LEEDS TEACHING HOSPITALS NHS TRUST Division of Diagnostic and Therapeutic Services

1. LEEDS TEACHING HOSPITALS NHS TRUSTDivision of Diagnostic and Therapeutic Services

2. WRITING A BUSINESS CASE FOR AN IR SERVICE BRIAN GODFREY DIVISIONAL GENERAL MANAGER DIAGNOSTIC & THERAPEUTICS DIVISION

3. LEEDS TEACHING HOSPITALS NHS TRUST • 2,200 Beds • Two Large Acute Hospitals • 3 Peripheral Hospitals • Range of Off-Site Facilities • 260k Inpatients and Day Cases Per Year

4. DIAGNOSTICS & THERAPUETICS DIVISION Pathology 850 Radiology 500 Pharmacy 500 Medical Illustration 30 Infection Prevention 20 1,900 wte Annual Budget £100M

5. Radiology Directorate Full Range of Imaging Modalities inc PET-CT 5 Sites - 11 Locations 500 wte 56 Consultants 11 Vascular / Neuro Interventionists 24/7 Intervention Service 2 Main acute sites

6. Background • Two former Trusts competing for services in one city • Duplication of services • Merger • Strategy of centralisation of clinical services. SOC withdrawn • Emergence of two complimentary acute hospitals • Trauma established at LGI • Vascular at LGI

7. Drivers for Change • Clinical Reconfiguration Strategy • Ageing equipment • Serious Untoward Incidents • Technological advances in interventional devices – neuro coiling • Medicines & Healthcare Products Regulatory Agency • Reduce vascular surgery “open” procedures

8. Drivers for Change • Abdominal Aortic Aneurysm Screening Programme • Vascular Services Review – Y&H SHA • Potential for new income streams • Patient Choice • Need to plan diagnostic services to support the Clinical Reconfiguration

9. Interventional Radiology • Full range of diagnostic and treatment procedures • Business cases concerned with Neuro and Vascular Intervention • 11 specialised consultants – working city –wide on-call on two sites • Trained radiographers and nurses

10. Planning the Development • Involve the Experts – Clinical Lead • Structured Planning Programme • Dedicated Planner • Multi – Discipline Approach inc Surgery • Understand the Pathway • Recognise joint MDT, M&M and Clinics • Scope the activity – Acutes / Electives

11. Benefits • Minimal Invasive Therapies - reduce infection rates - reduce recovery time - shorter LOS • Alternative to open procedures - Patient choice • Safety – Compliance with guidance etc • Develop Service • Robust Equipment

12. Contents of the Business Case • Background • Strategic Fit • Impact on Activity and Case for Demand • Patient Pathway and Risk Management • Finance - Capital Ancillary Equipment Revenue Risk and Return on Investment

13. Contents of the Business Case • Current Performance of the Directorate • Other Impacts of the Case • Summary of Options • Preferred Option • Risks • Deliver Method • Recommendation

14. Design • Consulting Rooms • Waiting Area – booking in etc • Theatre Quality • Anaesthetic Rooms • Compliance with NHRA, SHA • Recovery Area / Day Case • Changing Accommodation

15. Lessons Learned • Understand the Pathway • Responsibility for the Pathway • Involvement of surgeons and bed holding specialties, Radiographers and Nurses • Junior Doctor support • Co-location of services • Agree Income Streams • Stent 10k • Coil 7k • Return on investment • Patience – Two phase approach • Governance - Joint MDTs with surgeons - Audit and Joint M&M meetings

16. Lessons Learned • Plan for both Acute and Elective cases • Dedicated Planner • Networks • Comprehensive 24hr service • Compliance with statutory agencies etc.

17. And Finally • The case for investment should reflect the service need • ‘Prepare the Ground’ • TeamWork • Viability • Review and Audit