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

Figure 7.27: Clinical dependencies for a hospital with a major A&E
The clinical board determined that delivering safe and effective A&E services on a 24/7 basis
requires rapid access to emergency surgery and expertise for complex medical cases on a
24/7 basis as well as level 3 critical case (intensive care). The Clinical Board identified
additional services that required access to level 3 critical care and/or emergency surgery.
These included:
Complex elective surgery
Obstetric units
Acute cardiac and hyper acute stroke care
Major trauma units.
Clinicians used the combination of clinical standards and clinical interdependencies to set
out proposals for four acute service delivery models, they are:
1. Local hospital
2. Major hospital
3. Elective hospital
4. Specialist hospital
A fifth service delivery model was considered, one with urgent care and some acute
medicine, however this was judged to not be sustainable in the long term in NW London due
to the lower quality of care it would offer and the low travel times between sites. However, it
was recognised that some of the hospitals in NW London are currently be configured in this
way and that they could continue to safely operate in the short to medium term as a stepping
stone to becoming one of the other service delivery models.
7.6.1 Local hospitals
The local hospital is a site from which most care currently delivered
in traditional district general (DGH) hospitals will be delivered in the
future. We estimate over 75% of the care that would be delivered in
a DGH in 2014/15 can be delivered from a local hospital. It will be
a place that provides specialist staff (many of whom will also work
7a. Clinical vision, standards and service models 128