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

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Figure 9.93: Summary of sensitivity analyses – Expanded NPV 23 Positive NPV Negative NPV £m Sensitivity tests NPV relative to ‘do nothing’ – 20 years Op A Op B Op C NPV relative to ‘do nothing’ – 60 years Op A Op B Op C Base modelling outputs 224 138 -38 653 496 167 a) Demand growth I: 1%pt pa higher, trust income allowed to grow 183 124 -77 605 500 125 b) Demand growth II: 1%pt pa higher , trust income fixed c) QIPP plans I: 60% of plans achieved, trust receive income 183 96 124 21 -77 -161 605 480 500 356 125 71 d) QIPP plans II: 60% of plans achieved, trust income is capped 96 21 -120 480 356 71 e) QIPP plans III: 110% of QIPP achieved (Trusts recover costs) 253 168 -8 693 537 211 f) Efficiencies I: Monitor inflation and 90% CIPs 245 192 -8 697 609 229 g) Efficiencies II: Monitor downside h) LOS reduction I: 10% reduction achieved i) LOS reduction II: no reduction on maternity, paeds &critical care j) Transition costs: 20% higher than plan k) Consolidation savings I: 50% of consolidation savings achieved l) New build/refurbishment cost I: 30% higher than plan m) Lower net land receipts: 30% lower than plan n) Higher cost of capital: NPV discount rate of 4.5% instead of 3.5% o) Time to deliver reconfiguration: 2 year delay p) Lower outpatient activity:40% of activity retained instead of 80% q) Period for NPV assessment from 20 years to 60 years r) Theatre efficiency run 50 hours a week instead of 40 hours s) New build/refurbishment cost II: 30% lower than plan t) Lower fixed cost saving from local hospital: 75% of plan u) Imperial College I: NHS contributes 100% capital; no revenue impact v) Imperial College II: NHS contributes 100% capital; full revenue impact (est. 11.5% of capital) 260 104 -1 117 215 160 77 -13 184 187 209 235 224 278 371 128 224 156 214 9 127 67 -146 -147 -48 -95 -180 88 -74 107 -52 129 -36 148 -33 138 -38 210 288 21 -105 138 -38 121 -106 4 49 104 728 470 491 644 518 439 613 495 610 676 653 735 867 451 653 512 656 285 300 485 346 278 446 364 463 518 496 606 714 251 496 461 -41 254 2 1 157 47 131 95 156 177 167 299 374 25 167 25 23 Sensitivity U - This is already included in the expanded NPV and will only impact VFM evaluation 9d. Decision making analysis stage 6 and stage 7 412
Figure 9.94: Change in expanded NPV vs baseline 24 Positive NPV Negative NPV Change in expanded NPV due to sensitivity, £m Change in NPV – 20 years Change in NPV– 60 years Sensitivity tests Op A Op B Op C Op A Op B Op C Base modelling outputs 0 0 0 0 0 0 a) Demand growth I: 1%pt pa higher, trust income allowed to grow -41 -14 -39 -48 4 -42 b) Demand growth II: 1%pt pa higher , trust income fixed -41 -14 -39 -48 4 -42 c) QIPP plans I: 60% of plans achieved, trust receive income -129 -117 -82 -173 -140 -95 d) QIPP plans II: 60% of plans achieved, trust income is capped -129 -117 -82 -173 -140 -95 e) QIPP plans III: 110% of QIPP achieved (Trusts recover costs) 29 30 30 40 41 44 f) Efficiencies I: Monitor inflation and 90% CIPs 21 54 30 44 114 63 g) Efficiencies II: Monitor downside 35 76 42 75 160 88 h) LOS reduction I: 10% reduction achieved -120 -138 -108 -183 -210 -165 i) LOS reduction II: no reduction on maternity, paeds &critical care -107 -129 -109 -162 -195 -166 j) Transition costs: 20% higher than plan -9 -10 -10 -9 -10 -10 k) Consolidation savings I: 50% of consolidation savings achieved -64 -71 -57 -135 -150 -120 l) New build/refurbishment cost I: 30% higher than plan -147 -150 -142 -214 -218 -208 m) Lower net land receipts: 30% lower than plan -40 -50 -36 -40 -50 -36 n) Higher cost of capital: NPV discount rate of 4.5% instead of 3.5% -37 -30 -14 -158 -131 -72 o) Time to deliver reconfiguration: 2 year delay p) Lower outpatient activity: 40% of activity retained instead of 80% q) Period for NPV assessment from 20 years to 60 years -15 11 0 -9 10 0 3 5 0 -43 23 0 -33 22 0 -11 10 0 r) Theatre efficiency run 50 hours a week instead of 40 hours s) New build/refurbishment cost II: 30% lower than plan t) Lower fixed cost saving from local hospital: 75% of plan -96 54 147 -116 73 150 -67 87 142 -202 82 214 -245 110 218 -142 132 208 u) Imperial College I: NHS contributes 100% capital; no revenue impact 0 v) Imperial College II: NHS contributes 100% capital; full revenue impact (est. 11.5% of capital) -68 24 Source: sensitivity modelling -17 0 0 -68 0 -141 -35 0 0 -141 9d. Decision making analysis stage 6 and stage 7 413
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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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Figure 9.51: Blue light travel time
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Figure 9.52 shows the reduction in
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3 Value for money 9.9.26 The purpos
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Page 401 and 402: 5 Research and Education: 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,
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
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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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