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

9a. Decision making analysis stages 1 to 4
The four parts of this chapter describe the analysis undertaken to identify a recommended
option for reconfiguration. Using the seven stage process for identifying options for
consultation we explain the analysis undertaken at each stage of the process. We describe
how we have considered the feedback received during consultation and undertaken new
analysis based on this feedback (including re-appraisals of the latest evidence, activity and
financial data) to enable the programme to review options at each stage in order to come to
the final recommendation. The case for change, vision and clinical standards were
reconfirmed. These were used in conjunction with agreed clinical dependencies to develop
the service models. Options for the configuration of major hospitals were assessed using
hurdle criteria to determine that five were needed and to produce a list of eight configuration
options. These eight options were evaluated using criteria (covering quality of care, access
to care, value for money, deliverability and research & education) developed before and after
consultation. This evaluation enabled us to determine a preferred option. We confirmed that
this remained the best option if our modelling assumptions changed through the sensitivity
analysis.
9.1 What is decision making analysis
Chapter 5 describes the seven stage process for identifying a recommended option for
reconfiguration. Decision making analysis is the analysis required at each stage of the seven
stage process to enable the programme to undertake an evaluation before proceeding to the
next stage of the process. This analysis includes exploring clinical evidence, defining service
models, calculating financial implications and assessing travel times.
Pre-consultation we used the process and associated analysis to identify options for
consultation. The clinical work was led by the Clinical Board (which includes clinical
representatives for each provider Trust and for each CCG) with support from an Expert
Clinical Panel (which provided external challenge to test and refine our proposals). The
financial work was led by the Finance and Business Planning group (which has financial
leads from all the CCGs, providers, a patient representative and NHS London). Patients,
members of the public, local NHS Trusts, Local Authorities, the Travel Advisory Group, local
HOSCs and the JHOSC also provided input. During consultation we received feedback
about the decision making analysis.
9.2 The analysis for decision making
In Chapter 5 we explained why we have concluded that the seven stage process to identify
options for consultation is appropriate to be re-used to make a recommendation to the
Programme Board. In this chapter we describe how we used the process for a second time
to identify a single recommended option for reconfiguring services in NW London. We went
through the seven stage process, incorporating the feedback we received during
consultation and additional analysis undertaken to support this process using the latest
evidence, information and data.
Figure 9.1 summarises the seven stage process used in this chapter for identifying the
recommended option followed in this chapter (see Chapter 5 for a full description).
The subsequent sections of this chapter describe the analysis for each stage of the process
in detail.
9a. Decision making analysis stages 1 to 4 271