NCL Service & Organisation Review Presentation to board members 14 th /15 th October 2009

Agenda  Project update and option appraisal process  Clinical model  Criteria  Public and patient involvement  Organisational form

The funding gap £0.5bn Base case 2009/10 Total spend 2016/17 Funding forecast basecase Funding best & worst case Commissioner spend basecase Local NCL data has been used to refresh the modelling and confirm the funding gap £ billion

The current option appraisal timeline for major acute reconfiguration is challenging 18 / 12 Submission of ISP Stakeholder events to discuss criteria 26 / 10 5 / / / 10 2 / 119 / 1116 / / 1130 / 11 Modelling short listed options Development of criteria for appraising short list and appraisal planning CAG Long list narrowed to short list Option appraisal against shortlisted options Criteria developed for moving from long to short list and Validation of clinical model CAG 5 weeks notice for appraisal events Further validation of modelling assumptions Outcomes of appraisal used to develop final report October NovemberDecember Planning for public events Rolling communications plan and stakeholder engagement

Recommendations for the clinical model for NCL have been developed by clinical working groups and sent to NHS London Recommendations made to NHS London on 30 th September NCL needs a maximum of 3 major acute hospitals, given the population size of NCL (including adjustments for patients flowing in and out of the sector), recommendations from HfL, and the Royal Colleges Duplication of specialist services should be eliminated through consolidation of these services to one of the designated major acute sites There should be a maximum of two local hospitals; however, the clinical model for local hospitals in the sector is still to be completely defined The main outstanding clinical decision is whether emergency medical and surgical takes should be separated which will determine the exact nature of the local hospital model for NCL However, concerns were raised at the Clinical Advisory Group, Steering Group and CEO/MD workshop that the proposed solution of three Major Acutes and two full Local Hospitals is not radical enough, given the size of the affordability challenge

The appraisal process includes detailed modelling of a short list of options to support the identification of a single preferred option Modelling of short listed options Scenarios will be built from the bottom-up to maximise accuracy Each scenario requires manual mapping of services and potential shifts This will allow for local circumstances to be captured within each scenario Agree clinical model and long list of options “Hurdle” criteria applied Short list Option Appraisal Detailed financial modelling and non- financial evidence collation Barnet Chase Farm NMUH Royal Free Whitti ngton UCLH Preferred Option This process will involve a number of modelling iterations to adapt the scenarios as appropriate

The recommendation is three major acutes for the sector with a consolidation of specialist services onto a subset of these sites 3 Major acute hospitals providing acute services for the sector Consolidated specialist services provided from a subset of the major acutes, providing networked services to the other major acutes and local hospitals within the sector Local hospitals and polysystems providing a large proportion of the current DGH activity, fulfilling the requirement to “localise where possible” and allowing major acutes to focus on core services Major Acute Hospital Specialist services Local hospitals Specialist services Poly systems

‘Hurdle’ criteria will be used to apply this model to existing sites and create a condensed options list Initial criteria for option evaluation have been identified by both the Clinical Advisory Group and the Directors of Public Health The planned combined Steering Group and Clinical Advisory event for agreeing options will use a brief set of ‘hurdle’ criteria in order to rapidly reduce the long list to a condensed list for more detailed modelling. This process will be based on the proposed model of care Key hurdle criteria will include:  Clinically robust – endorsed by sector clinical groups and reflecting Healthcare for London recommendations  Public acceptability – particularly with regard to geographic accessibility and travel times  Physical capacity – will it fit These criteria will be applied pragmatically using a combination of common sense and available metrics A more extensive set of criteria for use in the short list option appraisal stage are being further developed during October and will include input from the public and patient involvement events These criteria will be applied during the option appraisal stage in late November

Patient and public involvement is a key part of this process and events are planned for November Meetings have been held with three of the five Local Involvement Networks from across the sector A more substantial public engagement process is scheduled for November to outline the process being undertaken and discuss the criteria Meetings are scheduled with three external providers this week to discuss support for the public engagement process

Organisational form is the next issue which will be explored Having focused on the service model in the first instance, the sector will now explore options for organisational form Vertical integration is increasingly being viewed as a favoured option in a number of forums, having been discussed at the CEO/MD workshop, with London AHSCs viewing this as a vehicle for increased population health benefits as well as efficiency A working group is being established to review strengths and weaknesses, from both provider and commissioner perspectives, of different organisational form options including vertical integration JCPCT will review the evidence developed relating to the different options This review will precede and inform further work around the future of specific NCL organisations