Better Services, Better Value: Joint Overview and Scrutiny Bill Gillespie – Director, Strategy and Performance 27 th January 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 care 3. Maternity and newborn care 4. Children’s services 5. 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. 25/05/2015 3

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 4

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

From here to the final decision: the main stages of the options appraisal process Models of care Up to 3,500 different options Need to filter 3,500 to about 20. Filters are based on ability to implement, feasibility, capacity, etc. 20 options are then scored using the criteria which you have helped us to weight The top scoring options (about 5) will be tested to check they are affordable and deliverable The top 2 or 3 options will form the basis of a full public consultation exercise

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 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 - 7 Urgent Maternity 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 8

The criteria to be used to assess shortlisted options DRAFT Clinical Outcomes and Safety Workforce Development Access to Service Transport and Travel Patient Experience 9 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 CriteriaDescription 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 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. Deliverability 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. 10

How have we agreed criteria weightings? GP engagement event, (1 st Dec) “What matters to you?” E-survey, (to 6 th Jan) Multi-stakeholder briefings (early Jan) CWG meetings (mid Jan) DECJAN FEB Joint CSG and PPAG meeting makes a recommendation for weightings to be taken to the Programme Board 18 th Jan24 th Jan Programme Board approves methodology including weightings but withstanding scoring 1 Deliberative events, (summer 11)

The order of importance was similar for all groups that ranked the scoring criteria Clinical Outcomes and Safety Workforce Development Patient Experience Delivera bility Transp ort and Travel Access to Service Clinical Outcomes and Safety Workforce Development Patient Experience Access to Services Transport and Travel GP Event Survey Clinical Outcomes and Safety Patient Experience Workforce Development Access to Service Transpo rt and Travel Delivera bility CWGs Clinical Outcomes and Safety Patient Experience Workforce Development Access to Service Transport and Travel Delivera bility Deliberative Events

...and jointly the CSG and PPAG have recommended the following weightings The joint PPAG and CSG meeting on the 18 th 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: Importance HighLow Weighting Assigned What this means? 32%22%19%11%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 13

The composition of the scoring panel 14 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 Director 1 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 SuttonKingston Richmond & Twickenham Merton Croydon additional Wandsworth Sutton additional CCGs leads, including additional reps for those not chairing CWG 4 ESH SLAM Your Healthcare RMHHRCH West Mid SWL Providers not chairing CWGs 3 CroydonMertonRichmond SuttonKingstonWandsworth Local Authorities 5 Croydon Sutton Richmond KingstonWandsworth DPHs Public / Patient / Carer / Community representatives 6 7 Merton 60 people Maternity Co-Chair EoL Co-Chair Children Co-Chair LTC Co-Chair Urgent Co-Chair Planned Co-Chair CroydonMertonRichmondSuttonKingstonWandsworth Croydon Merton Richmond SuttonKingstonWandsworthCroydon Merton Richmond SuttonKingstonWandsworth

Proposed process for scoring We expect the Scoring of Options to be held in two stages: 15 Outcome Pre-evaluation BriefingEvaluation 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 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 22 nd 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 16 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 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 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 18

19 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?