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

4. The Case for Change
This chapter describes why change is necessary and why it must start now. The NHS in NW
London is facing a range of pressures and challenges. From a clinical view, there is
increased demand caused by the ageing population and increased prevalence of long term
conditions and co-morbidities. There are also unacceptable variations in the quality of care
provided, evidenced by higher mortality rates for patients who are admitted in hospital at
night or during the weekend. Alongside this, there are financial pressures which require the
NHS to deliver efficiency savings for reinvestment. As such, doing nothing is not an option.
The Case for Change was developed by clinicians, who looked at the current and future
demands on the NHS in NW London, and showed that a new configuration of services was
necessary to deliver high quality care within the financial constraints on the system.
4.1 The clinical Case for Change
The Case for Change was developed by local clinicians with involvement from providers,
CCGs and representatives of patient groups and the public. It builds upon the Case for
Change set out in the 2011 Commissioning Strategic Plan, but represents the specific case
for service change in NW London. The key elements of the Case for Change are set out
below. Further detail is available in our full Case for Change, which was approved by the
Programme Board in January 2012 and published as a standalone document which is
available on our website www.healthiernorthwestlondon.nhs.uk, it can also be found in
Appendix D 1 . Further detail on clinical evidence can be found in Appendix E. Since the
approval of the Case for Change in early 2012, the financial analysis has been updated.
Further detail on the financial analysis can be found in Chapter 9d.
4.1.1 The demands on the NHS in NW London are changing
The population of NW London is growing and life expectancy is improving. NW London
population is forecast to increase by approximately 141,000 people (7%) growing from circa
2 million to circa 2.15 million over the period to 2018 (see Appendix N for further details
about ONS). Ten years ago life expectancy in NW London was 76.8 years for men and 81.9
years for women, but it is now about three years longer: 80 years for men and 84.5 years for
women 2 , particularly due to early diagnosis and improved treatments resulting in fewer
people dying prematurely from diseases such as cancer, heart disease and strokes.
For the NHS, this is hugely significant because older people are more likely to develop longterm
conditions such as diabetes, heart disease and breathing difficulties and are more at
risk of strokes, cancer and other health problems. Three out of every five people aged over
60 in England suffer from these kinds of conditions and as the population ages there will be
more people with age-related diseases. In NW London some 300,000 people, nearly one in
six, of people all ages have one of the following five long-term conditions: diabetes, asthma,
coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), and
congestive heart failure 3 .
1 Some of the references included in this chapter have been truncated. For full references, please refer to the full
case for change.
2 GP registered population figures used to calculate population weightings of each NW London PCT. Life
expectancies associated with each NW London PCT then multiplied by weightings to produce “average” life
expectancy for NW London
3 Source: QOF, Proportion of GP registered population in NW London who are on the CHD, COPD, CHF,
diabetes and asthma registers
4. The Case for Change 31