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

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have (or may have) been discounted before a specific element of appraisal is applied, and therefore options that may well have scored well in terms of later elements of the appraisal are dismissed before an assessment can be undertaken. In particular it unnecessarily limits the extent to which options can be tested in terms of quality and access, the criteria ranked most important by patients and clinicians”. London Borough of Hammersmith & Fulham and Hammersmith & Fulham Health, Housing & Adult Social Care Scrutiny Committee “The sequential nature of the methodology does not provide the opportunity for all of the options to be tested on a truly comparable basis”. Brent LINk “Brent LINk again concurs with the Rideout Report 3 , seeing SAHF‟s decision to only use travel times to determine the location of the five hospitals as inappropriate, given there are other factors such as relative clinical performance, population need and the interdependencies of other services”. 5.3.3 Petitions We also received 18 petitions and campaign responses. 12 of the petitions opposed the closure of A&E and other departments in hospitals; five were in support of Option A while one supported West Middlesex‟s status as a major hospital. The petitions (some with a large volume of signatories) were generally in support of particular hospitals. These tended to either be in support of a specific option for hospitals set out in the consultation document, or called for specific services (for instance A&E) to be preserved for a particular hospital or hospitals. These petitions did not comment on the specifics of the process. The largest petition with 25,193 signatories was a petition calling for Ealing, Central Middlesex, Charing Cross and Hammersmith Hospitals to retain their status and keep existing services, from Ealing Council. Further details of the petitions can be found in Chapter 6 and Section 16 of Appendix F includes details of the full set of petitions received. 5.3.4 The implications of this feedback for the process We have considered feedback received about the process. None of the respondents that disagreed with the process we used to identify options presented an alternative process, although some implied that a non-sequential approach would have been more appropriate, or suggested other evaluation criteria. On the question of using a non-sequential process, we believe that approach to be impractical – as it would generate an unmanageable number of options – and, more importantly, it would ignore the process of prioritisation of criteria established in the pre-consultation phase in discussion with the public and other stakeholders. Furthermore the JHOSC supported the process used by the programme and it was commended by the OGC. The suggestion for additional criteria is discussed in Chapter 9, but for completeness in this section, we believe that all have been effectively included in the development of the proposals through the definition of the individual criteria and the Equalities Impact Assessment. We reached the conclusion that the process used pre-consultation is robust and should be used post-consultation during decision making. 3 “<strong>Shaping</strong> a Healthier Future”, Independent Review Conducted by Tim Rideout Limited on behalf of the London Borough of Ealing, September 2012. 5. Process for identifying a recommendation 52
We confirmed this decision, and the process, with the following groups during the postconsultation phase: Clinical Board Finance and Business Planning Programme Board. 5.4 The seven stage process to identify a recommended option Figure 5.2 provides a summary of the process for identifying a recommended option. The remainder of the chapter describes each stage of the process in detail. 5. Process for identifying a recommendation 53
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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
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: Figure 5.1: Basis of decision of wh
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 113 and 114: 6.3.5 Theme 5: Proposals for local
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
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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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Correct care setting to deliver hig
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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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Changes to the designation of the M
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5 Research and Education: Disruptio
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Figure 9.60: Evaluation of disrupti
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9.9.48 The outcome of the disruptio
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Greg Hands, MP for Chelsea & Fulham
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comprises more than 22 million cita
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Quality/Impact score Figure 9.65 Re
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9. Decision making analysis - stage
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There were six distinct parts of th
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Figure 9.69: 5 year gross savings,
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Figure 9.73: Commissioners intend t
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Figure 9.75: Beds bridge: 2012/13 t
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The key modelling assumptions appli
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Figure 9.79: DMBC NHS net capital e
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Figure 9.81: Approach to estimating
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Figure 9.84: Summary of net surplus
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Figure 9.86: Evaluation of total su
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9.13.9 Impact of the changes: Updat
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Figure 9.89: Effect of the expanded
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Sensitivity tests g) Tariff efficie
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Figure 9.93 summarises the impact o
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Figure 9.94: Change in expanded NPV
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The sensitivity analysis supports t
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DMBC Chapter 10 - The recommendatio
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10. The proposed future configurati
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The changes to the scoring before a
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10.3. Why this is the recommendatio
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In the rest of this section, the se
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