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

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to deliver the options showed Options 5 and 6 were stronger and that Options 3, 4, 7 and 8 were weaker. Thirdly, we analysed co-dependencies with other strategies – previous Major Trauma designation, previous stroke designation, national initiatives, broader London initiatives and local strategies in place or in development. This identified that Options 5 and 6 were stronger and Options 3 and 4 were weaker against this sub-criterion. These evaluations were reviewed post consultation with no change to the results of the evaluation. For Research & Education, we considered disruption and support current and developing research and education delivery. Our evaluation of both sub-criteria was reviewed and updated post-consultation. Options 6 and 8 were stronger and Options 1 and 3 were weaker against the disruption sub-criterion. For the second sub-criterion, Options 5 and 7 were stronger followed by Options 6 and 8 followed by the remaining options. Stage 7 – Sensitivity analysis At the end of stage 6, we concluded that overall options 5, 6 and 7 were the strongest. Sensitivity analysis was used to test the options to establish whether the ranking changed under testing. Sensitivity analysis supports the conclusion that option 5 is the preferred financial option both before and after consultation. However, as highlighted in the PCBC the programme needs to mitigate against the risk of a number of downside sensitivities happening simultaneously if the overall financial benefits are to be realised. The proposed <strong>future</strong> configuration of hospitals in NW London The evaluation was brought together and a summary is shown below. Note that Options 5, 6 and 7 were renamed as Options A, B and C for public consultation. Executive summary xii
1 2 3 4 5 A 6 B 7 C 8 Quality of Care Clinical quality ++ ++ ++ ++ ++ ++ Clinical ++ quality* ++ Patient experience ++ + + - ++ + Patient experience + - Access Distance and time to access services - - - - - - - - Access Distance and time to access services** Patient choice + - + - ++ + Patient ++ choice + Value for Money Value for Money Capital cost to the system -- -- -- -- - - Capital cost - to the system + Transition costs -- -- -- -- - - Transition -costs - Viable Trusts and sites + + -- -- + -- Viable Trusts -- and sites -- Surplus for acute sector + + - -- + - Surplus for - acute sector -- Net Present Value - - -- -- + - Net Present -- Value - Deliverability ++ -- Deliverability Workforce + - + + + - Workforce + + Expected time to deliver - - -- -- + + Expected --time to deliver -- Co-dependencies with other strategies - - -- -- + + - - Research & Education High evaluation Low evaluation ▪ West Middlesex ▪ Hammersmith ▪ Chelsea & Westminster ▪ Northwick Park ▪ Hillingdon ▪West Middlesex ▪Hammersmith ▪Charing Cross ▪Northwick Park ▪Hillingdon ▪ Ealing ▪ Hammersmith ▪ Chelsea & Westminster ▪ Northwick Park ▪ Hillingdon ▪ Ealing ▪ Hammersmith ▪ Charing Cross ▪ Northwick Park ▪ Hillingdon ▪ West Middlesex ▪ St Mary’s ▪ Chelsea & Westminster ▪ Northwick Park ▪ Hillingdon ▪ West Middlesex ▪ St Mary’s ▪ Charing Cross ▪ Northwick Park ▪ Hillingdon Ealing Ealing St Mary’s St Mary’s ▪ Chelsea & ▪ Charing Cross Westminster Northwick Park Northwick Park ▪ Hillingdon ▪Quality Hillingdonof Care Co-dependencies with other strategies Research & Education Disruption -- - -- - - + Disruption - + Support current and developing research and education delivery - - - - ++ + ++ + Support current and developing research and education delivery Pre-consultation score -2 -7 -11 -16 +14 +7 +2 -4 Post-consultation score -3 -7 -12 -16 +10 0 -4 -4 Changes from pre-consultation REVIEWED AND NO CHANGE REVIEWED AND NO CHANGE REVIEWED AND NO CHANGE REVIEWED AND NO CHANGE UPDATED UPDATED UPDATED UPDATED UPDATED REVIEWED AND NO CHANGE REVIEWED AND NO CHANGE REVIEWED AND NO CHANGE UPDATED UPDATED Executive summary xiii
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 and 20: Stage 1 - Case for Change Our work
Page 21: For Quality of care, clinicians hav
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
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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
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
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Page 111 and 112:
Page 113 and 114:
6.3.5 Theme 5: Proposals for local
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Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
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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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