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Project name Broadmoor Redevelopment Programme E &N Herts. NHS Trust - LIFT scheme - new QEII hospital in Welwyn Garden City E & N Herts NHS Trust - Lister Hospital ('Our Changing Hospitals' Phase 4 Programme) Mersey Care NHS LIFT scheme (TIME - To Improve Mental health Environments) Royal National Orthopaedic Hospital NHS Trust PFI Project PFI - Royal Liverpool and Broadgreen ('World Class Hospitals; World Class Services - Renewing the Royal Liverpool University Hospital') Sandwell and West Birmingham Hospitals NHS Trust - The Midland Metropolitan Hospital Project Brighton & Sussex University Hospitals NHS Trust (3Ts Programme - The development of a leading teaching, trauma and tertiary care centre) N3 Extension NHSmail service refresh NME Programme for IT Summary Care Record (SCR) Southern Programme for IT Health and Care Modernisation Transition Programme IMS3 Pandemic Vaccine Sleeping Contract Pre-Pandemic Vaccine CAB Variation Electronic Prescription Service (EPS) Release 2 London Programme for IT HPA Chrysalis
Department DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH DoH
MPA RAG rating (A Delivery Confidence Assessment of the project at a fixed point in time, using a five-point scale, Red – Amber/Red – Amber – Amber/Green – Green; definitions in the MPA Annual Report) Amber/Green Amber/Green Amber/Red Amber/Green Green Amber/Green Amber/Green Amber/Green Amber Amber/Green Amber Amber/Green Amber/Green Amber/Red Green Green Amber/Green Amber/Green Amber/Green Amber/Red Amber
Description / aims To redevelop Broadmoor High Secure Hospital to replace Victorian accommodation which presents high levels of inherent risk to the safety of patients and staff and has been declared by regulators, including the CQC, as 'not fit for modern mental health services'. The new hospital will provide a total of 234 beds (210 commissioned, 24 decant) in 10 new wards and 6 existing wards in an adjacent unit built in 2003. It will also provide two support buildings: an entrance building to control all access/egress for the site and a central building to house all ward activities and administration. The programme includes the realignment of the site boundaries and the sale of surplus land/buildings to support programme funding. Following the consultation on the local strategy, Delivering Quality Healthcare for Hertfordshire (DQHH), the decision was made to develop two local general hospitals in Welwyn Hatfield and Hemel Hempstead. These will be campus style developments that would be tailor made to meet the needs of Hemel or Welwyn Hatfield and surrounding area. The preferred solution identified in the business case is the provision of a designed for purpose New QEII Hospital in Welwyn Garden City on part of the current site of the QEII Hospital. The new facility will provide a range of unscheduled care (including a local A & E), diagnostic, and treatment services supporting the strategic vision of DQHH. The New QEII Hospital is being procured through Assemble, the South East Midland LiftCo. The business case is a key component of the DQHH strategy in the provision of the New QEII Hospital in Welwyn Garden City, enabling the consolidation of acute services in East and North Hertfordshire onto the Lister Hospital site in Stevenage. This is the fourth and final stage of the Our Changing Hospitals programme which enable full consolidation of all acute inpatients services onto the Lister Hospital, Stevenage, Hertfordshire site in spring 2014. The programme is at the heart of the organisations strategy and addresses a number of clinical and financial challenges: allowing us to achieve best clinical practice and improve outcomes and productivity; providing the means for our response to the challenging economic conditions through the Quality, Innovation, Productivity and Prevention (QIPP) programme; create a mass of clinical and specialist staff to sustain a wider range of high quality services and introduce new technologies; facilitate modernisation of our facilities; improve patient experience; enable reductions in estate and related costs through reshaping the QEII hospital site in Welwyn Garden City, Hertfordshire to offset the income loss and support the revenue consequence of the capital investment on the Lister site. The TIME Project is a multi-phased £130m project which will eventually deliver 285 mental health beds in four/five sites across North Merseyside. Phase I comprises a new 85 bedded unit on the old Walton General site (£25m) and an 85 bedded unit in Edge Lane/Old Swan (£27m). The Phase I buildings are being procured under the NHS LIFT Initiative in conjunction with Liverpool and Sefton Health Partnership (LSHP). Phase II will follow but may be procured via other routes. The new accommodation will be single room en suite, with access to outside and therapy spaces. It will replace functionally unsuitable accommodation currently based on a number of disparate sites. This will release significant land for sale. The two Phase I schemes have now been designated for separate Financial Close, with Edge lane/Old Swan expected to be approximately six/nine months behind. Financial Close for Walton is expected to be September/October 2012 with occupation two years later. The Trust is the largest specialist orthopaedic hospital in the UK and continues to be regarded as a world leader in the field of orthopaedics despite its ageing and dysfunctional site. The proposed PFI facility has a capital value of approximately £90m and will include: - Adult Acute inpatients (49 beds); - The London Spinal Cord Injury Centre (38 inpatient beds); - Children and Young People's Services (37 beds); - Therapy areas for all three inpatient service areas; - A new main entrance; - Inpatient and complex imaging. The new Healthcare Facilities will deliver improvements to clinical adjacencies, forming a main entrance 'hub' in the centre of the existing site, thereby commencing a process of site rationalisation that will deliver improved patient outcomes including: Improved privacy and dignity for patients as the project will deliver 100% single rooms for adults; Improved utilisation of beds as the single-sex agenda and infection control will be easier to manage; Improved access to Imaging as the department will be planned to meet current and future activity and changes in technology; An attractive and modern environment to attract and recruit world-class professionals to train and work at the Trust. A new Royal Liverpool University Hospital is to be procured under the Private Finance Initiative. The scheme will address service delivery and building infrastructure concerns. It will secure the future provision of high quality health services for the local population, together with specialised services for Cheshire, Merseyside and beyond and support world class research and teaching in partnership with the University of Liverpool. This will be achieved through the implementation of a Clinical Services Delivery Model, the development of services outside hospital, redeveloping or better utilising facilities at Broadgreen Hospital and redeveloping the Royal Liverpool University Hospital. The development of a new acute hospital on a brown field site in the Grove Lane area of Smethwick (in Sandwell) to replace the current Sandwell General Hospital and City Hospital Birmingham, as part of the wider changes to health and social care within the health economy being undertaken in the Right Care, Right Here Programme. This will result in a major shift of care away from the acute hospital into community settings, major investment in new community and primary care facilities and the state of the art new single-site acute hospital . Since DH approval of the initial business case , Secretary of State has authorised use of compulsory purchase powers and 50% of the site has been acquired with the remainder due to come into Trust ownership in September 2012. 1. Replacement of the Barry Building at the Royal Sussex County Hospital. The building was opened in 1828 and contains 200 medical and care of the elderly beds (with circa 5% single rooms), plus the main hospital imaging department and other diagnostic and treatment facilities; 2. The transfer of the regional neurosciences centre from Hurstwood Park (on the Princess Royal Hospital campus which is also part of the Trust). The building is over 70 years old. The project will create the capacity to treat patients from Sussex in Sussex (many currently travel into London); 3. The creation of a Major Trauma Centre for the South East region in line with policy; 4. The expansion of the Sussex Cancer Centre to enable Sussex patients to be treated in Sussex for non-surgical procedures; and 5. Provision of teaching and research facilities for Brighton & Sussex Medical School. N3 is the National Network for the NHS. It is a Wide Area Network (WAN) deployed as a Virtual Private Network (VPN) and is one of the largest in Europe. It provides reliable, supporting IT infrastructure, world class Internet Protocol (IP) networking services and sufficient, secure connectivity and broadband capacity to meet current and future NHS IT needs. It provides connectivity to all NHS organisations in England, as well as non- NHS sites providing NHS care, ensuring a reliable service at every site where NHS services are delivered or managed. Via N3 Voice Services it makes best value IP telephony services available to all NHS organisations including GP’s. N3 Managed Video Conferencing services are also available supporting the full range of devices from large VC dedicated rooms to desktop webcams which affords the opportunity for significant cost saving and productivity benefits for subscribed users via the suite of collaboration tools. N3 is a fully managed IP network with over 46,000 connections (consisting of over 15,000 physical, 11,500 aggregator and 19,500 VPN Token connections) which is contracted to be available 24hrs, 7days a week for 365 days per year. NHSmail provides a secure email service for the NHS. Relay provides a message routing service linking NHS organisations and the NHS with the internet. To decommission over 9,000 locally provided email services - this will continue until at least 2013 (contract term). NMEPfIT Programme: Increased patient safety and quality of healthcare and also greater clinical effectiveness and administration efficiency Delivery of the SCR which supports urgent and emergency care settings, providing information to authorised health care professionals to support care where no information is currently held about a patient, for example in out-of-hours settings, emergency departments, treating temporary residents and emergency admissions to secondary care. SPFIT Programme: Ensuring patients detailed clinical information is available at the point of care. The purpose of the Transition Programme is to oversee all the structural change work undertaken to design and implement a new Health and Care system by 2013. These changes deliver: • A patient-led NHS • Delivering better health outcomes • A more autonomous and accountable system • Improved public health • Reforming long-term and social care. The reprocurement and implementation of the ICT managed service capability for DH and its ALBs. IMS3 is a project, running a procurement against the ASCC framework to provide the next generation of agile ICT services to DH and its ALBS. The project has now awarded the ICT contract and has entered a transition phase with Atos IT Solutions & Services Ltd to implement the new modernised ICT solution for core DH and ALB consumers and to "on-board" new emerging ALBs requiring ICT services in a phased approach. The aim of the project is to put in place advanced purchase agreements with vaccine suppliers to enable the rapid ordering and delivery of pandemic specific vaccine during a future UK pandemic. The aim of the project is to consult with subject matter experts on the feasibility of pre-pandemic vaccine and its effectiveness and, dependent on the outcome, procure further pre-pandemic vaccine to replace the existing stock that will expire in 2013. The purpose of this project is to continue with the existing Choose and Book service provided by the incumbent supplier Atos, with minimum necessary maintenance to meet existing requirements and maintain service level compliance. The Electronic Transmission of Prescriptions (ETP) Programme is delivering the Electronic Prescription Service (EPS) which is a national service that has its origins in a number of government policy initiatives from 1998. However, work on building this new service that will operate in all GP practices and pharmacies in England, began in December 2003. With 1.6 million paper prescriptions generated every working day in England and a predicted annual rise of 5 per cent, the EPS provides an alternative means of generating and processing the growing number of prescriptions The NHS Electronic Prescription Service (EPS) enables prescribers, such as GPs and practice nurses, to send prescriptions electronically to a dispenser (such as a community pharmacy or dispensing appliance contractor) of the patient’s choice. Dispensing contractors can subsequently send electronic reimbursement endorsement claims to the NHS Prescription Service. The main aims of the ETP programme are: o To enable the electronic transmission of prescription data in England between: - Prescribers (GP, nurses, supplementary) - Dispensing contractors (community pharmacy, dispensing doctors and dispensing appliance contractors) - The NHS Care Record Service - Reimbursement Agencies (e.g. the Business Services Authority’s NHS Prescription Services) o To facilitate the efficient, convenient and accurate dispensing of medication to patients. The scope of the programme covers all primary care prescribing and dispensing (excluding Schedule 2 and 3 controlled drugs) and supply of medicines, drugs, appliances and chemical reagents by authorised dispensing contractors. Secondary care prescriptions issued for dispensing in the community are also within scope o To enable the NHS Prescription Service to re-engineer their processes to increase capacity and reduce the unit cost of processing prescriptions. LPfIT has overall responsibility for upgrading NHS information technology to make it possible for hospitals, community services and mental health trusts to implement Electronic Patient Record as per the LSP contract with BT. This will enable the NHS to provide better, safer care for patients wherever and whenever they need it. The Chrysalis Programme initially focused on the urgent re-provision of the ageing, high security, high containment specialist microbiology laboratories at Porton Down that are a key part of the nation’s defence against novel and dangerous microbiological pathogens such as pandemic flu, Ebola, anthrax and many others. The preferred option is now broader than the above re-provision with the proposal to collocate synergistic microbiology and corporate HPA/Public Health England (PHE) functions from Porton, Colindale, and South Mimms onto a site in Harlow Essex. The vision for the programme is being strengthened and developed to describe how a national centre of public health expertise will link and support the network of PHE services across England. This includes exploring how a national integrated centre would support the wider responsibilities of PHE and how it contributes to the other two parts of PHE’s mission to improve the nation’s health and to reduce health inequalities.
Departmental narrative, actions on Delivery Confidence Assessment Gateway 2 Action plan to deal with the 5 recommendations: - Training for Staff on NEC3 Forms of Contract booked - Proportion Capital Investment Loan/Public Dividend Capital funding agreed. - Resource and recruitment planning for additional senior staff completed. - Market testing for property advisors planned and programmed for Q1 2013 - Gateway 3 programmed for Q1 2013 RPA low therefore no formal review required Since the Gateway review in 2009 the Trust has been heavily engaged with NHS Hertfordshire on this issue, and our assumptions in the refreshed outline business case are entirely consistent with PCT QIPP plans and commissioning intentions. A further programme gateway is planned for when the full business cases for the major schemes are approved by DoH. A risk potential assessment was completed for the emergency services scheme and the outcome was low 1) Update and enhance Benefits Realisation Plan and management processes - DONE 2) Broaden the scope of the Risk Register and review at every Project Board - DONE 3) Produce Critical Path Programme and update for each Project Board - DONE 4) Produce Dashboard of Key Deliverables for each Project Board - DONE 5) Review and Confirm resource and governance arrangements for future phases - ONGOING Actions recommended as a result of Gateway 2 included: 1) Trust should avoid creating any dependency of the project on the Foundation Trust application process; 2) Lead role for ensuring that risks and issues are updated to relevant governance meetings needs to be explicitly assigned; 3) Revised structures and governance arrangements need to ensure that clear lines of responsibility for managing advisors exist and governance arrangements draw in all relevant disciplines; 4) The Trust Board should consider how best to formalise assurance arrangements over the PFI project; 5) The project team resources need to supplemented at leadership, management and project support levels as soon as possible; 6) The Trust should "sell" service transformation progress and successes to external stakeholders and bidders whose support is needed for the PFI project to reach completion. The Trust responses to these actions have been considered and agreed as part of the draft Appointment of Preferred Bidder Business Case process. Continued high assurance from project audit reviews. A Gateway 3 being planned. The 4 recommendations for the Trust's action plan from the Gate 2 assessment were for: Team to comprehensively refresh the risk management process; and prepare quantified risk allowances to inform the Project budget and PFI financial analysis · Team to prepare a comprehensive resourced plan to map out all activity associated with the OJEU process and the associated dialogue and evaluation workstreams. · SRO to develop and agree a negotiation strategy for lead Trust negotiator(s). · SRO to refresh the governance structure for the Project so that the Project Board remains focussed on successful delivery of the Project whilst at the same time continuing to fully embrace key stakeholders. Clinical input into the Project must be fully embedded into Project Team activity. In Q2 2012/13 , the Trust implemented the second part of the compulsory purchase order for acquisition of the land. The outcome of the HM Treasury review on PFI (expected December 2012) is key to progressing the procurement. There were five recommendations made in the 2011 Gateway Review which had been implemented by Year 2 Q2. The Trust had submitted and received Full Planning Consent from the Local Planning Authority. This was a significant achievement given the sensitivity and location of the hospital site (adjacent to five conservation areas and with two Grade II listed structures on the site). The Trust has also refreshed and resubmitted the Outline Business Case to the Strategic Health Authority (the previous OBC approval had been in late 2009). The OBC was reapproved by the SHA at the end of March 2012. The OBC was then submitted to DH. DH forwarded the OBC to HM Treasury in June 2012. OGC Gateway 5 Review undertaken July 2012 OGC Gateway 0/3 Review undertaken March 2012 OGC Gateway 5 Review forecast for April 2013, subject to submission of RPA and agreement with MPA. At Q2 no assurance planned. OGC Gateway 0 Review undertaken February 2012 OGC Gateway 5 Review forecast for February 2013 OGC Gateway 5 Review forecast for March 2014 OGC Gateway 5 Review forecast for November 2012 The People Transition Programme is working with Senders and Receivers to ensure a series of organisation-related contingency plans are in place to enable HR teams to carry out consequential actions to meet the 1st April 2013 date. The programme is preparing State of Readiness reviews for all national bodies to complete by January 2013 and continuing to oversee SHA transition and to manage all risks and issues. Actions in train to continue to deliver to plan Gateway 5 Review forecast for November 2012 OGC Gateway 5 Review forecast for November 2012 OGC Gateway 5 Review forecast for December 2012. All preparatory work is being done to ensure that the design work can be recommenced as soon as the above conditions are met. Options to secure the site are being discussed with all relevant Government Departments. Absolute clarity will be sought on the OBC to be resubmitted and the timetable for its review.
Project - start date 01/08/2011 23/03/2011 04/08/2011 30/08/2011 09/04/2010 01/06/2010 31/03/2013 31/05/2012 19/02/2004 31/10/2004 01/04/2004 01/04/2006 26/01/2004 01/10/2011 16/05/2011 01/04/2010 01/10/2011 01/10/2011 28/11/2003 18/12/2003 30/11/2013
Project - end date 01/11/2018 01/04/2014 17/01/2014 20/01/2015 28/11/2016 01/11/2016 01/04/2019 24/12/2021 31/03/2014 30/06/2013 31/07/2016 31/03/2016 31/10/2015 01/04/2013 29/03/2013 01/06/2012 01/07/2014 15/12/2013 31/03/2014 19/10/2015 17/05/2019
Departmental narrative on schedule, including any deviation from planned schedule The original Outline Business Case (OBC) approval date was planned for 01/03/2010. Further design review and development has taken place and OBC revised accordingly. OBC approved July 2012 and Full Business Case progressed for approval in Q4. On Schedule The programme is currently on schedule, the Outline Business Case for the programme was approved by the Department of health (DoH) and HM Treasury in August 2011 and we are currently awaiting DoH approval of the full business case for the first of the major projects . On schedule On Schedule There has been a small 3 month slippage in the timetable. The procurement stage of the project has been delayed whilst we await the outcome of the HM Treasury consultation on the future of PFI . Once the outcome of the consultation and the consequences are known , the project will be re- baselined. There has been about a six month slippage in expected approval of the Outline Business Case which represents the increased scrutiny, challenge and due diligence on projects of this size undertaken by the SHA, Department of Health and HM Treasury to ensure that projects are robust and affordable. Programme is on schedule to end as per the current approved business case Programme is on schedule to end as per the current approved business case, however given that the current contract ends 30 June 2013, it would be difficult to close down the programme within that timescale should the Extension not be agreed. Programme is on schedule to end as per the current approved business case Programme is on schedule to end as per the current approved business case Programme is on schedule to end as per the current approved business case The Health and Care Transition Programme is on track to deliver 1 April 2013. DH and its ALBS continue to work together on the installation of an ICT shared service together with the deployment of the shared desktop service. Whilst currently at 3 months behind schedule appropriate contingency arrangements are in place. No deviation from planned schedule. No deviation from planned schedule. Programme is on schedule to end as per the current approved business case Programme is on schedule to end as per the current approved business case Programme is on schedule to end as per the current approved business case During this period of transition as a DH owned programme it has received advice from discussions across Government Departments that an 18 month timetable should be assumed to obtain an OBC decision. The estimate to complete the extra design work is 12 months once approval is given to proceed with this work. A period of 6 months has had to be assumed for the review of the OBC after this technical work is complete and the case resubmitted.
2012/13 Budget (£million) 16.219 0 28.43 0 0 7.9 0 26.8 114.314 7.9 273.0531331 24.87 102.39 699.3 70.11 30.09 8.85 163.35 91.02
2012/13 Forecast (£million) 16.219 0 21.493 0 0 7.9 0 54.38 120.34 22.83 405.7482079 24.17 78.95 699.3 55.4 29.09556348 10.26 174.67 5.9
Total budgeted whole life costs (£million) (including non-government costs) 256.246 70.25 201.52 208.8 309.93 1117.7 1116 500.8 371.89 96.05 5636.192321 51.1 634.06 1563.9 139.38 54.24 36.38 627.59 6237.56
Departmental narrative on budget/forecast variance for 2012/13 (if variance is more than 5%) Although no change to overall programme timetable some changes/slippage of elements within programme to enable improved co-ordination across the programme of works resulted in some budget reprofiling. The budgeted cash flow reflected the resource allocated to the programme at Year 2 Q2. The forecast cash flow anticipated an approval of the OBC in line with the forecast programme and that major spend would be required and allocated once the approval had been secured. The variances in pre 2012/13 and forecast for 2013/14 reflects this (as there are variances in those two periods which balance the forecast increase in 2012/13). The variance between the two figures is due mainly to GPNGA movements. The project spend slipped from 11-12 to 12-13 – the original EBC only had £5m for this project – the forecast shown in the GMPP was £20m. Re-evaluation of the spend profile was carried out for the budget request and this accounts for the rest of the delta. As of Q2, the most recent fully approved Business Case dates from 2004 where the budget for 2012/13 was set at £7.9M. During the same period (Q2>3), a Refresh Business Case was in approval to describe the current services provided by NHSmail. The current 2012/13 forecast therefore reflects this Refresh Case. Costs related to the most recent approved SARPA business case (2008/09) for NMEPfIT. Work is progressing on a revised case therefore there is a variance this quarter. Q1 costs related to another business case following review by the MPA specific elements of the FBC were reviewed and updated; therefore, the FBC was not approved in FY 2011/12 as anticipated. As a result a revised FBC, now covering the period 2012/13 to 2015/16 was produced which was approved by HMT on 24 July 2012. This meant a variance in the quarter return. Difference on figures between quarters relates to indexation as Q1 price bases were at 11/12 and Q2 price were adjusted to 12/13 prices. BAU activity to deploy ICT service running behind schedule. Resulting in milestone payments to supplier not being made as planned. Further the Capex for 12/13 was overallocaed. The procurement project completed in Jan 2012. Then began the BAU activity of design, build and installation of replacement IT infrastructure and desktop services for DH and its ALBS. Q2 Budget figures were updated to reflect the final negotiated position, as reflected in the updated Business Case (CAB Variation FBC v1.0). This resulted in a variance in the quarter return. Q1 costs related to the original EPS R2 business case. Following the MPA Gate 4 in May 2011, specific elements of the FBC were reviewed and updated. This led to a variance in the Q2 return. The main variance relates to a capital spend of £2m for Controlled Drugs functionality to be introduced into EPS, which was rolled over into the 2012/13 forecast from the 2011/12 budget. However, this was not included within 2012/13 budget. Costs relate to the most recent approved CCN4 (2011) for LPfIT. Work is progressing on a revised case therefore there is a variance this quarter. The programme budget for 2012/2013 assumed an OBC decision, acquisition of the site, detailed design and some early elements of construction. In the event the programme has been delayed for the reasons above with the resulting major variance forecasted.
Departmental narrative on budgeted whole life costs Funded using Public Capital Funded using Private Finance Will be funded using public capital Funded using Private Finance Funded using Private Finance Mixture of private finance and £100m public capital WLC based at this stage on public sector comparator in OBC. The project intends to use PFI as a procurement method. The project is proposed to be funded using Public Capital. WLC is Gov Spend There is no Non Gov Spend in this business case WLC is Gov Spend There is no Non Gov Spend in this business case WLC is Gov Spend There is no Non Gov Spend in this business case WLC is Gov Spend There is no Non Gov Spend in this business case WLC is Gov Spend There is no Non Gov Spend in this business case Whole life cost is Government spend Whole life cost is funded by DH and its ALBs as operational running costs WLC is Gov Spend There is no Non Gov Spend in this business case WLC is Gov Spend There is no Non Gov Spend in this business case WLC is Gov Spend There is no Non Gov Spend in this business case Currently assumed to be Government funded.