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

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Figure 9.44: Clinical Quality Data 2 However, another useful source of data on clinical quality are the Quality Dashboards produced by the East Midlands Quality Observatory. A summary of the outputs of these Quality Dashboards is set out in Figure 9.45. 2 Notes from Figure 9.44: 1. Dr Foster standardised mortality rate for 3 years. The current three year HSMR is for the financial years 2008/09, 2009/10 and 2010/11; Summary Hospital-level Mortality Indicator (SHMI), and Deaths After Surgery, 2010/11, National average is 100 2. Includes Charing Cross, Hammersmith and St. Mary‟s hospitals 3. Includes Northwick Park and Central Middlesex 4. Dr Foster Mortality Ratios 2010/11, Deaths in low risk conditions per 1,000 patients 9c Decision making analysis stage 6 342
Figure 9.45: Quality Dashboard data 3 In comparison to the Dr Foster data, according to the Quality Dashboard scores, Hillingdon is the top performer in NW London with better than national average performance against 62 of the metrics. Ealing has the lowest number of metrics that are above national average, however, the range between Ealing and Hillingdon is fairly small, with all the other Trusts having similar scores. It is not clear whether these scores help to sufficiently differentiate between the levels of clinical quality that are being achieved between the different Trusts. As described at the start of this section, clinicians have been clear since the start of Shaping a healthier future that clinical quality is at the heart of the programme and that it is the driving force behind all the proposals and recommendations. The reconfiguration is being pursued to achieve the clinical standards and the improved clinical quality through the re-shaped clinical service delivery models set out in Chapter7a. Prior to consultation, after reviewing the data available on clinical quality, clinicians agreed that all the eight options under consideration had been designed to achieve the highest levels of clinical quality and that the additional data reviewed at this stage of the evaluation did not provide any significant information that allowed them to differentiate between options on this basis. Therefore all eight options were evaluated to provide high quality of clinical care. A summary is provided in Figure 9.46. This recommendation was approved by the Clinical Board and the Programme Board pre-consultation. 3 East Midlands Quality Observatory: http://www.emqo.eastmidlands.nhs.uk/welcome/quality-indicators/acutetrust-quality-dashboard/published-dashboards/. Note from Figure 9.45: 1. The number of metrics that scored better for the Trust than national average, out of a total of 104 metrics (this takes into account metrics where a lower score is better (e.g. mortality) and metrics where a higher score is better (e.g. % patients seen within X weeks) 9c Decision making analysis stage 6 343
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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
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“The Brent Health Partnerships Ov
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Royal College of Midwives “The RC
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clinicians wanted to take this into
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9.6.3 Feedback received about the s
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Confirm the service models reflect
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Figure 9.9: The seven hurdle criter
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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
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Page 337 and 338: Figure 9.18: Impact on private car
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Page 341 and 342: Figure 9.21: Watershed map for blue
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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
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Page 353 and 354: Figure 9.31: Possible choices betwe
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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 365 and 366: Figure 9.38: Ranking of evaluation
Page 367 and 368: Figure 9.42: Evaluation criteria as
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Page 377 and 378: Figure 9.48: Quality of care - Acut
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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
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Page 389 and 390: 3 Value for money 9.9.26 The purpos
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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
Page 403 and 404: Figure 9.60: Evaluation of disrupti
Page 405 and 406: 9.9.48 The outcome of the disruptio
Page 407 and 408: Greg Hands, MP for Chelsea & Fulham
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Page 411 and 412: Quality/Impact score Figure 9.65 Re
Page 413 and 414: 9. Decision making analysis - stage
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Page 417 and 418: Figure 9.69: 5 year gross savings,
Page 419 and 420: Figure 9.73: Commissioners intend t
Page 421 and 422: 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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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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