Business Case (short form)

Transcription

1 Business Case (short form) IT & Telephony Systems April 2015

2 Document Control Version Date Issued Brief Summary of Change 1 1 April 15 Initial drafting AG 2 15 April 15 Draft review HP April 15 Updates and comments AG April 15 Draft second review HP April 15 Financial section updates HP April 15 Review and comments AG April 15 Draft complete HP Owner s Name

3 Contents 1 Introduction & Background Strategic Case for Change Support & Approvals Capital Programme Fit Programme Investment Objectives 7 2 IT & Telephony Systems Case Purpose of this document Case of Need Project systems and Benefits Interrelationships with other developments Options Identification Preferred Option Procurement Summary of Project Capital Costs Revenue Consequences Equipment 13 3 Financial Case Sources of I&E funding Sources of Capital funding Conclusion 14 4 Project Management Timescales and Implementation Plan Risk Management Benefit Realisation Register Links to QIPP initiatives 16 5 Conclusion & Recommendations 17 6 Appendices Benefits Realisation Plan Project Implementation Plan 19

4 1 Introduction & Background Following the approval of the Acquisition Business Case, and a subsequent Addendum, by the Trust Development Agency the University Hospital of North Staffordshire NHS Trust acquired the responsibility for the delivery of clinical services at Mid Staffordshire Foundation Trust for a period of 29 months from 1 November The two Trusts combined to form the University Hospitals of North Midlands NHS Trust (UHNM). There will be a series of business cases that will be submitted by UHNM against the agreed 80m capital allocation in the Acquisition Business Case. The 80m allocation will be applied for via a number of separate business cases to enable individual elements to be finalised whilst ensuring that the capital programme can be completed within the agreed 29 month timescale. It is important to recognise that each of these business cases is a subset of the total funding solution. This short form business case sets out the need for IT telephony systems (originally included within the IT Infrastructure allocation) that collectively form part of the IT FBCs. It sets out the case of need for the investment of 355k capital and 212k revenue per annum for the life of the project to implement the following IT and telephony systems to support the integration of clinical working between County and RSUH sites. Telecoms IVR (Interactive Voice Recognition) Winscribe & Medisec Netcall Public Internet web portal Local systems Integration A decision in respect of this business case is required if the Trust is to proceed with implementation of the preferred solution. 1.1 Strategic Case for Change The requirement for major capital investment to implement the findings of the TSA is set out in detail in the Acquisition FBC and is predicated on two key assessments: The facilities at SGH are not functionally suitable and are not of the standard required by UHNS, the CQC or other regulatory bodies for the delivery of clinical services. There is insufficient capacity on the CGH site to accommodate the service transfers from SGH that are required to deliver the TSAs clinical model. These issues not only affect the long-term viability of the TSAs' model, they also impact on the resilience within the health economy to the potential serious clinical service delivery risks at SGH identified by the Local Transition Board and Sustaining Services Board. While this Business Case will focus on one element of the capital programme it is important to recognise that the drivers for change as set out in the Acquisition FBC identified a range of issues to be addressed across both sites.

5 1.2 Support & Approvals The Trust Board approved the Acquisition Business Case at its meeting on the 5 July 2014 and the adjustments to this within the TDA supplementary funding at its Board meeting on the 14 October The latter was followed up with a detailed addendum to the ABC which was approved by the TDA in November The internal revenue and capital consequences of the Business Case have been accounted for in the addendum to the ABC. UHNM Standing Financial Instructions set out the required level of approval based on the value of the business case. In line with the Trusts SFIs this Business Case requires approval from the EAG and the CIG before submission to the TDA. It is proposed to submit to the TDA with the IT Infrastructure FBC. Table 1 UHNM SFI Business Case Approval Schedule Capital Business Cases (Capital Costs incl. VAT) Revenue Business Cases (Annual expenditure or income level) - Also applies to revenue implications of Capital Cases EAG CIG TEC FEC Board NTDA 3m 5m Up to 1m to 1m to and and 1m 3m 3m over over needs both Up to 250k Up to 1m 1m to 3m 3m and over 1.3 Capital Programme Fit The table below sets out a summary of the capital costs associated with the programme including the capital costs for this Business Case which are part of the IT FBC 2 5.5m shown below. It can be seen from the table that in addition to the 80m provided by the TDA the Trust is contributing over 19m of operational capital towards the works required to configure both hospital sites. Table 2 Capital Programme Cost Summary Business Case Projects Full Business Case Value RSUH FBC 1 (Contingency) Springfield Conversion 4,931,000 Lyme Wards 112 &113 2,954,000 Critical Care Unit 4,655,000 Cabins (Welfare / Estates) 449,000 Modular Facilities Capital Works & Equipping 2,149,000 Site Wide Infrastructure 2,670,000 17,808,000

6 RSUH FBC 2 Car parking Provision 3,652,000 RSUH FBC 3 Lyme Ward 110/111 2,744,000 RSUH FBC 4 Oncology Development 2,400,000 CH FBC 1 Renal Unit 3,117,000 Pathology 1,500,000 4,617,000 CH FBC 2 Theatres (laminar flow) 1,000,000 CH FBC 3 Theatres - refurbishment 2,000,000 CH FBC 4 Chemotherapy Unit 1,992,000 Ward Upgrade Programme 15,000,000 Emergency Department/Outpatients 4,000,000 20,992,000 CH FBC 5 Fire Safety and Essential Backlog Maintenance 10,887,000 Bid to TDA Early draw down Fire & Safety 1,200,000 IT FBC 1 IT Developments EPR 7,095,000 IT FBC 2 IT Developments Infrastructure & Systems 5,505,000 IT FBC 3 IT Developments - Systems 906,000 TOTAL BUSINESS CASE VALUE Operational Capital Schemes 12,600,000 79,900,000 Pathology Screening 100,000 Pharmacy Robot 250,000 Office Development 1,000,000 MLU 200,000 Paediatric Assessment 300,000 Endoscopy Medical Equipment 400,000 Catering Initiative 2,000,000 CH FBC 6 MRI 2,617,000 Equipment 10,000,000 TOTAL OPERATIONAL CAPITAL 16,867,000 Contingency - (Maintenance/Site Works/Car Parking) 2,900,000 TOTAL CAPITAL PROGRAMME 99,667,000

7 1.4 Programme Investment Objectives The Trust identified a number of key investment objectives for its capital programme that need to be satisfied by the overall preferred solution. The investment objectives that have informed the development of the overarching capital programme are set out below. The investment objectives will be used consistently through the FBC process including as the basis of the non-financial benefits appraisal and the benefits realisation work. The Critical Success Factors have been developed as a means of assessing the extent to which the investment objectives can/will be achieved; they were also used to develop the criteria to assess options as part of option appraisals process. Table 3 Investment objectives / benefit criteria and Critical Success Factors for the overarching capital programme Investment Objectives/Benefit Criteria Critical Success Factors 1) Address legacy estates issues to provide a safe patient environment, i.e. Statutory compliance Eliminate high-risk backlog maintenance 2) Improve patient privacy and dignity Reduce control of infection risks Provide appropriate capacity to deliver the TSAs model and the UHNS service model 3) Improve functional relationships/adjacencies and increase operational efficiency 4) Provide improved working environment for staff Compliance with statutory standards Compliance with HBNs Compliance with HTMs Registration of CQC achieved Part M Building Control regulations for disability requirements achieved. Eliminates high risk backlog maintenance Infection control risks are minimised Patient dignity and segregation requirements achieved Heating, cooling and ventilation of the areas are appropriate for their use Provides appropriate capacity on both sites to deliver TSAs model Provides appropriate capacity on both sites to deliver UHNS service requirements Commissioner support can be achieved for the service intentions The functional relationships support the Models of Care and patient flow Productivity increases at County Hospital can be clearly evidenced HSE standards for welfare facilities are achieved Change and wash facilities support infection control measures Staff are proud to work in the buildings

8 Investment Objectives/Benefit Criteria Critical Success Factors 5) Provide flexibility to respond to future changes in the service model 6) Support the optimum and environmentally sustainable long-term development of the Trust s estates 7) Create new image and improve reputation of County Hospital for patients and public 8) Minimise disruption to delivery of clinical services 9) Ensure implementation of TSAs clinical service model within designated timescales 10) Ensure the Trust receives value for money from capital investment New/reconfigured facilities at CGH can be adapted for alternative future use Reconfigured facilities at County Hospital can be adapted for alternative future use Additional capacity can be provided at both sites Design flexibility to support foreseeable developments is achieved Part L Building Regulations for sustainability are achieved Sustainability design standards are achieved to at least BREEAM Very Good Re-development works contribute to achievement of carbon reduction targets Addresses concerns found in the patient survey Simplicity of way finding is achieved Provides ease of access for patient and visitors Access to facilities supports the specialist needs of its visitors UHNS is able to demonstrate improvements in service provision and patient care Positive patient feedback and media coverage is achieved Activity volumes are not reduced as a result of construction works Patient safety is not compromised No untoward incidents or near misses as result of construction work Additional capacity at CGH is delivered by mid-2015 to support early service transfer of high risk services Reconfiguration required at County Hospital to deliver TSAs clinical model and steady state is achieved by April 2017 The investment is economically viable and is affordable for the Trust Costs are within benchmarked prices Preferred options can be delivered within identified funding

9 2 IT & Telephony Systems Case 2.1 Purpose of this document The purpose of this business case is to set out the case of need for integrating a number of IT telephony systems across the Trust. The Business Case aims to meet the following Trust investment objectives and benefits: Improve functional relationships/adjacencies and increase operational efficiency (3). Provide flexibility to respond to future changes in the service model (5). 2.2 Case of Need An external review was carried out in 2014, at County Hospital of the IT and telephony network infrastructures, systems and assets. The review identified a significant number of IT assets that are out of date or nearing their end of life; insufficient data-links between sites, IT storage, as well as systems and network infrastructure; and the lack of a central PC replacement programme for the site. The review informed the recommendations as set out in the Trust Specialist Administrators (TSA) KPMG Due Diligence report. The infrastructure elements are addressed in a separate IT Infrastructure FBC. It is important to recognise that to support the successful integration of clinical specialties and patient pathways, across RSUH and County Hospital sites, there is a dependence on the implementation of integrated IT systems to support target operating models and efficient working practices. The case of need for IT and telephony systems are driven by the acquisition, the use of out dated systems, and clinical working requirements. A key objective is to provide an efficient IT environment for clinical and non-clinical services and systems and timely access to information to support effective quality patient services. County switchboard service operates with the use of Interactive voice recognition (IVR). Royal Stoke site does not have this technology in place and have concerns over increasing call waiting times, volumes of calls into switchboard operators and pressures on the service. There is a requirement to integrate systems across sites to support consolidated team working as described in steady state target operating models. Currently clinical letters created within Medway and dictations recorded on out-dated analogue tape system. Clinical teams wish to integrate services and are transferring patients between sites which require flexible administrative processes and resources to underpin this and manage the information flow and timely transcription. Resource levels at County site have changed following service repatriation which leaves some areas vulnerable to continuity risks 2.3 Project systems and Benefits A description of the systems and benefits they would bring is set out below: Telecoms IVR ~ reduce wait times to switchboard service at Royal Stoke, improved switchboard customer service, reduce delays in responding to calls from public and staff,

10 improve staff satisfaction and achievement of switchboard KPI s, reduce associated operator pay costs. Winscribe digital dictation & Medisec ~ single system to generate production of digital transcription files to reduce clinic typing turnaround and backlog of typing. Also introduces a single system to generate clinic letters between Royal Stoke and County sites that integrates to the clinical portal and sends electronic copies to GPs in accordance with contract requirements. Netcall ~ single system that will generate text reminders for appointments, friends and family survey and call management tool within switchboard services, leading to improved switchboard call and demand management. Internet ~ improved up to date patient focused and public web portal to access public information for the Trust. Local systems integration ~ single system access to clinical information across sites, to allow local clinical systems, processes and databases to be consolidated or extended. These are set out in a Benefits Realisation Plan in Appendix Interrelationships with other developments IHSS Clinical service delivery of steady state target operating models Clinical specialty target operating models require access to integrated systems between sites to support clinician productivity, and have modelled future workforce structure and budgets on integrated systems across County and RSUH sites. IHSS IT infrastructure EPR This case has interdependency on the delivery of the IHSS IT infrastructure business case to ensure full benefits are realised; requiring robust infrastructure and connectivity to ensure timely access to shared systems between sites. To support operational effectiveness of the Trust it is important to note the interconnections this case has in relation to the EPR project; implementing the EPR programme including clinical portals will require other clinical systems (out of scope for the EPR programme) to be consolidated.

11 2.5 Options Identification The following list of options was developed and reviewed with the Project team. Table 4: Options Matrix Option Brief description Strengths Weaknesses Decision Option 1 - do nothing Continues the current as-is IT system provision Minimum impact No capital outlay Does not support Trust target operating models Inefficiencies for Trust by continuing manual processes affecting clinical productivity and timely patient care Rejected Lack of system integration across trust Option 2 - do minimum Implement extension of current system to opposite trust site Allows workforce efficiencies through implementation of electronic solutions replacing manual processes Supports clinician productivity accessing single system Not a new system implementation retains older system functionality Does not provide new hardware for all locations Preferred Supports ICT strategy Short implementation Lower implementation resource to support Option 3 - full investment Implement replacement system across both sites new system implementation Supports clinician productivity accessing single system Supports ICT strategy Increased capital implementation cost Increase timescales for implementation and benefits realisation Rejected Increases implementation resource Limited benefits and enhancements of new system as current systems are comparable to current market systems

12 2.6 Preferred Option The preferred option is Option 2, Do minimum Implement extension of current systems to opposite site. This option has been selected on the basis that the option provided: Addresses the case of need High level of familiarity, experience and control Technically easiest of options - extending existing systems Shortest implementation timescale Supports the delivery and reconfiguration of UHNM systems and services Is consistent with the delivery of the overall TDA Programme Investment objectives and benefits 2.7 Procurement The current systems are already in use at the Trust and it is intended that these existing systems are continued to be procured from the current supplier and extended across the Trust. All of the suppliers are within NHS Framework agreements. 2.8 Summary of Project This Business Case to extend the IT telephony systems includes the following capital investment elements: Table 5: Summary of Works Element Summary of Requirements Telecoms IVR Software & licenses Handsets Winscribe Dictaphones Foot pedals Software & licenses Netcall Software & licenses

13 2.9 Capital Costs The tables below set the relationship with wider IT infrastructure FBC and a summary of the capital costs associated with this telephony case: Table 6: Capital programme IT FBC Capital Cost,000 IT Infrastructure 4,927 IT Telephony system 355 Total 5,282 Table 7: Capital costs of preferred option Works,000 Telecoms IVR 210 Winscribe 138 Netcall 7 Total Capital Cost Revenue Consequences The annual revenue cost of the case for maintenance and support is 212k p.a. this cost will apply only for the life of the project and will be reduced when system integration is achieved at the end of the 29 months (March 2017). The recommended option utilises current systems which reduces the capital costs (i.e. technical and implementation resources), the revenue costs included within the case reflect the changes to current supplier contracts, and requirements to increase maintenance and support Equipment There is minimal equipment requirements within the capital costs, including handsets, dictation machines and foot pedals. These items of equipment are included in the capital costs.

14 3 Financial Case This Full Business Case (FBC) sets out the need for: 1. Capital expenditure funding requirement of 355k. 2. Revenue expenditure funding requirement of 212k p.a. for annual support and maintenance up to the project completion date (March 2017). Both the revenue and capital implications of the proposed investment have been considered and reflected in the Trust s Long Term Financial Model (LTFM). The LTFM demonstrates the affordability of the proposed development. 3.1 Sources of I&E funding The revenue costs of this case are expected to be 212k per annum until March 2017 this has been funded through Transitional Funding in alignment with the Acquisition Business Case. 3.2 Sources of Capital funding This Business Case will be funded through the TDA Capital Programme as presented and approved in the Addendum Business Case. 3.3 Conclusion This capital investment is considered affordable from a capital and revenue perspective on the basis that these sums will be met from the capital and transitional funding allocation agreed with the TDA for the acquisition of MSFT..

15 4 Project Management The Project is being led by Heidi Poole / Project support resource reporting into the ICT Capital group which meets fortnightly and reports to the Capital Programme Board. 4.1 Timescales and Implementation Plan Table 8; Key project timeline, for delivery and in operation Cost inc VAT Start Apr- 15 May- 15 Jun- 15 Jul- 15 Aug- 15 Sep- 15 Oct- 15 Nov- 15 Dec- 15 Digital Dictation 138 Jul-15 Telecoms IVR 210 Aug-15 Netcall 7 Nov See Appendix 6.2 for draft implementation plan and further tasks detail Table 9: Key milestones Milestone Start date Finish date end date UHNM Trust Approval April 2015 April 2015 Procurement On Approval May 2015 Implementation July weeks from start Operational July 2015 January Risk Management The specific risks identified for this project have been considered using a 5x5 impact/ likelihood matrix. Each risk has been considered according to the current situation. Unless specifically specified these risks are to all parties. Only those risks classified as High or above (risk score of 8 or over) have been included in this register. 1. An assessment of the likelihood of an event occurring is given a score from one to five, one being the lowest (very unlikely) and five being the highest (very likely), as shown in the table below:-

16 Level Description 1 Negligible (Very unlikely, hasn t occurred before) 2 Rare (rarely occurs) 3 Unlikely (possible, but not common) 4 Possible (has before, will again) 5 Probable (occurs frequently) 2. The impact of an event occurring in the area is mapped out against the impact on the health of patients, size of population affected, service quality, reputation of service, financial impact. The scores are also one to five, with one being the lowest (insignificant) to five the highest (catastrophic). Table 10. Project Risks Risk Risk Assessment Actions to Mitigate Mitigated score IT and telephone systems are not able to deliver functionality requirements to integrate services between sites Major Likely Ext-18 Investment in implementing integrated systems Communication plan with stakeholders, including third party suppliers Major Rare Mod-4 IT and telephony infrastructure are not effective and productive to support timely operational business services (clinical and non-clinical users) Moderate Likely Ext-12 Investment in infrastructure to deliver IT and telephony support integrated systems Identification of costs, risks and benefits to release maximum potential to end-users Moderate Rare Mod-4 Project failure due to complexity and not effectively managed or resourced Major Possible High-12 Structured project methodology Regular project meetings and highlight reports provided to Director of IT Monitoring against implementation plan and spend schedule Major Rare Mod Benefit Realisation Register The benefits table highlights key benefits associated to this capital investment case are described in Appendix Links to QIPP initiatives While there are no specific links to QIPP/CIP the case supports and enables the efficiency programme by ensuring IT and telephone systems and infrastructure provide clinical teams with the most effective and timely access to technology and systems.

17 5 Conclusion & Recommendations The commitment of the UHNM to the successful and safe acquisition of facilities and services from the former MSFT is set out in the Acquisition FBC. The acquisition proposal is fully supported by the clinical and operational teams within the Trust, external stakeholders and by the local Commissioners. This Business Case has set out the case of need for the investment of 355k capital and 212k revenue p.a. for the life of the project to implement a number of IT and telephony systems to support the integration of clinical working between County and RSUH. The approving bodies are formally asked to: Consider and approve this Business Case and recommend this action to the other approval bodies as appropriate. Recognise that within the target timescale of implementation by the end of December 2015, the usual approval processes will be fast tracked to ensure that the commencement and implementation of the capital programme is not delayed where such delay would have an inevitable impact on both delivery timescales and costs.

18 Appendices Contents 6 Appendices 6.1 Benefits Realisation Plan Objectives Benefits Enablers Timescales Owner Outcomes Address legacy analogue dictation and separate clinic letter system and improve efficiencies Supports a safe patient environment Contractual compliance Reduce delays and backlog of letters Capital scheme to address IT infrastructure issues and IT systems capital bid March 2016 Head of Service Development Single electronic digital dictation and clinic letter system Single portal for viewing clinical letters Reduced backlog of letter transcription Improved physical environment for staff by reducing number of health records awaiting letter transcription Address legacy manual process for internal callhandling Supports a safe patient environment Contractual compliance Reduce communication delays Capital scheme to address IT infrastructure issues and IT systems capital bid March 2016 Telecoms Manager Automated telephony system to signpost internal calls Reduced delays in call-handling response times and abandonment rates Improved switchboard customer service and experience Address legacy duplicate system processes for appointment reminders, staff and patient surveys Single system for management of appointment reminders and staff surveys Reduced DNAs Capital scheme to address IT infrastructure issues and IT systems capital bid March 2016 Head of Service Development Single systems in operation Reduced DNAs increased efficiency Capacity to deliver the TSAs model Allows Trust to deliver TSAs model Provides consolidated IT system (non-epr) between County and RSUH sites Capital scheme to address IT infrastructure issues and IT systems capital bid March 2016 Head of Service Development Single systems in operation Value for money from capital investment Ensure best use of capital resources Procurement framework and confirmed benchmark of costs May 2015 Head of Service Development Confirmed VFM against framework and benchmarks

19 Appendices Contents 6.2 Project Implementation Plan The draft plan below indicates specific tasks within project relating specifically to the capital investment: 2015/16 Description apr may jun jul aug sep oct nov dec jan Feb Mar Business case approval process Project team and governance structure established (fortnightly meetings) PID, project plan, risks and issue log signed-off Digital Dictation Confirm hardware and license requirements Procure, receive and distribute hardware Configure system Deploy software Train users IVR Confirm hardware and license requirements Procure, receive and distribute hardware Configure system Deploy software Train users Netcall Confirm license requirements Procure additional licenses Configure system Deploy software Train users Assessment and lessons learned Project closure Benefits realisation