Full Business Case Installatin f MRI Scanner at Cunty Hspital April 2015 1
1 Executive Summary 1.1 Intrductin & Backgrund In February 2014 the Secretary f State apprved the Trust Special Administratrs recmmendatins fr the future f Mid Staffrdshire NHS Fundatin Trust. This recmmended that University Hspital Nrth Staffrdshire NHS Trust assumed respnsibility fr the staff, assets and services delivered at the frmer Cunty Hspital and Ryal Wlverhamptn Trust assumed these respnsibilities fr Cannck Chase Hspital. The entity f Mid Staffrdshire Fundatin Trust was t be disslved. In July 2014 the Bard apprved the Acquisitin Business Case fr Cunty Hspital and submitted it t the NHS Trust Develpment Authrity fr their cnsideratin. The Acquisitin Business Case prpsed that University Hspitals Nrth Staffrdshire NHS Trust acquire the services and facilities frm Mid Staffrdshire Fundatin Trust. The acquisitin was t be undertaken n the basis that the clinical mdel set ut in the Trust Special Administratr s reprt dated December 2013 wuld be implemented. Fllwing the apprval f the Acquisitin Business Case, and a subsequent Addendum in Nvember 2014 by the Trust Develpment Authrity the University Hspital f Nrth Staffrdshire NHS Trust acquired the respnsibility fr the delivery f a number f clinical services at Mid Staffrdshire NHS Fundatin Trust fr a perid f 29 mnths frm 1 Nvember 2014. The tw Trusts cmbined t frm the University Hspitals f Nrth Midlands NHS Trust. This Full Business Case presents the case fr the prcurement and installatin f an MRI scanner at the Cunty Hspital site. This Business Case sets ut the need fr 3,182,000 capital. This investment is t supprt the implementatin f the mdel f care apprved by the Secretary f State in February 2014 and is ne f a series f cases that will be submitted by University Hspitals f Nrth Midlands NHS Trust against the agreed 83.2m capital allcatin utlined in the Acquisitin Business Case. The urgent requirement t cmplete capital wrks that enable University Hspitals f Nrth Midlands NHS Trust t implement the Trust Special Administratrs mdel has led t the decisin by University Hspitals f Nrth Midlands NHS Trust t prceed straight t Full Business Case bypassing the Outline Business Case stage. University Hspitals f Nrth Midlands NHS Trust understand the risk f ding this and in an attempt t mitigate this risk have ensured that the Full Business Case addresses the ptin appraisal wrk. In additin it is recgnised that t achieve the target timescale f cmpletin by April 2017, the usual apprval prcesses will be fast tracked t ensure that the cmmencement and implementatin f this prject is nt delayed. 1.2 Cmmissiner and Stakehlder Supprt The standard prcess fr the develpment f a large capital investment f this nature wuld be fr the Trust t develp a prgramme setting ut ptins that wuld be cnsulted n widely with a range f stakehlders. In this instance the principles underlying the need fr significant investment were tested by the Trust Special Administratrs prcess. The Trust Special Administratrs mdel f care was widely cnsulted upn with Cmmissiners, Staff, Patients and Regulatrs. Cmmissiners cnfirmed their supprt fr the Trust Special Administratrs mdel f care. Details f this prcess are set ut in the Acquisitin Business Case, Sectin 2. 1.3 Capital Prgramme The acquisitin f services and facilities frm Mid Staffrdshire NHS Fundatin Trust required changes t be made t bth the Cunty Hspital and the Ryal Stke University Hspital estate. This will enable University Hspitals f Nrth Midlands NHS Trust t meet regulatry and cmmissiner requirements and t deliver the benefits and synergies identified in the Acquisitin Business Case. 2
The Capital Business Case (July 2014) frmed an appendix t the Acquisitin Business Case and presented a number f investment prjects acrss the estate t ensure that: Each hspital site delivers the ptimal slutin; The verarching capital investment prgramme achieves the desired utcmes set ut in the Acquisitin Business Case. The Capital Business Case requested a ttal capital allcatin f 83m which will be applied fr via a number f separate business cases each business case will be a subset f the ttal funding slutin. This enables individual elements t be finalised whilst ensuring that the capital prgramme can be cmpleted within the agreed 29 mnth timescale. In additin t the 83m prvided by the Trust Develpment Authrity thrugh the Capital Business Case, University Hspitals f Nrth Midlands NHS Trust is cntributing ver 16.5 f peratinal capital twards the wrks required t cnfigure bth hspital sites. 1.4 Case f Need This Full Business Case is fr the installatin f an MRI Scanner at Cunty Hspital. Acrss the Trust, there are a number f issues and risks assciated with the current MRI service. The main clinical risks assciated with nt apprving this case are related t delayed diagnsis due t prlnged delays in waiting fr scans. The MRI service als supprts many tertiary services within the trust and lack f scanning capacity will result in patients attending ther rganisatin fr their care and nt receiving the right standards f investigatin t supprt the clinical discussin in the multi-disciplinary team meetings There are wider implicatins fr the rganisatin and fr primary care, regarding failure t achieve the diagnstic waiting time target when GP s are increasing their direct access activity. There is currently n MRI prvided at Cunty Hspital. Patients requiring MRI required transfer t Cannck Chase Hspital fr this service. Fllwing disaggregatin f the frmer MSFT, Cannck Chase was transferred t Ryal Wlverhamptn Trust (RWT). Alliance Medical Limited, wh run the Cannck Chase service. Alliance Medical Limited have already indicated that they have n mre capacity t increase activity at Cannck Chase Hspital and Ryal Wlverhamptn Trust has indicated that they intend t utilise Alliance Medical Limited at Cannck t help address their MRI capacity issues. The aim f this prject is t install a dedicated MRI Scanner at the Cunty Hspital site fr all patients that will receive clinical care at the Hspital as well as any additinal referrals frm ther hspitals f primary care prviders. The fllwing presents the key bjectives and benefits delivered by this prject: Prvisin f MRI service n the Cunty Hspital site where there currently is nt ne, t meet the apprved clinical mdel and prvide required MRI capacity. Imprved functinal relatinships at the Cunty Hspital site t supprt the mdel f care and patient flw in rder t increase prductivity Ensure there is future flexibility fr the range f clinical services that can be prvided frm the site. Imprve the patient pathway n the Cunty Hspital site and prvide better access t imaging services acrss the Trust. Minimise delayed diagnsis due t prlnged delays in waiting fr scans, t achieve the diagnstic target waiting time and cntribute t all waiting time targets. The design and installatin f the MRI Scanner must be delivered within the minimum pssible timescale after the acquisitin and Capital Business Case apprval. 1.5 Ecnmic case The nn-financial appraisal determined that the preferred ptin fr the delivery f the prject bjectives is Optin 4 which prvides a Permanent MRI slutin refurbishing the existing space t prvide a fitted MRI suite. This ptin has been selected n the basis that it will: Enable delivery f the TSAs clinical mdel 3
Realise the required benefits and prject investment bjectives Be delivered within the necessary timescales and within the cnstrained capital envelpe The ecnmic appraisal determined that the mst ecnmically advantageus ptins was D Nthing, hwever, cmbining the nn-financial appraisal and the ecnmic appraisal determined that the verall preferred ptin was Optin 4 based n a cst per benefit analysis. 1.6 Summary f FBC Scheme This Full Business Case is fr the prvisin f an MRI Scanner n the Cunty Hspital site. This will require the refurbishment f the existing unused X-ray rms and sme adjacent areas. The preferred ptin requires the permanent relcatin f the ultrasund suite. Space has been identified within the ftprint f the existing department and csts are included in the ttal prject csts. The prject includes prvisin f shell space t accmmdate additinal MRI in the future. Wrks t shell will be minimal and nt be fitted ut with an MRI machine; a separate business case must therefre be develped t secure funding fr assciated enabling wrks and MRI Scanner. 1.7 Capital Cst summary The ttal capital cst f the prpsed wrks is 3,182,000 as detailed in the table belw. GMP prices have been btained which gives certainty t the csts f these schemes. Table1: Capital cst summary 1.8 Changes t capital cst Optin 4 plus SK001 Ttal PSCP cnstructin Cst 1,307,042 Preliminaries 167,790 Stage 3 and 4 Design Fees 188,558 Risk 62,610 GMP Ttal 1,726,000 Trust Fees & Nn Wrks 29,000 Equipment 900,000 Cntingency 108,000 Sub Ttal 2,763,000 VAT 419,000 Ttal Cst 3,182,000 The Capital Business Case capital prgramme identified the capital required fr bth the verall capital prgramme and the initial cntingency capital wrks. The initial Trust Develpment Authrity capital bid f 2.6m excluded the capital assciated with the ultrasund suite relcatin and shell space This Full Business Case includes changes t capital csts, which are presented in the fllwing table. The capital cst can be funded within the cntingency allcatin apprved within the CBC. Table 2: Capital Cst Changes Budget Optin 4 plus SK001 4
P21 Wrks 1,009,000 1,234,000 Other Wrks Trust Fees & Nn Wrks 18,000 29,000 Equipment 1,000,000 900,000 Cntingency 184,000 108,000 VAT 406,000 419,000 Ttal 2,617,000 2,690,000 Ptential changes 492,000 Ttal 2,617,000 3,182,000 Ttal Change t Budget 565,000 1.9 Management Case Delivery f the verall capital prgramme will be gverned by the Trust s Capital Investment Grup t ensure the effective management f the prgramme. The Prgramme Bard will prvide the essential versight f prgramme delivery, csts, benefits, risks and dependencies. The Prgramme Bard will reprt t bth the Capital Investment Grup and the Trust Executive Cmmittee. Figure 1 Management Structure 1.10 Timescales The key milestne perids relating t this FBC scheme are set ut belw. Table 4: Key Timescales Element Milestne cmpletin Date 5
Latest Date fr Ordering MRI 23rd February 2015 Submissin f Guaranteed Maximum Price (GMP) 6th March 2015 Pssessin f the Site (Subject t Vacant Pssessin) 30th March 2015 Cmpletin f the wrks 2 nd Nvember 2015 1.11 UHNM Trust apprval The apprving bdies are frmally asked t cnsider and supprt the preferred ptin set ut in this FBC and apprve the Trust prceeding t the preparatin f a Full Business Case. All capital business cases needed t deliver the prpsals in the Acquisitin Business Case and the subsequent Addendum require frmal apprval frm the apprpriate bdy f the Trust. T be cnsidered fr apprval this business case needs t demnstrate that it meet 5 tests as fllws: T be part f the Acquisitin Business Case The prvisin f additinal MRI capacity was identified in the Capital Appendix f the ABC as a pririty scheme. T be cvered by the capital allcatin The capital cst f the scheme was riginally set at 2.6m as identified in the Capital Appendix f the ABC. As a result f needing t relcate ultrasund prvisin, the final cst f the prject is 3.1m with the additinal funding being fund frm the Cntingency allcatin. Capital is t be funded by the Trust Develpment Agency (TDA) and able t be managed within the verall agreed TDA capital allcatin apprved as part f the ABC. T be included within the revenue allcatin identified within the IHSS ABC, r t have the revenue implicatins apprved frm ther surces. The revenue csts are in accrdance with thse identified within the IHSS ABC. T deliver the functinal benefits envisaged including quality and safety. Prvisin f MRI service n the Cunty Hspital site where there currently is nt ne, t meet the apprved clinical mdel and prvide additinal MRI capacity acrss the Trust Imprved functinal relatinships at the Cunty Hspital site t supprt the mdel f care and patient flw in rder t increase prductivity Ensure there is future flexibility fr the range f clinical services that can be prvided frm the site. Imprve the patient pathway n the Cunty Hspital site and prvide better access t imaging services acrss the Trust. Minimise delayed diagnsis due t prlnged delays in waiting fr scans and supprt University Hspital Nrth Midlands t achieve the diagnstic target waiting time and cntribute t all waiting time targets. The design and installatin f the MRI Scanner must be delivered within the minimum pssible timescale after the acquisitin and Capital Business Case apprval T be in keeping with the Trust s 2025 Visin -The 2025 visin is t supprt the cre emergency, elective and reginal services between hspitals in key diagnstic facilities such as imaging and netwrked diagnstics 1.12 Recmmendatins The purpse f this dcument is t set ut the case fr investment and cnfirm the preferred ptin identified in the Acquisitin Business Case and Capital Business Case. This dcument has set ut the strategic case f need, financial case and management case f the preferred ptin. The capital cst f the preferred ptin is 3,182,000m The apprving bdies are frmally asked t cnsider and apprve this Full Business Case. 6