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

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Urgent care centre Outpatient and diagnostics 24/7 A&E Emergency Surgery ICU Level 3 Psychiatric liaison Complex Elective Surgery Major Trauma Emergency medicine Inpatient Paediatrics Obstetrics & Maternity Unit HASU Heart Attack Elective Surgery Elective Medicine ITU/HDU Cardiothoracic Neurosurgery Vascular Cancer Care 7 Figure 2.5: Current services provided at acute hospital sites in NW London 4 Acute Hospital 1 Elective 1 Specialist 8 Core services_ Central Middlesex u u u6 u u u u u u Charing Cross u u u u u u u u u u u u u u Chelsea & Westminster u u u u u u u u u u u u u u Ealing u u u u u u u u u u u u u Hammersmith (incl. QCCH) u u u u u u u u u u u u u u u u Hillingdon u u u u u u u u u u u u u Northwick Park u u u u u u u u u u u u u u u u St Mary's u u u u u u u u u u u u u u u u u West Middlesex u u u u u u u u u u u u u Mount Vernon Royal Marsden 2 Royal Brompton 3 u u u u u u u u u u u u u u u u u u u RNOH 4 u u Western Eye 5 u u u Harefield u u u u u u u u u u u u u 4 This Figure has been advised by Medical Directors from each site. Due to variations in services, not all categories are strictly comparable. Notes from Figure 2.5: 1. These services are grouped as services that are likely to be delivered in these types of hospital settings, although it does not necessarily mean that the services are provided in the same way across all sites 2. All services relate to cancer patients 3. Relates to heart and lung services 4. Relates to trauma and orthopaedic 5. Relates to eye care services 6. Not 24/7 7. Not all specialist tumour types at each site 8. Only a selection of specialist services shown in this table 2. Introduction to NHS NW London 8
major hospital, elective centre and specialist centre), which have been defined by local clinicians. These models are explained further in Chapter 7. 2.3.1 Acute hospital activity levels Across the nine acute hospital sites (this excludes the specialist hospitals of Royal Brompton, Royal Marsden and Royal National Orthopaedic Hospital) in NW London there are approximately 4,060 acute beds of which 3,450 are adult and 610 paediatric or maternity. A summary of activity in NW London hospitals is described in Figure 2.6. Figure 2.6: Current activity levels and beds by site (2012 / 2013) 5 Ealing Charing Cross Central Middlesex Chelsea & Westminster Northwick Park & St. Mark’s West Middlesex Hillingdon Hammersmith St. Mary’s Elective 14,650 44,536 14,779 33,131 28,742 12,187 15,008 167,073 29,293 Non- Elective 15,305 32,819 11,563 28,924 43,102 16,819 21,308 165,335 31,757 Maternity (Births) 3,141 - - 5,561 5,042 4,728 4,239 4,938 3,851 Maternity (General) 2,573 5 41 14,073 8,378 1,239 1,574 22,406 18,061 Neonates 4,219 - - 20,967 5,419 5,451 833 6,880 5,107 Activity Paediatrics 3,052 7 1,205 15,193 11,405 3,571 2,447 266 6,965 Critical Care 3,151 1,576 1,541 4,055 8,628 4,502 736 32,383 4,270 Outpatient 158,396 202,647 125,112 491,851 251,578 235,821 299,410 174,027 326,064 A&E (major & sta.) 26,246 25,439 11,957 28,927 57,209 39,399 52,206 15,591 41,621 A&E (minor) 19,832 8,113 2,784 14,006 37,039 20,756 32,986 5,657 100,977 UCC 71,540 49,612 53,602 70,328 74,964 80,430 29,033 32,016 - Other - - - 1,729 - - - - 2 Adult 239 436 182 325 627 327 412 316 321 Beds Critical Care 15 7 9 13 19 13 9 13 16 Maternity 42 - - 80 69 56 46 44 41 Paediatrics 16 - 6 80 24 24 41 - 40 Total 312 443 197 498 739 420 508 373 418 2.3.2 Acute hospital cross-border flows Some hospitals in NW London provide significant levels of activity for non-NW London patients, as demonstrated in Figure 2.7. 5 Source: Trust data. Central Middlesex A&E is only open restricted hours. 2. Introduction to NHS NW London 9
Page 1 and 2: North West London Shaping a healthi
Page 3 and 4: Table of contents Volume 1 Foreword
Page 5 and 6: Foreword Dr Mark Spencer The Clinic
Page 7 and 8: 6. Consultation, feedback and how w
Page 9 and 10: 13. Equalities implications This ch
Page 11 and 12: 1. Executive Summary Introduction t
Page 13 and 14: The overall programme timeline is b
Page 15 and 16: The process was used before consult
Page 17 and 18: • Delivery of multi-disciplinary
Page 19 and 20: Stage 1 - Case for Change Our work
Page 21 and 22: For Quality of care, clinicians hav
Page 23 and 24: 1 2 3 4 5 A 6 B 7 C 8 Quality of Ca
Page 25 and 26: Assuring the proposals Throughout t
Page 27 and 28: Programme implementation arrangemen
Page 29 and 30: 5. To agree that Hammersmith Hospit
Page 31 and 32: DMBC Chapter 2 - Introduction to th
Page 33 and 34: 2. Introduction to the NHS in NW Lo
Page 35 and 36: Figure 2.3: Clinical Commissioning
Page 37: West Middlesex University Hospital
Page 41 and 42: DMBC Chapter 3 - Introduction to th
Page 43 and 44: 3. Introduction to the Shaping a he
Page 45 and 46: 3.3 Programme governance The Joint
Page 47 and 48: The JCPCT is advised by a Programme
Page 49 and 50: Consultation - during this phase, t
Page 51 and 52: Ensure consistency of communication
Page 53 and 54: Stakeholder Group Political Individ
Page 55 and 56: o o o o o Rationale for options dev
Page 57 and 58: The implications of the options in
Page 59 and 60: DMBC Chapter 4 -The Case for Change
Page 61 and 62: 4. The Case for Change This chapter
Page 63 and 64: Stroke Services: The provision of s
Page 65 and 66: We need to do more to support patie
Page 67 and 68: In NW London, however, the NHS is s
Page 69 and 70: Figure 4.6: Emergency general surgi
Page 71 and 72: attack or stroke to designated cent
Page 73 and 74: Figure 4.9: Evaluation of primary c
Page 75 and 76: Inequalities would continue and pro
Page 77 and 78: DMBC Chapter 5 - Process for identi
Page 79 and 80: 5. Process for identifying a recomm
Page 81 and 82: Figure 5.1: Basis of decision of wh
Page 83 and 84: We confirmed this decision, and the
Page 85 and 86: 5.5 A detailed description of the s
Page 87 and 88: Correct care setting to deliver hig
Page 89 and 90:
Figure 5.11: Ratings used in evalua
Page 91 and 92:
DMBC Chapter 6 - Consultation, feed
Page 93 and 94:
6. Consultation, feedback and how w
Page 95 and 96:
6.2.1 Key findings from the consult
Page 97 and 98:
times (particularly for patients tr
Page 99 and 100:
Westminster City Council, Adult Ser
Page 101 and 102:
Analysed and considered consultatio
Page 103 and 104:
6.3 Our responses to feedback This
Page 105 and 106:
Feedback received Stakeholders who
Page 107 and 108:
6.3.3 Theme 3: Clinical vision and
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
6.3.5 Theme 5: Proposals for local
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
DMBC Chapter 7 - Clinical vision, s
Page 125 and 126:
7a. Clinical, vision, standards and
Page 127 and 128:
Local clinicians agreed that in ord
Page 129 and 130:
▪ Expectant mothers should have t
Page 131 and 132:
# 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
Page 159 and 160:
in major hospitals) and equipment t
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tangible differences for patients
Page 163 and 164:
Referral A&E Illustrative patient j
Page 165 and 166:
Illustrative patient journey matern
Page 167 and 168:
Illustrative patient journey in mat
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Illustrative patient journey planne
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GP-led care Illustrative patient jo
Page 173 and 174:
7.8.1 Scope of the CIG’s work The
Page 175 and 176:
Theme Clinical outcomes Staff attit
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Further stakeholder engagement is n
Page 179 and 180:
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
Page 185 and 186:
Exclusion criterion Mental health A
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Diagnostics 7.14.3 Streaming, regis
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Biochemistry Microbiology Radiology
Page 191 and 192:
The Provider must deliver appropria
Page 193 and 194:
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
Page 215 and 216:
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
Page 241 and 242:
6. The Maternity CIG have considere
Page 243 and 244:
DMBC Chapter 8A-E - Out of hospital
Page 245 and 246:
Out of hospital improvements This c
Page 247 and 248:
8.2. Settings of out of hospital ca
Page 249 and 250:
practical solution for the site, wh
Page 251 and 252:
Brent Health Partnerships Overview
Page 253 and 254:
Consultation theme Standards for ca
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Consultation theme Integration Inve
Page 257 and 258:
8.5.3. Workforce Following feedback
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Delivering this workforce shift wil
Page 261 and 262:
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
Page 287 and 288:
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
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
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DMBC Chapter 9 - Decision making an
Page 301 and 302:
9a. Decision making analysis stages
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Correct care setting to deliver hig
Page 305 and 306:
“The Brent Health Partnerships Ov
Page 307 and 308:
Page 309 and 310:
Royal College of Midwives “The RC
Page 311 and 312:
Page 313 and 314:
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
Page 319 and 320:
Figure 9.9: The seven hurdle criter
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surgeons in NW London, but we would
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We confirmed this decision with the
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Appropriate staffing is integral to
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The proposals are supported by Depa
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NW London to deliver high quality c
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1. Support predicting where activit
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Figure 9.15: Example travel time ma
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The analysis shown in Figure 9.18,
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Figure 9.18: Impact on private car
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33% support 10% opposed 57% of peop
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Figure 9.21: Watershed map for blue
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etained as a major hospital, becaus
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9.7.29 The implications of this fee
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Figure 9.25: Potential activity flo
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Figure 9.27: Changes in travel time
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Figure 9.29: Changes in travel time
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Figure 9.31: Possible choices betwe
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Either Charing Cross or Chelsea & W
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Figure 9.33: Option A, excluding ca
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Figure 9.36: Option C responses, in
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Richmond Upon Thames LINk Royal Bor
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Southall Black Sisters “The closu
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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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Page 439 and 440:
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
Page 455 and 456:
In the rest of this section, the se
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