Working with stakeholders
to shape our hospital appraisal process
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New photo to come
June 2020
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Welcome and introductions Louise Halfpenny
Director of Communications West Herts Hospitals NHS Trust
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Agenda
• Using Zoom
• Presentation
• Your opportunities to ask questions:
1. submit via chat during presentation
2. submit during the break
3. send to us afterwards
• Further information
• Meeting closes
Your input to the appraisal process has begun! The deadline for your contribution is midday Wednesday 1 July 2020.
Stakeholder Reference Group Stakeholder Reference Group
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About the stakeholder reference group
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• Views expressed through this engagement process will help shape our approach and contribute to the appraisal
• We will listen to what you have to say and respect everyone’s views (however we may not be able to give everyone what they want)
• You can get involved in the co-production of new care models and be part of task groups on issues like transport and digital technology
• We will ask you to complete surveys and send us feedback
• We will let you know what happens as a result of your feedback
We won’t have fixed meeting times but will bring people together as needed. Meetings will be online for now.
More information can be found in the Terms of Reference.
Purpose of today’s session and your role
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• Recap/introduce the redevelopment programme
• Set out the process over the coming months
• Stakeholder involvement – how you and others can help shape our appraisal framework
Your hosts for this session
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Freddie Banks Consultant Urologist West Herts Hospitals NHS Trust
Helen Brown Deputy Chief Executive West Herts Hospitals NHS Trust
David Evans, Interim Managing Director Herts Valleys CCG
Esther Moors Acute Redevelopment Programme Director West Herts Hospitals NHS Trust
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• Plans before the global financial crash
• 2017 – our strategic outline case (SOC)
• 2018 – our ‘refreshed’ SOC with upper financial limit of £350m (in line with 2017/18 turnover)
• 2019 – West Herts Hospitals NHS Trust named as one of six hospital trusts in Health Infrastructure Plan - £400m pledged
• 2020 – (last week) feedback from regulators confirmed that an option including more new build at WGH, including replacing rather than refurbishing the main clinical block (costing c£590m) could be included within the OBC option appraisal BUT there is no guarantee at this stage that this amount of funding is available.
Background – getting this far has taken a long time!
Last 103 days has transformed the way we deliver care
Emergency and planned/elective care isn't working (if it worked I would have done an elective operation in the last 3 months.)
The nation has divided care into emergency (NHS) elective (private)
Fundamental re-think of how care is delivered
• Not just closer to home but It will be IN your home
• Segregation of emergency and elective services essential
• Services should not impact on each other
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What we want for our patients
Elective:
• Initial consultation at home via telephone & other devices
• Planned diagnostic day - all the equipment, staff and patient under the same roof in same place
• State of the art diagnostics
• Follow up on the day or at home
• Patients can manage their own bookings
• Care with GPs integrated with providers e.g. community, mental health
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Our clinical vision What we want for our patients
Emergency
•80% of inpatients come in as emergencies
•100+ ambulances, 330 attendances, up to 60 patients an hour!
•Complexity of patients hugely increased
•Numbers , age of patients and expectations hugely increased
•Access to right team, right investigations
•Dedicated teams looking after emergencies
• Integrated assessment with the right diagnostics
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Our clinical vision What we want for our patients
Buildings:
•Must have A&E and assessment space fit for purpose
•Designed around patient flow into and out of hospital
•State of art diagnostics (like our MRI/CT suite)
•Digital hospital – electronic patient record
•More privacy, dignity and more single rooms
•Enhanced infection control
• Improved ‘clinical adjacencies’ (related services close to each other)
•Continue to attract staff to work here
•Excellent staff facilities to support health and wellbeing
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Our clinical vision What we want for our patients
HM Treasury’s approach (‘green book’) to developing business cases
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ESTHER
Strategic Outline Case Outline Business Case Full Business Case
Case for change
established and a preferred way
forward identified
Preferred option
identified
Best value for
money supplier chosen
Decision to
undertake a thorough appraisal
of the shortlist
Decision to proceed
with procurement
Decision
to sign contract
Planning to construction timeline
SOC submitted
2020 - 2021
Q3 Q
2021 - 2022
Q1
Q2
Q4
Feb 2021
2023
Q3
OBC developed, preferred
option identified
2019
SRG input on appraisal approach (essential criteria and clinical model) and other stakeholder engagement
£400m pledged via HIP1
Approval of Shortlist
Approval of OBC preferred option
Oct 2020
Summer 2020
September
July
Dec 2021
OBC completed
Approval and endorsement from
WHHT Board, HVCCG Board & regulators and
government
Approval and endorsement from WHHT Board & HVCCG
Building begins
FBC Dec 2022
(12 months)
12-18 months
2025-2026
NEW BUILDINGS
OPEN
Approval and endorsement from WHHT Board, HVCCG Board and
regulators/government
Project milestones
Stakeholder Reference Group We want your input! 15
We want your input
Critical Success Factors Critical Success Factors Investment objectives 16
Investment objectives
Investment objectives – the outcomes we want to achieve
The Treasury requires us to explain the outcomes we expect as a result of the money spent. Our investment objectives are specific, measurable and have a deadline.
We want to achieve:
• Very significant improvement to emergency care services as a priority
• Increased separation between planned and emergency care services
• New ways of working and maximised use of digital technology (with electronic patient record well before new facilities open)
• Specialty and sub-specialty services to be provided from no more than two sites by 2026 (except high-volume services such as maternity and diabetes) to help make the best use of workforce & equipment
• Greater value for public money by having more efficient buildings and ways of working (2025/6 for emergency care, 2030 for planned care)
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Investment objectives – the outcomes we want to achieve
Emergency Care Planned care
Scope: significant improvement for all emergency care facilities and associated services
Scope: improvement to all planned care facilities across all our hospitals
Standard and lifetime: the work must meet NHS estate code standards B – from a current range of A – D (i.e. a very significant improvement) The lifetime of new/redeveloped buildings to be 30 years minimum
Standard and lifetime: the work must meet NHS estate code standard B – from a current range of A – D (i.e. a very significant improvement) The lifetime of new/redeveloped buildings to be 30 years minimum
Timeline: Buildings open in 2025/26
Timeline: As close as possible to 2030
The needs of emergency services and planned care are not the same
Stakeholder reference group involvement
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Develop
investment
objectives
Develop
Essential
Criteria
Longlist
developed
Appraise long
list against
essential
criteria
short list; to
‘preferred
option’
Stakeholder
reference group
reviews
new clinical model
and approach to
longlist
Stakeholder
reference group
(today)
Stakeholder
reference group
reviews longlist
appraisal
Critical Success Factors Critical Success Factors Essential Criteria
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Your views on our criteria
As well as investment objectives, we will use ‘essential criteria’ in our appraisal process. They will help us apply a pass/fail test to each option.
The appraisal process is designed to rule out undeliverable* options.
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Our proposed essential criteria
1. Fits with strategy 5. Value for money
2. Patient experience 6. Affordability
3. Quality 7. Deliverability
4. Access
*Options are unrealistic , risky and will not meet affordability and delivery timeline.
Your thoughts on our critical success factors
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Proposed
essential
criteria
How it helps us to assess options for inclusion on the
shortlist (sample definitions only to get you thinking!)
1. Fits with
strategy • ensures flexibility for the future, meets our clinical strategy
and priorities, fits with wider health system plans
2. Patient
experience • supports an improvement in patient experience
3. Quality • maintains patient safety
4. Access • maintains or improves access by patients
5. Value for money
• delivers sufficient healthcare benefits for the money invested
6. Affordability • supports the long term financial health of the trust and health
system
7.Deliverability • sufficient space & ability to deliver required infrastructure,
acceptable planning risk, capable of completion by 2025/26
Please consider the definitions below – do you think they explain the criteria?
Considering our investment objectives and essential criteria, please answer these questions:
1. Do you think these are the right investment objectives ?
Yes/no
2. Do you think the essential criteria will help us to rule out undeliverable options for the shortlist?
Yes/no? (it’s important to hear from you either way)
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Your task
3. If you answered no, please tell us what other investment objectives we should include and other essential criteria we could use to reject undeliverable options 4. Do you agree that the investment objectives and essential criteria will help rule out options which do not support what we want for our patients? Yes/no? (it’s important to hear from you either way)
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Your task
Next steps
A question sheet will be issued with a copy of the slides. Please send your response to [email protected] by midday on Wednesday July 1. We will ask health professionals working in the trust the same questions as we are asking you We will update you on our emerging longlist in July
We will invite more people to join the stakeholder reference group as we continue to develop our outline business case.
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