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

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distribution of major hospitals across NW London and minimise the impact of changes on local residents, we concluded that: For all options, a major hospital should be located at Hillingdon and Northwick Park For all options, Central Middlesex should be a local hospital and an elective hospital The remaining options should compare the remaining sites in pairs: o Either Charing Cross or Chelsea & Westminster o Either Ealing or West Middlesex o Either Hammersmith or St Mary’s. This produced a list of eight configuration options, shown below, which we analysed in more detail. Note that Options 5, 6 and 7 were renamed as Options A, B and C for public consultation. Site Option 1 Option 2 Option 3 Option 4 Option 5 (A) Option 6 (B) Option 7 (C) Option 8 St Mary’s Local hospital Local hospital Local hospital Local hospital Major hospital Major hospital Major hospital Major hospital Hammersmith Major hospital Major hospital Major hospital Major hospital Specialist hospital Specialist hospital Specialist hospital Specialist hospital Charing Cross Local hospital Major hospital Local hospital Major hospital Local hospital Major hospital Local hospital Major hospital Chelsea & Westminster Major hospital Local hospital Major hospital Local hospital Major hospital Local hospital Major hospital Local hospital West Middlesex Major hospital Major hospital Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Major hospital Major hospital Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Ealing Local hospital Local hospital Major hospital Major hospital Local hospital Local hospital Major hospital Major hospital Central Middlesex Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Northwick Park Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Hillingdon Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Local hospital Major hospital Local Hospital & Elective hospital Specialist hospital Stage 6 – Evaluation criteria The purpose of the sixth stage was to test in detail the eight options using evaluation criteria agreed by clinicians and the public. We reviewed the feedback from consultation about the evaluation criteria and concluded we should use the same set before and after consultation as shown below: Executive summary x
For Quality of care, clinicians have been clear since the start of Shaping a healthier future that clinical quality is at the heart of the programme and that it is the driving force behind all the proposals and recommendations. Clinicians agreed that all the eight options under consideration had been designed to achieve the highest levels of clinical quality and that the additional data reviewed at this stage of the evaluation did not provide information that allowed them to differentiate between options on this basis. For the patient experience element, we analysed patient experience data and the quality of the estate. This identified that Options 1 and 5 were stronger and Options 4 and 8 were weaker against this subcriterion. These evaluations were reviewed post consultation with no change to the results of the evaluation. For Access to care, we analysed the distance and time to access services based on blue light, off-peak car, peak car and public transport travel times. The analysis showed that that any impact on travel times as a result of the proposed options would be clinically acceptable and that changes in travel times across all options were so similar it did not enable any differentiation between the options so all options are evaluated identically. For patient choice, we considered the reduction in the number of sites delivering emergency care, obstetrics, elective care, outpatients and diagnostics as well as the number of trusts with major hospital sites. This identified that Options 5 and 7 were stronger and Options 2 and 4 were weaker against this sub-criterion. These evaluations were reviewed post consultation with no change to the results of the evaluation. The Finance and Business Planning (F&BP) group was tasked with overseeing the evaluation of the Value for Money criterion. This covered activity, capacity, estates and finance analyses, including commissioner forecasts, Trust forecasts, the out of hospital forecasts and the capital requirement to deliver the proposed changes. The group was tasked with advising on the value for money of the options consulted upon both relative to each other, and compared to the ‘do nothing’ (i.e. current configuration) situation. The analysis indicates that: Commissioner forecasts over the five years involve gross QIPP of £550m with reinvestment in out of hospital services of £190m. The acute trust I&E forecast in the ‘do nothing’ is that most sites would move into deficit with no overall net surplus. In the downside scenario there would be an overall deficit of £89m with all bar one acute site in deficit. The value for money evaluation criteria used to assess the options are: Capital costs Transition costs Site viability Total trust surplus/deficit Net present value. The evaluation shows that all three options score less well than in the pre-consultation analysis but that option A remains the highest scoring. Option A requires net capital investment of £206m to implement the major hospital model, results in a positive I&E position of £42m for the acute sector and has a positive net present value. For all three options, the capital investment in out of hospital estates required to deliver the required changes has been assessed at £6m-112m for hubs and up to £74m for GP premises. For deliverability we considered three sub-criteria. Firstly, analysis of the impact on workforce (done through staff satisfaction data) showed that Options 2 and 6 were weaker with all other options equally strong as each other. Secondly, analysis of the expected time Executive summary xi
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 and 18: • Delivery of multi-disciplinary
Page 19: Stage 1 - Case for Change Our work
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
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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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DMBC Chapter 7 - Clinical vision, s
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7a. Clinical, vision, standards and
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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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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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