Improving healthcare for

two million people in North

West London

Joint Committee of PCTs: Item 5

NWL Pre Consultation Business Case

Dr Mark Spencer

25 June 2012

Contents of the presentation

Slide 2

• Background

• Case for change

• Vision

• How will we deliver the vision?

• Where should the FIVE major hospitals be?

• Final thoughts

Background

A clinically-led programme

• A Clinical Board has developed the proposals. Its membership includes the 8

CCG Chairs and Medical Directors from the acute, community and mental health

NHS and Foundation Trusts in NHS NW London)

• This Pre Consultation Business Case and consultation plan are recommended

to the JCPCT by

– The Clinical Executive Committee (CEC)

– The Clinical Board

– The Programme Board

Brent

Ealing

Harrow

Hillingdon

– Harrow

– Hillingdon

– Hounslow

– West London (Kensington & Chelsea, Queen’s

Park and Paddington)

• Led by all 8 Clinical Commissioning Groups in North West London who form the

NHS North West London Clinical Executive Committee:

– Brent

– Central London (Westminster)

– Ealing

– Hammersmith and Fulham

The support

needed to take

better care of

themselves

A better

understanding of

where, when and

how they can be

treated

The tools and

support to better

manage their own

conditions

Easy 24/7 access

to primary care

clinicians like GPs –

by phone, email or

in person – when

they have an urgent

health need

Timely and well-

coordinated access

to specialists,

community and

social care

providers, managed

by their GP

Properly maintained

and up-to-date

hospital facilities

with highly trained

specialists available

all the time

5

GP leaders in NW London have pledged to

give everyone...

6

The NHS in NW London

Case for Change

There is a growing and ageing

population with more long term

chronic conditions and there is a

difference of 17 years in life

expectancy between the most

and least deprived

It is difficult to access GP care

and too many people end up in

A&E. There are not enough

services for people with long-

term conditions leading to more

complications and unnecessary

hospital admissions.

The NHS needs to save around

4% per year for at least the next

three years – something that has

never been done before

Having senior hospital staff in

hospitals for more of the time

saves lives. These clinicians

need excellent facilities to work

from.

Therefore the way we deliver healthcare services must change

!

!

!

!

8

The NHS in NW London is facing serious

challenges

• Inequalities would continue and probably get worse

• People with long term conditions will continue to suffer

unnecessary complications and hospital admissions

• Trusts would be under severe financial pressure, they could

literally run out of money

• People would continue to die unnecessarily

What will happen if we do nothing?

Vision

11

Our vision of care

1 Localising routine medical services means

better access closer to home and improved

patient experience

2 Centralising most specialist services

means better clinical outcomes and safer

services for patients

Where possible, care should be integrated

between primary and secondary care, with

involvement from social care, to ensure joined

up patient care

3

Three

overarching

principles form

our vision for

care

World class health care outside hospital

13

Quality standards for care outside hospital

14

Making hospitals centres of excellence

Delivering our vision will...

• Localise

– Improved access

– Supported self-care

– Improve care for people with Long Term Condition

• Centralise

– Consistent access to senior doctors

– Specialist skills developed and accessible

• Integrate

– Co-ordinate Care and reduce errors

– Reduce duplication and improve communication

• Save Lives

How will we deliver the

vision?

17

Delivering the vision from eight settings of

care

18

Delivering care outside of hospital

2

Potential site for

health centre

Urgent care centre at

your local hospital

12

4

10

5

6

7

9

14

15 17

16

1

3

Network area

6 networks

51 practices

3 health centres

5 networks

54 practices

1 health centre

4-5 networks

32 practices

1 health centre

5 H&F 6 Hounslow

8 Hillingdon

6 networks

57 practices

18 community clinics

2-3 additional services

Harrow

2 Brent

1

4 West London

Central London 3

7 Ealing

6 networks

51 practices

3 health centres

6 networks

36 practices

2-3 health centres

5 networks

70 practices

3 health centres

3 networks

54 practices

2 potential health centres

2 networks

43 practices

2 health centres

Mt Vernon 1

Health centres

Hillingdon Hospital 2

HESM health

centre

The Pinn

Alexandra Avenue

3

4

5

Grand Union

Village

Jubilee Gardens

Ealing Hospital

6

7

8

9

10

Heart of Hounslow

Wembley Centre

Central Middlesex 11

Willesden Centre

White City

St Charles

12

13

14

16

15 Earls court

Church Street

East Fitzrovia 17

Business care

needed

18

Hillingdon

West Middlesex Charing

cross

St Mary’s

C&W

Hammer-

smith

Ealing

Central

Middlesex

Northwick

Park

Where you can receive care

At Home

At a GP practice

In a health centre

++

UCC in your local hospital

++

In a care network

++++

+ +

18

11

8

13

18

19

Quicker and more joined up

healthcare

Access to specialist skills

Outpatients, Tests / Diagnostics

Urgent Care

Bringing services together

Better nursing, therapy and

rehabilitation services

Local hospitals

Urgent Care Centres in NW

London will:

• Be open 24/7

• See and treat patients within 4 hours of

arrival

• Be led by Primary Care Clinicians –

GPs and nurses

• Be linked with other services like the

new non-emergency phone number for

the NHS ‘111’

• Have access to tests and specialist

clinicians

The kind of health problems they

would all be able to treat include:

• Illnesses and injuries not likely to

require a stay in hospital

• X-rays and other tests

• Treatment of minor fractures (breaks)

including the manipulation of

uncomplicated fractures

• Simple anaesthesia for wound closure

• Drainage of abscesses that don’t need

general anaesthetic

• Minor ear, nose, throat and eye

infections

• Children with no lower age limit.

20

Urgent care centres

21

Elective hospitals

• Elective hospitals will carry out operations that are planned – such as hip

replacements and cataract operations

• Treatment is not disrupted by emergency cases

• Elective hospitals can more easily be kept clean and free from hospital

infections

• Elective hospitals can be located within, or independently of, major

hospitals

• It is proposed we make use of any high quality buildings with spare space

to house our elective hospitals, particularly West Middlesex Hospital and

Central Middlesex Hospital

• We propose that Central Middlesex Hospital should be an elective

hospital in all options

22

Major hospitals

In hospitals some services rely on others…

Driver of service model Adjacent services requiring access to

emergency surgery and/or ICU, level 3

KEY ADJACENCIES OPTIONAL

Acute cardiac care

Hyperacute stroke

care

Complex elective

surgery

Interventional

radiology

i.e. x-ray guided

treatment

Obstetric unit with

neonatal

+/-

Inpatient Paediatric

unit Major trauma with

surgical specialties

e.g. cardiothoracic

A&E

Emergency surgery/trauma

and cover for complex

medical cases

Level 3 Critical care

i.e. intensive care unit

We propose there should be 5 major

hospitals

Where should the FIVE

major hospitals be?

25

First we looked at travel times

26

Northwick Park Hospital and Hillingdon Hospital

should be major hospitals due to location

minutes

27

The other three major hospitals should be

spread evenly across NW London

28

Criteria Sub-criteria

Quality of care ●Clinical quality

●Patient experience

Access to care ●Distance and time to access services

●Patient choice

Value for money ● Capital cost to system

● Transition costs

● Viable Trusts and sites

● Surplus for acute sector

● Net Present Value

Deliverability ● Workforce

● Expected time to deliver

● Co-dependencies with other strategies

Research and Education ● Disruption

● Support current and developing research and education

delivery

3

4

5

2

1

Criteria for evaluating the options were

developed with clinicians and patients

29

The evaluation of the options gave three

options for consultation

▪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 ▪ St Mary’s ▪ Chelsea &

Westminster ▪ Northwick Park ▪ Hillingdon

▪ Ealing ▪ St Mary’s ▪ Charing Cross ▪ Northwick Park ▪ Hillingdon

Qu

ality

of

Care

Clinical quality* ++ ++ ++ ++ ++ ++ ++ ++ Patient experience ++ + + - ++ + + -

Access

Distance and time to

access services** - - - - - - - -

Patient choice + - + - ++ + ++ +

Affo

rdab

ility &

Valu

e fo

r

Mo

ney

Capital cost to the

system -- -- -- -- + + + +

Transition costs -- -- -- -- - - - - Viable Trusts and

sites + + -- -- + + -- -- Surplus for acute

sector + + - -- + - - --

Net Present Value - - -- -- ++ + + -

Deliv

era

bility

Workforce + - + + + - + + Expected time to

deliver - - -- -- + + -- -- Co-dependencies

with other strategies - - -- -- + + - -

Researc

h &

Ed

ucatio

n

Disruption - - - - + + + + Support current and

developing research

and education

delivery

- - - - + + + +

2 3 4 5 7 8 1 6

High evaluation ++

Low evaluation --

30

Why is Hammersmith not proposed as a

major hospital ?

• Significant extra cost

• Complicated to deliver

• Allows an extra maternity unit at Queen Charlotte’s

• Better support for research and education

31

Why is Central Middlesex not proposed as a

major hospital ?

• Smallest site in NW London – would need major investment

• Patients can access services in nearby hospitals

• No emergency surgery, paediatrics and obstetrics currently.

• Workforce challenges in A&E

32

Option A Option B Option C

Three options proposed for the remaining

major hospitals

Hillingdon, Northwick Park

St Mary’s

West Middlesex

Chelsea and Westminster

Hillingdon, Northwick Park, St

Mary’s

West Middlesex

Charing Cross

Hillingdon, Northwick Park, St

Mary’s

Ealing

Chelsea & Westminster

• Hillingdon

• Northwick Park

• St Mary’s

• West Middlesex

• Chelsea and Westminster

33

Why is option A the preferred option?

• Value for money - high quality estate (WMUH, C&W)

• Better patient experience

• Supports research and education (HH, StM’s, C&W)

• Easiest to deliver

34

Options B and C do not evaluate as well as

Option A

Option B would:

• Be more difficult to deliver

• Be a poor use of estates

• Give worse value for money

• Leave two Trusts/hospitals in deficit

• Reduce patient choice

Hillingdon, Northwick Park, St Mary’s,

West Middlesex and Charing Cross

Option C would:

• Give worse value for money

• Be a poor use of estates

• Leave two Trusts/three hospitals in

deficit

• Be more difficult to deliver

Hillingdon, Northwick Park, St Mary’s,

Ealing and Chelsea & Westminster

35

Hyper acute

stroke unit at

Charing

Cross

● If Charing Cross Hospital is a local hospital, a HASU cannot be

maintained there and would need to move

● HASUs should preferably be located alongside Major Trauma

Units

● As there is a Major Trauma Unit at St Mary’s Hospital, it is

proposed the HASU at Charing Cross moves to St Mary’s in

Option A and Option C.

Specialist services - proposals

Western Eye

● It is proposed the Western Eye moves to St Mary’s, leading to:

o Improved quality of care

o Improved service

o Limited travel impact

o Value for money

Final thoughts

37

Final thoughts

• The proposed changes have been delivered elsewhere and are known to

work

• Most patients are already using ‘urgent care centres’ – they are not

actually using A&E departments

• Many health services provided outside hospital are already being

improved

• We have plans for new facilities to deliver services

• We are investing in bigger, better specialist teams in and out of hospital

• Getting to the right place is more important than getting there quickly

• This will take time but services will be in place outside hospital before

changes are made in hospital

Improving healthcare for

two million people in North

West London

Joint Committee of PCTs: Item 6

Stakeholder engagement and Quality

Assurance

Daniel Elkeles

25 June 2012

Stakeholder engagement

Many different stakeholders were engaged

pre-consultation

There were a range of engagement

activities

• 1:1 briefings

• Newsletters

• Website and social media

• Three large open forum public events

• Attending public meetings

• Clinical engagement meetings

• Focus groups with hard-to-reach groups

We listened to

feedback and

incorporated it into

our proposals

Patient and Public Advisory Group

• The Patient and Public Advisory Group (PPAG) brings

together representatives of all 8 NW London Local

Involvement Networks (LINks)

• PPAG have reviewed the proposals and consultation plan

• PPAG have advised on the consultation document and

consultation materials

• Members of PPAG sit on key groups including Programme

Board, Clinical Board, Finance & Business Planning Group,

Travel Advisory Group and Equalities Impact Review

Steering Group

Quality assurance

• Joint Health Overview and Scrutiny Committee

• National Clinical Advisory Team (NCAT)

• Equality Impact Review

• NHS London

• External Clinical Panel

• Office of Government Commerce (OGC) Gateway review

Quality assurance of the programme

The Joint Health Overview and Scrutiny

Committee (JHOSC) scrutinised our proposals

• Programme proposals have been shared with individual

HOSCs and the shadow JHOSC

• On 17 May, JHOSC agreed 14 week consultation to start on

2 July 2012

• On 12 June, the JHOSC approved the proposed consultation

plan and reviewed a draft of the consultation document

The National Clinical Advisory Team

reviewed the clinical proposals

• Reviewed emergency care, maternity and paediatrics

– Case for Change

– Clinical Standards

– Service delivery models

– Development of proposals through the evaluation process

• Supported the proposals in principle and agreed with the

proposals to move to five major hospitals in NW London

An independent equalities impact review was

commissioned

• Independent Equalities Impact Review of our proposals for

consultation by Mott MacDonald

• Looked at potential impact on populations with protected

characteristics within NW London

• The difference between the three options for consultation was

found to be minimal

• Report gave recommendations for pre-decision-making tasks

– an action plan is being developed

• Review will be refreshed before decision-making