Primary Care Urgents
A&E Minors
A&E Majors
Crit Care Acute IP
Recovery & Theatres
Primary Care Chronics
Outpatients
Primary Care Follow-up
Intermediate Care
Rehab IP
Step-down IP
Elective IP DTC
Urgent Treatment Step-down Expert consulting panel
Acute care centre
Elective Care
Small scale organisation (NWLHT)
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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
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So, we need a new planning system…
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Stage1 : Health systems with different starting points & drivers Workforce
issuesNew standards& guidelines
Building Maintenance
Proposed planning process ( Pre SOC)
Stage 3: Defining the limits of the possible
Stage 5: Preferred option for whole system
Stage 4: Options for change
Stage 2: Developing the whole system vision
Hospital-Community/Primary-Social
Stage 7: Outline business case
Workforce ChangeCommunications Building
changesIT
Pati
en
t an
d p
ub
lic in
volv
em
en
t th
rou
gh
ou
t th
e
pro
cess
, Stage 6: Strategies for organisations and functions
Dialogue with Local People
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Service planning and environmental design
Service planning scale getting smaller>>>>>>>>>
Environmental design getting more detailed>>>>>>>>>>>Estates strategy
Outline designs
Concept designs
Detailed design
Strategic overview
Inside/outside hospital care
New models of care
Clinical aggregations
Detailed design of components
Care pathways
Clinical components
Life of project >>>>>>>>>>>
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Integrated planning
pro
cure
men
t
Private public partnerships
Changing workforce
New Clinical models
Building design
Impact of technologyW
hole
syst
em
con
fig
ura
tion
Inside hospitals
Outside hospitals
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New clinical models
Changing workforce
Impact of technology
Building design
Possible impact areas
EUWTD E learning
Redes
ign
of
clin
ical
proc
esse
s
Stan
dard
com
pone
nts
EPR
Knowledge management Access to
scarce skills
Intelligent buildings
Efficient building layout
Changing roles Patient
/staff environment
Demography
Environmentally robust
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Timescale
year 1 year 2 year 3 year 4 year 5 year 6 year 7 year 82002/3 2003/4 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10
PFI Building process
DTC development
Primary building process
Technology procurement
Care redesign processes
Workforce change
29 large PFI projects phase 1
Projects
42 LIFT projects
New procurement process
pilots
phase 2
pilots
Next Election?
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Conclusions
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Key issues for the FHN
1. Ensure that the £value of good design is recognised
2. More resources to support service planning3. Decentralisation of care and ICT – but how4. Patient focused infra-structure what does it
mean?5. 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
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Issues for whole system planning
• PFI / LIFT interface• What can be done outside
hospitals• Implications for GMS contract• Chronic disease management• Affordability• Timescales