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

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Royal College of Physicians “The RCP believes that there will need to be a radical service redesign to ensure that patients receive safe and high quality care that they deserve at all times. For many communities this will require reorganisation and consolidation of hospital services to facilitate the optimum application of hospitals services for patients. This must be accompanied by supportive improvements in primary, community and social care, recognising the needs of public and patients across the spectrum of potential health intervention.” The Royal College of Midwives “The loss of consultant obstetric services at Ealing could have a negative impact on tackling health inequalities in the borough; this could be mitigated – at least for women at low medical risk - if the obstetric service were replaced by a FMU…. we are extremely disappointed that Shaping a healthier future does not include any proposals for the establishment of freestanding midwife-led units (FMUs).” Focus groups Broadly speaking the focus group attendees understood and accepted the models of care; for further information refer to Appendix F. 9.6.4 The implications of this feedback for the service models The feedback received suggests no alternative to the eight models proposed by local clinicians. However, the following work has been undertaken: There was a request for more detailed descriptions for urgent care centres and local hospitals. We provided this information during consultation in factsheets and the urgent and emergency care CIG has been engaged in work to develop the UCC specification. This work is all reflected in the descriptions found in Chapter 7b. Ealing and Hammersmith & Fulham CCGs wish to respond in detail to the feedback about the range of services that would be available at Ealing and Charing Cross hospitals and have developed a separate set of proposals for the JCPCT to consider. These are set out in separate documents for the JCPCT to consider independent of this DMBC. The Maternity CIG considered the issue of standalone birthing and midwife led units but do not consider there would be sufficient demand for a standalone or birthing centre for the population of North West London. This was reinforced by the previous local experience of the Fetal Medicine Unit at Central Middlesex. Therefore the proposal at this stage is to continue recommend that NW London will not have standalone birthing units. We will ensure that there is a Midwifery led homebirth community service for all women in NWL. The Paediatric CIG has agreed that amongst the six Neonatal Units there will be two Level 3 (Neonatal Intensive Care) units. The final disposition of the other four units will be decided during implementation, recognising that current and future workforce issues may be a constraint. Given the clinical support for the proposals and the absence of alternative suggestions, the service models and principles are largely unchanged. 9.6.5 Outcome of the fourth stage about the service models to deliver change We reached the following conclusions about the service models to deliver change: 9a. Decision making analysis stages 1 to 4 286
Confirm the service models reflect the latest clinical thinking and reflect relevant feedback received during consultation The service models and principles proposed in consultation are still valid and have been reviewed by local clinicians and updated in accordance with the latest evidence and guidance from LHP. Confirm the service models will contribute to deliver the clinical case required Local clinicians and the CIGs have developed the standards to address the challenges described in the Case for Change. There use will contribute to the delivery of clinical benefits. We confirmed this recommendation and the validity of the Case for Change with the Clinical Board and the Programme Board during the decision making phase. 9a. Decision making analysis stages 1 to 4 287
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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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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
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
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: 9.6.3 Feedback received about the s
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
Page 327 and 328: The proposals are supported by Depa
Page 329 and 330: NW London to deliver high quality c
Page 331 and 332: 1. Support predicting where activit
Page 333 and 334: Figure 9.15: Example travel time ma
Page 335 and 336: The analysis shown in Figure 9.18,
Page 337 and 338: Figure 9.18: Impact on private car
Page 339 and 340: 33% support 10% opposed 57% of peop
Page 341 and 342: Figure 9.21: Watershed map for blue
Page 343 and 344: etained as a major hospital, becaus
Page 345 and 346: 9.7.29 The implications of this fee
Page 347 and 348: Figure 9.25: Potential activity flo
Page 349 and 350: Figure 9.27: Changes in travel time
Page 351 and 352: Figure 9.29: Changes in travel time
Page 353 and 354: Figure 9.31: Possible choices betwe
Page 355 and 356: Either Charing Cross or Chelsea & W
Page 357 and 358: Figure 9.33: Option A, excluding ca
Page 359 and 360: Figure 9.36: Option C responses, in
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Page 363 and 364: Southall Black Sisters “The closu
Page 365 and 366: 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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