The Implementation Business Case (IMBC) for NW London The business - - PowerPoint PPT Presentation
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
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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
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:
As new clinical models become clear, Equality Impact Assessments will be undertaken.
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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.
services are co-located and primary care is delivered at scale
clinical and financial sustainability. This is principally achieved by concentrating valuable clinical capability across fewer sites.
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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:
conditions in primary care
We will also:
individual can be shared by everybody involved in their care
with complex needs
digital technologies.
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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:
a net reduction in acute activity, quantified through detailed forecasts and modelling
for people living with long term conditions
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We have evidence of seven areas where we have been able to effect change:
and major trauma centres in London
pathways on non-elective activity in secondary care
since 2011/12
nationally it shows a clear upward trend.
in practice and our collaboration with GP surgeries, local NHS hospitals and community and social care services
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The investment in SOC 1 will cover:
stand-alone out of hospital hubs
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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:
They will provide a range of enhanced primary care and integrated services including:
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Developing more out of hospital services at 11 sites:
This includes the development of seven new hubs.
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We have already improved access to GP appointments at weekends and in the evening. GPs also provide more services in the community than ever before The buildings that GPs operate out of, however, need investment and modernisation to improve:
We want to invest £69million to improve building access, treatment and waiting areas, ensuring that services are fit for purpose.
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We have already made improvements in children’s and maternity care across NW London, with more senior clinicians, consultants and specialist staff available day and night.
Emergency services at Central Middlesex and Hammersmith hospitals were changed, providing two 24/7 urgent care services, following the closure of underused and unsustainable A&E services on these sites
We still have work to do in providing the right, specialist and well staffed services in our hospitals. We want to invest, as part of SOC1, more than £300m in:
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The Economic Case sets out the value for money case for the proposed capital investment Benefits
Annual Cost (EAC)
EAC terms) of the investment of £181m Our option offers a positive return on the investment (five times the capital invested based on EAC excluding wider economic benefits and health benefits, and 16 times the capital invested based on EAC including wider economic benefits and health benefits We have demonstrated that the case represents value for money under a range of scenarios by conducting sensitivity analyses.
The financial case assesses the affordability of the proposed capital investment to CCGs and trusts. It sets out proposed funding routes for the capital investment and for transition costs that are affordable We have used current proposals for hubs and hospital services to inform this
sustainable financial position for North West London CCGs is demonstrated through 10 year financial projections Under the ‘comparator’ all trusts will be in financial deficit, with a combined deficit of £114m at 24/25. Trust financial projections demonstrate that all trusts have a sustainable income & expenditure surplus position of £27.6m at 24/25, with the reconfiguration contributing a £50m benefit. Currently the trusts are running in-year deficits which would require an estimated cash support of £1.1bn over the next 10 years (and continue thereafter). Under the SOC option, these reduce, with the cash support reducing to £0.4bn and are in due course eliminated.
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We will deliver the procurements through existing arrangements. The individual trusts will lead on procurements, supported by a central programme function to realise the benefits of economies of scale. The procurement implications of the proposals have been identified and worked through: Indicative commercial arrangements have been identified for each of the 27 hubs The hospital reconfiguration element involves five projects across three
those assumptions will be developed in Outline Business Cases Where staff are affected by changes, we will aim to retain them within NW London.
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The Management Case demonstrates that the preferred option is capable of being delivered successfully, in accordance with recognised best practice We have a strong and effective Programme Management Office (PMO) with a Programme Executive in place We have built strong relationships with stakeholders and engaged widely on our proposals with patients and the broader community We have already made significant progress, with a proven track record of successful and safe transformation We have built on our existing arrangements and are updating our governance to ensure it is fit for purpose to deliver the Sustainability and Transformation Plan (STP) and the next phase of SaHF. We have set out the lessons learnt and key changes For the next phase of business case development we have prepared clear project plans, established programme assurance and identified key risks We have drawn up a benefits framework which we will use to track benefits realisation.
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We have already made improvements in children’s and maternity care across NW London, with more senior clinicians, consultants and specialist staff available day and night. NW London is now, not only meeting national guidelines, but going beyond But there is still work to do Our current system is unsustainable, with, an increasing population, significant unwarranted variation in the quality of clinical care and an increasing deficit It is clear that we have to change the way we care for our patients We want to invest £513milion over the next ten years to improve care for NW London residents.
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Community out of hospital hubs New out of hospital hub built in:
Developing more out of hospital services at:
GPs Improving practice buildings and facilities, and better access to GPs Hospital services Developing community services at Central Middlesex Hospital.
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Community out of hospital hubs Two new out of hospital hubs will be built:
GPs Improving practice buildings and facilities, and better access to GPs Hospital services Funding for services provided by Imperial College Healthcare NHS Trust, including the redevelopment of St Mary’s and an out of hospital hub on the St Mary’s site, will be discussed at a later date. An additional business case will be developed to look at funding for these projects.
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Community out of hospital hubs Two new out of hospital hubs will be built:
GPs Improving practice buildings and facilities, and better access to GPs Hospital services Ealing Hospital is changing to a new-style local hospital. We want to provide local people with the services they use the most, backed up by 24/7 expert care at nearby hospitals when they need it Starting in early 2017, we will talk to patients, residents and staff to develop what Ealing local hospital will look like.
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Community out of hospital hubs
Developing more out of hospital services at:
GPs Improving practice buildings and facilities, and better access to GPs Hospital services Funding for services provided by Imperial College Healthcare NHS Trust, including the redevelopment of Charing Cross and out of hospital hub on site, will be discussed at a later date. An additional business case will be developed to look at funding for these projects.
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Community out of hospital hubs Developing more out of hospital services at:
GPs Improving practice buildings and facilities, and better access to GPs Hospital services Northwick Park Hospital has one of the countries largest repair bilIs in the
surgery recovery beds.
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Community out of hospital hubs
Two new out of hospital hubs will be built:
GPs Improving practice buildings and facilities, and better access to GPs Hospital services Improved environment and more A&E and maternity beds at Hillingdon Hospital.
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Community out of hospital hubs
Developing more out of hospital services at:
GPs Improving practice buildings and facilities, and better access to GPs Hospital services Funding for services provided by Chelsea and Westminster NHS Foundation Trust, including improvements to services at Chelsea and Westminster Hospital, will be discussed at a later date. An additional business case will be developed to look at funding for these projects.
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