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

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Notes NHS North West London Shaping a healthier future Decision making business case Edition 1.1 14 February 2013 Volume 1 of 7
Table of contents Volume 1 Foreword DMBC navigator 1. Executive summary 2. Introduction to NHS NW London 3. Introduction to Shaping a healthier future and the purpose of this document 4. The Case for Change 5. Process for identifying a recommendation 6. Consultation, feedback and how we have responded 7a. Clinical vision, standards and service models 7b. Work of the Emergency and urgent care CIG 7c. Work of the Paediatrics CIG 7d. Work of the Maternity CIG 8a. Development of out of hospital plans in NW London 8b. Primary care development 8c. Out of hospital estates 8d. Urgent care centres 8e. Delivering out of hospital care 9a. Decision making analysis stages 1 to 4 9b. Decision making analysis stage 5 9c. Decision making analysis stage 6 (excluding value for money) 9d. Decision making analysis stage 6 (value for money) and stage 7 10. The proposed future configuration of hospitals in NW London Page i 1 11 29 47 61 93 142 180 194 213 233 238 251 258 269 288 326 383 417 Volume 2 11. Assuring the proposals 12. Travel and access implications 13. Equalities implications 14. Workforce implications 15. Implementation of proposals for hospital sites 16. Implementation of proposals across the CCGs 17. Programme implementation arrangements 18. Benefits framework 19. Conclusion, final recommendation and resolutions Glossary – abbreviations explained V 427 459 495 533 573 603 657 703 731 737
Page 1: North West London Shaping a healthi
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 and 18: • Delivery of multi-disciplinary
Page 19 and 20: Stage 1 - Case for Change Our work
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
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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
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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
Page 85 and 86:
5.5 A detailed description of the s
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Correct care setting to deliver hig
Page 89 and 90:
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
Page 95 and 96:
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
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
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▪ Expectant mothers should have t
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# Standard care services (111). As
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Figure 7.8: Development of the acut
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# Standard Adapted from source depa
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Figure 7.11: Shaping a healthier fu
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No. Standard Adapted from source Su
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No. Standard Adapted from source se
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# Standard All emergency department
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# Standard All non-urgent - within
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Figure 7.18: Shaping a healthier fu
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# Standard Adapted from source shou
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# Standard Adapted from source Comm
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The final standards are more demand
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Figure 7.26: Proposed services to b
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Each CCG is taking steps to help pr
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in major hospitals) and equipment t
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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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“The Brent Health Partnerships Ov
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Royal College of Midwives “The RC
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Page 313 and 314:
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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