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

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The extent to which the anticipated benefits of implementing the standards have been achieved. This would include measures such as the percentage of patients with care plans reporting an improved sense of independence. To understand more about the different measures we could use to achieve this, we reviewed a wide range of existing national and international frameworks to identify potential existing measures that we could use to track the implementation of out of hospital standards. These measures fell into two categories. First, over-arching outcome measures to measure the benefits of implementing the standards in aggregate. Second, process measures within each domain of the standards, to assess the extent to which each standard is being implemented. On the whole, the measures attempt to look at both health and social care measures and include efficiency, outcome and user experience measures, where available. These potential measures are summarised in Figure 8.5. Figure 8.5: Potential measures of out of hospital standards Measure type Domain Potential measures Outcome / benefits measures Process / implementation measures All Individual empowerment and self care Rate of non-elective admissions Re-admissions within 28 days Unplanned hospitalisations for individuals with an ambulatory care sensitive chronic condition (over 18 years) per 100,000 population Unplanned hospitalisations for asthma, diabetes or epilepsy in under 19s per 100,000 population Individuals with long-term conditions feel independent and in control of their condition The proportion of people who use services who have control over their daily life Social care related quality of life Carer reported quality of life Survey question: Overall, how would you describe your experience of your GP surgery Proportion of people who use services and carers who find it easy to find information about support Friends and Family test Survey question: My GP was good or very good in involving me in decisions about my care Survey question (for patients with long term conditions): In the last 6 months have you had enough help from local services and organisations to help you manage your long term conditions. 8a. Development of out of hospital plans in NW London 230
Measure type Domain Potential measures Access, convenience and responsiveness Care planning and multidisciplinary care Information and communication Percentage of patients identified as needing to speak to a GP practice within
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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
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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
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 and 226: in NWL will have a choice of delive
Page 227 and 228: Support for the proposal is higher
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: Delivering this workforce shift wil
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
Page 275 and 276: The result is an emerging picture o
Page 277 and 278: Across NW London, these sites will
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Page 281 and 282: 8d. Urgent care centres When indivi
Page 283 and 284: Figure 8.22: NW London urgent care
Page 285 and 286: Conditions suitable for UCC Clinica
Page 287 and 288: Key differences Governance As with
Page 289 and 290: processes of the CCG and as such th
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Page 293 and 294: Improved empowerment - specifically
Page 295 and 296: Figure 8.28: Realising our integrat
Page 297 and 298: Figure 8.29: Summary of CCG commiss
Page 299 and 300: DMBC Chapter 9 - Decision making an
Page 301 and 302: 9a. Decision making analysis stages
Page 303 and 304: Correct care setting to deliver hig
Page 305 and 306: “The Brent Health Partnerships Ov
Page 307 and 308: Correct care setting to deliver hig
Page 309 and 310: 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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