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 westherts.redevelopment@nhs.net 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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Thank you &

Questions

Further questions can be sent to westherts.redevelopment@nhs.net

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