SCPCT Business Case for the RSH

Full Business Case

RSH Outpatient

Building

ISTC, Level C

Clearance

7.

6.

5.

4.

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2.

3.

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Full Business Case RSH Outpatient Building ISTC, Level C Clearance. Chris Darling, September 2006

Contents

CEO’s Foreword

Executive Summary

Introduction

Business Case Purpose, Objectives, Project scope & Structure

4.1 Purpose

4.2 Objectives

4.3 Principles

4.4 Scope

4.5 Structure

Background and Strategic Case

5.1 Greater Southampton Health Plan

5.2 The ISTC programme

5.3 The IS diagnostics procurement

5.4 Southampton City PCT

5.5 Partnership working with SUHT/others

The Royal South Hants Hospital & Outpatient building

6.4 Outpatient Building

Level C Occupancy &Option Appraisals

7.1 Identification of Estates Projects

7.2 Genito-Urinary-Medicine (GUM)

7.2.1 GUM Options Appraisal (Option 1)

7.2.2 Option 2

7.2.3 Option 3

7.2.4 Option 4

7.2.5 Summary of financial analysis and preferred option – GUM

7.3 Central Rehab Team (CRT)

7.3.1 CRT Options Appraisal (Option 1)

7.3.2 Option 2

7.3.3 Option 3

7.3.4 Summary of financial analysis and preferred option - CRT

7.4 Paediatric Dentistry

7.5 Office accommodation

7.6 SUHT services

Composite & Preferred Options

8.2 Composite Options Table

8.3 The Preferred Option

Financial Analysis

Early Enabling Works & IT Risks

10.5 IT Issues & Risks

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G.

H.

I.

J.

C.

D.

E.

F.

11.


Communications & Consultation

11.1 Communications

11.2 Patient and Public Involvement

12.

13.

HR Considerations

12.1 HR Considerations

12.2 Staff Transfers between sites

12.3 Staff Transfers to SCPCT

12.4 Staff Transfer to ISTC

12.5 Reductions in staff numbers

14.

Timetable & General Issues

13.3 Key Milestones

13.4 General Issues

Risks

15.

Appendices:

A.

B.

Recommendations

Greater Southampton Health Plan (GSHP)

RSH Outpatient Building floor plans

Discounted Cash Flow Forms: GUM & CRT

Options Appraisal Scoring: GUM & CRT

GUM relocation to Level B, floor plans

CRT relocation to Level A, floor plans

SHA Director of Finance letter 2 nd Aug 2006

Chair Southampton Logistics Group letter 22 nd Aug 2006

Risk Log

SUHT Exit Strategy Business Case

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1.0 CEO’s Foreword

1.1

1.2

1.3

1.4

Southampton City Primary Care Trust (SCPCT) is a 3 star NHS organisation which has stayed in financial balance since its inception, yet has pursued and delivered an exciting stream of strategic developments and service improvements for Southampton people.

This performance record has been recognised in the PCT’s recent Fit for

Purpose review which has judged it be a high quality, performance focussed organisation with a good track record for financial sustainability, service reform and delivery e.g.:

 Rapid response, stroke and neuro rehab services for older people

 new palliative care and CAMHs services for young people

 new clinics, GP premises, ‘Walk in’ and city disability centres

 lead organisation for one of the biggest LIFT schemes in the country

National and local NHS delivery agendas are fast moving and complex.

It is important for the PCT to remain at the leading edge of service reform and transformation if we are to fulfil our purpose for improving the health of Southampton people.

Bringing in new partners, new concepts and new ways of working is a key part of the PCT’s market development and commissioning assurance plans. The PCT is keen to:

 maintain ongoing financial stability

 make the best use of NHS assets

 establish the right ‘menu’ of providers, who are empowered to do what they do best

 ease market entry for new providers

 establish open and transparent procedures for assessing provider performance and determining funding priorities

 enter into new forms of risk sharing and partnership working

A key example for achieving these aims is the development of an

Independent Sector Treatment Centre (ISTC) within the city. It has a good strategic fit with national initiatives such as ‘our health, our care

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our say’ and our own plans for developing the role of local NHS facilities. Consequently, the PCT, along with its partners from the City

Council and Local Strategic Partnership welcome this NHS development for people in Southampton and its surrounding areas.

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2.

1.


2.0 Executive Summary

Introduction

The establishment of an Independent Sector Treatment Centre (ISTC) to serve the population of Southampton and surrounding districts is a priority strategic development for Southampton City Primary Care Trust (PCT) and its partners within the local health economy.

The ISTC programme is a nationally driven initiative, which supports NHS policy to improve access, introduce choice and expand the involvement of the independent sector in healthcare delivery

The Southampton ISTC is the largest initiative to date. Locally the initiative is being led by the South Central Strategic Health Authority working with

Southampton City PCT and Southampton University Hospitals NHS Trust

(SUHT).

The PCT‘s plans for re-development of the Royal South Hans (RSH) hospital site as a city community hospital campus within one of the most deprived neighbourhoods of the city, are ambitious and far reaching.

The Southampton ISTC has been offered the whole of level C of the

Outpatient building on the RSH site for use by the independent sector partner. This accommodation is currently occupied by existing SUHT and

SCPCT services, and will need to be vacated as part of the enabling works for the ISTC. This business case focuses on the clearance of Level C.

Purpose, Objectives, Scope and Structure

This Business Case looks to set out the Trust’s proposals for relocating the occupants of Level C of the RSH Outpatient Building.

To provide detail of the preferred options including cost, affordability analysis, risk, and benefits.

The PCT will link closely with the parallel work being led by SUHT on the

SUHT Exit Strategy.

Principles of the Business Case include:

 Service and accommodation moves will be on a like for like basis

 Moves will be timetabled to fit with the ISTC programme requirements

 Relocation options will be affordable and realistic

 Changes will be fully in line with the Greater Southampton Health

Plan (GSHP), the SCPCT SSDP (Strategic Services Delivery Plan), clinical blueprint, and the SUHT 2020 vision

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3.


The ISTC programme is managed through the South Central Strategic

Health Authority, with an established complex structure of subgroups at which the PCT is represented as key stakeholders.

Background and Strategic Case

The GSHP has been adopted across the health community as a priority agenda, the GSHP includes the following recommendations which are directly relevant to the RSH:

 SUHT to provide and develop the activities of its Foundation Trust core business on the SGH/Princess Anne Hospital (PAH) sites only and exit the RSH site

 Southampton City PCT to assume ownership and management of the

RSH site. The following services to be provided on the site and any surplus land remaining after their provision will be disposed of: o A treatment centre o A walk in centre o A primary care centre o A range of interface clinic outpatient services o A diagnostic capability o A new adult mental health unit

Southampton City PCT has been identified as part of a Department of

Health nationwide initiative to develop a second wave Independent

Sector Treatment Centre (ISTC).

The Southampton ISTC will be delivered within Level C of the Outpatient

Building and will be operational from October 2007

The ISTC procurement is underway with the preferred bidder due to be announced in September 2006.

Southampton City PCT is a prominent partner within the local health community, with respect to Strategic Estates Planning, and is the leading organisation for a number of priority estate initiatives.

The Trust views the RSH site as a flagship site for future delivery of services both for the central locality of Southampton and for the wider population.

At the same time that the PCT is planning the clearance of Level C, SUHT is also working on a key associated business cases:

 SUHT RSH exit strategy/ Theatre continuity plan (including exit of SUHT services from Level C), see Appendix J

There is clear overlap between the business cases being prepared by

SCPCT and by SUHT.

It is imperative that SCPCT and SUHT work closely together to ensure as smooth an exit as possible and with minimal disruption to patient services.

The Trust is committed to this scheme and to joint working and has put dedicated resource in place to progress the project.

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4.

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Due to the very short timescales for delivery (clearing Level C), the specific

RSH knowledge held by SUHT, and the critically integrated nature of the schemes involved in vacating level C, it has been agreed that the SUHT

Estates and Capital Development department will lead the estates and implementation of the whole programme to clear level C.

The Royal South Hants Hospital and Outpatient Building

The site is currently in the ownership of the SUHT, although site ownership will transfer to the PCT within the 06/07 financial year.

Full detail of site occupancy and development plans will be presented in the PCT’s RSH Site Transfer Business Case, which is being prepared in parallel with the Level C Clearance Business Case.

The Outpatient (OP) Building is the largest building on the RSH site. It is located at the rear of the site with direct access from Graham road.

Level C of the OP Building has a gross area of 4648 sqm

Level C Occupancy and Clearance

Service changes that need to take place to ensure clearance of Level C have been broken down into two parallel estates projects. The first comprises of projects to be undertaken at the RSH. As the RSH site will transfer to SCPCT by 1 April 2007, these schemes are designated PCT capital expenditure. The second part includes projects to be undertaken at the SGH and PAH. These schemes are designated SUHT capital expenditure.

This business case analyses the options for SCPCTs main services and services relocating within the RSH. SUHT’s business case (appendix J) looks at all services including services moving off the RSH (level C) to the SGH and PAH.

The short listed options for the GUM service included relocating the service to level B of the OP Building, level D of the OP Building, level A of the OP

Building and off site. The preferred option for GUM was to relocate this service to level B of the OP Building.

The options analysed for the Central Rehab Team (CRT) included relocating the service to level A of the OP Building, level B of the OP

Building and off site. The preferred option for the CRT was to relocate this service to level A of the OP Building.

It was established that the paediatric dentistry that currently uses space within the day theatre area of level C will split off with paediatric dental sedation service relocating from level C to level B of the Radiotherapy building (RSH), into the new Primary Care Delivery Centre (PCDC). The dental anaesthesia service will transfer to SUHT as part of the Theatre

Continuity plan which has been produced by SUHT.

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5.


The other moves within the RSH to clear Level C consists of office accommodation space which is to be provided on level A by remodelling the eatery area/rationalising ex- pathology labs and offices, and reallocating some office functions better.

The SUHT Programme consists of 6 projects to be developed at the SGH and 11 projects at Princess Anne Hospital (PAH)

Composite option & preferred options

The preferred options for each service must ultimately come together to form an overall achievable and acceptable composite option. This means that there are dependencies between preferred options, which must be taken into account.

The overall option to clear level C (both SCPT’s programme and SUHT’s programme) is option 5 in SUHT’s exit strategy business case, appendix J.

The breakdown of this option can be seen below.

 GUM to RSH Level B

 Central Rehab to Level A RSH

 Medical Prep to Level D RSH

 Breast Imaging to Level E at PAH

 GI OPD from Level B to SGH West Wing

 SUHT Endoscopy to SGH – within medical/surgical GI areas

 Convert 1 Endoscopy room to procedure room on Level D RSH, to accommodate SCPCT community dental, pain and dermatology work

 Medical and Surgical Offices to Level C at PAH

 Admin offices from Level E at PAH to Level J at PAH

 Nutrition and Dietetics offices to Level A at RSH

 Breast Imaging support to Level C at PAH

 Move 2 X-ray Imaging machines to SGH

The table below of the preferred option shows how these relocations are all linked and all come together to form one joint (SCPCT/SUHT) preferred option.

SCPCT Programme

1. GUM Clinic from Level C OP

Building

Enabling Measure – GI OPD from

Level B OP Building

2. Central Rehab from Level C OP

Building

Proposed location

OP Building Level B

West Wing SGH

OP Building Level A

Enabling Measure – Remodelling OP Building Level A

3. Nutrition/other offices from Level C OP Building Level A

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6.


OP Building

Enabling Measure – N/A

OP Building Level D 4. Medical Prep from Level C OP

Building

5. Medical and Surgical offices from

Level C OP Building

OP Building Level A


6. Dermatology offices from Level C

OP Building


SUHT Programme

7. GI OPD facility from Level B OP

Building

Enabling Measure – NA

8. Surgical pre-assessment and

Orthopaedic pre-assessment from

Level C OP Building


9. SUHT Endoscopy from Level D OP

Building

OP Building level D and Dermatology

Unit

West Wing SGH

West Wing SGH

West Wing SGH


10. Non-invasive Cardiology from

Level C OP Building


11. Two theatres from Level C


12. Breast Imaging Clinical service from Level C OP Building

Enabling Measure – Medical Records from Level E PAH

Admin/offices from Level EPAH

13. Breast Surgical Support & Breast

Imaging Support from Level C OP

Building

East Wing SGH

North Wing (F Level) SGH

Level E PAH

Level C PAH

Level J PAH

Level C PAH

Enabling Measure – Catering

Remodelling and a reduced Eatery on Level E PAH

Provide new entrance lobby/info point

Level E PAH

Level E PAH

Financial Analysis

The financial summary for SCPCT's preferred option in capital cost terms for

Level C clearance can be seen below (SCPCT’s Programme):

SCPCT Programme Cost

GUM relocates from level C to level B OP Building:

CRT from level C to level B

OP Building:

£775k

£225k

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7.


Catering remodelling:

(enabling works on level A)

£225k

Nutrition/ other offices from level C to level A: £42k

Medical prep from level C to level A:

Medical & Surgical admin from level C to level A:

Dermatology offices from level C to level D and

Dermatology unit

Sub total:

12% planning contingency

SCPCT Programme total project cost:

£5k

£100k

NIL

£1,422,000

£171k

£1,593,000

The total cost (preferred option) to clear level C (including both SCPCT’s

Programme and SUHT’s Programme) can be seen below:

Element £k

GUM to Level B RSH

Central Rehab to Level A RSH

775

500

Medical Prep to Level D RSH

Breast Imaging to Level E at PAH

SUHT Endoscopy to SGH West Wing

GI OPD to SGH West Wing

5

2,080

1,270

1,085

Medical and Surgical offices from Level C

Cardiology to SGH

Nutrition and Dietetics offices to Level A at RSH

Equipment


Total

100

117

42

350

793

7,117m

No capital is available within the PCT for investment within the above options; the PCT would require any available capital to clear level C.

Early Enabling Works

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9.

8.

10.


The SHA have identified some initial capital funds from the SHA discretionary capital to be allocated for ‘pump priming’ the ISTC. They invited a joint bid for accessing these funds for the purpose of early enabling works to progress the Level C exit. Consequently a joint bid was prepared on behalf of SUHT and SCPCT and was submitted to SHA for consideration.

This bid was successful and £900k was allocated for enabling works at PAH in advance of business case approval.

IT Risks/Issues

IT risks are being managed via the ISTC project groups.

Both HUB rooms are on C level and their relocation could create costs of up to £100k due to the nature of the links i.e. links to other buildings on site through unknown ducting. SCPCTs preferred option is for the ISP to relocate this hub and bear the cost, if this does not happen the PCT needs to evaluate how relocating these hubs will be paid for.

Communications

The Public Relations department of the PCT is working on a

Communications Strategy for the development of the RSH site, and an appendix to that is the communications action plan for the development of the ISTC.

Consultation with patient and public is an essential part of the Trusts’ business and we will fully comply with current legislation and national guidance during the ISTC Programme and changes at the RSH site.

HR

A number of Human Resource issues are relevant to this project. These include:

The transfer of staff from the RSH site to the SGH/PAH sites, where the services they provide are to transfer.

The transfer of staff from SUHT to Southampton City PCT where the services they provide are to transfer.

Reductions in staff numbers, where the overall volume of services delivered by SUHT is to reduce, but services are not directly transferring to another provider.

These HR issues will be dealt with in accordance to relevant SCPCT and

SUHT policies.

11. Timetable

This project is influenced by timescales for the implementation of the ISTC project at the RSH site. This has resulted in the following requirements:

 the delivery of this FBC by September 2006

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12.


 the vacation of Level C of the RSH site by the end of March 2007, other than for Breast Imaging

 the move of Breast Imaging by the end of June 2007

 the transfer of ownership of the RSH site to Southampton City PCT on 1 st

April 2007

 ISTC Commissioned and Operational by Oct 07

Risk

The main risks identified with clearing level C of the Outpatient Building include capital affordability; SCPCT doesn’t have the capital budget to implement the relocations, establishing how and who will relocate the IT hub from level C and who will pay for this, and adhering to the ISTC programme timeframes. These risks as well as others have all been identified and are being managed via the project structure in place.

13. Recommendations

Southampton City Primary Care Trust Board, Southampton University

Hospitals NHS Trust Board, and South Central Strategic Health Authority

Board are recommended to approve this FBC.

South Central Strategic Health Authority is recommended to allocate the capital funds identified in Chapter 9 of this FBC and Chapter 6 of SUHT's

Business Case.

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3: Introduction

3.1 The establishment of an Independent Sector Treatment Centre (ISTC) to serve the population of Southampton and surrounding districts is a priority strategic development for Southampton City Primary Care Trust (PCT) and its partners within the local health economy.

3.2 The ISTC programme is a nationally driven initiative, which supports NHS policy to improve access, introduce choice and expand the involvement of the independent sector in healthcare delivery. There are 21 ISTC schemes already established across the country, with a further 11 opening over the next 18 months.

3.3 ISTCs are an integral part of the Department of Health’s plans to refocus health services on the needs of the patient and significantly reduce the time that a patient waits for treatment.

3.4 Examples of ISTCs include Capio at New Hall hospital near Salisbury, which provides approximately 2,000 orthopaedic procedures per year, and the new Shepton Mallet ISTC, which has 34 inpatient beds, four operating theatres and 18 day case beds.

3.5 The Southampton ISTC is the largest initiative to date. It will concentrate on elective surgery, providing 20,000 treatments per year, and will play a key role in the delivery of contestability and choice agendas. Within the ISTC, patient services will be delivered in modern accommodation with the most up to date equipment, and will be provided in an accessible and prominent city centre location. The centre will be run by the independent sector but will be funded by the NHS to provide NHS services, which are free at the point of delivery to patients.

3.6 Locally the initiative is being led by the South Central Strategic Health

Authority working with Southampton City PCT and Southampton University

Hospitals NHS Trust (SUHT).

3.7 The ISTC will provide additional capacity for elective procedures including:

 General Surgery including breast and vascular surgery

 Urology

 Trauma & Orthopaedics

 ENT

 Ophthalmology

 Oral Surgery

 Cardiac Surgery

 Pain Management

 Dermatology

 Gynaecology

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3.8


The ISTC provider will be expected to work with the NHS, medical schools, deaneries and universities to ensure that training and teaching of medical staff, nursing staff and others continues~ ensuring the future provision of qualified professionals and being an important part of the workforce’s day to day job.

3.9 The PCT‘s plans for re-development of the Royal South Hans (RSH) hospital site as a city community hospital campus within one of the most deprived neighbourhoods of the city, are ambitious and far reaching. In the future, the Trust intends to develop the site into a high profile primary and community care hub, including ‘see and treat’, 24/7 access, elderly rehabilitation beds, and an extensive case mix of outpatient services. The adult mental health inpatient facility will also remain on site but will be rehoused within a brand new facility.

3.10 PCTs view the ISTC as a keystone development which will support their role as commissioners of services for their populations, providing capacity and choice for themselves, and their GPs through practice based commissioning.

The Southampton ISTC has been offered the whole of level C of the

Outpatient building on the RSH site for use by the independent sector partner. This accommodation is currently occupied by existing SUHT and

SCPCT services, and will need to be vacated as part of the enabling works for the ISTC. This business case focuses on the clearance of Level C.

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4: Business Case Purpose, Objectives,

Project Scope & Structure

4.1 The Purpose of this business case is:

To set out the Trust’s proposals for relocating the occupants of Level C of the RSH Outpatient building. The business case supports the strategic objective of clearing the space on Level C that has been allocated for use by the ISTC, and to show how this can be achieved within the ISTC programme timescales and within affordability limits.

The business case follows the requirements of the capital investment

manual as far as possible within the timeframes.

4.2 Key Objectives of the business case are,

 To identify the preferred options for occupants of Level C in order to clear the space for the ISTC

 To provide detail of the preferred options including cost, affordability analysis, risk, benefits

 To make the strategic and economic case for implementing the preferred options

 To link closely with the parallel work being led by SUHT on the SUHT Exit

Strategy and Theatre Continuity Plan, and to deliver a key element of the overall RSH site strategy.

4.3 Principles of the business case are,

 Service and accommodation moves will be on a like for like basis

 Moves will be timetabled to fit with the ISTC programme requirements

 Relocation options will be affordable and realistic

 Moves will be agreed by SCPCT, SUHT, and the ISTC Logistics group

 Moves will not adversely affect patient services and will be agreed by lead clinicians

 Service continuity plans will be implemented

 Each component of the strategy will, wherever possible, deliver its target and act as an enabling scheme for future components

 Moves will maintain, and where possible within the scope, improve the quality of patient care provided

 Changes will be fully in line with the Greater Southampton Health

Plan (GSHP), the SCPCT SSDP (Strategic Services Delivery Plan) and clinical blueprint, and the SUHT 2020 vision

 Service relocations should be minimised and ideally services should move once

 Wherever possible space requirements will be minimised and/or reduced

4.4 Project Scope of this business case covers:

 identification of the services that currently occupy Level C of the outpatient building, including SUHT services off the level (SUHT Exit

Strategy Business Case)

 description of options for relocation of level C services

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4.5


 identification of service issues arising as a result of the need to relocate, together with proposed solutions

 description of service redesign and modernisation that will be achieved through the moves where applicable.

 option evaluation and selection of preferred relocation options

 financial analysis and value for money

 risk management

 the business case meets the requirements of the capital investment manual as far as possible within the timeframes

This business case does not cover:

 service management changes which are happening in parallel

 service development beyond the modernisation that can be achieved within a ‘like for like’ transfer

 service descriptions are not covered in the business case

 accommodation or equipment enhancement beyond current levels, other than where shown to be essential or to facilitate moves

 service or accommodation changes once services have relocated from Level C – these would need to be part of separate business cases

Project structure

The ISTC programme is managed through the South Central Strategic

Health Authority, with an established complex structure of subgroups at which the PCT is represented as key stakeholders.

The Trust has appointed an ISTC Project Manager to oversee the procurement, organise and administer the project structure, and be responsible for the clinical and wider service implementation of the

Treatment centre. They will be responsible for the successful delivery of the

ISTC.

An RSH Programme Manager has also been appointed, who will lead for the PCT on the Level C clearance programme, and also be responsible for other key work on the RSH site, including the site transfer, and car parking policy.

The PCT attends weekly SUHT Project meetings at Southampton General

Hospital (SGH) to take forward the SUHT Exit Strategy, Level C business case, and Theatre Continuity Plan.

The PCT have started to hold weekly internal management meetings, to highlight developments, concerns issues within the PCT.

The project is monitored through the PCTs Capital and Capacity Steering

Group

The PCT will shortly establish an internal RSH Project Board to coordinate all

PCT activity and issues associated with the site and to ensure good communication between PCT stakeholders.

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Public communications will be lead by the PCT and will include

Southampton–wide and RSH residential communications.

SCPCT is involved in staff meetings on the RSH site which are being led by

SUHT.

PPI consultation is being undertaken by relevant organisations on a service by service basis.

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5: Background and strategic case

5.1 The Greater Southampton Health Plan

The GSHP was published in March 2006, and sets out the top priority changes for the Mid and South West Hants local health community over the next three years. A copy of the GSHP can be found in Appendix A

The recommendations within the plan are:

 designed to enable the transformation and modernisation of clinical services

 deliver a balanced and complementary healthcare system

 provide services which are safe, sustainable, and affordable.

The GSHP, which has been adopted across the health community as a priority agenda, includes the following recommendations which are directly relevant to the RSH:

 SUHT to provide and develop the activities of its Foundation Trust core business on the SGH/Princess Anne Hospital (PAH) sites only and exit the RSH site

 Southampton City PCT to assume ownership and management of the

RSH site. The following services to be provided on the site and any surplus land remaining after their provision will be disposed of: o A treatment centre o A walk in centre o A primary care centre o A range of interface clinic outpatient services o A diagnostic capability o A new adult mental health unit

5.2 The ISTC programme

Southampton City has been identified as part of a Department of Health nationwide initiative to develop a second wave Independent Sector

Treatment Centre (ISTC). The RSH Hospital site has been identified as a central point within the city to situate the new centre which will bring many benefits to the local health economy and the people of Southampton.

The RSH site has been selected as the site for the development of an ISTC as part of the national wave 2 procurement. The Southampton ISTC will be delivered within Level C of the outpatient building and will be operational from October 2007. The ISTC will provide a case mix of 20,000 day case/short stay procedures and related diagnostics.

The ISTC procurement is underway with the preferred bidder due to be announced in October 2006.

5.3 The independent sector diagnostics procurement

At the same time as the ISTC procurement is taking place, the SHA are also leading on a separate procurement for an independent sector partner for the provision of diagnostic services.

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5.4

5.5


The independent sector diagnostics procurement programme is running slightly ahead of the ISTC procurement and the independent sector diagnostics independent partner was announced in August 2006 as ATOS

Origin.

There may be scope for negotiation with the independent sector diagnostics partner to work with the health community to resolve some of the service issues that are being raised through the ISTC project, e.g. future provision of endoscopy services

Southampton City PCT

Southampton City PCT is a prominent partner within the local health community, with respect to Strategic Estates Planning, and is the leading organisation for a number of priority estate initiatives.

 The Trust’s Chief Executive is the lead within the Greater Southampton

Health Plan for Estates projects.

 The Trust’s Director for Business and Corporate Services chairs the joint

Locality Estates Group, which covers the Southampton, South West

Hants, and Winchester locality.

 SCPCT is the lead organisation for the South West Hampshire Local

Initiative Finance Trust (LIFT) project.

 SCPCT is the host organisation for the GSHP, and is the employer of the Programme Director and support staff

 SCPCT will take ownership of the RSH site within the 06/07 financial year

 SCPCT led the development of the initial joint SSDP for south west

Hants and is leading on the 06/07 SSDP refresh.

The Trust is delivering a dynamic and ambitious estate programme to modernise and improve primary and community care within

Southampton, in which it is delivering across a range of schemes. These include new developments, site disposals, relocations, rationalisation, and refurbishments. The estate programme is driven by service, locality, and estate strategies, including the SSDP.

The Trust views the RSH site as a flagship site for future delivery of services both for the central locality of Southampton and for the wider population.

Partnership working with SUHT/others

At the same time that the PCT is planning the clearance of Level C, SUHT is also working on a key associated business case:

 SUHT RSH exit strategy/Theatre continuity plan (including exit of SUHT services from Level C), see Appendix J

There is clear overlap between the business cases being prepared by

SCPCT and by SUHT, and therefore there needs to be very close working and collaboration between the two organisations in order to synchronise the separate pieces of work.

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It is imperative that SCPCT and SUHT work closely together to ensure as smooth an exit as possible and with minimal disruption to patient services.

The Trust is committed to this scheme and to joint working and has put dedicated resource in place to progress the project.

The PCT has employed an RSH Programme Manager who will be liaising closely with their counterpart at SUHT to ensure that the Level C clearance is achieved successfully. They will be leading on the estates and technical issues arising for the PCT, preparing the business case, and they will lead the Level C clearance for the PCT.

SCPCT has also employed an ISTC Project Manager who is maintaining an overview of work across the wider ISTC project, and who will be coordinating service and commissioning input from SCPCT. They will also lead on service changes.

In order to ensure good communication around work on the ISTC and the

Level C Exit, SUHT have established a weekly project group which is attended by SCPCT representatives.

Due to the very short timescales for delivery (clearing Level C), the specific

RSH knowledge held by SUHT, and the critically integrated nature of the schemes involved in vacating level C, it has been agreed that the SUHT

Estates and Capital Development department will lead the estates and implementation of the whole programme to clear level C.

21


6: The Royal South Hants hospital

& Outpatient Building

6.1

6.2

The Royal South Hants hospital has served the population of Southampton for over a hundred years; and was at one time the town’s biggest hospital facility, (12 hectares). In line with its age, the hospital occupies a land locked urban city centre site.

The site is currently in the ownership of the SUHT, although site ownership will transfer to the PCT within the 06/07 financial year.

Over recent years, use of the RSH site has declined, being used mainly for the delivery of acute/secondary services including cancer services, outpatient services, minor surgery, and the inpatient mental health unit.

The PCT manages some services on site and also occupies a number of buildings within the close vicinity, which together contribute to and form a wider ‘RSH campus’

 Newtown Clinic/Nicholstown PMS GP practice

 East Park Terrace/Cumberland Place

 Third Age Centre

Estates works are currently taking place on the site, as there is a programme of service moves already underway. SUHT are rationalising service delivery and use of their acute hospital sites, and are moving services off the RSH site. The PCT is also moving some services onto the site within the same timeframe.

These rationalisation programmes are linked to strategic service development and modernisation plans together with the urgent need to meet financial recovery targets.

6.3 The GSHP has identified the RSH site as a key site for rationalisation and for the potential identification of surplus land for sale/disposal.





Current work programmes underway on site include:





SUHT radiology services moving out of the radiotherapy building and relocating back to SGH creation of a Central Southampton ‘One stop’ Locality Primary Care



Delivery Centre, including combination of two GP practices within a single building, minor injuries, community services, and dental services enabling works to car parks and roads to facilitate the delivery of a new build Adult Mental Health Inpatient Unit (AMHU) through the

LIFT project some demolitions in connection with the new build AMHU rationalisation programme for elderly care beds for Southampton patients.

22

6.4


Current work programmes affecting the wider ‘RSH campus’ area, all of which are linked to the East Park Terrace disposal programme include:

 change of use, and refurbishment, of Newtown clinic

 vacation and disposal of East Park Terrace

 refurbishment and occupancy of Cumberland Place.

Full detail of site occupancy and development plans will be presented in the PCT’s RSH Site Transfer Business case, which is being prepared in parallel with the Level C Clearance business case.

The Outpatient building

The OP building is the largest building on the RSH site. It is located at the rear of the site with direct pedestrian access from Graham road and vehicle access from Raven Road.

6.4.1 The building consists of four floors, which are laid out in a square configuration, surrounding four internal square courtyards, which effectively divide the building into quarters (see floor plans, Appendix B).

23


Current occupants of the floors are as follows:

Level A (gross area = 5561sqm)

Restaurant and kitchens

Stores and loading bays

Cancer outpatient clinic

Clinic prep

Pathology/Venepuncture

Audiology

Diabetic resource centre

ENT

Pharmacy/dispensary

Speech Therapy – specialist and non specialist

Conference/seminar room

Level B (gross area = 5362sqm)

Chest clinic

Cardio thoracic

MRI

Plain film X-Ray

Ultrasound

Orthopaedics

Occupational health

Dept of Psychiatry

Specialist nurses/skills

Medical

Level C (gross area = 4648 sqm)

Genito- Urinary medicine

Cardio – non invasive

Breast imaging

Central rehab team

Paediatric dentistry – day theatre

Theatres x 4

Nutrition and dietician

Surgical pre- assessment

Surgery admin/offices

Blood bank

Surgery admin/consultants

IT

Cytology/pathology

Medical offices

Orthopaedic pre-assessment

Medical prep

Dermatology

Level D (gross area = 3897 sqm)

Endoscopy

Plant room

Office

24


7: Level C Occupancy/Clearance

7.1 Identification of Estates Projects

Service changes that need to take place to ensure clearance of Level C have been broken down into two parallel estates projects. The first comprises of projects to be undertaken at the RSH. As the RSH site will transfer to SCPCT by 1 April 2007, these schemes are designated PCT capital expenditure. The second part includes projects to be undertaken at the SGH and PAH. These schemes are designated SUHT capital expenditure. Due to the very short timescale for delivery, the specific RSH knowledge held by SUHT, and the critically integrated nature of the schemes involved in vacating level C, it has been agreed that the SUHT

Estates and Capital Development team will lead the estates implementation for the whole Programme.

This section of the Business Case concentrates on the projects to be undertaken at the RSH site, that is, the SCPCT Programme (projects to be undertaken at the RSH). Section 7.6 details the SUHT Programme (projects to move services from the RSH to the SGH or PAH).

7.2 Genito–Urinary Medicine (GUM)

The Genito-Urinary Medicine service aims to provide a confidential, selfreferral service for the diagnosis and treatment of sexually transmitted infections and their complications including HIV.

It is open access and takes clients from a large geographic area, including

Winchester, parts of Salisbury and the Isle of Wight, although most will come from the Southampton and South West Hampshire areas.

The service is primarily outpatient based, with patients with HIV making up the majority of the small element of inpatient work, and constitutes the following key components:

 All aspects of diagnosis, treatment and clinical management of STIs

 Support and advice with partner notification, prevention of onward transmission

 Screening for blood borne viral infections e.g. Hep B and Hep C

 Treatment and management of HIV

 24 hour Medical On call Service (covering Southampton and SW

Hampshire)

 Follow up investigation and care of victims of sexual assault

 Health promotion/patient education forms an intrinsic component to all

G.U. Medicine work

Education and training is an important role of the GUM service, including medical undergraduates, post qualification training of nurses and specialist training of GUM physicians and primary care clinicians

25

7.2.1


From November 2006, the service will be transferring its management from

SUHT to SCPCT; discussions are still ongoing as to whether this will include the HIV element; this may or may not transfer at a later date.

The GUM service at the RSH is located within 755 sqm on Level C. The accommodation consists of offices, waiting areas, and consulting rooms.

A well established GUM project structure is in place, including representation from clinical /non clinical stakeholders. A Project Team and

Project Board meet regularly to take forward the project remit which covers:

 change of management of the wider GUM service from SUHT to

SCPCT

 future service model

 exit of the existing SCPCT GUM service from RSH level C Outpatient building.

Potential issues with relocating this service

Future management and location of HIV service is under discussion. To be confirmed.

Ensuring confidentiality is considered within the design (e.g. consideration to be given to patient flows, privacy at reception areas)

Ensuring security is considered within the design (i.e. designing out potential security problems plus provision of panic alarms etc – NB. Clinics currently run on into the evenings and there is a distinct possibility that the suite will be used evenings and weekends in future)

Anonymity – it is important that, whilst clients need to easily be able to find the GUM clinic within the building, it should not be instantly obvious to people outside the department that that is where people are going

Environment (should be pleasant, friendly and relaxed)

Proximity to hospital pharmacy – the current design proposals assume that the existing pharmacy remains at the RSH; if this is not the case, there will be a need to build more accommodation for storing and dispensing drugs into the design

GUM Options Appraisal

Option 1

GUM relocate to Level B Outpatient building

The GUM clinic that is currently located on level C occupies 755 sqm which is mainly waiting areas, consulting rooms, and offices. The accommodation is laid out in a logical progression to facilitate the patient pathway between waiting, assessment, treatment, and administration areas.

26


A move to Level B would entail relocation to the equivalent area of space on the floor directly below the current GUM area.

This space on level B is currently occupied by Orthopaedic surgery and part by medical outpatients. These services would be relocated to SGH

West Wing as part of the SUHT Exit strategy.

A move to Level B would be least disruptive to the service and the room configuration suggests that the current GUM layout could be reproduced on level B.

Benefits

 like for like in terms of space available on level B

 opportunity to expand in the future if funding is available

 feasibility work already underway

 supported by GUM staff

 close proximity to hospital pharmacy

 similar level of anonymity to the current GUM service on level C

 appropriate environment for the service

 level B option supported by GUM service staff

Constraints

 Disruption to service during relocation period

Financial Analysis GUM Option 1

Service

GUM Clinic from

C level


Area

M2

RSH level B 755

Costs taken from SUHT Capital Investment Programme

Approx cost

£M2

£1000

Project Cost £k rounded

£775k

The main revenue costs associated with GUM option 1 is the capital charges on the capital outlay of £775k. The forecast capital charges would be circa 43k. The PCT would need to manage these costs within the other revenue costs associated with the RSH transfer.

It is likely that the expenditure of £775k is not likely to enhance the value of the RSH, the DV will value the assets on the transfer, there is a possibility capital charges will not be payable on this improvement as a result of it not enhancing the buildings value. Should they be payable 43k is not seen as a prohibitive investment in the service. The income received through payment by results (PBR) for GUM services will cover this increase.

There should be no other incremental revenue costs associated with this option compared to the current costs associated with the service at the

RSH.

27

7.2.2


Option 2

GUM relocate to Level D Outpatient Building

Level D of the outpatient building is currently occupied by the Endoscopy suite plus general office accommodation.

A move to Level D would entail relocation to the equivalent area of space on the floor directly above the current GUM area.

Benefits

 same building for the service, minimal disruption




Constraints

 Feasibility work undertaken and not enough space on this floor to accommodate the GUM service and Endoscopy


Financial Analysis GUM option 2

Service Proposed location

Area

M2

Approx cost

£M2


GUM Clinic from

C level

RSH level

D

755 £1000 £775


The incremental revenue costs should be the same as option 1- the main revenue costs associated with GUM option 2 is the capital charges on the capital outlay of £775k. The forecast capital charges would be circa 43k.

The PCT would need to manage these costs within the other revenue costs associated with the RSH transfer.

It is likely that the expenditure of £775k is not likely to enhance the value of the RSH, the DV will value the assets on the transfer, there is a possibility capital charges will not be payable on this improvement as a result of it not enhancing the buildings value. Should they be payable 43k is not seen as a prohibitive investment in the service. The income received through payment by results for GUM services will cover this increase.

There should be no other incremental revenue costs associated with this option compared to the current costs associated with the service at the

RSH.

Level D was originally proposed as a potential destination for GUM before the future of the Endoscopy service had been discussed in detail.

It has now been agreed by the PCT, SUHT, and the ISTC Logistics group that an Endoscopy service needs to remain on site within the building, although

28

7.2.3

Full Business Case RSH Outpatient Building ISTC, Level C Clearance. Chris Darling, September 2006 part will transfer to SGH. This means that there will not be enough space on

Level D to also accommodate GUM.

Therefore a level D relocation option is not seen as viable. As set out in

SUHT's exit strategy (see Appendix J section 4.34)

Option 3

Level A Outpatient building

Level A of the outpatient building has some considerable areas of reusable space. However the majority of the available space is in the catering/kitchen area and would require expensive conversion costs totalling approx £1.2m.

It would also require a series of complex enabling works.

Benefits

 same building for the service, minimal disruption




Constraints

 expensive conversion costs totalling approx £1.2m. due to the current use of level A

 Extra enabling works would need to take place before the space was available on level A to start the refurbishment for GUM


7.2.4



Area

M2

Approx cost

£M2


GUM Clinic from

C level

RSH level

A

755 £1500 £1,200k


In options 1 and 2 the capital costs are £775k. Option 3 has increased capital costs to £1.2m. The main reason for this is the added complexity of the works required to the kitchen area. Capital charges on an outlay of

£1.2m would be circa 66k. As with options 1 and 2 they would not be seen as prohibitive but the PCT would wish to minimise such expenditure.

Other revenue costs as with options 1-2 should be no different to the existing costs associated with the current location of the GUM service.

Option 4

Relocate GUM off site

29


There is no alternative NHS accommodation available that is either vacant or that would be suitable for the GUM service without incurring significant refurbishment costs.

Outside property searches and lease arrangements for commercial property would take too long and it is possible that the accommodation found would not be suitable.

Benefits

 no extra relocations if vacant space could be found at alternative

NHS sites or in the commercial sector

Constraints

 no suitable NHS accommodation in the local health community to house the GUM service

 a property search for commercial property would be too time consuming, give the tight vacation timeframes

 no feasibility work started

 accommodation unlikely to be in close proximity to hospital pharmacy

 new site will not necessarily have a similar level of anonymity to the current GUM service on level C

 new site will not necessarily be in the appropriate environment for the service


 Commercial sector prices, likely to be too expensive in terms of rent and rates


Service

GUM Clinic from

C level


Commercial

Premises

Area M2 Approx cost £M2

755 £1000


£775k

£1000 per sqm a cost estimate from HPT FM and Estates shared services for refurbishing commercial office accommodation into clinical accommodation

As well as the capital cost this option also means the PCT would have the additional revenue consequences of renting space from the commercial sector.

The capital cost is assumed to be the same as in options 1 and 2 however this really does depend upon the accommodation found. Rented accommodation is likely to bring the usual issues around accessibility and parking. Capital charges over a lease life of 10 years on 775k would be

104k. The PCT will still be incurring capital charges on the space left vacant at the RSH so not only will it be paying capital charges on “spare space” it will be incurring capital charges on property it doesn’t own. It will also incur

30

Full Business Case RSH Outpatient Building ISTC, Level C Clearance. Chris Darling, September 2006 rent, rates, service charges and energy. We estimate these costs to be circa £278 per square metre based upon recent searches.

Estimated rent and associated running costs of £210k with capital charges of around £110k would take the total running costs to circa £320k. The PCT does not feel this would be affordable within the current PBR tariff associated with the GUM service.

Recent experience the commercial property sector shows the complexities of finding appropriate sized properties, negotiating the lease and refurbishing them within a short timescale.

7.2.5 Summary of financial analysis and preferred option – GUM

From a capital and revenue point of view options 1 and 2 provide the lowest capital and revenue outlay.

However as discussed earlier Level D was originally proposed as a potential destination for GUM before the future of the Endoscopy service had been discussed in detail. Now it has been agreed an Endoscopy service needs to remain on site within the building, although part will transfer to SGH. This means that there will not be enough space on Level D to also accommodate GUM.

The net present values have been calculated for the 4 options associated with the GUM options. Revenue consequences have been included for all

4 options. So cleaning, rates and fuel have been included for all options even through they are not incremental, it enhances the comparability between the options. Capital charges have been excluded as they should not be part of any options appraisal. The discounted cash flow forms can be seen in appendix C.

Option - Capital / Revenue costs consequences over 60 years

Net Present

Value

Rank

GUM Option 1: Level B Outpatient Building

GUM Option 2: Level D Outpatient Building

GUM Option 3: Level A Outpatient Building

1,834,084

1,834,084

2,259,084

1

1

3

GUM Option 4: Off site to commercial premises 6,330,194 4

The above table shows that options 1 and 2 have the same net present value. Although this is unusual the same costs have been assumed for capital based upon the same type of area being used for refurbishment.

On this basis options 1 or 2 would be acceptable options for the PCT.

The revenue funding of options 1 and 2 could be managed within the PBR income for GUM, however the PCT currently has no new access to capital and as such would be unable to fund the capital costs associated with options 1 and 2. The PCT would however like to use its estate to best use, and locating the GUM service within the RSH does this.

31


As a result of the shortfall on capital the PCT would ask the SHA to provide capital to allow options 1 or 2 to go ahead, along with enabling works to facilitate these options as shown in SUHT's exit strategy.

To measure the options in terms of costed benefits a non financial options appraisal was undertaken, to ensure the service and related benefits could be quantified. The same criteria was used as that in the SUHT exit strategy business case.

Summary of GUM options appraisal scoring:

Option score

Option

1

Net

Present

Cost

525 £1,834,084

Option

2

Option

3

495 £1,834,084

310 £2,259,084

£ cost/benefit point

£3,493

£3,705

Difference Switching

£212

6.06%

£7,287 £3,582

Option

4 325 £6,330,194 £19,478 £12,190

The above table shows that option 1 would be the chosen method in terms of value for money, in that it has the lowest cost per benefit point of

£3,493 compared to option 2 with a cost per benefit point of £3,582. A 6% change between options 1 and 2 would result in a switching of the chosen options.

The completed options appraisal scoring for each option can be seen in appendix D.

To conclude, the preferred option (for GUM) on a value for money basis would be option 1 (relocate to level B). The location for option 1 is seen as better than option 2; for the service to retain an entrance used by other services, the service deemed this as very important, to ensure patients retain the privacy required from such a service.

The team has agreed that a move to the same amount of accommodation on level B is their preferred exit solution.

The early design feasibility work for relocating GUM to level B can be seen in appendix E. This shows the like for like relocation to the floor below (level

B).

The revenue consequences of option 1 can be contained within the GUM

PBR income; capital costs require support from the SHA.

32


7.3 Central Rehabilitation Team (CRT)

The Rehab team offer a community based rehabilitation service to over 18 year olds (predominantly elderly clients). Staff operate from an RSH base and visit clients at home. The Central Rehabilitation Team currently occupies 156 sqm on Level C.

The service is a joint service which is led by Southampton City Council

(SCC) Social Services, but which also includes Trust rehabilitation staff. The joint service was established in 2003 when the intermediate care teams integrated.

The PCT element of the service is managed through the Adult Services provider arm. Key stakeholders include:

Debbie Clarke, Local General Manager/PCT Lead for Adult Services

Michaela Tarrant, Service Manager, Intermediate Care, SCPCT

Adrianne Topham, Service manager, SCC

The stakeholders are engaged in the relocation process. Implementation project meetings are set up and these take place on a two weekly basis.

These meetings are to investigate accommodation options and agree feasibility drawings with the users.

Potential issue with relocating this service

The team will need access to SCC computer systems. This has proved a problem in previous rehab team moves and needs to be scoped out as part of the relocation process.

The whole Team use the SCC PARIS IT system. This system is essential to the

Teams ability to function as it is how they receive referrals, record all assessments and case notes and transfer cases onto other Intermediate and Social Services teams. It also provides the performance management information. Therefore any move of this Team will need to take into account the network issues involved in accessing PARIS. Access to the PCT network and PAS system is also needed.

There are strategic reasons for this team to remain at the RSH, there are other rehab staff based in different buildings at the RSH who these staff link with on a regular basis.

It is important the preferred option identified has appropriate office accommodation i.e. natural light etc as some of the staff are office based

9 – 5 Monday – Friday.

7.3.1 CRT Options Appraisal

Option 1

CRT relocates to Level A Outpatient building

Level A of the outpatient building is partly occupied by catering facilities including an Eatery and kitchen/food preparation areas. This area is oversized as it was originally sized to cater for a developing District General

33


Hospital (DGH). However the direction of local NHS policy moved on and the DGH was never developed. This means that there is spare capacity within the area on level A, which can be refurbished and used for relocation of Level C services. Refurbishment of part Level A can be achieved without major disruption to existing services, other than catering, and without displacing patient services.

The requirements for relocating the Community Rehabilitation team include office based accommodation, with IT access to the SCC computer system.

Any move of the team will incur costs around establishing suitable IT links.

This issue is not restricted to the option of moving to Level A, but would equally apply to any relocation destination.

The space available on level A will allow a like for like move.

Conversion costs for moving into a former catering area could be higher than for conversion of other areas.

Enabling measures for this option include; remodel catering on Level A and relocating medical prep from Level C, costs for these enabling works can be seen in section 9.

Benefits

 like for like in terms of space available on level A

 relatively low amount of enabling works to level A to cater for the

CRT

 feasibility work already underway

 suitable office accommodation identified

 supported by CRT staff

 close proximity to other rehab staff on the RSH site

 can be implemented fairly quickly

Constraints

 conversion costs might be relatively high, due to the current use on level A

 disruption to service during relocation period

Financial Analysis Option 1 CRT


Area

M2

CRT from C level RSH level

A


Approx cost

£M2

156 £1500


£250k

34

7.3.2


The capital costs associated with the above option are assumed to be circa 250k. Capital charges on such an investment would be circa 14k.

Such an amount would not be deemed prohibitive in revenue terms.

There should be no incremental change in revenue costs as a result of the service moving from its existing location at the RSH.

Option 2

CRT relocates to Level B Outpatient Building

Relocation to Level B would incur a chain of moves to create space for the rehabilitation service. This would put more pressure on the already tight timeframes.

There is not enough available space on Level B to accommodate GUM as well as the other remaining services, and also to accommodate central rehabilitation.

Benefits

 close proximity to other rehab staff on the RSH site

Constraints

 disruption to service during relocation period

 not enough space to cater for CRT and the GUM service

 level B would be better utilised for clinical space rather than just office space

7.3.3

Financial Analysis option 2 CRT


Area

M2

Approx cost

£M2


CRT from C level RSH level

B

156 £1000 £175k


Capital costs associated with option 2 are less than option 1 by 75k. The capital costs associated with option 2 are £175k. Capital charges on this investment would be circa 10k as with option 1 such an investment would not be seen as prohibitive in revenue terms.

There should be no other revenue concrescences as shown in option 1.

Option 3

CRT Relocate off site

The service is a hospital based service and needs to remain on site. There is no available NHS office accommodation in the central locality area – all

NHS accommodation is already being used to enable other programmes such as clearance of East Park Terrace.

35


Outside property searches and lease arrangements for commercial property would take too long and there would be refurbishment costs. It is highly unlikely that an outside solution could be found close enough to the

RSH to support the rehabilitation service.

Benefits

 no extra relocations if vacant space could be found at alternative

NHS sites or in the commercial sector

Constraints

 no suitable NHS office accommodation in the local health community (central locality) to house the CRT

 a property search for commercial property would be too time consuming, give the tight vacation timeframes

 no feasibility work started

 accommodation unlikely to be in close proximity to the RSH


 Commercial sector prices, likely to be too expensive in terms of rent and rates

Financial Analysis option 3 CRT


CRT from C level Commercial

Premises

Area

M2

Approx cost

£M2

156 £575


£90k

£575 cost per sqm based on tendered total project cost per sqm for Cumberland House (office accommodation)

The capital consequences of this option are assumed to be circa £90k. This is based upon recently tendered works for other estates developments within the PCT on leased commercial premises. Assuming rental over 10 years, this will make the capital charges £12k per year. Rent, rates, energy and services charges have been assumed at £278 per sqm metre to take the revenue cost to circa 43k. However, it is unlikely the PCT would find a building of the exact footprint needed; it is therefore possible that the PCT would have to take a building too larger or too small.

Other costs would be included in excess mileage and travel time which would increase the cost of this option. As with the private rental accommodation in GUM, the PCT would wish to use the space at the RSH effectively before looking to the private sector for its accommodation to relocate CRT.

This option also brings more uncertainty over achieving the relocation within the ISTC programme timeframes, due to the extra unknown variables, such as lease negotiations, finding a suitable premises etc.

36


7.3.4 Summary of financial analysis and preferred option – CRT

The 3 options proposed have a relatively low level capital outlay, option 1 being the highest with option 3 being the lowest. However option 3 would incur recurring revenue investment which the PCT would not be willing to meet within the current financial climate, with option 1 and 2 available.

Option 2 provides the second lowest capital investment.

The net present value of the capital outlay and the associated revenue costs (excluding capital charges) have been reduced (see appendix D) to allow the PCT to analyse the costs of the options over 60 years.

Option - Capital / Revenue costs consequences over 60 years

Net Present

Value

Rank

CRT Option 1: Level A Outpatient Building

CRT Option 2: Level B Outpatient Building

CRT Option 3: Off site to commercial premises

468,831

393,831

1,237,828

2

1

3

Option 3 is the most expensive option with option 2 being the cheapest option in net present value terms. This option is £75k cheaper over the 60 year appraisal period. On this basis option 2 would be the chosen option.

A non financial benefits scoring was undertaken to look at the service benefits of options 1-3. As with the GUM appraisal the same criteria where used that where used for the SUHT exit strategy.

Option score

Net

Present cost

£ cost/benefit point Difference Switching

Option

1

Option

2

660 £468,831 £710 0.80%

550 £393,831 £716 £6

Option

3 375 £1,237,828 £3,301

Option 1 is shown to offer the best value for money in that each benefit point costs £710. The next best option is that of option 2 at £716.

There is little to choose between options 1 and 2 in value for money terms.

A change of less than 1% between the values of option 1 and option 2 would cause a switching.

However, in value for money terms option 1 is the best option. This option is supported by the CRT clinical leads; the early design work for relocating

CRT to Level A can be seen in Appendix F.

37

7.4


Option 2 is not seen as an achievable option if GUM relocates to level B

(GUM preferred option) due to the available space on this floor within the timeframes. Therefore option 1 is also the most achievable option, given the preferred option for GUM.

To conclude option 1 is the best in value for money terms with a 14k investment required in revenue terms. The capital as with the GUM options causes the PCT a problem in that it is keen to use the RSH as much as it can for the benefit of the local population but the 250k required along with the enabling woks highlighted in the SUHT exist strategy (see appendix

J and section 9 of this business case) are prohibitive, we would ask the SHA to support us in the capital requirements of the preferred option 1.

Dentistry

The Trust currently uses space within the day theatre area of Level C for paediatric dentistry where children need interventions under anaesthetic.

The adult sedation service will relocate from level C to level B of the

Radiotherapy building and use the dental surgeries in the new PCDC development (being created at the time of writing this Business Case, as part of the new RSH Primary Care Delivery Centre (PCDC)).

7.5

The dental anaesthesia service, including Paediatrics will transfer to SUHT as part of the Theatre Continuity plan (included in SUHT’s Business Case) which has been produced by SUHT, see appendix J.

Office accommodation

The other moves within the RSH to clear Level C consists of office accommodation space which is to be provided on level A by remodelling/rationalising ex- pathology labs and offices, and reallocating some office functions better.

The Medical Preparation service located on Level C is to be moved into

Level D of the RSH, where it will be adjacent to the existing Orthopaedic

Preparation service. This will allow some operational efficiencies to be achieved as well as achieving the release of space required.

The Nutrition and Dietetics offices on Level C will be relocated to existing space at the RSH on Level A, while the Level C clinical area will use part of the main Outpatients area at the RSH on Level B.

The Medical and Surgical administration offices on Level C will also relocate to Level A at the RSH. This is the balance of Medical and Surgical

Admin not relocated into the existing accommodation at SGH West Wing; and IT support officers from Level C.

Dermatology offices move from level C to level D into existing vacant offices and also to the Dermatology Unit in the ex-Radiotherapy building.

SUHT have examined alternative options for their office accommodation functions. As these offices support functions which will remain on the RSH, this is the preferred site for these offices. There is insufficient space at the

38

7.6


SGH/PAH to cater for these offices, within the timescale required, bearing in mind the RSH and other commitments. Furthermore, the location at the

RSH for these offices was limited by the preferred options for other services relocating within the RSH.

Financial Analysis


RSH level A Nutrition/ other offices from level C

RSH

RSH level D Medical prep from C level RSH

Medical &

Surgical

Admin from

C level RSH

Dermatology offices from

C level RSH

RSH level A

RSH level D and

Dermatology

Unit

Area M2

84

77

100

TBC

Approx cost £M2

£500

N/A

£1000

N/A

Project Cost

£k rounded

£42k

£5k

£100k

NIL

SUHT services

The programme of moves to clear services from level of the RSH has been put into two categories. The SCPCT Programme; these are all the projects to be undertaken at the RSH, as discussed above and the SUHT

Programme. The SUHT Programme consists of 6 projects to be developed at the SGH and 11 projects at Princess Anne Hospital (PAH). A summary of these projects (preferred options) can be seen below. The full analysis and scoring to establish these preferred options can be seen in SUHT's Exit

Strategy business case (appendix J sections 4 & 5).

At SGH the projects are:

 The GI OPD facility, which releases the space for GUM on level B at the

RSH, will be integrated into the Surgical Division’s West Wing facilities on levels E and F.

 Surgical Pre-Assessment and Orthopaedic Pre-Assessment will both be absorbed within the existing facilities in the West Wing to enable the vacation of level C at RSH.

 Endoscopy, relocated from level D at RSH, will have 2 rooms and decontamination, and will be placed adjacent to the GI OPD facilities and the GI ward on E level West Wing. A treatment room will be integrated with Urology facilities on F level West Wing.

 Non-invasive Cardiology from C level RSH, will be incorporated in an enlarged scheme on D level East Wing, with this service being

39

Full Business Case RSH Outpatient Building ISTC, Level C Clearance. Chris Darling, September 2006 delivered under the Cardiac Revascularisation project, currently in the last phases of its development.

 The 2 Theatres will be located on the F level roof of the new North Wing

(the latter is designed to take 2 additional floors), and will be immediately alongside the existing Centre Block Theatres.

The projects at PAH are all focused on accommodating the Breast

Services currently on C level of RSH, and include enabling schemes designed to release sufficient space for the specialty in appropriate clinical and support adjacencies within the Obstetric and Gynaecology

(O&G) environment. The projects are as follows:

 The Breast Imaging clinical service is to be located immediately adjacent to the Obstetrics and Gynaecology (O&G) OPD on E level

PAH. This space is currently occupied by Medical Records offices which are to be relocated down to C level PAH into space released by the closure of the TSSU and Admin & Management offices which will be moved up to J level of PAH.

 There are two minor clinical support schemes: Breast Surgical OPD requires the creation of 3 clinic rooms, whilst the integration of the

Breast Imaging within the O&G OPD results in the need for a new O&G

Reception.

 The Breast Imaging Support and Breast Surgical Support are to be relocated onto level C PAH, into space released by the Catering

Remodelling Project and the provision of a reduced Eatery on E level

PAH.

 To enable the above changes there are 3 minor supporting schemes.

These are: Modify Ward Kitchens, Provide new Entrance Lobby and

Information Point

40


8: Composite & Preferred Options

8.1

It was established in section 7 that the preferred option for GUM would be relocating this service from Level C OP Building to Level B OP Building in a like for like relocation.

It was established in section 7 that the preferred option for CRT is relocating this service down from Level C to Level A of the OP Building.

The adult dental sedation service will relocate from level C to level B of the

Radiotherapy building and use the dental surgeries in the new PCDC development (being created at the time of writing this Business Case, as part of the new RSH Primary Care Delivery Centre (PCDC)).

The dental anaesthesia service will transfer to SUHT as part of the Theatre

Continuity plan which has been produced by SUHT, see appendix J.

The final moves within the RSH include the relocation of offices within the

OP Building, these will move to the available space mainly on Level A after the catering has been remodelled. A full breakdown of these moves can be seen in section 7.5

Whilst options for each service have been considered independently, due to restrictions of the availability of suitable space for service destinations, the preferred options for each service must ultimately come together to form an overall achievable and acceptable composite option. This means that there are dependencies between preferred options, which must be taken into account. This can be seen by choosing the preferred option for

GUM, which limits the space on level B (available within the ISTC

Programme timeframes) for the CRT team (Option 2 for CRT). The preferred options chosen by SCPCT and SUHT ensure all services can be successfully relocated within the agreed timeframes.

Consequently, SUHT Technical Estates, acting for both SUHT and the PCT have developed a number of composite options which provide solutions to multiple service destinations. These options were scored (see appendix

J, section 4) and the preferred option was table 5 below, which fits in with the preferred option of relocating GUM to Level B and CRT to Level A. For a detailed breakdown of each of the options and their scoring please see appendix J.

8.2 Composite Options Table 5

SCPCT Programme Proposed location

1. GUM Clinic from Level C OP Building OP Building Level B

Enabling Measure – GI OPD from Level B

OP Building

2. Central Rehab from Level C OP

West Wing SGH

OP Building Level A

41


Building

Enabling Measure – Remodelling

3. Nutrition/other offices from Level C OP

Building

OP Building Level A

OP Building Level A


4. Medical Prep from Level C OP

Building

5. Medical and Surgical offices from

OP Building Level D

OP Building Level A

Level C OP Building


6. Dermatology offices from Level C OP

Building


SUHT Programme

7. GI OPD facility from Level B OP

Building

Enabling Measure – NA

8. Surgical pre-assessment and

Orthopaedic pre-assessment from Level

C OP Building

OP Building level D and Dermatology Unit

West Wing SGH

West Wing SGH


9. SUHT Endoscopy from Level D OP

Building


10. Non-invasive Cardiology from Level

C OP Building


11. Two theatres from Level C


12. Breast Imaging Clinical service from

Level C OP Building

Enabling Measure – Medical Records from Level E PAH

Admin/offices from Level EPAH

13. Breast Surgical Support & Breast

Imaging Support from Level C OP

Building

Enabling Measure – Catering

Remodelling and a reduced Eatery on

Level E PAH

Provide new entrance lobby/info point

8.3

West Wing SGH

East Wing SGH

North Wing (F Level) SGH

Level E PAH

Level C PAH

Level J PAH

Level C PAH

Level E PAH

Level E PAH

The Preferred Option

The preferred option for the relocation of Level C services is set out in section 4 & 5 of SUHT's Exit Strategy business case, appendix J). A summary of the moves can be seen below.

 GUM to RSH Level B

 Central Rehab to Level A RSH

 Medical Prep to Level D RSH

42


 Breast Imaging to Level E at PAH

 GI OPD from Level B to SGH West Wing

 SUHT Endoscopy to SGH – within medical/surgical GI areas

 Convert 1 Endoscopy room to procedure room on Level D RSH to accommodate SCPCT community dental, pain and dermatology work

 Medical and Surgical Offices to Level C at PAH

 Admin offices from Level E at PAH to Level J at PAH

 Nutrition and Dietetics offices to Level A at RSH

 Breast Imaging support to Level C at PAH

 Move 2 X-ray Imaging machines to SGH

The preferred option also provides suitable and acceptable relocation solutions for SCPCT services as set out in section 7 of this business case, including (the preferred option relocations) CRT and GUM. The options for these services have been fully scored by SCPCT and SUHT and the preferred options have been agreed by staff from both project teams.

43


9: Financial analysis

9.1 The financial summary for SCPCT's preferred option in capital cost terms for

Level C clearance can be seen below (SCPCT’s Programme):

SCPCT Programme

GUM relocates from level C to level B OP Building:

CRT from level C to level B

Cost

£775k

£225k

£225k

OP Building:

Catering remodelling:

(enabling works on level A)

Nutrition/ other offices from level C to level A:

Medical prep from level C to level A:

Medical & Surgical admin from level C to level A:

Dermatology offices from level C to level D and

Dermatology unit

Sub total:


SCPCT Programme total project cost:

£42k

£5k

£100k

NIL

£1,422,000

£171k

£1,593,000

These costs have been put together by SUHT's Estates and Capital

Development department, in calibration with the Quantity Surveyor and are total project costs.

The revenue consequences for each of these moves was discussed in section 7.

The total cost (preferred option) to clear level C (including both SCPCT’s

Programme and SUHT’s Programme) can be seen below:

Element £k

GUM to Level B RSH

Central Rehab to Level A RSH

Medical Prep to Level D RSH

Breast Imaging to Level E at PAH

SUHT Endoscopy to SGH West Wing

GI OPD to SGH West Wing

44

775

500

5

2,080

1,270

1,085

9.2


Medical and Surgical offices from Level C 100

Cardiology to SGH

Nutrition and Dietetics offices to Level A at RSH

117

42

Equipment


350

793

Total 7,117m

This includes a planning contingency of 12%. For more information on this sum please see section 6 of appendix J.

Capital charges will be payable on the above capital investment by

SCPCT and SUHT. SCPCT have tried to include the capital costs within the options appraisal. It is hoped that any expenditure will be rolled into the

DV valuations of the site to be transferred thus avoiding capital charges.

Even if this is not possible the capital charges associated with the changes and benefits to clients mean that the PCT will seek to manage these changes within existing resources.

No capital is available within the PCT for investment within the above options; the PCT would require any available capital to clear level C. The

PCT has to seek to reduce the backlog maintenance on the RSH which is circa £6.1m.

45


10: Early Enabling Works & IT risks

10.1 The SHA have identified some initial capital funds from SHA discretionary capital to be allocated for ‘pump priming’ the ISTC. They invited a joint bid for accessing these funds for the purpose of early enabling works to progress the Level C exit. Consequently a joint bid was prepared on behalf of SUHT and SCPCT and was submitted to SHA for consideration.

10.2

10.3

A response was received from the SHA Director of Finance (Alan Butler) on

2 August 2006, which gave approval for funds to be used for the following purposes (Appendix G):

 £0.45 million to remodel RSH Level A catering, allowing the immediate relocation of PCT central rehabilitation from Level C at the hospital

 £0.45 million to remodel Princess PAH Level E, enabling future transfer of breast imaging from RSH Level C in line with the project timetable

An alternative proposal has since been developed which has been discussed with Nick Roberts (NHS Estates Strategic Advisor) and considered and recommended for approval by the Logistics Group (See Appendix H).

This alternative is self contained and does not require any commitment to additional to funding prior to Business Case approval. This involves:

 Design of the RSH Level A Catering/Rehabilitation Scheme. The design cost is about £50k and this would be underwritten by SUHT. SUHT will also commit funds to essential replacement equipment (£30k

Dishwasher) Once design work is completed the scheme can be implemented quickly post Business Case approval.

 Complete all enabling elements of the works at PAH to enable the conversion of space so that Breast Imaging can transfer (circa £900k).

This includes remodelling of the kitchen, in a similar way to the RHS scheme, to clear space for the release of Level E for Breast Imaging.

SUHT will also commit funds to essential replacement equipment (£30k dishwasher).

10.4 Both schemes stand in their own right and enable more economic and efficient use to be made of assets and support SUHT’s FRP.

A bid for £0.25 million per organisation for fees and project management costs was not approved, and the two organisations were informed that they will be expected to cover these costs themselves as a share of the risk of the larger development not going ahead as planned.

The early enabling works support the preferred composite option; see table 8.2 which is the preferred solution to the clearance of Level C. Details of the early enabling works are being prepared for consideration and approval by the SHA Estates Advisor.

46

10.5


IT Issues & Risks

Business process driven risks relating to IT:

 Interfacing and compatibility with Connecting for Health project and impact on ability to refer electronically

 Continuity of mandatory reporting e.g.. Access to PACs, Clearnet, patient records, etc

 Presence of the RSH IT hub on level C. This occupies space which has been earmarked for alternative use by the bidders, and will need to be relocated. Initial estimate is approx cost £100k. The independent sector partner will be required to fund the move.

 Ensuring continuity of software connectivity for services which are moving, e.g.. rehabilitation team need to access SCC system and vice versa.

 The links to SCC systems will be covered after the PCT has determined the success of their pilot sites (Josian Centre and Bitterne Park) on using their newly finish solution.

CfH programme related risks:

 Access to PACS (images and radiology reports) and not populating the PACS repository

 Access to Electronic Patient Records via Cerner Millennium

 Utilising Cerner Millennium for Patient Administration (if applicable)

 Interfacing with Choose and Book (including population of DoS and therefore becoming a DBS)

 Information Reporting; Continuity of mandatory reporting e.g.. Access to PACs, Clearnet, patient records. There is a clear difference between performance management reporting and clinical operational reporting.

 Interfacing and mandatory reporting are directed towards the ISTC developments which are currently being discussed in the ISTC IM&T work stream meetings.

There will be some implications for the core infrastructure (fibre optic cabling) for the site terminating in HUB room 40 and desktop cabling for level C and parts of B and D terminating in HUB rooms 40 and 39. Both HUB rooms are on C level and their relocation could create costs of up to

£100k due to the nature of the links i.e. links to other buildings on site through unknown ducting. SCPCTs preferred option is for the ISP to relocate this hub and bear the cost, if this does not happen the PCT needs to evaluate how relocating these hubs will be paid for.

IT is a standing item on the GUM and CRT project meetings and issues and risks are managed via these groups with the appropriate IT representatives.

47


11: Communications & Consultations

11.1 Communications

The Public Relations department of the PCT is working on a

Communications Strategy for the development of the RSH site, and an appendix to that is the communications action plan for the development of the ISTC. The Action Plan is designed to address communication needs during the changes that will take place as we deliver the development of the Independent Sector Treatment Centre (ISTC) at the Royal South Hants hospital (RSH) site by the timescales required.

Using the ‘A communications strategy for the development of the Royal

South Hants hospital site’ as an umbrella document, this action plan provides guidelines for all communications relating to the development of the ISTC and for the delivery of activities to achieve this.

11.2 Patient and Public Involvement

Consultation with patient and public is an essential part of the Trusts’ business and we will fully comply with current legislation and national guidance as set out below:

 NHS organisations are required by law to consult on substantial variations and developments to services separately from the requirements of

Section 11.

 Section 11 places a wider duty to involve and consult patients and the public: o Not just when a major change is proposed, but in the ongoing planning of services o Not just when considering a proposal but in developing that proposal; and o In decisions that may affect the operation of services

 The Overview and Scrutiny Committee - Regulations under section 7 of the Health and Social Care Act requires NHS organisations to consult overview and scrutiny committees on any proposal for a substantial development or variation of the health service.

In addition to any necessary formal consultation we need to undertake, we will ensure active patient and public engagement and involvement in the projects appended in the communications strategy using a variety of media, e.g. PPI Forum, GP Patient Groups, Patient Forums, user groups and stakeholder meetings.

We will work with our partners in health and liaise with the local authority and other local agencies to ensure a co-ordinated approach to public engagement activity.

48


12: HR Considerations

12.1 HR Considerations

A number of Human Resource issues are relevant to this project. These are:

The transfer of staff from the RSH site to the SGH/PAH sites, where the services they provide are to transfer

The transfer of staff from SUHT to Southampton City PCT where the services they provide are to transfer

Reductions in staff numbers, where the overall volume of services delivered by SUHT is to reduce, but services are not directly transferring to another provider.

12.2

12.3

12.4

12.5

The way in which these issues will be managed is outlined below.

Staff Transfers between Sites

Where a service is to transfer from the RSH to the SGH/PAH sites, some staff currently based at the RSH will need to move with the service. Staff contracts include provision for changes of base where this is necessary for service reasons. Staff affected will be informed of the planned change and consulted on relevant details as required by current Trust policies.

Mileage or other travel allowances to compensate for changed locations will be payable for between 2 and 4 years, depending on the individual’s contract of employment for those staff whose travel distances will be increased by the change.

Staff Transfers to SCPCT

Some services identified in section 7 will be transferred to Southampton

City PCT as part of this project (i.e. GUM). The staff working in those services will also transfer to the management of the PCT. These transfers will take place in accordance with TUPE regulations. As the transfers are from one NHS organisation to another, staff terms and conditions of employment and associated entitlements such as pensions will be unaffected.

Staff Transfers to ISTC

Within the overall project, there is scope for some staff to transfer to the

ISTC. DH guidance on how this would be carried out is awaited.

Reductions in Staff Numbers

Any requirement for reductions in staff numbers resulting from the RSH Exit

Strategy will be managed in accordance with relevant SUHT policies. As noted above, this project is being planned and implemented in the context of other change programmes within the Trust, such as the

Financial Recovery Plan. Trust action across these programmes will be consistent.

49


13: Timetable & General Issues

13.1 This project is influenced by timescales for the implementation of the ISTC project at the RSH site. This has resulted in the following requirements:

 the delivery of this FBC by September 2006

13.2

 the vacation of Level C of the RSH site by the end of March 2007, other than for Breast Imaging

 the move of Breast Imaging by the end of June 2007

 the transfer of ownership of the RSH site to Southampton City PCT on 1 st

April 2007

The PCT is working with SUHT's Estates and Capital Development team to ensure the services based on level C vacate this area within the agreed timescales as set out above.

13.3

The ISTC programme timeframes have been shared with the design team

(including Architect, M&E Consultant and Quantity Surveyor) and they have confirmed that the timeframes to clear Level C (end of March 2007, apart from Breast Imaging) are achievable. A detailed timetable is currently being worked on.

Key Milestones :

 Initial PCT position statement to SLG

 Business case to PCT Directors group

 Business case to SHA capital group

 Business case to PCT Trust Board briefing

 Business Case to PCT Public Trust Board

 Early enabling works

 ISTC financial close

 RSH site transferred to SCPCT

 CRT & Office moves to Level A

 GUM and Theatres relocate from Level C

 Breast Imaging relocate from Level C





Vacation of Level C and ISP access

Full vacation of Level C

 ISTC Commissioned and Operational

Milestones for SUHT associated work :

 Draft Exit strategy to SLG

 Early enabling works

 RSH Exit Strategy BC & Theatre Continuity plan

To Trust Board

4 Aug 06

8 Sept 06

14 Sept 06

19 Sept 06

28 Sept 06

Sept/Oct 06

Dec 06

Apr 07

End December 06

End March 07

End June 07

1 st April 06

1 st July 07

Oct 07

4 Aug 06

Sept/Oct 06

End Sept 06

13.4 General Issues

 Site transfer from SUHT to SCPCT to be finalised – SUHT Trust Board concerns to be identified and addressed. Business cases to be agreed in September.

 IT hub on Level C – currently serves the RSH site ,and will need to be moved with minimal interruption to service

50


 Breast imaging equipment - imaging equipment is bulky and in many cases fixed to the floor on Level C. It will need a specialist removal team to move it to PAH. It will be costly to move and may affect waiting times as it would mean no service provision during the move and set up at PAH. Needs to be identified in the Theatre Continuity

Plan from SUHT as service will need to be provided locally due to the

Cancer 2 week wait etc.

 Understanding of services provided by SUHT at RSH are still not resolved

 Management of some services will transfer to the PCT

 Transport criteria to be formalised to fit in with the PCTs current arrangements. GPs need to be aware of any new arrangements, including restrictions

 Site car parking to be reviewed

 RSH telephony is managed through the main switchboard at SGH.

 Dependency identified between ENT and breast imaging – to be investigated

 Potential disruption due to site construction works

51


14: Risks

1.

Affordability

2.

Tight delivery timetable

3.

Business continuity throughout the changes

4.

Possible risks to patient care

5.

Ability to control costs – unexpected additions

6.

Possibility of unexpected technical problems arising e.g. Asbestos, IT , telecoms

7.

Maintenance of activity levels and meeting waiting targets

8.

Multiple organisations involved – different political agendas

9.

Maintaining communication across a complex project structure

10.

Complex plan with dependencies and chains. Slippage affects critical path.

11.

Very little leeway for slippage – reduced opportunities for contingency plans

12.

Complexity of site ownership negotiations

13.

Concurrent site construction works through LIFT enabling

14.

Concurrent service management changes

See risk log in appendix I to review the main risks relating to clearing level C within the timeframes.

52


15: Recommendations

15.1

15.2

Southampton City Primary Care Trust Board, Southampton University

Hospitals NHS Trust Board, and South Central Strategic Health Authority

Board are recommended to approve this FBC.

South Central Strategic Health Authority is recommended to allocate the capital funds identified in Chapter 9 of this FBC and Chapter 6 of SUHT's

Business Case.

53

SCPCT Business Case for the RSH

Full Business Case

RSH Outpatient

Building

ISTC, Level C

Clearance

Contents

1.0 CEO’s Foreword

2.0 Executive Summary

3: Introduction

4: Business Case Purpose, Objectives,

Project Scope & Structure

5: Background and strategic case

6: The Royal South Hants hospital

& Outpatient Building

7: Level C Occupancy/Clearance

8: Composite & Preferred Options

9: Financial analysis

10: Early Enabling Works & IT risks

11: Communications & Consultations

12: HR Considerations

13: Timetable & General Issues

14: Risks

15: Recommendations

Related documents

Products

Support

SCPCT Business Case for the RSH

Full Business Case

RSH Outpatient

Building

ISTC, Level C

Clearance

Contents

1.0 CEO’s Foreword

2.0 Executive Summary

3: Introduction

4: Business Case Purpose, Objectives,

Project Scope & Structure

5: Background and strategic case

6: The Royal South Hants hospital

& Outpatient Building

7: Level C Occupancy/Clearance

8: Composite & Preferred Options

9: Financial analysis

10: Early Enabling Works & IT risks

11: Communications & Consultations

12: HR Considerations

13: Timetable & General Issues

14: Risks

15: Recommendations

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