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

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Figure 9.68: Changes to population projections following 2011 census 1 Population changes for NWL Change in population estimates (2011 Census value minus 2010 SNPP estimates) Relative % difference (compared to 2010 SNPP estimates) 2011 2012 2013 47,962 48,724 49,595 2.5% 2.5% 2.5% ▪ Population estimates across NWL are c.50,000 (2.5%) greater within the 2011 Census than the 2010 SNPP projection ▪ <strong>SaHF</strong> modelling is based on Trust 2012/13 forecast outturn activity, therefore the actual population across NWL as per the 2011 Census has been accounted for within this Rate of population increase to 2018 Average annual change (2011-18) % 2010 SNPP % 2011 Census % Hammersmith and Fulham 0.4 0.3 Kensington and Chelsea 0.0 0.3 Westminster 0.8 1.7 Brent 1.3 0.7 Ealing 1.2 1.1 Harrow 1.5 1.5 Hillingdon 1.5 1.6 Hounslow 1.6 1.5 NWL 1.1 1.1 ▪ The rate of population increase across NWL is very similar for both 2010 SNPP and 2011 Census population estimates, however there are differences at borough-level, as shown in the table. ▪ The 2011 census overall rate of increase of 1.1% pa differs across age groups, and taking the differential rates of increase, plus the relative cost of different age groups into account, would indicate a cost-weighted increase of approx. 2% pa ▪ The financial and activity modelling has assumed total activity growth of 2.8% per annum across NWL (equivalent to 3.9% in financial terms) Commissioners have the strategic intention to rebalance their spending from acute to out of hospital while maintaining a minimum 1% surplus over the next 5 years. To do so, commissioners plan £365 million net savings and £190 million investment, resulting in £555 million gross savings by 2017/18. The gross QIPP of £555 million and the planned investment of £190 million are distributed across the eight CCGs as shown in Figure 9.69. 1 Source: Comparison of the 2010 sub-national population projections1 (SNPP) with 2011 Census-based projections. This is a mid-year estimate produced by ONS based on the 2001 Census and “known” components of change in the intervening years, i.e. births, deaths, internal migration and estimates of net international migration. From this “known” base year ONS then project. 9d. Decision making analysis stage 6 and stage 7 386
Figure 9.69: 5 year gross savings, investment and net savings breakdown by PCT 2 12/13 to 17/18, £m Gross QIPP savings Investments Net QIPP savings £344 million (62%) of gross savings are planned to come from the acute sector as shown in Figure 9.70. Figure 9.70: 62% of gross savings are planned to come from the acute sector 3 Average net QIPP as % of annual allocation 1 Brent -74 30 -44 1.5% Harrow -91 30 -61 3.4% Ealing -88 31 -57 1.8% Hillingdon -83 28 -55 2.6% Hounslow -64 23 -42 1.9% H&F -57 17 -40 2.1% K&C -50 15 -35 1.8% Westminster -49 16 -33 1.1% Total -555 190 -365 2.0% £m, % ‟Other‟ savings 1 Primary care& prescribing Community Mental health & Learning disability Acute Breakdown of total NWL GROSS QIPP savings by setting 100% = 555 44 (8%) 74 (13%) 44 (8%) 49 (9%) 344 (62%) Estimated QIPP 13/14 – 17/18 (5 yrs) The breakdown of this by Point Of Delivery (POD) is shown in the Figure 9.71. 2 Total 5 year net QIPP saving divided by 5, as percentage of 2012 total allocation (recurrent and non-recurrent) 3 Source: NWL Commissioner forecast model Commissioner forecast assumptions and plans developed for modelling purposes based on extrapolation from existing out of hospital plans. High level findings agreed with CCG finance leads as representing the best available estimates at the time of the analysis 1. „Other‟ savings cover a range of initiatives not analysed by setting 9d. Decision making analysis stage 6 and stage 7 387
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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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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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Page 379 and 380: experience. In order to use this as
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
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
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Page 405 and 406: 9.9.48 The outcome of the disruptio
Page 407 and 408: Greg Hands, MP for Chelsea & Fulham
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 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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