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

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6.3.7 Theme 7: Proposals for out of hospital care There is an ambition to offer more healthcare services out of hospital. Figure 6.8: Theme 7 – Proposals for out of hospital care Feedback received Stakeholders who provided this feedback Our consideration of the feedback DMBC reference Assurances required that out of hospital care will be ready and able to meet demand before acute services reconfigure Brent LINk Richmond LINk Kensington & Chelsea LINk Hillingdon LINk Ealing HOSC JHOSC Hammersmith & Fulham HOSC Hounslow HOSC Kensington & Chelsea HOSC. The Case for Change states that it is essential to ensure that out of hospital services are working well in order to ensure an improvement in the whole healthcare system in NW London. Patient safety is critical and we remain committed to ensuring services continue to be safe when any changes are made. It is also important to remember that CCGs are already commissioning, running and monitoring out of hospital services and these services are safe. During implementation we expect some services to be ‘double run’, particularly while capacity in community services is developed; refer to our implementation plans for further details. We have created a monitoring mechanism for key out of hospital initiatives across the eight CCGs and mapping this to actual changes in the system, for example, through monitoring system-wide impact on beds and the use of beds. This ‘implementation tracker’ has been developed for use at CCG and system level. Implementation plans: Chapter 17 Implementation tracker: Chapter 17, Section 17.4.6 Safety during implementation: Chapter 17, Section 17.4.5 We have developed a decision making framework that aims to ensure any service change only occurs when it is safe to do so; this builds upon existing governance structures for commissioning services. Out of hospital plans are not detailed enough to support implementation Harrow HOSC/ Council Ealing Council JHOSC Hillingdon LINk Kensington & Chelsea HOSC. High level implementation plans were developed pre-consultation and these were sufficient for the JCPCT to decide to proceed to consultation. CCGs have developed more detailed out of hospital implementation plans during decision making based upon their 2013/14 CCG commissioning intentions. This work is included in this document. Out of hospital plans: Chapter 16 Implementation plans: Chapter 17 6. Consultation, feedback and how we responded 86
Feedback received Stakeholders who provided this feedback Our consideration of the feedback DMBC reference Is there the necessary workforce to deliver OOH Ealing HOSC Westminster HOSC Richmond CCG Hounslow HOSC. Post consultation the out of hospital workstream has considered the workforce requirements for out of hospital care, building on the work already done to understand the skills and competency requirements of the OOH nursing workforce, the quantity required and the implications on training for the activity shift planned. This work is described in this document. We have also established a transformational workforce group, who developed the plans for out of hospital workforce and will provide assurances about deliverability. Out of hospital workforce: Chapter 8, Section 8.5.3 and Chapter 14 Urgent and emergency care workforce: Chapter 7, Section 7.17 and Chapter 14 Post consultation the Urgent and Emergency and Maternity CIGs considered their workforce requirements to deliver relevant community and local hospital services to the standards required, this is described in their reports. Is the money being made available for out of hospital care Kensington & Chelsea LINk Hillingdon LINk Hammersmith & Fulham LINk Brent HOSC. The financial models and out of hospital plans demonstrate that there would be significant investment in out of hospital care for delivering the out of hospital standards and in moving appropriate activity from the acute setting to the out of hospital setting. The DMBC describes the investments. Initial estimates for out of hospital investments for 2013/14 are described in the Commissioning Intentions found in Appendix J. Please note, these Commissioning Intentions are currently being updated and the latest proposals can be found on CCG websites. Out of hospital investment: Chapter 8, Section 8.20 and Chapter 16 Commissioning intentions: Appendix J Plans should be produced which set out how all parts of the population will be educated in how to how to access services, in particular urgent care centres JHOSC Imperial College Healthcare NHS Trust Hammersmith & Fulham LINk Harrow HOSC / Council Central London Community Healthcare We continued with our stakeholder engagement throughout the post consultation period, and have developed plans for further engagement throughout implementation so that we can communicate with the public about potential service changes during implementation. The role of public education is supported by the wider NHS. To inform this work our implementation planning considers the need for public education programmes to ensure the public know how and when to access services such as primary care, out of hospital services, UCCs and hospital care as changes are made. Stakeholder engagement through post consultation: Chapter 6, Section 6.2.7 Stakeholder engagement through implementation: Chapter 17, Section 17.5 6. Consultation, feedback and how we responded 87
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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
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4. The Case for Change This chapter
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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 113 and 114: 6.3.5 Theme 5: Proposals for local
Page 115: 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
Page 163 and 164: Referral A&E Illustrative patient j
Page 165 and 166: 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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