Executive Summary Pre Consultation Business Case Version 4.2 October 2020 1 | Page July 2020 Executive Summary Contents 1 Executive Summary .............................................................................................................. 1 Strategic Statement ............................................................................................................. 1 System and Programme Vision ........................................................................................... 2 Why we think that change is needed .................................................................................. 3 Working together to identify proposals .............................................................................. 4 Our preferred options ......................................................................................................... 5 Finance, workforce and resources ...................................................................................... 6 Coronavirus (COVID 19) ...................................................................................................... 6 Proposed public consultation .............................................................................................. 6 2 Purpose of the document .................................................................................................... 8 Document Purpose .............................................................................................................. 8 Intended Audiences and their Decision Making Roles ....................................................... 8 Document Status ................................................................................................................. 9 3 Introduction to the System ................................................................................................ 10 One Gloucestershire Integrated Care System ................................................................... 10 Local Health Context ......................................................................................................... 10 Joint Strategic Needs Assessment & Joint Health and Wellbeing Strategy ...................... 12 Local Services Context ....................................................................................................... 13 Coronavirus (COVID 19) .................................................................................................... 14 4 Introduction to the Programme ........................................................................................ 17 Fit for the Future ............................................................................................................... 17 Centres of Excellence ........................................................................................................ 18 Scope ................................................................................................................................. 19 What is the ‘current state’ service model? ....................................................................... 21 5 Case for change .................................................................................................................. 28 Local population needs ..................................................................................................... 28 National drivers/context ................................................................................................... 32 Why improvements to current provision are needed ...................................................... 34 6 Engaging with clinicians, patients the public and other stakeholders .............................. 41 Public Engagement ............................................................................................................ 41 Clinical Workstreams ......................................................................................................... 45 Staff communication and engagement ............................................................................. 47 Other Stakeholders ........................................................................................................... 49 7 Developing clinical models................................................................................................. 52 July 2020 A structured process ......................................................................................................... 52 Solutions Development Process – Steps and Timeline ..................................................... 52 Evaluating clinical models ................................................................................................. 53 8 Proposals for consultation ................................................................................................. 66 What are the options for the ‘future state’ service model? ............................................. 66 Components of the clinical models ................................................................................... 66 Proposed new clinical solutions ........................................................................................ 67 Baseline Activity .............................................................................................................. 124 9 Proposed Models and Impact Assessment ...................................................................... 127 Two Potential Service Models ......................................................................................... 127 Impacts common to all Models ....................................................................................... 128 Model D (4.4) ................................................................................................................... 155 Model E (5.4) ................................................................................................................... 162 Is there a preferred option? ............................................................................................ 169 Implementation plan ....................................................................................................... 170 10 Integrated Impact Assessment ........................................................................................ 175 Executive summary ................................................................................................... 175 Integrated Impact Assessment (IIA) – background information .............................. 187 Equality Impact assessment: the impact on groups with protected characteristics191 Health Inequalities Impact Assessment ................................................................... 196 Health Impact Assessment ....................................................................................... 200 Impact analysis of the two pilot changes (Gastroenterology and Trauma & Orthopaedic inpatient services) ...................................................................................... 201 Next steps ................................................................................................................. 202 11 Economic and Financial Analysis ...................................................................................... 203 Introduction .............................................................................................................. 203 Methodology ............................................................................................................ 203 Activity Baseline ........................................................................................................ 204 Financial and Workforce Baseline ............................................................................ 204 Financial aspects common to all models .................................................................. 205 Downside Risks ......................................................................................................... 208 Analysis of the two models ...................................................................................... 209 Enabler schemes ....................................................................................................... 215 Benefits Realisation .................................................................................................. 215 12 Governance and decision making .................................................................................... 216 Internal Assurance .................................................................................................... 217 External Assurance ................................................................................................... 219 Five Tests .................................................................................................................. 221 Public sector equality duty (PSED) ........................................................................... 225 Information Governance (IG) issues and privacy impact assessment ..................... 226 13 Proposed consultation ..................................................................................................... 227 Legal requirements ................................................................................................... 227 FFTF Communication and Consultation Strategy and Plan ...................................... 228 Planned next steps ..................................................................................................