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

More documents

Recommendations

Info

included comments on out-of-hospital proposals and many people requested more detail on the plans. Since consultation, further work has been undertaken and more detail is now available in the following areas: Primary care development Impact of out-of-hospital services on carers Workforce plans including detail of the additional staff required to deliver these services Out-of-hospital estate – GP practices and GP ‘hubs’ UCCs Standards of out of hospital care Delivering out of hospital services Feedback from consultation emphasised the need for a consistent UCC specification across NW London. In response, the Emergency and Urgent Care CIG conducted a significant programme of stakeholder engagement and considered evidence from a broad range of sources. This group then made a number of recommendations which have enabled the programme to outline the key features of a UCC, shown below. If the recommendations are agreed, nine urgent care centres, all operating 24 hours a day, 7 days a week to consistent standards, will be provided across NW London located at all proposed major and local hospital sites. Decision making analysis We used the seven-stage process described earlier to identify options for consultation. The feedback received during consultation was considered and new analysis was undertaken based on this feedback (including re-appraisals of the latest evidence, activity and financial data). The analysis for each stage is defined below. Executive summary viii
Stage 1 – Case for Change Our work before, during and after consultation enabled us to conclude that: A robust platform exists for service change Improvements and clinical benefits could be delivered by changes ‘Doing nothing’ is not an option. Stage 2 – Vision Our work before, during and after consultation enabled us to conclude that the vision created by local clinicians for Shaping a healthier future will deliver the required improvements and clinical benefits. Stage 3 – Clinical standards Our work before, during and after consultation, particularly with the CIGs, confirmed that the clinical standards are based on the latest evidence and clinical thinking, in particular LHP’s London Quality Standards. It also established that if the standards are achieved they will contribute to the improvements outlined in the Case for Change. Stage 4 – Service models Our work before, during and after consultation, particularly with the CIGs, confirmed the service models reflect the latest clinical thinking, in particular LHP’s London Quality Standards, and reflect relevant feedback received during consultation. It also established that if the service models are implemented they will contribute to the improvements outlined in the Case for Change. Stage 5 – Hurdle criteria The purpose of this stage was to use seven hurdle criteria, developed by clinicians, to establish the right number of major hospitals in the options. Within this stage, there were seven hurdles: 1 2 3 4 5 6 7 ● ● ● ● ● ● The correct care setting model to deliver high quality care Consider the nine existing major hospital sites only and not new locations There should be enough major hospitals to support the population of NW London The number of major hospitals must be viable in the medium term Ensure a good geographical spread of major hospitals across NW London Use sites currently delivering high quality major hospital services ● Geographic distribution of the remaining sites is proposed to minimise the impact of changes on local residents The millions of options for the configuration of major hospitals were considered against the hurdle criteria. This enabled us to determine that five major hospitals were needed to balance access with meeting the clinical standards. To ensure a good geographic Executive summary ix
Page 1 and 2: North West London Shaping a healthi
Page 3 and 4: Table of contents Volume 1 Foreword
Page 5 and 6: Foreword Dr Mark Spencer The Clinic
Page 7 and 8: 6. Consultation, feedback and how w
Page 9 and 10: 13. Equalities implications This ch
Page 11 and 12: 1. Executive Summary Introduction t
Page 13 and 14: The overall programme timeline is b
Page 15 and 16: The process was used before consult
Page 17: • Delivery of multi-disciplinary
Page 21 and 22: For Quality of care, clinicians hav
Page 23 and 24: 1 2 3 4 5 A 6 B 7 C 8 Quality of Ca
Page 25 and 26: Assuring the proposals Throughout t
Page 27 and 28: Programme implementation arrangemen
Page 29 and 30: 5. To agree that Hammersmith Hospit
Page 31 and 32: DMBC Chapter 2 - Introduction to th
Page 33 and 34: 2. Introduction to the NHS in NW Lo
Page 35 and 36: Figure 2.3: Clinical Commissioning
Page 37 and 38: West Middlesex University Hospital
Page 39 and 40: major hospital, elective centre and
Page 41 and 42: DMBC Chapter 3 - Introduction to th
Page 43 and 44: 3. Introduction to the Shaping a he
Page 45 and 46: 3.3 Programme governance The Joint
Page 47 and 48: The JCPCT is advised by a Programme
Page 49 and 50: Consultation - during this phase, t
Page 51 and 52: Ensure consistency of communication
Page 53 and 54: Stakeholder Group Political Individ
Page 55 and 56: 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 and 108:
6.3.3 Theme 3: Clinical vision and
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
6.3.5 Theme 5: Proposals for local
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
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 and 172:
GP-led care Illustrative patient jo
Page 173 and 174:
7.8.1 Scope of the CIG’s work The
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
Page 223 and 224:
3. There would be an additional "st
Page 225 and 226:
in NWL will have a choice of delive
Page 227 and 228:
Support for the proposal is higher
Page 229 and 230:
Figure 7.49: Specific feedback the
Page 231 and 232:
Sub-Theme Organisation Support Conc
Page 233 and 234:
Sub-Theme Organisation Support Conc
Page 235 and 236:
7.36.1 National Clinical Advisory T
Page 237 and 238:
NCAT recommendation Further engagem
Page 239 and 240:
edistributed nationwide. We envisag
Page 241 and 242:
6. The Maternity CIG have considere
Page 243 and 244:
DMBC Chapter 8A-E - Out of hospital
Page 245 and 246:
Out of hospital improvements This c
Page 247 and 248:
8.2. Settings of out of hospital ca
Page 249 and 250:
practical solution for the site, wh
Page 251 and 252:
Brent Health Partnerships Overview
Page 253 and 254:
Consultation theme Standards for ca
Page 255 and 256:
Consultation theme Integration Inve
Page 257 and 258:
8.5.3. Workforce Following feedback
Page 259 and 260:
Delivering this workforce shift wil
Page 261 and 262:
Measure type Domain Potential measu
Page 263 and 264:
8b. Primary care development 8.6. S
Page 265 and 266:
consultation they could have receiv
Page 267 and 268:
8.10. Next steps We are developing
Page 269 and 270:
Figure 8.11: Hub/health centre requ
Page 271 and 272:
some cases, these will be offered o
Page 273 and 274:
Process for development of local ho
Page 275 and 276:
The result is an emerging picture o
Page 277 and 278:
Across NW London, these sites will
Page 279 and 280:
need redeveloping or rebuilding to
Page 281 and 282:
8d. Urgent care centres When indivi
Page 283 and 284:
Figure 8.22: NW London urgent care
Page 285 and 286:
Conditions suitable for UCC Clinica
Page 287 and 288:
Key differences Governance As with
Page 289 and 290:
processes of the CCG and as such th
Page 291 and 292:
around the table accelerates the un
Page 293 and 294:
Improved empowerment - specifically
Page 295 and 296:
Figure 8.28: Realising our integrat
Page 297 and 298:
Figure 8.29: Summary of CCG commiss
Page 299 and 300:
DMBC Chapter 9 - Decision making an
Page 301 and 302:
9a. Decision making analysis stages
Page 303 and 304:
Page 305 and 306:
“The Brent Health Partnerships Ov
Page 307 and 308:
Page 309 and 310:
Royal College of Midwives “The RC
Page 311 and 312:
Page 313 and 314:
clinicians wanted to take this into
Page 315 and 316:
9.6.3 Feedback received about the s
Page 317 and 318:
Confirm the service models reflect
Page 319 and 320:
Figure 9.9: The seven hurdle criter
Page 321 and 322:
surgeons in NW London, but we would
Page 323 and 324:
We confirmed this decision with the
Page 325 and 326:
Appropriate staffing is integral to
Page 327 and 328:
The proposals are supported by Depa
Page 329 and 330:
NW London to deliver high quality c
Page 331 and 332:
1. Support predicting where activit
Page 333 and 334:
Figure 9.15: Example travel time ma
Page 335 and 336:
The analysis shown in Figure 9.18,
Page 337 and 338:
Figure 9.18: Impact on private car
Page 339 and 340:
33% support 10% opposed 57% of peop
Page 341 and 342:
Figure 9.21: Watershed map for blue
Page 343 and 344:
etained as a major hospital, becaus
Page 345 and 346:
9.7.29 The implications of this fee
Page 347 and 348:
Figure 9.25: Potential activity flo
Page 349 and 350:
Figure 9.27: Changes in travel time
Page 351 and 352:
Figure 9.29: Changes in travel time
Page 353 and 354:
Figure 9.31: Possible choices betwe
Page 355 and 356:
Either Charing Cross or Chelsea & W
Page 357 and 358:
Figure 9.33: Option A, excluding ca
Page 359 and 360:
Figure 9.36: Option C responses, in
Page 361 and 362:
Richmond Upon Thames LINk Royal Bor
Page 363 and 364:
Southall Black Sisters “The closu
Page 365 and 366:
Figure 9.38: Ranking of evaluation
Page 367 and 368:
Figure 9.42: Evaluation criteria as
Page 369 and 370:
anked third according to the mean s
Page 371 and 372:
9.9.5 The analysis of the five eval
Page 373 and 374:
Figure 9.45: Quality Dashboard data
Page 375 and 376:
Response to feedback about the eval
Page 377 and 378:
Figure 9.48: Quality of care - Acut
Page 379 and 380:
experience. In order to use this as
Page 381 and 382:
Figure 9.50: Time to major hospital
Page 383 and 384:
Rationalising provision across the
Page 385 and 386:
Figure 9.51: Blue light travel time
Page 387 and 388:
Figure 9.52 shows the reduction in
Page 389 and 390:
3 Value for money 9.9.26 The purpos
Page 391 and 392:
Staff recommendation as a place to
Page 393 and 394:
This analysis was agreed prior to c
Page 395 and 396:
Figure 9.56: Ease of delivering eac
Page 397 and 398:
Response to feedback about implemen
Page 399 and 400:
Changes to the designation of the M
Page 401 and 402:
5 Research and Education: Disruptio
Page 403 and 404:
Figure 9.60: Evaluation of disrupti
Page 405 and 406:
9.9.48 The outcome of the disruptio
Page 407 and 408:
Greg Hands, MP for Chelsea & Fulham
Page 409 and 410:
comprises more than 22 million cita
Page 411 and 412:
Quality/Impact score Figure 9.65 Re
Page 413 and 414:
9. Decision making analysis - stage
Page 415 and 416:
There were six distinct parts of th
Page 417 and 418:
Figure 9.69: 5 year gross savings,
Page 419 and 420:
Figure 9.73: Commissioners intend t
Page 421 and 422:
Figure 9.75: Beds bridge: 2012/13 t
Page 423 and 424:
The key modelling assumptions appli
Page 425 and 426:
Figure 9.79: DMBC NHS net capital e
Page 427 and 428:
Figure 9.81: Approach to estimating
Page 429 and 430:
Figure 9.84: Summary of net surplus
Page 431 and 432:
Figure 9.86: Evaluation of total su
Page 433 and 434:
9.13.9 Impact of the changes: Updat
Page 435 and 436:
Figure 9.89: Effect of the expanded
Page 437 and 438:
Page 439 and 440:
Sensitivity tests g) Tariff efficie
Page 441 and 442:
Figure 9.93 summarises the impact o
Page 443 and 444:
Figure 9.94: Change in expanded NPV
Page 445 and 446:
The sensitivity analysis supports t
Page 447 and 448:
DMBC Chapter 10 - The recommendatio
Page 449 and 450:
10. The proposed future configurati
Page 451 and 452:
The changes to the scoring before a
Page 453 and 454:
10.3. Why this is the recommendatio
Page 455 and 456:
In the rest of this section, the se
show all

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

Create successful ePaper yourself

Delete template?

Save as template?