Full Business Case. County Hospital Outpatients (Executive Summary) May Contents

Transcription

1 County Hospital Outpatients (Executive Summary) May 2016 Contents 1 Executive Summary Introduction & Background Commissioner and Stakeholder Support Capital Programme Case of Need Economic case Summary of FBC Scheme Capital Cost summary Financial Case Management Case Timescales UHNM Trust approval Recommendation 5 1

2 1 Executive Summary 1.1 Introduction & Background In February 2014 the Secretary of State approved the Trust Special Administrators (TSA) recommendations for the future of Mid Staffordshire NHS Foundation Trust. This recommended that University Hospital North Staffordshire NHS Trust assumed responsibility for the staff, assets and services delivered at the former County Hospital and Royal Wolverhampton Trust assumed these responsibilities for Cannock Chase Hospital. The entity of Mid Staffordshire Foundation Trust was to be dissolved. In July 2014 the Board approved the Acquisition Business Case for County Hospital and submitted it to the NHS Trust Development Authority for their consideration. The Acquisition Business Case proposed that University Hospitals North Staffordshire NHS Trust acquire the services and facilities from Mid Staffordshire Foundation Trust. The acquisition was to be undertaken on the basis that the clinical model set out in the Trust Special Administrator s report dated December 2013 would be implemented. Following the approval of the Acquisition Business Case, and a subsequent Addendum November 2014 by the Trust Development Authority, the University Hospital of North Staffordshire NHS Trust acquired the responsibility for the delivery of a number of clinical services at Mid Staffordshire NHS Foundation Trust for a period of 29 months from 1 November The two Trusts combined to form the University Hospitals of North Midlands NHS Trust. This Full Business Case presents the case for refurbishment work in the Outpatients Department at the County Hospital site. This Business Case sets out the need for 1,337,000 capital. This investment is to support the implementation of the model of care approved by the Secretary of State in February 2014 and is one of a series of cases that will be submitted by University Hospitals of North Midlands NHS Trust against the agreed 83.2m capital allocation outlined in the Acquisition Business Case. The urgent requirement to complete capital works that enable University Hospitals of North Midlands NHS Trust to implement the Trust Special Administrators model has led to the decision by University Hospitals of North Midlands NHS Trust to proceed straight to Full Business Case bypassing the Outline Business Case stage. University Hospitals of North Midlands NHS Trust understand the risk of doing this and in an attempt to mitigate this risk have ensured that the Full Business Case addresses the option appraisal work. In addition it is recognised that to achieve the target timescale of completion by April 2017 the usual approval processes will be fast tracked to ensure that the commencement and implementation of this project is not delayed. 1.2 Commissioner and Stakeholder Support The standard process for the development of a large capital investment of this nature would be for the Trust to develop a programme setting out options that would be consulted on widely with a range of stakeholders. In this instance the principles underlying the need for significant investment were tested by the Trust Special Administrators process. The Trust Special Administrators model of care was widely consulted upon with Commissioners, Staff, Patients and Regulators. Commissioners confirmed their support for the Trust Special Administrators model of care. Details of this process are set out in the Acquisition Business Case, Section 2.

3 1.3 Capital Programme The acquisition of services and facilities from Mid Staffordshire NHS Foundation Trust required changes to be made to both the County Hospital and the Royal Stoke University Hospital estate. This will enable University Hospitals of North Midlands NHS Trust to meet regulatory and commissioner requirements and to deliver the benefits and synergies identified in the Acquisition Business Case. The Capital Business Case (July 2014) formed an appendix to the Acquisition Business Case and presented a number of investment projects across the estate to ensure that: Each hospital site delivers the optimal solution; The overarching capital investment programme achieves the desired outcomes set out in the Acquisition Business Case. The Capital Business Case requested a total capital allocation of 83.2m which will be applied for via a number of separate business cases each business case will be a subset of the total funding solution. This enables individual elements to be finalised whilst ensuring that the capital programme can be completed within the agreed 29 month timescale. In addition to the 83.2m provided by the Trust Development Authority through the Capital Business Case, University Hospitals of North Midlands NHS Trust is contributing over 16.5m of operational capital towards the works required to configure both hospital sites. 1.4 Case of Need The TSA model confirmed that Outpatients Clinics would continue to be provided at County Hospital and this business case supports that decision by setting out the capital requirements to maintain Outpatient services. This Full Business Case is to enable the refurbishment of the Outpatients department. The requirement for investment in the Outpatients department at the County Hospital site is driven by a number of factors identified below: The existing Outpatients department does not currently meet infection control standards, with one clean/dirty utility room currently provided for 51 clinical rooms across whole range of outpatient services. Insufficient dental/oral maxilla facial rooms, with orthodontic patients treated in maxilla facial rooms. The levels of patient privacy and dignity are currently inappropriate, impacting upon patient experience. For example there is no separation of children and adult services which can cause significant issues for the patients experience and cause distress. An example of this is that a large proportion of orthodontic patients are under the age of 16 years and have to share a small wait with adult patients, some of whom are being treated for disfiguring facial conditions, such as trauma and head and neck cancer. Due to other service transitions associated with the implementation of the TSA model between County and Cannock Hospitals, there is a need to provide appropriate number of clinical rooms for services provided at County Hospital. The physical layout of the Outpatients department is inadequate and there is a requirement to provide a trolley wait area to support better privacy and dignity. The patient movement, the patient experience and workflow practices are compromised by the existing arrangements. Inappropriate environment to delivery ambulatory outpatient services (heart failure). Lack of patient counselling provision. The Facilities Management rooms are inadequate for the size of the outpatients department and do not comply with national and local policy. 2

4 The existing functional content does not meet the expected future activity and service delivery requirements. The key objectives are to create an Outpatients service which will facilitate changes in the model of care and patient flows leading to an enhanced service for patients and achieving: Compliance with infection control best practice guidance. Improved Patient Safety. Improved environment to deliver service resulting in greater clinical efficiency and effectiveness for Clinical and nursing staff. Improved Patient Dignity and an enhanced department with improved privacy including the separation of Adult and Children patient flow within the department. Additional interview/consulting facilities. 1.5 Economic case The economic appraisal determined that the preferred option for the delivery of the project objectives is Option 2 which incorporates a refurbishment of the existing Outpatient areas at the County Hospital. See further details in Section 3. This option has been selected on the basis that it will: Enable delivery of the TSAs clinical model. Realise the required benefits and project investment objectives. Be delivered within the necessary timescales and within the constrained capital envelope. Enable improved capacity for the continued delivery of Outpatient care i.e. the right level of clinical care in the right location. Demonstrate a low cost per benefit point when compared to a full refurbishment. 1.6 Summary of FBC Scheme The total scheme is to create a series of new clinical spaces and address existing maintenance issues for Outpatients with the objective of: Creating facilities that meet clinical working practices and flows. Improving patient flow throughout the outpatient department. Improving Infection Control and Prevention. Works include: Provide appropriate number of dirty and clean utilities to support Infection Prevention. Re-provision and refurbishment of consult/exam/treatment rooms. Relocating disposal rooms to improve Infection Prevention. Providing appropriate weights and measures rooms to improve patient flows and provide better patient privacy and dignity facilities. Providing compliant Facilities Management rooms. Addition of a trolley wait area. Provide patient counselling room. Provide appropriate patient area for ambulatory outpatient services. Creating a Children s waiting area for Maxilla/facial patients and orthopaedic patients. 3

5 1.7 Capital Cost summary The total capital cost of the proposed works is 1, as detailed in the table below. GMP prices have been obtained for the some elements of the scheme. The Measured Terms Contract process will be followed for other elements. Table 1: Capital cost summary 1.8 Financial Case Option 2 Total construction Cost 854,864 Trust Fees 132,441 Equipment 84,583 Non Works cost 24,000 Trust Risk Contingency 70,709 VAT 206,831 VAT recovery ( 36,428) Total Cost 1,337,000 This Full Business Case sets out the need for: 1, 337,000 capital expenditure funding requirement in the form of exceptional Public Dividend Capital (PDC) as set out in the ABC, and The funding requirement for revenue expenditure is limited to the need to fund additional capital charges and as stated in the original Acquisition Business Case. Any additional revenue costs associated with service delivery will need to be determined as part of the Trust s Annual Business Plan. Both the revenue and capital implications of the proposed investment have been considered and reflected in the Trust s Long Term Financial Model. The Long Term Financial Model demonstrates the affordability of the proposed development. 1.9 Management Case Delivery of the overall capital programme will be governed by the Trust s Capital Investment Group to ensure the effective management of the programme. The Programme Board will provide the essential oversight of programme delivery, costs, benefits, risks and dependencies. The Programme Board will report to both the Capital Investment Group and the Trust Executive Committee. Figure 1: Management Structure 4

6 1.10 Timescales The key milestone periods relating to the Full Business Case for the reconfiguration of Outpatients are shown below: Table 2: Key Timescales Outpatients Element Milestone completion Date Design Development 29/02/2016 Business Case Submission to NHSI May 2016 Mobilisation starts May 2016 Construction starts June 2016 Completion December UHNM Trust approval All capital business cases needed to deliver the proposals in the Acquisition Business Case and the subsequent Addendum require formal approval from the appropriate delegated body of the Trust. With the capital value of this particular scheme being 1,337,000 approval is being sought from the Trust s Finance and Efficiency Committee. To be able to be considered for approval this business case needs to demonstrate that it meets five tests as follows: To be part of the Acquisition Business Case The Outpatients Department was identified as a key scheme in the Acquisition Business Case To be covered by the capital allocation Within the ABC, the capital allocation for outpatients was combined with the emergency centre. The allocation was originally set at 4,047,000 as identified in the Capital Appendix of the Acquisition Business Case. The final cost of the Outpatients project is 1,337,000 and overall remains within the total allocation of 4,047,000. To be included within the revenue allocation identified within the Acquisition Business Case, or to have the revenue implications approved from other sources. The revenue provision to provide a full range of outpatient services was identified within the Acquisition Business Case. To deliver the functional benefits envisaged including quality and safety this Full Business Case aims to deliver the following functional objectives and benefits in line with the agreed Objectives and Benefits (see appendices): Ensure implementation of TSAs clinical service model within designated timescales Improve patient privacy and dignity; reduce control of infection risks; provide appropriate capacity to deliver the TSAs model and the UHNS service model. Improve functional relationships/adjacencies and increase operational efficiency. Address legacy estates issues to provide a safe patient environment, i.e. statutory compliance, Eliminate high-risk backlog maintenance. Provide improved working environment for staff. Ensure the Trust receives value for money from capital investment To be in keeping with the Trust s 2025 Vision this Full Business Case works towards the Delivery of Patient Excellence and building on defining core services Recommendation The Committee is recommended to approve this Full Business Case on the grounds it meets the five tests as set out in Integrating Health Services for Staffordshire Capital Expenditure Report. 5