The Implementation Business Case (IMBC) for NW London
The business case We want to continue transforming health services in North West London over the next ten years This is our business case for £513m of capital investment for the next phase of our transformation This first Strategic Outline Case (SOC 1) sets out how the right investment will be made to help close the three gaps identified in the Five Year Forward View: • health and wellbeing • care and quality • finance and efficiency This SOC 1 comes with support of clinicians, hospital trusts, community providers and health commissioners across NW London. 2
SOC part 1 SOC 1 is a set of technical papers, setting out the case for capital investment in buildings and facilities in primary care, community and acute hospitals to deliver the Shaping a Healthier Future programme agreed by the Secretary of State in 2013 SOC1 does not further develop any clinical or other service changes set out in SaHF or explicitly further consider transport, communications or equalities These were addressed in 2013’s DMBC. SOC 1 does however, set out an updated list of services to be engaged on at Ealing Hospital SOC 2 , which will be developed in 2017, will include the case for investment in acute hospitals in the inner part of NW London (table) We will be engaging at local level from early 2017 with staff, patients and local communities around the best clinical models and service to meet local need. If through this engagement we find ways to improve services: - in a better way - for less money - or faster, we will. As new clinical models become clear, Equality Impact Assessments will be undertaken . 3
Strategic case – case for change Our current system is unsustainable, with an increasing population, significant unwarranted variation in the quality of clinical care and an increasing deficit The challenges: • ageing population have increasingly complex health needs • 1/3 of hospital beds are occupied by people who could be better cared for elsewhere, preferably in their own homes • variation in the quality and delivery of all services and health outcomes • a reactive rather than proactive health service • shortages of specialist staff – need to deliver 7 day services • too many small hospitals, clinical resources spread too thinly • poor quality estate across hospital and primary care • It is clear that we have to change the way we care for our patients • this is a real opportunity to develop an NHS that is fit for the 21 st century. 4
Strategic case (2) We want residents of NW London to have their clinical and social care needs met in the place that is most familiar to them, which will, for the most part, be in their own home We will implement a new model of care, reducing reliance on use of acute hospitals and tackling unwarranted variation in the management of long term conditions, improving the consistency of care planning and case management, and ensuring seven-day access to out of hospital care. We will achieve better outcomes through consolidating expert care for particular acute conditions onto fewer sites We have already achieved a lot but we know there is sizable opportunity to do much more. 5
Strategic case (3) We have a strategy to meet our residents clinical and social care needs in the right place at the right time. We will reconfigure health services so they are: localised where possible; centralised where necessary and in all settings integrated across health and social care We are confident that based on our experience of successfully delivering change and identified opportunities, our new model of care will address the key issues. Our new model of care requires major changes. • Retains activity in the community, enabled by out of hospital hubs where services are co-located and primary care is delivered at scale • Reconfigures our acute services to deliver high quality care and provide clinical and financial sustainability. This is principally achieved by concentrating valuable clinical capability across fewer sites. 6
Strategic case (4) Our proactive model of care for primary care encourages GPs to work together, organised into federations, and care will be increasingly delivered through a hub-and-spoke approach, providing a range of population and system benefits. It will enable us to: • reduce unwarranted variation and improve patient outcomes for people with long term conditions in primary care • provide a multidisciplinary team-based model of care delivery • provide a consistent approach to seven-day extended access to primary care • deliver better care-planning and case management. We will also: • improve co-ordination of care by making sure information relevant to the care of an individual can be shared by everybody involved in their care • provide a support function for unpaid carers that look after the majority of residents with complex needs • support people to better manage their long term conditions, increasingly by adopting digital technologies. 7
Strategic case (5) We have four discrete opportunities to deliver more care to people at or close to home, and only deliver care in acute settings when it is really needed: • The opportunity to look after patients in a place that is most appropriate to their needs • Day of care audits • People in their last phase of life • The opportunities to provide non-elective care in a setting that is most appropriate with a net reduction in acute activity, quantified through detailed forecasts and modelling • The opportunities to transfer care from acute setting to the out of hospital hubs • The opportunity to reduce variation in care processes and to deliver better outcomes for people living with long term conditions • Diabetes management 8
Strategic case (6) We have evidence of seven areas where we have been able to effect change: • The impact of the changes made to maternity and paediatric services • The clinical benefits of centralising specialist services such as hyper acute stroke units and major trauma centres in London • The impact of work we are already undertaking to improve care processes and patient pathways on non-elective activity in secondary care • All our CCGs have seen a reduction in the occupied bed days per 100,000 since 2011/12 • Six of the eight CCGs have seen reductions in non-elective admission rates per 100,000 in since 2011/12 • In contrast, the non-elective admission rate in London as a whole has increased slightly, and nationally it shows a clear upward trend. • The diabetes performance dashboard by CCG and by GP federation and network • The impact of work we are already undertaking to improve seven-day acute services • Integrated care to align clinical care and infrastructure around the needs of the patient • The case study of the St Charles Hub in West London to demonstrate integrated care in practice and our collaboration with GP surgeries, local NHS hospitals and community and social care services 9
What are the patient benefits • 334 lives saved per year, (resulting in an extra 2118 quality adjusted life years (QALY)) • by 2024 hospital admissions will be reduced by 20,000 per year The investment in SOC 1 will cover: • Modernising 11 existing community hubs and building 7 new ones, creating 18 new stand-alone out of hospital hubs • Improving GP practices • Supporting Ealing Hospital’s transition to a local hospital • a larger A&E and more beds at West Middlesex • a bigger A&E and maternity unit at Hillingdon • more primary and community care services at Central Middlesex Hospital • more post-surgery recovery beds for Northwick Park. 10
Out of hospital hubs We want to invest £140million in out of hospital hubs. They will reduce unnecessary hospital appointments and use of hospital services, bringing care closer to home. By: • Integrating care for patients, linking GP and hospital care, reducing appointments • improving quality of life for those with complex conditions • ensuring seven-day access to care They will provide a range of enhanced primary care and integrated services including: -ophthalmology -SALT -diabetes service -long term condition management -CAMHS - (dementia) -integrated nursing -physiotherapy -local authority/health and wellbeing -ultrasound community services -phlebotomy -enhanced primary care -MSK -cardiology community mental health -paediatrics -WiC -community champions/health trainers -falls prevention 11
Out of hospital hubs Developing more out of hospital services at 11 sites: • Wembley centre for Health and Care • Willesden Centre for Health and Care • Parsons Green • The Pinn Medical Centre • Alexandra Avenue Health and Social Care Centre • Heston Health Centre • Heart of Hounslow Centre for Health • Brentford Health Centre • Chiswick Health Centre • St Charles Centre • Violet Melchett This includes the development of seven new hubs . • Church Street Hub • Central Westminster Hub • Ealing Hub North • Ealing East Hub • North East Harrow • North Hillingdon • Uxbridge and West Drayton 12
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