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

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Figure 9.87: Evaluation of Net Present Value 19 Net present value (£m), absolute and relative to „do nothing‟ Option Major hospitals A ▪ ▪ ▪ ▪ ▪ West Middlesex St Mary‟s Chelsea & Westminster Northwick Park 2017/18 & St.Mark‟s Hillingdon Year to complete Investment in reconfig. (by end Major of year) 1 Hospital Investment and costs -222 Investment in Local Hospital -31 NHS contribution to Imperial College move -31 Backlog Maintenance -49 Transitio n Costs -47 Fixed costs for activity flowing outside NWL -23 -232 Benefits Fixed cost of major Net hospital Receipts investm from land ent sale Consoli dation savings Net savings from conversion to local hospital NPV 135 132 384 17 114 Positive NPV Negative NPV Total NPV (relative to „do nothing‟) Evaluation (+) B ▪ ▪ ▪ ▪ ▪ West Middlesex St Mary‟s Charing Cross Northwick Park & St.Mark‟s Hillingdon 2017/18 -288 -49 -16 -56 -51 -138 -297 166 190 466 -74 22 (-) C ▪ ▪ ▪ ▪ ▪ Ealing St Mary‟s Chelsea & Westminster Northwick Park & St.Mark‟s Hillingdon 2017/18 -273 -13 -31 -55 -49 -81 -285 120 132 269 -266 -170 (--) ▪ Do Nothing -64 -32 -96 ▪ Net present value is calculated over 20 years (2012/13 to 31/32) at 3.5% discount and no terminal value, and values are reported relative to the NPV of the „do nothing‟ scenario. The decision to assess NPV over 20 years is a matter of judgement, and was selected by the F&BP board to strike a balance between accounting for the ongoing benefits post-reconfiguration, while not giving undue weighting to the long term forecasts that are necessarily less accurate (which may be the case with a longer period.) The sensitivity analyses look at the relative impact on the NPV for the options if this timeframe were extended to 60 years ▪ „Do nothing‟ scenario includes backlog maintenance and the ongoing capex to maintain these increased assets ▪ Evaluation ratings based on £100m increments between above the „do nothing‟ scenario: £200m (++) 19 Source: Reconfiguration modelling 1. NPV calculation on cash flows for capital investment and receipts based on implementation timeline 9d. Decision making analysis stage 6 and stage 7 402
9.13.9 Impact of the changes: Updated evaluation The result of the evaluation is that Option A remains the best option under the financial appraisal with a score of +1 (from +4 from the pre consultation analysis). Option B remains second with a score of -6 (from +1) and Option C has moved to -7 (from -2). This is shown in Figure 9.88. Figure 9.88: Post-consultation Value for Money evaluation 20 PCBC Capital cost Transition to the system costs Site viability Surplus for acute sector Net Present Value Count for VfM DMBC Capital cost Transition to the system costs Site viability Surplus for acute sector Net Present Value Count for VfM A ▪ ▪ ▪ ▪ ▪ West Middlesex St Mary‟s Chelsea & Westminster Northwick Park &St.Mark‟s Hillingdon + - + + ++ 4 - - + + + 1 B C ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ West Middlesex St Mary‟s Charing Cross Northwick Park & St.Mark‟s Hillingdon Ealing St Mary‟s Chelsea & Westminster Northwick Park &St.Mark‟s Hillingdon + - + - + 1 + - -- - + -2 - - -- - - - - -- - -- -7 -6 The changes to the Value for Money evaluation from pre-consultation to the postconsultation phase are summarised below: Total net capital required to deliver the reconfigurations has increased by £94 million - £155 million and the gross costs and capital receipts by a larger amount. The following describes the net capital required by option: Option A: £112 million (PCBC) vs. £206 million (DMBC) Option B: £153 million (PCBC) vs. £253 million (DMBC) assuming £139 million net receipt at Chelsea & Westminster NHS Foundation Trust can be used to fund development at other non Foundation Trusts, otherwise capital requirement increases to £388 million Option C: £113 million (PCBC) vs. £268 million (DMBC) Improvement in total I&E across the sector has reduced by £11 million - £13 million consistently across all options due to higher gross capital investment to make changes to the estates: Option A: £55 million (PCBC) vs. £42 million (DMBC) Option B: £37 million (PCBC) vs. £26 million (DMBC) Option C: £38 million (PCBC) vs. £25 million (DMBC) 20 Source: Reconfiguration modelling 9d. Decision making analysis stage 6 and stage 7 403
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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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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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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
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Page 393 and 394: This analysis was agreed prior to c
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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 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
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: Figure 9.86: Evaluation of total su
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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