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

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Figure 8.17: Potential hubs/health centres across NW London 3 CCG boundary Hubs and Multi-practice GP sites Localit boundary New or rebuilt hubs Mt. Vernon / N&P The Pinn Alexandra Avenue Potential 3 rd Harrow hub Grand Union Village Featherstone Road RAF Uxbridge HESA Health Centre Heston Health Centre Heart of Hounslow Feltham Centre for Health Bedfont solution (site tbd) Jubilee Gardens Services at Ealing Hospital Brentford Health Centre Mattock Lane Acton Chiswick Health Centre Greenford Green Hillview Surgery Wembley Centre for Health and Care Willesden Centre for Health and Care Earls Court South Fulham potential hub North End MC Richford Gate Services at Central Middlesex Hosp. White City St. Charles Church St. hub St. Mary‟s OOH hub Services at Charing Cross Hospital South Westminster Centre for Health 3 Locations shown are approximate 8c. Out of hospital estates 246
Across NW London, these sites will deliver a range of intermediate services, including extended primary care, management of long-term conditions, diagnostics, therapies and outpatient services (including consultant-led clinics). Delivering these hubs/health centres is expected to require investment of £6 million for the minimum needed for Shaping a healthier future and £60–112 million for the range of enhanced services to offer a fuller clinical service at each site. These are indicative estimates: in the coming months, more detailed work will be carried out to deliver outline business cases for the investment in these sites, including detailed work on affordability. Initial assessments of revenue affordability for individual proposed hubs suggest 58% of them would be affordable under current assumptions and affordability is most challenging for new-build hubs. Further work is required in this area and investments for each individual site will require an outline business case including detailed analysis of revenue affordability in the next phase of this process. This configuration of hubs is based on the configuration of services outlined in the recommendation. A different option would result in a different range of hubs, reflecting changes in local hospitals. However, overall investment would remain the same. Chapter 16 details – for each CCG – the services modelled for these locations, the associated volume, and the estimated investment needed. 8.11.3. GP premises 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 the boroughs and the condition of different estates. In parallel, a survey of GP premises was conducted in seven of the CCGs. The estates review, which eventually reached nearly half of practices in the participating CCGs, looked at the condition of GP estates as well as the cost for any upgrades needed to meet condition standards and ensure the sites comply with access legislation. This process is outlined in Figure 8.18. NHS Brent CCG conducted an independent review, which has been aligned with the findings of the NW London-wide work. 8c. Out of hospital estates 247
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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
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Future capacity in centralised serv
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3. There would be an additional "st
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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 and 272: some cases, these will be offered o
Page 273 and 274: Process for development of local ho
Page 275: The result is an emerging picture o
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
Page 321 and 322: surgeons in NW London, but we would
Page 323 and 324: We confirmed this decision with the
Page 325 and 326: 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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