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

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As a result of the decision-making analysis, the Clinical Board agreed that Option 5 (Option A in the table above) was the strongest option. The Finance & Business Planning Working Group agreed that Option 5 was better than the other options. The Programme Board reviewed the completed evaluation and analysis and considered the recommendations of the Clinical Board and the Finance & Business Planning Working Group. The Board noted the two recommendations and agreed with the assessment that Option A should be the recommended configuration. The recommended hospital configuration proposes the following service models at each site. At: Chelsea & Westminster – a local hospital and a major hospital Hillingdon – a local hospital and a major hospital Northwick Park – a local hospital and a major hospital St Mary’s – a local hospital, a major hospital, a Hyper Acute Stroke Unit (moved from Charing Cross Hospital) and a specialist ophthalmology hospital (moving the Western Eye Hospital onto the site) West Middlesex – a local hospital and a major hospital Central Middlesex – a local hospital and an elective hospital Charing Cross – a local hospital 1 Ealing – a local hospital 2 Hammersmith – a specialist hospital with obstetric-led maternity unit and a local hospital This is shown in the map below. Mount Vernon RNOH M Specialist hospital Local and Specialist hospital with obstetric-led maternity unit Harefield Local and Elective hospital Northwick Park Local and Major hospital Local and Major hospital and specialist eye hospital and Hyper Acute Stroke Unit Hillingdon Central Middlesex Local hospital Ealing Hammersmith M St Mary’s West Middlesex Charing Cross Royal Marsden Royal Brompton Chelsea and Westminster 1 Hammersmith and Fulham CCG is considering whether Charing Cross could be developed into a specialist health and social care hospital. The specialist health and social care hospital model adopts the local hospital model together with enhanced primary and community that reflect Hammersmith and Fulham CCG’s out of hospital strategy. This is not included within the DMBC and is the subject of a separate paper to the JCPCT. 2 Ealing CCG is considering whether additional services could be provided on the same site. This model adopts the local hospital model together with enhanced primary and community services that reflect Ealing CCG’s out of hospital strategy. This is not included within the DMBC and is the subject of a separate paper to the JCPCT. Executive summary xiv
Assuring the proposals Throughout the Shaping a healthier future programme there has been ongoing assurance to ensure that proposals are sound, scrutinised and well communicated and considered by all stakeholders. During the pre-consultation phase the programme was assured by an Office of Government Commerce Gateway review and was given an ‘excellent’ rating of Amber/Green. The clinical proposals were assured by the National Clinical Advisory Team (NCAT) firstly pre-consultation in April 2012 and secondly post-consultation in November 2012 and February 2013. The April review highlighted a number of important issues, solutions to which were incorporated into the programme’s plans, and the November review was supportive of the way in which the proposals were developing, recognising there had been good progress made. Further assurance came from external clinical reviews and through our own review of the relevant clinical evidence. NHS London confirmed that the programme met the Four Tests for reconfiguration set out by the Secretary of State in May 2012. Travel and access implications Clinicians recognise the importance of access to NHS services for the local population and at the very earliest stages of Shaping a healthier future agreed that travel and access would be a key element to the development of the recommendation. 91% of activity is unaffected by the proposals. The programme undertook a range of travel analysis both during our planned programme of work and in response to feedback we received during consultation. Impacts by borough and site for all modes of transport, including emergency travel times and maximum private journey times to the proposed major hospital sites, were considered. The majority of feedback received during the consultation on travel and access was about general issues that affect the range of NHS services throughout NW London and did not differentiate between the options proposed. The key themes included: Improvements to public transport required to support access to all sites Potential impact of changes on the accessibility of services by vulnerable groups Issues around patients being deterred from attending follow-up appointments due to travel costs Requests for further analysis to be undertaken and checks to be made to the accuracy of analysis undertaken Potential impact of changes on ambulance journeys The need to develop clear transfer pathways Potential impact of travel on the quality of care. The Travel Advisory Group proposed a list of priority areas for further work with regards to patient transport, should the programme be implemented. This included continuing with a Travel Advisory Group during implementation, to establish links with local authority public transport planning liaison groups and local authority transport planners to review strategic transport requirements or changes and to consider prioritising access to health care sites in reviewing transport routes. Equalities implications For the work of the programme, NHS NW London has sought to exceed the duty under the Equalities Act 2010. Under the Equality Act 2010, consideration of equality issues must Executive summary xv
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 and 22: For Quality of care, clinicians hav
Page 23: 1 2 3 4 5 A 6 B 7 C 8 Quality of Ca
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
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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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