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

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# published papers Figure 9.64: Number of research publications by institution 500 450 400 350 300 250 200 150 100 50 0 Hammersmith St Mary's Charing Cross Chelsea & Westminster Ealing 2010 2011 2012 West Middlesex The data indicates that over the past three years: Hammersmith and St Mary‟s hospitals have published more papers than either Charing Cross or Chelsea & Westminster hospitals To date this year, Chelsea & Westminster have produced 18% more research papers than Charing Cross Ealing and West Middlesex hospitals have published less research papers than the other institutions. For the remainder of the analysis we have focused on Chelsea & Westminster and Charing Cross. We do not analyse Hammersmith any further because it is designated a specialist hospital under all the options being analysed in Stage 6. Ealing and West Middlesex are excluded from further analysis due to the small number of research publications. Finally St Mary‟s is excluded because it was designated as a major hospital under all three consultation options. The additional analysis focuses on clarifying the „quality‟ of the research completed at both Charing Cross and Chelsea & Westminster hospitals to enable a direct comparison to be made, using the JIF factor as a proxy. Evaluating the quality/impact of research undertaken at each institution A proxy for the quality of the research undertaken by Charing Cross, and Chelsea & Westminster was determined by identifying the number of research papers published this year to date in medical journals with a JIF of over 5. This year to date, Charing Cross and Chelsea & Westminster Hospitals have published 12 and 18 research publications respectively, in journals with a JIF>5. Factoring in actual JIFs for those publications (i.e. sum of the JIFs for the 12/18 publications) gives a score for Charing Cross of 133 and for Chelsea & Westminster of 174 (shown in Figure 9.65). 9c Decision making analysis stage 6 380
Quality/Impact score Figure 9.65 Research Publication Quality/Impact scores by institution (2012) 200 180 2011 2012 160 140 120 100 80 60 40 20 0 Charing Cross Chelsea & Westminster These findings together with those outlined in section 3.2, demonstrate that in 2011 and 2012 to date, Chelsea & Westminster publish a larger volume of research papers in journals with a higher impact factor (JIF). The implications of this analysis on the evaluation of research and education This additional analysis undertaken in response to feedback received during consultation supports the higher relative ranking of options that designate Chelsea & Westminster as a major hospital over those that designate Charing Cross as a major hospital. This has the following impact on the evaluation of research and education, see Figure 9.66: Figure 9.66: The post consultation evaluation of support to current research and education delivery Proposed Option PCBC Evaluation <strong>DMBC</strong> Evaluation Rationale 1 2 ▪ West Middlesex ▪ Hammersmith ▪ Chelsea & Westminster ▪ Northwick Park ▪ Hillingdon ▪ West Middlesex ▪ Hammersmith ▪ Charing Cross ▪ Northwick Park ▪ Hillingdon - - - - ▪ St Mary‟s produces a substantial volume of research papers, therefore options where St Mary‟s is not designated as a major hospital attract a lower ranking 3 4 ▪ Ealing ▪ Hammersmith ▪ Chelsea & Westminster ▪ Northwick Park ▪ Hillingdon ▪ Ealing ▪ Hammersmith ▪ Charing Cross ▪ Northwick Park ▪ Hillingdon - - - - ▪ Chelsea & Westminster produces a higher volume of research with a higher impact factor, therefore options that designate Chelsea & Westminster a major hospital are ranked higher 5 ▪ West Middlesex ▪ St Mary‟s ▪ Chelsea & Westminster ▪ Northwick Park ▪ Hillingdon + ++ 6 ▪ West Middlesex ▪ St Mary‟s ▪ Charing Cross ▪ Northwick Park ▪ Hillingdon + + 7 ▪ Ealing ▪ St Mary‟s ▪ Chelsea & Westminster ▪ Northwick Park ▪ Hillingdon + ++ 8 ▪ Ealing ▪ St Mary‟s ▪ Charing Cross ▪ Northwick Park ▪ Hillingdon + + 9c Decision making analysis stage 6 381
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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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Either Charing Cross or Chelsea & W
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Figure 9.33: Option A, excluding ca
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Page 363 and 364: Southall Black Sisters “The closu
Page 365 and 366: Figure 9.38: Ranking of evaluation
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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
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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
Page 383 and 384: Rationalising provision across the
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
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
Page 409: comprises more than 22 million cita
Page 413 and 414: 9. Decision making analysis - stage
Page 415 and 416: There were six distinct parts of th
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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