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

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The Future Workforce in Obstetrics and Gynaecology England and Wales. (2009) RCOG. The clinical standards have been defined for the same three clinical areas (Emergency Surgery and A&E, Maternity and Paediatrics) to support the visions. Delivery of the clinical standards creates the need for changes that drive the hospital reconfiguration proposals, ultimately leading to improved clinical outcomes for patients as well as improved experiences for both patients and staff. 7.34 Consultation A public Consultation on three options was undertaken during the summer and autumn of 2012. These paragraphs consider the proposal in the consultation document that all major hospitals will have a consultant-led maternity unit. Respondents were asked how far they support or oppose the recommendation that all major hospitals in North West London should have consultant-led maternity units, with an extra consultant-led maternity unit at Queen Charlotte‟s and Chelsea Hospital if Hammersmith Hospital is not a major hospital. Figure 7.48 shows that this question was answered by 4,564 respondents, and a large majority support the proposal (75%). However, this view is not strongly held, and respondents are more likely to „tend to support‟ than „strongly support‟ this proposal (47% and 28% respectively). One in twenty of the respondents answering this question oppose the proposal (5%), giving a net support score of +70 percentage points. Figure 7.48: Consultation responses to the recommendation for all major hospitals to have a consultant-led maternity unit Q19. How far do you support or oppose the recommendation that all major hospitals in NW London should have consultant-led maternity units, with an extra consultant-led maternity unit at Queen Charlotte‟s and Chelsea Hospital if Hammersmith is not a major hospital 2% 2% 11% 9% 28% Strongly support (1,297) Tend to support (2,124) No views either way (399) Tend to oppose (112) Strongly oppose (112) Not sure/ don’t know (520) 47% Support 75% 3,421 Oppose 5% 224 7d. Work of the Maternity CIG 196
Support for the proposal is higher among women (77%) than men (72%), and higher among those from BME groups (82%) compared with those from white backgrounds (73%). Those aged 25-34 are more likely to support the proposal than overall (81% vs 75%). There is no significant difference in support between respondents with a disability and those without a disability. There is no significant difference in overall support between current/past workers of the NHS or independent health sector and those who have never worked in the health sector. Across the eight North West London boroughs, support is significantly higher among those living in Kensington and Chelsea than overall (85%). Higher levels of support are also seen among those living in Richmond (87%) and Wandsworth (92%). Support for the proposal is also significantly higher than overall among those most likely to receive urgent care at Chelsea and Westminster Hospital (83%) and West Middlesex Hospital (81%). 7.35 Paediatric and maternity units in major hospital Very few stakeholders commented on the specific proposal that all major hospitals should have inpatient paediatric units. Those that did, including the Royal College of Paediatrics and Child Health, supported it. The proposal for all major hospitals to have consultant-led maternity units, together with a unit at Queen Charlotte‟s and Chelsea Hospital if Hammersmith Hospital is not a major hospital, was also supported by most of the relatively small numbers of stakeholders commenting on it. The Royal College of Midwives supported the proposals but criticised the absence of any freestanding midwife-led units in the proposals or discussions on how to facilitate home births: “The loss of consultant obstetric services at Ealing could have a negative impact on tackling health inequalities in the borough; this could be mitigated – at least for women at low medical risk - if the obstetric service were replaced by a FMU…. we are extremely disappointed that Shaping a healthier future does not include any proposals for the establishment of freestanding midwife-led units (FMUs).” This proposal also attracted some concerns and criticisms. Ealing Hospital Medical Staff Committee questioned where the „extra births‟ were going to go to and how maternity services are going to cope. Ealing Council raised “the clear risk of loss of valued and high quality maternity services should SaHF proposals be taken forward.” Hillingdon LINk argued that the targets to increase the number of home births are highly ambitious and questioned whether “large maternity units” meet the needs of expectant mothers. 7.36 Specific Feedback During Consultation a number of specific organisational responses were received. These were individually considered by the CIG. Details of these and other responses are below. 7d. Work of the Maternity CIG 197
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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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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
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: in NWL will have a choice of delive
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
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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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