document

Holme Valley Memorial Hospital - Development of Primary Care and Community Hospital Services

NHS Kirklees

7th January 2010

Development of Primary Care and Community Hospital Services

Version 08 - Draft

i

Document control sheet

Client NHS Kirklees

Document Title Holme Valley Memorial Hospital - Development of Primary Care and Community Hospital Services

Version 08

Status Draft

Reference

Author Tony Shaw

Date 7th January 2010

Further copies from email: [email protected] quoting reference and author

Quality assurance by:

Document history

Version Date Author Comments

08 7th January 2010 Tony Shaw ES 1.5, S2.3, S10.3, S11

Contact details

Main point of contact

Telephone number Email address Postal address

Tony Shaw 07798 584992 [email protected]


Version 08 - Draft

ii

Contents

1 Executive Summary ...................................................................................................... 1 1.1 Introduction and Background .............................................................................. 1

1.2 The Strategic Case.............................................................................................. 2

1.3 The Economic Case .......................................................................................... 11

1.4 The Commercial Case (Procurement) .............................................................. 13

1.5 The Financial Case (Affordability) ..................................................................... 14

1.6 The Management Case..................................................................................... 15

1.7 Conclusion......................................................................................................... 16

2 Introduction and Background ...................................................................................... 17 2.1 Introduction........................................................................................................ 17

2.2 Project Objectives ............................................................................................. 17

2.3 Business Case Structure and Scope ................................................................ 18

2.4 Approvals and Support...................................................................................... 19

3 Strategic Case – Profile of NHS Kirklees.................................................................... 20 3.1 NHS Kirklees Profile – Introduction................................................................... 20

3.2 NHS Kirklees Profile – Key Goals ..................................................................... 20

3.3 NHS Kirklees Profile – Population Profile ......................................................... 21

3.4 NHS Kirklees Profile – Financial Profile ............................................................ 22

3.5 NHS Kirklees Profile – Estates Profile .............................................................. 23

3.6 NHS Kirklees Profile – Staff and Cost Profile.................................................... 24

3.7 NHS Kirklees Profile – Summary ...................................................................... 25

4 Strategic Case – Profile of Current HVMH Services................................................... 26 4.1 HVMH – Introduction ......................................................................................... 26

4.2 HVMH – Services and Activity .......................................................................... 26

4.3 HVMH – Estates and Facilities Condition ......................................................... 26

4.4 HVMH – Staffing and Cost Profile..................................................................... 28

4.5 HVMH – Summary ............................................................................................ 29

5 Strategic Case – Strategy for Change ........................................................................ 30 5.1 Introduction........................................................................................................ 30

5.2 National Drivers of Change ............................................................................... 30

5.3 Regional Drivers of Change .............................................................................. 32

5.4 Local Drivers of Change.................................................................................... 32

5.5 Community Hospitals Fund – Programme Investment Board Submission ....... 36

5.6 Summary ........................................................................................................... 37

6 Strategic Case – Current and Future Service Models ................................................ 38 6.1 Introduction........................................................................................................ 38

6.2 The Case for Change ........................................................................................ 38


Version 08 - Draft

iii

6.3 Current and Future Service Models – Summary............................................... 40

6.4 Summary ........................................................................................................... 50

7 Strategic Case – Future Activity and Capacity Requirements.................................... 51 7.1 Introduction........................................................................................................ 51

7.2 Overview of Methodology.................................................................................. 51

7.3 Baseline............................................................................................................. 51

7.4 Activity Modelling Assumptions......................................................................... 52

7.5 Population Growth............................................................................................. 55

7.6 Activity Projections ............................................................................................ 55

7.7 Sensitivity Analysis............................................................................................ 57

7.8 Summary ........................................................................................................... 57

8 Economic Case – Non Financial Option Appraisal ..................................................... 59 8.1 Process.............................................................................................................. 59

8.2 Constraints ........................................................................................................ 59

8.3 Project Vision and Objectives ........................................................................... 59

8.4 Benefits Criteria and Weighting......................................................................... 60

8.5 The Longlist and Shortlist.................................................................................. 62

8.6 Revised Qualitative Benefits Appraisal – December 2009 ............................... 66

8.7 Revised Sensitivity Analysis.............................................................................. 67

8.8 Revised Summary............................................................................................. 68

9 Economic Case – Economic Analysis (VFM) ............................................................. 69 9.1 Introduction........................................................................................................ 69

9.2 Methodology and Assumptions ......................................................................... 69

9.3 Net Present Cost and EAC Analysis ................................................................. 71

9.4 Preferred Option................................................................................................ 72

9.5 Sensitivity Analyses........................................................................................... 73

9.6 Conclusion......................................................................................................... 74

10 Economic Case – Risk Analysis and Overall Preferred Option .................................. 75 10.1 Introduction........................................................................................................ 75

10.2 Results of Risk Assessment.............................................................................. 76

10.3 Risk Quantification for Preferred Option ........................................................... 78

10.4 The Preferred Option......................................................................................... 80

11 Financial Case – Financial Analysis (Affordability) ..................................................... 81 11.1 Introduction........................................................................................................ 81

11.2 Capital Costs and Revenue Costs .................................................................... 81

11.3 Balance Sheet Impact ....................................................................................... 82

11.4 Revenue Impact of the Scheme........................................................................ 82

12 The Commercial Case – Procurement........................................................................ 85


Version 08 - Draft

iv

12.1 Introduction........................................................................................................ 85

12.2 Procurement Routes ......................................................................................... 86

12.3 Procurement Strategy ....................................................................................... 87

12.4 Summary ........................................................................................................... 93

13 Management Case...................................................................................................... 96 13.1 Introduction........................................................................................................ 96

13.2 Project Timetable .............................................................................................. 96

13.3 Project Structure, Skills and Resources............................................................ 96

13.4 Stakeholder Involvement and Consultation....................................................... 98

13.5 Benefits Realisation Plan .................................................................................. 99

13.6 Gateway Review ............................................................................................... 99

13.7 Workforce Planning and Development............................................................ 100

13.8 Information Management and Technology...................................................... 101

13.9 Equality Impact Plan........................................................................................ 102

13.10 Regeneration, Sustainability and Corporate Citizenship................................. 103

13.11 Post Project Evaluation ................................................................................... 103

13.12 Summary ......................................................................................................... 105

Figures

Figure 1-1 – National, Regional and Local Drivers of Change .................................................. 3

Figure 1-2 – HVMH – Current and Future Service Models – Summary .................................... 4

Figure 1-3 – Project Objectives.................................................................................................. 9

Figure 1-4 – Projected Appointments per Year at HVMH........................................................ 11

Figure 1-5 – The Shortlist......................................................................................................... 12

Figure 1-6 – Revised Qualitative Benefits Appraisal ............................................................... 12

Figure 1-7 – Identification of the Overall Preferred Option ...................................................... 13

Figure 1-8 – Preferred Option Revenue Funding Sources ...................................................... 14

Figure 1-9 – Preferred Option Capital Affordability Analysis ................................................... 14

Figure 1-10 – Key Project Milestones ...................................................................................... 15

Figure 1-11 – NHS – Project Structure .................................................................................... 16

Figure 2-1 – HVMH Project Objectives .................................................................................... 18

Figure 2-2 – OBC Structure ..................................................................................................... 19

Figure 3-1 – Map of the Seven Localities of Kirklees .............................................................. 20

Figure 3-2 – NHS Kirklees Goals ............................................................................................. 21

Figure 3-3 – Kirklees Population – 2006 v 2018...................................................................... 21

Figure 3-4 – Kirklees – Income and Expenditure – 2006/07 – 2008/09 .................................. 22

Figure 3-5 – NHS Kirklees Balance Sheets – 2006/07 – 2008/09........................................... 22

Figure 3-6 – Location of Key PCT Premises............................................................................ 23


Version 08 - Draft

v

Figure 3-7 – Kirklees PCT Premises – Targets for 2013 ......................................................... 24

Figure 3-8 – NHS Kirklees – Staff and Cost Profile ................................................................. 24

Figure 4-1 – Baseline Activity in HVMH ................................................................................... 26

Figure 4-2 – Summary of Condition Appraisal for HVMH ........................................................ 27

Figure 4-3 – Estates Budget 2009/10 ...................................................................................... 28

Figure 4-4 – HVMH – Staffing Profile....................................................................................... 28

Figure 5-1 – Overview of Chapter Structure and Key Points................................................... 30

Figure 5-2 – National Drivers of Change ................................................................................. 30

Figure 5-3 – Regional Drivers of Change ................................................................................ 32

Figure 5-4 – Key Local Drivers of Change............................................................................... 33

Figure 5-5 – PIB Submission Summary................................................................................... 37

Figure 6-1 – HVMH – Current and Future Service Models - Summary ................................... 41

Figure 7-1 – Baseline Activity 2008/09 .................................................................................... 52

Figure 7-2 – Practices’ Population – Access to HVMH............................................................ 53

Figure 7-3 – Proportion of Activity Relocating into HVMH (%) ................................................ 54

Figure 7-4 – Projected Appointments per Year at HVMH........................................................ 55

Figure 7-5 – Breakdown of Additional Activity Relocating into HVMH by Practice – 2018/19.56

Figure 7-6 – Impact of Population Growth and Diverted Activity on HVMH Baseline Activity .57

Figure 8-1 – Project Objectives................................................................................................ 59

Figure 8-2 – Benefits Definition................................................................................................ 60

Figure 8-3 – Weighted Benefit Criteria Groups........................................................................ 62

Figure 8-4 – Revised Shortlisted Options – December 2009 .................................................. 63

Figure 8-5 – Revised Qualitative Benefits Appraisal – December 2009.................................. 67

Figure 8-6 – Sensitivity Analysis – December 2009 ................................................................ 67

Figure 9-1 – Capital Costs of Shortlisted Options - £000 ........................................................ 69

Figure 9-2 – Phasing of Capital Costs - £000.......................................................................... 70

Figure 9-3 – Net Present Cost and Equivalent Annual Cost of Lifecycle Spend..................... 70

Figure 9-4 – New Building Running Costs ............................................................................... 71

Figure 9-5 – Net Present Cost EAC of Short Listed Options ................................................... 72

Figure 9-6 – Cost Benefit Ratio................................................................................................ 72

Figure 9-7 – Comparison of Costs and Benefits ...................................................................... 73

Figure 9-8 – Sensitivity Analysis .............................................................................................. 73

Figure 10-1 – Probability Scoring Matrix.................................................................................. 75

Figure 10-2 – Impact Scoring Matrix ........................................................................................ 75

Figure 10-3 – Risk Results for Option 1A ................................................................................ 76

Figure 10-4 – Results for Option 1B ........................................................................................ 76

Figure 10-5 – Results for Option 2C ........................................................................................ 77

Figure 10-6 – Results of Qualitative Risk assessment ............................................................ 77


Version 08 - Draft

vi

Figure 10-7 – Diagram Representing Approach to Revenue Risk Quantification ................... 79

Figure 10-8 – Net Present Cost of Quantified Risk.................................................................. 79

Figure 10-9 Revenue Risk Distribution (Undiscounted)........................................................... 80

Figure 11-1 – Capital Costs of the Preferred Option ............................................................... 81

Figure 11-2 – Phasing of Capital Costs of Preferred 0ption .................................................... 81

Figure 11-3 – Capital Charges Implications of Preferred Option ............................................. 82

Figure 11-4 – Balance Sheet Implications of Preferred Option ............................................... 82

Figure 11-5 – Revenue Impact of the Scheme ........................................................................ 82

Figure 11-6 – Revenue Funding Sources and Requirements ................................................. 83

Figure 12-1 – Procurement Strategies..................................................................................... 93

Figure 13-1 – Project Timetable – Key Milestones .................................................................. 96

Figure 13-2 – HVMH Project Structure .................................................................................... 97

Figure 13-3 – Benefit Realisation Plan .................................................................................... 99

Figure 13-4 – HVMH – Staff Using HVMH – Current and Future .......................................... 100

Figure 13-5 – Post-Project Evaluation Plan – Framework..................................................... 104


Version 08 - Draft

1

1 Executive Summary

1.1 Introduction and Background

Introduction

1.1.1 This outline business case (OBC) is for the development of primary care and community hospital services at Holme Valley Memorial Hospital (HVMH), Holmfirth.

1.1.2 The proposed reconfiguration of HVMH services marks the culmination of a process of major change that began with the landmark public consultation exercise “Looking to the Future” (October 2005).

1.1.3 The overall vision at that time which has been built on over recent years and continues to be implemented was:

“….to provide as much care as possible closer to people’s homes, wherever this is safe and practical, and to provide high quality, specialist services in our hospitals. We want to make sure that we are offering the right care, by the right people, at the right time”

1.1.4 The proposed redevelopment of HVMH is consistent with Looking to the Future and current strategic thinking e.g. the recent 5 year Strategic Plan (2008 – 2013)

1 “Ambitions

for a Healthy Kirklees” states:

“We believe that a population of the size of Kirklees could support around three larger community sites, from which a range of services could be provided. Our view is that these three key sites are:

■ Holme Valley Memorial Hospital, Holmfirth

■ Princess Royal Community Hospital, Huddersfield Town Centre

■ Dewsbury Health Centre.

Background

1.1.5 The Government consultation ‘Our Health Our Care Our Say’ highlighted the desire of patients to see more services provided in the community, closer to home, and in a suitable setting. In response the Kirklees and Calderdale health community developed an integrated service strategy for the delivery of a whole system approach to health care, which has been approved through the public consultation ‘Looking to the Future’.

1.1.6 One of the key principles of this strategy is to support the provision of services closer to home. This approach remains consistent with the more recent strategic direction set out by ‘High Quality Care for All’ the final report of the NHS Next Stage Review. This proposal is aligned to the regional strategy implementation document ‘Healthy Ambitions’ and the local PCT strategy ‘Ambitions for a Healthy Kirklees’.

1.1.7 The award of Community Hospitals Fund capital will enable NHS Kirklees to develop the infrastructure needed to bring to life the PCT’s vision for local services. The Department of Health, via its Programme Investment Board, has previously given outline approval for the investment of £13.79 million of Community Hospitals Fund capital in the Calderdale and Kirklees health communities.

1 Revision March 2009


Version 08 - Draft

2

1.1.8 An award from the Community Hospitals Fund capital above has been made by the DH to NHS Kirklees in order to take forward the HVMH development

2.

1.1.9 The starting point for this project, the Holme Valley Memorial Hospital, is a facility which is much loved by local communities.

1.1.10 This fact has been at the forefront of the business case team’s thinking throughout the project and the design team and the architect have striven to develop options which retain the identity of the HVMH whilst creating a facility that will deliver 21

st Century healthcare

in line with national, regional and local policies.

1.1.11 HVMH currently delivers minor surgical procedures, intermediate care beds, some therapies and some outpatient activity.

1.1.12 This project will mark a considerable expansion of the above HVMH service range and its related activity levels – for example activity is forecast to increase by 72% over the next 10 years whilst 14 service models have been have been reviewed for inclusion in the new HVMH facility.

1.1.13 Once the project is commissioned HVMH will take its place as one of the three community hubs for extended primary care and community provision in Kirklees.

1.1.14 This OBC explores the options for creating the new Holme Valley Community Hospital facility and related service models of care.

1.2 The Strategic Case

1. National, Regional and Local Drivers of Change

1.2.1 The figure below provides an overview of the strategic drivers of change at national, regional and local level leading up to the development of this OBC

3.

2 See Chapter 5.5 for details and Appendix B4 – Project Investment Submission

3 NB The full Programme Investment Board submission is included in Appendix B4.


Version 08 - Draft

3

Figure 1-1 – National, Regional and Local Drivers of Change

NationalDrivers of Change

• NHS Next Stage Review (2008)

• Our health, our care, our say

(2006)• Choosing Health (2004)

� Personalised Care

� Care Closer to Home

� Healthy Lives

� Quality

Regional Drivers

of Change

• Healthy Ambitions – Y&H

SHA (2008)

� Health and Inequality

� Quality and Safety

� Service Delivery Needs to Change

� VFM

Local Drivers of

Change

• Looking to the Future (2005)

• Joint Strategic Needs Assessment (2008)

• Ambitions for a Healthy Kirklees

� Services to community where

possible� Priorities – MH, obesity, pain

management, dementia, CHD, stroke and diabetes

� Food, alcohol, smoking and physical activity

� Tackle inequalities

• Aim to provide 20% of all first attendances and 30% of follow up attendances – in the community (5.5% in 2006/07

OPD Activity

• Increased testing at community sites

• Aim to broadly double diagnostic tests in the community

Diagnostics

• Aim to increase provision

• Facilitate early discharge from hospital

Specialist Rehabilitation Beds

• New care pathways to reduce overall OPD appointments

• Reduced follow-up appointments

• Community led “see and treat” services in community

OPD, Diagnostic and Minor Surgical Procedures

• Long term conditions management, rehabilitation and intermediate careCapacity

Community Hospitals Fund – Programme Submission Bid – Key Priorities


OPD Activity



Diagnostics










• QIPP (2009)

1.2.2 The commissioning approach derived from the above is to shift, where appropriate, services to primary care from secondary care.

2. Current and Future Models of Care

1.2.3 The figure below provides a summary of current and future service models to be provided on the HVMH site.


Version 08 - Draft

4

Figure 1-2 – HVMH – Current and Future Service Models – Summary4

Service Current Service description

Future Service Description

Benefits

1. Inpatients The Holme Valley Memorial Hospital site has historically always provided inpatient care.

A total of 20 step up and step down beds will continue to be provided on the site supported by a wider range of services.

■ Avoidance of unnecessary admission into acute hospitals

■ Prevention of premature admission to long term care

■ Reduction in the need to access A&E

■ Provision of rehabilitation to eligible users

2. Outpatients The majority of current outpatient procedures are commissioned from Calderdale and Huddersfield NHS Foundation Trust as main acute providers with provision at a range of sites within NHS Kirklees including HVMH

It is planned that at least 40% of all new outpatients and 60% of follow ups (year on year) that are still provided in acute settings and outside of general practice – routine appointments, are provided within community sites in the future

■ Improved local access to services

■ Rapid access to diagnostics in a one stop shop approach

■ No need to travel to acute sites which will be of particular benefit to the elderly population, who may have difficulties in mobility and transport, and to those with young families.

■ Implements Darzi approach

3. Diagnostics There are currently no diagnostics facilities provided on the HVMH site other than those routinely performed for inpatient care.

A wide range of diagnostics will be provided at HVMH taking account of critical mass issues and population centres

■ Faster diagnosis and treatment

■ Reduction in consultation and specialist time

■ Collaboration

4 See Chapter 7 – Future Activity and Capacity Requirements for details of activity by specialty and service model – 2008/09 to

2018/19.


Version 08 - Draft

5



Benefits

Future modalities will include (NB Examples only – not exhaustive) :

■ Breath tests

■ Pulse oximetry

■ Urine flows

■ Blood tests

■ Near patient testing

■ Echocardiography/ECG

■ Spirometry

■ Other pathology services e.g. histopathology, cytology, microbiology

■ Imaging - x- ray, ultra sound

■ Telemedicine

■ Mobile Docking

across community/primary/secondary care

■ Increased ability to prioritise patient care

■ Achievement of current access standards

■ Improve access and choice

■ Deliver greater consistency and equality in service provision

.

4. Therapies Nutrition and dietetics, occupational therapy, physiotherapy, podiatry and speech and language therapy are all currently provided on the HMVH site

Therapy services will continue to be provided on the HVMH site however through an integrated model for therapy services, professional demarcations will be reduced and a more holistic approach developed focusing on patient needs and achievement of health outcomes

■ Reduce admissions to secondary care and GP appointments

■ Enable early discharges

■ Contribute to the reduction in morbidity for patients with long term conditions

■ Improve mobility and independence

■ Achieve better self-management

■ Promote multidisciplinary and integrated working practices


Version 08 - Draft

6



Benefits

5. Day Cases Daycase procedures are currently performed on the HVMH site.

The level and breadth of procedures performed is quite limited

High volumes of specified surgical day case procedures will be moved from delivery in the acute setting to delivery in fully equipped surgical facilities at the community hospital site

Key procedures that will be transferred in high volumes from Calderdale and Huddersfield NHS Foundation Trust into community settings include:

■ General surgery

■ Gynaecology including colposcopy, TOP, hysteroscopy, endometrial ablation

■ ENT – adult local anaesthetic grommits only

■ Trauma and orthopaedics

■ Urology - blue light laser TURP

■ Minor skin procedures

■ Plastic surgery

■ Greater theatre utilisation as day surgery is planned well in advance and has a high proportion of 'standard' cases;

■ Reduction in costs

■ Frees up inpatient beds

■ Reduced waiting lists

■ Improved utilisation of operating lists

■ Reduced cancellations

■ Increased capacity (more bed days available).

6. Dental The salaried primary care dental service operates from 5 locations including Holme Valley Memorial Hospital

The service will become more specialised, with more multi-skilled teams. With this will be a requirement for treatment areas to be able to flex in order to deal with both sedated and non sedated patients, especially for those with physical

■ Enables access for remote communities in South Kirklees

■ Improves emphasis on dental health prevention

■ Maintains and expands service for clients with special needs


Version 08 - Draft

7



Benefits

disabilities

■ Helps to consolidate services across the area

7. Long Term Conditions /Intermediate Care

There are 8 intermediate care teams/community rehabilitation teams for Kirklees which are part of intermediate care services. These work in co-operation with other health, social care and voluntary sector services, who are also required to deliver the integrated intermediate care pathway. The Holme Valley teams are based at Fartown Health Centre

The future service model will focus on improved service provision based on care pathways that work cross boundary, across primary, secondary and community domains providing systemic care in the right place for the client. A key element of this will be to further develop the single assessment process

■ The team is well located to access the locality when required

■ Sessional activity maintains and enhances the service provided locally

■ Development of the service along side long term conditions will improve and enable the delivery of integrated care packages

8. Mental Health There is a recognised need to shift the focus to health promotion provided at the first point of contact in primary care to enable healthier communities, reducing the need to access secondary care services

In order to manage patients in the primary care setting and to reduce the likelihood of referral into secondary care it is necessary to strengthen primary and community care services

The service direction nationally for mental health services is to reduce care in inpatient settings

To deliver NHS Kirklees strategies a team base for community mental health teams will be created on the Holme Valley Memorial Hospital site

In addition the HVMH site will provide memory clinic services

■ Increased opportunity for integration in care planning for patients

■ Less difficulties in accessing timely specialist mental health advice and support

■ Improved opportunity for sharing of skills

9. End of Life End of life services provide assessment and intervention of patients in the last stages of life to people who will benefit from home nursing care and support from the district

This service will be maintained and expanded in the locality

In addition a team base will be provided to enhance the local

■ Accessibility of the service

■ Expansion potential on site

■ Delivery of improved quality standards in end


Version 08 - Draft

8



Benefits

nurse service

delivery of services of life care

■ Improved access to ward and health promotion areas to deliver services.

10. Social Services

Social Services do not have a base on the current HVMH site

A single flexible desk will be provided on the HVMH site for adult case management workers along with access to flexible consulting space for one to one client interviews.

■ Integrated working

■ Improved communication

■ Improved patient management

11. Drug and Alcohol

There are significant numbers of people with drug and alcohol problems around the Huddersfield area although services are not currently provided on site at HMVH

This model will focus on the client’s holistic needs and outcome focused care plans mapping out the ‘treatment journey’ with exit strategies

Whilst a team base is not required clinical sessions will be delivered on site

■ Improved local access for patients

■ Integrated working with other specialties such as mental health teams on site

■ Access to clinical facilities for staff and patients

12. Children’s Services

The PCT supports the development of extended service models, and wherever practical to consider such new venues as a point of service delivery, or for the co-location of staff with partner agencies. The extended service agenda is still in its infancy, though it is anticipated that by 2010 all areas of the county will have some form of extended service setting within the local community.

The majority of services for children, young people and their families will be provided in children’s centres, schools or GP practices. This includes CAMHS and children with disabilities

Some children’s out patients may be delivered in children’s centres too, but they are also likely to need some capacity in community sites in the future

The Acute Trust will provide some children’s outpatient services at

■ Delivery of extended service agenda

■ Increased opportunities to expand group work

■ Reduced professional isolation

■ Maintains some locality services and enables one stop shop approach to treatment where appropriate

■ More efficient use of HV time and increased


Version 08 - Draft

9



Benefits

HVMH in the future and therefore it is appropriate to allow some child orientated space in an area of outpatients to allow flexibility in the future for specific services such as children’s orthopaedics whereby the need for diagnostics is higher

ability to cross cover

■ Cross fertilisation of ideas.

13. Education and Training

Recruitment and retention of staff is a key issue for NHS Kirklees and a robust education and training strategy supported by modern and purpose built facilities, which includes effective IT systems, is seen as a high priority in ensuring that the workforce is appropriately staffed and equipped with the necessary skills to deliver the agenda

Provision of education and training of medical, dentistry, allied health professional and nursing students needs to be accessible within local facilities

Integrated training with education and local authority staff will be provided

The HVMH will contain multifunctional rooms that will accommodate health education, seminars, and staff training.

■ Improved ability to recruit and retain staff

■ Reduced travel time to training venues for staff

■ Improved teaching environment.

1.2.4 The figure above summarises the wide ranging review of service models undertaken as part of this OBC. Full details including benefits are shown in Chapter 6 – Current and Future Service Models.

3. Project Objectives

1.2.5 Given the above drivers of change arising from national, regional and local policies NHS Kirklees has compiled the following high level lists of objectives for the project.

Figure 1-3 – Project Objectives

Objective Description

1 ■ To create enhanced primary care and community hospital facilities (“community hubs”) in the Valleys locality by March 2011

2 ■ To provide safe5 and efficient facilities that enhance the patient

experience and assist the delivery of high quality services

5 e.g. Good infection control


Version 08 - Draft

10


3 ■ To enable the implementation of the NHS Kirklees Strategic Plan and deliver key policy imperatives

6

4 ■ To provide opportunities for the service models developed by commissioners (Health Improvement Teams and Practice Based Commissioners) to be implemented

5 ■ To bring increased primary and secondary care services e.g. diagnostic and outpatient activity to the community in partnership with local providers

6 ■ To work with GP practices and other partners to deliver integrated care

7 ■ To improve local geographic and physical access to services in the Valleys locality

8 ■ To ensure the longer term sustainability of services on the HVMH site

7 by developing supporting services and facilities on the HVMH

site

9 ■ To significantly reduce backlog maintenance at HVMH

10 ■ To reduce the HVMH carbon footprint, both on site through modern building techniques and in terms of reduced patient travel required to access services.

11 ■ To deliver one-stop services on site at HVMH (particularly for patient pathways involving Hawthorne Ward).

4. Capacity Planning and Activity

1.2.6 Activity projections are shown in the figures below. There is a significant 72% rise in activity projected for the new HVMH.

6 “Care closer to home”, “High Quality Care for All”, “Transforming Community Services”, “The Next Stage Review” and

“Looking to the Future”

7 e.g. the 20 bedded intermediate care ward


Version 08 - Draft

11

Figure 1-4 – Projected Appointments per Year at HVMH

Appointment Type

Baseline Appointments

2008/09

Projected Appointments

2018/19

Percentage Difference

First 3,827 10,007 +161%

Follow Up 11,972 29,100 +143%

Outpatients

Total 15,799 39,108 +148%

Day Case Patients

Total 2,425 4,885 +89%

First 2,226 2,360 +6%

Follow Up 13,207 13,999 +6%

Therapies

Total 15,433 16,359 +6%

Mental Health Total 2,680 2,841 +6%

End of Life Care Total 16 17 +6%

Inpatients Total 193 205 +6%

Integrated Care Total 1040 1105 +6%

Total 37,586 64,520 +72%

1.3 The Economic Case

1. Option Appraisal (Non Financial)8

1.3.1 Three shortlisted options were considered by the business case team at first option scoring workshop held on the 4

th September 2009. A full description of this workshop is

shown in Appendix C4 – First Option Scoring Workshop – 04/09/09.

1.3.2 Following the imposition of a capital constraint of £12.39m later on in the process a final short list of three options was taken forward, consisting of 2 new options (1A & 2C) and one previously scored option 1B (whose score was retained).

1.3.3 The final shortlist of options is shown below:

8 Also known as the Qualitative Benefits Appraisal


Version 08 - Draft

12

Figure 1-5 – The Shortlist

Ref Description

1A New Do Minimum – Refurbish Existing Estate to Current Standards (No New Build)

1B Mainly Refurbish – Reuse Existing Buildings plus 10% New Build (Infill)

2C Mainly New Build/Some Refurbishment (67% New: 33% Refurbished Existing Structures)

Qualitative Benefits Appraisal

1.3.4 The results of the revised qualitative benefits appraisal are shown below.

Figure 1-6 – Revised Qualitative Benefits Appraisal

Ref Benefit Criteria Group Weight % New Option 1A

New Do Minimum – Refurbish Existing Estate to Current

Standards (No New

Build)

Option 1B

Mainly Refurbish –

Reuse Existing Buildings plus 10% New Build

(Infill)

New Option 2C

Mainly New Build/Some

Refurbishment (67% New :

33% Refurbished

Existing Structures)

W Score WxS Score WxS Score WxS

1 Clinical Quality of Care 29.2 3 87.6 5 146.0 8 233.6

2 Environmental Quality of Services

20.4 5 102 4 81.6 8 163.2

3 Operational Suitability 19.4 3 58.2 5 97.0 9 174.6

=4 Access to Care 15.5 4 62 5 77.5 9 139.5

=4 Future Flexibility 15.5 2 31 3 46.5 8 124.0

Total 100.0 340.8 448.6 834.9

1.3.5 The non financial preferred option was Option 2C – Mainly New Build, Some Refurbishment (67%: 33%).

2. Identification of the Overall Preferred Option

1.3.6 The figure below brings together all the key financial and qualitative factors influencing the choice of the preferred option.


Version 08 - Draft

13

Figure 1-7 – Identification of the Overall Preferred Option

Option 1A Option 1B Option 2C

Net Present Cost (NPC) 16,822 19,223 19,206

Equivalent Annual Cost (EAC) 634 725 724

Rank ��

Benefit Points 340.8 448.6 834.9

Ratio of EAC (£’000) to Benefit points

1.86 1.62 0.87

Ranking ��

Qualitative Risk Appraisal 134 138 140

Ranking ��

1.3.7 From the above analysis NHS Kirklees can determine that Option 2C has the lowest EAC cost per benefit point with a similar risk profile relative to the other 2 options and as such is the best option from a balanced financial and non financial perspective.

The Overall Preferred Option

1.3.8 From the analysis provided above, the PCT have determined that Option 2C – New Build, Some Refurbishment (67%: 33%) is the overall preferred option.

1.4 The Commercial Case (Procurement)

1.4.1 The business case team examined a range of procurement routes including:

■ PFI

■ Procure 21

■ Traditional Lump Sum

■ Develop and Construct – Design and Build

■ LIFT and Express LIFT.

1.4.2 The criteria used to decide between the different procurement routes were:

■ Early cost certainty

■ Project deliverability

■ Design, functionality and quality

■ Value for money

■ Risk management.

1.4.3 The outcome of the above process was that P21 was identified as the most effective procurement route to deliver this project when evaluated against the criteria above and the OBC project objectives.


Version 08 - Draft

14

1.5 The Financial Case (Affordability)

1.5.1 The financial case examines the affordability of the preferred option, Option 2C. The following tables identify the affordability of the scheme relating to capital and revenue funding.

Figure 1-8 – Preferred Option Revenue Funding Sources

2009/10 2010/11 2011/12 2012/13 2013/14

Baseline Funding

PCT 525 502 486 456 456

Total 525 502 486 456 456

Additional Funding Requirement to be Agreed with Partners

PCT 0 5,488 0 0 0

Partner 1 KCHS 4 101 270 270 262

Partner 2 CHFT 8 202 539 538 530

Total Additional Funding 12 5,791 809 808 792

1.5.2 There is an increased revenue cost of approximately £800k per annum which needs to be funded by the occupiers of the building. The figure above shows how this breaks down between KCHS and CHFT based on the proportion of the new build occupied by each party.

1.5.3 Agreement needs to be reached with each of the partner organisations that they will fund this level of increased costs before the scheme commences. Conversations to this effect have already taken place with the partners and these need to be concluded before the Final Business Case is completed.

1.5.4 The additional PCT funding is assumed revenue cover for the impairment of assets resulting from bringing the new build onto the PCT’s balance sheet. This assumes that existing resource arrangements continue into 2010/11, and this needs to be confirmed before the scheme progresses.

Figure 1-9 – Preferred Option Capital Affordability Analysis

2009/10 2010/11 2011/12 2012/13 Total

Capital Funding Required (including Optimism Bias)

677 11,459 52 161 12,349

Capital Funding Available 677 11,459 52 161 12,349

Capital Surplus/(Deficit) 0 0 0 0 0


Version 08 - Draft

15

1.5.5 The figure above shows the major capital requirement for the scheme being in 2010/11. The capital requirement in 2009/10 reflects the cash flow timings in the OB Forms, which are estimates. Some costs have been incurred in working up the scheme and more will be incurred if the scheme is approved. However, until approval is given these costs will remain as estimates. The expectation is that Community Hospitals funding can be accessed this year to cover these costs.

1.5.6 Capital costs in future years are relatively small in value and relate to the timing of cash flows. It is expected that these will be funded from Community Hospitals funding and managed via accruals. This means that the full cost of the scheme is expected to be funded from Community Hospitals funding.

1.5.7 The level of available capital funding in the figure is based on the assumption that the full amount of Community Hospitals funding allocated to the Calderdale and Kirklees health economies is available to fund the scheme. This needs to be agreed before the scheme can progress.

1.5.8 The above figures demonstrate that there are still some revenue affordability issues which need to be resolved prior to the commencement of the scheme. In addition, confirmation of the amount of available capital funding is also required.

1.6 The Management Case

Project timetable

1.6.1 A summary of the key milestones is outlined below.

Figure 1-10 – Key Project Milestones

Key Event/Task Timing

Trust Board Approve OBC January 2010

Strategic Health Authority (SHA) Receive/Approve OBC

January 2010

Decision to Appoint PSCP Approved by Trust Board

January 2010

Prepare FBC and Agree GMP March 2010

Trust Board Approval of FBC/Financial Case March 2010

SHA Approval of FBC March 2010

(Subject to Approvals Process)

Start on Site April 2010

Completion March 2011

Project Management Structure

1.6.2 The project management structure to take the project forward is shown below.


Version 08 - Draft

16

Figure 1-11 – NHS – Project Structure

Board of NHS Kirklees

Strategic Development Committee (programme board)

HVMH Project Board

She

ila D

ilks

SR

O

HVMH Business

Case TeamHVMH Design Team

Ja

me

s D

rury

PM

Tribal GroupRance Booth & Smith

Architects



HVMH Project Board

She

ila D

ilks

SR

O

HVMH Business


Ja

me

s D

rury

PM


Architects

1.6.3 The role of each body is summarised in Section 13.3 – Project Structure, Skills and Resources.

Benefits Realisation

1.6.4 The Trust developed a detailed Benefits Realisation Plan derived from project objectives and the benefit criteria used to appraise the shortlisted options – See Section 13.5 of the OBC and Appendix F1 – Benefits Realisation Plan.

1.7 Conclusion

1.7.1 It is recommended that approval be given to the OBC to enable NHS Kirklees to proceed to an early implementation of this key scheme.

1.7.2 This will expedite the realisation of the significant benefits the scheme will deliver to the people of The Valleys and beyond.

Signed……………………………………………….


Version 08 - Draft

17

2 Introduction and Background

2.1 Introduction

2.1.1 This outline business case (OBC) is for the development of primary care and community hospital services at Holme Valley Memorial Hospital, Holmfirth.

2.1.2 The proposed reconfiguration of HVMH services marks the culmination of a process of major change that began with the landmark public consultation exercise “Looking to the Future” (October 2005). The overall vision at that time which has been built on over recent years and continues to be implemented was:

“….to provide as much care as possible closer to people’s homes, wherever this is safe and practical, and to provide high quality, specialist services in our hospitals. We want to make sure that we are offering the right care, by the right people, at the right time”

2.1.3 The proposed redevelopment of HVMH is consistent with Looking to the Future and current strategic thinking e.g. the recent 5 year Strategic Plan (2008 – 2013)

9 “Ambitions

for a Healthy Kirklees” states:

“We believe that a population of the size of Kirklees could support around three larger community sites, from which a range of services could be provided. Our view is that these three key sites are:

■ Holme Valley Memorial Hospital, Holmfirth

■ Princess Royal Community Hospital, Huddersfield Town Centre

■ Dewsbury Health Centre.

Background

2.1.4 The Government consultation ‘Our Health Our Care Our Say’ highlighted the desire of patients to see more services provided in the community, closer to home, and in a suitable setting. In response the Kirklees and Calderdale health community developed an integrated service strategy for the delivery of a whole system approach to health care, which has been approved through the public consultation ‘Looking to the Future’.

2.1.5 One of the key principles of this strategy is to support the provision of services closer to home. This approach remains consistent with the more recent strategic direction set out by ‘High Quality Care for All’ the final report of the NHS Next Stage Review. This proposal is aligned to the regional strategy implementation document ‘Healthy Ambitions’ and the local PCT strategy ‘Ambitions for a Healthy Kirklees’.

2.1.6 The award of Community Hospitals Fund capital will enable NHS Kirklees to develop the infrastructure needed to bring to life the PCT’s vision for local services. The Department of Health, via its Programme Investment Board, has previously given outline approval for the investment of £13.79 million of Community Hospitals Fund capital in the Calderdale and Kirklees health communities.

2.2 Project Objectives

2.2.1 The figure below shows the HVMH project objectives derived from national and local strategic documents.

9 Revision March 2009


Version 08 - Draft

18

Figure 2-1 – HVMH Project Objectives



2 ■ To provide safe10

and efficient facilities that enhance the patient experience and assist the delivery of high quality services


11







site




2.3 Business Case Structure and Scope

2.3.1 The OBC is in three volumes:

■ Volume 1 – the Outline Business Case

■ Volume 2 – Appendices

■ Volume 3 – the Estates Annex.

2.3.2 The document structure for Volume 1 – the OBC is summarised below.






Version 08 - Draft

19

Figure 2-2 – OBC Structure

2. Introduction

3. Trust Profile

Strategic Case

4. Profile of Current HVMH Services

5. Strategy for Change6. Current and Future Service Models7. Future Activity and Services‘

Requirements

Economic Case

8. Non financial Option Appraisal

9. Economic Analysis (VFM)

10. Risk Analysis and

Preferred Option

11. Financial Case (Affordability)

• Capital and Revenue Costs of Preferred Option• Income and Cost Assumptions• Funding

12. Commercial Case

• Procurement Strategy• Documenting the “Deal”

• Procurement Resources and Skills

13. Management Case

• Project Structure and timescale

• Stakeholder, Public and Patient Involvement• Benefits Realisation Plan• Gateway Plan

• Workforce Plans

• IM&T Plans• Health & Equality Impact• Post Project Evaluation

1. Executive Summary

2. Introduction

3. Trust Profile

Strategic Case

4. Profile of Current HVMH Services

5. Strategy for Change6. Current and Future Service Models7. Future Activity and Services‘

Requirements

Economic Case

8. Non financial Option Appraisal

9. Economic Analysis (VFM)

10. Risk Analysis and

Preferred Option

11. Financial Case (Affordability)

• Capital and Revenue Costs of Preferred Option• Income and Cost Assumptions• Funding

12. Commercial Case



12. Commercial Case



13. Management Case

• Project Structure and timescale

• Stakeholder, Public and Patient Involvement• Benefits Realisation Plan• Gateway Plan

• Workforce Plans

• IM&T Plans• Health & Equality Impact• Post Project Evaluation

1. Executive Summary

2.3.3 The business case has been compiled using:

■ The Capital Investment Manual – DH 1994 – plus subsequent updates

■ HM Treasury, The Green Book : Appraisal and Evaluation in Central Government : Treasury Guidance (2003)

2.4 Approvals and Support

2.4.1 The OBC status is:

■ Project Board – meeting December 2009

■ PCT Board – meeting January 13th 2010

■ SHA – January 2010 (tbc)

2.4.2 Appendix A – Letters of Approval and Support provides details.


Version 08 - Draft

20

3 Strategic Case – Profile of NHS Kirklees

3.1 NHS Kirklees Profile – Introduction

3.1.1 This chapter provides the strategic context to the OBC at NHS Kirklees level, setting the scene for the service level changes in the later chapters.

3.2 NHS Kirklees Profile – Key Goals

3.2.1 Kirklees PCT was established in October 2006 from three former PCTs in Huddersfield and North Kirklees.

Figure 3-1 – Map of the Seven Localities of Kirklees

3.2.2 The PCT has eight key goals as shown in the figure below.


Version 08 - Draft

21

Figure 3-2 – NHS Kirklees Goals

Goal Description

1 Place the person at the centre of everything we do

2 Improve health and reduce health inequalities

3 Improve quality and promote safety

4 Promote choice and accessibility

5 Work well in partnership with communities, individuals and their families, staff and organisations

6 Promote local sensitivity through effective commissioning

7 Promote strong clinical leadership to drive service re-design and innovation

8 Be a visibly credible organisation, operating to the highest standards.

3.2.3 Goals will be delivered through:

■ Commissioning Approach – driven by users, carers and commissioners

■ Clinical Leadership – e.g. via the Kirklees Commissioning College

■ Service User and Public Engagement – as part of World Class Commissioning

■ Financial and Investment Plans – an integrated approach using performance management tools.

3.3 NHS Kirklees Profile – Population Profile

3.3.1 Kirklees comprises both urban and rural communities with a total population of over 400,000 which is both increasing and ageing. By 2018 the population is predicted to increase by 8%. See the figure below.

Figure 3-3 – Kirklees Population – 2006 v 201813

Age Group (Yrs)

2006 2018 Change (Nos.) Change %

0 - 19 105.0 110.4 5.4 5.1

20 - 64 236.8 248.9 12.1 5.1

65 - 84 51.2 64.5 13.3 26.0

85 + 7.6 9.7 2.1 27.6

Total 400.6 433.5 32.9 8.2

13 ONS 2006 based sub-national population projections 2006-18


Version 08 - Draft

22

3.3.2 By 2018 17% of the population will be over 65 years of age. This change in demography will have a major impact on demand on local services. Coupled with a relatively modest growth in the number of people working age, this will impact on the ability of local health care organisations to attract and retain staff.

3.3.3 Overall, the numbers of births are static, but increasing among families of South Asian origin. More than one in five young people under 19 are now of South Asian origin, whilst 86% of the total population overall are white.

3.3.4 The population is relatively stable, although there has been some immigration – e.g. Kurdish and Hungarian immigrants mainly based in Dewsbury and Polish immigrants settling in Huddersfield. Often, these immigrant populations have particularly challenging health needs (especially in the case of asylum seekers and refugees) and the PCT needs to be mindful of these needs in the planning services.

3.4 NHS Kirklees Profile – Financial Profile

3.4.1 The figure below provides an overview of recent NHS Kirklees financial performance.

Figure 3-4 – Kirklees – Income and Expenditure – 2006/07 – 2008/09

2008/09 2007/08 2006/07

Resource Allocation 584,315 530,205 487,035

Income 124,827 22,158 23,210

Gross Income 709,142 552,363 510,245

Expenditure (706,355) (547,958) (509,339)

Total 2,787 4,405 906

3.4.2 Key points to note are:

■ Resource allocation is effectively funding provided by the Department of Health

■ Income are sales either within the NHS or external to the NHS

■ The reason for the large increase in both income and expenditure in 2008/09 is because the PCT was hosting the Yorkshire PCT Collaborative service on behalf of all the other PCTs in the region.

3.4.3 The PCT’s balance sheet for the most recently available years is shown below.

Figure 3-5 – NHS Kirklees Balance Sheets – 2006/07 – 2008/09

2008/09 2007/08 2006/07

Fixed Assets 17,932 18,086 17,322

Current Assets 6,863 5,632 7,000

Creditors (45,483) (36,521) (36,372)

Total Assets Employed (20,688) (12,803) (12,050)


Version 08 - Draft

23

2008/09 2007/08 2006/07

General Fund (23,031) (17,013) (15,337)

Revaluation Reserve 2,343 4,210 3,160

Other - - 127

Total Taxpayers, Equity (20,688) (12,803) (12,050)

3.5 NHS Kirklees Profile – Estates Profile

3.5.1 The PCT’s Estates Strategy for 2008 – 2013 shows 25 key PCT premises located across the PCT’s geographical area.

Figure 3-6 – Location of Key PCT Premises

3.5.2 PCT backlog maintenance amounts to £2.156m as at December 2007. The 2013 target for this figure and other key measures of estate performance are shown below.


Version 08 - Draft

24

Figure 3-7 – Kirklees PCT Premises14 – Targets for 2013

Item Current Situation Target for 2013

Backlog Total £2.156m £0

Physical Condition Categories C and D15

33% 0%

Fire Categories C and D 24% 0%

Health and Safety Categories C and D 42% 10%

DDA Compliance Categories C and D 32% 5%

Energy Consumption Categories C and D 38% 20%

Space Utilisation Overcrowded 3% 0%

Functional Suitability Categories C and D 27% 0%

Quality Categories C and D 33% 0%

3.5.3 In general terms C = operational but in poor condition, replacement needed soon and D – very poor, serious risk of imminent breakdown.

3.6 NHS Kirklees Profile – Staff and Cost Profile

3.6.1 The figure below provides a summary of Kirklees PCT staff numbers as at the end of March 2009. There are 1,528 staff on a headcount basis.

Figure 3-8 – NHS Kirklees – Staff and Cost Profile

Staff Group Commissioning PCT

Kirklees Community

Health Services

Wte £000

Additional Professional, Scientific and Technical

16.2 - 16.2 786.8

Additional Clinical Services 1.1 133.3 134.4 3,023.9

Administrative and Clerical 189.5 151.7 341.2 9,283.9

Allied Health Professionals 1.0 101.8 102.8 3,878.7

Estates and Ancillary 0.4 7.0 7.4 124.8

Medical and Dental 4.4 21.9 26.3 2,423.1

14 All premises (excluding GP owned properties)

15 Definitions of the various categories are included in the Estate Strategy


Version 08 - Draft

25

Staff Group Commissioning PCT

Kirklees Community

Health Services

Wte £000

Nursing and Midwifery Registered

33.3 459.8 493.1 17,106.8

Senior Manager 71.6 23.2 94.8 5,826.8

Students - 2.0 2.0 61.0

Total 317.5 900.7 1,218.2 42,515.8

3.7 NHS Kirklees Profile – Summary

3.7.1 The analysis above together with the 5 year Strategic Plan 2008 - 2013 shows Kirklees as a diverse area with people identifying closely with the locality in which they live rather than Kirklees as a whole.

3.7.2 This latter issue i.e. people’s strong attachment to their communities and services is a key factor in this OBC – with HVMH, the subject of the next chapter, being a strong focus for the local community’s affection.


Version 08 - Draft

26

4 Strategic Case – Profile of Current HVMH Services

4.1 HVMH – Introduction

4.1.1 This section provides an overview of current HVMH services, activity and performance levels together with an overview of the current estate condition and staff on site.

4.2 HVMH – Services and Activity

4.2.1 A summary of the baseline activity in HVMH is shown in the figure below.

Figure 4-1 – Baseline Activity in HVMH

Appointment Type Appointments 2008/09

First 3,827

Follow Up 11,972

Outpatients

Total 15,799

Day Case Patients Total 2,425

First 2,226

Follow Up 13,207

Therapies

Total 15,433

Mental Health Total 2,680

End of Life Care Total 16

Inpatients Total 193

Integrated Care Total 1,040

Total 37,586

4.2.2 Further detailed breakdowns of the baseline data above can be found in Appendix B1 – Breakdown of Baseline Activity 2008/09 by Specialty.

4.2.3 Baseline data collection consisted of data from the acute outpatient data set and from information gathered from staff within HVMH.

4.2.4 Where baseline data was limited any assumptions used to derive baseline activity are also stated in Appendix B1.

4.3 HVMH – Estates and Facilities Condition

Introduction

4.3.1 The following overview of HVMH was taken from the Kirklees PCT Draft Estates Development Strategy 2008/13 V4.0 18

th December 2007:


Version 08 - Draft

27

■ “Whilst the building structure remains sound the major problems with the buildings on this site are the need to replace most of the softwood windows and the likely need to completely re-engineer the mechanical and electrical engineering services which are generally reaching the end of their useful life

■ Each of the departments within the hospital are generally functionally adequate for their requirements except the two parts of Maple Ward which is completely outdated and functionally unsuitable

■ The Hawthorne Ward is a newer addition to the site with its own independent engineering services serving it but the previous occupants have moved out and it is currently lying empty

■ An obvious solution would be to move the Maple Ward into the Hawthorne Ward on either a temporary or permanent basis

16"

Backlog Maintenance

4.3.2 Backlog maintenance for HVMH was £1.189m (out of £2.156m for the PCT) made up of:

■ Physical Condition – £1.127m

■ Fire, H&S and DDA compliance – £62k.

4.3.3 NB The Do Minimum option in Chapter 9 – Economic Case – Economic Analysis – shows a capital cost of £8.0m for the “New Do Minimum – Refurbish existing estate to current standards (no new build) – maintain existing services and service levels plus some refurbishment and internal alteration to achieve an improved patient environment “.

Summary of Condition appraisal

4.3.4 The figure below provides an overview of the condition appraisal for HVMH.

Figure 4-2 – Summary of Condition Appraisal for HVMH

Statutory Standards

Name Physical Condition

Environmental Management

H&S Fire DDA

Quality Functional Suitability

Space Utilisation

HVMH C C/D C C C C C Under

4.3.5 In general terms C = operational but in poor condition, replacement needed soon and D = very poor, serious risk of imminent breakdown.

Ownership

4.3.6 HVMH is a freehold community hospital with 20 beds and includes Elmwood, a GP surgery (site leased by developer from PCT).

4.3.7 The estates related running costs for HVMH are shown below.

16 This is now scheduled for mid-July 2009.


Version 08 - Draft

28

Figure 4-3 – Estates Budget 2009/10

Description HVMH

Medical and Surgical Equipment Repair 3,300

Other General Supplies and Services 5,100

Electricity 29,400

Gas 47,000

Water 4,100

Sewerage 3,400

Rates 26,500

Contracted Refuse and Clinical Waste 10,900

Contracted Estate Management 57,000

Total 186,700

4.4 HVMH – Staffing and Cost Profile

4.4.1 NHS Kirklees has 41 provider arm staff (headcount) on site and a further 13 provider arm staff at the Oaklands Medical Centre which is one of the GP practices within the grounds of the community hospital.

4.4.2 A summary of staff groups and roles is shown below. The total salary cost is £926.2k including oncosts.

Figure 4-4 – HVMH – Staffing Profile

Staff Group Role Total

Additional Clinical Services Health Care Support Worker 11.53

Administrative and Clerical Clerical Worker 4.50

Manager 1.00

Allied Health Professionals Chiropodist/Podiatrist 0.80

Medical and Dental Consultant 1.03

Salaried General Practitioner 0.08

Nursing and Midwifery Registered Community Nurse 11.03

Sister/Charge Nurse 1.00

Staff Nurse 1.00


Version 08 - Draft

29

Staff Group Role Total

Total 31.97

4.5 HVMH – Summary

4.5.1 The above analysis provides an overview of the HVMH site, services and facilities.

4.5.2 This provides a useful baseline against which to assess the extensive changes proposed at HVMH in the following chapters – commencing with the Strategy for Change in the next chapter.


Version 08 - Draft

30

5 Strategic Case – Strategy for Change

5.1 Introduction

5.1.1 This section sets out the national, regional and local drivers of change underlying the need to develop services on the HVMH site.

5.1.2 The figure below provides an overview of the chapter structure and key points.

Figure 5-1 – Overview of Chapter Structure and Key Points

NationalDrivers of Change

• NHS Next Stage Review (2008)

• Our health, our care, our say

(2006)• Choosing Health (2004)

� Personalised Care

� Care Closer to Home

� Healthy Lives

� Quality

Regional Drivers

of Change

• Healthy Ambitions – Y&H

SHA (2008)

� Health and Inequality

� Quality and Safety

� Service Delivery Needs to Change

� VFM

Local Drivers of

Change

• Looking to the Future (2005)

• Joint Strategic Needs Assessment (2008)

• Ambitions for a Healthy Kirklees

� Services to community where

possible� Priorities – MH, obesity, pain

management, dementia, CHD, stroke and diabetes

� Food, alcohol, smoking and physical activity

� Tackle inequalities


OPD Activity



Diagnostics











OPD Activity



Diagnostics










• QIPP (2009)

5.2 National Drivers of Change

5.2.1 The figure below summarises key national drivers of change.

Figure 5-2 – National Drivers of Change

NHS Next Stage Review – Our vision for primary and community care (DH – July 2008)

Four broad themes were identified:

■ People Shaping Services

� Personal and responsive healthcare

� Patient access to a greater range of services locally

� By 2010 – people with long-term conditions will have personalised care plans


Version 08 - Draft

31

■ Promoting Healthy Lives

� Incentives for health and wellbeing

� Integrated access to musculoskeletal, psychological and other services

� Vascular risk assessment programme

� Quality and Outcomes Framework incentives for maintaining good health

■ Continuously Improving Quality

� Strengthened clinical leadership skills for primary and community care professionals

� Tariff based incentives for more healthcare in the community

■ Leading Local Change

� Support for local decision making

� Central role for Practice Based Commissioning

� Formation of new integrated care organisations.

Our health, our care, our say : a new direction for community services (DH – January 2006)

■ Personalised services and care closer to home

■ Improved prevention services with earlier intervention

■ Collaboration between health and social care to create networks for those with complex needs

■ Improved access to community services

■ Support for people with long-term needs – focus on Expert Patient Programme

■ Allowing different providers to compete for services.

Choosing Health – Making healthy choices easier (DH – 2004)

Key Principles:

■ Informed Choice – supported by creating the right environment

■ Personalisation – tailored support

■ Working together – NHS, Local Government, business, voluntary sector.

Key Priorities:

■ Reducing the numbers who smoke

■ Reducing obesity and improving diets

■ Increasing exercise

■ Sensible drinking

■ Improving sexual health and mental health.


Version 08 - Draft

32

Quality, Innovation, Productivity and Prevention (QIPP)

The Chief Executive of the NHS gave a commitment to “service with quality” – supported by an “evidenced based approach to the QIPP challenge”

17

The HVMH development helps to deliver against this agenda by contributing to the 4 key areas identified by the NHS Chief Executive:

■ Ensuring there is the capacity and capability to support the scale and pace of change required

■ Creating opportunities for clinical leadership across new care models and pathways

■ Engaging with the public, partners and staff – the PCT is engaged in a major consultation programme with key partners and the public

■ Creating change at the local level – the proposed HVMH provides tangible evidence of change for the benefit of the people in Holme Valley and surrounds.

5.3 Regional Drivers of Change

5.3.1 The above national drivers of change have been augmented by the Yorkshire and Humber SHA (Y&H) report “Healthy Ambitions” (2008) – summarised below.

Figure 5-3 – Regional Drivers of Change

Healthy Ambitions (2008)

Case for Change:

■ Population health and inequality – some parts of Y&H have the lowest life expectancy in England

■ Quality and safety of care – access to care is uneven

■ The local NHS does not meet public expectations – 14% of those polled

■ Service delivery needs to change – to match advances in research, science and technology

■ VFM – the demographic “time bomb” requires that every pound is spent effectively.

5.3.2 Taken together, Healthy Ambitions and the national reports above provided a sound base for Kirklees PCT to develop its own local vision for service development – outlined below.

5.4 Local Drivers of Change

5.4.1 The figure below summarises the key local drivers of change.

17 David Nicholson, CBE, NHS Chief Executive (August 2009)


Version 08 - Draft

33

Figure 5-4 – Key Local Drivers of Change

Looking to the Future (October 2005)

■ This review set out proposals for changes to children’s, women’s and surgical services and outlined changes to improve access to diagnostics, services for older people and people with long term conditions

■ At the same time consultation also took place on local mental health and learning disability services

■ A key recommendation was that “general health” services that could be provided in a community setting be reprovided along with their “underpinning resources”.

Joint Strategic Needs Assessment (February 2009)

Children and Young People

Key Challenges:

■ Infant deaths (dying before their first birthday)

■ Personal unhappiness and social isolation

■ Obesity

The key issues affecting the challenges above are:

■ Emotional wellbeing

■ Educational attainment

■ Food

■ Physical inactivity

■ Smoking tobacco

■ Drug and alcohol misuse

■ Teenage pregnancies and sexual health

■ Health behaviours of women of child bearing age

■ Disabilities

■ Safeguarding children

Adults

Specific vulnerable groups

■ Young adults (18 – 44 years)

■ Women of child bearing age

■ Older people

■ Carers

■ People with physical disability

■ People with learning disabilities

■ Those with long-term conditions e.g. diabetes


Version 08 - Draft

34

Health behaviours

■ Smoking

■ Alcohol

■ Physical inactivity

■ Food and nutrition

Social, community and wider factors

■ Feeling isolated

■ Volunteering

■ Getting on with each other

■ Low income

■ Inadequate housing

■ Unemployed

■ Climate change


Version 08 - Draft

35

Ambitions for a Healthy Kirklees – Five Year Strategic Plan 2008-2013 (Revised March 2009)

■ Local priorities chosen in line with Joint Strategic Needs Assessment (JSNA)

■ Increasing population – 8% increase from 2006 to 2018

■ Need to tackle health inequalities identified in the JSNA – shown in the two figures below.


Version 08 - Draft

36

5.5 Community Hospitals Fund – Programme Investment Board Submission

5.5.1 The DH has given outline approval for the investment of £13.79m of Community Hospitals Fund capital to develop seven schemes across the Calderdale and Kirklees PCT areas. The process by which this investment is made is through approval of business cases for each scheme by the Yorkshire and the Humber Strategic Health Authority.


Version 08 - Draft

37

5.5.2 The SHA will apply their usual robust business case approval process. Community Hospitals Fund capital is available within the following constraints. All capital must be spent by 31

st March 2011. Strategic Health Authorities must be satisfied that the scheme

is consistent with the Community Hospitals Metrics. These are measures originally reported in the PIB submission for the scheme which report movement of activity from acute to community settings. In particular movement of diagnostic and out patient activity is encouraged.

5.5.3 The Holme Valley Memorial Hospital scheme is part of the above funding allocation.

5.5.4 The PCT will develop a locality based service delivery model with community hospitals e.g. HVMH and health centres acting as local “hubs” around which a network of extended primary care provision will be created for each community.

5.5.5 The new service model proposed for the HVMH hub is detailed in the following chapter. The case for change in the PIB submission is summarised in the figure below.

Figure 5-5 – PIB18 Submission Summary

Capacity

■ Long term conditions’ management

■ Rehabilitation

■ Intermediate care.


■ New care pathways to reduce overall outpatient appointments

■ Reduction in follow-up appointments

■ Replacement of consultant led outpatient clinics with multi-disciplinary team led “see and treat” services in community locations.


■ Aim to increase provision

■ Facilitate early discharge from the acute hospital setting.

Diagnostics

■ Increased testing at community sites

■ Aim to broadly double diagnostic tests in the community.

Outpatient Activity

■ Aim to provide 20% of all first attendance activity and 30% of follow-up activity in a community setting (currently 5.5% (2006/07)).

5.6 Summary

5.6.1 The proposed investment in HVMH facilities sits squarely in the mainstream of national, regional and local strategies for change.

18 Programme Investment Board


Version 08 - Draft

38

6 Strategic Case – Current and Future Service Models

6.1 Introduction

6.1.1 This chapter describes the background to the development of a new range of service models giving rise to the significant shifts in activity modelled in Chapter 7 – Future Activity and Capacity Requirements.

6.2 The Case for Change

National Policy Agenda

6.2.1 A number of policies have influenced the direction of service model development for NHS Kirklees.

6.2.2 The White Paper ‘Our health, our care, our say’ was published in 2006. It identified greater third sector involvement, in both commissioning and service provision, as a key factor in realising its goals of improving health and well-being and giving people more choice, a stronger voice, and better access to a wide range of community services. The White Paper set out a new direction for community services and outlined a vision of community-based care. It built upon broader public sector reforms, allowing people to live more independently and exercising greater personal choice.

6.2.3 To deliver the above goals NHS Kirklees and its partners need to see a significant “shift” in the way care is delivered, away from the 'one size fits all' reactive approach, (usually delivered in hospital settings), to community-based, responsive, adaptable services.

6.2.4 Commissioning is central to ensuring change so that care is provided in the right place at the right time. In response to this, current provider landscapes will also need to change opening new opportunities for providers who are best suited to meet the needs of local populations. To achieve this, historical commissioning systems and intentions will need to change. Locality and practice based commissioners are in the best position to ensure that this happens.

6.2.5 It recognised that third sector organisations have a wealth of knowledge and experience, of both health and social care services and local service user needs, which have the potential to translate into provision of the kind of high-quality, user-focused services which the White Paper envisages.

6.2.6 The White Paper ‘ Care Outside of Hospitals’ has firmly confirmed a more localised model of care as being the optimum way to deliver services. The plans will make NHS care more accessible by moving services from hospitals into the community. It will pave the way for many changes to the services people receive in the community. Some examples are:

■ A new generation of community hospitals, providing diagnostics, minor surgery, intermediate care and basic primary care

■ Family doctors to be encouraged to open for longer and set up specialist clinics for conditions such as diabetes and ear, nose and throat treatment

■ Health MOTs allowing patients the option of having a health check up to see if they are at risk of developing conditions such as heart disease and diabetes.


Version 08 - Draft

39

6.2.7 The service review undertaken by Professor Lord Ara Darzi, Health for London – A Framework for Action, July 2007

19 has also supported the case for change through

localising services where possible and centralising services where necessary. The configuration to support such change is characterised by greater use and new developments for community services, specialised centres and polyclinics which support a firm move away from care in the acute setting for non complex care.

6.2.8 The provision of more local care to patients, in the form of diagnostics, enhanced GP services, and outpatient appointments are creating the need to provide integrated facilities where patients can receive the majority of their care, with the exception of more specialised or invasive diagnostics and treatment, which will continue to be accessed through acute services.

6.2.9 The Older Persons NSF and research through initiatives such as the Kaiser Permanente approach are increasingly influencing the way that long-term conditions are managed. Co-ordinated and proactive care in the community, with the emphasis on health promotion, and reduction in unnecessary acute intervention is acknowledged as the preferred model of care for the future.

6.2.10 Access to the most appropriate services in the NHS can be difficult, and resources can be wasted thorough patients being assessed and seen by a number of professions before the correct service is identified. The national initiative to develop local Capture Assess and Treat Services (CATs) is aimed at improving signposting to services, reducing duplication of assessment, and reducing unnecessary access to secondary care services.

Kirklees Approach and Principles

6.2.11 Previous workshop information, interviews and strategic documents have been examined and new confirmatory interviews have been held with service leads from health, and social care, along with examination of Trust data and information. In addition the scope of services has been influenced by public views during the workshop events.

6.2.12 NHS Kirklees has applied the following principles20

to the development of new service models that will remove any current limitations in services:

■ Quality services should be timely, designed around the patient, the patient journey and the needs of the population

■ Services should focus on education and prevention of ill health, as much as treatment and rehabilitation

■ Developments should support a reduction in health inequalities

■ Service developments should reflect good modern practice

■ Services should be clinically effective and cost efficient

■ Wherever possible patients should be able to choose from a range of treatments and providers

■ Services should meet the needs of the individual and facilitate continuity of care

■ Health and social care services should be integrated and seamless

■ Services that need to work closely together, including Health, Social Services, District Council and the voluntary sector should be co-located

19 Later – High Quality Care for All : NHS Next Stage Review Final Report 30

th June 2008

20 See also S13.4 – Stakeholder Involvement and Consultation for details of feedback from the public re HVMH.


Version 08 - Draft

40

■ Service models should support recruitment and retention of staff and provide career opportunities for professionals

■ Services should be provided in high quality, accessible premises using modern, efficient equipment.

6.2.13 By bringing services closer together, it is hoped that patients have greater choice, easier access, and reap the benefits of professionals working in an integrated way.

6.2.14 This model of care will be facilitated through the development of a new facility that will enable preventative, educational, diagnostic, treatment and rehabilitation services to be carried out as locally as possible.

6.2.15 Emphasis will be placed on creating flexible accommodation that can be adapted to new working methods and clinical activity throughout the lifespan of the building.

Key Benefits

6.2.16 In addition to the principles identified in the above section, the approval and implementation of the agreed outline business case should also give benefits in the following areas;

■ Delivery of Darzi recommendations

■ Achievement of 18 week targets

■ Achievement of Working Lives targets

■ Delivery of NSFs

■ Implementation of primary care mental health initiatives

■ Development of GP specialist roles with increased local VTS opportunities

■ Local facilities for staff education and training

■ Delivery of Children’s Trust agenda

■ Delivery of NHS Kirklees Long Term Conditions Programme as specified in Ambitions for a Healthy Kirklees.

6.2.17 NB. All the service models need to be read in conjunction with the NHS Kirklees Five Year Strategic Plan 2008-2013.

6.3 Current and Future Service Models – Summary

6.3.1 The figure below provides a summary of current and future service models with a summary of the expected benefits that change will bring in the near future.


Version 08 - Draft

41

Figure 6-1 – HVMH – Current and Future Service Models - Summary21



Benefits

1. Inpatients The Holme Valley Memorial Hospital site has historically always provided in patient care. The prime determinant of this has been location of the area in relation to acute services. 20 beds are currently provided in a new building on the HMVH site

A total of 20 step up and step down beds will continue to be provided on the site supported by a wider range of services.

There are opportunities to increase occupancy levels and reduce LoS

■ Avoidance of unnecessary admission into acute hospitals

■ Prevention of premature admission to long term care

■ Reduction in the need to access A&E.

■ Provision of rehabilitation to eligible users

2. Outpatients The majority of current outpatient procedures are commissioned from Calderdale and Huddersfield NHS Foundation Trust as main acute providers with provision at a range of sites within NHS Kirklees including HVMH

It is planned that at least 40% of all new outpatients and 60% of follow ups (year on year) that are still provided in acute settings and outside of general practice – routine appointments, are provided within community sites in the future

Activity and population profiling has determined those patients that would ordinarily have to travel to attend an acute site will be able to attend locally where critical mass and complexity of the condition allows this

20 core specialities will be provided in clinics on the HVMH in future

■ Improved local access to services

■ Rapid access to diagnostics in a one stop shop approach

■ No need to travel to acute sites which will be of particular benefit to the elderly population, who may have difficulties in mobility and transport, and to those with young families.

■ Implements Darzi approach

3. Diagnostics There are currently no diagnostics facilities

A wide range of diagnostics will be

■ Faster diagnosis and treatment

21 See Chapter 7 – Future Activity sand Capacity Requirements for details of activity by specialty and service model – 2008/09

to 2018/19


Version 08 - Draft

42



Benefits

provided on the HVMH site other than those routinely performed for inpatient care such as routine blood tests and samples taken for histopathology, microbiology etc which would be processed on the acute site

provided at HVMH taking account of critical mass issues and population centres

Future modalities will include

■ Breath tests

■ Pulse oximetry

■ Urine flows

■ Blood tests (U&Es, FBC )

■ Near patient testing for example INR/BP monitoring

■ Echocardiography/ECG

■ Beta Naturetic Peptide

■ D Dimer

■ 24 hr monitoring

■ Spirometry

■ Access to other pathology services e.g. Histopathology, cytology, microbiology

■ Imaging - x- ray, ultra sound

■ Telemedicine

■ Carotid scanning

■ Venous Doppler

■ Visual Fields

■ Mobile Docking

■ Colposcopy

■ Fluoroscopy

■ Reduction in consultation and specialist time

■ Collaboration across community/primary/secondary care

■ Increased ability to prioritise patient care

■ Achievement of current access standards

■ Improve access and choice

■ Deliver greater consistency and equality in service provision

.

4. Therapies Nutrition and dietetics, occupational therapy, physiotherapy, podiatry and speech and language therapy are

Therapy services will continue to be provided on the HVMH site however through an integrated model for

■ Reduce admissions to secondary care

■ Enable early discharges


Version 08 - Draft

43



Benefits

all currently provided on the HMVH site

therapy services, professional demarcations will be reduced and a more holistic approach developed focusing on patient needs and achievement of health outcomes

For inpatient care there will be in particular a lack of demarcation between where therapy input begins and ends during the patient stay. The total environment will be conducive to active rehabilitation and although there will be qualified therapists caring for patients, all staff will work to a therapeutic and rehabilitative ethos

There will be an increase in outpatient sessions in terms of sessions to support consultant clinics, and nurse led clinics, respiratory care and oxygen assessment

Therapy staff will deliver clinical care on site and a team will also be based there

■ Reduce GP appointments

■ Contribute to the reduction in morbidity for patients with long term conditions including parkinsons, motor neurone disease, multiple sclerosis and epilepsy

■ Improve mobility and independence

■ Achieve better self-management by patients and their carers

■ Provide specialist advice, mentoring and training to other health professionals to improve their skills

■ Promote multidisciplinary and integrated working practices to deliver an holistic approach to care

5. Day Cases Day case procedures are currently performed on the HVMH site.

The level and breadth of procedures performed is quite limited

High volumes of specified surgical day case procedures will be moved from delivery in the acute setting to delivery in fully equipped surgical facilities at the community hospital site

Key procedures from

■ Greater theatre utilisation as day surgery is planned well in advance and has a high proportion of 'standard' cases;

■ Reduction in costs

■ Frees up


Version 08 - Draft

44



Benefits

the core business specialties that will be transferred in high volumes from Calderdale and Huddersfield NHS Foundation Trust into community settings include:

■ General surgery

■ Gynaecology including colposcopy, TOP, hysteroscopy, endometrial ablation

■ ENT – adult local anaesthetic grommits only

■ Trauma and orthopaedics

■ Urology - blue light laser TURP

■ Minor skin procedures

■ Plastic surgery

inpatient beds;

■ Reduced waiting lists;

■ Improved utilisation of operating lists;

■ Reduced cancellations;

■ Increased capacity (more bed days available).

6. Dental The salaried primary care dental service operates from the following locations in the Huddersfield area within Kirklees:

■ Holme Valley Memorial Hospital,

■ The Barton Unit at St Lukes Hospital,

■ Princess Royal Community Health Centre,

■ Fartown Health Centre,

■ Huddersfield Royal Infirmary

It is recognised that in

The service will become more specialised, with more multi-skilled teams. With this will be a requirement for treatment areas to be able to flex in order to deal with both sedated and non sedated patients, especially for those with physical disabilities

Preventive and health promotion services will also need to be accommodated

3 surgeries will be provided, including a preventative suite

■ Enables access for remote communities in South Kirklees

■ Improves emphasis on dental health prevention

■ Maintains and expands service for clients with special needs

■ Helps to consolidate services across the area


Version 08 - Draft

45



Benefits

future there may be opportunities to consolidate service delivery on a smaller number of locations, while still maintaining access for more remote communities and maintaining close links with related specialist services, such as those provided at the Barton Unit. 1 surgery is provided currently

7. Long Term Conditions /Intermediate Care

There are 8 intermediate care teams/community rehabilitation teams (ICT/CRT) for Kirklees which are part of intermediate care services which work in co-operation with other health, social care and voluntary sector services, who are also required to deliver the integrated intermediate care pathway. The Holme Valley teams are based at Fartown Health Centre

The teams practise inter-disciplinary/agency working, skill mix, and include generic multi- skilled workers.

The future service model will focus on improved service provision based on care pathways that work cross boundary, across primary, secondary and community domains providing systemic care in the right place for the client. A key element of this will be to further develop the single assessment process

A fundamental part of this service model will be to place the client at the centre of a network of care through identifying ways in which existing intermediate care pathways can be developed alongside long term condition care pathways. To achieve this, services such as GP practices, therapies, community nursing and specialist nursing, hospital specialists will need to come together with intermediate care provision

Fartown will continue to be the base for the team with clinic

■ The team is well located to access the locality when required.

■ Sessional activity maintains and enhances the service provided locally

■ Development of the service along side long term conditions will improve and enable the delivery of integrated care packages


Version 08 - Draft

46



Benefits

sessions provided on site

8. Mental Health There is a recognised need to shift the focus to health promotion provided at the first point of contact in primary care to enable healthier communities, reducing the need to access secondary care services

The current lack of co-location of primary and community mental health services with other primary and community care services, results in the following difficulties

■ Reduced opportunity for integration in care planning for patients

■ More difficulties in accessing timely specialist mental health advice and support

■ Reduced opportunity for sharing of skills.

In order to manage patients in the primary care setting and to reduce the likelihood of referral into secondary care it is necessary to strengthen primary and community care services

The service direction nationally for mental health services is to reduce care in inpatient settings

To deliver NHS Kirklees strategies a team base for community mental health teams will be created on the Holme Valley Memorial Hospital site

In addition the HVMH site will provide memory clinic services

■ Increased opportunity for integration in care planning for patients

■ Less difficulties in accessing timely specialist mental health advice and support

■ Improved opportunity for sharing of skills

9. End of Life End of life services provide assessment and intervention of patients in the last stages of life to people who will benefit from home nursing care and

This service will be maintained and expanded in the locality

In addition a team base will be provided to

■ Accessibility of the service

■ Expansion potential on site

■ Delivery of improved quality standards in end


Version 08 - Draft

47



Benefits

support from the district nurse service

End of life is deemed as within the final 12 months of life following a life limiting condition where curative treatment is no longer feasible

The service also includes intensive support to patients and carers for the last few days of life

This service is accessible for all residents of NHS Kirklees as well as the healthcare and allied professionals who are involved in their care

The current team serves Holme Valley but is not based in the current hospital

enhance the local delivery of services

of life care

■ Improved access to ward and health promotion areas to deliver services.

10. Social Services

Social Services do not have a base on the current HVMH site

A single flexible desk will be provided on the HVMH site for adult case management workers along with access to flexible consulting space for one to one client interviews. The facility may also be used by the Financial Assessment Team

■ Integrated working

■ Improved communication

■ Improved patient management

11. Drug and Alcohol

There are significant numbers of people with drug and alcohol problems around the Huddersfield area although services are not currently provided on site at HMVH

This model will focus on the client’s holistic needs and outcome focused care plans mapping out the ‘treatment journey’ with exit strategies

This approach will ensure that over the next ten years there will be improvements

■ Improved local access for patients

■ Integrated working with other specialties such as mental health teams on site

■ Access to clinical facilities for staff and


Version 08 - Draft

48



Benefits

in access to services. Developments will initially be prioritised and based on evidence of a particular rural/large conurbation needs analysis. This should also lead to better communication networks with partnerships developing services and communities with the ability to respond to the diverse needs of those particular communities

Whilst a team base is not required clinical sessions will be delivered on site

patients

12. Children’s Services

The PCT supports the development of extended service models, and wherever practical to consider such new venues as a point of service delivery, or for the co-location of staff with partner agencies. The extended service agenda is still in its infancy, though it is anticipated that by 2010 all areas of the county will have some form of extended service setting within the local community. In many cases this will provide an alternative venue for the full range of generic children’s services to be delivered, though not all will have estate capacity and will need to be virtual

The majority of services for children, young people and their families will be provided in children’s centres, schools or GP practices. This includes CAMHS and children with disabilities

Some children’s out patients may be delivered in children’s centres too, but they are also likely to need some capacity in community sites in the future

The Acute Trust will provide some children’s outpatient services at HVMH in the future and therefore it is appropriate to allow some child orientated space in an area of outpatients to allow flexibility in the future for specific services such as children’s orthopaedics whereby

■ Delivery of extended service agenda

■ Increased opportunities to expand group work

■ Reduced professional isolation

■ Maintains some locality services and enables one stop shop approach to treatment where appropriate

■ More efficient use of HV time and increased ability to cross cover

■ Cross fertilisation of ideas.


Version 08 - Draft

49



Benefits

the need for diagnostics is higher

The HVMH site will be not be used as a main base for accommodation of teams of health visitors, midwives and school nurses however flexibility will be allowed in hot-desk accommodation to allow them to work and integrate with other key staff as required on site

13. Education and Training

Recruitment and retention of staff is a key issue for NHS Kirklees and a robust education and training strategy supported by modern and purpose built facilities, which includes effective IT systems, is seen as a high priority in ensuring that the workforce is appropriately staffed and equipped with the necessary skills to deliver the agenda

The PCT is working with relevant organisations including the Deaneries and HEIs to ensure that appropriate training places are commissioned, particularly with regard to professions that are experiencing national recruitment difficulties such as therapists, dentists and doctors.

The PCT is committed to providing fit for purpose training including mandatory, non mandatory, NVQ, competency based training to all its staff.

Provision of education and training of medical, dentistry, allied health professional and nursing students needs to be accessible within local facilities

Integrated training with education and local authority staff will be provided

The HVMH will contain multifunctional rooms that will accommodate health education, seminars, and staff training. The rooms will have robust IT systems that allow virtual meetings/training sessions etc. Training rooms will accommodate large groups and flexibility will be created by the use of sound-proof partitions to create a larger space as required. In addition a large health education area will be provided to accommodate group sessions such as DESMOND and the Expert Patient

■ Improved ability to recruit and retain staff

■ Reduced travel time to training venues for staff

■ Improved teaching environment.


Version 08 - Draft

50



Benefits

These training routes are offered currently but do need to be developed

Training venues are at present limited in the locality

Programme

6.4 Summary

6.4.1 The figure above summarises the wide ranging review of service models undertaken as part of this OBC.

6.4.2 The next chapter documents the activity and capacity requirements that flow from the above analysis.


Version 08 - Draft

51

7 Strategic Case – Future Activity and Capacity Requirements

7.1 Introduction

7.1.1 The purpose of this chapter of the OBC is to:

■ Document the methodology and assumptions that have been used in obtaining baseline data and projecting future capacity requirements for HVMH

■ Identify likely future activity levels in HVMH.

7.1.2 The planning horizon for the projections covers the first ten years of operation of the proposed development.

7.1.3 The modelling allows activity and capacity projections to be calculated for each financial year (and service areas outlined in Chapter 6) up to 2018/19.

7.2 Overview of Methodology

7.2.1 An activity forecasting model has been built to generate activity projections. The model works on the basis of using actual Trust activity as a baseline, and then applying changes to the baseline in sequence so that the impact of each of the changes can be calculated separately. The final output is the aggregate effect of applying all the changes together.

7.2.1 At a high level, the methodology is as follows;

■ Start with baseline activity as provided by NHS Kirklees for 2008/09

■ Apply predicted population changes to the baseline activity

■ Apply additional activity being moved from other provider arms, to HVMH, as set out in the service models detailed in Chapter 6.

7.3 Baseline

7.3.1 Actual activity at the Trust for 2008/09 was used to reflect the model baseline. The baseline data collection consisted of data from the Outpatient and Day Case Patient minimum data set, and also data collected from HVMH staff.

7.3.2 A summary of baseline activity in HVMH is shown in the figure below.


Version 08 - Draft

52

Figure 7-1 – Baseline Activity 2008/09

Appointment Type Appointments 2008/09

First 3,827

Follow Up 11,972

Outpatients

Total 15,799

Day Case Patients Total 2,425

First 2,226

Follow Up 13,207

Therapies

Total 15,433

Mental Health Total 2,680

End of Life Care Total 16

Inpatients Total 193

Integrated Care Total 1040

Total 37,586

7.4 Activity Modelling Assumptions

7.4.1 As outlined in Chapter 6 of this OBC, there will be some diversion of services which are currently provided through Calderdale and Huddersfield NHS Foundation Trust. The specialities that will be affected by the transfers from Calderdale and Huddersfield NHS Foundation Trust to HVMH will be:

■ General Medicine

■ General Surgery

■ Cardiology

■ Obstetrics

■ Urology

■ Gynaecology

■ Trauma & Orthopaedics (linked to existing musculoskeletal service)

■ Soft Tissue

■ ENT

■ Audiology – including second tier assessments

■ Neurology

■ Ophthalmology

■ Nephrology

■ Oral Surgery/Orthodontics


Version 08 - Draft

53

■ Thoracic Medicine

■ Plastics

■ Podiatry Surgery (pre and post operative sessions)

■ Dermatology

■ Pain Medicine (Consultant led clinics only)

■ Rheumatology

■ Osteoporosis

■ Nurse led clinics mainly based in outpatient departments

■ Mental health, particularly for older people and child and adolescent mental

■ Learning Disabilities

■ Specialist prescribing for Drugs and Alcohol

■ Podiatric Surgery (pre and post operative sessions)

■ Tele health monitoring.

7.4.2 The modelling takes 40% of all new outpatients and 60% of follow up appointments from the above specialities and moves this activity into HVMH.

7.4.3 A key element of the modelling presented here has been analysing the geographical catchment areas of HVMH and in particular where any additional potential patients would transfer from other providers.

7.4.4 The map below shows for each GP practice in the HVMH area, what % of the population surrounding the GP practice is estimated to have access to HVMH. The size of the circle represents the proportion able to use HVMH, with a larger circle indicating more of the population have access to HVMH.

Figure 7-2 – Practices’ Population – Access to HVMH


Version 08 - Draft

54

7.4.5 The amount of activity predicted to move out of each of the practices displayed on the map and into HVMH is shown in the figure below.

7.4.6 All other practices are assumed to have no movement into HVMH.

Figure 7-3 – Proportion of Activity Relocating into HVMH22 (%)

Practice Name Location Proportion of Total Current Activity Within

the Practice Being Moved to HVMH

Barnwell Lepton 15%

Orme Shepley 100%

Priestman Kirkburton 90%

Seeley Scissett 80%

Welch Skelmanthorpe 80%

Aggarwal Lockwood 30%

Hamid Newsome 15%

Jabczynski Almondbury 25%

Sharman Lockwood 15%

Boulton Milnsbridge 30%

Deacon Marsden 20%

Faulkner Golcar 0%

Hariharan Golcar 0%

Jennison Holmfirth 100%

Latham Slaithwaite 5%

Lord Honley 90%

Mitchell Meltham 90%

Pacynko Meltham 90%

Shamsee Holmfirth 100%

22 i.e. the proportion of activity to be moved into HVMH from each Calderdale and Huddersfield practice, shown as a

percentage of total activity within that practice.


Version 08 - Draft

55

Practice Name Location Proportion of Total Current Activity Within

the Practice Being Moved to HVMH

Wright Slaithwaite 5%

Note: Sourced from James Drury at Kirklees Trust

7.4.7 NB. It is assumed all current activity within HVMH will remain in HVMH.

7.5 Population Growth

7.5.1 Population projections have been sourced from the latest Office for National Statistics (ONS) figures for local authorities and counties within North East, North West and Yorkshire and the Humber GORs.

7.5.2 These are trend based projections, which means assumptions for future levels of births, deaths and migration are based on observed levels, mainly over the previous five years. They show what the population will be if recent trends in these variables continue.

7.5.3 For NHS Kirklees PT overall projected population growth is +6% by 2018/19. The impact of applying this growth to Trust baseline activity of 37,586 patients in HVMH would be an increase of 2,262 patients, taking the total number to 39,848 in 2018/19.

7.6 Activity Projections

7.6.1 Based on the methodology and assumptions documented above, the resulting activity projections below have been calculated for the financial years to 2018/19, as well as the 2008/09 baseline for comparison.

Figure 7-4 – Projected Appointments per Year at HVMH

Appointment Type


2008/09


2018/19


First 3,827 10,007 +161%

Follow Up 11,972 29,100 +143%

Outpatients

Total 15,799 39,108 +148%

Day Case Patients

Total 2,425 4,885 +89%

First 2,226 2,360 +6%

Follow Up 13,207 13,999 +6%

Therapies

Total 15,433 16,359 +6%

Mental Health Total 2,680 2,841 +6%

End of Life Care Total 16 17 +6%


Version 08 - Draft

56

Appointment Type


2008/09


2018/19


Inpatients Total 193 205 +6%

Integrated Care Total 1040 1105 +6%

Total 37,586 64,520 +72%

Analysis of Increase in Activity

7.6.2 The breakdown of projected activity at HVMH as a result of new activity being transferred from other practices can be seen in the figure below.

7.6.3 A detailed breakdown by specialty is shown in Appendix B2 – Breakdown of Projected Activity 2018/19 by Specialty.

Figure 7-5 – Breakdown of Additional Activity Relocating into HVMH by Practice – 2018/1923

Practice Name Location Projected Patients Being Diverted into HVMH

Barnwell Lepton 462

Orme Shepley 2,123

Priestman Kirkburton 2,338

Seeley Scissett 476

Welch Skelmanthorpe 1,885

Aggarwal Lockwood 959

Hamid Newsome 442

Jabczynski Almondbury 532

Sharman Lockwood 280

Boulton Milnsbridge 951

Deacon Marsden 367

Faulkner Golcar -

Hariharan Golcar -

Jennison Holmfirth 4,481

23 NB. This is additional to population growth.


Version 08 - Draft

57

Practice Name Location Projected Patients Being Diverted into HVMH

Latham Slaithwaite 83

Lord Honley 2,814

Mitchell Meltham 1,977

Pacynko Meltham 1,082

Shamsee Holmfirth 2,210

Wright Slaithwaite 144

Total 23,606

Note: Totals may not sum due to rounding

7.7 Sensitivity Analysis

7.7.1 The activity projected by the model has been supported by Trust clinicians and managers who were involved in formulating the drivers for change and assumptions used in the activity model.

7.7.2 To illustrate the sensitivity of the model, the figure below shows the impact of each factor (e.g. population change and relocated or “diverted” activity) on the resultant activity totals for 2018/19.

7.7.3 The figures shown are the 2018/19 activity increases combining both population growth and additional patient referrals.

7.7.4 The combined effect takes total activity up to 64,520 patients in 2018/19.

Figure 7-6 – Impact of Population Growth and Diverted Activity on HVMH Baseline Activity

First

Follow Up Total Impact (% Change

from Baseline)

Population change +752 +1,510 + 2,262 +6%

Additional Referred Activity +7,345 +17,323 + 24,668 +66%

Total +8,097 +18,833 +26,930 +72%

7.8 Summary

7.8.1 The modelling has generated a robust projection of the future growth in activity that could be treated in the future HVMH.

7.8.2 The activity projected by the model has been supported by Trust clinicians and managers involved formulating the drivers for change and assumptions.


Version 08 - Draft

58

7.8.3 The number of patients projected at HVMH is set to increase significantly, +72%, predominantly as a result of local GP practices “diverting” their patients from Calderdale and Huddersfield NHS Trust Foundation Trust into HVMH.


Version 08 - Draft

59

8 Economic Case – Non Financial Option Appraisal

8.1 Process

8.1.1 The business case team assessed the options in the context of the constraints, project objectives and benefit criteria shown below.

8.2 Constraints

8.2.1 The team recognised a number of constraints on the business case process and these are listed below.

■ Timing – the new HVMH facility, inasmuch as it is dependent upon Community Hospital Funds

24 needs to be commissioned by March 2011

■ Capital Cost – options will need to fit within available capital funding - £12.39m25

■ Revenue Cost – must fit within the existing envelope of the PCT’s medium term financial plan

■ Space – there is one location (Holme Valley Memorial Hospital) and the proposed project will need to fit within its curtilage

■ NB Practical Issues – the decant of HVMH services and the obtaining of planning approval may constrain the options available under this project.

8.3 Project Vision and Objectives

Vision26

8.3.1 “Our vision is to deliver a range of appropriate services which increase community partnership by encouraging greater responsibility for personal and community health and well being.”

Project Objectives

8.3.2 The figure below shows the HVMH project objectives derived from national and local strategies.

Figure 8-1 – Project Objectives



2 ■ To provide safe27


24 NB Further development and expenditure is not constrained by this deadline.

25 Added in late 2009 – after the first option scoring workshop.

26 Turner & Townsend – Report of meetings 26/8/08 and 1/09/08



Version 08 - Draft

60



28







site




8.4 Benefits Criteria and Weighting

8.4.1 The benefit criteria derived from NHS Kirklees and HVMH project objectives are shown below.

Figure 8-2 – Benefits Definition

Benefit Criteria

1 Clinical Quality of Care – delivers safe, sustainable and responsive care

1.1 ■ Delivery – supports the delivery and development of new models of care and pathways e.g. self management – improving health outcomes and reducing health inequalities

1.2 ■ Safe Care – creates a “critical, sustainable mass” of activity, staff and resources to deliver consistently safe, expert care

1.3 ■ Patient Focused – person centred care delivered by integrated, multi-disciplinary teams

1.4 ■ A Complete Service – e.g. outpatient appointment and treatment delivered in one location and a seamless transition between services





Version 08 - Draft

61

Benefit Criteria

1.5 ■ Clinical Engagement – GPs, community and secondary care providers should see HVMH as a “real” hub”

1.6 ■ Support Services – e.g. voluntary groups, social services - for a growing elderly population and others.

2 Environmental Quality of Services – an improved environment for patients, visitors and staff

2.1 ■ Buildings and Facilities – appropriate for client groups

2.2 ■ Safety and Security – meets requirements of legislation and good practice e.g. infection control

2.3 ■ Modern Décor and Design – with spaces, rooms designed with a non-clinical ambience

2.4 ■ Privacy and Dignity – assured by good design and facilities

2.5 ■ Facilities – for patients’ families, visitors and staff e.g. café/restaurant, meeting/counselling rooms, changing areas

2.6 ■ HVMH Identity – site and services to retain their strong links to the local community

2.7 ■ Correct Functional Requirements – in terms of clinical adjacencies e.g. optimises patient journey

2.8 ■ Meets all HBN HTN30

/Primary/Social Care Sizing Guidance for Space Allowances – e.g. room for equipment, visitors, family members and others

2.9 ■ Meets Technical Requirements – including green issues, access routes, etc.

3 Operational Suitability – for the facility’s intended usage

3.1 ■ Facilitates – integrated, multi-disciplinary care appropriate to a hub site

3.2 ■ Staff Recruitment and Retention – attracts and retains staff

3.3 ■ Efficiency – improves efficiency by optimising clinical adjacencies and staff working relationships

3.4 ■ Hub Facilities – rooms, space and offices available e.g. for social services, community groups, network members and support staff.

=4 Access to Care – improved access to services both clinically and logistically

4.1 ■ Care Closer to Home – improved geographical access i.e. locally based services (within clinical and safety parameters) to increase uptake and outcomes

4.2 ■ Diagnostics – appropriate diagnostics available on site when required

4.3 ■ Physical and Logistical Access – Disability Discrimination Act (DDA) compliant, adequate car parking, pedestrian access.

30 Health Building Note, Health Technical Note


Version 08 - Draft

62

Benefit Criteria

=4 Future Flexibility – the capability to respond flexibly to changes over the longer term

4.1 ■ Changes – to service models

4.2 ■ Changes – in activity levels (both up and down)

4.3 ■ Changes – in IM&T

4.4 ■ Changes – in use of space and facilities (generic and shelled spaces).

Ranking and Weighting of Benefit Criteria

8.4.2 The next stage of the process was to rank and weight the benefit criteria.

8.4.3 Details of the workshop held on the 27th May 2009 e.g. attendees are shown in C1 –

Benefits Definition and Weighting Workshop – 270509

8.4.4 The delegates first ranked the benefit criteria then weighted them using the paired comparisons method. The results are summarised below and details are included in Appendix C2 – HVMH Paired Comparison Results.

Figure 8-3 – Weighted Benefit Criteria Groups

Ref Benefit Criteria Weights %

1 Clinical Quality of Care 29.2

2 Environmental Quality of Services 20.4

3 Operational Suitability 19.4

=4 Access to Care 15.5

=4 Future Flexibility 15.5

Total 100

8.5 The Longlist and Shortlist

8.5.1 Following the process indicated in Appendix C4 – First Option Scoring Workshop – 04/09/09 it was necessary to revisit the choice of shortlist options for the development in the light of further constraints being identified relating to affordability (December 2009). Specifically a capital affordability limit of £12.39m was agreed.

8.5.2 This is the total amount of capital available through the Community Hospitals Fund to NHS Kirklees and NHS Calderdale.

8.5.3 It was recognised that there may be scenarios in which this total amount would not be available to NHS Kirklees, such as the development of a Central Halifax scheme by NHS Calderdale.

8.5.4 In view of this possible scenario it was decided to develop at least one option which would be deliverable within a £9m capital affordability envelope.


Version 08 - Draft

63

Revised Short List

8.5.5 The revised options developed in response to affordability constraints were as follows

Figure 8-4 – Revised Shortlisted Options – December 2009

Option Ref.

Description and Comments Shortlist?

1A New Do Minimum – Refurbish existing estate to current standards (no new build) – Maintain existing services and service levels plus some refurbishment and internal alteration to achieve an improved patient environment.

Yes – baseline option

Service Model

Advantages

■ The baseline option

■ Ensures current services maintained

■ Achieves improved patient environment

■ Addresses maintenance issues which pose a risk to service continuity

Disadvantages

■ Full future service models not provided e.g. dental, daycase, preventative health interventions. Other areas compromised e.g. outpatients, therapies and diagnostics

■ Clinical adjacencies compromised

■ HBN/HTN sizing guidance not met in most areas

■ Minimal support services’ space provided.

Estates

Advantages

■ Net floor areas – 2,260 square metres excluding Hawthorn Ward

■ Car parking spaces – 75 including 3 for disabled people

■ Minimal disruption to services – short, timescale to implement

■ Low risk of local objections.

Disadvantages

■ Does not meet requirements of 2006 Health Act

■ Deteriorating estate quality, increasing revenue costs.

■ Functional Suitability, Health and Safety, Fire and Utilisation assessed as category C in Estates Strategy

■ Energy Performance assessed as Category D

■ Previously highlighted problems with car parking remain


Version 08 - Draft

64

Option Ref.


■ No improvement in size of accommodation.

1B Mainly Refurbish – Re-use existing buildings plus 10% new build (infill) – delivers improved operational suitability for existing services plus some limited capacity for additional services plus an improved patient environment.

Yes – fits affordability

criterion

Service Model

Advantages

■ Ensures current services maintained and allows some new growth to fulfil elements of the service model requirements

■ Achieves improved patient areas

■ Improves on modern spatial requirements where possible within building constraints

■ Allows some of the planned future activity levels to be delivered on site

Disadvantages

■ Future service models will be compromised i.e. reduced O/P activity, reduced therapy activity, omission of diagnostics, day surgery and dental services (or other services requiring an equivalent space).

■ Clinical adjacencies will be compromised, not optimal for patients

■ Some disruption to services

■ HBN/HTN sizing guidance will not be met in all areas

■ Minimal support services’ space provided

■ Not all activity can be transferred.

Estates

Advantages

■ Net floor areas – 2,560 square metres, excluding Hawthorn Ward

■ Car parking spaces 75 – including 3 spaces for disabled people and space for 2 ambulances

■ Retains the current Dental Block during construction

■ Limited improvement in most aspects of building performance potentially to category B i.e. estate quality, Functional Suitability, Health and Safety, Fire, Energy performance and Quality

■ Moderate increase in size of accommodation

■ Reduction in backlog maintenance issues


Version 08 - Draft

65

Option Ref.


■ Reduction in non compliance issues.

Disadvantages

■ Difficult to differentiate from option 1A

■ Unavoidable compromise in design and integrated service provision

■ Disruption to service during construction (decant required)

■ Proportionally larger footprint than new build for less functionality and useful service delivery space.

2C Mainly New Build – (67% new: 33% refurbished existing structures) – retains all current buildings along frontage of hospital, including Villa which is well regarded by local people. Provides sufficient accommodation to deliver the full proposed service model and all anticipated future levels of activity. Provides an improved patient environment and delivers improvement on HBN/Primary and Social Care guidance space standards.

Yes – delivers full service model

Service Model

Advantages

■ Ensures current services maintained and allows full growth in line with planned expansion

■ Ensures all future service models are delivered on site

■ Service co-location is delivered to optimal level

■ Allows future activity levels to be delivered on site

■ Achieves improved patient areas

■ Improves on modern spatial requirements where possible within building constraints

■ Allows future activity levels to be delivered on site.

Disadvantages

■ Some compromise in room size within the refurbished elements of the building.

■ Disruption to services

■ Limited compromise to clinical adjacencies. Internal travel distances not optimal for patients in the refurbished parts of the building

■ HBN/HTN sizing guidance not guaranteed to be met in refurbished parts of the building

■ Minimal support services’ space provided.


Version 08 - Draft

66

Option Ref.


Estates

Advantages

■ Net floor areas – 2,337 square metres

■ Car parking spaces – 54 including 4 for disabled people and 2 ambulances

■ Retains identity of building through re-use of existing estate

■ New build element allows for flexibility regarding the use of space in the future. It also helps achieve HBN standards and good operational/clinical adjacencies

■ Reduction in backlog maintenance issues

■ Reduction in non compliance issues.

Disadvantages

■ Some compromise in design and integrated service provision

■ Major disruption to service during construction (decant required)

■ Relatively low car parking numbers for the number of additional people attending the site.

8.6 Revised Qualitative Benefits Appraisal – December 2009

8.6.1 Following the development of the revised shortlisted options the process of qualitative benefits appraisal was repeated for the new shortlisted options. The same criteria and weightings were used, and the same group of stakeholders were asked to participate to ensure consistency of approach.

8.6.2 The results of the revised Qualitative Benefits Appraisal are shown below. Option 1B is as originally scored in the first workshop on 04/09/09.


Version 08 - Draft

67

Figure 8-5 – Revised Qualitative Benefits Appraisal – December 2009

Ref Benefit Criteria Group Weight % New Option 1A

New Do Minimum – Refurbish Existing Estate to Current

Standards (No New

Build)

Option 1B

Mainly Refurbish –

Reuse Existing Buildings plus 10% New Build

(Infill)

New Option 2C

Mainly New Build/Some

Refurbishment (67% New :

33% Refurbished

Existing Structures)

W Score WxS Score WxS Score WxS

1 Clinical Quality of Care 29.2 3 87.6 5 146.0 8 233.6

2 Environmental Quality of Services

20.4 5 102 4 81.6 8 163.2

3 Operational Suitability 19.4 3 58.2 5 97.0 9 174.6

=4 Access to Care 15.5 4 62 5 77.5 9 139.5

=4 Future Flexibility 15.5 2 31 3 46.5 8 124.0

Total 100.0 340.8 448.6 834.9

8.7 Revised Sensitivity Analysis

8.7.1 The sensitivity analysis for the revised shortlisted options is shown below.

Figure 8-6 – Sensitivity Analysis – December 2009

New Option 1A

Option 1B

New Option 2C

Score before sensitivity test 340.8 448.6 834.9

Rank � � �

Scores at maximum 356.3 464.1 870.8

Rank � � �

Scores at minimum 325.3 388.4 764.1

Rank � � �

8.7.2 Option 2C – Mainly New Build/Some Refurbishment (67% New: 33% Refurbished Existing

Structures) – ranked first at the qualitative benefits appraisal stage of the OBC.

8.7.3 During sensitivity analysis its minimum score was greater than the next best option at its maximum score – and it is therefore a robust option.


Version 08 - Draft

68

8.8 Revised Summary

8.8.1 The qualitative or non financial preferred option was therefore – Option 2C – Mainly New

Build/Some Refurbishment (67% New: 33% Refurbished Existing Structures).


Version 08 - Draft

69

9 Economic Case – Economic Analysis (VFM)

9.1 Introduction

9.1.1 A discounted cash flow for each of the options has been undertaken using a discount rate

of 3.5% for years 0 to 30 and 3.0% for the remaining years. This is in line with the

requirements of the HM Treasury Green Book and Department of Health guidance.

9.1.2 Both the Net Present Cost (NPC) and Equivalent Annual Cost (EAC) have been

calculated. The EAC is useful to show the annual cost of the investment in today’s

money. It can also be used for comparison where the options have different life spans as

it converts the NPC to an annual figure.

9.2 Methodology and Assumptions

9.2.1 A discounted cash flow model, following the principles of the Department of Health

Generic Economic Model (GEM), was populated with the base data for each option. The

key outputs from the model are available at Appendix C5 – Economic Appraisal – DCF

Analysis V3.

9.2.2 All options have been assumed to have a life of 60 years after construction, giving a total

life of 62 years (including year zero). It has been assumed for comparability purposes that

all the facilities become operational at the start of 2011/12.

9.2.3 Further details of the costs used for the economic appraisal are detailed below.

Capital Costs

9.2.4 The capital costs of the short listed options are summarised below. Further details can be found in the Estate Annex – Section 6.10 – QS Report OB Forms & Lifecycle Costs & Estate Appendices D & E. These capital costs have been prepared for the PCT by Derrick Kershaw Partnership.

Figure 9-1 – Capital Costs of Shortlisted Options - £000

Option 1A Option 1B Option 2c

Departmental Costs (from Form OB2) 2,515 3,135 3,005

On-Costs (from Form OB3) 1,599 2,677 3,747

Works Cost Total 4,114 5,812 6,752

Provisional location adjustment (206) (291) (338)

Sub-Total 3,908 5,521 6,414

Fees 586 828 962

Non-Works Costs (from Form OB4) 30 30 30

Equipment Cost (from Form OB2) 500 500 750

Contingencies 419 464 561


Version 08 - Draft

70

Option 1A Option 1B Option 2c

TOTAL (for approval purposes) 5,443 7,343 8,717

Optimism Bias (after mitigation) 1,306 1,762 1,700

TOTAL (for approval purposes) & Optimism Bias

6,749 9,105 10,417

Inflation 153 206 236

VAT 1,105 1,485 1,696

Total including VAT 8,008 10,796 12,349

9.2.5 The capital cash flows associated with each of the short listed options are summarised below. It can be seen that the vast majority of the spend would occur in the financial year 2010/11.

Figure 9-2 – Phasing of Capital Costs - £000

2009/2010 2010/2011 2011/2012 2012/2013 Total

Option 1A 446 7,425 34 103 8,008

Option 1B 610 9,996 47 143 10,796

Option 2C 677 11,459 52 161 12,349

9.2.6 Because the project involves a construction period of less than two years they have been estimated using MIPS FP indices. The cash flows are therefore given in nominal terms. To convert them into real costs, which will be comparable with other costs within the DCF analysis a differential inflation adjustment has therefore been applied to the capital costs. This is shown in Appendix C5 – Economic Appraisal – DCF Analysis V3.

Lifecycle Costs

9.2.7 Derek Kershaw Partnership has estimated the lifecycle costs associated with each short listed option. The detailed estimates can be found in the Estate Annex – Section 6.10 – QS Report OB Forms & Lifecycle Costs & Estate Appendices D & E. These figures have been converted into an equivalent annual cost to allow them to be entered into the DCF analysis. These are summarised below.

Figure 9-3 – Net Present Cost and Equivalent Annual Cost of Lifecycle Spend

Discounted Value Option 1A Option 1B Option 2C

Major Replacement 592,356 727,137 789,742

Redecoration 48,002 76,110 93,876

Minor Replacement, Repairs and Maintenance

174,266 250,290 298,377


Version 08 - Draft

71

Total Maintenance Costs 814,624 1,053,537 1,181,996

Equivalent Annual Cost 31,553 40,807 45,782

Building Running Costs

9.2.8 Current building running costs associated with the Holme Valley Hospital site have been estimated by the PCT.

9.2.9 The PCT has estimated the future building running costs based on benchmarks and its experience with other community hospital and primary care developments. It has assumed:

■ Facilities management costs - £65 per m2

■ Business rate - £73 per m2

Figure 9-4 – New Building Running Costs

M2 Cost per M2 Cost £

Option 1A 2,290 138 316,020

Option 1B 2,260 138 311,880

Option 2C 1,810 138 249,780

Clinical Costs

9.2.10 Any changes to the cost of services at HVMH will be covered separately to this OBC. They will be confirmed in the PCT spending plans agreed with HIT teams and commissioners. These have therefore been excluded from the economic appraisal as they fall outside the scope of this project.

Transitional Costs

9.2.11 The OBC has been developed on the basis that there will be no temporary structures on site and that decant would be to existing operational sites. Transitional costs are therefore likely to be minimal and similar between all options.

Opportunity Costs and Residual Value

9.2.12 The current land value of the HVMH site has been included as an opportunity cost for each option. This is currently £920k. At the end of the appraisal period this will be available for disposal and has therefore been included as a residual value. No residual value has been assumed for equipment or buildings, as these will have reached the end of their life.

9.3 Net Present Cost and EAC Analysis

9.3.1 The net present cost and equivalent annual cost of each option is summarised below.


Version 08 - Draft

72

Figure 9-5 – Net Present Cost EAC of Short Listed Options


Land opportunity costs 920 920 920

Capital costs 6,675 9,005 10,302

Capital costs inflation discounting adjustment ( 158) ( 213) ( 244)

Lifecycle costs 775 1,002 1,124

Lifecycle costs - equipment 983 983 1,103

Current building running costs - - -

Future building running costs 7,759 7,657 6,132

Residual value ( 131) ( 131) ( 131)

Total Net Present Cost 16,822 19,223 19,206

Equivalent Annual Cost 634 725 724

9.4 Preferred Option

9.4.1 To identify the preferred option the PCT considered the costs and benefits of each option.

9.4.2 The table below compares the ratio of cost and benefits for the shortlisted options.

Figure 9-6 – Cost Benefit Ratio


Equivalent Annual Cost 634 725 724

Benefit Points 340.8 448.6 834.9

Cost per Benefit Point 1.86 1.62 0.87

9.4.3 The chart below shows the benefits of the options, as established at the benefits workshop, and the net present costs of the options, as established from the discounted cash flow analysis.

9.4.4 The red line represents the cost-efficiency frontier. Options that fall below this frontier cannot be optimal, as it is possible to increase the benefits delivered by either reducing costs or holding costs constant. For example, option 1B cannot be the optimal option as it delivers fewer benefits than Option 2C, but at a higher cost/comparable cost.


Version 08 - Draft

73

Figure 9-7 – Comparison of Costs and Benefits

Comparison of benefit points and costs for short-listed options

0

100

200

300

400

500

600

700

800

900

- 100 200 300 400 500 600 700 800

Equivalent annual cost

bene

fit po

ints

Option 1A

Option 1B

Option 2C

9.5 Sensitivity Analyses

9.5.1 The results of the economic appraisal illustrated above have been subject to a sensitivity

analysis to examine the impact of movements in capital and revenue costs

Figure 9-8 – Sensitivity Analysis


Land opportunity costs -1067.5% -1087.7% 0.0%

Capital costs -147.1% -111.1% 0.0%

Capital costs inflation discounting adjustment 6221.8% 4699.1% 0.0%

Lifecycle costs -1267.8% -998.8% 0.0%

Lifecycle costs - equipment -999.4% -1018.3% 0.0%

Current building running costs N/A N/A N/A

Future building running costs 7490.9% 7632.5% 0.0%

Residual value 7490.9% 7632.5% 0.0%

Total Net Present Cost -58.4% -52.1% 0.0%

9.5.2 Switching value analysis has been applied to areas of material cash flows, to identify the

extent that costs must change in order for the ratio of EAC to benefit points to equal that

of the preferred option. The results are presented above. It can be seen that dramatic


Version 08 - Draft

74

changes would be required for the non preferred options to achieve the same EAC to

benefit ratio of the preferred option. This confirms the robustness of the result.

9.6 Conclusion

9.6.1 A thorough economic analysis in compliance with DoH requirements has been performed. This has concluded that Option 2C offers the best combination of costs and benefits and so offers the best value for money. The robustness of the decision has been confirmed by sensitivity analysis.


Version 08 - Draft

75

10 Economic Case – Risk Analysis and Overall Preferred Option

10.1 Introduction

10.1.1 A revenue risk appraisal of the risks associated with each of the options was carried out at a workshop on the 09 September 2009. This was performed by key members of the project team and was facilitated by Tribal. Capital risks have been considered separately by the design team when developing the capital costs.

10.1.2 The assessment was a qualitative assessment, with each risk been assessed on a qualitative scale to assess the probability of the risk occurring and the impact of the risk if it were to occur. Combined together these gave an overall assessment of the severity of each risk.

10.1.3 The table below show the scoring matrices that were used for assessing the probability and impact of each risk

Figure 10-1 – Probability Scoring Matrix

Level Descriptor Indicative Percentage Chance of Risk Occurring

1 Rare 5%

2 Unlikely 10%

3 Possible 25%

4 Likely 50%

5 Almost certain 75%

Figure 10-2 – Impact Scoring Matrix

Level Descriptor Textual Description of Impact

1 Very minor No material impact on the project

2 Minor Project would achieve all of its objectives, but difficulties would be encountered as part of the development

3 Moderate Project would continue but may not achieve all of its objectives, or be able to deliver them on time

4 Major Project will be able to continue, but its scope or objectives would be materially changed

5 Catastrophic Likely to stop the project proceeding


Version 08 - Draft

76

10.2 Results of Risk Assessment

10.2.1 The overall results of the risk assessment are shown below. See also Appendix C6 – Risk Assessment.

Figure 10-3 – Risk Results for Option 1A

Option 1A - Do Minimum Impact

Low Low /

Medium Medium

Medium /

High High

Low 3 2 1

Low /

Medium3 5 2

ProbabilityMedium 2 1 1

Medium /

High1

High

Figure 10-4 – Results for Option 1B

Option 1B Impact

Low Low /

Medium Medium

Medium /

High High

Low 1 2 2 1

Low /

Medium2 6 2

ProbabilityMedium 2 1 1

Medium /

High1

High


Version 08 - Draft

77

Figure 10-5 – Results for Option 2C

Option 2C Impact

Low Low /

Medium Medium

Medium /

High High

Low 1 3 2 1

Low /

Medium7 1

ProbabilityMedium 1 1 3 1

Medium /

High

High

10.2.2 No option has any risks falling into the high risk red category. There is however some variation in the number of risks falling into the medium/low, medium and medium/high categories. Option 1A has the lowest risk level, followed by Option 1B and then Option 2C. Overall though, it can be seen that the risk distributions between the options is very similar.

Figure 10-6 – Results of Qualitative Risk assessment

Option 1A

Option 1B

Option 2C

Service interruption due to construction works/ decanting 12 12 6

Build not completed in time to receive community hospitals’ funding 15 15 15

Planning application / consultation process takes longer than predicted 8 8 12

Planning application rejected 5 5 5

Construction inflation greater than expected (e.g. due to Olympics) 2 2 2

Delay to approval of OBC and/or FBC (by Board or SHA) 8 8 8

Size of capital funding for scheme lower than expected 6 6 12

Not achieving activity shift which business case is designed to deliver 9 9 9

Clinical activity delivered at Holme Valley not that within commissioning plan (e.g. due to Acute Trust placing different activity on site) 6 6 6


Version 08 - Draft

78

Option 1A

Option 1B

Option 2C

Redundant space due to lack of agreements with tenants 4 4 6

Redundant space due to clinical model changes 4 4 6

Delay to construction due to ecological factors (e.g. bats) 4 4 4

Construction costs need to be increased to achieve required BREAM score. 2 3 3

Delay to FBC approval due to national political issues (forthcoming general election) 4 4 4

Failure to recruit additional staff required to deliver additional activity (e.g. diagnostics) 6 6 6

Failure to achieve skills required to deliver additional activity (e.g. diagnostics) 6 6 6

Equipment costs higher than anticipated 4 6 6

Building running costs higher than expected (including backlog maintenance and non-compliance) 9 9 3

Implications of development on asset values (MEA) 12 12 12

Procurement of equipment takes longer than expected 2 3 3

Potential IM&T risks 6 6 6

Total Score 134 138 140

Rank 1st 2nd 3rd

10.3 Risk Quantification for Preferred Option

10.3.1 A risk quantification exercise has been performed for the preferred option. This has focussed on risks identified in the main risk register in Appendix C6 – Risk Assessment that could be subject to ready quantification.

10.3.2 The quantifiable risks have been quantified in four stages, the first stage assesses the likely chance of the risk occurring at all, while the second stage identifies the years in which the risk will occur. The third stage assesses the minimum, most likely and maximum impacts of the risk with the chance of each scenario happening. The fourth stage assesses the expected differences between options of the risk. An example of this is shown below.


Version 08 - Draft

79

Figure 10-7 – Diagram Representing Approach to Revenue Risk Quantification

10.3.3 To provide a better assessment of the range of risk values that might occur for revenue items, Tribal Consulting has modelled the risks using @Risk, a spreadsheet based Monte Carlo simulation package.

10.3.4 Monte Carlo simulation was named after Monte Carlo, Monaco, where the primary attractions are casinos containing games of chance. Games of chance such as roulette wheels, dice, and slot machines, exhibit random behaviour. It was first developed as part of the Manhattan Project at Los Alamos to model the decay that occurs in nuclear chain reactions. It was then developed by the RAND Corporation and the US Airforce in the 1950s. As a methodology it only became practicable with the development of increased computer power. It is a technique that is used extensively within the financial services sector, the energy sector, academia and government departments.

10.3.5 The @Risk model is based on 1,000 iterations. Because of the sampling method used (Latin Hypercube) this should be sufficient to give a reasonable representation of the likely spread of results.

10.3.6 The mean results of the revenue risk quantification are shown in figure below. It should be noted that the appraisal periods used for the discounted cash flow analysis are 62 years for all options (year 0 plus 61 years).

Figure 10-8 – Net Present Cost of Quantified Risk

Risk Area Net

Present Cost £k

% Cumulative

%

Redundant space due to clinical model changes 157 31.1% 31.1%

Redundant space due to lack of agreements with tenants

157 31.1% 62.3%

Building running costs higher than expected (including backlog maintenance and non-compliance)

115 22.8% 85.1%


Version 08 - Draft

80

Construction costs need to be increased to achieve required BREAM score.

33 6.5% 91.6%

Equipment costs higher than anticipated 21 4.2% 95.8%

Size of capital funding for scheme lower than expected

21 4.2% 100.0%

Total Expected NPV of Risk 505 100.0%

10.3.7 The chart below shows the undiscounted risk output by year with the potential variation in risks illustrated.

Figure 10-9 Revenue Risk Distribution (Undiscounted)

Undiscounted revenue risks by year

-0

50

100

150

200

250

300

350

2009/2010 2017/2018 2025/2026 2033/2034 2041/2042 2049/2050 2057/2058 2065/2066

Year

Valu

e £

000

+95% Perc, -5%

Perc+1SD, -1SD

Mean

10.3.8 A risk management plan for quantified and non quantified risks is included in Appendix C7 – Risk Mitigation Plan.

10.4 The Preferred Option

10.4.1 A thorough economic analysis and risk assessment in compliance with DoH requirements has been performed. This has concluded that Option 2C offers the best combination of costs, benefits and risk and so offers the best value for money.


Version 08 - Draft

81

11 Financial Case – Financial Analysis (Affordability)

11.1 Introduction

11.1.1 The purpose of this section is to outline the financial implications of the preferred option selected by the economic appraisal.

11.1.2 The preferred option from the economic appraisal is Option 2C – Mainly New Build/Some

Refurbishment (67% New: 33% Refurbished Existing Structures).

11.2 Capital Costs and Revenue Costs

11.2.1 The capital costs of the preferred option are summarised below.

Figure 11-1 – Capital Costs of the Preferred Option

Option 2c

Departmental Costs (from Form OB2) 3,005

On-Costs (from Form OB3) 3,747

Works Cost Total 6,752

Provisional location adjustment -338

Sub-Total 6,414

Fees 962

Non-Works Costs (from Form OB4) 30

Equipment Cost (from Form OB2) 750

Contingencies 561

TOTAL (for approval purposes) 8,717

Optimism Bias (after mitigation) 1,700

TOTAL (for approval purposes)+Optimism Bias

10,417

Inflation 236

VAT 1,696

Total + VAT 12,349

Figure 11-2 – Phasing of Capital Costs of Preferred 0ption

2009/10 2010/11 2011/12 2012/13 Total

Option 2C 677 11,459 52 161 12,349


Version 08 - Draft

82

11.2.2 The capital charges implications of this investment have been modelled by the PCT and the impact on capital charges is shown below.

Figure 11-3 – Capital Charges Implications of Preferred Option

2009/10 2010/11 2011/12 2012/13 2013/14

Capital charges on existing buildings (Including Depreciation)

265 242 200 196 196

Interest on assets under construction

0 0 0 0 0

Capital charges on new facilities (Including Depreciation)

12 303 466 465 449

Impairments 0 5,488 0 0 0

Total 277 6,033 666 661 645

11.3 Balance Sheet Impact

11.3.1 The balance sheet impact of the scheme on the PCT is summarised below.

Figure 11-4 – Balance Sheet Implications of Preferred Option

2009/10 2010/11 2011/12 2012/13 2013/14

Existing buildings 1,200 0 0 0 0

Assets under construction

0 0 0 0 0

New facilities 677 11,459 52 161 0

Less Impairments 0 -5,488 0 0 0

Total 1,877 5,971 52 161 0

11.4 Revenue Impact of the Scheme

11.4.1 The revenue impact of the scheme is summarised below

Figure 11-5 – Revenue Impact of the Scheme

2009/10 2010/11 2011/12 2012/13 2013/14

Capital charges 12 303 466 465 449

Impairments 0 5,488 0 0 0

Building running costs 0 0 343 343 343


Version 08 - Draft

83

2009/10 2010/11 2011/12 2012/13 2013/14

Transitional costs 0 TBC 0 0 0

Total 12 5,791 809 808 792

11.4.2 It can be seen that there is an increase in recurrent costs of around £800k per year as a result of increased capital charges and running costs. The transitional arrangements required to ensure continuity of delivery of existing services during the construction phase have not yet been established. Consequently no costs are included at this stage, although it is likely that there will be some incremental costs.

11.4.3 In addition there is a significant impairment in 2010/11. This is due to the demolition of some of the existing structures and the fact that, when the completed asset is valued by the District Valuer for the purposes of accounting for it on the PCT’s balance sheet, this value will be less than the currently estimated building costs.

11.4.4 The value of the impairment is based on a review of the available plans and costings by the District Valuer. However, it should be noted that there is a high degree of risk associated with the figure due to the high level of estimation required in arriving at it.

11.4.5 The revenue impact will be funded by the following sources:

■ It is assumed that resource cover will be available to the PCT in 2010/11 to offset the impairment required in that year. This is consistent with existing arrangements which are anticipated to continue into 2010/11

■ The capital charges and increased running costs will need to be covered by the occupiers of the building i.e. KCHS and CHFT and the business case has been developed on this understanding in conjunction with the partners. However, at this stage no formal sign up has been agreed with the partners to the levels of funding indicated in the figure below. The figures in the table are therefore funding requirements rather than agreed sources of funding at this stage. Formal sign up by the partners to the funding requirements is required before the scheme will commence.

11.4.6 The figure below outlines the baseline funding within the PCT for the existing provision at HVMH and the additional funding requirements resulting from the new build. The totals included for additional funding are as per the figure above – Revenue Impact of the Scheme. The split by partner is based on the proportion of the new build occupied by them.

Figure 11-6 – Revenue Funding Sources and Requirements

2009/10 2010/11 2011/12 2012/13 2013/14

Baseline Funding

PCT 525 502 486 456 456

Total 525 502 486 456 456

Additional Funding Requirement to be Agreed with Partners

PCT 0 5,488 0 0 0


Version 08 - Draft

84

2009/10 2010/11 2011/12 2012/13 2013/14

Partner 1 KCHS 4 101 270 270 262

Partner 2 CHFT 8 202 539 538 530

Total Additional Funding 12 5,791 809 808 792


Version 08 - Draft

85

12 The Commercial Case – Procurement

12.1 Introduction

12.1.1 An optimal procurement strategy has to suit the PCT’s needs, project requirements and risk exposure and should reflect the project owner’s experience, internal management expertise, resources and funding capabilities.

12.1.2 It is accepted that there is no single procurement system which is suited to all projects and which will meet all PCT individual requirements. When selecting the appropriate procurement route, it is crucial to align the ‘culture’ and experience of the PCT’s organisation with the project requirements and the procurement strategy, which best fits the project criteria and project objectives.

12.1.3 Procurement strategies and contract types must support the development of collaborative relationships between the client and its suppliers and should facilitate the early appointment of integrated supply teams (each part of which should incorporate an integrated supply chain).

12.1.4 Procurement routes should be limited to those which support-integrated team-working, the recommended procurement routes are:

■ PFI/PPP,

■ The Prime-type Contracting/ Framework approach

■ Design and Build.

12.1.5 “Traditional, non-integrated procurement approaches should not be used unless it can be clearly shown that they offer best value for money – this means, in practice they will seldom be used.”

31

12.1.6 The Core Project Team feels that it is essential at OBC stage that the ‘Project Board’ considers and approves a well-reasoned and evaluated project procurement and contract strategy compliant with the above OGC directive.

Definitions

Private Finance Initiative Where the public sector contracts to purchase quality services, with defined outputs from the private sector on long term basis, and including maintaining or constructing the necessary infrastructure so as to take advantage of private management skills incentivised by having private finance at risk

Prime Contracting (including OJEU compliant Framework agreements)

Using a single contractor to act as sole point of responsibility to a public sector client for management and delivery of a construction project on time, within agreed budget and fit for purpose as intended

31 (Office of Government Commerce (OGC), “Common Minimum Standards”, Mandated with Immediate Effect, 2006).


Version 08 - Draft

86

Definitions

Design and Build Using a single contractor to act as sole point of responsibility to a public sector client for design, management and delivery of a construction project on time, within the agreed budget and in accordance with a pre-defined output specification

LIFT and Express LIFT NHS LIFT is a vehicle for improving and developing frontline primary and community care facilities. It allows PCTs to invest in new premises in new locations, not merely reproduce existing types of service. It provides patients with modern integrated health services in high quality, fit for purpose primary care premises.

12.2 Procurement Routes

Summary

12.2.1 This section examines the various procurement routes that may be used for this project and evaluates each against the fundamental project procurement criteria and user project objectives:

12.2.2 Fundamental project criteria include:

■ Early Cost Certainty

■ Project Deliverability (Programme)

■ Design, Functionality and Quality

■ Value for Money

■ Risk Management – Financial, Design.

User Determined Project Objectives

12.2.3 Project objectives are shown in Section 8.3 and the Executive Summary of the OBC.

12.2.4 The procurement selection process has been an experienced judgmental assessment of the delivery of the fundamental project procurement criteria whilst also giving appropriate weight to the effective delivery of the project objectives.

12.2.5 The procurement routes that have been evaluated in relation to delivery of the foregoing fundamental criteria and user objectives are:

■ Private Finance Initiative (PFI)

■ Procure 21 (NHS Bespoke Framework Agreement)


■ Develop and Construct - Design and Build

■ LIFT and Express LIFT.


Version 08 - Draft

87

12.2.6 Each construction procurement route above has been examined and rated against each of the fundamental criteria and project objectives in terms of value - high, medium or low, the result of which was to identify the Procure 21 and Develop and Construct systems as most closely meeting NHS Kirklees needs.

12.2.7 The Traditional route was considered not to provide sufficient programme certainty, value for money and risk transfer and is not favoured under the OGC, “Common Minimum Standards” 2006, for construction procurement.

12.2.8 PFI was evaluated as being unsuitable regarding programme deliverability, value for money, flexibility and considered unattractive to project companies due to costs below £20 million.

12.2.9 LIFT and Express LIFT were evaluated as being unsuitable regarding the revenue required to lease the building, insufficient requirement for a portfolio of buildings within the PCT, no other local schemes on which to ‘piggy back’ and the Trust would not have ownership of the building in the future should services change or a change in market conditions exist.

Recommendation

12.2.10 On further analysis and after direct comparison with the P21 system it is felt that the Develop and Construct route does not sufficiently meet the criteria or project objectives to as high a standard as P21

12.2.11 It is recommended that the Procure 21 DoH project procurement process using a Trust appointed Principal Supply Chain Partner be utilized, using the ECC, Option C contract for the delivery of the Integrated Health and Social Care Project.

12.3 Procurement Strategy

Introduction

12.3.1 Statistical evidence dictates that uncertainty/risk within a project is greatest at the forefront of any project development process, that is, not having clarity of thought regarding what is actually needed and how that need is to be satisfied in an affordable manner.

12.3.2 It should be noted that the risk would not be wholly financial, substantial risk would also exist regarding the design solution for the right project to suit the PCT’s needs. The Office of Government Commerce, National Audit Office, DoH and HM Treasury all advocate the engagement of integrated project teams and supply chains at the earliest point in the development of any project.

12.3.3 This ensures that the design and costing process is made robust and is enriched by the extensive and diverse experience and knowledge that an integrated project team and stakeholders can provide.

12.3.4 The 4 methodologies being considered for procuring the project construction work are evaluated in the following pages together with a summary of their main advantages and disadvantages.

■ Private Finance Initiative (PFI)

■ Procure 21 (NHS Bespoke Framework Agreement)


■ Develop and Construct - Design and Build

■ LIFT and Express LIFT


Version 08 - Draft

88

12.3.5 The procurement strategy and the final selection of the form of contract are inherently connected. When selecting a procurement option for a project, it is likely that there will be more than one way to achieve the requirements of the project. It is crucial to consider carefully each option, as each will address the various influencing factors to a varying extent.

12.3.6 In selecting a procurement strategy, a potential danger is that only the most obvious course of action may be considered. This is not necessarily the best in the longer term and this analysis seeks to address that concern.

Procurement Strategies Evaluated

12.3.7 For a procurement strategy to be considered suitable, it must satisfy all of the five criteria below and project objectives to a medium level or higher:

■ Early Cost Certainty – of primary importance to NHS Kirklees – enabling affordability to be addressed early on in the project

■ Project Deliverability (Programme) – again of high importance to NHS Kirklees. Fast track procurement arrangements can be considered and time constraints must be satisfied

■ Design, Functionality and Quality – allow for specialist advice for complex matters

■ Value for Money – using guidance from government and other bodies

■ Risk Management – financial, design – should be placed with those best placed to manage risk.

12.3.8 The following sections discuss the characteristics, advantages and disadvantages of each strategy and recommends whether each should be considered further.

Private Finance Initiative (PFI)

12.3.9 Under PFI the Government or client awards a long-term contract to the private sector to finance the building of a new facility and run the non-clinical services in it such as maintenance, cleaning and security.

12.3.10 The key difference between PFI and the other more conventional procurement strategies is that the Trust will not own the asset until the agreed term has elapsed, usually 25 years. The Trust would make a unitary payment to the project company who provides the building and associated services.

12.3.11 The project company set up specially to run the scheme would own a typical PFI project. These companies are usually consortia including a construction firm, a funding institution and a facilities’ management company. Whilst PFI projects can be structured in different ways, there are usually four key elements: Design, Finance, Build and Operate.

12.3.12 Advantages and disadvantages can be summarised as follows:

Advantages Disadvantages

■ No capital cost risk for Trust

■ No need for Trust to employ FM or maintenance staff.

■ Asset not owned by Trust

■ Higher long term revenue costs

■ Need for good quality brief

■ Emphasis on needs of consortium, not clinical needs

■ Variations difficult to incorporate


Version 08 - Draft

89


■ Change is expensive

■ Reduced flexibility

■ Length of procurement time is considerable

■ Legal representation is costly

■ Current government intelligence suggests that projects under £20 million would not be attractive to consortia or would be disproportionately expensive to the Trust.

12.3.13 It is considered that as NHS Kirklees will not own the building until the end of the term, PFI does not give the PCT the flexibility it requires to respond to changes in operational practices or the Trust’s future needs. Furthermore, there will be a long-term revenue cost, which would be considerably more expensive over the contract term than if the building was to be privately or publicly funded also the time frame required to bring a PFI to fruition would be detrimental to the Trust’s ability to close existing premises ‘not fit for purpose’.

12.3.14 It is for these above reasons that PFI is not considered to fulfil all the Trust’s requirements and will not be considered further.

Procure 21

12.3.15 NHS Procure 21 was launched in April 2000 by NHS Estates as a response to the government’s “Rethinking Construction” report. It is a standardised approach to the procurement of healthcare facilities based upon long-term relationships with selected integrated supply chains and complies with the OGC “Common Minimum Standards” 2006.

12.3.16 Under Procure 21 the Trust utilizes the Principal Supply Chain Partner (PSCP) from a supply chain framework put in place by NHS Estates and is in accordance with OJEU guidelines. The PSCP must be suitably qualified and experienced to carry out any proposed works

12.3.17 Features of the strategy along with advantages and disadvantages are expressed below:


■ Single point contact and responsibility

■ Inherent buildability

■ Early Guaranteed Maximum Price (GMP)

■ Reduced total project time

■ Partnering approach to problem solving

■ Early stakeholder engagement

■ Early design/cost certainty

■ Existing relationships and project

■ Sometimes difficult for clients to prepare adequate employer’s requirements at an early stage

■ Client driven changes can be expensive post GMP

■ Potential for design quality to suffer due to the PSCP contractor being possibly cost-driven

■ Possibility to over-price to share savings.


Version 08 - Draft

90


history

■ Known up-front charges for project front-end development

■ Sub-contractor work packages tendered competitively

■ Open-book accounting

■ Satisfactory public accountability

■ PSCP incentivised

■ Compliance with the “Common Minimum Standards” OGC 2006.

12.3.18 The sequence of activities executed under the Procure 21 strategy is indicated below. The overlapping of the design, procurement and construction phase allows the overall delivery period to be reduced.

12.3.19 As a P21 strategy is able to offer all the Trust’s criteria to a medium level or higher, it should be considered further.

Traditional Lump Sum

12.3.20 Under this procurement arrangement, the responsibility for construction is in a single contract, separate from the design, utilising either Bills of Quantities or Specifications and Drawings. Bills of Quantities should only be prepared once design has been fully completed. Such a document provides measured quantities that allow competing contractors to price all material, plant and labour used on the project to arrive at a “lump sum” tender for the project.

12.3.21 The main contractor is responsible for executing and completing the building works including placing all sub-contract orders. As such, the contractor accepts some “risks”; particularly those associated with completion dates and provide cost certainty, provided that no changes are made to the project once the main contract is let, this is heavily reliant on the completeness and detail of the specification.

12.3.22 The advantages and disadvantages are as follows:


■ Open, competitive tendering

■ Procedures well known

■ Client has potential cost certainty before start of construction

■ Sub-contractors are under the main contractors control

■ Slow to start on site (no parallel working)

■ Contractor not involved in design or planning (no buildability, unless a two stage process is used)

■ Heavily reliant on the quality and completeness of tender documents

■ Adversarial

■ Can be subject to costly “claims” if design information is issued late or incomplete

■ Variations can cause delay and claims


Version 08 - Draft

91


■ Not supported by OGC “Common Minimum Standards” 2006

■ Does not deliver the project front-end engagement process to deliver VFM

■ Nationally, problems historically with programme, cost, quality and final accounts

12.3.23 The sequence of the project is characterised as being “end to end”, that is, one process must end before the next in the sequence may begin. As a result the overall delivery period for a project is at its maximum. The sequence of activities undertaken with the Traditional procurement strategy is shown below:

12.3.24 A Traditional Lump Sum strategy is able to offer all the criteria to a medium level or higher however, it is considered that as this strategy will only give programme certainty, value for money and risk management to a medium level it does not give the overall confidence required. This strategy is therefore not recommended or supported by the “Common Minimum Standards” OGC, 2006 and will not be considered further.

Develop and Construct – Design and Build

12.3.25 For the purposes of this evaluation, "Design and Build" assumes that the design is taken to concept design by the employer’s design team and a set of employer’s performance requirements are issued to the contractor for tender. The contractor then submits a lump sum bid and design proposals back to the employer as part of the tender process. For the purposes of this evaluation, "Develop and Construct" is defined as the design being undertaken to detail design by the employer’s design team and then tendered. The contractor submits a lump sum bid and confirms that they can develop the design in to working drawings for the price submitted.

12.3.26 Under this procurement arrangement, the contractor assumes the risk and responsibility for completing the design and building the project, in return for a fixed lump sum price. If used appropriately, this provides one point of contact between the client and his team, financial and programme benefits and clear definition of responsibilities.

12.3.27 The design team can either be novated to complete the design under the contractor’s guidance, or the employer can retain the design team to carry out due diligence work on the contractor’s appointed design team.

12.3.28 The advantages/disadvantages of this approach are as follows:


■ Competitive tendering

■ Satisfactory public accountability

■ Procedures well known

■ Possible single point contact and responsibility

■ Inherent buildability

■ Early firm price possible

■ Client needs to commit before design is complete

■ No design overview unless client retains design team or appoints due diligence consultant – extra expense.

■ Client driven changes can be expensive

■ Potential for design quality to suffer


Version 08 - Draft

92


■ Reduced total project time

■ Significant risk transfer

■ Sub-contractors and design team under the main contractor's control.

due to the contractor being primarily cost-driven

■ Value for money suspect

■ Potentially adversarial.

12.3.29 This system fundamentally shifts the majority of risk towards the contractor. However, it should be recognised that if the contractor accepts such risks, the client would pay a premium cost and possibly experience programme uncertainty.

12.3.30 As a “develop and construct” strategy is able to offer all the criteria to a medium level or higher, it should be considered further.

LIFT and Express LIFT

12.3.31 NHS LIFT is a vehicle for improving and developing frontline primary and community care facilities. It is allowing PCTs to invest in new premises in new locations, not merely reproduce existing types of service. It is providing patients with modern integrated health services in high quality, fit for purpose primary care premises.

12.3.32 LIFT starts with a local health economy getting together to develop its Strategic Service Development Plan. This planning process enables all of the statutory bodies that have a responsibility for improving health in a locality to plan for the health needs of their population. But they do not just plan in isolation. They plan together. The benefit of this is that all parties can help find the best solutions. Examples of the sorts of local health economy participants working together in LIFT are PCTs working with Acute Trusts, Ambulance Trusts, Local Authorities, and Mental Health Trusts etc. to draw up a plan which considers a joint strategy for delivering an improved service for patients.

12.3.33 Having drawn up a plan the local health economy then looks for a partner with whom it will set up a LIFT company. This company is owned partly by the private sector and partly by the public sector participants. Simply put, it will build, maintain and operate primary care buildings and it will assist the local health economy to develop the best solutions to its service needs. This may include property development expertise which can be used to assist a PCT with an affordability problem or perhaps might be putting a retail element in a one-stop centre to bring in additional revenue for a PCT.

12.3.34 A private sector partner is identified through a competitive procurement, and then a joint venture is established between the local health bodies, Partnerships for Health and the private sector partner.

12.3.35 The local joint venture – the local LIFT Company – will have a long term partnering agreement to deliver investment and services in local care facilities.

12.3.36 The NHS LIFT approach provides a number of benefits. It establishes a long term sustainable relationship focused on delivering primary care investment and services; it will involve the private sector where they can add most value. Most importantly, it will provide investment in modern integrated primary care services in areas where patients most need it.

12.3.37 It is considered that as NHS Kirklees will lease the building throughout the term of the LIFT contract, there will be a long-term revenue cost, which would be considerably more expensive over the contract term than if the building was to be privately or publicly funded.


Version 08 - Draft

93

12.3.38 LIFT and Express LIFT do not give the Trust the flexibility it requires to respond to changes in operational practices or the Trust’s future needs. Furthermore there is an insufficient portfolio of buildings required by the PCT to support a LIFT programme, likewise no other local LIFT schemes are available on which the Trust are able to ‘piggy back’. In addition the need to develop and have approved an SSDP in order to become accredited for LIFT builds further delay into the programme.

12.3.39 It is for these above reasons that LIFT and Express LIFT is not considered to fulfil all the Trust’s requirements and will not be considered further.

12.4 Summary

12.4.1 Section 12.2 of this OBC – Procurement Strategy examines various procurement strategies that may be used on this scheme and identifies those systems that may be suitable for the project when considered against the key criteria and project objectives identified by Kirklees.

12.4.2 Of those procurement strategies examined and assessed, two were identified as most closely meeting these criteria and objectives with a medium or high value rating. These are Develop and Construct and Procure 21. Their individual assessments are as follows:

Figure 12-1 – Procurement Strategies

Develop and Construct

Procure 21

Project Criteria Level Level

■ Early Cost Certainty High High

■ Project Deliverability (Programme) High High

■ Design, Functionality and Quality Medium High

■ Value for Money Medium High

■ Risk Management – Finance, Design Medium Medium

Project Objectives

■ To create enhanced primary care and community hospital facilities (“community hubs”) in the Valleys locality by March 2011

Medium High

■ To provide safe32


Medium High

■ To enable the implementation of the NHS Kirklees Strategic Plan and deliver key policy imperatives

33

High High





Version 08 - Draft

94

Develop and Construct

Procure 21

■ To provide opportunities for the service models developed by commissioners (Health Improvement Teams and Practice Based Commissioners) to be implemented

High High

■ To bring increased primary and secondary care services e.g. diagnostic and outpatient activity to the community in partnership with local providers

High High

■ To work with GP practices and other partners to deliver integrated care

Medium Medium

■ To improve local geographic and physical access to services in the Valleys locality

High High

■ To ensure the longer term sustainability of services on the HVMH site

34 by

developing supporting services and facilities on the HVMH site

High High

■ To significantly reduce backlog maintenance at HVMH

High High

■ To reduce the HVMH carbon footprint, both on site through modern building techniques and in terms of reduced patient travel required to access services

Medium High

■ To deliver one-stop services on site at HVMH (particularly for patient pathways involving Hawthorne Ward).

High High

12.4.3 From the matrix above it is demonstrated that the P21 procurement process delivers a higher value overall than the design and construct approach.

12.4.4 Procure 21 has been identified as the most effective procurement route to deliver this project evaluated against the project criteria and user identified objectives.

12.4.5 P21 conforms to the OGC “Common Minimum Standards” 2006 and complies with OJEU regulations, National Audit Office, HM Treasury and DoH Estates and Facilities guidance.

12.4.6 The Department of Health, Estates and Facilities has produced and published the following nationally prepared performance data regarding P21 KPIs:

■ 97% of schemes were delivered within budget in 2008

■ 97% of schemes were delivered on time in 2008

■ Trusts have rated ProCure21 at 8.5/10 for product satisfaction

■ Trusts have rated ProCure21 at 7.8/10 for service satisfaction

■ 86% of trusts schemes achieved a zero percentage accident rate



Version 08 - Draft

95

■ Trusts have rated ProCure21 at 7.7/10 on defects.

PSCP Experience

12.4.7 As stated previously, it is essential that the Trust PSCP have demonstrable experience in the delivery of comparably complex and technical projects to the required standards of the Trust and the users.


Version 08 - Draft

96

13 Management Case

13.1 Introduction

13.1.1 This chapter focuses on the planning and delivery of the project in terms of project structure going forward, workforce and other plans, key milestones, stakeholder consultation, the Gateway Review, benefits’ realisation and plans for post project evaluation.

13.2 Project Timetable

13.2.1 The figure below provides an overview of the key project milestones.

Figure 13-1 – Project Timetable – Key Milestones

Key Event/Task Timing

Trust Board Approve OBC January 2010

Strategic Health Authority (SHA) Receive/Approve OBC

January 2010

Decision to Appoint PSCP Approved by Trust Board

January 2010

Prepare FBC and Agree GMP March 2010

Trust Board Approval of FBC/Financial Case March 2010

SHA Approval of FBC March 2010

(Subject to Approvals Process)

Start on Site April 2010

Completion March 2011

13.3 Project Structure, Skills and Resources

13.3.1 The figure below provides an overview of the HVMH project structure.


Version 08 - Draft

97

Figure 13-2 – HVMH Project Structure



HVMH Project Board

She

ila D

ilks

SR

O

HVMH Business


Ja

me

s D

rury

PM


Architects



HVMH Project Board

She

ila D

ilks

SR

O

HVMH Business


Ja

me

s D

rury

PM


Architects

13.3.2 The role of each body is summarised below.

NHS Kirklees – Trust Board

13.3.3 The Trust Board is the investment decision maker in relation to major capital projects. The project senior responsible owner (SRO) Sheila Dilks is a member of the Trust Board as the Executive Director of Patient Care and Professions.

Strategic Development Committee

13.3.4 This is a sub-committee of the main Trust Board. It acts as programme board for a range of major projects including the Holme Valley Memorial Hospital (HVMH) project. It is chaired by the Executive Director of Commissioning and Strategic Development. Members also include the Director of Finance, and the Director of Patient Care and Professions, who is the project SRO. James Drury is the project manager for the HVMH project and provides regular reports to this committee from the Project Board.

HVMH Project Board

13.3.5 The Project Board is chaired by the SRO Sheila Dilks. Users are represented on the Project Board by senior commissioners and healthcare providers. Suppliers are represented by the PCT’s Head of Estates and the Director of Consulting from advisers Tribal Newchurch Consulting. The project manager is a member of the project board.

Business Case Team

13.3.6 The Project Board is supported by two ‘core teams’, the first of which is the Business Case Team. This team is responsible for developing the Outline Business Case. The business case team includes internal experts representing functions such as commissioning and finance, alongside expert external advisers such as Tony Shaw, Sue Hart and Robert Thorp (Tribal).


Version 08 - Draft

98

Design Team

13.3.7 The Design Team is led by Rance Booth and Smith Architects and has been commissioned by the PCT to support the development of the Estates Annex elements of the Outline Business Case. Key internal support is provided by David Henwood, Keith Geldard and Peter Tullock. Key external support is provided by RBS Architects and Derrick Kershaw Quantity Surveyors.

13.4 Stakeholder Involvement and Consultation

13.4.1 The development of Holme Valley Memorial Hospital is described in the local joint service strategy “Looking to the Future” 2006 and in the NHS Kirklees Strategic Plan 2008 – 2013, both of which were consulted on widely.

13.4.2 This project team has also undertaken considerable engagement and consultation with patients, public and professionals (although these proposals are not considered major service change requiring a formal consultation process as set out under Section 242 of the NHS Act 2006).

13.4.3 NHS Kirklees has ensured that a broad range of people have had many opportunities to be involved in shaping these developments.

13.4.4 This has included regular liaison with the Local Involvement Network (LINk), and a community-led communications group chaired by a local parish councillor and involving representatives of the LINk and the League of Friends of Holme Valley. Members of this group have taken an active role in shaping the proposals and have made special efforts to promote the project to community groups in their neighbourhoods.

13.4.5 NHS staff involved in the provision of services to the people of The Valleys and neighbouring localities have participated in several workshop events over the last two to three years, as the ideas presented in this business case have been developed. They have influenced both the range of services and the approach to service delivery.

13.4.6 Since 2008 the project has been discussed regularly at Local Area Committee meetings in the Holme Valley, which are led by elected members and attended by members of the public. In this way local people and councillors have commented on and impacted the development of the service model to be implemented and the nature of the building development proposed. The proposal is strongly supported by the Area Committees.

13.4.7 The Kirklees Overview and Scrutiny Committee for Health has reviewed the proposed development and in particular the plans for public engagement and consultation. In addition advice has been sought from the Strategic Health Authority with regard to the appropriate approach to engagement within this project.

13.4.8 An open consultation has been undertaken recently to gauge the views of local people with regard to the three short-listed options for the redevelopment of the site. The consultation document has been available at various locations including the Memorial Hospital itself.

13.4.9 There have been six local drop-in sessions for members of the public to view plans and discuss the proposals with project team members. The sessions have been held in Holmfirth (x2), Honley, Meltham, Marsden, and Denby Dale. See Appendix F3 – Shaping Services at HVMH.


Version 08 - Draft

99

13.4.10 These sessions were advertised using the Voluntary Action Kirklees Health Bulletin – which is emailed to over 800 voluntary organisations. They were also advertised in the “Get Involved: Have Your Say” newsletter- which goes out to 140 people that have expressed an interest in being involved.

13.4.11 This project has been well publicised by the local press including coverage on the front page of the Weekly News, which is delivered free to every house in the Huddersfield area. NHS Kirklees has also highlighted the consultation on its website and highlighted it to local NHS staff via intranet and weekly email bulletin.

13.5 Benefits Realisation Plan

13.5.1 A comprehensive Benefits Realisation Plan (BRP) has been developed to ensure that the benefits sought can be delivered.

Figure 13-3 – Benefit Realisation Plan

BRP Ref Benefit Realisation Plan – Overview of Criteria

Responsible Director

Responsible Manager

1 Quality of Care – delivers safe, sustainable and responsive care

Sheila Dilks Joanne Crewe

2 Environmental Quality of Services – an improved environment for patients, visitors and staff

Bryan Machin Dave Henwood

3 Operational Suitability – for the facility’s intended usage

Carol McKenna AD Strategic Development

= 4 Access to Care – improved access to services both clinically and logistically


= 4 Future Flexibility – the capability to respond flexibly to changes over the longer term


13.5.2 The BRP includes timed, measured benefits with a nominated responsible director and project manager. See Appendix F1 – Benefits Realisation Plan.

13.6 Gateway Review

13.6.1 The OGC Gateway Review process helps programmes and projects to establish their state of readiness, planning and capability to undertake the tasks they have been established to do.

13.6.2 In 2008 the Calderdale and Kirklees Community Hospitals Programme undertook a Gateway Review Risk Potential Assessment, and determined that in view of the risk posed by all seven of the projects then included within the programme, a Gate Zero ‘Readiness Check’ should be invited.

13.6.3 The Gateway Review of the local Community Hospitals Programme highlighted the need for additional resource and for changes to the project governance arrangements, before progressing with the implementation of the individual projects, including this project at Holme Valley Memorial Hospital.


Version 08 - Draft

100

13.6.4 As a result of the Gateway Review separate governance arrangements were put in place in both NHS Kirklees and in NHS Calderdale.

13.6.5 In NHS Kirklees the Strategic Development Committee became the programme board for the HVMH project. The Gateway Review was also instrumental in highlighting the need for additional support to deliver the projects in question.

13.6.6 A procurement process followed using the PASA Consultancy Services Framework, through which Tribal Group was appointed as consultants to the project.

13.6.7 In July 2009 the Holme Valley Memorial Hospital Project Board undertook a new Risk Potential Assessment of the HVMH project itself. This project scored ‘low risk’ on the RPA, and as a result it was decided that a further Gateway Review would not be required at this time.

13.7 Workforce Planning and Development

13.7.1 NHS Kirklees’ Strategic Plan recognises that “people are at the heart of everything we do”.

13.7.2 This firmly-held value covers NHS Kirklees local population, partners, and the staff that deliver services. People are the most valuable asset that NHS Kirklees has in delivering the objectives of World Class Commissioning, Healthy Ambitions and the PCT’s own strategic goals.

13.7.3 It follows that to achieve the best possible health and wellbeing of its population, both now and in the future, it is essential that services are delivered for the people of Kirklees by a motivated, correctly deployed workforce with the right skills and competencies. Such a workforce cannot be achieved without realistic and engaged workforce planning.

13.7.4 The PCT’s workforce plan Workforce Ambitions for a Healthy Kirklees 2009-2014, describes the key workforce challenges and aspirations that the PCT faces in the period 2009 - 2014.

13.7.5 This project at Holme Valley Memorial Hospital (HVMH) will require careful planning with regard to workforce planning. The project will involve an increase in the number of staff who regularly work at the HVMH site, although there will not be a significant number of additional staff permanently based at HVMH. See the figure below.

Figure 13-4 – HVMH – Staff Using HVMH – Current and Future

Current Average

Current Peak

Future Peak

Staff based mostly on site 32 44 55

Staff using HVMH part of the day 2835

32 5036

35 Including 16 community nursing staff

36 Average approximately 40. Main increase is 30 staff involved in OPD and diagnostics.


Version 08 - Draft

101

13.7.6 Staff working at HVMH will require additional training and development to perform their roles in the future. For example the role undertaken by the team on Maple Ward will develop and staff will receive training and support to enable them to offer a broader range of support to patients.

13.7.7 There will also be growth in skills in other areas of the hospital. For example, with the addition of diagnostic testing there will be a need to develop the capabilities of the workforce to provide the flexibility to offer a broad range of diagnostic modalities.

13.8 Information Management and Technology

13.8.1 The NHS Kirklees IM&T Plan (2009 – 2014) sets out the high level vision for the use of technology in the local health economy.

13.8.2 NHS Kirklees will continue to deploy the Connecting for Health (CfH) sponsored solutions.

13.8.3 NHS Kirklees will continue to upgrade and refresh the IT equipment across its corporate and clinical staff and GP practices to support their use of a “GP Systems of Choice (GPSoC)” clinical system, which will support NHS Kirklees ability to deploy a virtual full service user record.

13.8.4 All NHS Kirklees GPs are on GPSoC clinical systems with 58% expected on the local service provider application TPP SystmOne.

13.8.5 In parallel with this, NHS Kirklees expects to be implementing the national programme initiatives of the Summary Care Record (SCR) and Electronic prescription transfers service phase 2. These will enable increased safety and effectiveness of clinical care within Kirklees.

13.8.6 The planned investment level in CfH solutions is estimated to be £250,000 per annum over each of the next five years.

13.8.7 In support of commissioning, NHS Kirklees is expecting to use a data warehouse to enable the planning of services and activity levels to be managed effectively. NHS Kirklees anticipates that this will be done collaboratively with other PCTs within Yorkshire and Humber. NHS Kirklees have also developed a joint warehouse of health data and information with Kirklees Metropolitan Council.

13.8.8 In addition, NHS Kirklees expects that further developments in telehealth and telecare will revolutionise the ability to deliver services and support to people in their own homes. The focus will be on high quality information, supported self care and self management using the latest advances in assistive technology.

IT Objectives

13.8.9 The Local Health Community IM&T plan identifies the major national, regional and local imperatives for IT development. The following objectives are of particular relevance to this project:

■ Secure and legitimate access to health records and information for patients and staff

■ Ensuring that information is available to staff and patients in a timely manner; across all locations that deliver clinical care, thus contributing to an improved patient experience, staff satisfaction and engagement and improved clinical decision making and effectiveness


Version 08 - Draft

102

■ Optimisation of existing systems to maximise benefits realisation and quality of clinical care. To appraise and implement options for delivery of interim solutions in advance of the national programme solutions where appropriate.

13.8.10 The plan identifies the clinical systems planned locally and the interaction required between them.

■ TPP SystmOne is being rolled out to all community services and primary care services where agreed or a GPSoC compliant system. This will provide a consistent platform, enabling shared electronic records, and access to the Spine

■ PACS is in place for diagnostic imaging and requests

■ NPfIT PAS systems are in place in secondary care.

IT Infrastructure

13.8.11 The Community of Interest Network (CoIN) was implemented during 2004/5 to exploit the N3 contract with BT across the Calderdale, Kirklees and Wakefield locations.

13.8.12 The Health Informatics Service (tHIS) manages the network, supports the IT infrastructure and provides a wide range of IT support functions.

Requirements at Holme Valley Memorial Hospital

13.8.13 The major IT infrastructure requirements at HVMH will be:

■ Access to the secure N3 network

■ Access to the HIS administered Community of Interest Network, which will enable multiple constituent organisations to access their required network drives and software from this site

■ Appropriate server room with air-conditioning and back-up power supply

■ It is intended that HVMH will be equipped with a wired network, providing multiple data points at each work station

■ In addition a wireless network may be considered if user requirements dictate. For example this may have application on the new Maple Ward. 20% growth potential in network points will be incorporated during installation to minimise the costs of possible future expansion.

13.8.14 Each work station will be equipped with:

■ Desktop pc or laptop docking facilities

■ VOIP telephony – this will mean a managed VOIP service is required

■ Multiple power sockets.

13.8.15 Printing and scanning facilities will be shared within office areas, and copying will be undertaken at one work station on the site. It is not anticipated that this will be a big part of the activity on this site, which is primarily focused on direct service delivery.

13.9 Equality Impact Plan

13.9.1 The NHS Kirklees has carried out an equality impact assessment for the new facility.

13.9.2 Full details are shown in Appendix F4 – Equality Impact Assessment.


Version 08 - Draft

103

13.10 Regeneration, Sustainability and Corporate Citizenship

Corporate Citizenship for OBC HVMH

Travel

13.10.1 As part of this development, and that of the PCT’s new headquarters building at Bradley Park, a green travel plan will be put in place. This will include encouraging staff to cycle and walk and the Workforce Management sub group is developing a cycle to work scheme.

13.10.2 NHS Kirklees developed a home working scheme that will enable some staff to work at some time from home reducing travel.

13.10.3 The PCT has recently approved an Environmental Strategy to meet the requirements of Saving Carbon, Improving Health: NHS Carbon Reduction Strategy for England. The PCT is working with Metro on transport issues that arise out of commissioning service provision changes.

Procurement

13.10.4 The PCT secures supplies and procurement functions from CHFT and the Yorkshire and Humber Commercial Procurement Collaborative both of which are working to NHS sustainable procurement plans.

Workforce

13.10.5 The PCT has a workforce plan Workforce Ambitions for a Healthy Kirklees – 2009 – 2014. This is aligned to the PCT’s current strategic plan and addresses the skills required and the needs of workers associated with service developments such as those at HVMH.

13.10.6 The PCT has both apprenticeship and volunteering schemes in place. It provides occupational health services for staff that includes access to counselling, stop smoking and weight management support. The PCT has a partnership forum to consult and involve staff and staff are also involved and consulted with through groups like the Investors in People working group. The PCT has a range of HR policies that are designed to support staff.

Community Engagement

13.10.7 The PPI Annual Report is included as Appendix F2. There is also the CLICK Survey and the year 9 survey that are undertaken every 2 year that informs the JSNA. The PCT works in partnership with Kirklees Council on the Duty to involve and Links.

13.11 Post Project Evaluation

Introduction

13.11.1 At OBC and FBC stages Trusts are required to:

■ Prepare their strategy for PPE

■ Outline the framework to ensure PPE takes place, for example the management arrangements

■ Set out plans and expected timings for PPE arrangements with a named individual responsible for their execution.


Version 08 - Draft

104

Strategy

13.11.2 The Trust’s strategy is to apply the relevant guidance in a unified and consistent way including:

■ Capital Investment Manual – Post-Project Evaluation (Department of Health – 1994)

■ Good Practice Guide – Learning Lessons from Post-Project Evaluation (Department of Health – modified February 2007).

Framework and Plans

13.11.3 The Trust’s overall framework and plans for PPE are outlined below covering both OBC and FBC stages.

Figure 13-5 – Post-Project Evaluation Plan – Framework

PPE Activities Timing

Stage 1 – Plan and Cost PPE

OBC

■ Identify PPE “evaluation steering group” representing all stakeholders

■ Identify PPE project manager

■ Develop resourcing approach for PPE

■ Develop indicative post project evaluation plan

■ Develop indicative benefits realisation plan

Q1 2010

FBC

■ Set out objectives of PPE

■ Set out the scope of PPE

■ Define success criteria

■ Define performance indicators

■ Identify team members

■ State the proposed membership of the evaluation steering group

■ Identify the resources and budget

■ Develop a dissemination plan

■ Clarify timing of PPE

■ Use “Logical Framework Approach” methodology

Q1 2010

Stage 2 – Monitor progress and evaluate project outputs (physical) on completion of facilities

Q1 2011

Stage 3 – Initial post-project evaluation of the service outcomes 6/12 months after the facility has been commissioned

Q1 2012


Version 08 - Draft

105

PPE Activities Timing

Stage 4 – Follow-up to assess longer-term service outcomes e.g. 2 years after facility commissioned. Thereafter use PPE information for market testing/benchmarking.

Q1 2013

Key Stage Description

13.11.4 An outline of each stage is shown below:

Stage 1 – plan and cost the scope of PPE at the project appraisal stage with the output being an evaluation plan. This stage covers the development of the OBC and FBC i.e. the procurement strategy and investment decision stages.

Stage 2 – evaluate project outputs i.e. the physical output of the project such as construction phases – the “project evaluation review.”

Stages 3/4 – initial and follow-up evaluation of service outcomes i.e. the post implementation review to appraise whether the project has delivered the anticipated benefits and improvements.

13.11.5 The outcome of the PPE process will be an evaluation report – see example format below.

Evaluation Reports

13.11.6 The evaluation report at each stage will as far as possible address the following issues:

■ Were the project objectives achieved?

■ Was the project completed on time, within budget, and according to specification?

■ Are users, patients and other stakeholders satisfied with the project results?

■ Were the business case forecasts (success criteria) achieved?

■ Overall success of the project – taking into account all the success criteria and performance indicators, was the project a success?

■ Organisation and implementation of project – did the Trust and wider team adopt the right processes? In retrospect, could the Trust and wider team have organised and implemented the project better?

■ What lessons were learned about the way the project was developed and implemented?

■ What went well? What did not proceed according to plan?

■ Project team recommendations – record lessons and insights for posterity. These may include, for example, changes in procurement practice, delivery, or the continuation, modification or replacement of the project.

Summary

13.11.7 NHS Kirklees has a clear PPE framework and plan in place for this outline business case and beyond.

13.12 Summary

13.12.1 The above sections demonstrate that NHS Kirklees have put in place the foundations for future project delivery and management.


Version 08 - Draft

106

13.12.2 As the business case process progresses plans and policies will be refined and developed in conjunction with NHS Kirklees partners.

document

Documents

nhs kirklees profile

nhs kirklees profile

nhs kirklees profile

cost profile

development of primary

economic case

management case

financial case affordability