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9.7.34 The implications of this feedback on our analysis to identify the best geographical spread of the remaining sites The feedback we received about the pairings did include suggestions for alternatives. We considered the feedback received as follows: Response to feedback requesting evidence about increased travel times in the Rideout report: There is a limited evidence base to consider the impact of travel time to outcomes. There is evidence showing no deterioration and improved outcomes in stroke, heart attack, aortic aneurysm and major trauma and these services have already benefitted from centralisation. Infant death risk has been shown not to be affected by hospital accessibility 22 following a review of all infant deaths in Cumbria from 1950-1993, where travel times are much greater than experienced in North West London. A review by Nicholl 23 suggests that the time to initial treatment is the key factor. There has also been much progression in training ambulance crews and the development of the paramedic role 24 . It is considered that ambulances are no longer just fast buses for the injured, but more akin to "Intensive Care Units on wheels" 25 . The areas of NW London furthest from hospital centres remain unchanged in the proposed consultation options. Response to feedback suggesting alternative pairings in the Rideout report: The suggested alternative is not supported by the data. The pairings analysis indicates the activity flowing between West Middlesex and Hillingdon is as follows: o Blue light: 8%-8% respectively o Private car: 4%-6% respectively o Public transport: 0%-0% The analysis indicates that if one of these hospitals was no longer providing a particular service then patients would not elect to use the other hospital on the basis of travel time. The pairings analysis indicates the activity flowing between Hillingdon and Wexham Park is as follows: o Blue light: 5% respectively o Private car: 22% respectively o Public transport: 57% The pairs analysis indicates that people travelling by ambulances and private car would not travel to Wexham Park on the basis of travel time. 9.7.35 Outcome of the seventh hurdle criterion to identify the best geographical spread of the remaining sites We have considered feedback received about clinicians‟ recommendation. Given the feedback, the absence of any viable alternative, clinicians concluded that a geographic distribution of the remaining three locations for major hospitals would minimise the impact of changes on local residents and the location of the remaining three major hospital sites would be between: 22 TJB Dummer, L Parker 'Hospital accessibility and infant death risk. Arch Dis Child. 2004. 89:232-234. 23 J Nicholl (2007 op cit) 24 H Barratt, R Raine. Hospital Service reconfiguration: the battle for hearts and minds. BMJ (2012); 344:e953 25 Prof Martin Gore. conversation Clinical Board. Jan 2013 9b. Decision making analysis stage 5 324
Either Charing Cross or Chelsea & Westminster Either Ealing or West Middlesex Either Hammersmith or St Mary’s. This is based on the analysis that: The impact of removing one hospital in each pair on peak car travel times had little impact on travel times The impact on peak car travel times on populations if both hospitals in a pair were removed showed a large impact on some residents Activity flows between Trusts based on blue-light and private car travel times showed the highest patient flows were between the pairs. We confirmed this decision with the Clinical Board and the Programme Board during the post consultation phase. This outcome is unchanged from pre-consultation. 9.7.36 Outcome of the hurdle criteria As a result of the process set out above, clinicians agreed that eight options were identified as a result of the fifth stage of the process to identify a recommendation. Each of these eight options located a major hospital at Northwick Park and Hillingdon Hospital and Central Middlesex was not proposed as a major hospital. Figure 9.32 illustrates the eight options. Figure 9.32: Summary of the outcome of Stage 5 (proposed eight options for the location of major hospitals in NW London) as recommended by the Clinical Board Site Option 1 Option 2 Option 3 Option 4 Option 5 (A) Option 6 (B) Option 7 (C) Option 8 St Mary’s Local hospital Local hospital Local hospital Local hospital Major hospital Major hospital Major hospital Major hospital Hammersmith Major hospital Major hospital Major hospital Major hospital Specialist hospital Specialist hospital Specialist hospital Specialist hospital Charing Cross Local hospital Major hospital Local hospital Major hospital Local hospital Major hospital Local hospital Major hospital Chelsea & Westminster Major hospital Local hospital Major hospital Local hospital Major hospital Local hospital Major hospital Local hospital West Middlesex Major hospital Major hospital Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Major hospital Major hospital Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Ealing Local hospital Local hospital Major hospital Major hospital Local hospital Local hospital Major hospital Major hospital Central Middlesex Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Local hospital/ Elective hosp’ Northwick Park Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Hillingdon Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Major hospital Local hospital Major hospital Local Hospital & Elective hospital Specialist hospital Central Middlesex is described as a local and elective hospital in the figure. Hospitals that aren‟t recommended as major hospitals are therefore potential local hospital sites. Central Middlesex also has capacity that could be used for elective procedures. Therefore in the ongoing decision making analysis we explore the benefits of Central Middlesex being designated an elective centre. We confirmed this decision with the Clinical Board and the Programme Board during the post consultation phase. This outcome is unchanged from that reached pre-consultation. 9b. Decision making analysis stage 5 325
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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
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consultation they could have receiv
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8.10. Next steps We are developing
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Figure 8.11: Hub/health centre requ
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some cases, these will be offered o
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Process for development of local ho
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The result is an emerging picture o
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Across NW London, these sites will
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need redeveloping or rebuilding to
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8d. Urgent care centres When indivi
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Figure 8.22: NW London urgent care
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Conditions suitable for UCC Clinica
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Key differences Governance As with
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processes of the CCG and as such th
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around the table accelerates the un
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Improved empowerment - specifically
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Figure 8.28: Realising our integrat
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Figure 8.29: Summary of CCG commiss
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DMBC Chapter 9 - Decision making an
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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
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: Figure 9.31: Possible choices betwe
Page 357 and 358: Figure 9.33: Option A, excluding ca
Page 359 and 360: Figure 9.36: Option C responses, in
Page 361 and 362: Richmond Upon Thames LINk Royal Bor
Page 363 and 364: Southall Black Sisters “The closu
Page 365 and 366: Figure 9.38: Ranking of evaluation
Page 367 and 368: Figure 9.42: Evaluation criteria as
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Page 371 and 372: 9.9.5 The analysis of the five eval
Page 373 and 374: Figure 9.45: Quality Dashboard data
Page 375 and 376: Response to feedback about the eval
Page 377 and 378: Figure 9.48: Quality of care - Acut
Page 379 and 380: experience. In order to use this as
Page 381 and 382: Figure 9.50: Time to major hospital
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Page 385 and 386: Figure 9.51: Blue light travel time
Page 387 and 388: Figure 9.52 shows the reduction in
Page 389 and 390: 3 Value for money 9.9.26 The purpos
Page 391 and 392: Staff recommendation as a place to
Page 393 and 394: This analysis was agreed prior to c
Page 395 and 396: Figure 9.56: Ease of delivering eac
Page 397 and 398: Response to feedback about implemen
Page 399 and 400: Changes to the designation of the M
Page 401 and 402: 5 Research and Education: Disruptio
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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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