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

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Hammersmith has ~60% of Imperial College space (39,000m 2 ) and received the majority of major research infrastructure investment over recent years 15 St Mary‟s has 17,000m 2 of research space with the development of the new surgical innovation centre Imperial College is investing in new White City Health Research Campus Therefore options that included St Mary‟s received a higher evaluation than options that didn‟t. Figure 9.62 details the evaluation undertaken by clinicians for this sub-criterion. Figure 9.62: Evaluation of support to current research and education delivery 16 Prior to consultation clinicians agreed the ranking detailed in Figure 9.62. They also stated that they believed education was not a differentiating factor as education can move with clinical activity, and the ability to develop teaching will be maintained regardless of the option recommended. The recommendation was approved by the Clinical Board and the Programme Board pre-consultation. 9.9.51 Feedback received about the support for current and developing research and education delivery sub-criterion during consultation During consultation we received the following feedback about the sub-criterion: Hillingdon Hospitals NHS Foundation Trust “We formally support the recommended option (option A) which, provided it is effectively implemented and backed by the requisite investment, has the potential to improve the quality of care, make good use of buildings and resources, and support research and education” 15 This allocation focuses on the Faculty of Medicine and excludes the wider Imperial College space at the South Kensington campus 16 Notes from Figure 9.62: 1. Hammersmith has ~60% of Imperial College space (39,000m2) and received the majority of major research infrastructure investment over recent years; St Mary‟s has 17,000m2 of research space and the ability to recruit patients for Imperial College trials through their outpatient clinics 9c Decision making analysis stage 6 376
Greg Hands, MP for Chelsea & Fulham “…..Charing Cross Hospital is a world-class research and teaching facility….” Petition H by users of the West Middlesex University Hospital, Ipsos MORI report “Support research and education: West Middlesex Hospital has the research facilities and some of the most important research in NW London is currently carried out a WMUH Imperial AHSC “The implications of the proposals on education and research need to be addressed” Charing Cross staff event on 17th July 2012 “Potential impact on medical research at Charing Cross” Excerpt from letter received from Dr McRobbie (2nd October 2012), Charing Cross Hospital “On reading your detailed business case, it appears that your measure of research and education activity is the “space available”. You have not used any recognised indicator of research or educational output e.g. the number of clinical trials conducted, the number of research patients enrolled on studies, the research income through grants, the number of publications produced. These are data easily accessible and are un-ambiguously quantifiable, but you have chosen to invent your own indicator of activity, which you have presented to the public as fact. In particular, you have stated as factual and without evidence, to support your preferred option A, that “most important medical research and education is carried out at Hammersmith, St Mary‟s and Chelsea and Westminster Hospitals”. This is very misleading. At a recent open meeting at Charing Cross Hospital your team admitted that „in terms of publications etc. Charing Cross does more research than Chelsea and Westminster.” 9.9.52 The implications of this feedback for the support for current and developing research and education delivery sub-criterion We have considered the feedback received during consultation as follows: In summarising the pre-consultation business case for the consultation document, some of the detailed explanations for these criteria have been over simplified. The statements regarding research & education in the consultation document state the positive effect that each of the options would have. Other issues that need to be considered are ICHT‟s stated intention to concentrate research in particular on the St Mary‟s and Hammersmith sites, along with the advantage in continuing research & education provided at Chelsea & Westminster as this Trust has fewer opportunities to move its research & education facilities elsewhere. There was no intention to dismiss or overlook the value of the research & education currently undertaken at Charing Cross. We have revisited the original evaluation against the two research & education subcriteria to check its validity in light of the feedback received and are content that the original evaluation was correct. We are aware that research is often multi-site, suggesting research could be done out of an alternative site should the other site cease to be a research facility following reconfiguration. We also realise that much of the research undertaken will be training driven and will be revisited if training is relocated. 9c Decision making analysis stage 6 377
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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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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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Page 379 and 380: experience. In order to use this as
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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
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
Page 403 and 404: Figure 9.60: Evaluation of disrupti
Page 405: 9.9.48 The outcome of the disruptio
Page 409 and 410: comprises more than 22 million cita
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
Page 423 and 424: The key modelling assumptions appli
Page 425 and 426: Figure 9.79: DMBC NHS net capital e
Page 427 and 428: Figure 9.81: Approach to estimating
Page 429 and 430: Figure 9.84: Summary of net surplus
Page 431 and 432: Figure 9.86: Evaluation of total su
Page 433 and 434: 9.13.9 Impact of the changes: Updat
Page 435 and 436: Figure 9.89: Effect of the expanded
Page 437 and 438: Correct care setting to deliver hig
Page 439 and 440: Sensitivity tests g) Tariff efficie
Page 441 and 442: Figure 9.93 summarises the impact o
Page 443 and 444: Figure 9.94: Change in expanded NPV
Page 445 and 446: The sensitivity analysis supports t
Page 447 and 448: DMBC Chapter 10 - The recommendatio
Page 449 and 450: 10. The proposed future configurati
Page 451 and 452: The changes to the scoring before a
Page 453 and 454: 10.3. Why this is the recommendatio
Page 455 and 456: In the rest of this section, the se
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