National Priorities 2003-04
NHS Lothian – Service Re-design. Final
(a)
Title of Service:
SERVICE RE-DESIGN
Service redesign is a key part of service modernisation. Sharpening patient focus
and improving patient pathways is central to service redesign and crucial to
delivering a modern NHS in Lothian. Redesign can help to reduce inequalities and
enhance the patients’ journey while shortening hospital admission.
(b)
Local Position
Redesign takes place across all NHS boundaries and NHS Lothian has an ambitious
and successful programme involving hospital, primary care and community services
as well as teams from neighbouring NHS Boards.
Much of the work in the acute sector is linked to existing or developing Managed
Clinical Networks (MCNs). A local stocktake of activity has identified a great deal of
enthusiasm for and activity on the concept locally.
NHS Lothian is developing a strategic approach to MCNs taking account of national
policies in this area. MCNs often stretch across NHS Board boundaries ensuring that
protocol driven evidence based care is available to patients wherever they live. A
number of MCNs have been prioritised for further development in the coming months
including :
 Stroke,
CHD
Gynaecology
 Ophthalmology
Epilepsy
 Paediatric Dentistry
Colorectal
The order of priority in which these are developed will need to be jointly agreed
between the services, NHS Lothian and the relevant partner organisations.
Redesigning cancer services is a particular priority for the NHS.
 Redesign of the lung cancer service, as part of the SCAN Lung Group, aiming to
develop a single entry point for patients and a smoother pathway avoiding
unnecessary delays in investigations.
 A major NHS Lothian investment in premises and a redesign of the breast cancer
clinical service at the Western General Hospital has led to improved efficiency and
an improved experience for women with breast cancer.
The work of the Clinical Standards Board for Scotland (CSBS) in cancer services and
the patient focus it brings to care pathways more generally have been important
stimuli to service redesign. Surveys of inpatient and outpatients as well as staff
views and compliments received are important in driving this work toward making
NHS Lothian more patient friendly.
Other areas where services have been redesigned in a major way are – :
 Maternity – a community based model of care has been introduced and is
welcomed by patients. It is linked to the move of maternity services to the new
RIE at Little France.
 Mental Health – an ongoing strategy of major change, involving a realignment of services between hospital and community with the focus
shifting to the community
 Breast Cancer – development of referral guidelines.
JT.401286387
Page 1
30/06/2016
National Priorities 2003-04
NHS Lothian – Service Re-design. Final
(c) Changes To Improve Services
From a recent Stakeholders event, involving statutory and voluntary partners, the
following key areas for re-design work during 2003-04 have been identified : Developing clear priorities for service modernisation targeting problem areas, e.g.
long waits.
 Using re-design to tackle the bottlenecks in service provision
 Clarifying patient care pathways, including improving diagnosis and consistent
good practice.
 Ensuring patients are seen in the most appropriate setting and by the most
appropriate practitioner according to their needs.
 Making the best use of available skills and extending staff roles where
appropriate, in particular when in the patient’s benefit.
 Use of assessment clinics to help triage referrals and manage waiting times to be
seen by a Consultant. Some referrals may not need to be seen at all.
(d) Outcomes
Specific Areas Being Targeted in 2003/04: Orthopaedics, both out-patient and in-patient.
 Chronic Disease Management.
 Development of diabetic care in Lothian, shifting the focus to the community.
 Linking GP out of hours services with NHS 24 next year.
 Re-design of gynaecology services in West Lothian following recently completed
Lothian gynaecology guidelines
 Endoscopy – planned re-design of care pathway for dyspepsia co-ordinated with
publication of SIGN guidelines.
 Dermatology – LUHT/LPCT liaison group to re-design service following the
Group’s completion and agreement on guidelines.
 Improving Primary Care access to Diagnostic Services
 Lothian has attracted national funding from the Scottish Executive for a colorectal
cancer redesign which will build on the opportunity afforded by the combination of
colorectal services in Edinburgh onto one site.
Outcomes To Be Achieved

Consistency in approach to re-design initiatives achieved by the setting up of a
Lothian Re-design Group by mid-2003.

To have developed a Re-Design Framework which can be used to initiate redesign work for any speciality. This will be built around the good practice
guidance used in England.

‘Seamless’ care becoming a reality as a result of redesign work to eliminate
visible boundaries between services within the NHS.

Agreed patient pathways resulting in shorter waiting times.
JT.401286387
Page 2
30/06/2016