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

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Appendices Volume 3 A. Programme governance B. Stakeholder engagement record (pre-consultation) C. Activities undertaken during consultation D. Case for Change E. Literature review of available relevant clinical evidence F. Ipsos MORI consultation analysis report Volume 4 G. Equalities reviews H. Carers reports I. Assurance (NCAT reports, OGC gateway review, ECP, Consultation Institute letter) Volume 5 J. CCG commissioning intentions K. Travel Advisory Group report, travel briefing and further travel analysis Volume 6 L. CCG out of hospital strategies Volume 7 M. Inner North West London ICP: independent evaluation N. Finance and Business Planning analysis O. Patient choice report P. Workforce analysis for consultant cover
Foreword Dr Mark Spencer The Clinical Board, which includes the North West London medical directors of all the acute and mental health trusts and the chairs of all the Clinical Commissioning Groups, has led the Shaping a healthier future programme in considering the challenges facing the local health system. As chair of the board I commend the work on this Decision-Making Business Care which reflects the recommendations of the Clinical Board and trust that the Joint Committee of Primary Care Trusts will consider this carefully. It is clear that there are examples of great care within the NHS in North West London, in hospitals, the community and general practice - but this is not consistent. More importantly the current way of working in the NHS is not going to be able to meet the future challenges. We need to develop new ways of providing care and support to an ageing population, often with multiple chronic illnesses. Having examined this in depth as clinical leaders we have proposed changes to create fewer, more comprehensive and better staffed hospitals, able to provide the best quality care throughout the whole week, whilst developing out of hospital services to allow co-ordinated integrated care for people with less severe acute illness and those with chronic conditions. We are clear that these proposals would help us meet the challenge of the NHS mandate, save lives and improve clinical outcomes. I do also want to take the opportunity to thank the large number of clinicians who have played a part in developing this work, GPs from all the commissioning groups, specialists and nurses from all North West London’s hospitals, as well as from around the country who have given input. I particularly want to thank Dr Susan LaBrooy, Dr Mike Anderson and Dr Tim Spicer who have helped lead the clinical work. We have also benefitted from the many members of public, patients and carers, clinical colleges and other organisations who have taken part in the discussions, shared their concerns, and allowed us to improve the proposals and make them more robust. As a Clinical Board we look forward to ensuring, whatever decisions are made, that we implement any changes carefully and safely so that we can continue to be proud of the care and treatments we deliver to the people of North West London. Mark Spencer (PEC Chair) on behalf of the full Executive Committee Executive summary i
Page 1 and 2: North West London Shaping a healthi
Page 3: Table of contents Volume 1 Foreword
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 and 38: West Middlesex University Hospital
Page 39 and 40: major hospital, elective centre and
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
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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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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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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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