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