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

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Figure 9.90: Expanded NPV of acute reconfiguration (20 years) 22 Expanded net present value (£m), absolute and relative to „do nothing‟ Positive NPV Negative NPV Investment and costs Benefits A Option Major hospitals ▪ ▪ ▪ ▪ ▪ 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 -190 Investment in local hospital -26 NHS contribution to Imperial College move -51 -49 Transitio n Costs -33 Fixed costs for activity flowing outside NWL -23 Fixed cost of major Net hospital Receipts investm from land ent sale -232 Backlog Maintenance Consolidation savings Avoid cost of new service standards Net savings from conversion to local hospital Total NPV, 20 years 135 132 228 298 190 Total NPV, 20 years (relative to „do nothing‟) 286 B ▪ ▪ ▪ ▪ ▪ West Middlesex St Mary‟s Charing Cross Northwick Park & St.Mark‟s Hillingdon 2017/18 -246 -42 -15 -56 -38 -138 -297 166 190 228 356 108 205 C ▪ ▪ ▪ ▪ ▪ Ealing St Mary‟s Chelsea & Westminster Northwick Park & St.Mark‟s Hillingdon 2017/18 -232 -11 -51 -55 -36 -81 -285 120 132 228 205 -67 29 ▪ „Do nothing‟ NPV -64 -32 -96 22 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 7 406
Correct care setting to deliver high quality care Use existing sites Enough major hosp. to support population of 1.9million Number of major hosp. must be viable in medium term Ensure good geographical spread Use sites currently delivering major hospital services Minimise access impacts for residents 9.15 Stage 7 - Sensitivity Analysis This section describes the seventh stage of the process – sensitivity analysis. Figure 9.91 highlights the relevant step. Figure 9.91: Highlighting Stage 7 of the process described in this section Key principles Continue expanding out of hospital services Located with, or independent of major hospitals All specialist services will remain as they are All 9 sites with an A&E to provide local hospital services and a UCC 4 Service models Out of hospital 1 Case for change 2 Vision • Provides platform for service change 1 Localising • Defines improvements 2 Centralising and clinical benefits • Confirm ‘do nothing’ is 3 Integrating not an option 3 Standards Out of hospital: Acute: • Urgent and emergency care • Maternity • Paediatrics Clinical dependencies 5 Hurdle criteria 8 Borough level, out of hospital strategies covering: • Case for improving OOH services • Steps to delivering 7better care • List of initiatives • Investment • Next steps 6 Evaluation criteria Sensitivity analysis 1 Quality of care 7 Sensitivity analysis 2 Access to care • Tests 18 underlying 3 Value for money assumptions for acute reconfiguration 4 Deliverability • Test 3 sensitivities for out of hospital 5 Research and education • Tests 22 underlying Recommended option Criteria include sub-criteria Number of options: MILLIONS Number of options: < 20 Number of options: ~ 3 Number of options: ~ 3 Number of options: 1 Sensitivity analysis has been used to test the options to establish whether the ranking changes under testing. 22 sensitivities have been run as summarised in Figure 9.92. 9d. Decision making analysis stage 6 and stage 7 407
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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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Figure 9.50: Time to major hospital
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Rationalising provision across the
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Page 405 and 406: 9.9.48 The outcome of the disruptio
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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,
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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
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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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