Greater Peterborough

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Greater Peterborough

Health Investment Plan

Full Business Case

for the

Greater Peterborough

Heath Investment Plan

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5.1 Introduction ... 5-1 5.2 Key Elements of the Model... 5-1 5.3 System Flows... 5-2 5.4 Acute Model of Care ... 5-4 5.5 Emergency Care ... 5-4 5.6 Elective Care (Inpatients) ... 5-6 5.7 Treatment Centre Care (Ambulatory) ... 5-10 5.8 Intermediate and Primary Care... 5-11 5.9 Women’s and Children’s Services ... 5-14

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Greater Peterborough Health Investment Plan Contents

Full Business Case Section ii

5.10 Education and Learning ... 5-16 5.11 Mental Health Services ... 5-17 5.12 Model of Care Delivery Structure... 5-19

6 CAPACITY PLANNING ... 6-1

6.1 Introduction ... 6-1 6.2 Acute Services ... 6-1 6.3 Methodology... 6-1 6.4 Baseline Data... 6-2 6.5 Future Activity Projections ... 6-3 6.6 Outpatient Capacity Planning ... 6-6 6.7 Bed Modelling ... 6-7 6.8 Theatre and Endoscopy Capacity Planning... 6-8 6.9 Linear Accelerator Requirements ... 6-10 6.10 Future Changes to East of England SHA Patient Flows ... 6-11 6.11 Summary... 6-12 6.12 Future Service Requirements – Mental Health Unit ... 6-12 6.13 Methodology... 6-12 6.14 Results ... 6-14 6.15 Summary of Bed Requirements... 6-15 6.16 Future Service Requirements – Primary Care Services ... 6-15 6.17 Methodology... 6-16 6.18 Results ... 6-16 6.19 Impact on Commissioners ... 6-19

7 SYNOPSIS OF THE OUTLINE BUSINESS CASES... 7-1

7.1 Introduction ... 7-1 7.2 Background ... 7-1 7.3 The Options... 7-1 7.4 Option Appraisal Outcomes ... 7-2 7.5 The Preferred Option ... 7-4 7.6 Changes from the OBC stage... 7-5 7.7 Impact on the Original Option Appraisal ... 7-7

8 THE PUBLIC SECTOR COMPARATOR ... 8-1

8.1 Introduction ... 8-1 8.2 Outline of the PSC ... 8-1 8.3 The design concept - Acute Hospital ... 8-1 8.4 The design concept – Mental Health Unit... 8-2 8.5 The design concept – Integrated Care Centre... 8-2

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8.6 Outline planning approval ... 8-2 8.7 Programme ... 8-2 8.8 Capital cost forms ... 8-3 8.9 Optimism bias ... 8-4 8.10 Life Cycle Costs. ... 8-5 8.11 Revenue costs ... 8-5 8.12 Projected Costs – Acute Hospital ... 8-5 8.13 Projected Costs – Integrated Care Centre ... 8-6 8.14 Projected Costs – Mental Health ... 8-7 8.15 Projected Costs – Total Project ... 8-8 8.16 Transitional and double running costs ... 8-9 8.17 Changes from the OBC ... 8-10

9 THE PFI PROCUREMENT PROCESS ... 9-1

9.1 Introduction ... 9-1 9.2 Procurement process... 9-1 9.3 Advisors ... 9-1 9.4 Prequalification Process ... 9-2 9.5 ITN Process ... 9-2 9.6 Preferred Bidder Selection... 9-3 9.7 Preferred Bidder to Financial Close... 9-4 9.8 Stakeholder Involvement ... 9-4 9.9 Clinical staff and GP involvement ... 9-5 9.10 Public consultation ... 9-5 9.11 Health Overview and Scrutiny Committee ... 9-5 9.12 Department of Health Review... 9-6

10 THE PREFERRED PFI SOLUTION ... 10-7

10.1 Introduction ... 10-7 10.2 Progress Health ... 10-7 10.3 Design Proposals... 10-8 10.4 Planning consent ... 10-10 10.5 Judicial review period ... 10-11 10.6 Design data... 10-11 10.7 AEDET ... 10-11 10.8 DoH Estates and Facilities Directorate design review... 10-13 10.9 Compliance with statutory requirements ... 10-13 10.10Consumerism... 10-13 10.11Sustainability... 10-13

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Full Business Case Section iv

10.12Hard FM services ... 10-14 10.13Soft FM services ... 10-14 10.14Managed equipment service... 10-15 10.15Changes from preferred bidder appointment... 10-15 10.16Timetable ... 10-15 10.17Price ...10-1 11 RISK ... 11-1 11.1 Introduction ... 11-1 11.2 Quantifiable risks ... 11-1 11.3 NPV/EAC of Risks ... 11-3 11.4 Gateway risk potential assessment and Reviews... 11-5

12 ECONOMIC APPRAISAL... 12-1

12.1 Introduction ... 12-1 12.2 Methodology and Assumptions... 12-1 12.3 Results before Risk Transfer ... 12-2 12.4 Value of Risk Transfer ... 12-3 12.5 Results after Risk Transfer ... 12-3 12.6 Sensitivity Analyses ... 12-5 12.7 Interest Rates... 12-6

13 FINANCIAL APPRAISAL ... 13-1

13.1 Introduction ... 13-1 13.2 Assumptions... 13-1 13.3 Revenue Cost Implications ... 13-1 13.4 Financial Impact on Trusts... 13-2 13.5 Integrated Care Centre ...Error! Bookmark not defined. 13.6 Mental Health ... 13-8 13.7 Sensitivity Analysis ... 13-10 13.8 Accounting Treatment... 13-11 13.9 Land Transactions ... 13-11 13.10Land in the PFI deal... 13-11 13.11Residual Estate ... 13-11 13.12Asset Impairments/Write-offs... 13-12 13.13VAT Recovery ... 13-13 13.14Composite Trader ... 13-13

14 STANDARD CONTRACT TERMS AND PAYMENT MECHANISM ... 14-1

14.1 Introduction ... 14-1 14.2 Contract Structure... 14-1

Deleted: 10-17

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14.3 Compliance with standard form contract version 3... 14-3 14.4 Outline of the Project Agreement... 14-3 14.5 Project Specific Amendments... 14-5 14.6 Incorporating the three trust issues ... 14-6 14.7 Project Specific Legal Issues... 14-9 14.8 Payment mechanism ... 14-11 14.9 Performance requirements for FM and MES services... 14-12 14.10Tolerances ... 14-12 14.11Deductions modelling for performance ... 14-12 14.12Deductions for unavailability ... 14-13 14.13MES deductions cap ... 14-14 14.14Service failure points ... 14-14 14.15Interim services... 14-15 14.16Handover and training ... 14-15 14.17Energy... 14-16 14.18Joint Working Agreement ... 14-16

15 FINANCING OF THE SCHEME ... 15-1

15.1 Introduction ... 15-1 15.2 Synopsis ... 15-1 15.3 Overview of the PFI deal ... 15-1 15.4 Approach and solution to funding ... 15-3 15.5 Cost assumptions underlying the level of service payment... 15-4 15.6 The consortium’s financing proposal ... 15-4 15.7 Method of funding ... 15-5 15.8 Description of the financial model and auditing undertaken... 15-7 15.9 Financial adviser’s commentary on the funding structure ... 15-7 15.10Conclusion ... 15-9 15.11Supporting documents ... 15-9

16 ACCOUNTING TREATMENT ... 16-1

16.1 Introduction ... 16-1 16.2 Balance sheet treatment... 16-1 16.3 External audit view... 16-2 16.4 Residual interest and deferred assets ... 16-3

17 PROJECT MANAGEMENT ARRANGEMENTS ... 17-1

17.1 Introduction ... 17-1 17.2 Project plan ... 17-1 17.3 Outline commissioning plan... 17-1

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Full Business Case Section vi

17.4 Contract management arrangements ... 17-2 17.5 Publication of the FBC ... 17-3

18 BENEFITS ASSESSMENT AND REALISATION PLAN ... 18-1

18.1 Introduction ... 18-1 18.2 The key benefits of the project... 18-1 18.3 Benefits assessment... 18-1 18.4 Action required to achieve the benefits plan... 18-2 18.5 Management arrangements... 18-3 18.6 Measuring the degree of achievement ... 18-3 18.7 Monitoring and reporting progress ... 18-4

19 HUMAN RESOURCES ... 19-1

19.1 Introduction ... 19-1 19.2 Trade Union involvement ... 19-1 19.3 Recognition agreements ... 19-3 19.4 Staff transfers... 19-3 19.5 Retention of Employment... 19-3 19.6 TUPE... 19-4 19.7 Interim services and timing of transfers ... 19-4 19.8 Pensions and GAD ... 19-4 19.9 Compliance with Treasury guidance on fair treatment of staff ... 19-4 19.10Progress Health employment policies ... 19-4 19.11Clinical staff... 19-4 19.12Work force plans - hospital services and ICC... 19-4 19.13Workforce plans - mental health services... 19-6

20 ICT INVESTMENT ... 20-1

20.1 Introduction ... 20-1 20.2 Local ICT plan ... 20-1 20.3 ICT provided through the PFI project... 20-1 20.4 ICT provided outside the PFI project ... 20-2 20.5 Project dependant IT developments ... 20-2

21 EQUIPMENT ... 21-1

21.1 Introduction ... 21-1 21.2 Equipment requirements... 21-1 21.3 Equipment procurement PFI ... 21-1 21.4 M1 equipment and lifecycle plan... 21-2 21.5 Equipment Investment Process ... 21-2 21.6 Risk ... 21-3

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21.7 Payment mechanism ... 21-6 21.8 Accounting treatment for the equipment service ... 21-6 21.9 Equipment provided by the Trusts ... 21-6 21.10Incentives for Practical Completion ... 21-6 21.11Replacement of non-performing MES contractor ... 21-6 21.12Termination ... 21-6 21.13Consequences of termination ... 21-7

22 RISK MANAGEMENT PLAN ... 22-1

22.1 Introduction ... 22-1 22.2 Residual Risks ... 22-1 22.3 Risk Management Strategy ... 22-2

23 POST PROJECT EVALUATION ... 23-1

23.1 Introduction ... 23-1 23.2 Outline Plan ... 23-1 23.3 Resources... 23-1 23.4 Costs ... 23-1

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Full Business Case Section viii

List of Tables

Table 1 – The NHS Plan: Requirements and Implications... 2-1 Table 2 – The NHS Improvement plan: Requirements and Implications ... 2-2 Table 3 – The Ten High Impact changes: Requirements and Implications ... 2-4 Table 4 – Patient Choice: Requirements and Implications ... 2-5 Table 5 – The White Paper: Requirements and Implications... 2-6 Table 6 – National Service Frameworks: Requirements and Implications... 2-8 Table 7 – Practice Based Commissioning: Requirements and Implications... 2-9 Table 8 – PbR: Requirements and Implications ... 2-11 Table 9 – Independent Sector Commissioning: Requirements and Implications... 2-11 Table 10 – Foundation Trust Status: Requirements and Implications ... 2-12 Table 11 – National Cancer Plan: Requirements and Implications... 2-12 Table 12 – Mental Health Policy Implementation Guide: Requirements and Implications .. 2-13 Table 13 – Signposts for Success: Requirements and Implications ... 2-13 Table 14 – Reforming Emergency Care: Requirements and Implications ... 2-14 Table 15 – NPfIT programme: Requirements and Implications ... 2-14 Table 16 – Consumerism: Requirements and Implications... 2-15 Table 17 – Disability Discrimination Act: Requirements and Implications ... 2-15 Table 18 – Equality and Diversity: Requirements and Implications ... 2-16 Table 19 – Agenda for Change: Requirements and Implications ... 2-17 Table 20 – New General Medical Services Contract: Requirements and Implications... 2-18 Table 21 – New Consultants Contract: Requirements and Implications... 2-18 Table 22 – Modernising Pathology Services: Requirements and Implications ... 2-18 Table 23 – Health Strategy 2005-2010: Requirements and Implications... 2-19 Table 24 – Community Strategy: Requirements and Implications ... 2-22 Table 25 – National, Regional and local Strategies ... 4-5 Table 26 – 2005/06 Outpatient Activity ... 6-2 Table 27 – 2005/06 Admitted Patient Care Activity... 6-2 Table 28 – 2005/06 A&E Attendances ... 6-2 Table 29 – Outpatient Activity Projections – 2010/11 & 2020/21 ... 6-4 Table 30 – Admitted Patient Care Activity Projections – 2010/11 & 2020/2021 ... 6-5 Table 31 – Projected A&E Attendances – 2010/11 & 2020/21 ... 6-6 Table 32 – Outpatient Clinic Requirements – 2010/11 & 2020/2021... 6-6 Table 33 – Admitted Patient Care Bed Requirements – 2010/11 & 2020/2021... 6-7 Table 34 – Theatre & Endoscopy Requirements – 2010/11 & 2020/21... 6-9 Table 35 – Linear Accelerator Requirements... 6-10 Table 36 – Sensitivity Analysis – Linear Accelerator Workload ... 6-11 Table 37 – Summary Linear Accelerator Requirement – 2016/17 ... 6-11

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Table 38 – Additional Activity and Beds: East of England Acute Services Review ... 6-12 Table 39 – Summary of Future Capacity Requirements ... 6-12 Table 40 – Adult Mental Health Services Bed Requirements -2010/11 & 2020/21 ... 6-14 Table 41 – Learning Disability Bed Requirements – 2010/11 & 2020/21 ... 6-14 Table 42 – Older Adult Services Bed Requirements -2010/11 & 2020/21... 6-15 Table 43 – Summary of Beds Required ... 6-15 Table 44 – Intensive Rehabilitation Bed Requirements -2010/11 & 2020/21 ... 6-17 Table 45 – Minor Injuries Unit Future Attendances- 2010/11 & 2020/21 ... 6-17 Table 46 – Integrated Children’s Unit Future Activity – 2010/11 & 2020/21 ... 6-18 Table 47 – Imaging Activity – 2010/11 & 2020/21... 6-18 Table 48 – ICC Outpatient Requirements – 2010/11 & 2020/21 ... 6-18 Table 49 – Summary of Integrated Care Centre Requirements ... 6-19 Table 50 - Activity changes for the three commissioners ... 6-19 Table 51 – Results of the Acute Hospital OBC option appraisal... 7-3 Table 52 – Affordability assessment ... 7-3 Table 53 – Results of the Mental Health Unit option appraisal ... 7-3 Table 54 – Revenue costs for the preferred option... 7-3 Table 55 – Change in capital cost from OBC to FBC... 7-6 Table 56 – Change in revenue cost from OBC to FBC ... 7-6 Table 57 – Summary of the original OBC option appraisal... 7-7 Table 58 – Development programme for the Acute Hospital ... 8-3 Table 59 – Summary of the PSC capital costs at MIPS 445 (£m) ... 8-3 Table 60 – PSC Out-turn capital costs at MIPS 449 inc. VAT (£m)... 8-4 Table 61 – Results of the Optimism Bias Assessment ... 8-4 Table 62 – PSC Out-turn Capital Cost Including Optimism Bias inc VAT (£m) ... 8-5 Table 63 – PSC Revenue Costs – Acute Hospital ... 8-6 Table 64 – PSC Revenue Costs – ICC ... 8-7 Table 65 – PSC Revenue Costs – Mental Health ... 8-8 Table 66 – PSC Revenue Costs – Total Project ... 8-9 Table 67 – The external advisors to the project ... 9-1 Table 68 – Targets from Preferred Bidder to Financial Close... 9-4 Table 69 – Energy Targets... 10-14 Table 70 – Soft FM VFM analysis ... 10-15 Table 71 – Non-MES Risk Allocations ... 11-1 Table 72 – EAC of Risk Transfer – 60 Years post-construction ... 11-4 Table 73 – EAC of Risk Transfer - 35 Years Concession Period ... 11-4 Table 74 – Economic Appraisal 60 Years post-construction – Pre-Risk ... 12-2 Table 75 – Economic Appraisal 35 Years Concession Period – Pre-Risk... 12-2

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Full Business Case Section x

Table 76 – Economic Appraisal 60 Years post-construction – Post-Risk ... 12-3 Table 77 – Economic Appraisal 35 Years concession period – Post-Risk ... 12-4 Table 78 – Results of Sensitivity Analyses... 12-5 Table 79 – Recurrent Revenue Costs ... 13-1 Table 80 – PFI Revenue Costs – Acute Hospital ... 13-2 Table 81 – Actual Income & Expenditure out-turn - Acute Trust... 13-3 Table 82 – PFI Revenue Costs – ICC ... 13-5 Table 83 – Expected PCT resources ... 13-7 Table 84 – Estimated additional PCT expenditure ... 13-7 Table 85 – PFI Revenue Costs – Mental Health ... 13-8 Table 86 – Mental Health income under PbR ... 13-9 Table 87 – Non- Project specifc amendments to SF3... 14-3 Table 88 – Project specific amendments to SF3... 14-1 Table 89 – Three Trust amendments to SF3 ... 14-7 Table 90 – The basic elements of the payment mechanism... 14-11 Table 91 – Sample results of the deduction modelling (FM and MES) ... 14-13 Table 92 – Example deductions for unavailability ... 14-14 Table 93 – MES SFP termination trigger analysis ... 14-14 Table 94 – SFP Trigger Level Settings ... 14-15 Table 95 – Key issues in the Joint Working Agreement... 14-16 Table 96 – Key costs ... 15-4 Table 97 – Sources of funds ... 15-4 Table 98 – Uses of funds... 15-4 Table 99 – Key Terms of Bond Debt ... 15-5 Table 100 – Key Terms of the Standby Facilities... 15-5 Table 101 – Sponsors Funding Proportion... 15-6 Table 102 – Terms of Subordinated Loan... 15-6 Table 103 – Terms of RPI Swap ... 15-7 Table 104 – The key property risks in the PFI contract (Acute Hospital and MHU)... 16-1 Table 105 – The key property risks in the PFI contract (ICC) ... 16-1 Table 106 – The key property risks in the PFI contract (MES) ... 16-2 Table 107 – Pre PC planning tasks... 17-1 Table 108 – Trust pre PC access requirements and activities... 17-1 Table 109 – Post PC commissioning activities... 17-2 Table 110 – Post service transfer tasks ... 17-2 Table 111 – Project and contract management costs... 17-3 Table 112 – Results of the Benefit Assessment ... 18-2 Table 113 – Staff transfers to Progress Health ... 19-3

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Table 114 – Equipment responsibility matrix ... 21-1 Table 115 - MES VFM assessment ... 21-2 Table 116 – Equipment life-cycles ... 21-2 Table 117 – MES specific risks ... 21-5 Table 118 - MES Risk analysis (35 years at 3.5% discount rate) ... 21-5 Table 119 – Residual risks ... 22-1

List of Figures

Figure 1 – Catchment area of the GPHIP ... 3-1 Figure 2 – Locations of the Trust’s Services in the Peterborough locality ... 3-3 Figure 3 – The location of the Acute Hospital sites in Peterborough ... 3-3 Figure 4 – The PDH East and West Sites... 4-2 Figure 5 – The ECH Site ... 4-2 Figure 6 – Flow Diagram of the Proposed Health System... 5-3 Figure 7 – Acute Model of Care for Greater Peterborough... 5-4 Figure 8 – Emergency Pathway ... 5-8 Figure 9 – Pathway for a Patient with Complex Medical Needs ... 5-9 Figure 10 – Elective Pathway, Including the Treatment Centre... 5-12 Figure 11 – The Paediatric Service Pathway ... 5-15 Figure 12 – Service Planning Structure ... 5-19 Figure 13 – Capacity Planning Methodology ... 6-2 Figure 14 – Peterborough Unitary Authority 2003 Population Projections ... 6-4 Figure 15 – Growth in 1st Outpatient Appointments to meet Waiting Time Targets... 6-4 Figure 16 – Schematic of the preferred option, the PSC ... 7-4 Figure 17 – An artist’s impression of the entrance to the new hospital ... 8-1 Figure 18 – An artist’s impression of the Integrated Care Centre... 8-2 Figure 19 – Consortium structure... 10-7 Figure 20 – ECH site master plan ... 10-8 Figure 21 – ICC site master plan ... 10-10 Figure 22 – AEDET scores for the Acute Hospital design ... 10-12 Figure 23 – AEDET scores for the Mental Health Unit design... 10-12 Figure 24 – AEDET scores for the ICC design ... 10-12 Figure 25 – Programme from FBC to financial close ...10-1 Figure 26 – The relationships between the parties to the deal ... 14-2 Figure 27 – Random triangular distribution used for simulating performance failures... 14-13 Figure 28 – Project structure ... 15-2 Figure 29 – Equipment investment process... 21-4

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1 I

NTRODUCTION

1.1 Objective of the FBC

1.1.1 The objective of this full business case (FBC) is to seek approval to enter into private

finance initiative (PFI) contract with Progress Health to provide the healthcare facilities required to support the implementation of the Greater Peterborough Health Investment Plan (GPHIP).

1.1.2 The FBC sets out the case for the investment and demonstrates that the private finance

initiative (PFI) option is affordable and provides better value for money (VFM) than the public sector comparator (PSC).

1.2 Scope

1.2.1 The PFI project is a joint initiative by three health service organisations and will provide:

• A 612 bed Acute Hospital that includes general and specialist outpatient services, day surgery, elective and emergency services, diagnostics, cancer and therapy services

• A 102 bed Mental Health Unit providing adult acute and older peoples psychiatry, psychiatric high dependency unit and learning disabilities services; and

• A 34 bed Integrated Care Centre (ICC) that includes a range of outpatient and diagnostic services, minor injuries unit, child and adolescent psychiatry, child development unit, respite care for children with complex needs, general rehabilitation services and an administrative base for community staff • A wide range of hard and soft FM services to all three facilities

1.3 Document Structure and Contents

1.3.1 The FBC has been structured in accordance with the Department of Health (DoH)

Guidance and FBC checklist.

1.3.2 The FBC sets out:

• The strategic context for the investment • The Outline Business Case

• The Public Sector Comparator • The PFI procurement process • The PFI solution

• The economics, funding and financial impact of the investment • The risk analysis; The financial appraisal;

• The legal terms of the PFI contract • The financing of the project • The accounting treatment

• The project management arrangements • The benefits of the scheme

• Human resource issues • The IT services

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Full Business Case Section 1-2

• The risk management strategy

• The arrangements for post project evaluation

1.4 Appendices

Detail data and supporting evidence is provided in the appendices. Some of these are only available in electronic format or as spreadsheets.

• Appendix A - FBC Checklist • Appendix B - Local Population Data • Appendix C - Activity and Capacity Planning • Appendix D - Philosophies of Care

• Appendix E - Summary of the OBCs

• Appendix F - Change in Capital and Revenue Costs from OBC to FBC • Appendix G - Capital cost forms for the Public Sector Comparator • Appendix H - Optimism Bias Assessment

• Appendix I - Life Cycle Cost Estimates

• Appendix J - OJEC Notice for the PFI Procurement • Appendix K - Stakeholder Analysis

• Appendix L - Letters of Support

• Appendix M - Planning Report and Approval • Appendix N - AEDET Assessment • Appendix O - NEAT Assessment • Appendix P - Preferred Bidder Letter

• Appendix Q - Financial Analysis and Economic Model • Appendix R - Land Transactions

• Appendix S - Risk Register and Analysis

• Appendix T - Gateway Risk Potential Assessment and Recommendations • Appendix U - Letter from Customs and Excise on Tax Treatment

• Appendix V - Performance Mechanism Model Outputs • Appendix W - PWC Letter on VFM of Project Funding • Appendix X - Technical Accounting Treatment Opinion • Appendix Y - Project Management Arrangements • Appendix Z - Benefit Assessment

• Appendix AA - GAD Letter

• Appendix BB - Equipment VFM Analysis

• Appendix CC - Residual Risk Management Strategy • Appendix DD - Post Project Evaluation

• Appendix EE - Trust Board Minutes • Appendix FF – District Valuer’s Report

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• Appendix HH - Department of Health Review

1.5 FBC

Checklist

1.5.1 The completed Department of Health FBC Revision 2 checklist is provided in Appendix

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2 S

TRATEGIC

C

ONTEXT

-

N

ATIONAL

,

R

EGIONAL AND

L

OCAL

2.1 Introduction

2.1.1 This section of the Full Business Case (FBC) sets out the main strategic drivers for

change that has driven the strategy to develop health service provision in the Greater Peterborough area. It identifies national, regional and local priorities and how the Greater Peterborough Health Investment Plan (GPHIP) is addressing these.

2.1.2 The GPHIP is the local strategy for the modernisation of health services that serve the

population of Greater Peterborough and Southwest Lincolnshire. Based on the NHS Plan, the GPHIP will provide the local population with fast and convenient care delivered to a consistently high standard with services available when people require them and tailored to their individual needs.

2.1.3 The GPHIP is a partnership development by the Peterborough and Stamford Hospitals

NHS Foundation Trust (PSHFT), Cambridgeshire and Peterborough Mental Health Partnership NHS Trust (CPMHT) and the Greater Peterborough Primary Care Partnership (GPPCP).

2.1.4 The GPHIP plan covers the whole of the local health system from Acute Hospital

services to intermediate and local primary care services. The only elements of the health system not included are routine GP services, dental services and primary care access targets. These are covered by the PCPs own local delivery plans and estate strategies.

2.2 National

Strategies

2.2.1 This section details the key national strategies relevant to this scheme and their

implications for the scheme.

The NHS Plan

2.2.2 The NHS Plan is the Government’s ten-year plan for the modernisation of the NHS. It

was produced to assist Trusts to identify areas of service provision that need to be improved and to help them build a new, modern NHS based around the needs of the patient. Although the scheme goes beyond the 10-year timeframe of the NHS plan, consistency with the requirements of the NHS remain an important foundation for the scheme.

2.2.3 Table 1 identifies some of the key requirements of the NHS Plan and scheme

consistency with this policy.

Table 1 – The NHS Plan: Requirements and Implications

Policy Requirements Scheme consistency with Policy Requirements

100 new hospitals and 7,000 beds to provide new state of the art facilities that will provide faster, more convenient services for patients.

Development of easy to access hospital services from a modern facility including a Treatment Centre and increased theatre and intensive rehabilitation bed capacity in the community.

A purpose built Mental Health Unit for adult, older people and learning disability

Reductions to waiting times, enhanced performance targets and improvements in emergency care.

Separation of emergency and elective care with dedicated theatres, beds and diagnostic facilities and the creation of a modern emergency centre. Minor Injuries unit in the Integrated Care Centre aligned to urgent care strategy

As much work as clinically appropriate should be delivered in ambulatory or short stay facilities.

All elective work requiring up to a 23-hour stay will be undertaken in the Treatment Centre.

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Greater Peterborough Health Investment Plan Strategic Context

Improved services through better partnership working.

Integrated care services will be delivered away from the main acute site to offer patient choice in accessing services through the implementation of care pathways that span primary and secondary care.

Designing around the patient Use of user profiles and public consultations throughout the project and service planning process 40% of NHS buildings to be less than 15

years old by 2010

Replacing premises that are substantially older than 15 years old with new build and refurbish modern premises.

Empowering patients, giving more choice and protecting their rights.

See section on Choice Introduction/Implementation of the

National Service Frameworks

See section on NSFs below

The NHS Improvement Plan – Putting people at the heart of Public Services (2004)

2.2.4 The NHS Improvement Plan sets out the priorities for the NHS between now and 2008.

It supports the ongoing commitment to a 10-year process of reform that is set out in the NHS Plan.

2.2.5 The major component of the GPHIP, the Acute Hospital, will not be open until the time

frame for the NHS Improvement Plan has passed. Improvements were however, factored into the programme (having planned backwards from the goals articulated in Our Healthier Nation). The hospital has been commissioned to reflect these changes with an ongoing commitment to partnership working to ensure service improvements are consistent with national and local aspirations to support care being delivered in the most appropriate setting, utilising all the available resources efficiently and effectively.

2.2.6 The Mental Health Unit will be open in 2008 providing purpose-built facilities for mental

health patients in the most acute phase of their illness. This facility will support a network of community services which are being developed for a responsive, convenient and personalised service to improve patient care.

2.2.7 The Integrated Care Centre will open in 2008 to provide the patients of Peterborough a

local community facility, removing this work from the Acute Hospital.

2.2.8 Table 2 identifies some of the key requirements of the improvement plan and

demonstrates scheme consistency with policy requirements.

Table 2 – The NHS Improvement Plan: Requirements and Implications

Patients will be admitted for treatment within a maximum of 18 weeks from referral by their GP, and those with urgent conditions will be treated much faster.

The assumptions factored into the activity modelling and sensitivity testing used to establish the capacity requirements beyond 2010 have taken into account the impact of these objectives.

The model of care developed within the GPHIP supports the optimal use of the health system’s resources. To aid demand management in primary care, access to diagnostic services will be provided in the Integrated Care Centre together with a range of community and general outpatient and rehabilitation services. The Acute Hospital will only manage the most critical and complex care, and those services that need access to high tech equipment and diagnostics.

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Policy Requirements Scheme consistency with Policy Requirements Patients will be able to choose between

a range of providers that meet NHS standards, within the national maximum price that the NHS pays for the treatment they need.

The provision of an Integrated Care Centre supports care being delivered in the community and assists in providing an efficient service delivery model for Practice Based Commissioning by consolidating the most costly and scarce resources based in a unit with a strong community emphasis.

As a Foundation Trust with new patient focused services and facilities, there will be the potential to attract patients through patient choice.

Patients will have access to a wider range of services in primary care, including access to services nearer their workplace.

The scheme involves moving services from tertiary hospitals when safe to do so, including radiotherapy, cardiac and respiratory and renal dialysis

Moving services out of the Acute Hospital where possible. Providing more choice over where non-Acute Hospital services are provided. The PCT provides a direct access service for people for dentistry, minor ailments and illness but the ICC will enable expansion of services to meet wider range of needs.

A new minor injuries unit within ICC in conjunction with the existing minor injuries unit at Stamford will provide patients with increased access. Both of these units will link to the main emergency centre in the Acute Hospital to ensure high quality of services are maintained. Significant health improvement services being delivered and planned with employers and our communities to increase the range and reduce health inequalities

Mental health outpatient and day care facilities moved into community. New crisis resolution and home treatment services established to work in conjunction with the inpatient teams, to support patients remaining in their own home environment.

In every care setting the quality of care will continue to improve, with the Healthcare Commission providing an independent assurance of standards, and patient safety being a top priority.

Scheme includes:

Managed equipment service, incorporating training and education with all three facilities

Pharmacy robot which improves the quality control of dispensing of medication

Investment in IT – electronic patient record linking to National IT programme – ensures all MDT notes and PACS are always available

Purpose built Mental Health Unit designed with safety, privacy and dignity of the patient as a key attribute Major investment in services closer to

home will ensure much better support for patients who have long-term conditions, enabling them to minimise the impact of these on their lives

The development of a satellite cancer unit with radiotherapy facilities to support the West Anglia Cancer Network lack of capacity by 2010 in the north of the county will avoid patients from the Greater Peterborough area travelling long distances for treatment.

Local communities will have greater influence and say over how their local services are run, with local services meeting local priorities

As a Foundation Trust the public governors play an active part in the strategic planning of the Acute Trust services. This has included planning for GPHIP Changes in the way services are

delivered

Patients suffering from mental health problems will be managed outside of the Mental Health Unit by outreach community teams.

Patients with life long chronic diseases will be managed outside of the Acute Hospital as far as possible. The emphasis being on lifestyle management and the expert patient programme to ensure patients are fully involved in the decision making process.

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Improvements in the patient experience An increase of single bedrooms from 27% to 59% in the Acute Hospital, 20% to 100% in the Mental Health Unit and 100% single bedrooms in the ICC.

All single rooms and four bed-rooms will have an en-suite shower, WC and wash hand basin.

A single gender ward for women’s health conditions will be provided as requested during the public

consultation.

Delivery of food by hostess from FM provider to ensure more tailored services, which will link to the Trust housekeeper role of ensuring that the non-nursing duties are undertaken by the Trusts housekeeper. The Trust will commit to providing Freeview TV at the patients bedside, along with an IT socket. Patients will be allowed to use their mobile phones during their stay. The Ten High Impact Changes

2.2.9 This Modernisation Agency publication identified ten changes to healthcare provision

that can have a significant impact on appropriateness, quality and responsiveness of patient care.

2.2.10 Table 3 identifies the key requirements of the Ten High Impact Changes and how the

scheme delivers against these requirements.

Table 3 – The Ten High Impact Changes: Requirements and Implications

Treat day surgery (rather than inpatient surgery) as the norm for elective surgery

The provision of a dedicated treatment centre with additional theatre capacity in the Acute Hospital and a surgical procedure suite in the ICC will enable procedures to be treated in an appropriate setting to achieve all day cases within the 90th percentile, see Chapter 6..

Improve patient flow across the whole NHS system by improving access to key diagnostic tests

The increase in the provision of complex diagnostics namely CT and MRI within the Acute Hospital will improve the patient flow.

The provision of x-ray, DEXA and ultrasound facilities in primary care will improve access for GPs. Manage variation in patient discharge

thereby reducing length of stay

Single acute site inpatient facilities will ensure patients are cared for in the most appropriate place, by the right person at the right time. Use of predictive dates for discharge and joint transfer of care team established to ensure timely discharge

Workforce redesign, in conjunction with new models of care, will avoid multiple patient handoffs, reducing the number of professionals with which the patient comes into contact.

Manage variation in the patient admission process

Streaming of patients, dedicated emergency beds adjacent to the emergency centre and seven day provision of all services for non-elective work within the emergency care pathway

Avoid unnecessary follow-ups for patients and provide necessary follow-ups in the right care setting

Reduce follow-ups in the Acute Hospital to the 75th percentile initially, see Chapter 6.

Provide chronic disease management in the community or ICC setting

Increase the reliability of performing therapeutic interventions through a Care Bundle approach

Care programme for mental health clients. Ensuring optimal care planning and shared records (refers to pharmaceutical management etc), increased use of Map of Medicine due to availability of IT near bedside

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Policy Requirements Scheme consistency with Policy Requirements Apply a systematic approach to care for

people with long-term conditions

The development of community models aims to provide local people with a systematic approach to long-term conditions and reduce crises admissions.

Improve patient access by reducing the number of queues

Continue to develop the elective and treatment centre model of care, increasing ‘one stop’ OPD clinics with multidisciplinary involvement within a single department.

Optimise patient flow through service bottlenecks using process templates

The provision of a range of diagnostics within other settings is aimed to ensure work is streamlined and bottlenecks minimised to support the hospital in being a hospital of choice by constantly exceeding national milestones.

Redesign and extend roles in line with efficient patient pathways to attract and retain an effective workforce

Changes in the workforce have been ongoing in the Peterborough health system and the opportunities of consolidating services will provide greater career opportunities.

Patient Choice

2.2.11 Patient choice is central to the NHS modernisation agenda and key to offering a

personalised health service for every patient. From December 2005 patients requiring planned hospital care have been able to book appointments from their choice of 4-5 hospitals (or other suitable alternative providers) at the point of referral from their GP practice including the time and date of the appointment. By January 2007 patients will be able to choose any service provider within the UK at the point of referral into secondary care.

2.2.12 Table 4 outlines the key requirements of patient choice and how the scheme delivers

against these requirements.

Table 4 – Patient Choice: Requirements and Implications

Treat day surgery (rather than inpatient surgery) as the norm for elective surgery

The provision of a dedicated treatment centre with additional theatre capacity in the Acute Hospital and a surgical procedure suite in the ICC will enable procedures to be treated in an appropriate setting to achieve all day cases within the 90th percentile, see Chapter 6

Improve patient flow across the whole NHS system by improving access to key diagnostic tests

The increase in the provision of complex diagnostics, namely CT and MRI, within the Acute Hospital will improve the patient flow.

The provision of x-ray, DEXA and ultrasound facilities in primary care will improve access for GPs

Manage variation in patient discharge thereby reducing length of stay

Single acute site inpatient facilities will ensure patients are cared for in the most appropriate place, by the right person at the right time. Use of predictive dates for discharge and joint transfer of care team established to ensure timely discharge

Workforce redesign in conjunction with new models of care will avoid multiple patient handoffs reducing the numbers of professionals in which the patient comes into contact.

Manage variation in the patient admission process

Streaming of patients, dedicated emergency beds adjacent to the emergency centre and seven day provision of all services for non-elective work within the emergency care pathway

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Avoid unnecessary follow-ups for patients and provide necessary follow-ups in the right care setting

Reduce follow-ups in the Acute Hospital to the 75th percentile initially, see Chapter 6.

Provide chronic disease management in the community or ICC setting

Increase the reliability of performing therapeutic interventions through a Care Bundle approach

Care programme for mental health clients. Ensuring optimal care planning and shared records (refers to pharmaceutical management etc) increased use of Map of Medicine due to availability of IT near bedside Apply a systematic approach to care for

people with long-term conditions

The development of community models aims to provide local people with a systematic approach to long-term conditions and reduce crises admissions.

Improve patient access by reducing the number of queues

Continue to develop the elective and treatment centre model of care, increasing ‘one stop’ OPD clinics with multidisciplinary involvement within a single department.

Optimise patient flow through service bottlenecks using process templates

The provision of a range of diagnostics within other settings is aimed to ensure work is streamlined and bottlenecks minimised to support the hospital in being a hospital of choice by constantly exceeding national milestones.

Redesign and extend roles in line with efficient patient pathways to attract and retain an effective workforce

Changes in the workforce have been ongoing in the Peterborough health system and the opportunities of consolidating services will provide greater career opportunities.

NHS White Paper: Our health, our care, our say: a new direction for community services (January 2006)

2.2.13 The White Paper is part of the long-term strategy of reforming health and social care in

England. It aims to achieve four main goals: Better prevention services with earlier intervention; more choice and a louder voice for patients/users; tackling inequalities and improving access to community services; and more support for people with long-term needs. These issues have been a core part of the planning for the GPHIP from its inception.

2.2.14 Table 5 identifies the key requirements of the White Paper and the scheme consistency

with these requirements.

Table 5 – The White Paper: Requirements and Implications

Services that put the patient first and support them to care for themselves as much as they can.

Service development plans and health planning has included designing services around the needs of the patient, see Chapter 5.

More choice of services and services that are easier to use and more local.

The GPHIP is based on a number of objectives including ‘to provide better access to services and increase choice’. This includes moving services out of tertiary centres closer to home such as radiotherapy, complex respiratory function tests, cardiac angiography and increasing renal services; moving services out of the Acute Hospital where possible and providing more choice over where non-Acute Hospital services are provided. An increased range of services will be available within the ICC

Improving the planning of services for people who need longer term care.

Supporting patients with chronic conditions during an acute phase by providing rapid available access to staff and services.

Intensive rehabilitation for patients with chronic disease in crisis, available in the ICC to minimise the risks of

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Policy Requirements Scheme consistency with Policy Requirements crisis admissions to hospital. Aligned with the wider PCT strategy to increase choice for long term care in a range of supported living facilities

Improving palliative care GPHIP links to another strand of work here on palliative care and the development of increased community services, to allow more patients to be cared for in the community rather than in an Acute Hospital bed. The palliative care review led by the PCT, supports a number of palliative care beds in the community, provided by the voluntary sector and enhanced community nursing services. National Service Frameworks

2.2.15 National Service Frameworks have been developed for a number of health service

areas, to state clearly the services that patients and users should be able to access, ensure that equality of provision is maintained nationally and build on best practice observed from local developments.

2.2.16 The National Service Framework (NSF) for Mental Health Services sets out a

comprehensive agenda for Mental Health Services, which acknowledges the need for a whole system of care. The NSF contains seven broad standards that set global objectives for the services as opposed to fixed targets. The standards cover five key service areas, in accordance with the holistic approach adopted by the Framework, these are: mental health promotion; primary care and access to services; effective services for people with severe mental illness; caring about carers; and preventing suicide.

2.2.17 The NSF for Older People sets out a programme of action to deliver higher quality

services for older people. It incorporates eight standards for the provision of services: Rooting out age discrimination; person-centred care; intermediate care; general hospital care; stroke; falls; and promoting an active healthy life in older age.

2.2.18 The National Service Framework for Coronary Heart Disease (CHD) sets out the

standards and services for the prevention, diagnosis, treatment and rehabilitation of coronary heart disease. It is a 10-year programme, which aims to modernise CHD services, reduce premature deaths from CHD and provide equal and rapid access to high quality services. The NSF sets out 12 standards with the aims of: ‘reducing heart disease in the population; preventing CHD in high-risk patients in primary care; treating heart attack and other acute coronary syndromes, investigating and treating stable angina; revascularisation; managing heart failure; and cardiac rehabilitation’.

2.2.19 The Children’s National Service Framework is a 10-year programme setting out the

standards to be achieved by children’s health, social and educational services. The programme aims to ensure fair, high quality and integrated health and social care services that are child centred and provided from pregnancy, right through to adulthood. There are 11 standards set over three parts: Part I (Standards 1 to 5) sets out the standards for all children and cover a number of areas including early intervention, promotion of health and well-being, and the provision of family centred services; Part II (Standards 6 to 10) sets out the standards for particular groups of children including children and young people who are ill, in hospital, disabled, and those who have complex needs; Part III (Standard 11) sets out the standards for maternity services.

2.2.20 The NSF for Renal Services sets standards and markers of good practice which will help

the NHS and its partners manage demand, increase fairness of access and improve choice and quality in dialysis and kidney transplant services. It also sets the quality requirements and to help the NHS limit the development and progression of chronic kidney disease; minimise the impact of acute renal failure, and extend palliative care to people dying with kidney failure.

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2.2.21 The Diabetes National Service Framework sets out the first ever set of national

standards for the treatment of diabetes, to raise the quality of NHS services and reduce unacceptable variations between them. In keeping with the principles of The NHS Plan, and The Expert Patient, the primary goal is to enable the person with diabetes, or at risk of developing diabetes, to manage their own lifestyle and diabetes, by providing support and structured education as well as drugs and treatments.

2.2.22 Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term covering a range of

conditions including chronic bronchitis and emphysema. It is a long-term condition that leads to damaged airways, causing them to become narrow, making it harder for air to get in and out of the lungs. There is no cure for COPD, but it can be managed through drug therapy. The development of a National Services Framework (planned publication – 2008) for COPD will result in new quality requirements and markers of good practice. It will improve the quality of and access to COPD services, reducing inequalities and lead to a reduction in NHS costs. The proposed NSF for COPD patients will seek to:

• Provide more choice in treatment for patients

• Reduce inequalities in treatment, which can vary across the country, and • Improve standards of care for patients.

2.2.23 Table 6 identifies some of the key requirements of the National Service Frameworks and

scheme consistency with these requirements.

Table 6 – National Service Frameworks: Requirements and Implications

Greater integration of mental health services.

Planned relocation of Acute Mental Health Services onto the main Acute Hospital site.

Improved services for older people. Intensive rehabilitation beds are planned within the ICC, with structured and planned short-term rehabilitation targeted at helping older people regain their independence following hospital admission. A wider range of choices will be available to support adults and older people to maintain independent living within their own home with intensive care packages, community matron programme, extra care housing and remodelling day care provision.

Improved management of patients suffering from Coronary Heart Disease.

Provision of a cardiac catheter lab and cardiac investigations unit brought together in an expanded service with a dedicated cardiac ward.

Improved services for children. Integration of secondary and community paediatric services and development of an integrated care pathway, to ensure all children receive the most appropriate care from the most appropriate person, in the most appropriate place at the most appropriate time. Provision of a Childrens Centre within the ICC offers the opportunity to support children with dual diagnosis and consolidate the joint working between agencies with a clear focus on the child.

Maternity services – expanding home from home facilities, i.e. low tech rooms, six hour length of stay, provision of neonatal intensive care Level 2+ - to support Addenbrooke’s Level 3 unit in line with the network review.

Links with care trusts, especially around respite care facilities in ICC, for children with learning disabilities and complex medical needs.

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Renal Increase renal dialysis in line with network. See

Chapter 6. Capacity Planning

Education facilities to enable patients to undertake dialysis in their own home, will be provided locally to avoid patients travelling to Leicester.

Diabetes The provision of a diabetes centre within the healthy

living centre currently being developed in accordance with the PCT estate strategy, will provide multi-disciplinary community services for patients with diabetes.

Chronic Obstructive Pulmonary disease The provision of a respiratory investigations unit undertaking complex lung function tests will be provided in the Acute Hospital. The current service is at Papworth Hospital or Leicester, thereby bringing services closer to home. Pulmonary rehab in the community is part of wider integration programme with the hospital and PCT.

Practice Based Commissioning

2.2.24 As practice based commissioners, GPs will be able to determine whether they undertake

services themselves or commission others to undertake services on their behalf. Health Reform in England: update and commissioning framework (2006) outlines ‘how practice-based commissioning will empower GPs to develop new services that are flexible to reflect patients’ needs and be delivered closer to home’.

2.2.25 Table 7 outlines the implications of Practice Based Commissioning on the scheme.

Table 7 – Practice Based Commissioning: Requirements and Implications

Implement Practice Based Commissioning

The GPPCP has already established PBC and are now in the 2nd year of a programme. The focus has been to reduce emergency admissions, working with secondary care to minimise follow ups and target key areas of development in alignment with the capacity plans developed for the GPHIP. The changes to the PCT in 1/10/06 will aim to consolidate this work further. A greater variety of services, from a

greater number of providers in settings that are closer to home and more convenient to patients.

The GPPCP will commission a range of services within the ICC; the prioritisation of these is part of a planned programme working with current and potential providers to support the provision of improved choice for our local population. The PCT have options for utilizing capacity within the centre to support core primary care functions as necessary, due to the flexible design of the building and the potential to expand the integrated minor injuries unit into clinical suites. The PCT has evaluated the affordability of the ICC against a primary care based model and the ICC offers a cost effective solution for primary care in

commissioning pathways to support key client groups, particularly patients with long term conditions with co-morbidities who benefit from a multi-professional team approach.

Increased support of clinician-to-clinician dialogue about improving and developing care processes. Early and continuing involvement of practitioners in service development.

Redesigned pathways involving clinical locality leads and secondary care consultants are being developed in line with GPHIP patient pathways, to support ongoing development of services within community and primary care settings.

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More patient choice All practices will operate a full Choose and Book by December 2006.

Information that meets the needs of our local populations cultural diversity, aims to ensure we provide a range of services in environments that are seen as conducive to support optimal attendance. Work is ongoing with 3rd sector, current and potential providers, to ensure that any service we need are subject to contestability and meet local people’s needs. An additional set of levers to aid demand

management.

The restructuring of the PCT has enabled a far greater alignment of performance functions to evidence the full pathway for patients.

Capacity modelling has been developed to identify the priority areas to target activity within primary care, see Chapter 6.

The Expert Patient Programme is also being reviewed to tender for key work programmes that align with high demand areas that have evidence from elsewhere of impact.

The PCT is involved in a national benchmarking club to share and disseminate best practice.

Improve quality of services and the patient experience. Reduce inequality and provide value for money.

The development of practices and community support is increasingly targeting key groups of staff to improve their access to services in ways that meet the needs of those communities by utilising benchmarking and best practice evidence.

Payment by Results

2.2.26 Payment by Results (PbR) is a new system for commissioners to pay hospitals for the

activity that they deliver. For the majority of NHS organisations, 2006/7 is the second financial year in which it has operated. The aim of PbR, as stated by the DoH, is to provide ‘a transparent, rules-based system for paying trusts. It will reward efficiency, support patient choice and diversity and encourage activity for sustainable waiting time reductions. Payment will be linked to activity and adjusted for case mix. Importantly, this system will ensure a fair and consistent basis for hospital funding rather than being reliant principally on historic budgets and the negotiating skills of individual managers’.

2.2.27 Most NHS organisations are currently undergoing a period of PbR transition. The effect

of PbR is that some hospitals will gain financially, giving them additional resources to invest in patient care. Other hospitals will lose financially, and have to make additional efficiencies. The effect of the PbR transition is to smooth the impact of these changes over four years from 2005/6 to 2008/9. This should enable organisations to better manage the impact of PbR.

2.2.28 A number of services are currently excluded from PbR. However, as data improves, and

reliable tariffs can be developed, the aim is to extend the scope of PbR further. Services currently excluded from PbR include: community services, mental health services, ambulance services (other than patient transport services), chemotherapy, learning disabilities, critical care, continuing/intermediate care, respite care, radiotherapy, direct access radiology and pathology, and renal dialysis.

2.2.29 The Acute Trusts current reference costs (2005/06) results show an overall index of 90.

This is ranked as the 31st lowest index of all NHS Trusts.

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Table 8 – PbR: Requirements and Implications

Implementation of Payment by Results Payment by Results (PbR) directly links Trust income to activity. The Acute Trust is currently being paid for each patient treated based on their classification by Healthcare Resource Group (HRG) and the national tariff for each HRG.

PbR already covers a significant proportion of current activity. The financial modelling for the GPHIP has assumed the full impact of the operation of PbR,

It is anticipated that PbR will be applicable to mental health services in the future. The currencies and timescales of this are still unclear.

Independent Sector Commissioning

2.2.31 Established in 2002 the Independent Sector Treatment Centres (ISTC) programme

provides an increasing network of units that provide pre-booked surgery and diagnostic tests for patients. The activity planning assumptions and modelling require PCTs to consider the potential to commission a range of diagnostics from the independent sector, to support achievement of key targets. This is not ‘instead of’ commissioning from current acute services, but is an addition.

2.2.32 Table 9 identifies one of the key requirements of independent sector commissioning and

implications for the scheme.

Table 9 – Independent Sector Commissioning: Requirements and Implications

Choice of Providers: independent sector commissioning

Due to the need to ensure financial viability of the commissioning programme of work, capacity planning aims to ensure that the ‘mix’ of diagnostics provided across a range of providers meets the needs. With the advent of choice (and experience to date) this is unlikely to have an adverse impact as the public have tended to opt for their local NHS provider if it is a local ‘accessible’ option.

Within the Peterborough area there are no ISTCs and no plans for one to be built. The commissioning approach has factored in any likely impact of Choice, alternative providers and the use of the adjacent diagnostic resources at Huntingdon and within the private sector. The activity assumptions have been informed by the impact of these alternatives. Foundation Trust Status

2.2.33 Foundation Trusts are public benefit corporations that provide services for NHS patients

and are part of the NHS, and subject to NHS systems of inspection, but controlled and run locally with local accountability. They have increased financial freedom to retain operating surpluses and additional options for raising capital funds.

2.2.34 Table 10 identifies the requirement of achieving Foundation Trust Status.

Deleted: Table 9

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Table 10 – Foundation Trust Status: Requirements and Implications

To Achieve Foundation Trust Status The Peterborough & Stamford Hospitals Trust achieved Foundation status in 2004. The activity assumptions and income forecasts used in the GPHIP do not include any allowances for additional work derived from the opportunities provided by Foundation status.

The Mental Health Trust is currently undertaking an assessment process in preparation for Foundation trust status, with aspirations to achieve this by April 2008.

Choice The likely impact of any ‘outflow’ due to choice is likely

to be offset by the opportunities the hospital gain by providing modern facilities at tariff and within national targets. Becoming a provider of choice for a wider geographical area and thus attracting additional income.

The Cancer Plan

2.2.35 The National Cancer Plan drew together actions required to ensure that cancer care

across the nation is provided in an appropriate and equitable way.

2.2.36 Table 11 identifies the key requirement of The Cancer Plan and how the scheme delivers

against this policy.

Table 11 – National Cancer Plan: Requirements and Implications

Modern cancer-care facilities. Development of cancer services in conjunction with the tertiary centre at Addenbrookes Hospital, Cambridge and the West Anglia Cancer Network. The

development control plan for the Acute Hospital site will provide two Linear Accelerator (LINAC) Bunkers with expansion space for a further two and will enable co-location of all local cancer services.

The GPHIP development of a satellite cancer unit will address the shortfall in capacity for the network from 2010. The current cancer centre at Addenbrookes is unable to support a future expansion of radiotherapy services due to lack of adjacent estate.

Mental Health Policy Implementation Guide

2.2.37 To support the implementation of new mental health services in line with the NHS Plan

and National Service Framework, a Mental Health Policy Implementation Guide (PIG) was issued in March 2001. This guide describes the new services to be introduced and has been supplemented by further information in the Adult Acute In-patient Care Provision Guidance and the National Minimum Standards for Psychiatric Intensive Care Units and Low Secure Environments guidance which are particularly relevant to this project.

2.2.38 The Adult Acute In-patient Care Provision guidance reaffirms that acute inpatient care is

a core and integral component of the NSF, and that improving adult acute inpatient care and its connections and integration with the other key elements of the whole system of care is a priority NSF implementation target.

2.2.39 Table 12 identifies some of the key requirements of the Policy Implementation Guidance

(PIG) and the scheme consistency with these requirements.

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Table 12 – Mental Health Policy Implementation Guide: Requirements and Implications

The physical inpatient environment and domestic arrangements must be organised to deliver a comfortable, relaxed, safe, and secure environment.

A ‘non-institutional’ environment, allowing patients the freedom of movement balanced against patient safety, has been considered in the design of the internal and external areas.

Specific attention must be placed on ensuring the physical and psychological safety of women.

Female only areas both in day and night space is provided, including a mother and baby area. Commissioners of new inpatient

provision should seek to develop services in socially inclusive settings that reflect a positive vision of mental health.

The provision of central support areas i.e. day spaces, restaurant / dining area and internal gardens, provide a modern ‘hotel’ like facility.

New acute care provision should be designed to maximise service and community connections.

The model of care will aim to deliver seamless services with staff working across inpatient and community services.

Signposts for Success - In Commissioning and Providing Health Services for People with Learning Disabilities

2.2.40 Good practice guidance identifies the need to develop services specifically for persons

with Learning Disabilities, which are separate from mainstream Mental Health Services, whilst maintaining close linkages with them.

2.2.41 Table 13 identifies some of the key requirements of the Signposts for Success document

and how the GPHIP respond to these requirements.

Table 13 – Signposts for Success: Requirements and Implications

Requirements for close liaison with other services in particular Primary Care and other community services.

A care programme approach in line with the holistic model of care including facilities for advocacy officers, psychotherapy, chaplaincy services is provided within the Mental Health Unit

Self-contained inpatient facilities, for persons with behavioural problems relating to their mental health that minimise the risk to other mental health patients within the facility.

Psychiatric intensive care facility - for use with clients who are particularly vulnerable, has been designed with an emphasis on patient and staff safety - will be provided.

The provision of specialist community teams, to support well trained confident staff, so that the use of in-patient beds are restricted to a small number of people with specific admission criteria and discharge planning.

Crisis resolution home treatment team, community mental health teams including specialist teams, outpatient clinics and day care centres will manage patients in the community, with the mental health inpatient facility providing care in the most acute phase of their illness.

Reforming Emergency Care

2.2.42 The Reforming Emergency Care strategy introduced radical changes to A&E

departments that will dramatically speed up advice and treatment for patients who do not need to be admitted and improve the speed of assessment and treatment for those who do need admission.

2.2.43 Table 14 identifies some of the key requirements of Reforming Emergency Care and

how this scheme delivers against these requirements.

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Table 14 – Reforming Emergency Care: Requirements and Implications

Streaming of care pathways for emergency patients.

Early triage system planned in Models of Care that will provide direct access to specialist assessment and treatment areas with dedicated staff.

Provision of local access to emergency treatment.

The ICC will provide a city centre Minor Injuries Unit / Walk in Centre with local diagnostic support, working in collaboration with first responders and integrated community teams to provide 24/7 cover.

Reduce waiting times for treatment. Streaming of patients through an assessment service to specialist emergency areas and minor injuries areas will reduce waits.

Dedicated diagnostics with the emergency centre. National Programme for Information Technology (NPfIT)

2.2.44 The National Programme for Information Technology is one component in the ten-year

plan to modernise the NHS. NHS Connecting for Health, which came into operation on April 1 2005, is the agency of the Department of Health that will deliver the integrated IT systems and services required to help modernise the NHS and ensure care is centred on the needs of the patient.

2.2.45 Table 15 identifies the programme requirements of the NPfIT and how the scheme will

deliver against these requirements.

Table 15 – NPfIT programme: Requirements and Implications

The NHS Care Records Service. Patient-centred care requires information to follow the patient so that it is available wherever and whenever it is needed. The models of care rely on the introduction of the NHS Care Records Service (NHS CRS) to provide a safer and effective delivery of care to the patient supported by robust security.

As this is crucial to service delivery, the Acute Trust will reinforce this by the introduction of an electronic document management system, which will capture all written documentation within one document linking to the NHS care records service.

The electronic booking service, Choose and Book.

The models of care are based around the electronic booking service to ensure patients can choose their appointment and reduce DNAs with the outpatient department.

Electronic Transmission of Prescriptions.

This service will allow those who prescribe and dispense in primary care to generate, transmit and receive prescriptions so that pharmacists and other dispensers can dispense against them.

A new national IT network for the NHS. Provision for N3 has been made within all facilities. Picture archiving and communications

systems for digital imaging.

PACS will implement change through the use of IT to support effective clinical practice in a timely fashion. The introduction of PACS technology significantly reduces the time to undertake the images, thereby reducing the requirement of the number of x-ray rooms and storage facilities required for old x-rays.