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

Royal Colleges have indicated that a population of 350,000 to 450,000 is required to have
sufficient scale to run a high quality urgent surgery service where staff are seeing sufficient
volumes to maintain skills 11 . Alongside this evidence has shown that by establishing
specialist centres and networks, patients will experience better clinical outcomes. An
example of this in emergency surgery is around access to surgeons who are trained in
laparoscopic surgery for emergency situations.
Clinicians agreed that having more than five major hospital sites would not enable the
specialist expertise to be concentrated into enough centres and seeing sufficient volumes of
patients to deliver the highest quality care.
Rationale for proposing a minimum of three hospitals
The Clinical Board recommended that potential options with only one or two major hospitals
would be too difficult to deliver in the timescales required and would compromise access for
patients.
Prior to consultation clinicians concluded that NW London required three to five major
hospitals. This recommendation was approved by the Clinical Board and the Programme
Board pre-consultation.
9.7.13 Feedback received about identify the number of major hospitals required for
NW London
During consultation we received the following feedback related to the third hurdle criterion:
Independent reports conducted by Tim Rideout Limited on behalf of the London
Borough of Ealing and Hammersmith & Fulham Council
“The clinicians considered evidence about factors that were judged to contribute to high
quality clinical care, including links between senior staff presence and quality, patient
volumes to maintain skills, technology and the interdependencies between different acute
and support services. The business case states that as a result of this consideration
clinicians “identified that there should be between three to five major hospitals in NW London
to support the projected population of 2 million”, with a view that more than five major
hospitals would lead to sub-optimal care. The proposals centred on five as the proposed
number, primarily in light of current capacity constraints. Although explained in summary
terms, the detailed evidence base for this decision to propose five major hospitals is not
provided with the business case and is therefore open to challenge.”
9.7.14 The implications of this feedback on our analysis to identify the number of
major hospitals required for NW London
The feedback we received about the third hurdle criterion did not include suggestions for
alternatives. We considered the feedback received as follows:
Response to feedback from Rideout about current capacity constraints: The
statement; “The proposals centred on five as the proposed number, primarily in light
of current capacity constraints” is incorrect. Our recommendation is based upon:
o
o
More than 5 hospitals would not provide the clinical quality required
Fewer than 5 would be difficult to deliver, require significant building work and
patient journey time would increase
11 Academy of Royal Colleges, Acute Healthcare Services Report, 2007
9b. Decision making analysis stage 5 296