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

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Figure 10.1: Summary of the decision-making analysis of the eight medium list options 1 2 3 4 5 A 6 B 7 C 8 Quality of Care Clinical quality ++ ++ ++ ++ ++ ++ Clinical ++ quality* ++ Patient experience ++ + + - ++ + Patient experience + - Access Distance and time to access services - - - - - - - - Access Distance and time to access services** Patient choice + - + - ++ + Patient ++ choice + Value for Money Value for Money Capital cost to the system -- -- -- -- - - Capital cost - to the system + Transition costs -- -- -- -- - - Transition -costs - Viable Trusts and sites + + -- -- + -- Viable Trusts -- and sites -- Surplus for acute sector + + - -- + - Surplus for - acute sector -- Net Present Value - - -- -- + - Net Present -- Value - Deliverability ++ -- Deliverability Workforce + - + + + - Workforce + + Expected time to deliver - - -- -- + + Expected --time to deliver -- Co-dependencies with other strategies - - -- -- + + - - Research & Education High evaluation Low evaluation ▪ West Middlesex ▪ Hammersmith ▪ Chelsea & Westminster ▪ Northwick Park ▪ Hillingdon ▪West Middlesex ▪Hammersmith ▪Charing Cross ▪Northwick Park ▪Hillingdon ▪ Ealing ▪ Hammersmith ▪ Chelsea & Westminster ▪ Northwick Park ▪ Hillingdon ▪ Ealing ▪ Hammersmith ▪ Charing Cross ▪ Northwick Park ▪ Hillingdon ▪ West Middlesex ▪ St Mary’s ▪ Chelsea & Westminster ▪ Northwick Park ▪ Hillingdon ▪ West Middlesex ▪ St Mary’s ▪ Charing Cross ▪ Northwick Park ▪ Hillingdon Ealing Ealing St Mary’s St Mary’s ▪ Chelsea & ▪ Charing Cross Westminster Northwick Park Northwick Park ▪ Hillingdon ▪Quality Hillingdonof Care Co-dependencies with other strategies Research & Education Disruption -- - -- - - + Disruption - + Support current and developing research and education delivery - - - - ++ + ++ + Support current and developing research and education delivery Pre-consultation score -2 -7 -11 -16 +14 +7 +2 -4 Post-consultation score -3 -7 -12 -16 +10 0 -4 -4 Changes from pre-consultation REVIEWED AND NO CHANGE REVIEWED AND NO CHANGE REVIEWED AND NO CHANGE REVIEWED AND NO CHANGE UPDATED UPDATED UPDATED UPDATED UPDATED REVIEWED AND NO CHANGE REVIEWED AND NO CHANGE REVIEWED AND NO CHANGE UPDATED UPDATED 10. The proposed <strong>future</strong> configuration of hospitals in NW London 420
The changes to the scoring before and after consultation have primarily decreased because of the refreshed value for money analysis for the three consultation options. Additional analysis undertaken on research and education in response to feedback received during consultation supports the higher relative ranking of options that designate Chelsea and Westminster as a major hospital over those that designate Charing Cross as a major hospital, and strengthens the data collated to support designation of reconfiguration option A. Note that although the score for the other options has not decreased, this may be due to the value for money analysis not being refreshed for these options. The sensitivity analysis confirmed that Option A (Option 5 in the table above) remains the strongest. As a result of the decision-making analysis, the Clinical Board agreed that Option A (Option 5 in the table above) should be the recommendation. The Finance & Business Planning Working Group agreed that Option A was better than the other options. The Programme Board reviewed the completed evaluation and analysis and considered the recommendations of the Clinical Board and the Finance & Business Planning Working Group. The Board noted the two recommendations and agreed with the assessment that Option A should be the recommended configuration. 10.2. The recommended configuration Based on the pre-consultation options evaluation, Option A was our preferred option at the start of the consultation. During consultation we received feedback about the process of reaching this preferred option and about the evaluation itself. Post-consultation, we have responded to the feedback and refreshed the options evaluation. Option A remains our recommended option for configuration. The evaluation and post-consultation analysis did not change the high level configuration in the preferred option. However, it did enable us to consider additional services that could be located as part of local hospital sites and this meant some lower-level changes to the configuration of the Charing Cross site. The recommended configuration proposes the following service models at each site. At: Chelsea & Westminster – a local hospital and a major hospital Hillingdon – a local hospital and a major hospital Northwick Park – a local hospital and a major hospital St Mary’s – a local hospital, a major hospital, a Hyper Acute Stroke Unit (moved from Charing Cross Hospital) and a specialist ophthalmology hospital (moving the Western Eye Hospital onto the site) West Middlesex – a local hospital and a major hospital Central Middlesex – a local hospital and an elective hospital Charing Cross – a local hospital Ealing – a local hospital Hammersmith – a specialist hospital with obstetric-led maternity unit and a local hospital Five specialist hospitals in NW London are not affected by these proposals. These are Harefield, Mount Vernon, Royal Brompton, Royal Marsden and RNOH. 10. The proposed <strong>future</strong> configuration of hospitals in NW London 421
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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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Staff recommendation as a place to
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This analysis was agreed prior to c
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Figure 9.56: Ease of delivering eac
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Response to feedback about implemen
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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
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 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: 10. The proposed future configurati
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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