Better Services, Better Value: Joint Overview and Scrutiny
Bill Gillespie – Director, Strategy and Performance27th January 2012
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Health, Social Care and Housing Scrutiny Sub Committee
28 February 2012
Agenda item 9
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The review is looking at six areas of care:
1. Planned care
2. Urgent, unscheduled and emergency care3. Maternity and newborn care4. Children’s services5. Long term conditions
6. End of life care
For each area, a separate Clinical Working Group has examined best practices and standards of care, evidence about quality and patient experiences, and possible ways forward.
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Emerging recommendations from clinical working groups
The clinical working groups have produced draft reports with a number of suggestions. Examples include:
•An ‘urgent care centre’ attached to every A&E
•More senior doctors in fewer maternity units or different levels of service at existing maternity units – to meet Royal College guidelines
•Dedicated planned surgery centre(s) to separate planned operations from emergencies
•Paediatric Assessment Units on all sites providing urgent care to children
•Proactive case management, including a care plan, should be in place for all patients with long term conditions and patients and carers should be supported to manage their conditions
•End of life care: system change to allow 75% of patients to die in their place of choice
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There will have to be changes across all settings of care
• Reconfiguration of hospital services is highly dependent on shifts in settings of care relating to LTC and EoLC and some aspects of Urgent Care and Social Care
• Programme delivery boards will be set up for Urgent Care and LTC to support a step-up in implementation from 2012/13
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End of Life CWG
Long Term Conditions
CWG
Maternity and Newborn CWG
Children’s Services
CWG
Planned CareCWG
Urgent CareCWG
System Changes Acute Reconfigurations
Elements of Urgent Care
CWGSocial Care
Enabler
From here to the final decision: the main stages of the options appraisal process
Decision trees will be used to establish the number of potential options per service reconfiguration
Approach to Decision TreesDecision trees will be used to establish the number of potential options per service
reconfiguration, these will be narrowed down and combined one at a time
1. Establish the baseline:What is current activity, and what are the assumptions around activity and flows?
2. Establish “fixed points”: e.g. St George’s remains a tertiary centre
e.g. There is HMT commitment to major investment on St Helier site
3. Apply decision tree:These will be applied in a specific order according to interdependencies -
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UrgentMaternity
and Newborn
Children’s Services
Planned Care
Scoring of options
Approach to Scoring Options
A panel of stakeholders will score the long shortlist to determine a ranked list from which the top scorers will become the shortlist:
1. Determine the evaluation criteria and their relative weighting
2. Establish the pointers that sit behind each criterion to ensure there is a shared understanding of the criterion
3. Agree the composition of the scoring panel
4. Establish the scoring mechanism
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The criteria to be used to assess shortlisted options
DRAFT
Clinical Outcomes and Safety
Workforce Development
Access to Service
Transport and TravelPatient Experience
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Deliverability
Non-financial criteria
Commissioner Affordability
Provider Sustainability
Financial criteria
The non-financial criteria to be used to assess the long shortlisted options
Clinical Outcomes and Safety
Workforce Development
Access to Service
Transport and Travel
Patient Experience
Criteria DescriptionThis criterion will assess whether the option enables standards, set by Royal Colleges (and equivalents), the Department of Health and NHS London, to be consistently delivered across SWL, enabling more co-ordinated care for patients and resulting in better healthcare for the population of SWL
This criterion will assess whether the option will improve or maintain patient experience at a high level of satisfaction.
This criterion will assess whether options will allow the NHS in SWL to attract, develop and retain the staff needed to provide high quality healthcare.
This criterion will assess whether the option enables an equitable access to services across SWL for all population groups.
This criterion will assess whether the option results in a significant increase in journey times for carers, patients and visitors.
DeliverabilityThis criterion will assess whether the option enables sustainable change to be delivered by the dates that have been set out, including assessing the risks associated with the implementation of this option in SWL.
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How have we agreed criteria weightings?
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2
3
4
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GP engagement event, (1st Dec)
“What matters to you?” E-survey, (to 6th Jan) Multi-stakeholder
briefings (early Jan)
CWG meetings (mid Jan)
DEC JAN FEB
Joint CSG and PPAG meeting makes a recommendation for weightings to be taken to the Programme Board
18th Jan 24th Jan
2011 2012
Programme Board
approves methodology
including weightings
but withstanding
scoring
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Deliberative events, (summer 11)
The order of importance was similar for all groups that ranked the scoring criteria...
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Clinical Outcomes and Safety
Workforce Development
Patient Experience Delivera
bilityTransport and Travel
Access to
Service
Clinical Outcomes
and Safety
Workforce Development Patient
ExperienceAccess to Services
Transport and
Travel
Clinical Outcomes and Safety
Patient Experience
Workforce Development
Access to
ServiceTransport and Travel
Deliverability
Clinical Outcomes and Safety
Patient Experience
Workforce Development Access to
ServiceTransport and Travel
Deliverability
...and jointly the CSG and PPAG have recommended the following weightings
• The joint PPAG and CSG meeting on the 18th January worked together, using the data gathered through engagement events as reference, to generate the recommended weightings for the criteria
• The criteria were attributed percentage weightings as follows:
High Low
Wei
ghtin
gAs
sign
edW
hat t
his
mea
ns?
32% 22% 19% 11% 8% 8%
This is 5 times more important than Transport and Travel
Access to Services, Deliverability and Transport and Travel are closely weighted as important as each other
This is close to 4 times more important that Transport and Travel
Clinical Outcomes and Safety
Patient Experience
Workforce Development
Access to
Service
Trans-port and
Travel
Deliver-ability
This is more than twice as important than Transport and Travel
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The composition of the scoring panel
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SWL Med Dir(CSG Co-Chair)
SWL Med Dir(CSG Co-Chair)
SWL Med Dir(CSG Co-Chair)
SWL Dir of Nursing
Cluster Medical Directors and Nursing Director1
Maternity Co-Chair
EoL Co-Chair
Children Co-Chair
LTC Co-Chair
Urgent Co-Chair
Planned Co-Chair
CWG Co-chairs (Providers and GPs)2
Croydon
Sutton Kingston
Richmond & Twickenham Merton
Croydon additionalWandsworth
Sutton additional
CCGs leads, including additional reps for those not chairing CWG4
ESH
SLAM
Your Healthcare
RMH HRCH
West Mid
SWL Providers not chairing CWGs3
Croydon MertonRichmond
Sutton Kingston Wandsworth
Local Authorities5
Croydon
Sutton
Richmond
Kingston Wandsworth
DPHs
Public / Patient / Carer / Community representatives
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7
Merton
60 people
Maternity Co-Chair
EoL Co-Chair
Children Co-Chair
LTC Co-Chair
Urgent Co-Chair
Planned Co-Chair
Croydon MertonRichmond Sutton KingstonWandsworth
Croydon
Merton
Richmond
Sutton KingstonWandsworthCroydon
Merton
Richmond
Sutton KingstonWandsworth
Proposed process for scoring
• We expect the Scoring of Options to be held in two stages:
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Outcome
Pre-evaluation Briefing Evaluation Event
Aim
Audience
• Ensure stakeholders understand their role as a ‘options scorer’
• Allow stakeholders to understand the materials that will be made available for them to make their decision
• Engage all stakeholders in making the decision of scoring options
• Make the decision on what options to include in the long shortlist
• All 60 participants that will attend the evaluation event
• All 60 participants that will attend the evaluation event
• Stakeholders have a clear understanding of the process and their role
• A list of additional data points to be compiled by the evaluation date, if necessary
• Produce a scored long shortlist of options through a process of scoring during the event
• Ranked list of options will be produced
For Information – to be approved on 22nd February
Engaging local people
• Initial public feedback in July 2011 – 2 meetings for residents 2 for stakeholders,
patient representatives and LINks - feedback changed the clinical reports
• Over 100 meetings with local community groups (e.g. colleges, charities, social groups), clinicians and Overview and Scrutiny Committees
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• Public meetings in each borough organised with Local Involvement Networks (LINks) and extensive social media engagement
• Patient and Public Advisory Group (PPAG) advising us on our approach. • Events in December for frontline GPs and practice nurses – support for case for change
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Communication and engagement timeline overview
Timeline
Content of engagement
Key publications
By end of December
2011
Emerging ideas
Case for Change
Jan – June 2012
Whole systems options
appraisal
Final clinical reports
July – Oct 2012
Public consultation on options
Public consultation document
Oct 2012 onwards
Decision-making,
implemen-tation
Communi-cation on decision
Late Feb/early March
Late Oct/Nov
Possible JOSC meetings May
Key milestones for JOSC
• Late Feb 2012- Briefing pack in advance - First draft consultation plan for JOSC review- prepare for options scoring panel (mid-March)
• May- Review consultation plans and outline public consultation document
• Late October/November- Review consultation outcomes and decisions
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Questions to consider
Meeting milestones and dates – are
they the right ones?
What information is useful for a full
briefing pack?- clinical reports
- Phase 1 communications and engagement plan
- public engagement reports
Impact of purdah on engagement and
communication?