ANEURIN BEVAN HEALTH BOARD Aneurin Bevan Health Board CLINICAL FUTURES STRATEGY AND SPECIALIST CRITICAL CARE CENTRE: BRIEFING 1 PURPOSE The purpose of this paper to is to brief Board members on the proposed next steps for the continued implementation of the Clinical Futures Strategy and the current position relating to the Specialist and Critical Care Centre. The Board is asked to note that a formal programme is to be established to take forward the next implementation steps for Clinical Futures, including the delivery of the updated Specialist and Critical Care Centre Outline Business Case, with the current Clinical Futures Programme Board acting as the Programme Board and leading this programme of work, supported by a Programme Team. Financial Assessment and link to Financial Recovery Plan Risk Assessment Annual Quality Framework Standards Health Wales for Services Equality Impact Assessment This report sets out a proposed programme for next steps in terms of delivering Clinical Futures and the Specialist and Critical Care Centre (SCCC) Outline Business Case (OBC). Finance, including identification of capital and revenue costs, will be an integral part of the programme. Capital will also be required for the re-engagement of the Supply Chain Partner (SCP), external project management, cost advisors and internal resource team. The programme and individual projects will incorporate a risk management process including risk assessment and maintenance of a risk register. Delivery of the programme will contribute to the delivery of future national priorities and targets. Delivery of the programme will contribute to the delivery of the Standards for Health Services. Individual project level requirement. 1
2. CONTEXT The Health Board is currently implementing its service strategy known as Clinical Futures (CF). CF is essentially a service strategy which is driving service change and improvement at four levels of care across the Health Board, namely: increase the range of services provided in communities through primary, community and mental health services using Setting the Direction as a model framework (Level 1) develop a new network of Local General Hospitals providing routine hospital services including emergency care, day case and short stay surgery, outpatients, diagnostic and integrated care (Level 2) develop a single Specialist and Critical Care Centre (SCCC) providing specialist and critical care services that cannot be provided on multiple sites based on sustainability, clinical effectiveness, patient safety and affordability (Level 3) improve quality and access to highly specialist services working with the Welsh Health Specialised Services Committee (Level 4). 3. PROGRESS Significant progress has been made across the Health Board in implementing all four levels of the CF strategy, including the following: Primary & Community Based Services Frailty Programme Setting the Direction implementation process including the establishment of twelve Neighbourhood Care Networks Alignment of health and social care teams in some localities Patient Education Programmes Development of Mental Health Crisis Intervention Teams Service Redesign Modernised orthopaedic services with development of musculo-skeletal triage services Development of an integrated Mental Health and Learning Disability Strategy Improved process and patient flow in A&E Pathway development including stroke and chronic obstructive pulmonary disease Workforce Ongoing development of medical model Development of nursing and therapies strategies Healthcare support worker project Facilities YAB opened on target in October 2010 YYF on target to be commissioned at end of 2011 Prioritisation of investment in Primary Care estates in all Localities 2
4. SPECIALIST AND CRITICAL CARE CENTRE Over the last eighteen months and following a previous request from the Welsh Assembly Government to consider a phased approach to the SCCC, the Health Board has been working with the Welsh Assembly Government and partners to reduce the capital cost of the SCCC as a result of the changing financial climate and reduction in the All Wales Capital Programme. The outcome of two desktop exercises (known as the SCCC Phase 1a and Phase 1b projects) explored a number of options and reported their conclusions to the Welsh Assembly Government (WAG), most recently at the end of March 2011. As a result of this work and discussions with WAG, the Minister for Health and Social Services wrote to Assembly Members on 23 March 2011 outlining the following: Following this feasibility study colleagues in Aneurin Bevan Health Board have reviewed the core functional content, particularly in the context of the service benefits which the commissioning of Ysbyty Aneurin Bevan and Ysbyty Ystrad Fawr will have on patients flows and have reduced the overall estimated cost of the Project to around 230m. Having seen at first hand the need to improve hospital services in Gwent and the difference which strategic schemes I approved for other parts of Wales are making to patient care, I believe this project should go ahead. Furthermore, I have been impressed with the commitment of the Aneurin Bevan Health Board to delivery a sustainable Project. However, even at the reduced cost of 230m this will place a huge strain on the capital programme particularly between 2015 to 2018, would significantly impact on the other Health Boards plans for investment and modernisation during this period. Also the SCCC will not entirely resolve hospital infrastructure problems in Gwent and further resources will have to be found for a new Local Hospital for Newport and upgrading work at Nevill Hall Hospital. I wish to support the Health Board in completing the Outline Business Case, which is due at the end of this year, so that they can proceed to the production of the Final Business Case and start of construction by the end of 2013. 3
At the Capital Review meeting held with Welsh Assembly Government (WAG) on 21 April 2011, the Health Board was authorised to re-engage with the Supply Chain Partner for the purposes of developing the updated SCCC OBC. A provisional capital figure of 1.9m has been included by WAG in the 2011-2012 ABHB Capital Resource Limit to fund initial project costs resulting from this work and capital is provisionally identified within the All Wales Capital Programme from 2011-2012 to 2017-2018. It must be emphasised that the work done to demonstrate capital affordability within the limits set by WAG was a feasibility study and now detailed design work must be carried out to test all the assumptions made. 5. CLINICAL FUTURES: PROGRAMME INITIATION Given the requirement set out above by the Minister, there now needs to be a significant step-up in the implementation and resourcing of the next phases of the Clinical Futures Strategy, not least the delivery of the OBC for the SCCC. However it is important to note that in order to successfully gain approval for, plan, design, construct and commission the SCCC, this also requires that plans are in place and delivered for the remainder of the Clinical Futures programme. 5.1 Establishing a Formal Programme The current Clinical Futures Programme Board chaired by the Chief Executive will be the Programme Board for this next phase of work, supported by a Programme Team. 5.2 Programme Timetable a) Clinical Futures Programme The following sets out a current draft, high level programme timetable: 4
Requirement Level 1 Primary and Community Care Services Level 2 Timescale Start Present Complete Full service impact and benefits need to be in place as soon as possible to ensure level 2 services function appropriately by the opening of the SCCC. Blaenau Gwent Present New hospital Ysbyty Aneurin Bevan - opened in October 2011 with level 2 services being delivered, benefits realisation plan in place. Caerphilly Present New hospital - Ysbyty Ystrad Fawr - and level 2 services should be in place by early 2012. A benefits realisation plan will be required. Newport TBC Level 2 services need to be in place by the opening of the SCCC. North Monmouthshire TBC Level 2 services need to be in place by the opening of the SCCC Torfaen TBC Level 2 services need to be in place by the opening of the SCCC Level 3 Specialist and Critical Care Centre June 2011 Complete the Outline Business Case. b) Specialist and Critical Care Centre Project The SCCC is a distinct, major project within the proposed CF Programme, with a number of immediate actions recently initiated: Discussions are ongoing with both the Assembly and the Supply Chain Partner about the plan for this work. A meeting has taken place with the Torfaen Planning Department to brief them on the current status of the project. They have indicated that they will allocate a case officer as soon as the project is formally re-established. Early work on seasonally sensitive ecology site surveys has also been initiated. A Capital Project Workshop has been held with the SCP to identify the scope and timing of work required to plan the OBC process. WAG has requested that a Gateway Review of the SCCC Project is carried out as soon as possible. This work will: o test the readiness of the Health Board to take this project forward; o check stakeholder engagement; 5
o assist in identifying risks and issues; o provide external expertise to advise on the initiation phase of the project; o provide assurance that the project can progress; o improve knowledge and skills within the in-house team. 5.3 Programme Resources The Clinical Futures Programme, with its sub-projects will be a highly complex and significant change management programme. Each significant element of the programme, broken down into a project, requires a clear Senior Responsible Officer (SRO) and supporting project infrastructure. The SROs will need to work together effectively and will be key members of the Programme Board. They will need to ensure that individual project critical paths and interdependencies are clear as part of the overall programme management approach. The previous health community had a significant support resource working alongside clinicians and the community at the peak of its activity and it is envisaged that this will need to be re-established as soon as possible in order to carry out essential work on the following areas to inform business case development and design. This includes: o activity modelling o capacity modelling o performance assumptions o revenue affordability o service configuration o operational policies o functional content o user engagement. a) Supply Chain Partner Laing O Rourke was appointed as Supply Chain Partner for the under the NHS Wales Construction Procurement Framework Designed for Life: Building for Wales The SCP appointment provides an integrated collaborative supply chain that incorporates the full range of design and construction services and functions. There are key work streams to support the necessary level of design to inform the OBC and provide a cost not to exceed. These include: Health planning expertise and end user consultation to understand and test functionality of building to meet operational policy requirements. 6
Identify early site and off-site infrastructure requirements and develop as enablers to prepare for site construction. Develop building design in conjunction with Local Authority planning consultation. Ensure ecology studies for the site meet planning requirements, particularly in relation to any potential site layout constraints or mitigation required. Understand programme risk and identify critical paths including agreement interface, lead and responsibilities for decanting site strategy. Understand programme issues associated with Local General Hospital model that may require a level of design and capacity flexibility to accommodate any emerging service model changes over life of project. Based on the agreement from WAG the SCP will now be formally reengaged and the Health Board is currently liaising with Assembly officers on these arrangements. b) External Project Manager and Cost Advisor The External Project Manager is also a Construction Procurement Framework appointment. A key role of the External Project Manager is to reduce programme and cost risk by robust management of the SCP in delivery of the work streams to be undertaken. An essential requirement is also to ensure that other work streams undertaken by others to support the project, such as clinical consultation, are fully integrated into the processes on the scheme. There is currently no Cost Advisor appointment but this will be necessary to support OBC preparation. c) Internal Resource Team From previous experience, recent discussions and consideration of the potential programme of work, the level of detail needed, requires a significant amount of detailed technical expertise and input from within the Health Board including: Programme Director Project Clinicians (multidisciplinary) Service Planning Information Workforce Finance (Revenue and Capital) Capital Estates Procurement Programme/Project Management Configuration Librarian Commissioning Non-pay costs 7
Work is underway to identify the level, quantity and cost of the proposed internal resource team. Recent WAG guidance on internal costs for All Wales Capital Projects has set an upper limit of 1% of constructions costs as an internal budget. 6. CONCLUSION The Health Board has been working with WAG and our partners to reduce the capital cost of the SCCC. As a result of this work, WAG has asked the Health Board to prepare an updated Outline Business Case for the SCCC. The SCP is therefore being formally re-engaged and work has started to develop a CF Programme, a SCCC OBC Project Plan and associated resource schedules. A Gateway Review of the current status of the SCCC OBC Project is also to be carried out as an early part of this process. 7. RECOMMENDATION The Board is asked to: 1. note that a formal programme is to be established to take forward the next implementation steps for Clinical Futures, including the delivery of the SCCC OBC; 2. note that the current CF Programme Board will act as the Programme Board and lead this programme, supported by a Programme Team; 3. note that WAG has authorised ABHB to re-engage with the Supply Chain Partner for the purposes of developing the SCCC OBC; 4. note that the SCCC OBC project is to undergo a WAG Gateway Review. Report sponsored by Judith Paget, Director of Planning and Operations. Report prepared by Ruth Treharne, Associate Director of Planning and Service Improvement and Chris Hopper, Head of Capital Planning. 8