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

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Build new Local Hospital facilities Dispose of estate when changing the site to a Local Hospital (net receipts from disposal) Cover high risk and significant risk backlog maintenance (this is included because backlog maintenance is assumed to be one off additional spend over and above the ongoing programmes to replace assets and the requirement differentiates the options as it is not required for sites becoming Local Hospitals). The capital estimates for Options B and C were derived from the extensive work done on Option A by pro-rating costs and values as appropriate, except for Ealing under Option C and Charing Cross under Option B where an estimated range was provided by the estate advisors. In options where Imperial College is impacted by changes (Charing Cross in Option A and C, and Chelsea and Westminster in Option B), a capital cost equivalent to the estimated NHS contribution to relocating the College in acute premises has been included (this excludes additional potential NHS capital contributions to provide teaching space in out of hospital hubs and GP practices). This amounts to £35 million in Options A and C and £18 million in Option B. Based on consultation feedback for Trusts impacted, capital has been estimated for activity flowing out of NW London sector. Estimates of activity flows were used to estimate the requirement for new beds and the feedback from Trusts from out of sector who responded to the consultation was applied to assess the cost. Land and capital receipts have been estimated on the basis of market value assuming planning permission for residential use. To be prudent, an additional 20% risk adjustment discount has been applied. With these planning assumptions, revised capital estimates have been assessed for the three shortlisted options as set out in Figure 9.79. 9d. Decision making analysis stage 6 and stage 7 394
Figure 9.79: DMBC NHS net capital estimates for Options A, B and C 12 £m Site 4 Do nothing Backlog maintenance DMBC option A Backlog maintenance Required new investment Net land receipt Net total capital spend DMBC option B 3 Backlog maintenance Required new investment Net land receipt Net total capital spend DMBC option C 3 Backlog maintenance Required new investment Net land receipt Net total capital spend Ealing 6 0 19 -21 -2 0 19 -21 -2 6 39 5 0 45 Charing Cross Central Middlesex Chelsea & Westminster Northwick park and St. Mark‟s 8 0 15 1 -136 -121 8 111 1,6 0 119 0 15 1 -136 -121 0 0 9 0 9 0 9 0 9 0 9 0 9 1 1 26 0 27 0 36 1 -175 -139 1 18 0 19 28 28 20 0 48 28 20 0 48 28 9 0 37 West Middlesex 1 1 22 0 23 1 10 0 11 1 5 -3 3 Hillingdon 19 9 17 17 10 0 34 17 17 10 0 34 17 4 0 21 Hammersmith 2 2 25 0 27 2 14 0 16 2 25 0 27 St Mary‟s 2 3 3 132 1,7 -10 125 3 75 -10 68 3 140 1,7 -10 133 NHS‟ contribution - - 35 - 35 - 18 - 18 - 35 - 35 to Imperial College 8 Out of sector - - - - - - 70 - 70 - 60 - 60 Total 69 52 320 -167 206 59 400 -206 253 58 359 -149 268 12 Source: Trusts, reconfiguration modelling, DJD 1. Excludes cost of college reprovision 2. Land receipt across all options include ~£10m from Western Eye; 3. Options B and C estimated at a lesser level of granularity than option A; 4. Only includes acute business for the specific site – i.e., excludes community services and services at sites not specifically listed (e.g., Mount Vernon); 5. Median of estimated range £32-46m; 6. High range of estimated range £95-111m given feedback of higher cost to create a new NICU/PICU on a site that does not currently have maternity nor paediatrics; 7. Includes £14m rehousing pathology labs currently at Charing Cross; 8. Estimated NHS contribution to relocating the College in acute premises ; excludes additional potential NHS capital contributions to provide teaching space in OOH hubs and GP practices; 9. Subject to revised condition survey report to be published end of 12/13; 10 Includes £2.4m of MRI equipment for which I&E impact is assumed to replace current cost of service outsourcing 9d. Decision making analysis stage 6 and stage 7 395
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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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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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Page 397 and 398: Response to feedback about implemen
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Page 405 and 406: 9.9.48 The outcome of the disruptio
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Page 421 and 422: Figure 9.75: Beds bridge: 2012/13 t
Page 423: The key modelling assumptions appli
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Page 429 and 430: Figure 9.84: Summary of net surplus
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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
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Page 443 and 444: Figure 9.94: Change in expanded NPV
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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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