Simplified presentation of 2012 "Sharing a Healthier Future" consultation on reorganisation of hospital services in NW London. This is important and is being generally completely misunderstood, which is why I wrote this simplified version for my GP's patient group. I have tried to give an accurate and dispassionate view of what the consultation document actually says; not what many local agitation groups think, or would like, it to mean. Remember that this was written for my doctor's patient's group and slide 9 is specific to them, although all the principles still apply and all the other slides are non-geography specific.

1. Shaping a Healthier Future
Summary for Barnabas MC PPG
Dr Keith C Marshall
19 September 2012
© Dr Keith C Marshall, 2012

2. Shaping a Healthier Future
Why NWL NHS Needs to Change
• Improve care
• Changing population – predicted 5% (100,000) increase in next 10 years
• Aging population – life expectancy increased by 3 years in last 10 years
• Increases in long-term medical conditions, eg. diabetes, heart disease
• Overall less than optimal access to GPs
• Care improves with greater access to specialists
• Care improves when specialists see more, and more challenging, patients
• Increasing need for, and complexity of, maternity services
• Elderly & disabled too often stuck in hospital
• Financial Constraint
• Significant budget constraints; £1billion savings required by 2014/15
• Current funding level guaranteed only to 2015
• High capital cost of new & replacement medical technology
• Over supply of A&E provision cf. national average
• Over use of A&E cf. national average
• Major hospital building maintenance challenges
If we do nothing … money will run out … services will get worse …
buildings will get worse … services will end up being cut
2 © Dr Keith C Marshall, 2012

3. Shaping a Healthier Future
What is included?
• NWL NHS hospital services
• 9 hospitals (in blue)
• Alignment of hospital services,
especially A&E
What is NOT included?
• Doing nothing!
• Closing hospitals
• Postcode lottery of care
• Mental health and social care
• Out-of-hospital care*
* Out-of-hospital care is already happening
and is a pre-requisite to the hospital changes
3 © Dr Keith C Marshall, 2012

4. Shaping a Healthier Future
What factors have been considered?
1 Quality of care ● Clinical quality
● Patient experience
2 Access to care ● Distance and time to access services
● Distance and time for hospital visitors
● Patient choice
3 Affordability ● Recurrent cost to system
● Capital cost to system
● Financially sustainable Trusts
● Transition costs
4 Deliverability ● Workforce disruption
● Expected time to deliver
● Co-dependencies with other strategies
5 Research and Education ● Education and research
4 © Dr Keith C Marshall, 2012

5. Shaping a Healthier Future
What is the Vision of Care?
Three main principles …
Local routine medical services giving better access
1 closer to home and improved patient experience
Central specialist services means better clinical
2 outcomes and safer services for patients
Integration (wherever possible) of care between
3 primary, secondary and social care teams to
ensure seamless patient experience
Deliver care as close to home as possible
• Build on already existing out-of-hospital care strategy
• Empower individuals to self-care
• Improved access to GPs
• Better support for carers
Where required centralise specialist services to
provide better patient outcomes
5 © Dr Keith C Marshall, 2012

6. Shaping a Healthier Future
What is Urgent Care? What is A&E?
Roughly 80% of what goes through “Casualty” is Urgent Care
Urgent Care
• Anything not likely to require hospital admission
• Minor fractures, wounds, kids with saucepans on heads, urgent illness
• Where necessary stabilise patients for transfer to A&E
• Will continue to be provided at all 9 hospitals
• Open 24/7
• If someone can take you by car this is where you go – just as now!
A&E
• Anything requiring an ambulance or likely to require hospital admission
• Accident, major trauma, diabetic crises, urgent surgery, obstetric and
paediatric emergencies
• Will include Urgent Care facilities
• Will be provided at 5 “Major Hospitals”
• Open 24/7
Emergency heart attack and stroke care
is already centralised on Northwick Park and St Mary’s
6 © Dr Keith C Marshall, 2012

7. Shaping a Healthier Future
What is proposed?
Current Option A Option B Option C
St Mary’s Major Hospital Major Hospital Major Hospital Major Hospital
Hammersmith Part Major Hospital Specialist Hospital Specialist Hospital Specialist Hospital
Charing Cross Part Major Hospital Local Hospital Major Hospital Local Hospital
Chelsea &
Major Hospital Major Hospital Local Hospital Major Hospital
Westminster
Local Hospital
West Middlesex Major Hospital Major Hospital Major Hospital
Elective Hospital
Ealing Major Hospital Local Hospital Local Hospital Major Hospital
Central Part Major Hospital Local Hospital Local Hospital Local Hospital
Middlesex Elective Hospital Elective Hospital Elective Hospital Elective Hospital
Northwick Park Major Hospital Major Hospital Major Hospital Major Hospital
Hillingdon Major Hospital Major Hospital Major Hospital Major Hospital
Approx. % Change: 9% 13% 9%
Best value Needs limited capital
Good use existing buildings
Advantages Minimal new build
Needs limited capital
Easiest to deliver
1 hospital site in deficit Greatest effect on staff 3 hospitals in deficit
2 hospitals in deficit Lowest return on investment
Disadvantages
Poor use of buildings Poor use of buildings
Most difficult to deliver
7 © Dr Keith C Marshall, 2012

8. Shaping a Healthier Future
When will the Changes Happen?
• Consultation runs to 8 October 2012
• Final report / decision due in early 2013
• Out-of-hospital care has to be in place before hospital
changes can take place
• Already happening but expected to take 2-3 years to complete
• Hospital building programmes may start in 2013-15 period
• Hospital service realignment will start around 2015 and take
at least 3 years to implement
8 © Dr Keith C Marshall, 2012

9. Shaping a Healthier Future
What does this mean for Barnabas MC Patients?
NHS Service Current Provider New Provider
GP services Barnabas MC No change
Local Clinic Services
Local clinic or hospital No change
(eg. blood tests, podiatry)
Outpatient Diagnostics Any appropriate hospital No change
Outpatient Consultations Any appropriate hospital Possibly a different hospital
Heart Attack & Stroke
Northwick Park or St Mary’s No change
Emergencies
Other “Blue Light” Nearest appropriate A&E Nearest appropriate A&E
Emergencies (likely Northwick Park or Ealing) (likely Northwick Park)
Urgent Care Any of 9 hospitals No change
More likely to be
Elective Surgery Any appropriate hospital
Central Middlesex
More likely to be at one of 6
Specialist Care Any appropriate hospital
Major or Specialist Hospitals
Patient Choice Any appropriate hospital No change
BETTER CARE – MORE AFFORDABLE CARE
9 © Dr Keith C Marshall, 2012

10. Shaping a Healthier Future
What should you do?
• If possible, read the Shaping a Healthier Future consultation
document
• Online at
http://www.healthiernorthwestlondon.nhs.uk/sites/default/files/documen
ts/SaHF%20Consultation%20Document.UpdatedAugust2012_0.pdf
• It is 80 pages, so please do not print it unless you have to
• Have your say – fill in the consultation questionnaire
• Online at http://www.ipsos-mori.com/shapingahealthierfuture
• You will need the consultation document as the questions refer to it
• Take what local pressure groups say with a large pinch of
salt
• Explain to other people what this actually means
10 © Dr Keith C Marshall, 2012