NATIONAL REVIEW OF REGIONAL PLANNING 2012 North of

NATIONAL REVIEW OF REGIONAL PLANNING 2012 North of Scotland Planning Group Meeting 12 th December 2012 1

Recap on focus and methodology for the work How helpful has regional planning been for Boards to date? To what extent has regional planning achieved the original policy aims? Links between Regional and National Planning? How Boards would like to see regional planning evolve? NB Also need to remember link to review of ‘planning architecture’ 22 interviews & 5 questionnaires returned. Workshop 15 delegates 2

What has worked well? • Collaborative focus, corporate approach and ability to develop working relationships • Safe space to develop a common view/reflect • Driving through redesign • Useful role – “honest broker” facilitator • Useful to have regional perspective- thinking outwith normal boundaries • Clearing house roles of Do. Fs /Do. Ps or specialist services groups helpful 3

What has worked well? • Valued the input of the workforce perspective around the table • “Patients don’t recognise boundaries so we do need to ensure equity and consistency across the region” • Medical workforce planning and input from NES • Success across a range of services cancer specialist paediatrics, specialist mental health etc • Collaboration across regions and NSD really positive • “Where would we have been if we hadn’t had it? ” 4

What has got in the way? Resource? Although financial climate has sharpened focus Agenda hasn’t targeted the best or most high value activities Doesn’t work if it is not mutually beneficial Personalities Clinical teams local focus - (can also work as a positive force) Communication within Boards Local priorities - time capacity Board performance management doesn’t take account of how Boards engage regionally • Inter Board tensions… • • 5

What has got in the way? • Assumption against centralisation • Politics local and national - although regional planning can also help • Lack of clarity around medical workforce agenda nationally • Tension between being an agent of the Boards and also taking direction from Scottish Government • Not taking the leap around shared services • Disconnect between buy in at Chief Exec level and middle managers • Goes against the prevailing organisational culture 6

Good collaboration in specialist planning Mental Health Child & Adolescent Mental Health Eating Disorders Neurosurgery Primary PCI Paediatrics Regional cancer networks Oral Maxillofacial Surgery Joint training and education for workforce and skills development Mutual aid frameworks (e. g. pandemics, severe weather etc) 7

Acute Services could do more? • • • Orthopaedics - SEAT Remote and Rural DGHs Spinal Vascular Lanarkshire Picture of Health 8

Collaboration to achieve equity of access Renal (particularly Wo. S) No. S – telemedicine IVF Learning disability Low secure forensic mental health services Primary PCI Eating disorders Telestroke (SEAT with D&G) Some obesity work Interventional cardiology Renal replacement therapy Chemotherapy Radiotherapy Complex drug therapies Spinal 9

Collaboration to achieve service sustainability Sexual health Vascular Services Paediatrics Cancer Learning Disability Oral Maxillofacial ENT services – limited success Surgical sarcoma Renal dialysis ICD implants Oesophogastric resection surgery Cancer services Child Health Acute Services review - No. S Eating Disorders Deaf blind Service (SEAT) Bariatrics Neonatal Orthopaedics Ovarian cancer surgery Specialist oncology Child Sex Abuse Perinatal psychiatry 10

Bringing together service, workforce and financial planning and the planning events • • Successes and challenges Key success with medical workforce planning Financial planning as needed Workforce input to regional service planning groups But workforce planning remains a challenge (at all levels) Tried to meet too many different audiences Targeted events worked best 11

Links between regional and National Planning • Regional planning groups can help to drive the agenda e. g. TAVI • NDP specialist Paediatrics -excellent model here re the pan Scotland work • Regional overview to inform national planning • Boards can choose to use Regional Planning Groups to develop a common view • BUT need to be sure that form fits function regional planning not the only planning response Board representation is key • Key role in influencing workforce planning nationally 12

Role in Supporting National Planning Forum • Depends on the issue - “Form follows function” some topics appropriate for regional approach others not • 2 Way flow - Key role in shaping the NPF agenda and also taking away issues to work on them 13

Role in supporting the Chief Executives Group • Chief Execs needs a clearing house and the ability to commission work more easily • Filter in and out needs to be established and RPG(s) could be part of this • Needs clear link to NPF • RPGs can be used as a forum to develop a view 14

Role in Supporting the Quality Agenda • Should be integral not an add on • Have we got enough focus on outcomes in regional planning • Not about performance management but joint collaborative review • “I’m not feeling the connection” • Not sure where the Quality Alliance Board and the Strategy Delivery Groups fit in? 15

How would you like to see Regional Planning evolve? Workshop Questions • Build on it • More outcomes focussed? • Is there a role for a national planning resource and how would this link to Regional planning? • Need to consider the implications of the health and social care integration agenda • Should we develop clinical services review on a regional basis? • What will the impact be of diminishing resource both financial and workforce 16

How can we best build on regional planning Potential solution 1: The mandate to contribute to/or support regional working should be embedded into more people’s job descriptions and functions Potential solution 2: There is a need to increase the reach and visibility of regional engagement including sharing regional strategic priorities and work plans Potential solution 3: Identify a series of test questions / criteria to help identify the appropriate planning level for service redesign and other regional priorities 17

Outcomes Focus Potential solution 4: A more explicit improvement approach to regional working, integrated with local Board reporting structures, would support an outcomes focus Potential solution 5: Consider the potential for peer-assessment within each region of each Board’s contribution to regional working Potential solution 6: Consider use of the LDP process to enhance Boards’ regional delivery and accountability 18

2 Way Flow: National and Regional Planning Potential solution 7: Ensure that this review of regional planning and proposed options for consideration inform the wider review of the ‘architecture’ for delivering quality Potential solution 8: Ensure that Scottish Government policy leads are fully sighted on the outcomes of the current review of the ‘architecture’ for delivery and quality and can respond appropriately 19

Impact of diminishing Resources? Potential solution 9: Boards should continue to review opportunities on a regional basis for efficiencies both through shared services or clinical service redesign Potential solution 10: Boards’ commitment to collaborative working and the wider interest needs to be reinforced Potential solution 11: Directors of Finance to jointly consider financial arrangements that better support regional planning Potential solution 12: Regional Planning Groups to consider the increased participation of Regional Directors in national policy work and any consequent resource implications 20

Principles for any Regional Clinical Service Reviews Potential solution 13: Boards, working in regional planning groups to review acute services that present patient safety and sustainability issues. Regional Planning Directors to consider a common methodology for this work 21

Health and Social Care integration? Potential solution 14: Boards to consider opportunities to engage strategically through regional groups with health and social care partnerships and also raise awareness of specialist services and the associated organisational arrangements Potential solution 15: Boards need to continue to foster and promote flexible approaches to regional collaborative working in the context of the health and social care integration agenda 22