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

More documents

Recommendations

Info

Figure 10.2 Map illustrating the recommended configuration Mount Vernon RNOH M Specialist hospital Local and Specialist hospital with obstetric-led maternity unit Harefield Local and Elective hospital Hillingdon Northwick Park Central Middlesex Local and Major hospital Local and Major hospital and specialist eye hospital and Hyper Acute Stroke Unit Local hospital Ealing Hammersmith M St Mary’s West Middlesex Charing Cross Royal Brompton Royal Marsden Chelsea and Westminster 10. The proposed future configuration of hospitals in NW London 422
10.3. Why this is the recommendation All configuration options have been considered and detailed analysis has been carried out on the eight strongest of these options. The recommended option is felt to be significantly superior (demonstrated through the evaluation detailed in Chapter 9) than all of the others. This configuration provides an improved quality of care as it reduces the number of sites providing major hospital services to five, which will mean there will be more specialist and experienced doctors available for more of the time, and that they will be able to build and maintain the skills and expertise they need to deliver high quality care. Compared with the other options it would deliver the greatest benefits for NW London: A high quality patient experience. Chelsea & Westminster and West Middlesex both consist of very recently built buildings, with space that is suitable for both current and future requirements. Given what we have demonstrated about the need to manage and maintain NHS buildings in NW London, and the difficulty of finding or building new ones, this is a key factor Value for money. The least amount of capital expenditure (on buildings and equipment) would be required to implement this option and it would leave NW London with a projected overall financial surplus. This option is predicted to provide the best return on investment of all the options. In other words, it means the NHS in NW London would be in a much better financial position than if nothing changes Relatively easy to deliver. This option corresponds most closely with services already being delivered at particular sites, and with other changes taking place outside of this reconfiguration. The scale of the change required would be smallest under this option Supports research and education. The majority of important medical research in NW London is currently carried out at Hammersmith, St Mary’s and Chelsea & Westminster. Under this option, Hammersmith becomes a Specialist Hospital and St Mary’s a Major Hospital, which allows for the continuation of research at both those sites. The impact of this recommendation on undergraduate education has been built in to the decision-making analysis. Throughout the evaluation, Option A has been consistently strong and local clinicians recommend that it will lead to the greatest improvement in quality of care and patient choice. The distance and time to access the different sites is clinically acceptable. Around 25% of patients would have to travel a little further for their care under any of the eight options, but the increase in blue-light travel time would be less than 10 minutes and, as noted previously, it is more important that those patients receive higher quality care. This option provides the highest confidence for deliverability and supports wider work on research and education. The alternative proposals for Charing Cross and Ealing Hospitals (referred to in 10.4.2 and 10.4.4 respectively) are consistent with and supportive of the recommendation for NW London as a whole. 10.4. Services at each site The services that will be offered by each site where changes are proposed under the recommended configuration are shown in Figure 10.3. The specialist hospitals that are not affected by the proposals are not shown in the table but are covered in the following subsections. 10. The proposed future configuration of hospitals in NW London 423
Page 1 and 2:
North West London Shaping a healthi
Page 3 and 4:
Table of contents Volume 1 Foreword
Page 5 and 6:
Foreword Dr Mark Spencer The Clinic
Page 7 and 8:
6. Consultation, feedback and how w
Page 9 and 10:
13. Equalities implications This ch
Page 11 and 12:
1. Executive Summary Introduction t
Page 13 and 14:
The overall programme timeline is b
Page 15 and 16:
The process was used before consult
Page 17 and 18:
• Delivery of multi-disciplinary
Page 19 and 20:
Stage 1 - Case for Change Our work
Page 21 and 22:
For Quality of care, clinicians hav
Page 23 and 24:
1 2 3 4 5 A 6 B 7 C 8 Quality of Ca
Page 25 and 26:
Assuring the proposals Throughout t
Page 27 and 28:
Programme implementation arrangemen
Page 29 and 30:
5. To agree that Hammersmith Hospit
Page 31 and 32:
DMBC Chapter 2 - Introduction to th
Page 33 and 34:
2. Introduction to the NHS in NW Lo
Page 35 and 36:
Figure 2.3: Clinical Commissioning
Page 37 and 38:
West Middlesex University Hospital
Page 39 and 40:
major hospital, elective centre and
Page 41 and 42:
DMBC Chapter 3 - Introduction to th
Page 43 and 44:
3. Introduction to the Shaping a he
Page 45 and 46:
3.3 Programme governance The Joint
Page 47 and 48:
The JCPCT is advised by a Programme
Page 49 and 50:
Consultation - during this phase, t
Page 51 and 52:
Ensure consistency of communication
Page 53 and 54:
Stakeholder Group Political Individ
Page 55 and 56:
o o o o o Rationale for options dev
Page 57 and 58:
The implications of the options in
Page 59 and 60:
DMBC Chapter 4 -The Case for Change
Page 61 and 62:
4. The Case for Change This chapter
Page 63 and 64:
Stroke Services: The provision of s
Page 65 and 66:
We need to do more to support patie
Page 67 and 68:
In NW London, however, the NHS is s
Page 69 and 70:
Figure 4.6: Emergency general surgi
Page 71 and 72:
attack or stroke to designated cent
Page 73 and 74:
Figure 4.9: Evaluation of primary c
Page 75 and 76:
Inequalities would continue and pro
Page 77 and 78:
DMBC Chapter 5 - Process for identi
Page 79 and 80:
5. Process for identifying a recomm
Page 81 and 82:
Figure 5.1: Basis of decision of wh
Page 83 and 84:
We confirmed this decision, and the
Page 85 and 86:
5.5 A detailed description of the s
Page 87 and 88:
Correct care setting to deliver hig
Page 89 and 90:
Figure 5.11: Ratings used in evalua
Page 91 and 92:
DMBC Chapter 6 - Consultation, feed
Page 93 and 94:
6. Consultation, feedback and how w
Page 95 and 96:
6.2.1 Key findings from the consult
Page 97 and 98:
times (particularly for patients tr
Page 99 and 100:
Westminster City Council, Adult Ser
Page 101 and 102:
Analysed and considered consultatio
Page 103 and 104:
6.3 Our responses to feedback This
Page 105 and 106:
Feedback received Stakeholders who
Page 107 and 108:
6.3.3 Theme 3: Clinical vision and
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
6.3.5 Theme 5: Proposals for local
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
DMBC Chapter 7 - Clinical vision, s
Page 125 and 126:
7a. Clinical, vision, standards and
Page 127 and 128:
Local clinicians agreed that in ord
Page 129 and 130:
▪ Expectant mothers should have t
Page 131 and 132:
# Standard care services (111). As
Page 133 and 134:
Figure 7.8: Development of the acut
Page 135 and 136:
# Standard Adapted from source depa
Page 137 and 138:
Figure 7.11: Shaping a healthier fu
Page 139 and 140:
No. Standard Adapted from source Su
Page 141 and 142:
No. Standard Adapted from source se
Page 143 and 144:
# Standard All emergency department
Page 145 and 146:
# Standard All non-urgent - within
Page 147 and 148:
Figure 7.18: Shaping a healthier fu
Page 149 and 150:
# Standard Adapted from source shou
Page 151 and 152:
# Standard Adapted from source Comm
Page 153 and 154:
The final standards are more demand
Page 155 and 156:
Figure 7.26: Proposed services to b
Page 157 and 158:
Each CCG is taking steps to help pr
Page 159 and 160:
in major hospitals) and equipment t
Page 161 and 162:
tangible differences for patients
Page 163 and 164:
Referral A&E Illustrative patient j
Page 165 and 166:
Illustrative patient journey matern
Page 167 and 168:
Illustrative patient journey in mat
Page 169 and 170:
Illustrative patient journey planne
Page 171 and 172:
GP-led care Illustrative patient jo
Page 173 and 174:
7.8.1 Scope of the CIG’s work The
Page 175 and 176:
Theme Clinical outcomes Staff attit
Page 177 and 178:
Further stakeholder engagement is n
Page 179 and 180:
Figure 7.31 E&UC CIG Responses to N
Page 181 and 182:
NCAT recommendation CIG response Se
Page 183 and 184:
Conditions suitable for UCC Clinica
Page 185 and 186:
Exclusion criterion Mental health A
Page 187 and 188:
Diagnostics 7.14.3 Streaming, regis
Page 189 and 190:
Biochemistry Microbiology Radiology
Page 191 and 192:
The Provider must deliver appropria
Page 193 and 194:
Figure 7.41: E&UC CIG recommended k
Page 195 and 196:
will be able to establish a service
Page 197 and 198:
The UCC provider will be responsibl
Page 199 and 200:
Key differences Governance As with
Page 201 and 202:
should be provided with appropriate
Page 203 and 204:
Process map 1: Assessing UCC patien
Page 205 and 206:
Process map 3: UCC to ED transfer p
Page 207 and 208:
make an appointment with their own
Page 209 and 210:
7.19 ED workforce A programme-wide
Page 211 and 212:
The purpose of this section is to s
Page 213 and 214:
Figure 7.45 Consultation results on
Page 215 and 216:
Figure 7.46: Specific Responses the
Page 217 and 218:
NCAT recommendation Original Progra
Page 219 and 220:
7.25.1 London Health Programmes cli
Page 221 and 222:
Future capacity in centralised serv
Page 223 and 224:
3. There would be an additional "st
Page 225 and 226:
in NWL will have a choice of delive
Page 227 and 228:
Support for the proposal is higher
Page 229 and 230:
Figure 7.49: Specific feedback the
Page 231 and 232:
Sub-Theme Organisation Support Conc
Page 233 and 234:
Sub-Theme Organisation Support Conc
Page 235 and 236:
7.36.1 National Clinical Advisory T
Page 237 and 238:
NCAT recommendation Further engagem
Page 239 and 240:
edistributed nationwide. We envisag
Page 241 and 242:
6. The Maternity CIG have considere
Page 243 and 244:
DMBC Chapter 8A-E - Out of hospital
Page 245 and 246:
Out of hospital improvements This c
Page 247 and 248:
8.2. Settings of out of hospital ca
Page 249 and 250:
practical solution for the site, wh
Page 251 and 252:
Brent Health Partnerships Overview
Page 253 and 254:
Consultation theme Standards for ca
Page 255 and 256:
Consultation theme Integration Inve
Page 257 and 258:
8.5.3. Workforce Following feedback
Page 259 and 260:
Delivering this workforce shift wil
Page 261 and 262:
Measure type Domain Potential measu
Page 263 and 264:
8b. Primary care development 8.6. S
Page 265 and 266:
consultation they could have receiv
Page 267 and 268:
8.10. Next steps We are developing
Page 269 and 270:
Figure 8.11: Hub/health centre requ
Page 271 and 272:
some cases, these will be offered o
Page 273 and 274:
Process for development of local ho
Page 275 and 276:
The result is an emerging picture o
Page 277 and 278:
Across NW London, these sites will
Page 279 and 280:
need redeveloping or rebuilding to
Page 281 and 282:
8d. Urgent care centres When indivi
Page 283 and 284:
Figure 8.22: NW London urgent care
Page 285 and 286:
Conditions suitable for UCC Clinica
Page 287 and 288:
Key differences Governance As with
Page 289 and 290:
processes of the CCG and as such th
Page 291 and 292:
around the table accelerates the un
Page 293 and 294:
Improved empowerment - specifically
Page 295 and 296:
Figure 8.28: Realising our integrat
Page 297 and 298:
Figure 8.29: Summary of CCG commiss
Page 299 and 300:
DMBC Chapter 9 - Decision making an
Page 301 and 302:
9a. Decision making analysis stages
Page 303 and 304:
Page 305 and 306:
“The Brent Health Partnerships Ov
Page 307 and 308:
Page 309 and 310:
Royal College of Midwives “The RC
Page 311 and 312:
Page 313 and 314:
clinicians wanted to take this into
Page 315 and 316:
9.6.3 Feedback received about the s
Page 317 and 318:
Confirm the service models reflect
Page 319 and 320:
Figure 9.9: The seven hurdle criter
Page 321 and 322:
surgeons in NW London, but we would
Page 323 and 324:
We confirmed this decision with the
Page 325 and 326:
Appropriate staffing is integral to
Page 327 and 328:
The proposals are supported by Depa
Page 329 and 330:
NW London to deliver high quality c
Page 331 and 332:
1. Support predicting where activit
Page 333 and 334:
Figure 9.15: Example travel time ma
Page 335 and 336:
The analysis shown in Figure 9.18,
Page 337 and 338:
Figure 9.18: Impact on private car
Page 339 and 340:
33% support 10% opposed 57% of peop
Page 341 and 342:
Figure 9.21: Watershed map for blue
Page 343 and 344:
etained as a major hospital, becaus
Page 345 and 346:
9.7.29 The implications of this fee
Page 347 and 348:
Figure 9.25: Potential activity flo
Page 349 and 350:
Figure 9.27: Changes in travel time
Page 351 and 352:
Figure 9.29: Changes in travel time
Page 353 and 354:
Figure 9.31: Possible choices betwe
Page 355 and 356:
Either Charing Cross or Chelsea & W
Page 357 and 358:
Figure 9.33: Option A, excluding ca
Page 359 and 360:
Figure 9.36: Option C responses, in
Page 361 and 362:
Richmond Upon Thames LINk Royal Bor
Page 363 and 364:
Southall Black Sisters “The closu
Page 365 and 366:
Figure 9.38: Ranking of evaluation
Page 367 and 368:
Figure 9.42: Evaluation criteria as
Page 369 and 370:
anked third according to the mean s
Page 371 and 372:
9.9.5 The analysis of the five eval
Page 373 and 374:
Figure 9.45: Quality Dashboard data
Page 375 and 376:
Response to feedback about the eval
Page 377 and 378:
Figure 9.48: Quality of care - Acut
Page 379 and 380:
experience. In order to use this as
Page 381 and 382:
Figure 9.50: Time to major hospital
Page 383 and 384:
Rationalising provision across the
Page 385 and 386:
Figure 9.51: Blue light travel time
Page 387 and 388:
Figure 9.52 shows the reduction in
Page 389 and 390:
3 Value for money 9.9.26 The purpos
Page 391 and 392:
Staff recommendation as a place to
Page 393 and 394:
This analysis was agreed prior to c
Page 395 and 396:
Figure 9.56: Ease of delivering eac
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 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 and 450: 10. The proposed future configurati
Page 451: The changes to the scoring before a
Page 455 and 456: In the rest of this section, the se
show all

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

Create successful ePaper yourself

Delete template?

Save as template?