Working Paper 5 - Clinical Services Strategy – The Engagement Process

Revised 19^th May 2004

Seven steps are proposed

Having reflected on comments on Working Paper 1, this paper describes our revised intention and timetable for each of these.

Step 1

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 A proposed network of Local Care Hospitals for each PCT area will be formulated by each PCT. This will describe the range of facilities each network is expected to offer, relating to the population served by the PCT. Each PCT will assess how well the network meets the relevant criteria. This will be issued as Working Paper 9 and 10 early June.

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 Four sites will be evaluated for a Critical Care Hospital – Epsom

General: West Park: St Helier (with a sub-option of the playing fields opposite explored as to technical deliverability) and Sutton.

1.5 The benefits criteria against which site will be evaluated, and the

weighting to be applied to the criteria was by an NHS panel revised on April 30^th, and Working Paper 6 now sets out these (available mid May).

1.6 The data being collected to evaluate these options against the criteria will be published as Working Paper 12 (aim early June).

1.7 The cost implication of the local care hospitals network and the critical care hospital to support the network will be issued as Working Paper 13 – capital, and 14 - revenue (early June).

Step 2

2.1 The working paper listed in Step 1 will be available for comment over

a four week period (early June to early July).

2.2 On 17^th June 2004 a session will be held for Local Authorities Chief

Officer/Leaders, MP’s and Chief Executives of neighbouring Trusts to meet the authors of the Working Papers and pose questions. This is in order to assist them in preparing any comments they may wish to make by early July. It does not replace the rights they have to comment during the formal consultation process.

2.3 In mid July NHS officials will consider the comments received and

begin the process of drafting a consultation document.

2.4 In mid to late July an NHS panel will be convened to undertake a

scoring exercise, rating each site option for the Critical Care Hospital

against the criteria set out in Working Paper 6.

(This panel will have a much more limited remit than that envisaged for June 17^th. It will not go on to assess each options benefit

against cost, and it will not therefore arrive at a preferred option.

The exposition of cost against benefit will appear in the formal consultation document itself.

If the analysis appears to show a clear cut best option, this may be suggested as the NHS preferred option – but if the analysis is less clear cut, then the NHS may simply lay out the range of options. In any event the decision will only be made after the end of the consultation and a period of reflection on comments).

2.5 In view of the more limited remit of the panel, we will aim for

transparency mainly by publishing their scores as part of the consultation document – but we will also invite the joint local authority scrutiny committee to observe the panel discussion. The date for this panel meeting will therefore be set after discussion with those committee members.

Step 3

3.1 Having drafted the formal consultation document NHS officials will present this to two separate statutory Primary Care Trust Boards with recommendation by their two separate Chief Executives. Assuming endorsed by those Boards, it would be issued for consultation to begin 1^st September 2004.

3.2 The formal consultation document will bring together the proposed

model of care: the proposed local care hospitals network: options for the critical care hospital site (possibly indicating a preferred option in the light of cost considerations). It will be set out as follows:-

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 – an analysis in relation to the siting of the Critical Care Hospital, with supporting data.

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).

3.3 Over a 12 week period, 1^st September – end November, ‘open forums’

will be held. They 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. More details will be available nearer the time from the two PCT’s concerned.

3.4 The two statutory boards referred to in paragraph 3.1and 3.3 are those of the PCTs (EEMS and Sutton & Merton). They have the responsibility of consulting their public about service changes in their area regardless of which Trust is the provider.

The Trust providing the service – in this case Epsom/St Helier NHS Trust – is party to the consultation insofar as it will support the consultation process with information and staff to meet the public and respond to questions. When it comes to Business Case to implement any decision, then all those providing the services will be responsible for its production and submission to D of H.

3.5 Comments would also be accepted in writing.

Step 4

4.1 All responses will be considered by the Programme Board during December 2004 who will prepare a report for each of the NHS Boards (EEMS, S&M PCTs).

4.2 The Boards would meet in Jan 05 to consider the report and make their decision.

4.3 At this point, the joint 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.

Step 5

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 their endorsement and submission to D of H officials (Feb 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, leading to Full Business Case two years later (Feb 07).

Step 6

6.1 The Full Business Case (Feb 07) 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.

Step 7

7.1 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. (Spring 07)

Keith Ford

Programme Director

18 May 2004