Better Services, Better Value: Joint Overview and Scrutiny

1. Health, Social Care and Housing Scrutiny Sub Committee 28 February 2012 Agenda item 9 Better Services, Better Value: Joint Overview and Scrutiny Bill Gillespie – Director, Strategy and Performance 27th January 2012

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3. 3 21/08/2014 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.

4. 4 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

5. 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 EoLCand 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 Acute Reconfigurations System Changes Maternity and Newborn CWG Children’s Services CWG End of Life CWG Long Term Conditions CWG Enabler Social Care Elements of Urgent Care CWG Urgent Care CWG Planned Care CWG

6. From here to the final decision: • the main stages of the options appraisal process

7. Decision trees will be used to establish the number of potential options per service reconfiguration Approach to Decision Trees Decision 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 • Establish the baseline: What is current activity, and what are the assumptions around activity and flows? • 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 • Apply decision tree: These will be applied in a specific order according to interdependencies - Urgent Maternity and Newborn Children’s Services Planned Care

8. 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

9. DRAFT The criteria to be used to assess shortlisted options Non-financial criteria Financial criteria Clinical Outcomes and Safety Access to Service Commissioner Affordability Patient Experience Transport and Travel Provider Sustainability Workforce Development Deliverability

10. The non-financial criteria to be used to assess the long shortlisted options Criteria Description This 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 Clinical Outcomes and Safety This criterion will assess whether the option will improve or maintain patient experience at a high level of satisfaction. Patient Experience 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. Workforce Development This criterion will assess whether the option enables an equitable access to services across SWL for all population groups. Access to Service This criterion will assess whether the option results in a significant increase in journey times for carers, patients and visitors. Transport and Travel This 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. Deliverability

11. How have we agreed criteria weightings? 2011 2012 18th Jan 24th Jan DEC JAN FEB 1 Joint CSG and PPAG meeting makes a recommendation for weightings to be taken to the Programme Board Deliberative events, (summer 11) GP engagement event, (1st Dec) 2 Programme Board approves methodology including weightings but withstanding scoring 3 “What matters to you?” E-survey, (to 6th Jan) Multi-stakeholder briefings (early Jan) 4 5 CWG meetings (mid Jan)

12. The order of importance was similar for all groups that ranked the scoring criteria... Clinical Outcomes and Safety GP Event Workforce Development Patient Experience Access to Services Transport and Travel Clinical Outcomes and Safety Survey Workforce Development Patient Experience Deliverability Access to Service Transport and Travel Clinical Outcomes and Safety Deliberative Events Patient Experience Workforce Development Access to Service Transport and Travel Deliverability Clinical Outcomes and Safety CWGs Patient Experience Workforce Development Access to Service Deliverability Transport and Travel

13. ...and jointly the CSG and PPAG have recommended the following weightings Importance • 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: Clinical Outcomes and Safety Patient Experience Workforce Development Access to Service Deliver-ability Trans-port and Travel High Low Weighting Assigned 32% 22% 19% 11% 8% 8% Access to Services, Deliverability and Transport and Travel are closely weighted as important as each other This is 5 times more important than Transport and Travel This is close to 4 times more important that Transport and Travel This is more than twice as important than Transport and Travel What this means?

14. The composition of the scoring panel Cluster Medical Directors and Nursing Director 1 60 people SWL Med Dir (CSG Co-Chair) SWL Med Dir (CSG Co-Chair) SWL Med Dir (CSG Co-Chair) SWL Dir of Nursing CWG Co-chairs (Providers and GPs) 2 Urgent Co-Chair Maternity Co-Chair Children Co-Chair Urgent Co-Chair Maternity Co-Chair Children Co-Chair Planned Co-Chair EoL Co-Chair LTC Co-Chair Planned Co-Chair EoL Co-Chair LTC Co-Chair SWL Providers not chairing CWGs CCGs leads, including additional reps for those not chairing CWG 3 4 ESH Your Healthcare West Mid Croydon Richmond & Twickenham Merton Sutton additional SLAM RMH HRCH Sutton Kingston Wandsworth Croydon additional Local Authorities DPHs 5 6 Croydon Richmond Merton Croydon Richmond Merton Sutton Kingston Wandsworth Sutton Kingston Wandsworth Public / Patient / Carer / Community representatives 7 Croydon Richmond Merton Sutton Wandsworth Kingston Croydon Richmond Merton Sutton Wandsworth Kingston Croydon Richmond Merton Sutton Wandsworth Kingston

15. For Information – to be approved on 22nd February Proposed process for scoring • We expect the Scoring of Options to be held in two stages: Pre-evaluation Briefing Evaluation Event Aim • 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 Audience • All 60 participants that will attend the evaluation event • All 60 participants that will attend the evaluation event Outcome • 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

16. 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 • 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

17. Communication and engagement timeline overview Timeline By end of December 2011 Jan – June 2012 Oct 2012 onwards July – Oct 2012 Content of engagement Emerging ideas Whole systems options appraisal Decision-making, implemen-tation Public consultation on options Key publications Case for Change Final clinical reports Public consultation document Communi-cation on decision Possible JOSC meetings Late Feb/early March Late Oct/Nov May

18. 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

19. 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 Questions to consider Impact of purdah on engagement and communication?