Shared Services: Towards

a distributed service model

for delivery of

NHSScotland’s laboratory

services.

Dr Bill Bartlett

21st June 2018

http://www.sharedservices.scot.nhs.uk/health-portfolio/programmes/laboratories/

Present State

14 Territorial Boards 2 Special Boards 32 Local Authorities 31 Integration Joint Boards

1 Nation 5.3 million People

Organisational Complexity

NHSScotland in Numbers

Health Services Cost Book 2014 to 2015 R130: - 22 locations 13 boards: -

Labs in Scotland PHI Map

Speciality Specimens

Microbiology 5 Million

Histopathology 2 Million

Haematology 11 Million

Tests

Biochemistry 82 Million

National

Regional

Multi-Board

BOARD

Hospital

Community

Patient

Laboratory services

• Current service:

• 27 laboratory locations, 87 laboratories:

• 21 Medical Micro

• 26 Biochemistry

• 26 Haematology

• 10 Histopathology

• 4 Immunology

• Covering 16 Boards (14 territorial and 2 special)

• 19 Specialities

• Approximately 3759 FTE staff

• Annual costs estimated at £251.6m

• £178.9m staffing costs

• £72.7m non-staffing costs

Once for Scotland

New models of care

Increasing Demand

Rising Expectations

Technology & Innovation

Service Sustainability

Quality & Safety

He

alth &

Social C

are In

tegratio

n

Th

e B

ig C

on

vers

atio

n:

Beyo

nd

2020

Drivers of change applying to NHS services

Resource constraints: Financial and Workforce

By working differently, Shared Services will deliver new ways of working which are flexible and responsive to the changing needs of NHSScotland for 2020 and beyond

Transformation service to meet needs.

Once for Scotland

www.sharedservices.scot.nhs.uk

2014: NHSScotland Shared Services

Health

Business

Operational

Laboratories

Clinical Engineering

Pharmacy

Public Health

Radiology

Shared Services

Strategy & Policy Context

MDN Paper to DSG Nov 2015

Shared Services Lab Team 2016

Workshops

Position Paper to CEs Sept 2016: Distributed Service Model

Strategic case for DSM CEs August 2017: Guiding Principles

Shared Services

Business case for the DSM

Positioning Paper

Strategic Paper

Business Case

Implementation

MANDATE

Data

IT

Innovation

Standardisation

Distributed Service Model Design Group

Guiding Principles Blueprint

Workstreams

Future State:

Distributed Services Model

Triple Aim Focus:

What is the Vision?

Patient centric,

outcome focussed,

whole system wise

Scotland wide access to

state of the art services

through a distributed service

-Right test

-Right place

-Right time

Delivery through a Distributed Service Model

What are we trying to achieve

with a DSM?

Investment objectives Why is change required?

To put in place a scalable configuration of

facilities that can meet future demand for

Laboratory services

Existing configuration is

unable to meet increasing

demand and new models of

care

To enhance service resilience through

minimising variation and enabling cross border

working

Risk of failure as the current

service model is not resilient

To provide a sustainable, resilient, adaptable

workforce lined to a credible workforce plan

Current workforce is not

sustainable

To provide improved and equitable outcomes

for patients

To refresh outdated

technology/ageing

infrastructure and increase

best practice

To deliver value for money Shrinking budgets and

competing demand for

revenue

Shared Services

A Distributed Service

“Functional distribution of laboratory resource that

enables equitable delivery of high quality health

care independent of location.”

Functional distribution NOT centralisation

Right test

Right place

Right time

Laboratory services

Efficient

Effective

Equitable Resilient

Affordable

Blod Sciences

Blood Transfusion

Bacteriology

Virology

Histopathology

Immunology

Genetics

Shared Services

National Laboratories Pie

Triple Aim Focus: Better Care, Better Experience of Care, Cost per Capita

Blod Sciences

Blood Transfusion

Bacteriology

Virology

Histopathology

Immunology

Genetics

National Pie

Functional distribution of service to Boards

Triple Aim Focus: Better Care, Better Experience of Care, Cost per Capita

Region 1

Region 3 Region 2

Governance: National Laboratory Oversight Board

Regional service

Supra-Regional service

• sustainability through a scalable, flexible, innovative service configuration.

• resilience through efficient and effective use of

– workforce knowledge and skills

– estate and physical resources

• equity of service across the country

• access to latest technologies at enabled centres accessible to all Boards.

• increased efficiency and effectiveness to either realise cost savings/containment or increase capacity through reduced waste and economies of scale.

Distributed service compliant with the

shared service agenda will deliver : -

-Right test

-Right place

-Right time

Design, Business Case & Implementation

Vision

Design

Incremental change

Incremental Approach to Change Distributed Service Model proposed

to CEs - August 2017

? Blood Sciences

Blood Transfusion

Bacteriology

Virology

Histopathology

Immunology

Genetics

Business Case

Data Group

IT Group

DSM Design Group Laboratories DSM Blueprint

Proposed Governance Framework

Data solution: National Labs Data Mart

IT Connectivity Solution: NPEx

High Level Specification for LIMS

Business

Case

£6.6M

BC Approved CE Meeting April 10th

2018

1.

2.

3. which will provide an (almost) real time

4.

1. A new governance framework: to facilitate the design and development of the Distributed Service Model and the delivery of the National Laboratories Blueprint.

2. IT Connectivity solution: which will enable laboratory to laboratory electronic communication and the management of work flow across NHSScotland Boards.

3. A National Laboratories Data Mart: which will provide an (almost) real time data set for multiple purposes e.g. clinical and business intelligence.

4. A high level technical specification: for the future procurement of Laboratory Information Management Systems.

Guiding Principles, Blueprint & Governance Structure

1. Enables national planning of services while enabling a focus on local needs

(right testing, right place, and right time).

2. Is aligned with the National Clinical Strategy, supporting health care improvement with a Triple Aim focus.

3. Employs a Once for Scotland approach through an appropriate governance structure.

4. Enables national workforce planning.

5. Allows the free flow of materials, information, data, knowledge and skills across organisations.

6. Enables optimised demand on services locally and nationally via appropriate interfaces with users and planners.

………………………………16

DSM Guiding Principles

http://www.sharedservices.scot.nhs.uk/media/1482/2018-02-06-laboratories-blueprint-final-version.pdfs

Organisation Technology Information

The Blueprint & Guiding Principle

Current model not optimised to deliver sustainable services to underpin current and future NHSScotland

requirements

National distributed service model (DSM) with unified vision configured to enable consistent delivery of

national, regional and local plans/ priorities enabling equity of access to servics..

Sta

rtIn

teri

mE

nd

Baseline and activity map of service use and project requirements.

Design and incrementally deliver a distributed service to meet current and emerging demands

Compliance of Boards/Regions with guiding principles, development of shared priorities, sharing of

outputs from processes such as procurement exercises

Region 1

Region 3 Region 2

Laboratories Services Oversight Board Regional delivery

Regional service

Supra-Regional service

New Governance Framework

Laboratory Services Oversight Board

Blueprint

Consistency

Blue Skies

Opportunity

Delivering Value

Guiding Principles

Enabling the Wider System

Triple Aim

Sharing

National Context

Connectivity and Data

IT Connectivity solution

• National funding for the procurement and

implementation of NPEx across Scotland

National Laboratories Data Mart (NLDM) solution

• National funding for the development and

implementation of a National Data Mart for

laboratories

Essential Infrastructure

Solving the IT/Data problems

Data Requiring Domains

Data Requiring Domains Data mart

development with prioritised

functionality

Fully developed Data Marts designed to

meet the needs of a DSM for labs.

• Vision

Laboratories DSM Blueprint

• Delivery of the vision

• Enables and supports regionalisation

Proposed Governance Framework

• Delivery & adds value

• Drives standardisation

Data Sharing: National Labs Mart Data

• Enables the evolution

• Connection of new and old systems

Lab to Lab Connectivity: NPEx

• Assures consistency

High Level Specification for LIMS

What are the Benefits?

Southern

Ireland

Carter

STP

Hub & Spoke

Shared Services

DSM

Making the future happen

• Far greater opportunities exist for

systems that want to be ambitious

• There is scope for new approaches

that consider the whole pathway

together with Laboratory Medicine

• Systematic collaboration between

sites will deliver greater benefits

than consolidation

• need for better supported IT that is

interoperable so patients and other

institutions can easily access data

• Reinvestment of efficiency savings.

“We cannot solve our problems with the same thinking we used when we created them”

(A. Einstein)

Laboratory services

Efficient

Effective

Equitable Resilient

Affordable