TRUST BOARD 24 OCTOBER OCH Phase 4 Chemotherapy Project The Macmillan Cancer Treatment and Support Centre Outline Business Case

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1 Our vision: To be amongst the best TRUST BOARD 24 OCTOBER 2012 def Agenda Item: 8 OCH Phase 4 Chemotherapy Project The Macmillan Cancer Treatment and Support Centre Outline Business Case PURPOSE PREVIOUSLY CONSIDERED BY To present the Macmillan Cancer Treatment and Support Centre Outline Business Case for approval. Executive Committee, OCH Programme Board& Finance and Performance Committee Objective(s) to which issue relates * 1. To improve continuously the quality of all aspects of our services 2. To consolidate acute services for complex or serious conditions onto a single site 3. To work with colleagues in primary care to expand local access to specialist acute services 4. To maintain the pre-eminence of Mount Vernon as a tertiary Cancer Centre, and to provide more cancer care locally Risk Issues (Quality, safety, financial, HR, legal issues, equality issues) Healthcare/ National Policy (includes CQC/Monitor) As identified in the Outline Business Case; risks will be reviewed and managed through the OCH Programme Board. Our NHS, Our Future: NHS Next Stage Review, Towards The Best Together. This project is consistent with national and local policy guidance on chemotherapy services. CRR/Board Assurance Framework * Corporate Risk Register BAF ACTION REQUIRED * For approval For discussion For decision For information DIRECTOR: PRESENTED BY: AUTHOR: Director of Strategic Development Director of Strategic Development Project Manager DATE: 18 October 2012 We put our patients first We work as a team We value everybody We are open and honest We strive for excellence and continuous improvement * tick applicable box

2 Executive Summary Our Changing Hospitals Phase 4 Chemotherapy Project The Macmillan Cancer Treatment and Support Centre Outline Business Case 1. Introduction 1.1. The purpose of this Outline Business Case (OBC) is to seek Trust Board approval and authorisation to invest 2.9m (inclusive of VAT) capital expenditure at outturn prices, for relocating and developing a modern and efficient chemotherapy centre at the Lister Hospital. This will be named the Macmillan Cancer Treatment and Support Centre (MCTSC). The proposed scheme is to be undertaken in collaboration with Macmillan Cancer Support who will provide 1.5m of the funding, enabling significant improvements in services and patient experience to take place at Lister. The total Trust commitment is therefore 1.4m. The investment delivers a rate of return of 5.63%. 2. Strategic Context 2.1. The relocation and expansion of the existing chemotherapy service into the administration corridor level 3 will form one of the final phases for the Our Changing Hospitals (OCH) Phase 4 acute services consolidation programme and in the process release part of ward 10a for refurbishment into a 29 bed ward due to commence on final consolidation of acute services at the Lister site in As part of the relocation and expansion into the administration corridor the new MCTSC will support regional and national strategic objectives, national policy and clinical drivers. The development remains consistent with DQHH the strategy for healthcare in Hertfordshire and local commissioning priorities together with the Trust s strategies for the Lister site master planning and it s application for Foundation Trust Status. 3. Case for change and objectives 3.1. The Trust s strategy to consolidate all acute inpatient services on to the Lister site formed the fundamental basis for the Phase 4 OBC, together with how associated services would be increased to deliver the anticipated level of healthcare activity. The number of patients now living with cancer continues to rise rapidly as does the need to provide modern functional chemotherapy facilities in which to deliver complex and ongoing cycles of treatment Currently two million people in the UK are living with cancer; approximately 250,000 new cases are diagnosed each year with 130,000 dying from the disease. Overall cancer incidence is increasing by 3% annually and it is on this annual growth projection that the new MCTSC OBC has been modelled. The service is currently delivering much higher levels of activity, and commissioners expect annual growth to be in the region of 5% 7.5% per annum. The commissioners have endorsed the assumptions contained within this business case The key objectives of the development are to: Provide a permanent solution to address capacity for ongoing chemotherapy services and Oncology/ Haematology outpatient clinic facilities Improve patient experience in line with Improving Outcomes Guidance (IOG) and National Institute of Clinical Excellence (NICE) Improve clinical outcomes in line with Cancer Reform Strategy (CRS 2007) demonstrated by improved access to services Improve staff retention by a better staff working environment, training facilities and career development opportunities

3 Release part of Ward 10a for refurbishment as a 29 bedded ward, refurbishments will commence after final consolidation of acute services in Macmillan Funding 4.1. Macmillan have undertaken a number of schemes nationally in order to support and develop the improvement of cancer services throughout the UK. The Trust have a long established and strong ongoing relationship with the Macmillan regional team who support and fund roles within the Trust. The financial contribution of 1.5m being provided towards the new MCTSC will strengthen this important and valued relationship in order to respond to existing and future demands for chemotherapy treatments and cancer services within the East and North Hertfordshire locality. 5. Activity and Workforce Modelling 5.1. The existing chemotherapy suite has 10 treatment chairs and is currently running at capacity to meet existing demand. The outlined assumptions are based on 3% growth, however, the commissioners letter indicated growth rates for chemotherapy to be in the range of 5% to 7.5% per annum It is anticipated that the existing chair compliment is increased by four to fourteen and the facility will be developed for 18 chairs future proofing for any additional increase in demand. The additional chairs will only be commissioned for chemotherapy in the event of demand and income increasing above that currently modelled The following table demonstrated the activity assumptions with 3% growth: Chemotherapy Activity Assumptions 2012/1 3 Plan 2013/ / / / / / / / /22 Current Planned activity Day Cases Current Planned activity Outpatients 3,550 3,550 3,550 3,550 3,550 3,550 3,550 3,550 3,550 3,550 Day Case Chemo Outpatient Chemo ,078 Repatriated Activity Total Activity 3,691 3,802 3,948 4,067 4,189 4,315 4,444 4,577 4,715 4,856 As the existing chemotherapy services for East and North Hertfordshire NHS Trust are already consolidated there are no further workforce changes planned on consolidation of acute services. The outcome from a benchmarking exercise through the National Cancer Action Team is expected in January 2013 the nursing workforce numbers are therefore provisional at this stage and will be subject to finalisation Angela Thompson, Director of Nursing ahead of the full business case The following table identifies the current workforce and the changes proposed to deliver the service from 14 and 18 chairs. Chemotherapy Staffing Levels - Whole Time Equivalents (WTE) Current Proposed increase Proposed increase Total for 14 Chairs for 18 Chairs Band 7 Charge Nurse Band 6 Chemotherapy Nurse Band 6 Service Coordinator Band 5 Nurse Band 4 Oncology Secretaries Band 3 Receptionists Band 3 Secretarial Support Band 3 CSW

4 6. Summary of Options 6.1. Each option in terms of its high level content and identified benefits and issues were assessed and Option 3 to refurbish and extend the existing Administration Corridor and increase the chair capacity from 10 to 18 chairs was selected as the preferred option. The 4 options considered were: Option 1. Option 2. Option 3. Option 4. Do nothing - This would leave all services configured as now with no improvements other than future lifecycle based refurbishment. Redevelop Existing Administration Corridor No disruption to existing chemotherapy services, improved environment for chemotherapy patients. Although an improvement the services would still be constrained by space and there would be no opportunity to increase capacity. Administration Corridor Extension - Improved environment for chemotherapy patients with an increase in capacity by 80%. There would be no disruption to existing chemotherapy services and the scheme would attract Macmillan funding. The scheme also has the potential for development training and education. Two Storey Development - Improved environment for chemotherapy patients with an increase capacity by 80% and no disruption to existing chemotherapy services. The scheme attracts Macmillan funding and would allow the potential for development and training. However substantial additional capital would be required In accordance with Capital Investment Manual and Department of Health Estates guidance on appraisals, a formal non-financial appraisal of the 4 short listed options has been undertaken. This was carried out by a multidisciplinary group of stakeholders and involved a sequential and systematic approach covering 6.3. When the economic appraisal was considered in conjunction with the above non-financial appraisal, the analysis showed that Option 3 was 36% better than the second placed option Affordability 7.1. The Trust has assessed the impact of the scheme in the context of the Trust Long Term Financial Model and assumes that the development is funded through a combination of the Trust s internally generated resources and funding from MacMillan. The table below provides a summary of the of the full impact of the additional costs identified, with additional income related to a 3% per annum growth in activity. Table 20: Additional Annual Income and Costs 2014/15 Recurrent Additional Area of Savings costs//income 000 Commentary Income 100 Direct Staff Costs Additional Clinical Staffing costs Related to the staffing of 4 additional 69 chairs Additional Clinical non pay Less than 1000 Drugs dealt with 0 outside of this appraisal Indirect costs Additional soft FM costs 55 Includes 10k set up costs Additional hard FM costs Based on cost of 56 per m2 for 47 additional space Total Additional Costs 171 Total contribution to I&E (71)

5 7.2. Based on 3% growth the 71,000 deficit is eliminated by year 3, a sensitivity based on 6% activity growth has been conducted. The whole asset will attract capital charges following the recent changes to accounting guidance on donated assets. The Trust will expect to offset this by charitable income in the future. 8. Procurement and equipment strategies 8.1. The Trust has developed procurement and equipment strategies for other Trust projects and these will be utilised for the project to ensure best value can be obtained from all procurement in line with legislation Integrated Health Partnerships (IHP) has been an appointed Principle Supply Chain Partner (PSCP) for design development Stage 3 of the P21+ process and is already well established as a PSCP partner for the Trust. The project board expect that the economies of scale presented by their existing involvement at Lister will ensure value for money is achieved for the Guaranteed Maximum Price for the scheme. 9. Project management arrangements As this project is an integral part of the OCH Programme, the project will be managed through the governance structure established for the OCH programme. A comprehensive risk register has been developed and will continue to be monitored and developed throughout the project until completion. 10. Timetable for approvals Table 1: Trust Project Governance Approvals Timeline Approval By OBC FBC Chemotherapy Project Board 26 September February 2013 OCH Programme Board 11 October March 2013 Finance and Performance Committee 17 October March 2013 Trust Board 24 October March 2013

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