Chief Operating Officer

Transcription

1 Affiliated Teaching Hospital BOARD OF DIRECTORS: 28 th OCTOBER 2016 AGENDA ITEM: 10.1 SUBJECT: RESPONSIBLE DIRECTOR: AUTHOR: PREVIOUSLY CONSIDERED BY: 5 TH ENDOSCOPY ROOM BUSINESS CASE Chief Operating Officer Tracey Reid General Manager Clinical Support Business Unit EXECUTIVE SUMMARY:. Following receipt of fully costed tender returns the paper requests the approval of the additional funding required for the Endoscopy 5 th Room project and the expansion of the Sterile Services Department ACTION REQUIRED BY THE BOARD OF DIRECTORS: RISK TO THE TRUST (include reference to BAF or Corporate Risk Register) WORKFORCE ISSUES: (including training and education implications) INCLUSION AND DIVERSITY FINANCIAL IMPLICATIONS: Specify No/Yes (Detailed within the report). COMMUNICATION/CONSULTATION ISSUES (including patient and public involvement) STRATEGIC OBJECTIVE: (specify trust strategic objective) The Board of Directors is asked to APPROVE the contents of the report. Detailed within the report paragraph 9 in the report Workforce issues contained within the report. Equality Impact Neutral Financial implications contained within the report. The performance of the organisation is detailed within the Board Brief circulated to staff and Governors. To be a clinically led and financially sustainable organisation CQC DOMAINS: safe effective caring responsive to people s needs well-led Please indicate which domain the report is providing assurance on safe effective caring responsive to people s needs well-led Chairman: Graham Foster Chief Executive: David Sissling

2 Affiliated Teaching Hospital AGENDA ITEM: APPENDIX 1 BUSINESS CASE- PRO-FORMA Committee case to be presented to: Date Of Meeting Trust Board 28 TH OCTOBER 2016 Trust Management Committee Capital Investment Group Charity Committee Other name of committee TITLE: 5 TH Endoscopy Room Additional Funding PURPOSE: RECOMMENDATION: Following receipt of fully costed tender returns this paper requests the approval of the additional funding required for the Endoscopy 5 th room project and the expansion of the Sterile Services Department.. Discussion Please tick Approval X Information Approve the additional funding of 944,517 required to complete the previously approved Endoscopy project and the purchase of the associated equipment. PREPARED BY: Tracy Reid / Lesley Shepherd PRESENTED BY: Dr G McCreanor, Dr A Dixon DIVISIONAL REPRESENTATIVES Project Manager: Business Partner: Divisional Director to confirm divisional approval: NAME: Gwyn McCreanor and Tracy Reid John Glover tbc CASE RECOMMENDED FOR SUBMISSION (DATE) 28 th October 2016 Attach confirmation CQC Standard: (specify standard) Financial Implications: Assurance Framework: (specify risk the report is providing assurance for) Strategic Objective: (specify objective) Freedom of Information Exception: (if applicable) NHS Constitution: N/a Yes N/a Yes- N/A In determining this matter, the Board should have regard to the Core principles contained in the Constitution of: Equality of treatment and access to services High Standards of excellence and professionalism Service user preferences Cross community working Best Value Accountability through local influence and scrutiny

3 Business Case Title: Additonal Funding for 5 th Endoscopy Room, CSSD Expansion and Purchase of Endoscopy Equipment EXECUTIVE SUMMARY 1. Service need and background A Strategy for Cancer (Jan 2011) sets out how, in order to save 3,000 lives per year, the Department of Health would invest 60 million between 2011 and 2015 to incorporate flexible sigmoidoscopy (bowel scope screening) into the current Bowel Cancer Screening Programme. KGH FT was a successful first wave site for the implementation of the above screening programme in order to provide sustainable on going high quality screening which will future proof the service and allow full roll out. In order for the screening centre to progress to full roll out of the Bowel Scope Screening service forward expansion is required. Essentially the trust has agreed to the expansion of the existing Endoscopy facilities. This would include modification of the existing infra-structure and flows to include a fifth room, administration areas and associated equipment. Since approval of the original business case in June 2013 the unit has undergone its 5 yearly JAG assessment (Royal College of Physicians Joint Advisory Group) in October The JAG Regulatory visit flagged that for a future development, now confirmed by a further recent advisory inspection, that plans to incorporate decontamination within the unit would not meet the new requirement for decontamination standards and thus prevent future JAG Accreditation (essential for provision of training, screening and potentially future commissioning). Plans therefore have been developed to provide a separate decontamination facility as an extension of the existing Sterile Services Department and to provide appropriate clinical and administrative space within the Endoscopy Unit to enable full roll out of the Bowel Scope programme and future regulatory compliance standards. Following a lengthy design phase, plans are now in place and a tender process completed to enable the appointment of a suitable contractor to complete the works. Recent History QMP (external design consultants) were tasked to compile separate feasibility reports for Endoscopy Refurbishment and Sterile Services Extension. It was decided to combine the proposals in each of these reports into a single project (because of the interdependencies), and the budget costs and recommendations therein (together with the JAG Accreditation report) were used in producing the business case. Following approval of the business case for 1.7m inc VAT for works and equipment, QMP were then tasked to design and administer the project. It should be noted that since approval of the original business case, there is now a requirement to include additional work on the ventilation system replacement of the air handling unit. This was not included in the earlier works as the equipment was considered fully serviceable in 2013, however, this was based on the review of the system carried out at that time. Recent work has identified that this requirement should now be included in the latest work package.

4 The design was originally tendered several months ago but unfortunately only 2 tender returns were received and one of these subsequently withdrew. Given that the remaining tender exceeded QMP s original pre-tender estimate of 1.658m exc VAT ( 2m inc VAT) for works only and the Trust were unable to demonstrate value for money, it was agreed that the project would have to be retendered. Current Situation Tenders have recently been received and have been evaluated by QMP. QMP have undertaken a careful review of all tenders received and have recommended an appropriate contractor to be appointed. Prior to the formal tender process, due to the requirement for additional work and equipment previously outside of the originally agreed project scope, the project team were aware the cost of the project was likely to increase and increased indicative costs were provided to the Trusts finance team for the Capital Plan. The formal tender evaluation has confirmed this assumption. The tender evaluation is as follows: The preferred contractor is SDC Builders Ltd as being the most cost effective. Note: Aspect Construction Contracts Ltd did not quote for the full scope of works and an evaluation of their tender assuming full cost of omitted sums places them at a higher cost than the preferred contractor Breakdown of additional costs (Total additional 944,517) Appendix 1 demonstrates the changes in costs in key areas of the project design. It should be noted that this costing breakdown has been subject to detailed scrutiny to all areas where costs have increased. The project cost now also includes appropriate funding for KGH Estates support and contingency values for optimism bias. Build Costs

5 Whilst some costs have reduced others have increased. The increased costs largely relate to works associated with the requirement to include the new air handling plant with notable increases for the costs associated with the mechanical and electrical infrastructure changes required Equipment costs The increased costs also reflect the requirement to replace the Trusts existing washer disinfecters as part of this project. The original project specification detailed two additional units on the basis that at the time the four existing units were relatively new and would remain viable for several more years. However due to the lengthy planning and design phase it is now necessary to replace the older units hence the revised tender costs reflects the need for six new washer disinfecters. These units would have been included in the capital plan for replacement in 2018/19 at the latest therefore at this stage inclusion in to the scope of the Endoscopy/SSD expansion is recommended to ensure there is no further operational disruption in the future. 2. Proposal To approve the additional funds to complete the 5 th Endoscopy Room, CSSD expansion and the purchase of endoscopy equipment. The anticipated timescale for delivery of this project is 5 months. Delay to approving the additional funding will compromise delivery of the project which will have a significant impact on income and activity revenue position for the department. The preferred supplier tender is held open for a period of 3 months, however, delays in decision making may affect that contractors ability to deliver within reasonable timescales. 3. Anticipated outcomes Significant increase in the capacity of both the Endoscopy Unit and the Sterile Services Department. This will enable successful roll out of the Bowel Scope Screening Programme with subsequent income benefits to the Trust as per the previously agreed business case in addition to ensuring this roll out does not compromise the Trusts capacity for other endoscopic examinations and therefore achievenment of the 6 week diagnostic target. 4. Justification Reference original business case. Justification Yes/No Summary notes The project is required for contractual reasons e.g. new service provision. Yes Delivery of Bowel Scope Screening The project is a revenue-making opportunity. The project will reduce operating costs. Yes No 400 per patient attending The project will increase quality of service. Yes Ensure that we are delivering a high quality service within an appropriate setting The project will provide new capability. Yes Additional Endoscopy capacity

6 4.1 Provide a detailed explanation where there are significant quality and performance issues that will be addressed with the proposed investment. This investment will ensure the Endoscopy Unit and Sterile Services Departments are in accordance with JAG requirements/national clinical standards and industry standards for decontamination. The build will also ensure privacy and dignity requirements are met by providing an environment that supports delivery of the service within a single sex environment. There is clear DoH guidance regarding the design of an endoscope re-processing unit which clearly describes in detail the best practice options for endoscope decontamination for a high throughput unit _Design_and_installation_Final.pdf _Operational_mgmt_Final.pdf Pack/JAG%20Accreditation%20Standards%20and%20Evidence%20Requirements%20for%20 all%20sectors%20v1.4.pdf Expansion of the Endoscopy facilities will provide adequate clinical space for full roll out of the bowel scope programme whilst avoiding any negative impact on the other patient flows within the Endoscopy Unit. Separation of the SSD component will provide more space within the unit thereby improving patient privacy and dignity and will also enable appropriate accommodation for the team and streamline patient flows. The proposed SSD expansion will utilise an open area of land immediately adjacent to the existing site. 5. Justification charity funded items only 5a) Which internal or external charity will be funding this item and if an external charity has it confirmed funding has been agreed? 5b) Explain how this case will provide patient benefit and how it meets the individual fund objectives? 5c) - Has this case been considered by any other Trust committee prior to this submission and what was the outcome of that proposal? 6. Options available to meet service need Option 1 (Recommended option) Proceed with previously agreed business case to expand the Endoscopy Department and develop a new SSD facility to centralise the decontamination process and equipment.

7 7. Financial Assessment Capital Cost Please see detail above. Description Option 1 Option 2 Option 3 Revised project cost 2,650,917 TOTAL (inc VAT) 2,650,917 Notes:. Revenue Income and Cost Where the investment proposal will achieve additional clinical income for the Trust, provide a detailed analysis of the clinical activity as an Appendix to this paper. Item Annualised Income and Expenditure Option 1 Option 2 Option3 Income NHS clinical income Other income Total Income Expenditure(-) Pay costs Consumables Maintenance Lease cost Other: Total Expenditure Net income/expenditure(-) I&E forcast as per original business case 8. Benefits Will enable the trust to expand the number of lists and sessions if demand increases and partners are unable to meet their targets. Full Bowel Scope Income possible. Continued JAG compliance and maintained, so obtaining Best Practice Tariff for all other endoscopy procedures. 9. Risks Increased financial cost. Building work disruption to the endoscopy service as a whole. Timescales work to be completed before next JAG accreditation visit in early 2018.

8 10. Recommendations The Committee is asked to: Appprove the case for additional funding.

9 Appendix 1 Comparison of Approved Business Case v Revised Costs APPROVED REVISED COST BUSINESS CASE COSTS VARIANCE Sterile Services Block Preparation Works 1,740 1,740 0 New build block 300, ,000 (30,000) Modification Works 5,390 6,790 (1,400) External Works 1,300 1,300 0 Mechanical & Electrical Installations 366, ,000 (65,000) Sub Total 674, ,830 (96,400) Endoscopy Department Kitchen 5,000 2,020 2,980 Office/Meeting Room 30,000 13,300 16,700 Capsule Room 11, ,080 Dirty Utility/Clean Utility/Store 32,000 12,050 19,950 Accessible WC 10,000 6,770 3,230 Consent/Changing/Waiting 23,000 13,350 9,650 Corridors 10,000 2,660 7,340 Endoscopy/Recovery Room 37,000 13,060 23,940 8 Bedded Ward 36,000 14,130 21,870 SSP Clinic 7,000 3,670 3,330 Electrical installations 17, ,000 (163,000) Mechanical installations 17, ,000 (233,000) Revisions to ventilation to Recovery Ward 30,000 (30,000) AHU Crane & Roof Modifications 0 7,600 (7,600) Sub Total 235, ,530 (314,530) Preliminaries 114, ,000 (86,000) Design Risk / Building Contingency & Day works 123, ,269 (2,269) Sub Total 237, ,269 (88,269) CONSTRUCTION WORKS TOTAL (EXCLUDING VAT) 1,146,430 1,645,629 (499,199) 20% 229, ,126 (99,840) CONSTRUCTION TOTAL (INCLUDING VAT) 1,375,716 1,974,755 (599,039) QMP Fees 151, ,748 (7,548) AER Washer Disinfectors 109, ,444 (171,244) Internal Estates Fees 5% 35,142 98,738 (63,596) Planning Contingency 35,142 98,738 (63,596) Optimism Bias (2%) 39,495 (39,495) Total Project Cost 1,706,400 2,650,917 (944,517)