Transforming Clinical Services

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Randell Hancock
5 years ago
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1 Transforming Clinical Services Executive Team Shortlisting for Consultation Wednesday 28 February 2018

2 Introduction What we need to do? - Consider the revised scoring against the criteria - Consider the revised preferred options reported - Consider the revised high-level affordability (including limitations and assumptions) - Consider the additional level of modelling completed on the 4 remaining options - Consider high level Estates ranking - Agree short-list to progress to consultation Final proposals can be changed / amended in response to consultation findings prior to progressing to next phase of work. 2

3 Changes in latest activity modelling Tenby as a Community hub (without beds) has been factored back in. Carmarthen enhanced Community Hub (with beds) has been factored in. Correction to baseline Cardigan hospital was overstated and outpatients overall was understated. Refinement of fixed cost assumptions using 2016/17 infrastructure costs per site. Assumption that 100% of patients move to another location at 72hrs in the urgent hospital reduced to 90% in revised modelling. 3

4 Scoring coverage Carmarthenshire Ceredigion Pembrokeshire HB wide ABMU Total Clinical Non-clinical Stakeholder Total validated responses* Carmarthenshire - 43% Ceredigion - 10% Pembrokeshire - 21% Health Board wide - 25% ABMU - 2% Clinical - 67% Non-clinical - 28% Stakeholder - 5% *A small number of scoring responses were invalidated due to duplicate submissions or where key fields were missing. 4

5 Scoring against criteria Final scores for all respondents and all areas by criteria (weighted) Option Score 21d 5,945 21b 4, ,376 6a 3,361 Option Score 6 3,530 10b 3,309 5

6 Preferred options reported Preferred option percentage Option All Clinical Non-clinical Stakeholder Carmarthenshire Ceredigion Pembrokeshire HB wide ABMU 2 7 % 6 % 10 % 0 % 10 % 0 % 4 % 4 % 33 % 6 5 % 5 % 3 % 17 % 4 % 0 % 8 % 8 % 0 % 6a 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 0 % 10b 4 % 4 % 3 % 0 % 0 % 30 % 4 % 0 % 0 % 21b 39 % 40 % 37 % 33 % 22 % 50 % 73 % 33 % 33 % 21d 45 % 44 % 47 % 50 % 64 % 20 % 12 % 54 % 33 % Preferred option reported Order in which option was either 1 st or 2 nd preferred option: 1. Option 21d 2. Option 21b 3. Option 2 6

7 Map Key - No difference between options Morriston Hospital Swansea (ABMU) General Hospital Bronglais General Hospital Community Hub (Enhanced - MIU with beds) Withybush Site (Repurposed) Betsi Cadwaladr North Wales Community Hub (MIU with Beds) Llandovery Hospital Community Hub (with Beds) Aberystwyth (new site) Community Hub (MIU without beds) Cardigan Integrated Care Centre Aberystwyth Community Hub (without beds) 1. Minaeron 2. South Pembs Hospital 3. Tenby Cottage Hospital 4. Delta Lakes 5. Cross Hands Integrated Care Centre 6. Cylch Caron 2 Cardigan Aberaeron 1 6 Tregaron Hywel Dda Powys South West & Mid Wales Mental Health Facility Fishguard Llandovery New build location Pembroke Dock 2 3 Tenby 4 5 Ammanford ABMU Swansea South East Wales

8 Map Key - Option 2 Urgent Care Hospital (New Build) Option 2 Local Hospital with specialist rehab Prince Philip Hospital Planned Care Hospital Glangwili Hospital (Repurposed) Betsi Cadwaladr North Wales Community Hub (with Beds) Amman Valley Aberystwyth Aberaeron Tregaron Powys South West & Mid Wales Cardigan Hywel Dda Fishguard Llandovery Ammanford Pembroke Dock Tenby ABMU Swansea South East Wales

9 Map Key - Option 6a Urgent Care Hospital (New Build) Option 6a Planned Care Hospital Prince Philip Hospital (Repurposed) Community Hub - Enhanced Glangwili Site (Repurposed) Betsi Cadwaladr North Wales Community Hub (without Beds) Amman Valley Aberystwyth Aberaeron Tregaron Powys South West & Mid Wales Cardigan Hywel Dda Fishguard Llandovery Ammanford Pembroke Dock Tenby ABMU Swansea South East Wales

10 Map Key - Option 21b Major Urgent and Planned Care Hospital (New Build) Option 21b Community Hub - Enhanced 1. Glangwili Site (Repurposed) 2. Prince Philip (Repurposed) Betsi Cadwaladr North Wales Community Hub (without Beds) Amman Valley Aberystwyth Aberaeron Tregaron Powys South West & Mid Wales Cardigan Hywel Dda Fishguard Llandovery 1 Ammanford Pembroke Dock Tenby 2 ABMU Swansea South East Wales

Map Key - Option 21d Major Urgent and Planned Care Hospital (New Build) Option 21d Local Hospital with specialist rehab Prince Philip Hospital Community Hub - Enhanced Glangwili Site (Repurposed)

11 Map Key - Option 21d Major Urgent and Planned Care Hospital (New Build) Option 21d Local Hospital with specialist rehab Prince Philip Hospital Community Hub - Enhanced Glangwili Site (Repurposed) Betsi Cadwaladr North Wales Community Hub (without Beds) Amman Valley Aberystwyth Aberaeron Tregaron Powys South West & Mid Wales Cardigan Hywel Dda Fishguard Llandovery Ammanford Pembroke Dock Tenby ABMU Swansea South East Wales

12 Option 2 - Modelling Considerations Finance - Affordability Acute Inpatient beds Activity model Acute Daycase beds Total costs modelled in activity model m Total operating expenditure Forecast outturn 17/18 including deficit Budget outturn 17/18 exluding deficit Add back 17/18 misc income Total costs excl misc income Forecast total costs 17/18 including deficit Budget outturn 17/18 exluding deficit Baseline position (2017/18) Acute sites 1, Community sites Additional OOH activity - Total baseline 17/18 1, Option 2 (2017/18) Acute sites Community sites Additional OOH activity 2.6 Total (all scenarios ticked) Baseline 1, Increase / (decrease) comparied to baseline % 0.6% -17.5% % 1.3% 0.0% -6.7% 1.3% 12

13 Option 6a - Modelling Considerations Finance - Affordability Acute Inpatient beds Activity model Acute Daycase beds Total costs modelled in activity model m Total operating expenditure Forecast outturn 17/18 including deficit Budget outturn 17/18 exluding deficit Add back 17/18 misc income Total costs excl misc income Forecast total costs 17/18 including deficit Budget outturn 17/18 exluding deficit Baseline position (2017/18) Acute sites 1, Community sites Additional OOH activity - Total baseline 17/18 1, Option 6a (2017/18) Acute sites Community sites Additional OOH activity 2.6 Total (all scenarios ticked) Baseline 1, Increase / (decrease) comparied to baseline % 0.6% -19.3% % 0.6% 0.0% -7.4% 0.5% 13

14 Option 21b - Modelling Considerations Finance - Affordability Option 21b (2017/18) Acute sites Community sites Additional OOH activity 2.6 Total (all scenarios ticked) Baseline 1, Increase / (decrease) comparied to baseline % 0.6% -20.1% % 0.2% 0.0% -7.7% 0.2% 14

15 Option 21d - Modelling Considerations Finance - Affordability Option 21d (2017/18) Acute sites Community sites Additional OOH activity 2.6 Total (all scenarios ticked) Baseline 1, Increase / (decrease) comparied to baseline % 0.6% -19.2% % 0.6% 0.0% -7.4% 0.5% 15

16 Estates considerations - capital costs Due to the lack of detailed information on the scale or capacity of the developments involved it is not possible to provide any indicative figures at this stage although it is possible to indicate the likely order of costs (most to least expensive), which would be as follows: Option 21d - Most expensive Due to new build, emergency and planned care and PPH retained. This is based on the assumption around HBN compliance and wards having 50% en-suite arrangements, and by the fact that this option would also require a substantial investment at PPH. Option 21b As above, new build emergency and planned but PPH retained only as community hub so may require less investment in HBN compliance. Option 2** New build limited to urgent care only. GGH however becomes a planned care facility which will require significant investment in estate if we are to achieve HBN compliance and removal of backlog maintenance. Due to the significant reduction in new build i.e. No new build planned care unit this Option should have lower Capital costs. However, the amount of demolition and new build required at GGH could increase costs substantially. The timeline for this type of solution, given the need for decant accommodation caused by redevelopment, also has the potential to increase costs. On balance however given that much of the infrastructure would already be in place at GGH it is expected that this option would be of lesser costs that Options 21d and 21b above. Option 6a - Least Expensive** As Option 2 above, new build is limited to urgent care only. WGH becomes an enhanced community hub which is likely to have a lower investment than Option 2 above where GGH becomes a planned care facility. Remaining comments in Option 2 above are applicable also to Option 6a for WGH. 16

17 Estates considerations - capital costs Any further indicative costs will require specialist input. **N.B. It is possible to refer to a number of projects where the client thought they couldn t afford a new hospital and planned a refurb and extension only to discover during bid stages that a completely new hospital was a cheaper option. 17

18 Option 2 - Workforce considerations Factors to consider A reduction in rota support from 4 to 3 (25% reduction) A potential reduction in unscheduled care nursing and therapy staff in acute settings [dependent on assumptions which presently show a shift in flow to community settings] An increased demand for less acute skills to manage community beds [community beds will only manage step down beds] Will need to resource 3 MIU s Will need to resource 4 bedded community units [including two new builds] Outpatient activity management model - need to look at workforce model for delivering follow up outpatient activity in community Need to consider services provided from various hubs 18

19 Option 6a - Workforce considerations Factors to consider A reduction in rota support from 4 to 3 (25% reduction) A new build urgent care centre and a separate Planned Care Centre [repurposed PPH]. The separation of urgent and planned care may impact on workforce by duplicated support staff and clinical staff working across two sites. Will need to resource 4 MIU s Will need to resource 4 bedded community units [including two new builds] 19

20 Option 21b - Workforce considerations Factors to consider A reduction in rota support from 4 to 2 (50% reduction) A new build urgent and planned care centre Repurposing of WGH, PPH and GGH Will need to resource 5 MIU s [highest option] Will need to resource 5 bedded community units 20

21 Option 21d - Workforce considerations Factors to consider A reduction in rota support from 4 to 3 (25% reduction) A new build urgent and planned care centre Repurposing of WGH and GGH Will need to resource 4 MIU s 21

22 Modelling - Activity Flow The flow of A&E attendances to Morriston is projected to be most significant under options 6a and 21b based on current assumptions for both A&E attendances and Inpatient (non-elective) activity. However, when reviewing the initial modelling outputs it did appear that some of the activity flow may be overestimated and we are carrying out further reviews and validation of the underlying assumptions to ensure we have a robust view. 22

23 Summary table Option 2 Option 6a Option 21b Option 21d Total weighted score 4,259 3,291 4,885 5,822 Hospital sites Affordability saving opportunity 59.4 m 65.4 m 68.2 m 65.2 m Cost per scoring unit 193 k 248 k 166 k 140 k Decision required now to move to final short-list to take forward to consultation. 23

SCHEDULE TO THE RATES AND ADJUSTMENTS CERTIFICATE DATED 31 MARCH 2017

H SCHEDULE TO THE RATES AND ADJUSTMENTS CERTIFICATE DATED 31 MARCH 2017 Major Scheduled Bodies 2018/19 2018/19 15.3% plus 15.3% plus Ceredigion County 15.3% 90,000 140,000 241,000 90,000 140,000 Carmarthenshire