Appendix 5.1: Horton Strategic Review STRATEGIC REVIEW OF THE HORTON GENERAL HOSPITAL: An opportunity to design a 21 st century hospital at Banbury OCTOBER 2016 CONFIDENTIAL AND DRAFT Page 1 of 112 Oxford University Hospitals NHS FT Table of Contents 1. Introduction ...................................................................................................................... 5 st 1.1. Responding to our challenges: an opportunity to design a 21 century hospital at Banbury 5 1.2. Healthcare today .......................................................................................................... 6 1.3. Oxfordshire’s Healthcare Strategy ................................................................................ 8 1.4. OUHFT’s Strategic Objectives ....................................................................................... 9 1.5. The Horton General: the case for further evolution .................................................... 10 2. Demography and Population Health ................................................................................ 13 2.1. Catchment population of the Horton General Hospital .............................................. 13 2.2. Planned major developments of transport infrastructure, economy, and housing within the catchment population areas ................................................................................. 13 2.3. Demography .............................................................................................................. 14 2.4. Projected growth of catchment population ................................................................ 15 2.5. Population Projections beyond 2026 .......................................................................... 16 2.6. Social factors – education and income ....................................................................... 16 2.7. Health behaviours, causes of ill health and prevalence of disease .............................. 16 2.8. Causes of ill health ..................................................................................................... 17 2.9. Burden of ill health across the catchment .................................................................. 17 2.10. Life expectancy .......................................................................................................... 17 2.11. Access to healthcare .................................................................................................. 18 2.12. Summary of North Oxfordshire demography and public health .................................. 18 3. The Case for Change ........................................................................................................ 19 3.1. Introduction ............................................................................................................... 19 3.2. Urgent and emergency care, including stroke care and critical care ........................... 19 3.3. Planned Care (Elective Care, Diagnostics and Outpatients) ......................................... 24 3.4. Maternity Services ..................................................................................................... 28 3.5. Children’s Services ..................................................................................................... 31 4. Process for Developing Options for the New Models of Care ........................................... 38 4.1. Introduction ............................................................................................................... 38 4.2. Approach to development of new pathways: Clinical leadership ................................ 38 4.3. Evaluation of models .................................................................................................. 40 4.4. Short List of Options ................................................................................................... 41 4.5. Summary: Process for the Development of Options for the New Models of Care ...... 43 Page 2 of 112 Oxford University Hospitals NHS FT 5. Clinical Review Groups’ Proposed Models of Care ........................................................... 44 5.1. Urgent and Emergency care and the development of Ambulatory Provision .............. 44 5.2. Planned Care, Diagnostics and Outpatients ................................................................ 49 5.3. Maternity Services: Model of Care ............................................................................. 52 5.4. Children’s Services: Model of Care ............................................................................. 55 6. Activity Analysis .............................................................................................................. 60 6.1. Activity Profile of the Horton General......................................................................... 60 6.2. Assumptions underpinning activity profiles ................................................................ 60 6.3. Urgent, emergency care, stroke and critical care activity profile ................................ 61 6.4. Planned Care, Diagnostics and Outpatients activity profile ......................................... 62 6.5. Maternity Services activity profile .............................................................................. 63 6.6. Children’s Services activity profile .............................................................................. 63 6.7. Summary of Activity Analysis ...................................................................................... 64 7. Access Analysis ............................................................................................................... 65 7.1. Methodology .............................................................................................................. 65 7.2. Blue light or private car at night ................................................................................. 65 7.3. Peak time with private car .......................................................................................... 65 7.4. Inter-peak time with public transport ......................................................................... 65 7.5. Alternative forms of transport .................................................................................... 66 7.6. Summary .................................................................................................................... 66 8. Estates Analysis .............................................................................................................. 67 8.1. Current Horton General estate ................................................................................... 67 8.2. Initial evaluation of estate condition for options ........................................................ 67 8.3. Early analysis of estates costings ................................................................................ 68 9. Workforce Analysis ......................................................................................................... 69 9.1. Introduction ............................................................................................................... 69 9.2. OUHFT workforce challenges ..................................................................................... 70 9.3. Urgent and Emergency Care (including critical care and stroke services) .................... 72 9.4. Planned Care, Diagnostics and Outpatients ................................................................ 74 9.5. Maternity Services ..................................................................................................... 77 9.6. Children’s Services ..................................................................................................... 79 9.7. Outline of broad challenges and required next steps .................................................. 82 10. Financial Assumptions and Analysis ................................................................................ 84 10.1. Summary .................................................................................................................... 84 10.2. Impact of national planning assumptions ................................................................... 84 Page 3 of 112 Oxford University Hospitals NHS FT 10.3. Approach to modelling ............................................................................................... 84 10.4. Savings assumptions .................................................................................................. 86 10.5. Base case assumptions ............................................................................................... 87 10.6. Activity shifts between sites ....................................................................................... 88 10.7. Capital cost of proposed options ................................................................................ 88 10.8. Adding new capacity .................................................................................................. 90 10.9. Income and expenditure impact ................................................................................. 91 10.10. Net present value ......................................................................................... 92 10.11. Transition costs ............................................................................................ 94 10.12. Summary of the financial evaluation............................................................