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

5

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?