RAIGMORE CRITICAL CARE AND THEATRE UPGRADE OUTLINE BUSINESS CASE

Transcription

1 Highland NHS Board 7 October 2014 Item 5.5 RAIGMORE CRITICAL CARE AND THEATRE UPGRADE Report by Eric Green, Head of Estates and Linda Kirkland, Interim Director of Operations, Raigmore (Project Sponsor) on behalf of Nick Kenton, Director of Finance (Senior Responsible Officer) and Deborah Jones, Chief Operating Officer The Board is asked to: Approve the Outline Business Case for Critical Care and Theatre upgrades. Note the progress made on agreement of the design. Note the amount of stakeholder engagement undertaken Note the change from the Initial Agreement; there are now 10 theatres as opposed to the existing 9. Note the financial challenges adopting this business case will provide in future years. 1 Background NHS Highland has previously had an Initial agreement for refurbishment of the Raigmore Critical Care facilities and refurbishment of the Raigmore theatre suite. The NHS Highland Board and Scottish Government previously approved this Initial Agreement and work has now progressed on the Outline Business Case (OBC), which is now complete. Raigmore Hospital is 30 years old, as is perfectly normal for a building of this age it is now in need of investment to ensure it remains fit for purpose going forward. During the 30 years of service several standards have changed and this provides an opportunity to ensure that the building is brought up to modern standards. Primarily this work is around enhanced fire compartmentation, renewing ventilation systems, and improving the fabric. In the case of the high dependency beds, over the period of time Raigmore has been operational the amount of equipment around a patient has grown exponentially meaning that the space around a bed requires to be increased. This project deals with this and also ensures that all critical care takes place in adjacent areas, allowing maximum flexibility in use of space and staff. This allows changes to be made that will improve patient flows and the privacy and dignity of patients. 2 Project Proposal The project remains very similar to that described in the IA. However as we have developed the design it became clear that the clinical data around theatre usage made 9 theatres unsustainable in the period of this project. Therefore the design team was challenged to find a solution that provided a tenth theatre in the vicinity that improved patient flows and minimised any new build. The design proposed has achieved this, with a corresponding increase in costs. However the cost increases are in line with SCIM guidance, as the design is developed. The case for this is clearly made in that we have data that backs this up. This is in line with the projections made in the original day services business case. The project team has engaged managers and clinicians in the development of this project; this was recognised by the independent gateway team as exemplary stakeholder engagement which is ongoing and will remain ongoing throughout the project. We have had agreement from clinicians on the stage C design; they will remain involved as we develop the design further.

2 This project will do much to improve the environment we deliver care from; it is entirely compatible with the Moray Firth Master plan work which will begin the discussions on the long term reprovision of Raigmore. This investment will not be wasted; any further developments at Raigmore will either incorporate this work or be delivered far enough into the future that this work would remain necessary to maintain services. 3 Contribution to Board Objectives This project will contribute to achievement of Better Health, Better Care, Better Value by providing the facilities to better care for patients throughout their care. This project will also ensure the projects we deliver achieve best value and demonstrate this is done. 4 Governance Implications Staff Governance Staff consultation is built into every project and this is will continue. Patient and Public Involvement Patient representatives are not required for this project. Clinical Governance This Project does not have Clinical Governance issues at this stage. Financial Impact There is a significant initial capital cost associated with this business case. This would exceed the funding available in the Board s formula funding for capital and this document therefore sets out a case for specific funding of 26m from the Scottish Government. The recommended option would also generate recurring capital charges of 782K, recurring revenue savings of 70K and non-recurring costs mainly during the construction phase of the theatres of 398K, which will need to be factored into financial plans going forward. There is no national funding for this however the revenue consequences are mitigated by some efficiencies resulting from co-location of services, and also allows for an expansion of 4 high dependency beds. 5 Risk Assessment The project has its own Risk Register, the main risk are in not progressing with the project. 6 Planning for Fairness An Equality and Impact Assessment meeting will be conducted if this project is moved on. 7 Engagement and Communication The project will require a communication strategy if moved forward to the next stage. Eric Green Head of Estates Linda Kirkland Interim Director of Operations, Raigmore (Project Officer) 26 September

3 NHS Highland Raigmore Hospital Critical Care Consolidation and Theatres Refurbishment (with necessary realignment of Services) Outline Business Case Rev th September 2014

4 1 PROJECT TITLE AND PROPOSED INVESTMENT 3 2 EXECUTIVE SUMMARY 5 3 INTRODUCTION 14 4 STRATEGIC CASE 24 5 ECONOMIC CASE 67 6 DEVELOPMENT OF THE PREFERRED OPTION 94 7 SUSTAINABILITY CASE COMMERCIAL CASE FINANCIAL CASE MANAGEMENT CASE CONCLUSION GLOSSARY APPENDICES 131 A APPENDIX IA APPROVAL CORRESPONDENCE B APPENDIX SMART INVESTMENT OBJECTIVES C APPENDIX BENEFITS CRITERIA LINK TO OBJECTIVES D APPENDIX LIST OF KEY STAKEHOLDERS E APPENDIX CATEGORIES OF CHOICE ASSESSMENT F APPENDIX SWOT ANALYSIS G APPENDIX OPTIMISM BIAS CALCULATIONS H APPENDIX ECONOMIC CASE COST ANALYSIS I APPENDIX STAGE C DESIGN REPORT J APPENDIX SCHEDULE OF ACCOMMODATION K APPENDIX DESIGN STATEMENT L APPENDIX FINANCIAL CASE COST ESTIMATE M APPENDIX RISK REGISTER N APPENDIX CURRENT PROGRAMME O APPENDIX BENEFITS REALISATION PLAN P APPENDIX CAPITAL EQUIPMENT LIST REVISION PURPOSE ISSUE DATE 12 Issued for NHS Highland Board Approval 19 th September

5 1 Project Title and Proposed Investment The title of the project is as follows: Critical Care Consolidation and Theatres Refurbishment (with necessary realignment of services) at Raigmore Hospital. This document presents the Outline Business Case (OBC) which has been developed by NHS Highland in accordance with the Scottish Government Health Directorate (SGHD) Capital Investment Manual (July 2011). This document provides evidence that the proposed project is robust, affordable and deliverable. It also provides clear guidance with regards to objectives, timescales, measurability and governance. The OBC proposes an investment to consolidate critical care services, and the necessary realignment of some other services to facilitate this, within the Tower Block at Raigmore Hospital. Critically, the investment will also address the current compliance issues and deficiencies associated with the Tower Block and the Theatres on the first floor adjacent to the Tower Block. In addition to the immediate benefits arising from these investments, there will be ancillary functional and operational benefits arising from the improved adjacencies for the other acute services, arising from the realignment of services. The proposed investment is aligned with and provides a substantial platform for any future development at Raigmore Hospital, but excludes any changes to the overall bed capacity (however 4 beds have been changed from Level 1 to Level 2 care) and theatre capacity provision which will be the subject of wider masterplan study. The project will address the immediate deficiencies of the accommodation, fittings and services infrastructure associated with the current Critical Care accommodation and the Theatres, so that facilities are commensurate with modern healthcare standards and comply with Building Standards. NHS Highland has commissioned a strategic review of health care provision in the Moray Firth area titled the Moray Firth masterplan. Both clinical and non-clinical facilities are being considered with options for optimal future Healthcare provision in the Highlands linked to clinical need over the foreseeable future. The Critical Services Upgrade proposals considered within this document are fully aligned with the wider rationalisation and coordination plans of NHS Highland services in the Moray Firth Masterplan area. The key findings which emerged in relation to the need for the consolidation of critical care and theatres refurbishment, at Raigmore Hospital, through the development of the approved Initial Agreement, have been further considered and reiterated through the development of this Outline Business Case. Implementing the proposed investment will address a range of deficiencies which exist across the Critical Care and Theatres accommodation, the most crucial of which are summarised as: Critical Care Accommodation the current lack of integrated critical care, the poor adjacencies and the inadequacies in the physical accommodation all have a significant impact on the quality of care given to critically ill patients at the hospital. Along with these patient care issues, it is clear that the associated inefficient working practices also lead to poor staff morale and increased revenue spend. The investment will also provide improvements in fire safety infrastructure and Building Standards. Theatre Accommodation the existing operating theatres and ancillary accommodation fail to meet modern standards, in terms of fire safety infrastructure, 3

6 infection control, ventilation, space provision, compliance with relevant current clinical guidance, and Building Standards. The proposed investment includes for the replacement of the modular theatre which is currently leased by NHS Highland, with an SHTM compliant theatre within the theatre block which will provide a more efficient and productive facility in terms of adjacency to ancillary facilities and personnel. The investment will provide facilities which enable Raigmore Hospital to achieve its strategic objectives and deliver a healthcare service which is commensurate with its status as the main acute hospital in the Highland region. The outcomes will address the shortcomings noted above and provide modern healthcare facilities which will enable staff to provide a vastly improved level of service to vulnerable patients, in line with the NHS Highland vision of providing Quality care to every person every day. 4

7 2 Executive Summary 2.1 Introduction This Outline Business Case (OBC) introduces NHS Highland s project Critical Care Consolidation and Theatres Refurbishment (with necessary and provides evidence that the proposed project is affordable, deliverable and robust. The project is presented on the basis that the current facilities for critical care services and operating theatres are inadequate. The OBC provides clear guidance with regards to the project objectives, timescales, benefits realisation and governance. NHS Highland presented an Initial Agreement document titled Critical Care Consolidation and Theatres Refurbishment (with necessary to the Scottish Government Capital Investment Group (CIG) in July 2013, which was subsequently approved in August Existing Situation Raigmore Hospital, in Inverness, is the only acute district general hospital (including specialist services) for patients in the Highlands, serving patients from its own and adjacent Health Board areas. The Hospital comprises part single, part two, part three and an eight storey block ( the Tower Block ) covering an overall foot print of circa 94,000 m 2. The Tower Block forms part of the original Phase 2 development of Raigmore Hospital and was opened in It is the most prominent part of the Hospital, comprising ward and associated accommodation on 8 floors, providing various medical and surgical services. Due to the age and condition of the Tower Block building at Raigmore and the lack of backlog maintenance works, there are a number of deficiencies with the existing accommodation which need to be addressed, and these are summarised below. Critical Care Services Critical care services, both Medical and Surgical related, are currently provided within different wards spread around the Tower Block, arising from development over a historical period. The dispersed services create a number of inefficiencies with the delivery of patient care as set out in the table below: Issue Description Lack of Integrated Critical Care with Single Nursing Management Function With regard to the provision of Critical Care, the historical sequence of developments has been supported by the notion of placing Critical Care services close to their various specialties. Historically, the development of HDUs has been unplanned and haphazard and largely relied on the interest of local clinicians to drive development. Raigmore Hospital s Critical Care service is spread across 3 floors, 4 departments and 2 clinical directorates, Medical and Surgical. The study confirms that this results in increased nursing and administration costs, a lack of flexibility, and a less patient focused service. 5

8 Issue Description A major thrust of the 2 Health Department reports on Critical Care (DoH 2000, SEHD 2000) is the need for flexibility in the provision of service. Hugely significant is that both of these Reports (DoH 2000, SEHD 2000) recommend that, wherever possible, all Critical Care beds should be in adjacent locations: Economies of scale and great benefits of flexibility can be achieved by siting HDUs in or next to ICUs, with use of a common nursing workforce. With such an arrangement, a bed can be an HDU bed in the morning and an ICU bed in the afternoon, or vice versa, depending on need (SEHD 2000). Flexibility is the real key to coping with growing pressures, especially peaks in demand (SEHD 2000). Too High Level of Occupancy Lack of HDU and CCU Beds / Too early Discharge Respiratory Medical Ward Operating as HDU Too High a Level of Care Poor Patient Flow Inappropriate Admission Policy The data showed Raigmore Hospital having high occupancy, but with much lower (but similar) occupancy in the 3 RGHs. The high occupancy within Raigmore Hospital reflects that it is the main provider of acute services in NHS Highland. A frequently cited or recorded reason for patients that required a Level 2 standard of care being in general wards was lack of HDU or CCU beds. A lack of available beds is directly related to levels of occupancy. The occupancy level for the 2 HDUs and CCU was high. Several patients within general ward areas were assessed as requiring a Level 2 standard of care, having been discharged too early from an HDU. Results reveal that 44% (12/27) of all ward-based medical patients assessed as requiring a Level 2 standard of care were in respiratory medicine. Results from the Needs Assessment Audit for Raigmore Hospital show that 33% (29/87) of all patients in the 2 HDUs and CCU were receiving too high a Level of Care. Poor patient flow was identified. Ultimately, better management of patient flow between areas will maximise opportunities for critically ill patients to receive high quality care in an appropriate setting. The study provides evidence to suggest that there is inequitable critical care access for medical and surgical patients e.g. some cases of medical care patients with a requirement for ward-based Level 1 care, being placed in Medical HDU. Consequently there will be other patients receiving too low a level of care due to lack of critical care facilities. Similarly there was evidence to suggest there was inappropriate discharge policy for Surgical HDU. This was to relieve pressure on nursing staff within the 2 step-down surgical wards by delaying the transfer from Surgical HDU of recovering patients who would require a high degree of Level 1 care. 6

9 Issue Lack of Available Critical Care Beds for Cardiac Patients Lack of Isolation Facilities ITU deficiencies Too High Level of Care Lack of HDU beds Description During the data collection process, the Project Co-ordinator noted that patients were admitted to wards with cardiac conditions that merited admission to CCU. However, at assessment these patients were no longer requiring a Level 2 standard of care. This information is noted to again show the extent of need for Critical Care beds. A model of care has existed over several years whereby Level 2 general medical patients needing isolation facilities are admitted to CCU, even though these patients have no cardiac conditions. (A reciprocal arrangement allows for the admission of a cardiac patient to the Medical HDU, should CCU be full in consequence of having accepted a noncardiac patient.). The Medical HDU, as previously described, has no single rooms. It is the only Critical Care Unit in Raigmore Hospital that is unable to provide isolation facilities to critically ill patients. The design of the ICU has not altered in almost 30 years since Raigmore Hospital was built. Some aspects of design are lagging. For example, the Unit has isolation facilities for just 2 patients. In recent years, this has proved inadequate with infectious patients also being managed in the 6 bedded bay area. This leads to the temporary closure of beds adjacent to the infectious patients as part of measures to prevent crossinfection. Therefore, the out-moded design of the ICU impacts on its ability to operate an efficient and cost-effective service. But there are other design faults with the ICU. For example, the visitors entrance/exit to the Unit (that is, the public access) necessitates close proximity to the medical equipment and intravenous fluids store rooms. Whilst nursing staff will endeavour to escort family members to and from the Unit, this cannot be guaranteed at times when staff are operating under extreme pressure. With regard to these issues of infection control, security and efficiency, there is clearly a requirement for the design of the ICU to be up-graded. Results from the HDU Needs Assessment Audit show that 7% (3/41) of patients in the ICU were receiving too high a Level of Care. This, as will become evident, relates to structural deficits necessitating a Level 3 care requirement where the true requirement would have been for Level 2 care. Within Raigmore Hospital, there is the need to address the various factors that inflate demand for Critical Care beds sub-optimal bed management; sub-optimal care at ward level; inappropriate admission and discharge policies; lack of CCU ownership of cardiac triage; lack of isolation facilities in Medical HDU and wards; uneven scheduling of surgical activity; knowledge/skills deficit at Level 2 and lack of a colocated, integrated Critical Care service with a single nursing and medical administration. Therefore, additional investment in Critical Care beds should be sequential to maximising the efficient and effective use of existing Critical Care beds. 7

10 Issue Description That said, the findings of this report also support that there is under provision of HDU beds, especially Medical HDU beds, within Raigmore Hospital. Lack of HDU Beds This also relates to too high level of care being provided (in ICU) due to lack of HDU beds to facilitate discharge from the ICU noting that the cost of beds in ICU is approximately double that of HDU Therefore, it may be reasonably asserted that there is a shortfall of 4 HDU beds, especially Medical beds, within Raigmore Hospital. ICU Beds Consideration must also be given to ICU bed provision. The very high occupancy data for 7 staffed ICU beds (86% during this study; 78% according to SICSAG (2009) data) support that an additional ICU bed should be funded. But as with the earlier discussion, this should be sequential to addressing the factors that inflate demand for ICU beds lack of HDU beds; inequity of access to Medical HDU beds; lack of CPAP provision in Surgical HDU; and lack of a co-located, integrated Critical Care service with a single nursing and medical administration. If these factors are addressed successfully then the current ICU bed provision is likely to prove adequate Theatres Raigmore Hospital s main operating theatre department has existed, along with the Tower Block, for a period of almost 30 years without any significant refurbishment. During that period there have been significant improvements in theatre practice, which whilst beneficial, has resulted in an increasing amount of necessary equipment with a consequential demand for space. Furthermore, due to the lack of refurbishment over this period, the existing fit-out and services infrastructure has fallen well behind SHTM s and other relevant standards. A summary of the various issues is provided in Section 4 of this OBC and these include issues with fire safety precautions, storage, HAI compliance and ventilation compliance. 2.3 Strategic Context NHS Highland provides strategic leadership and direction for NHS services and is accountable to the public and to the Scottish Government for all elements of the NHS system in the Highland and Argyll & Bute Council areas. As of 1st April 2012, with the integration of health and social care in the Highland region, NHS Highland is the lead agency for the delivery of Adult services across health and social care (The Highland Council are the lead agency for children's services). NHS Highland works with partners to improve the health of local people and the services they receive and to ensure that national clinical and service standards are delivered across the NHS system. NHS Highland is working to improve services with the involvement and support of the public, partners in other NHS Boards, Highland Council, and other independent and voluntary agencies. Section 3 of this document details NHS Highland s vision, aims and its principal constraints in the context of key national and local drivers including the Local Development Plan. 8

11 2.4 Background Following recommendations in a report by a Working Group of the Scottish Medical Scientific Advisory Committee (SMASAC) NHS Highland undertook a study to review High Dependency Unit (HDU) facilities to make recommendations on the development of a Critical Care Strategy within NHS Highland. The comprehensive study identified various deficiencies including the care issues associated with the highly dispersed nature of critical care and high dependency units in the Tower Block and lack of integrated critical care facilities, poor adjacencies and various other inadequacies in the accommodation. The NHS Highland study identified that these deficiencies currently have a significant impact on the quality of care of critically ill patients at the hospital. It was also clear that the associated inefficient working practices has led to reduced quality of patient care and staff morale. This OBC presents a proposal for an investment which will address existing deficiencies in Raigmore s Tower Block and adjacent Theatre facilities, including the dispersed nature of critical care services and significant compliance issues throughout. The current ongoing Fire Precautions Upgrade project presents a unique opportunity to undertake the much needed improvements, at a time when existing wards will be vacated. 2.5 Service Objectives NHS Highland has a published Local Health Plan that adheres to the national format. This sets out the strategic direction for the Board, provides evidence of performance to date and plans to address the national targets, which are detailed within the Local Delivery Plan. This plan sets out a simple vision for the people of the Highlands: Quality care to every person every day In delivering this vision, three key elements must be delivered simultaneously: Better Health improving the health of the population Better Care enhancing the experience of care for individuals Better Value controlling the per capita cost of care 2.6 Case for Change The aim of the project is to both overcome the shortcomings of the current built environment and facilitate and enable changes in service provision to meet the specific needs of the clinical service. Local and national drivers were reviewed to ensure these were appropriately identified and addressed where possible. 2.7 Critical Success Factors The key stakeholders have undertaken a review of the Investment Objectives and potential benefits, identifying the following list of Critical Success Factors: 9

12 No Critical Success Factor 1 The achievement of the project within the available financial parameters of NHS Highland (revenue funding). See section 9 for further information on funding 2 Consolidating high dependency units and critical care in order that clinical and administration efficiencies are delivered 3 Achieving the position where an increased percentage of patients have the correct level of care provided at all times during their hospital stay 4 Establishing a position whereby Theatre adjacency is at a more optimal and safe level with a reduced number of cancellations for scheduled surgery 5 Compliance with all relevant Health Guidance (unless otherwise agreed as being inappropriate) including HAIScribe guidance to ensure facilities are commensurate with current policy and reduce the risk of health related infection spread 6 Avoid significant disruption to existing clinical services 7 Quality Delivery of key stakeholders (including community representatives) expectations is critical to the success of the project. AEDET reviews will be undertaken and will achieve a minimum target score of 4/6 in all categories 8 Sustainability. The achievement of BREEAM pragmatic based on the refurbishment nature of the development 9 Health & Safety Delivery of the investment in a safe and effective manner with no adverse effect on the health & safety of patients, staff, visitors and construction delivery team 2.8 Summary of Short Listed Options Key stakeholders subsequently undertook a SWOT analysis of the long list of options to establish a shortlist of options to be taken forward for more detailed assessment at Outline Business Case Stage. The options selected are a combination of the scoping service solution, implementation and funding options noted above. A summary of the results is provided in Appendix E. In summary 6 key high level options were established (in addition to a Do Minimum option). Due to the complexity of the options, they are represented by the following table. 10

13 Do Minimum Option 2 Consolidate Critical Care Option 3 Consolidate Critical Care + Combined Assessment Unit Option 1 Option 2 Option 2A Option 2B Option 3 Option 3A Option 3B The Current configuration but assume - fire precautions works (ongoing) - endoscopy development but at ground floor of Tower - Upgrading of CCU, AMAU/MSCU, SHDU, Therapy, ITU, Critical Care Waiting, 1A(CAL, EDCU, SDCU, ITU - - All to be retained at their current location Consolidation of Critical Care on Ground and First Floor Levels based on acuity Co-locate AMAU and CCU on ground floor Cardiology also co-located on ground floor Co-locate ITU/SDHU on first floor MHDU at First Floor MHDU at Ground Floor Co-locate CCU and MHDU at Ground Floor No PACU Post No PACU Anaesthetic Care at Level 1 1A (CAL / Surgical DC / Eye Day Care to Ward 8 CAL / Surgical Day Case to Level 1 Surgical Triage to remain at Level 4 Consolidation of Critical Care on Ground and First Floor Levels based on acuity. Plus Combined Assessment Unit Combined Medical Assessment Unit on ground floor Cardiology remains on Level 6 CAL / Surgical Day Case to First Floor Co-locate CCU and MHDU at 1 st Floor CAL / Surgical Day Case to Ground level Co-locate CCU and MHDU/Short stay beds at Ground Floor Post Anaesthetic Care at Level 1 CAL / Surgical Day Case to First Floor Surgical Triage relocated to Ground Level Potential to move Renal Dialysis moved to Level 7 separate Investment Endoscopy at Level 6 Gynae/Breast (Ward 8) into Tower - Level 5 Respiratory moved into Tower Level 6 Medical Ward adjacent to Therapy Oncology & Haematology moved to Level 5 Child Ward moved out of Block (Ward 11) - Vascular Laboratory added at 5C Endoscopy re-locate to Ward 8 (funded secured) Gynae/Breast (Ward 8) to amalgamate to Ward 9 (funded secured) - Vascular Laboratory added at 5C Potential to provide Eye Day Case into the accommodation formally occupied by Renal (separate investment). However, this investment only to include limited allowance for Eye Day Case, currently in 1A 11

14 In addition to the above short-listed options for the consolidation of Critical Care services, a shortlist of options to deliver the benefits required for the theatre was developed for consideration, and this is tabled below: Theatre Options No Description Do Minimum Carry out backlog maintenance and fire safety upgrade works to the existing theatres. Reconfiguration of Theatre Block layout Carry out the backlog maintenance and fire safety upgrade works and alter the configuration of the ancillary /support facilities. Jack & Jill Theatre Provides shared wash and preparation facilities between theatre pairs. Barn Theatre Provides a Barn theatre space which houses 3 operating tables, while maintaining the remaining 6 individual theatres. Integrated Option Maintain the existing 9 theatres and add a 10 th theatre through reconfiguration of the ancillary/support facilities. 2.9 Non-Financial Benefits Review An extensive non-financial option appraisal was conducted for the options to consolidate Critical Care and the theatre elements of the proposed investment. The conclusion of this non-financial benefits process was that the preferred non-financial options were Option 2A and Option 5 for the Critical Care and Theatres elements respectively Results of Economic and Financial Appraisal In addition to the non-financial appraisal, capital costs and revenue cost estimates were established based on delivering on the identified investment objectives. An analysis of the Net Present Values (NPV) of the 7 Critical Care options, and the 5 Theatre Options indicated that Option 2A (critical care) and Option 5 (theatres) provided the best Value for Money (VfM) analysis which compared the cost per benefit point of the options. This is clearly tabled and detailed in Section 5 and in Appendix H of this document Outcome The results of the Economic and Financial Analysis consolidate the position of Option 2A (2014) for Critical Care Consolidation and Option 5 for Theatres as the preferred options, alongside that of the non-financial benefits. The preferred options optimise the use of the available accommodation to improve the facilities for patients, staff and visitors. These options are based on a model of service provision that is similar to that currently employed at Raigmore Hospital, but seeks to further integrate critical services and theatre services respectively, and have the potential to significantly improve patient care. Further improvements to the current service will be achieved through the provision of increased storage which will allow the removal of equipment which is currently stored in corridors, 12

15 and presents a constraint to the fire evacuation strategy within the Theatre block. The improved storage will also create a scenario where there is less damage to trays, and therefore reduced theatre downtime due to unavailability of instruments because of the result of tray damage. The HM Treasury Model has been used to demonstrate Value for Money Commercial Approach The Commercial Approach recommended for the proposed investment is detailed in Section 8 of this document. This recommendation favours the use of the Health Facilities Scotland Frameworks 2 to procure the project, utilising an NEC Contract to deliver a collaborative team-working approach which has proved successful on the Frameworks 1 projects which have been undertaken at Raigmore Hospital over the previous 4 years. This approach is consistent with SCIM guidance which assumes that Frameworks Scotland is the default procurement route for acute construction projects and all refurbishment projects in excess of 1m Affordability The affordability of this investment for NHS Highland has been assessed and the outcome is detailed in Section 5 of this Outline Business Case Benefits Realisation A Benefits Realisation Plan has been developed which will enable NHS Highland to identify, measure and manage the benefits which this project is intended to deliver. It is imperative that the perceived benefits to arise from this investment are identified, measured and managed for a stated period of time to formally record the benefits which are realised, and those which do not arise as anticipated. The Benefits Criteria articulated in this document are all desirable outcomes for the project that can be achieved by the Preferred Solution 2.15 Summary of Key Dates A summary of the estimated key project dates is provided in the table below: Table 2.1 Project Stages Stage 1A: Completion of OBC October 2014 Stage 1B: Completion of FBC April 2015 Stage 2: Construction Stage May 2015 Completion date May Scottish Capital Investment Manual (SCIM) Compliance This OBC has been prepared in accordance with the requirements of the Scottish Capital Investment Manual and presents the programme s objectives, benefits, risks, costs and other relevant information. 13