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 Capacity: Chapter 15 OPTION A: If option A is selected then reconsider services provided at Charing Cross under this option Imperial College Healthcare NHS Trust. The proposals were developed to a level to support the JCPCT’s decision to proceed to consultation with the proposed options. This included initial estates work with potential local hospital sites. Post consultation we have worked with Imperial College Healthcare Trust and Hammersmith and Fulham CCG to develop proposals for services provided at their sites in greater detail to support the decision making process. This detail is included within this document. Development of the Charing Cross site: Chapter 15, Section 15.5.1 and Chapter 16, Section 16.4.6 OPTION B: If Chelsea and Westminster is a local hospital St Thomas’s would require significant capital investment to cope with diverted demand Guy’s and St Thomas’ NHS Foundation Trust. In addition to the information we provided pre-consultation, we provided additional information to Guys and St Thomas’s during consultation about activity and bed numbers. We also revaluated Option B during the decision making phase and considered feedback from Guys and St Thomas’s. Identification of the preferred option: Chapter 9c and 9d OPTION C: West Middlesex is used by patients living in Richmond and Twickenham, Richmond OSC believe West Middlesex should be a major hospital Richmond HOSC. In addition to the information we provided pre-consultation, further details were provided to Richmond OSC during consultation about the travel implications of option C. We also undertook further travel analysis, which can be found in this document. We have reconsidered the impact of Option C on Richmond and Twickenham during decision making. Identification of the preferred option: Chapter 9c Travel: Chapter 12 6. Consultation, feedback and how we responded 82
6.3.5 Theme 5: Proposals for local hospitals Local hospitals will continue to deliver many services they currently provide. Figure 6.6: Theme 5 – Proposals for local hospitals Feedback received Stakeholders who provided this feedback Our consideration of the feedback DMBC reference Greater detail required about the services provided at local hospital sites Ealing Council Kensington & Chelsea LINk Hammersmith & Fulham LINk. We produced a local hospital factsheet outlining the expected services at local hospital sites, including conditions UCCs would treat, during consultation. This can be found on our consultation website (www.healthiernorthwestlondon.nhs.uk). We have worked with trusts and CCGs post consultation to develop the service models for local hospitals. This work is detailed in this document. Local hospital specification: Chapter 7, Section 7.6.1 and Chapter 8, Section 8.11.1 Assurances required that different local hospitals will provide consistent services Public Kensington & Chelsea LINk. Post consultation we worked with trusts and CCGs to develop the service model for local hospitals. Local hospitals are designed to provide services that directly relate to the needs of the local population. Different areas may have different services because the needs of local populations vary – this is one benefit of developing local hospitals. CCGs are working locally to define what the services should be and this would be reflected in commissioning of these hospitals. Local hospitals: Chapter 7, Section 7.6.1 and Chapter 8, Section 8.11.1 UCCs: Chapter 8d UCCs are an important component of the services proposed to be offered by local hospitals. We have developed a common UCC specification which details the conditions that UCCs should treat, those that would be excluded, the service models and transfer protocols, staff competencies, quality standards and governance arrangements. Any future tendering of UCC services would reflect this common UCC specification and consistency achieved as contracts are retendered. Detail required about the implementation and delivery of local hospitals Ealing Council Ealing Hospital Imperial College Healthcare Trust Kensington & A high level implementation plan was developed pre-consultation and this provided sufficient assurance to the JCPCT to proceed to consultation. Post consultation we have developed implementation plans with providers to ascertain how changes could be implemented. CCGs are also developing Implementation plans: Chapter 17 6. Consultation, feedback and how we responded 83
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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
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The implications of the options in
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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 and 108: 6.3.3 Theme 3: Clinical vision and
Page 111: Feedback received Stakeholders who
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
Page 159 and 160: in major hospitals) and equipment t
Page 161 and 162: 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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