Full Business Case Executive Summary Renal Unit June 2015 0
Document Control Version Date Issued Brief Summary of Change Owner s Name 1 4 June 15 Exec Summary prepared for Trust internal approval processes HD 2 5 June 15 Amendments following review by EA HD 1
Contents 1 Executive Summary 3 1.1 Introduction & Background 3 1.2 Commissioner and Stakeholder Support 3 1.3 Case of Need 4 1.4 Option Appraisal 5 1.5 Summary of FBC Scheme 6 1.6 Capital Cost Summary 6 1.7 Financial Case 6 1.8 Management Case 7 1.9 Timescales 7 1.10 UHNM Trust approval 7 1.11 Recommendations 8 2
1 Executive Summary 1.1 Introduction & Background Following the approval of the Acquisition Business Case, and a subsequent Addendum, by the Trust Development Agency the University Hospital of North Staffordshire NHS Trust acquired the responsibility for the delivery of clinical services at Mid Staffordshire Foundation Trust for a period of 29 months from 1 November 2014. The two Trusts combined to form the University Hospitals of North Midlands NHS Trust (UHNM). The 80m allocation agreed in the Acquisition Business Case will be applied for via a number of separate business cases to enable individual elements to be finalised whilst ensuring that the capital programme can be completed within the agreed 29 month timescale. It is important to recognise that each of these business cases is a subset of the total funding solution. This Full Business Case for Renal Unit scheme works at County Hospital sets out the need for 3,105,707 capital to develop a 12 station Renal Unit. This will consist of 10 dialysis bays and 2 private dialysis side rooms. The current service is provided from 7 stations with staff working 3 session days. It is proposed that the existing staffing establishment operate the new 12 station unit. This will be contained within the same revenue budget as the current service delivery model. Any additional costs associated with increased demand or service development will be the subject of a separate business case. The urgent requirement to complete capital works that enable UHNM to implement plans defined by the TSA has led to the decision by UHNM to proceed straight to FBC bypassing the Outline Business Case (OBC) stage. UHNM understand the risk of doing this and in an attempt to mitigate this risk have ensured that the FBC addresses the option appraisal work. In addition it is recognised that within the target timescale of completion by February 2016, the usual approval processes will be fast tracked to ensure that the commencement and implementation of the Project is not delayed. 1.2 Commissioner and Stakeholder Support The University Hospital of North Midlands (UHNM) is the lead provider of haemodialysis services for the Staffordshire and South East Cheshire catchment populations. The haemodialysis service is provided on a hub and spoke basis with the main dialysis hub located at Royal Stoke along with the inpatient beds and satellite dialysis units at Leighton Hospital (South East Cheshire) and Stafford Hospital (South Staffordshire). Staff, patients, and the National Kidney Association, as key stakeholders, have all been actively involved in designing the new facility and ensuring the design significantly improve the patient s experience. 3
1.3 Case of Need The standard of facilities supporting the Stafford satellite dialysis unit is extremely poor and non-compliant with the standards recommended in the Health Building Note (HBN) 07-01: Satellite Dialysis Unit (Department of Health, 2008). As a result of the profile of current facilities, there are key issues in respect of effective service operation and the care environment: Capacity and flexibility: The current facilities supporting dialysis are at full capacity, inflexible and completely unable to respond to further changes in service demand without additional space being provided. Quality of patient environment: The current quality of facilities supporting the haemodialysis service is poor and falls short of current standards (recommended in Health Building Note Guidance - HBN) in most respects. In particular: The HBN recommended floor area standards for a patient on dialysis are 10-11m2. The floor area per patient on dialysis in current facilities ranges between 7sqm & 7.5sqm, which is significantly below this required standard. This is of issue for two primary reasons. Firstly the inadequacy of the present patient space raises the risk of cross infection beyond defendable levels and secondly the amenity space that patients have during lengthy sessions on dialysis is compromised and falls well short of national consumerism standards. The HBN standard recommends single room provision of approximately 20% (1-2 dialysis stations for the Stafford satellite dialysis unit) should be provided in single rooms for control of infection and also for patient amenity purposes. Supporting accommodation is inadequate. There are issues relating to good nursing practice due to the lack of staff changing accommodation, and patient support accommodation including consulting and counselling areas., with, staff change and limited storage. There are no facilities provided for patient/escort wait. The recommended guidance is for between 1.5 2 waiting spaces to be provided per dialysis station to enable sufficient space for patients and escorts at shift change-overs. Patient WCs not provided within the unit. Access to the renal dialysis unit is difficult, with the facility located within the County Hospital some distance from the main entrance requiring patients to walk the length of the hospital. There are no dedicated car parking for renal patients and access for patients. HBN 07-01 recommends one dedicated carparking space for every 3 dialysis stations. Clinical Effectiveness Plant and Water Quality: The current Reverse Osmosis water plant was installed in 1999 and would normally be replaced on a 10 years frequency. When installed, the plant conformed to water quality standards recommended by the Renal Association. However, since this time standards have increased and the plant is unable to conform to current standards. The plant room has insufficient space for a new system to be installed, while maintaining the current system, which has significant issues for continuity in service. The plant relies on chemical sterilisation (with associated chemical handling risks), rather than the current standard of heat sterilisation. The plant is no longer 4
supported by its manufacturer, with spares becoming increasing difficult to source. Because of the age of plant it is becoming increasingly unreliable, resulting in interruption to patient care. Changes to the Trust s provision of renal dialysis services at County Hospital are therefore proposed for the following reasons: To comply with the Renal Association recommendation that, except in remote geographical areas the travel time to a haemodialysis facility should be less than 30 minutes services have to be provided in Stafford to serve the needs of the local population. Secondly the manner in which renal accommodation is provided at County Hospital has to meet the current service deficiencies previously detailed in this document which concern capacity and future flexibility, effectiveness of clinical service, quality of patient environment and access issues. 1.4 Option Appraisal The preferred option for the delivery of the project objectives is Option 4 - Remodelling of current Renal Unit and adjacent bulk store / lab / cytology screening area on County Hospital site. This option has been selected on the basis that it will: It addresses the capacity and future flexibility, clinical effectiveness and quality of patient environment issues, including non-compliance with HBN guidance for such facilities as regards space and specification standards It address the water quality issues that are currently faced by the unit It addresses privacy and dignity requirement and infection control issues It can be delivered within the necessary timescales It allows the development to be phased and patients to continue to use the Unit at County Hospital during development works The area proposed for the new service has recently been vacated following services changes to pathology, allowing for the renal unit to expand without the need to relocated services elsewhere Use of the existing facilities on the ground floor of County Hospital allow for easy access and egress for the unit s patients. Provides dedicated parking for renal patients improving accessibility for patients to the unit 5
1.5 Summary of FBC Scheme A summary of the key elements of work to be undertaken as part of the Renal Unit scheme is set out below. Table 1 Capital Scheme Summary Scheme Summary of works 12 Dialysis rooms (including 2 side rooms) Supporting clinical accommodation (consult/exam, treatment room, education room, clean utility, dirty utility) Renal Unit Patient Waiting Room New water plant and plant room Technician room Equipment stores Staff support (changing, office accommodation) Associated equipment and IT provision 1.6 Capital Cost Summary The confirmed capital cost of the proposed schemes is 3,105,707 as detailed in the table below. GMP prices have been obtained which gives certainty to the cost of the scheme. Table 2 Capital Cost Summary Project: Renal Unit Budget Current Costs GMP/Works Costs 2,114,000 2,199,748.09 Trust Fees & Non Works 113,000 148,000 Equipment 200,000 200,000 Contingency 234,000 150,000 Sub Total 2,661,000 2,697,748.09 Vat 532,200 539,549.62 Vat recovery - 76,200-131,589.92 Sub total ( ) 3,117,000 3,105,707.78 1.7 Financial Case This FBC supports capital expenditure funding requirement in the form of exceptional PDC for a total sum of 3,105,707 for the Renal Unit scheme. 6
Capital implications of the proposed investment have been considered and reflected in the Trust s Long Term Financial Model (LTFM). This FBC does not require additional revenue. Any changes to this service provision which result in the requirement for additional revenue funding, will need the development and approval of a separate business case. 1.8 Management Case Delivery of the overall capital programme will be governed by the IHSS Capital Programme Board (CPB) to ensure the effective management of the programme. The CPB will provide the essential oversight of programme delivery, costs, benefits, risks and dependencies. The IHSS Capital Programme Board will report to the UHNM Capital Investment Group. 1.9 Timescales The key milestone dates relating to this FBC scheme are set out below. Table 3 Key Milestones Element Start Date Target Completion Date FBC Development & Trust Approvals January 2015 May 2015 TDA Approval Period June 2015 August 2015 Construction Period June 2015 Phase 1 completed Nov 15 Phase 2 Completed February 2016 Commissioning February 2016 February 2016 Operational - March 2016 1.10 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 3.106m, approval is being sought from the Trust Board. To be considered for approval this business case needs to demonstrate that it meet 5 tests as follows: To be part of the Acquisition Business Case the refurbishment of the existing renal facilities and the creation of additional stations was identified in the Capital Appendix of the ABC as a priority scheme 7
To be covered by the capital allocation the capital cost of the scheme was originally set at 3.117m as identified in the Capital Appendix of the ABC. The final cost of the project is 3.106m, so within the agreed budget as set out in the ABC. To be included within the revenue allocation identified within the IHSS ABC, or to have the revenue implications approved from other sources. Revenue costs and sources, within the context of the IHSS ABC are summarised in a separate paper. To deliver the functional benefits envisaged including quality and safety this FBC for the development of renal services aims to deliver the following functional objectives and benefits: Capacity to meet growing demand for hospital haemodialysis in the Stafford catchment area whilst still meeting the Renal Associations recommendation that, except in remote geographical areas the travel time to a haemodialysis unit is less than 30 minutes away. Improved environment to deliver service, resulting in greater clinical efficiency and effectiveness for clinical and nursing staff. Improved patient environment with improved space standards per dialysis station allowing greater privacy & dignity to each individual patient. Compliance with best practice guidance, including health building note (HBN). Improved patient environment giving recognition to the individual patient with better gender segregation. Improving infection control with adequate wash hand basin and sanitary provision. Improved clinical facilities for the staff working environment. Improved access to the unit with dedicated parking for renal patients. Resolve issues with life-expired water treatment plant To be in keeping with the Trust s 2025 Vision the need to expand renal services in Stafford has been identified as a key element of developing metabolic/gi as one of the 6 defining services that the Trust wishes to produce outstanding research, innovation and service levels to patients as a legacy for future generations. 1.11 Recommendations The committee is recommended to approve this Full Business Case on the grounds it meets the 5 tests as set out in IHSS Capital Expenditure Report 1. 1 IHSS Capital Expenditure Report to UHNM Trust Board - June 2014. 8