Project Mandate Commissioning future clinical services at Clevedon Community Hospital Authors Ellie Devine/Ben Bennett/Debbie Clark Project Sponsor Jeanette George Project Director Ben Bennett Project Manager Ellie Devine Version no. 0.8 Version Date Comment 0.1 27.02.13 Document created 0.2 08.03.13 Second draft 0.3 09.03.13 Third draft 0.4 11.03.13 Fourth draft 0.5 02.04.13 Fifth draft 0.6 03.04.13 Sixth draft 0.7 04.04.13 Seventh draft Version control Status Final Project Aim To develop, sustain and improve the provision of high quality health care for the Clevedon catchment area If you need this document in a different format please telephone 01179841597 Page 1 of 11
1 Introduction 1.1 Document purpose This Project Mandate defines the scope of the proposed project to identify and develop the options for the commissioning of future clinical services at Clevedon Community Hospital, for review and approval by NHS North Somerset Governing Body. Whilst the Community Hospital is a resource for the population of North Somerset, the majority of services are delivered to the Clevedon catchment area which for the purposes of this project and in order to understand capacity and demand includes the following areas: Backwell, Clevedon, Congresbury, Long Ashton, Nailsea, Portishead, Yatton, Winscombe, Wrington and the Worle fringes. These populations are estimated to total approximately 100,000 people. Following approval of this mandate, a Project Initiation Document (PID) will be created, expanding upon this document, to provide the detailed framework for the project. 1.2 Project context The drivers for change include: 1. The need to ensure that services at Clevedon Community Hospital help to meet the needs of the Clevedon catchment area whilst delivering best value for commissioner investment 2. The commitment of the Clinical Commissioning Group to commission services outside of acute hospital settings and closer to home wherever clinically appropriate and cost effective to do so 3. The recent Clevedon Community Hospital conditions survey indicating that whilst services are being safely provided within the current building it is not possible to upgrade inpatient facilities in line with modern healthcare standards. 4. The requirement to replace the current diagnostic imaging equipment in order to be able to expand the range of outpatient and diagnostic services available at Clevedon Community Hospital 1.3 Proposed approach The establishment of a formal project reflects the intention of the North Somerset Clinical Commissioning Group to develop sustainable proposals for improving the provision of local high quality health care for the Clevedon catchment area. The intention is to build on the existing work already undertaken on the future provision of clinical services at Clevedon Community Hospital. A co-production methodology will be followed in order to ensure that service users have shared ownership and shared responsibility in the project and its decision making from the outset. It is proposed that the Project has a mandate to develop recommendations for both the future provision of rehabilitation services including local inpatient provision and outpatient services with associated diagnostic imaging and therapies. Page 2 of 11
Both clinical leadership and user involvement in the process will be critical to achieving a successful outcome which focuses on the needs of the community and how services need to be configured to meet future local need. 2 Project Definition 2.1 Objectives The project objectives currently identified are listed below 1. To define current activity and capacity for outpatient services including diagnostics at Clevedon Community Hospital. 2. To define the commissioning requirement for local outpatient, diagnostic and therapy services for the Clevedon catchment area. This will build on work undertaken previously on outpatients, diagnostics and therapy services with GPs and other partners as part of delivering the development of a new hospital. This will include defining activity requirement by specialty where possible. 3. To identify the demand for inpatient services at Clevedon Community Hospital, taking into account current capacity and the balance between inpatient and community based rehabilitation services and GP led/safe haven beds required for North Somerset patients and specifically for the Clevedon catchment area. 4. To identify options for diagnostic imaging including the replacement of equipment as appropriate. (This may include diagnostic support opportunities to the MIU) 5. To engage with local patient, public and clinical stakeholders in the Clevedon catchment population on the development of commissioning intentions based on the options identified for outpatient, diagnostics, therapy and inpatient services. 6. To identify detailed and evidenced based options with recommendations for the future provision of inpatient and community based rehabilitation services for the Clevedon catchment population. 7. To establish the capacity and capability of existing providers and of providers in the wider market to meet commissioning requirements 8. To determine the appropriate commissioning or procurement routes for the options considered and recommend subsequent commissioning or procurement actions for the next stage. 2.2 Anticipated benefits The project is expected to produce the following benefits: 1. Recommend a sustainable model for delivering high quality health services to patients in the Clevedon catchment area. 2. Effective engagement with local patients, public and stakeholders through the work of the project 3. Develop a clear commissioning plan (and subsequent commissioning and procurement actions) for services based at Clevedon Community Hospital Page 3 of 11
A detailed benefits plan will be developed in the next phase of work. 2.3 Project success criteria The proposed project success criteria will include the following. 2.4 Scope 1. Fully developed proposals approved by the project board and CCG Governing Body to be co-produced with the public and other stakeholders leading to agreement of a future commissioning plan for Clevedon Community Hospital. 2. Residents of the Clevedon catchment area will have access to high quality and sustainable services in a location close to home, wherever clinically appropriate and cost effective to do so. 3. All stakeholders feel they have been effectively engaged and have contributed to the development of options and agreement of commissioning plans for Clevedon Community Hospital. The project scope includes outpatient clinics (consultant led and therapy led), diagnostic facilities and inpatient services at Clevedon Community Hospital. It is also anticipated that in discussion with NHS Property Services, the commissioner proposals - once agreed - will inform decisions about the future of the Millcross site The following elements are outside the scope of this project: 1. The Minor Injury Unit as this has recently been subject to detailed review and improvement. The only element of the Minor Injuries Unit that is in scope is as a user of diagnostic services. 2. The resolution of outstanding commercial matters relating to the previous new build project. 3. Service provision outside the Clevedon Hospital site, except where the services are proposed to be transferred in or out of the site. 2.5 Constraints Proposals for improving local services for the Clevedon catchment area must be clinically and financially sustainable in the context of the wider CCG position Access to capital for investment in buildings or equipment will be a matter for NHS Property Services and service providers respectively. It is anticipated that the project team will work with NHS Property Services and with service providers to identify any building modifications or equipment issues associated with service proposals. Further to this the requirement for capital investment and any revenue consequences arising from this will be assessed by the project team and presented to the project board for consideration. Page 4 of 11
2.6 Assumptions That the commissioning proposals will be informed by patient, public and stakeholder involvement and sufficient time will be allowed in the project timetable to do this effectively. 2.7 Risks A risk and issues log will be developed as part of the project delivery. The mitigation of these risks will be integral to the successful delivery of this project. It is expected that a number of project risks will need to be considered including: 3 Interdependencies the commitment to implement the changes that are recommended by the process, even where these result in a change to the mix of clinical services on the site the availability of robust information and evidence on which to base decisions and model future service options; that the project is not able to be completed within the allocated timescale due to the capacity to undertake the review at a time when significant change is already taking place for both commissioner and provider organisations; the ability of participating organisations to identify the resources required to deliver the project. availability of capital for investment in the buildings by NHS Property Services availability of capital for investment in equipment (including IM&T) by service providers Changes in CQC regulatory requirements leading to a reappraisal of the inpatient environment suitability, which accelerates decisions about provision. The potential interdependency with other workstreams which could affect the timetable for agreeing and implementing plans for Clevedon Community Hospital A number of potential interdependencies with other projects have been identified and are summarised below. The project team will undertake further work to map these interdependencies in order to assess their relevance to the development of commissioning plans for Clevedon. Bristol North Somerset and South Gloucestershire (BNSSG) rehabilitation review BNSSG demand & capacity modelling North Somerset Integrated Care project Review of North Somerset safe-haven beds Page 5 of 11
4 Deliverables Bristol North Somerset and South Gloucestershire stroke pathway review CCG medium term financial plan and commissioning intentions. NHS Property Services maintenance programme Service strategy and operating models of potential providers, including North Bristol Trust and North Somerset Community Partnership. Weston Area Health Trust procurement. Acute services review being undertaken by University Hospitals Bristol and North Bristol Trust. Existing Healthy Future project to develop models of care and business case for ambulatory hot clinics. The following deliverables will be developed by the project team: 1. Project Initiation Document and project plan with establishment of project team, project board, stakeholder reference group and clinical reference group and other groups as required. 2. Information gathering exercise to consolidate and build upon existing information on the services and activity at Clevedon hospital including that previously completed for the new build plans. 3. Current baseline activity and capacity report for outpatients 4. Diagnostics activity and equipment review 5. Review of outpatient and diagnostic services with recommendations for future configuration of provision and their implications 6. Rehabilitation service requirements and review for the Clevedon area, with recommendations for future configuration of provision and their implications 7. A document and presentational materials outlining options with benefits and implications that can be used as the basis for engagement with patients and the public. 8. A report on the outcome of engagement with patients and the public showing how the CCGs plans have responded to what people have said. 9. A report following the outcome of engagement with patients and the public making recommendations for the Clinical Commissioning Leadership Group and Governing Body to agree on the future configuration of services 5 Project Organisation The proposed project governance arrangements are summarised below. The project will adopt the principles of good project management in relation to project controls and governance with reference to PRINCE alongside a coproduction approach with service users. Page 6 of 11
North Somerset Governing Body Clinical Reference Group Project Board Stakeholder Reference Group Project Team Work stream 1 (Outpatients and Diagnostics) Work stream (Inpatients) 5.1 Project Team The following table sets out the proposed project team. In addition consideration will be given to co-opting representatives from provider organisations - in particular North Somerset Community Partnership, Weston Area Health Trust and North Bristol Trust and from the Local Authority. Name Organisation Role Ben Bennett Ellie Devine Debbie Clark/ Jan Blews Elizabeth Williams Caroline Laing Mary Adams John Heather Commissioning Support Unit Commissioning Support Unit NHS North Somerset CCG Commissioning Support Unit Commissioning Support Unit NHS North Somerset CCG NHS North Somerset CCG Project Director Project Manager Commissioning leads for Joint and Community Services BNSSG Commissioning lead for Rehabilitation. Quality Assurance and Patient Safety Manager Co-production and Engagement lead GP Clinical Leader for Planned Care Page 7 of 11
Name Organisation Role Miriam Ainsworth NHS North Somerset CCG GP Clinical Leader for Community Services Jackie Green NHS North Somerset CCG Finance lead 5.2 Patient, public and stakeholder engagement There is a commitment to ensuring that the proposals for commissioning services for Clevedon Community Hospital that arise from this project are coproduced with patient, public and other stakeholders. A stakeholder reference group will be set up comprising: Patient Participation Group members from the Clevedon catchment area; Local councillors; League of Friends reps; Lay Volunteers, Healthwatch, representatives from provider organisation and any other interest groups. The group s terms of reference will include having an advisory role in the development and delivery of the project s communication and engagement plan. The CCG patient and public engagement manager will act as expert advisor and assure legal compliance of the engagement process The following pieces of work will inform the Communication and Engagement Plan: 5.3 Project Board An Equality Impact Screening Process and assessment A paper updating the Health Overview and Scrutiny Panel on the Project proposal to include the proposed Communication and Engagement Plan seeking comments on the proposed approach A paper updating HealthWatch North Somerset on the Project proposal asking for their input to the project and for gateways into the relevant parts of the Voluntary & Community Sector for engagement (A Service Change Readiness Assessment will be completed as appropriate as and when service changes are defined and proposed) The following table sets out the proposed membership of the Project Board. In addition the Project Director will attend project board meetings along with other members of the project team as required. Name Organisation Role Jeanette George North Somerset CCG Senior Responsible Officer and Project Board Chair Mary Backhouse North Somerset CCG Senior Clinical lead Kathy Headdon North Somerset CCG Senior Service User and PPE lead Page 8 of 11
Mike Vaughton North Somerset CCG Senior Finance Lead Liam Williams North Somerset CCG Senior Quality lead 5.4 Key Milestones and Timetable An outline summary of key milestones and a timetable is set out below. A detailed programme for public, patient and stakeholder involvement aligned with the overall milestones and timetable will be developed by the project team for approval by the project board. Further to this a detailed project plan will be developed by the project team for approval by the project board. Milestones Responsibility Timeline Project Mandate approved by April Jeanette George 19 th April 2013 CCG Governing Body meeting Establish project team, project board, Ellie Devine 26 th April 2013 stakeholder group and clinical reference group Information gathering exercise to Ellie Devine April inform project plan and workstream planning Draft Project Initiation document Ellie Devine April produced Engagement and Communication Mary Adams April Plan finalised Commence public, patient and Mary Adams May stakeholder engagement and communication Commence project team and Ellie Devine May workstream meetings Produce detailed project plan for Ellie Devine May approval by project board Project Board Jeanette George end of May BNSSG rehabilitation report Debbie Clark May outcomes reviewed Review of diagnostics activity and Ellie Devine May equipment requirements Develop first cut assessment for Project Team June future provision of outpatient and diagnostic services Develop first cut options for future provision of inpatient services Project Team June Page 9 of 11
Milestones Responsibility Timeline Review feedback from public, patient Mary Adams June and stakeholder engagement to date 2 nd Project Board Jeanette George early July Produce project board report including Project Team July/August draft options for future clinical services at Clevedon Community Hospital updated engagement and communications plan for next phase Report to Project Board Finalise governing body paper Report to CCG leadership group and Governing Body Present preferred option to HOSC and agree requirement for further engagement if indicated 7 Resourcing the project Jeanette George Ben Bennett Project Board Ben Bennett 12 th September September October October Project management will be provided by NHS South West Commissioning Support through the existing block contract and will include: Project Director Project management Project communication Contract information analysis A project resource plan will be developed by the project team and included in the project initiation document for approval by the project board. This will take account of estimated commitment from individual roles on the project board and the project team and expected contributions in addition to this. This will enable any capacity constraints to be indentified and resolved. The requirement for any specialist support or advice (e.g. procurement) including any requirement for external third party support will also be identified. 8 Project budget If required a project budget cost will be identified for approval by the project board, however subject to completion of the detailed project resource plan referred above, the majority of project management input is expected to be provided by existing staff in NHS South West Commissioning Support or North Somerset CCG. Page 10 of 11
Appendix 1 Project Governance The project governance arrangements are summarised below. The project board will agree the detailed project governance arrangements including relevant terms of reference. The Senior Responsible Officer (lead executive) chairs the Project Board and is the single individual with ultimate responsibility for ensuring that a project meets its objectives and delivers the projected benefits. The Project Director is responsible for ensuring that the project meets its objectives and delivers the projected benefits The Project Manager will manage the day to day project activities and coordinate the workstreams. The lead commissioner is responsible for the specification of the needs of all those who will use the services, commit any required resources and ensure access to clinical expertise The lead providers represent the interests of those designing, developing, operating and maintaining the project products. Project Assurance covers all interests of a project. According to the size and complexity of the project, the Project Board members may carry out these responsibilities themselves or delegate some or all of the assurance work. The Healthy Futures Project Management Office (PMO) will provide the Project Director with project support. Access to expertise in service redesign, finance, workforce planning, IM&T and data analysis will be made available through the CSU, as part of its Service Level Agreement with the CCG. Page 11 of 11