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The Proposed Merger of Ealing Hospital NHS Trust and the North West London Hospitals NHS Trust Full Business Case Version 15

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The Proposed Merger of Ealing Hospital NHS Trust and the North West London Hospitals NHS Trust Full Business Case Version 15 The proposed merger of Ealing Hospital NHS Trust and The North West London Hospitals NHS Trust Full Business Case Version 15: 20th June 2014 Table of Contents Table of Contents ................................................................................................ i List of Tables ...................................................................................................... v List of Figures .................................................................................................. vii Abbreviations .................................................................................................. viii 0. Executive Summary ................................................................................... 1 0.1 Background ........................................................................................................ 1 0.2 The case for change ........................................................................................... 1 0.3 London North West Healthcare – What will day 1 feel like? ................................ 2 0.4 London North West Healthcare - What will be different for patients? .................. 3 0.5 Conclusion ......................................................................................................... 3 1. Introduction................................................................................................. 4 1.1 Background to the FINAL business case ............................................................ 4 1.2 Strategic context ................................................................................................. 4 1.3 Purpose of the Full business case ...................................................................... 6 1.4 Note on SaHF and organisational change .......................................................... 7 1.5 Current situation ................................................................................................. 7 1.6 Chapter summaries ............................................................................................ 8 1.7 Summary of appendices and supporting documents ........................................ 16 1.8 Mapping of the Business Case to TDA Assurance Framework ......................... 18 1.9 Conclusion ....................................................................................................... 18 1.10 Appendices and supporting documents ............................................................ 18 2. Profile of the Trusts .................................................................................. 19 2.1 Overview of the organisations .......................................................................... 19 2.2 SWOT analyses ............................................................................................... 21 2.3 Ealing Hospital NHS Trust ................................................................................ 22 2.4 The North West London Hospitals NHS Trust ................................................... 24 2.5 Services provided ............................................................................................. 26 2.6 Current performance ........................................................................................ 28 2.7 Care Quality Commission inspections .............................................................. 35 2.8 Conclusion ....................................................................................................... 35 2.9 Appendices and supporting documents ............................................................ 36 3. Commissioning strategy in North West London ................................... 37 3.1 Overview .......................................................................................................... 37 3.2 Local commissioners ........................................................................................ 40 3.3 Demography – Latest trends ............................................................................ 40 i 3.4 CCG Profiles .................................................................................................... 41 3.5 NHS North West London and Shaping a Healthier Future ................................ 45 3.6 Results of the IRP............................................................................................. 47 3.7 Links with overall commissioning strategy ........................................................ 48 3.8 CCG out-of-hospital strategies.......................................................................... 49 3.9 CCGs’ vision for out-of-hospital care ................................................................ 50 3.10 Enablers and success factors ........................................................................... 52 3.11 Decommissioning and Procurement ................................................................. 52 3.12 Implications for the acute services .................................................................... 52 3.13 What this means for the future healthcare landscape? ..................................... 53 3.14 Conclusion ....................................................................................................... 54 3.15 Appendices and supporting documents ............................................................ 54 4. Why merge EHT-ICO and NWLHT? ......................................................... 55 4.1 Introduction....................................................................................................... 55 4.2 Why change is needed ..................................................................................... 58 4.3 Common Lessons from other mergers .............................................................. 60 4.4 Conclusion ....................................................................................................... 60 4.5 Appendices and supporting documents ............................................................ 60 5. Clinical and patient benefits of the merger ............................................ 61 5.1 Introduction....................................................................................................... 61 5.2 Benefits from acute and community integration – a model for service delivery . 63 5.3 Benefits from merged acute hospital-based services ........................................ 71 5.4 Benefits of the merger for training and education ............................................. 82 5.5 Benefits of the merger for research and innovation........................................... 85 5.6 Conclusion ....................................................................................................... 88 5.7 Appendices and supporting documents ............................................................ 88 6. Aims, vision and values of the new organisation .................................. 89 6.1 Introduction....................................................................................................... 89 6.2 Vision, aims and objectives .............................................................................. 89 6.3 Values and objectives ....................................................................................... 92 6.4 Development of clinical strategy ....................................................................... 93 6.5 Progressing Clinical Integration ........................................................................ 94 6.6 Conclusion ....................................................................................................... 99 6.7 Appendices and supporting documents ............................................................ 99 7. The new organisation’s structure and governance arrangements .... 100 7.1 Background .................................................................................................... 100 7.2 The Board and structure of the new organisation ........................................... 101 ii 7.3 Leadership roles and responsibilities .............................................................. 103 7.4 Board sub-committee reporting structure ........................................................ 107 7.5 Clinical operational structure of the new organisation ..................................... 109 7.6 Corporate quality governance ......................................................................... 114 7.7 Divisional quality governance ......................................................................... 116 7.8 Risk Management Arrangements ................................................................... 120 7.9 Conclusion ..................................................................................................... 121 7.10 Appendices and supporting documents .......................................................... 121 8. Financial evaluation / LTFM ................................................................... 122 8.1 Background and context ................................................................................. 123 8.2 Calculating financial viability ........................................................................... 124 8.3 Historical financial performance of the current Trusts ..................................... 125 8.4 North-west London health economy – financial position ................................. 126 8.5 Merger case modelling and scenarios overview ............................................. 128 8.6 Merger base case financial assessment
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