This paper describes our current ideas and timetable for each of these.
1.1 A best estimate will be made of how much decentralisation can be achieved, which will lead to an assessment of the type of services and workload to be handled by local care hospitals.
1.2 Numerous sites are possible for the network of Local Care Hospitals, each with a range of facilities.
The criteria for assessing the number and location will be published as a working paper (March 2004). Comments will be considered and responded to (April 2004).
Relevant staff, employed by the NHS and engaged as consultants, will consider the sites against the criteria, and propose how the network should be created.
This proposal will go forward to the appraisal process in June (see step 2) and to formal consultation in July - October (see step 3).
1.3 The work of the Critical Care Hospital will be defined as that work which cannot be decentralised to Local Care Hospitals.
1.4 Three sites will be evaluated for a Critical Care Hospital (Epsom, St Helier and Sutton). For the purposes of this appraisal, we will also calculate the point on the map which represents the minimum travel time overall for those using the Critical Care Hospital.
One of the possibilities we may explore during the consultation period would be whether that theoretical site could actually be acquired (depending on whether it, or any other site close by, would offer significant advantages over a site or NHS ownership).
1.5 The criteria against which each site will be evaluated will be published as a working paper (March 2004).
1.6 Comments will be considered and responded to. The Programme Board will then agree the criteria to be used in the appraisal. (April 2004).
1.7 Relevant staff, both employed and engaged as consultants, will assemble the evidence to be presented about each site in relation to criteria.
2.1 During June 2004 (probably June 17th), a panel will be convened comprising representatives of the Boards of East Elmbridge PCT; Sutton and Merton PCT; and Epsom/St Helier NHS Trust. These representatives will be Chief Executive, the Medical Director and one other Director (e.g. Nurse, HR, Finance) plus the person who has been nominated to sit on the Board of these three bodies from the Patient and Public Forum. In the case of Epsom/St Helier NHS Trust, two representatives from the PPI will join the panel, not one; one from the Epsom catchment, one from the St Helier catchment.
The panel will be facilitated by an outside person with relevant skills.
2.2 This panel will first be presented with a proposal for the location and number of local care hospitals, and what they will contain.
They will have the opportunity to question the logic of this presentation, and explore whether there are better options.
2.3 The panel will then go on to hear evidence from relevant technical experts, either within the NHS or engaged as consultants, on each option for the site for the Critical Care Hospital. Having heard the evidence, the panel will assess each of the three options against the criteria to arrive at a score, and then use those scores to promote a discussion leading to a recommendation.
The recommendation will take the form of a preferred option for the Critical Care Hospital.
2.4 The panels recommendations will, of course, be the subject of formal consultation (see step 3). But as an additional measure to provide transparency, we will arrange for their deliberations to be observed. Invitations will be made to all members of the Patient and Public Involvement Forum to attend, all members of relevant Local Authorities, the Boards of the PCTs/Epsom St Helier, the joint Staff Committees of the Trusts, and the chair of the PEC/Senior Medical Staff Committee.
The design of this event is to achieve transparency rather than obtain public comment. Public comment will be actively sought in the formal consultation phase (see step 3). However each PCT will be able to allocate any remaining spaces at the venue to stakeholders in their areas.
3.1 In July 2004, a document will be issued for formal consultation comprising:
Chapter 1 - a restatement of the logic, which led the NHS to conclude that the best option is a network of Local Care Hospitals supported by a Critical Care Hospital.
Chapter 2 - a proposal of the number and location of the Local Care Hospitals, describing the type of work to be undertaken in each of them.
Chapter 3 - a preferred option for the siting of the Critical Care Hospital, with supporting evidence and analysis derived from the appraisal.
Chapter 4 - a 'before and after' description of the location of major clinical services. (Technically speaking, it is this which is the subject of consultation).
3.2 This document will be presented to the Boards of East Elmbridge/Mid Surrey PCT, Sutton and Merton PCT and Epsom/St Helier NHS Trust for endorsement to be issued on their behalf for formal consultation over the 14 weeks mid July - end October (assuming that these Boards can meet late June/early July).
3.3 Over this 14 week period, ‘open forums’ would be held. There would run through the day and evening to allow the public to attend on a ‘drop-in’ basis. In the forum there would be staff and exhibits about different aspects of the proposals e.g. the role of local care hospitals: the critical care hospital: A&E: maternity: diagnostics. There would be one forum in each PCT area and on each site of Epsom general, Sutton Hospital and St Helier Hospital; for one day each month July, Sept, October (so 5 venues x 3 months: 15 open forums).
3.4 Comments would also be accepted in writing.
4.1 All responses will be considered by the Programme Board during November 2004 who will prepare a report for each of the NHS Boards (EEMS, S&M and Epsom/St Helier).
4.2 This report will analyse whether or not the preferred option remained a logical proposal to include in an Outline Business Case.
4.3 The Boards would meet in December 04/Jan 05 to consider the report and make their decision.
4.4 At this point, local authority Overview and Scrutiny Committee could refer the matter to the Secretary of State if they were of the opinion that the consultation process had been flawed, or that the decision was not in the interest of the health service in their area.
5.1 This step is contingent upon the decision reached in Step 4. If the NHS boards so conclude, they would authorise the Programme Board to prepare an Outline Business Case for submission to DoH officials (Jan 05 onwards).
5.2 The Outline Business Case is the key to securing approval to go ahead. If approved by DoH it authorises work to begin on a detailed design, leads to Full Business Care.
5.3 If there is no agreement to proceed to OBC, the problems faced by Epsom/St Helier Trust do not go away. The Trust would need to consider what else could be done.
6.1 The Full Business Case is the document which sets out the design solution and re-examines cost. Capital costs must have increased by no more than 10% since OBC, revenue costs must remain affordable to the PCTs.
Such a document could be two years after OBC, because of the level of detailed design work necessary - room numbers, sizes, drawings and elevations etc.
Approval for the FBC permits the NHS to finalise procurement - either Public Sector funded or Private Finance Initiative. Contract signing could be six months after FBC approval.
Programme
Director
4th March 2004