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

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7b. Work of the Emergency and Urgent Care Clinical Implementation Group This section sets out the revised proposals for the future development of emergency and urgent care in NW London, as part of the wider reconfiguration proposals for the Shaping a healthier future programme: Provides an overview of the original consultation proposal and the consultation responses to it Describes the work undertaken by the Emergency and Urgent Care Clinical Implementation and Planning Group (E&UC CIG) to review the original proposal in the light of consultation responses and further discussion by clinicians working in NWL Sets out recommendations that will be used to inform decision-making by the Shaping a Healthier Future Clinical and Programme Boards in relation to the postreconfiguration structure of emergency and urgent care services in NW London. 7.8 Summary of the CIG’s recommendations Pre-consultation we set out a number of recommendations for emergency and urgent care: 1. We propose five EDs located at Major Acute hospital sites in NW London 2. We propose nine UCCs in NW London 3. All UCCs will operate on a 24/7 basis 4. London Health Programme‟s London Quality Standards covering Emergency Surgery and Acute Medicine and UCCs should be adopted across NWL for Major Acute Hospitals. The E&UC CIG supports these recommendations and has made the following additional recommendations: 1. London Health Programmes quality standards covering Emergency Departments should be adopted in addition to those LHP standards already stipulated in the PCBC 2. All UCCs in NWL will operate to a consistent set of standards, irrespective of whether they are co-located with an ED 3. A UCC is a primary care service and will be expected to operate with a distinctive primary care ethos. This will be reflected in staffing, case-mix, integration with local primary care services and the implementation of positive re-direction back into the care of the patient‟s registered GP 4. Each UCC should partner with a specific ED. The partnership should include oversight of joint governance arrangements (e.g. a Joint Clinical Governance Group) 5. Robust transfer protocols will be implemented to ensure that, where necessary, UCC patients can be transferred to ED in a manner that is both timely and clinically safe 6. Detailed modelling work is required to understand anticipated ED and UCC activity volumes, including the likely volume and acuity of UCC to ED patient transfer, and its impact on the LAS and other ambulance transport to ensure that patient safety and experience of care are maintained. 7b. Work of the Emergency and Urgent Care CIG 142
7.8.1 Scope of the CIG’s work The proposals referred to in this section are for improving emergency and urgent care across NWL cover urgent care services (UCCs co-located with EDs, and those that are not) and emergency departments (ED). Emergency and urgent care services have important links with other services. The E&UC CIG is committed to developing recommendations for the pathway in its entirety as part of planning for implementation. The scope of this section of the chapter therefore includes recommendations for improving integration with other services, including: Transfer from UCC to ED (including „blue light‟ transfers) Positive re-direction to general practice from UCC Onward referral to specialist services from UCC Onward referral to community, social care and mental health services from UCC UCC integration with GP Out of Hours services. 7.8.2 The Emergency and urgent care CIG The E&UC CIG was established to take forward the Shaping a healthier future proposals relating to emergency and urgent care by: Developing recommendations in response to pre-consultation review, consultation feedback and input from clinicians, providers and commissioners Ensuring that the implications for emergency and urgent care communicated and fully understood at a local level, and that clinical colleagues are kept informed Ensuring that plans for implementing changes to emergency and urgent care receive appropriate input from clinicians and patients. The E&UC CIG is chaired jointly by Dr Susan LaBrooy (Medical Director, Hillingdon Hospital Trust) and Dr Tim Spicer (Clinical Commissioning Group Chair, NHS Hammersmith and Fulham). Its membership is includes: GPs UCC and ED clinicians Commissioners and providers drawn from across NWL NW London Patient and Public Advisory Group (PPAG) College of Emergency Medicine London Ambulance Service (LAS) Local Mental Health Trusts London Deanery. 7.9 Approach to stakeholder engagement The CIG itself represents a broad range of emergency and urgent care stakeholders from across NWL. In addition, the CIG has sought to engage with a wider body of stakeholder opinion via two routes: Site visits to all EDs and UCCs in NW London Focus groups with the public from across NW London to understand views and needs of urgent care. 7b. Work of the Emergency and Urgent Care CIG 143
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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
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We need to do more to support patie
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In NW London, however, the NHS is s
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Figure 4.6: Emergency general surgi
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attack or stroke to designated cent
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Figure 4.9: Evaluation of primary c
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Inequalities would continue and pro
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DMBC Chapter 5 - Process for identi
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5. Process for identifying a recomm
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Figure 5.1: Basis of decision of wh
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We confirmed this decision, and the
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5.5 A detailed description of the s
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Correct care setting to deliver hig
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Figure 5.11: Ratings used in evalua
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DMBC Chapter 6 - Consultation, feed
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6. Consultation, feedback and how w
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6.2.1 Key findings from the consult
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times (particularly for patients tr
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Westminster City Council, Adult Ser
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Analysed and considered consultatio
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6.3 Our responses to feedback This
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Feedback received Stakeholders who
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6.3.3 Theme 3: Clinical vision and
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6.3.5 Theme 5: Proposals for local
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Page 121 and 122: 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
Page 167 and 168: Illustrative patient journey in mat
Page 169 and 170: Illustrative patient journey planne
Page 171: GP-led care Illustrative patient jo
Page 175 and 176: Theme Clinical outcomes Staff attit
Page 177 and 178: Further stakeholder engagement is n
Page 179 and 180: Figure 7.31 E&UC CIG Responses to N
Page 181 and 182: NCAT recommendation CIG response Se
Page 183 and 184: Conditions suitable for UCC Clinica
Page 185 and 186: Exclusion criterion Mental health A
Page 187 and 188: Diagnostics 7.14.3 Streaming, regis
Page 189 and 190: Biochemistry Microbiology Radiology
Page 191 and 192: The Provider must deliver appropria
Page 193 and 194: Figure 7.41: E&UC CIG recommended k
Page 195 and 196: will be able to establish a service
Page 197 and 198: The UCC provider will be responsibl
Page 199 and 200: Key differences Governance As with
Page 201 and 202: should be provided with appropriate
Page 203 and 204: Process map 1: Assessing UCC patien
Page 205 and 206: Process map 3: UCC to ED transfer p
Page 207 and 208: make an appointment with their own
Page 209 and 210: 7.19 ED workforce A programme-wide
Page 211 and 212: The purpose of this section is to s
Page 213 and 214: Figure 7.45 Consultation results on
Page 215 and 216: Figure 7.46: Specific Responses the
Page 217 and 218: NCAT recommendation Original Progra
Page 219 and 220: 7.25.1 London Health Programmes cli
Page 221 and 222: 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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“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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