SWBTB (2/10) 045 (a) 12. PREFERRED OPTION In summary a comparison of the 3 options short listed for public consultation and Do Minimum shows: Table 14: Summary of Option Appraisal Clinical Case for Change Non- Option Scores Public Consultation Financial Appraisal Do Minimum Option 1 Option 2 Option 3 Does not meet Partly meets Partly meets NCAT or RCOG NCAT and RCOG NCAT and RCOG recommendations recommendations recommendations Lowest score Second highest score Not included 26% of respondents preferred Third score 24% of respondents preferred highest Meets NCAT and RCOG recommendations Highest score 43% of respondents preferred Capital Costs £3.3m £1.8m £1.8m £1.8m Affordability -£5,231k -£3,187k -£3,187k - £3,272k (based on the forecast Obstetrics trading position in 2013/14 and compared to a baseline deficit of £4.6m.) Investment 3 1 1 2 Ranking Cash Flow 3 1 1 2 Risks - Clinical Highest (numbers Joint lowest Joint lowest Second Highest of red & amber) (numbers of (numbers of (numbers of amber) amber) amber) Risks – Financial & Activity Lowest Middle Middle Highest On the basis of the above, ‘Do Minimum’ had the weakest position in most areas of analysis. Options 1 and 2 had the best position from a financial and risk analysis but neither of Options 1 and 2 were the preferred option from public consultation and neither fully meets the recommendations from external clinical reviews. Option 3 has the strongest non financial appraisal score and is clearly the preferred option from public consultation. In addition Option 3 meets the recommendations of the external clinical reviews. However, it is weaker from a financial (although not significantly weaker) and risk analysis. In terms of the risk analysis Option 3 carries similar financial and activity risks to those of options 1 and 2 and whilst it has no red clinical risks post mitigation it does have the additional risks associated with attracting sufficient births to the stand alone Birth Centre to make this clinically and financially viable. Option 3 is therefore the recommended option from the Project Steering Group. 30
SWBTB (2/10) 045 (a) 13. CASHFLOW PHASING OF PREFERRED OPTION Table 15: Cash Flow 2009/10 <strong>2010</strong>/11 2011/12 2012/13 2013/14 NPV Over 4 Yrs £'000 £'000 £'000 £'000 £'000 £'000 DCF 3.5% 1.00 1.00 0.97 0.93 0.90 Ranking Do Minimum Option 1 Option 2 Option 3 Income 27,875,559 27,898,819 28,150,754 28,332,506 28,522,675 Capital Costs 0 (2,424,027) (932,318) 0 0 Revenue (29,604,181) (30,255,914) (30,625,019) (30,727,245) (30,860,363) Cash flow total (1,728,622) (4,781,122) (3,406,583) (2,394,739) (2,337,688) Discounted Cash Flow (1,728,622) (4,781,122) (3,291,384) (2,235,515) (2,108,461) (12,416,482) 3 Income 27,875,559 27,898,819 27,186,021 27,912,074 28,646,566 Capital Costs 0 (1,521,040) (329,806) 0 0 Revenue (29,604,181) (29,506,080) (29,419,584) (29,506,795) (29,639,913) Cash flow total (1,728,622) (3,128,301) (2,563,369) (1,594,721) (993,347) Discounted Cash Flow (1,728,622) (3,128,301) (2,476,685) (1,488,689) (895,942) (7,989,616) 1 Income 27,875,559 27,898,819 27,186,021 27,912,074 28,646,566 Capital Costs 0 (1,521,040) (329,806) 0 0 Revenue (29,604,181) (29,506,080) (29,419,584) (29,506,795) (29,639,913) Cash flow total (1,728,622) (3,128,301) (2,563,369) (1,594,721) (993,347) Discounted Cash Flow (1,728,622) (3,128,301) (2,476,685) (1,488,689) (895,942) (7,989,616) 1 Income 27,875,559 27,898,819 27,086,021 28,175,077 29,454,073 Capital Costs 0 (1,521,040) (329,806) 0 0 Revenue (29,589,598) (29,506,080) (29,419,584) (29,882,628) (30,532,413) Cash flow total (1,714,039) (3,128,301) (2,663,369) (1,707,551) (1,078,340) Discounted Cash Flow (1,714,039) (3,128,301) (2,573,303) (1,594,017) (972,601) (8,268,222) 2 The table above shows a detailed discounted cash flow analysis of all options. Options 1 and 2 show the same NPV over the four year period and therefore have the same ranking. 14. PROPOSED TIMETABLE A detailed implementation plan will be developed once the preferred option has been approved by the <strong>Trust</strong> and <strong>Sandwell</strong> PCT at their <strong>Board</strong> meetings in February. This implementation plan will then be subject to a Gateway Review by the Office of Government Commerce in early May. The Department of Health, as part of its guidance on service reconfigurations requires such Gateway Reviews at critical points during a service reconfiguration project, with one being at the point of Business Case approval and prior to approval of the implementation plan. In this context key drivers to implementation timescale and proposed dates are summarised below. 31
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