SaHF DMBC Volume 1 Edition 1.1.pdf - Shaping a healthier future

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Feedback received Stakeholders who provided this feedback Our consideration of the feedback DMBC reference Are London Health Programme (LHP) standards consistent with the SaHF clinical standards SaHF Clinical Board. LHP standards were being developed when SaHF went to consultation in July 2012, and proposed standards were reviewed in late 2012. The final standards are due to be published by mid-February. During the post-consultation period the Clinical Board, U&EC, Paediatric and Maternity CIGs reviewed the proposed LHP standards against the standards our clinicians proposed pre-consultation to understand alignment. The three CIGs have all recommended adopting the proposed LHP standards. Clinical standards: Chapter 7 Greater consideration needs to be given to social care Harrow HOSC/ Council Imperial College Healthcare Trust Richmond Council Kensington & Chelsea HOSC Brent LINk Brent HOSC Hillingdon HOSC JHOSC Hillingdon LINk. We worked with the eight CCGs to develop their out of hospital strategies, and this work considered joint working with social care. We continue to support CCGs through the out of hospital work in developing their relationships with social care. This includes engagement with Health and Wellbeing Boards and the expectation is that CCG Commissioning Intentions would be signed off by each Boroughs Health and Wellbeing Board. CCGs are also progressing implementation of the integrated care model of local health and social care, working with local authorities to manage care needs of patients in a coordinated way; this includes work by the tri-borough on their community budget programme and whole systems ICP. Carers analysis: Chapter 13, Section 13.6.3 Post consultation we undertook work to explore the impact of the OOH strategies on carers, the outputs of this work are detailed in this document and support the detailed planning of each CCGs OOH initiatives. Assurances required that UCCs are safe and staff will have necessary competencies including providing junior staff training College of Emergency Medicine Public Ealing Council Ealing HOSC Brent LINk Brent HOSC The CIG is proposing that UCCs operate within a network to provide appropriate clinical governance and that they have a relationship with an A&E at a major hospital to support the safe delivery of emergency services. Where the proposal is for the UCC to be co-located with the major hospital then this would be the ‘partner’ A&E, where the UCC is on a local hospital site or stand alone then a neighbouring major hospital would provide the ‘partner’ A&E. The U&EC CIG has developed a common UCC specification which details the services a UCC should provide and the required quality standards. This UCC specifications: Chapter 7, Section 7.6.2 and Chapter 8d 6. Consultation, feedback and how we responded 78
Feedback received Stakeholders who provided this feedback Our consideration of the feedback DMBC reference Hillingdon LINk JHOSC. specification is intended to be used across NW London and would ensure UCC services are both safe and consistent. Clarity required about services provided at UCCs NHS Central London CCG Ealing Hospital Trust Ealing Council College of Emergency Medicine Kensington & Chelsea HOSC Kensington & Chelsea LINk JHOSC Public Westminster Hounslow. Pre-consultation we developed high level descriptions of the services provided at UCCs. Further details were provided during consultation as part of the production of the local hospital factsheet and these were shared at various borough events and put online. The U&EC CIG has developed a common UCC specification which details the conditions that UCCs should follow, those that are excluded, the service models and transfer protocols (i.e. when and how patients will be transferred from a UCC if they need full A&E services), staff competencies, quality standards and governance arrangements. This work is included within this document. UCC specifications: Chapter 7b and Chapter 8d How will the lack of consistency between services offered at different UCCs be addressed Hammersmith & Fulham LINk Public. The U&EC CIG has developed a common UCC specification which details the conditions that UCCs should follow, those that are excluded, the service models and transfer protocols, staff competencies, quality standards and governance arrangements. Future tendering of UCC services will reflect this common UCC specification and consistency achieved as contracts are retendered. Existing contracts would be renegotiated where possible. UCC specifications: Chapter 7b and Chapter 8d Is there the required workforce for staffing UCCs College of Emergency Medicine Hounslow HOSC JHOSC. We undertook workforce analysis prior to consultation. Our U&EC CIG has undertaken further analysis of staffing requirements for proposed UCCs, including workforce competencies. This work is included in this DMBC. UCC staffing: Chapters 7 and 16 6. Consultation, feedback and how we responded 79
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North West London Shaping a healthi
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Table of contents Volume 1 Foreword
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Foreword Dr Mark Spencer The Clinic
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6. Consultation, feedback and how w
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13. Equalities implications This ch
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1. Executive Summary Introduction t
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The overall programme timeline is b
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The process was used before consult
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• Delivery of multi-disciplinary
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Stage 1 - Case for Change Our work
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For Quality of care, clinicians hav
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1 2 3 4 5 A 6 B 7 C 8 Quality of Ca
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Assuring the proposals Throughout t
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Programme implementation arrangemen
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5. To agree that Hammersmith Hospit
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DMBC Chapter 2 - Introduction to th
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2. Introduction to the NHS in NW Lo
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Figure 2.3: Clinical Commissioning
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West Middlesex University Hospital
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major hospital, elective centre and
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DMBC Chapter 3 - Introduction to th
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3. Introduction to the Shaping a he
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3.3 Programme governance The Joint
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The JCPCT is advised by a Programme
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Consultation - during this phase, t
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Ensure consistency of communication
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Stakeholder Group Political Individ
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o o o o o Rationale for options dev
Page 57 and 58: The implications of the options in
Page 59 and 60: DMBC Chapter 4 -The Case for Change
Page 61 and 62: 4. The Case for Change This chapter
Page 63 and 64: Stroke Services: The provision of s
Page 65 and 66: We need to do more to support patie
Page 67 and 68: In NW London, however, the NHS is s
Page 69 and 70: Figure 4.6: Emergency general surgi
Page 71 and 72: attack or stroke to designated cent
Page 73 and 74: Figure 4.9: Evaluation of primary c
Page 75 and 76: Inequalities would continue and pro
Page 77 and 78: DMBC Chapter 5 - Process for identi
Page 79 and 80: 5. Process for identifying a recomm
Page 81 and 82: Figure 5.1: Basis of decision of wh
Page 83 and 84: We confirmed this decision, and the
Page 85 and 86: 5.5 A detailed description of the s
Page 87 and 88: Correct care setting to deliver hig
Page 89 and 90: Figure 5.11: Ratings used in evalua
Page 91 and 92: DMBC Chapter 6 - Consultation, feed
Page 93 and 94: 6. Consultation, feedback and how w
Page 95 and 96: 6.2.1 Key findings from the consult
Page 97 and 98: times (particularly for patients tr
Page 99 and 100: Westminster City Council, Adult Ser
Page 101 and 102: Analysed and considered consultatio
Page 103 and 104: 6.3 Our responses to feedback This
Page 105 and 106: Feedback received Stakeholders who
Page 107: 6.3.3 Theme 3: Clinical vision and
Page 113 and 114: 6.3.5 Theme 5: Proposals for local
Page 123 and 124: DMBC Chapter 7 - Clinical vision, s
Page 125 and 126: 7a. Clinical, vision, standards and
Page 127 and 128: Local clinicians agreed that in ord
Page 129 and 130: ▪ Expectant mothers should have t
Page 131 and 132: # Standard care services (111). As
Page 133 and 134: Figure 7.8: Development of the acut
Page 135 and 136: # Standard Adapted from source depa
Page 137 and 138: Figure 7.11: Shaping a healthier fu
Page 139 and 140: No. Standard Adapted from source Su
Page 141 and 142: No. Standard Adapted from source se
Page 143 and 144: # Standard All emergency department
Page 145 and 146: # Standard All non-urgent - within
Page 147 and 148: Figure 7.18: Shaping a healthier fu
Page 149 and 150: # Standard Adapted from source shou
Page 151 and 152: # Standard Adapted from source Comm
Page 153 and 154: The final standards are more demand
Page 155 and 156: Figure 7.26: Proposed services to b
Page 157 and 158: Each CCG is taking steps to help pr
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in major hospitals) and equipment t
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tangible differences for patients
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Referral A&E Illustrative patient j
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Illustrative patient journey matern
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Illustrative patient journey in mat
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Illustrative patient journey planne
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GP-led care Illustrative patient jo
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7.8.1 Scope of the CIG’s work The
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Theme Clinical outcomes Staff attit
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Further stakeholder engagement is n
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Figure 7.31 E&UC CIG Responses to N
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NCAT recommendation CIG response Se
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Conditions suitable for UCC Clinica
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Exclusion criterion Mental health A
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Diagnostics 7.14.3 Streaming, regis
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Biochemistry Microbiology Radiology
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The Provider must deliver appropria
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Figure 7.41: E&UC CIG recommended k
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will be able to establish a service
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The UCC provider will be responsibl
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Key differences Governance As with
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should be provided with appropriate
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Process map 1: Assessing UCC patien
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Process map 3: UCC to ED transfer p
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make an appointment with their own
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7.19 ED workforce A programme-wide
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The purpose of this section is to s
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Figure 7.45 Consultation results on
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Figure 7.46: Specific Responses the
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NCAT recommendation Original Progra
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7.25.1 London Health Programmes cli
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Future capacity in centralised serv
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3. There would be an additional "st
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in NWL will have a choice of delive
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Support for the proposal is higher
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Figure 7.49: Specific feedback the
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Sub-Theme Organisation Support Conc
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Sub-Theme Organisation Support Conc
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7.36.1 National Clinical Advisory T
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NCAT recommendation Further engagem
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edistributed nationwide. We envisag
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6. The Maternity CIG have considere
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DMBC Chapter 8A-E - Out of hospital
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Out of hospital improvements This c
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8.2. Settings of out of hospital ca
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practical solution for the site, wh
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Brent Health Partnerships Overview
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Consultation theme Standards for ca
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Consultation theme Integration Inve
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8.5.3. Workforce Following feedback
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Delivering this workforce shift wil
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Measure type Domain Potential measu
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8b. Primary care development 8.6. S
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consultation they could have receiv
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8.10. Next steps We are developing
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Figure 8.11: Hub/health centre requ
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some cases, these will be offered o
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Process for development of local ho
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The result is an emerging picture o
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Across NW London, these sites will
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need redeveloping or rebuilding to
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8d. Urgent care centres When indivi
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Figure 8.22: NW London urgent care
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Conditions suitable for UCC Clinica
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Key differences Governance As with
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processes of the CCG and as such th
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around the table accelerates the un
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Improved empowerment - specifically
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Figure 8.28: Realising our integrat
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Figure 8.29: Summary of CCG commiss
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DMBC Chapter 9 - Decision making an
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9a. Decision making analysis stages
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Correct care setting to deliver hig
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“The Brent Health Partnerships Ov
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Royal College of Midwives “The RC
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clinicians wanted to take this into
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9.6.3 Feedback received about the s
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Confirm the service models reflect
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Figure 9.9: The seven hurdle criter
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surgeons in NW London, but we would
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We confirmed this decision with the
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Appropriate staffing is integral to
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The proposals are supported by Depa
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NW London to deliver high quality c
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1. Support predicting where activit
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Figure 9.15: Example travel time ma
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The analysis shown in Figure 9.18,
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Figure 9.18: Impact on private car
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33% support 10% opposed 57% of peop
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Figure 9.21: Watershed map for blue
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etained as a major hospital, becaus
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9.7.29 The implications of this fee
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Figure 9.25: Potential activity flo
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Figure 9.27: Changes in travel time
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Figure 9.29: Changes in travel time
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Figure 9.31: Possible choices betwe
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Either Charing Cross or Chelsea & W
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Figure 9.33: Option A, excluding ca
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Figure 9.36: Option C responses, in
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Richmond Upon Thames LINk Royal Bor
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Southall Black Sisters “The closu
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Figure 9.38: Ranking of evaluation
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Figure 9.42: Evaluation criteria as
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anked third according to the mean s
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9.9.5 The analysis of the five eval
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Figure 9.45: Quality Dashboard data
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Response to feedback about the eval
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Figure 9.48: Quality of care - Acut
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experience. In order to use this as
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Figure 9.50: Time to major hospital
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Rationalising provision across the
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Figure 9.51: Blue light travel time
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Figure 9.52 shows the reduction in
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3 Value for money 9.9.26 The purpos
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Staff recommendation as a place to
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This analysis was agreed prior to c
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Figure 9.56: Ease of delivering eac
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Response to feedback about implemen
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Changes to the designation of the M
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5 Research and Education: Disruptio
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Figure 9.60: Evaluation of disrupti
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9.9.48 The outcome of the disruptio
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Greg Hands, MP for Chelsea & Fulham
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comprises more than 22 million cita
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Quality/Impact score Figure 9.65 Re
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9. Decision making analysis - stage
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There were six distinct parts of th
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Figure 9.69: 5 year gross savings,
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Figure 9.73: Commissioners intend t
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Figure 9.75: Beds bridge: 2012/13 t
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The key modelling assumptions appli
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Figure 9.79: DMBC NHS net capital e
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Figure 9.81: Approach to estimating
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Figure 9.84: Summary of net surplus
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Figure 9.86: Evaluation of total su
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9.13.9 Impact of the changes: Updat
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Figure 9.89: Effect of the expanded
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Sensitivity tests g) Tariff efficie
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Figure 9.93 summarises the impact o
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Figure 9.94: Change in expanded NPV
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The sensitivity analysis supports t
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DMBC Chapter 10 - The recommendatio
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10. The proposed future configurati
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The changes to the scoring before a
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10.3. Why this is the recommendatio
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In the rest of this section, the se
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