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

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Figure 8.13 Summary of current services provided at Queen Mary’s Hospital, Roehampton Description • Large community hospital, new building opened February 2006 • Provides a wide range of community and other services including inpatient beds, outpatient clinics, a minor injuries unit and a sexual health clinic, as well as the world famous amputee rehabilitation centre. • The new Queen Mary‟s opened in February 2006, almost 100 years after the hospital first opened its doors • The hospital is managed by Wandsworth Community Services • The hospital currently has 69 mental healthcare beds, 50 elderly and intermediate care beds and 20 rehabilitation beds • 600 members of staff work in the new hospital. Services • Emergency nurse practitioner staffed walk in centre/minor injuries unit • Outpatient clinics • Inpatient psychiatry and elderly care • Specialist community services • On site radiology, pathology, outpatient diagnostics • Therapy services • Pharmacy • Minor procedures • Wheelchair and rehab services • Mental health community services • Day hospital for the elderly • Sexual health clinic • Prosthetic limb fitting services • Specialist rehab services. Infrastructure • Housed in a state of the art, four - storey building containing a full range of modern diagnostic equipment • Total development cost of £55 million. Source: Wandsworth Teaching PCT website Figure 8.14 Summary of current services provided at St Charles, Ladbroke Grove Description • The main aim of the centre is to offer people the support and or treatment to keep them healthy and prevent them from going to hospital. • Part of the facility was redeveloped in 2009 thereby offering new state of the art Facilities • The centre is managed by NHS NW London. Services • Urgent Care Centre • Minor injuries unit • Walk - in Centre • GP services • X - Ray and Ultrasound • Palliative medicine • Pharmacy • Family planning services • Phlebotomy services • Community podiatry services • Community dentistry • Weight management • Smoking cessation. Infrastructure • Further development continues to restore the historic building enabling new services to move on site, including charities and third sector organisations. Source: NHS Choices and Kensington & Chelsea PCT website 8c. Out of hospital estates 242
Process for development of local hospital service models For each hospital, we have estimated the financial and estates implications of providing these services at each local hospital site. This process is summarised in Figure 8.15. Figure 8.15: Process of development of local hospital service models 1 2 3 4 5 Site context and Shaping a Healthier Future (SaHF) implications Description of clinical services and activity Space requirement for service mix Current site configuration Required capital expenditure Description of step ▪ Describe the existing activities on the site ▪ Outline the proposals in the Shaping a healthier future consultation and site implications ▪ ▪ ▪ ▪ Identify main services on site Quantify activity at the site after the reconfiguration Generate estate plans for preferred service model Analyse the required gross capital expenditure and net of disposal capital expenditure to deliver the preferred option for the site Methodology ▪ Review existing activity information from Trust ▪ Sense check against site visits ▪ Test information with Trust ▪ Review consultation document ▪ Describe constraints on site use ▪ Update modelling ▪ Test with CCGs and Trusts ▪ Identify the space requirements to deliver services ▪ Identify room requirements to deliver proposed services provided at the site ▪ Calculate the whole hospital area required for the site (i.e. total square meters required) ▪ Identify the existing estate and service configuration ▪ Identify existing estate and service configuration using Trust ▪ Carry out initial site inspections and review against information from Trust ▪ Develop baseline estate data 1 ▪ Develop surveyor/architect block plans for the site ▪ Calculate required capital expenditure based on assumptions of refurbishment/new CapEx costs ▪ Develop broad phasing and timing of build option plans 6 7 Site economics (include revenue and costs) Align with CCG strategy ▪ Estimate the income and expenditure surplus/deficit at the local hospital site ▪ Ensure alignment with CCG Out-of-Hospital strategy ▪ Test with CCGs ▪ Model the income, operating and capital costs at the site 1 Does not include updating existing Trust plans if out of date This process has supported the further work undertaken to address how the local hospitals under the recommendation will be clinically and financially sustainable and be developed including changes to estates and capital expenditure requirements. More information on this can be found in Chapter 16. 8.11.2. Hubs / health centres In their out of hospital strategies pre-consultation, the CCGs articulated their vision for delivering out of hospital services and looked in detail at the activity to be re-provided in response to activity avoided in acute. Since then, we have engaged with the CCGs to describe the distribution of services across different hubs/health centres, specify the space requirements, and estimate the volumes associated with the estates being planned. In parallel, a survey of potential sites was conducted to assess high level capacity and condition at these estates. The process of developing models for hubs/health centres is outlined in Figure 8.16. 8c. Out of hospital estates 243
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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
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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
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 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: some cases, these will be offered o
Page 275 and 276: The result is an emerging picture o
Page 277 and 278: Across NW London, these sites will
Page 279 and 280: need redeveloping or rebuilding to
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
Page 291 and 292: around the table accelerates the un
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 309 and 310: Royal College of Midwives “The RC
Page 313 and 314: clinicians wanted to take this into
Page 315 and 316: 9.6.3 Feedback received about the s
Page 317 and 318: Confirm the service models reflect
Page 319 and 320: Figure 9.9: The seven hurdle criter
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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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Correct care setting to deliver hig
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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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