Summarising the Need for Change. As previously mentioned, the new Mental Health Strategy for Scotland 2017-27 includes several actions of relevance to mental health care for children and young people who display offending behaviour. In particular, Action 20: “scope the required level of highly specialist mental health inpatient services for young people, and act on its findings. These collective actions will support progress in developing care pathways for patient who may be admitted to the proposed national secure service. When developing the clinical brief cognisance will have to be taken of the specialist nature of the service and workforce expertise. The clinical workshop held in Stirling Court on 19 April 2018 determined a number of key principals that will be adopted and embedded within the Model of Care, these are: • Clarity of referral criteria and pathway; • Active planning for discharge; • Outcomes and benchmarking; • Maximising assessment prior to admission; • Minimising length of stay; • Reducing variation and promoting consistency; • Capacity modelling. The key principals noted above are imbedded with the IA and will continue to be developed though the business case process and into the operational phase of the project. The table below summarises the need for change. What is the cause of the need for change? What effect is it having, or likely to have, on the organisation? Why action now: No provision in Scotland Patients would be transferred to England for specialist provision, raising significant costs, disconnection for children and families and potentially compromised clinical outcome Extensive stakeholder consultation has highlighted lack of provision and risk associated with this highly vulnerable population. Dispersed service locations Existing service arrangements effect service access and travel arrangements Service access is currently inequitable for this in Scotland High risk service arrangements Inefficient service provision Continuation of the existing service performance is unsustainable and we are unable to adequately meeting demand. There is a delay in young people getting the right service Service arrangements not person centred Service is not meeting current or future user requirements A service that isn’t meeting user requirements is unsustainable, even in the short term Increased complexity with children and young people Increased requirement to have highly specialist facilities. Service provision is not currently available within Scotland.
Summarising the Need for Change. Table S9 below summarises the preceding narrative in relation to cause and effect of the need for change and the need for investment. Table S9: Summary of the need for change What is the cause of the need for change? What effect is it having, or likely to have, on the organisation? Why action now? Current and projected future demand – linked to ageing population Existing physical capacity is unable to cope with current demand, and future demand projections. To improve service sustainability and access in future Services are limited in their potential to implement desirable Target Operating Models Service performance and efficiency is limited. Continuation of current performance in unsustainable Fragmented and ageing IT systems and equipment, and cultural aspects of embracing new ways of working which are enabled by technology Sub-optimal use of, and access to, technology. To maximise resource efficiency and support modern care models Dispersed service locations and accommodation with unsatisfactory physical condition Services are not sufficiently person centred. To improve service quality, outcomes, patient dignity and satisfaction. Sustainability of services is proving more challenging in terms of e.g. attracting and retaining skilled Retention and sustainability of services and workforce in Grampian and NoS is challenged, with inequitable service To promote equity of access and prevent situation from worsening in terms of staff availability, pressure, morale What is the cause of the need for change? What effect is it having, or likely to have, on the organisation? Why action now? workforce access. Lack of suitability of accommodation, poor adjacencies, outmoded models of care Avoidable admissions and outpatient attendances occur, or occur at wrong place/time. Ongoing deterioration and performance impact unless acted upon
Summarising the Need for Change. A full list of the main drivers for change is outlined below, most of which are related to the current and predicted increased demand for elective surgery, particularly in the area of Orthopaedics, General surgery and Urology. What is the cause of the need for change? What effect is it having, or likely to have, on the organisation? Why action now: Existing and predicted demand for surgical procedures, with prediction of increased future service demand. Existing NHS Tayside capacity is unable to cope with future projections of demand for Orthopaedic, General surgery, Urology and other surgical specialties procedures between now and 2035 Existing capacity is unable to cope with current activity and will be unable to cope with the significant future projections of demand. Waiting times are rising across all specialities. Service sustainability will be at risk if this proposal isn’t progressed. Patients will face unacceptably long waits for surgery resulting in increased levels of patient anxiety, pain and detriment. Treatment time guarantees will not be able to be achieved for a majority of patients Dispersed, inefficient elective surgery service delivery across at least three locations. 20-30% of patients are unsuitable to be treated at Stracathro’ due to their comorbidities and its geographical isolation from main Existing service arrangements affect service access and contribute to inefficient service performance. As population ages and prevalence of comorbidities rise, this issue will increase in magnitude. To enhance service performance and resilience through innovative and optimal pathways which improve continuity. The Tayside Elective Care Centre will be adjacent to Ninewells , so full range of medical support services are available to deal with any clinical eventuality Much of the current clinic and theatre accommodation is 44 years old and does not support innovation or efficient patient flow Existing facilities are functionally ineffective and are unable to support more innovative models of care and efficient patient flow New state of the art facilities that are purpose built are critical to the delivery of improved patient flow and improved clinical productivity in both in patient and day surgery – without new appropriate facilities the service will not be able to adopt innovative models which are more productive and more cost effective Difficulties with recruitment and retention of workforce Unsustainable level of vacancies in key sectors of work...
