Agenda and Papers for Public Board Meeting June 2013

BOARD OF DIRECTORS
MEETING IN PUBLIC
27 June 2013
PAPERS

Board of Directors’ Meeting Part I in Public
27 June 2013
09.00 Education Centre, Birmingham Children’s Hospital
AGENDA
Item No. Item Outcome Time Allocated
time
Report type
13.144 Apologies for absence Note 09.00 05 mins Verbal
13.145 Declarations of interest Note Verbal
13.146 Minutes of public Board meeting 30 May 2013 Approve 09.05 05 mins Enclosure 01
13.147 Matters arising from public Board meeting 30
May 2013
Note
Verbal
13.148 Chairman’s Report Note 09.10 15 mins Verbal
13.149 Chief Executive’s Report Note 09.25 30 mins Verbal
Strategy
13.150 CAMHS Tier 4 Business Case David Melbourne, Approve 09.55 40 mins Enclosure 02
Deputy CEO, Dr Linda Cullen, Clinical Service
Director Tier 4, Marie Crofts, Associate Service
Director CAMHS
10.35 Break – 10 minutes
13.151 E Vision at Birmingham Children’s Hospital, Approve 10.45 40 mins Enclosure 03
Taking the Hassle out of Healthcare
Georgina Dean, Deputy Chief Officer,
Contracting & Performance and Fiona Reynolds,
Deputy Chief Medical Officer
Quality & Resources
13.152 Quality Report Fiona Reynolds, Deputy Chief
Medical Officer and Michelle McLoughlin, Chief
Nurse
Note 11.25 20 mins Enclosure 04
13.153 Performance Report Georgina Dean, Deputy
Chief Officer, Contracting & Performance
13.154 Resources Report Phil Foster, Interim Chief
Finance Officer, Theresa Nelson, Chief Officer for
Workforce Development
Governance
13.155 Use of the Trust Seal Gwenny Scott, Company
Secretary
Note &
Approve
Note &
Approve
11.45 15 mins Enclosure 05
12.00 20 mins Enclosure 06
Approve 12.20 05 mins Enclosure 07
13.156 Questions from members of the public 12.25 10 mins Verbal
Part II of this meeting of the Board of Directors will be held in private, as the information to be discussed
is exempt from public disclosure under the Freedom of Information Act 2000.
Next meeting of the Board of Directors: 30 July 2013, Education Centre

Unconfirmed
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BOARD OF DIRECTORS MEETING
Minutes of the meeting held in public on 30 May 2013 at 09.00
in the Education Centre at Birmingham Children’s Hospital
Present Keith Lester KL Interim Chairman
Tim Atack TA Chief Operating Officer
Phil Foster PF Interim Chief Finance Officer
Jon Glasby JG Non Executive Director
Judy Green JAG Non Executive Director
Colin Horwath CH Non Executive Director
Michelle McLoughlin MM Chief Nursing Officer
David Melbourne DM Interim Chief Executive Officer
Theresa Nelson TN Chief Officer for Workforce Development
Roger Peace RP Non Executive Director
Fiona Reynolds FR Deputy Chief Medical Officer
Elaine Simpson ES Non Executive Director
Attending Gwenny Scott GS Company Secretary (minutes)
Matthew Boazman MB Director of Strategy and Planning
Jim Gray JXG Clinical Director - Clinical Support Services(for item
13.125)
Ref. Item Action
13.116 Apologies
Vin Diwakar, Chief Medical Officer, Elaine Simpson, Non Executive Director and Jon Glasby,
Non-Executive Director.
13.117 Declarations of Interest
None.
13.118 Minutes of the Board meeting held in public on 30 April 2013
Subject to a minor amendment to item 13.091 the minutes of the last meeting were agreed as
an accurate record.
13.119 Matters arising from the Board meeting held in public on 30 April 2013
There were no matters arising not covered by the agenda.
13.120 Chairman’s Report
KL verbally reported as follows:
• The new £3.6m PICU extension officially opened on 16 May.
• The 1000 th operation to take place in the Laparoscopic Theatre was celebrated this
month. The theatre opened in early 2012, providing cutting edge technology for the
benefit of our patients and a comfortable and safe working environment for our staff.
• Last week it was announced that Jo Davis will not be returning to the role of Chairman
for the last months of her final term following her recovery from a serious illness. KL
read out the message that has been circulated in this regard.
The Board noted the verbal report.
13.121 Chief Executive’s Report
DM reported verbally as follows:
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Internal Activity
• Last week was International Clinical Trials Day which gave an opportunity to celebrate the
impact of research for children and young people. There have been positive developments
in research over the last year, with 200 active clinical trials within the Trust and 2,000
children and young people taking part in 2012/13.
• Last week the Annual Patient Safety Congress took place in Birmingham and on Monday
the International Paediatric Patient Safety Day was hosted by Birmingham Children’s
Hospital. It was a great success with international speakers and our own clinicians
speaking on areas including the clinical handover project and patient safety initiatives in
PICU. The Board thanked the Chief Medical Officer and his team for arranging this
prestigious event.
The Congress was well attended by our staff and the Associate Director of Governance is
compiling all the learning to incorporate into our Safety Strategy.
• The Team commissioned by the Department of Health to investigate issues connected
with the Jimmy Savile inquiry visited the hospital as part of a fact finding mission involving
a range of trusts. The team met with a range of senior staff to discuss issues including
safeguarding, staff checks, celebrity visits, security and fundraising. They also visited wards
and talked to staff. Kate Lampard, who is leading the investigation, has provided very
positive verbal feedback; they were very impressed with what they saw and heard,
particularly our safeguarding practices and the understanding of staff about safeguarding,
which is amongst the best they have seen. They were also impressed with the way we
have addressed some difficult issues, such as the change to the law on criminal records
checks.
• Our application to join the NHS Employers equality and diversity programme was
successful. This is an important step following the Board’s away day on this subject.
• Following the Board debate about the Trust’s strategic priorities for the next 18 months a
staff leaflet has been distributed and sessions are taking place to support managers in
translating the priorities for their teams. There had been some concern from the Board
about the number of priorities but initial feedback from staff is that this provides
flexibility. Managers have requested a suite of tools to support them. This work will feed
into the Intent event in September.
• The Star of the Month this month was awarded in the Unsung Hero category to Lorraine
Cumberlidge in Procurement who was nominated by a number of people external to her
department for her contribution to the smooth running of the procurement team.
• The Big Bandage, the latest campaign in the cancer fundraising appeal, has been launched;
on 12 July people are being asked to wear a bandage for £1.
• Deutsche Bank, a friend and supporter of the Trust, have agreed to a £20k package for this
year’s winter ball. Their Global Head of Risk, whose son was treated in our cancer unit, is
also providing support and advice on reporting risk and ways to simplify the Board
Assurance Framework.
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TN added that a cross-mentoring relationship is also being developed with Deutsche Bank,
which is providing opportunities for leadership development.
External Activity
• Demands facing emergency departments across the NHS are taxing the system,
particularly in the West Midlands, where BCH is the only trust currently meeting its 4-hour
target. Emergency department leaders from across the region have written an open letter
to all chief executives describing the situation as a “crisis” which is approaching a safety
risk. 18 of the 21 emergency department leaders have signed the letter including our own
Ben Stanhope. He has confirmed, however, that he did so as an expression of solidarity
with his colleagues, as patient numbers are also increasing at BCH. He also confirmed that
there are no safety concerns in our ED.
TA added that every trust has been asked to produce an emergency department recovery
plan and our commissioners are focusing closely on the 4-hour target.
• A new Dean of Medicine at the University of Birmingham has been appointed. He has an
impressive track record and is already known to some of our clinical staff through his links
with liver services. He will be a key partner for BCH.
• Our joint response with UHB and the University of Birmingham has been submitted to the
invitation to tender for Applied Health Sciences Centre status. The Board will be kept
informed of progress.
• We have been successful in our bid to be the leader of the paediatric cross-cutting theme
for the NIHR Rare Diseases Translational Research Collaboration. This means BCH will be
the lead recruiting site for all rare diseases research, which provides commercial
opportunities and a strong position for future bids.
The Board noted the verbal report.
STRATEGY
13.122 Community Mental Health Services
DM presented a paper which links to one of our strategic priorities. Following a number of
events with CAMHS staff to discuss the impact of the funding withdrawal it is timely for the
Board to debate next steps.
So far, there has been engagement with a number of partners:
- Brigid Jones, Cabinet Member for Child and Family Services is very supportive but has
been clear that Birmingham City Council will not reinstate the funding, which was
withdrawn on the understanding from commissioners that it would be provided for by
the health economy.
- Steve Bedser, Cabinet Minister for Health and Wellbeing - a friend of BCH and very
supportive of a move to the Edgbaston site - wishes to work in partnership on this
issue. He has challenged the Trust to change the way services are delivered in response
to the cut, as the Council must do.
It is now clear that, while they may act as a civic broker, there is little practical support
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that the Council can offer.
- The Chair of the Health Overview and Scrutiny Committee (HOSC) had not been aware
of the issue and advised that approval through HOSC will be required. Legal advice has
confirmed this.
- Diane Reeves, CEO of the CCG has been clear that the 2013/14 funding will not be
provided beyond that period. The Commissioners do not accept that this is
decommissioning of services and they expect 100% delivery until 31 March 2014, which
will be a real challenge given that patients will need transition.
- A difficult meeting took place with the GP commissioners, at which a troubling lack of
understanding about the service was apparent. There was no comprehension that the
mental health needs of 1,500 children and young people will need to be met elsewhere
and there was a clear sense that concerns are not being listened to about the severity
of the risks. Informed decisions about clinical services cannot be made on this basis.
- A more positive meeting took place with a group of GPs with an interest in mental
health, who had no previous awareness of the issue. They understood the probable
impact on children and young people and resolved to write a report to the CCG.
A point has now been reached when the Board must decide how to move forward in balancing
the need to maintain strong relationships with the Trust’s partners with the need to fulfil the
Trust’s role as an advocate for children and young people.
Two avenues remain open:
- Sarah-Jane Marsh (SJM), Chief Executive will return to work in June and will be able to
take a fresh perspective to discussions with the three GP Chairs of the CCG.
- A risk summit involving the Local Area Team could be called. This would be a significant
step.
To support this, the Community CAMHS staff will work on case studies to demonstrate the
impact the loss of services will have on children and young people. This will include an impact
on tier 4 services, as more children and young people will reach crisis point and require
inpatient care.
The Board discussed the following points:
• The Council’s position is based on limited knowledge gained through the Health and
Wellbeing Board, which has no provider representation.
• The focus by the CCGs has been financial – this must be redressed.
• When considering the impact on children and young people in the context of numbers,
it is noteworthy that the number of breaches of the 4-hour ED target, which is closely
scrutinised by commissioners, is tiny compared to the numbers that will be affected by
these cuts.
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• There does seem to be some expectation from commissioners that the Trust should
divert funding from other services if this is considered a priority service. This is not in
the financial plan and indeed is not part of the contract.
• There is a need for some urgency, as redundancy notices will need to be issued to staff
in the autumn.
The Board agreed the following:
• This is a test of the Trust’s advocacy role and a strong position should be taken.
• A proposal based on service delivery with 25% less resource will be prepared and
presented as an offer to commissioners with a request for confirmation about how the
risk to the 1,500 children and young people will be managed.
• SJM will liaise with the CCG Chairs.
• If these actions do not achieve a satisfactory outcome the Board supports a call for a
Risk Summit.
• Board members will spend time with CAMHS staff to help understand the issues and
demonstrate support.
13.123 Quality Report
QUALITY & RESOURCES
MM and FR presented the report. The Board discussed the following highlights:
• One incident has been declared a Never Event for wrong site surgery. The child
required bilateral surgery on his feet which was scheduled for 2 separate operations.
Although the WHO checklist was completed, surgery commenced on the wrong leg. The
family was immediately informed and it was agreed that the bilateral surgery would be
completed at the same time. The RCA is not yet complete but initial scoping indicates
that the arrow marked on the child was not visible on his dark skin. The availability of
different coloured markers is being considered.
• The SIRI process has been Leaned so it is now more efficient, which means learning is
available much quicker. RCA chairs attend biannual risk training and are selected for
each SIRI based on their skills and experience. The quality of the RCA is dependent on
the panel chair and membership.
• Two other SIRIs are being considered as potential Never Events. The Commissioners
have been asked to look in more detail at the guidance, as the incidents do not appear
to meet the criteria.
• Mortality rates have returned to previous levels and there are no concerns on any of
the range of mortality data.
• An unannounced walkabout to Theatres three months into a recovery programme has
provided assurance that there are no unknown issues and that good progress is being
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made.
• Edward Timpson MP, Parliamentary Under Secretary of State for Children and Families
has written to the Chair of the Birmingham Safeguarding Children Board (BSCB)
requesting a summary of work done by partners to provide assurance that staff
understand their duties in respect of safeguarding and are properly trained and
supported to carry them out.
We have submitted information demonstrating our compliance and the Chair of the
BSCB is impressed by the monthly report to the public Board on key safeguarding
matters.
The letter also issues a reminder about the statutory responsibilities of all agencies to
work together, indicating there are concerns in this regard. We have requested
clarification of the basis of these concerns so that we can respond.
• We have been working with eight trusts to develop SCAN, a paediatric equivalent to the
safety thermometer. The outcome of the pilot has been taken to the National
Commissioning Board (NCB) with the recommendation that the indicators should be
adopted nationally. The NCB are enthusiastic about the work but are not yet in a
position to take a lead and have asked BCH to continue for a further six months. They
have requested that an additional high-level indicator is developed in relation to
medication – possibly opiate overdose or medication unlicensed for paediatrics.
The Quality Committee will be asked to consider this further, particularly given the
resource implications for the Trust.
The Board accepted the report.
13.124 Performance Report
PF presented the new report, which integrates the key performance indicators.
April was a very busy month which lead to challenges in cancelled operations, Emergency
Department, 18 weeks performance and diagnostics waits.
Cancelled operations
21 operations were cancelled on the day which is an improvement at 1% of all operations but
still above the 0.8% target. There were 47 cancellations in total. Key reasons remain capacity
and more urgent/complex patients.
Diagnostic Waits
TA provided an update on MRI waiting. Demand continues to be higher than capacity with the
waiting list at approximately 1,000, while the target is 750. The redesigned working practices
are having a positive impact. Revised job plans will allow a fourth mobile scanner to be
operated in June giving an additional 84 slots which should reduce the waiting list to 900. It is
hoped that this can be repeated in September.
Commissioners are concerned and are investigating the possibility of support from a private
provider. We are not confident, however, that they will be able to support our cohort of
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patients. Moreover, it is capacity of skilled radiologists to interpret and report on the scans,
which is the issue and often our consultants are asked to undertake this work by private
providers.
The possible use of ultrasound as an alternative for some patients is being investigated.
KL raised a concern highlighted by a parent whose child had to be sedated twice while waiting
for a scan, and came out of sedation during scanning, so the appointment had to be cancelled.
He requested assurance that this was not a systemic issue. TA, MM and FR confirmed that they
were not aware of such an issue but would investigate. The issue of sedation versus general
anaesthetic is currently being debated, as sedation in children has a high failure rate, yet
general anaesthetic carries higher risks.
18 Weeks
Staffing levels in theatres and anaesthetics have increased, allowing increased activity and
reducing waiting lists in April. However, a focus on long waits over 14 weeks has resulted in a
growing waiting list in May. Additional anaesthetic cover and the reintroduction of Sunday lists
in June will help redress this.
The Board discussed the impact on the Monitor rating and the potential for commissioner fines.
The Board noted the report.
13.125 Resources Report
PF presented the report, which had been reviewed in detail by the Finance and Resources
Committee. The following was highlighted:
• Monitor have indicated they have no concerns and confirmation of the predicted
ratings (green for governance and 4 for finance) is expected.
• Surplus is slightly below plan for month one but income and activity have performed
strongly.
• Cash is strong though this will start to drop when the capital programme comes to
fruition.
• CIP remains a challenge. So far only 70% of the CIP target has been identified and there
was a significant deficit in month one. The Quarterly Performance Reviews highlighted
a more positive position in the Medical Directorate with the main concern now in the
Specialised Services Directorate.
The Board discussed the CIP challenge. Historically, failure to achieve CIP has been balanced by
profit from increased activity, but this is no longer possible as high levels of surplus are
essential to the Trust’s strategy.
Clinical engagement is essential. One challenge for specialised services is that engagement from
the surgical directorate is required to achieve savings in Theatres; for example, a specialist was
commissioned to rationalise theatre supplies but the impact was negligible because clinicians
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did not engage.
The Board discussed a possible review of the directorate structure but it was recognised that a
foundation of strong clinical leadership and engagement must be in place first. Different
leadership models must be considered and cross directorate leadership also requires
development. Talent mapping has commenced with a view to the future.
The Audit Committee has requested assurance about clarity on the respective roles and
accountabilities of Associate Service Director and Clinical Director.
It was agreed that the Finance and Resources Committee will consider this further.
TN highlighted the following areas of the workforce section of the Report:
1. A more detailed review will be undertaken to understand the numbers of people
leaving in the first 12 months as this has the potential to impact on quality of care.
2. A review of bank usage has revealed that the reasons are not always correctly recorded
– a vacancy might relate to a vacant shift rather than a vacant post. CAMHS are using
high numbers of bank staff while they are holding vacancies but this is becoming
untenable.
3. Sickness levels are improving but are still behind target. Benchmarking shows we
compare well with other organisations and are well below the national average but this
is a key area for focus as it has an impact on productivity. The Board discussed the need
to use other measures of productivity.
The Board noted the report.
13.126 Infection Control Annual Report
MM presented the report and JXG highlighted the following:
1. The work that started in 2011/12 to control MSSA was maintained throughout 2012/13
resulting in further reductions. Although early in the year, so far in 2013/14 only one
MSSA bacterium has been seen – the best performance to date. These results have
taught us that a lot more can be done to prevent infections with clinical engagement.
2. We have established that there is no C.difficile issue at BCH so attentions are turning to
other antibiotic resistant bacteria. We are leading the field in this area.
MM added that antimicrobial stewardship and the sepsis pathway are two parallel work
streams and in 2013/14 the aim is to bring them together.
The Board discussed clinical engagement with the Right Test, Right Patient, Right Time
campaign which aims to reduce unnecessary testing, improve quality of care, improve patient
flow and manage demand. ED consultants are engaged and, while the campaign is at an early
stage, there are good processes in place.
The Board thanked JXG for the positive report, which demonstrates a good level of staff
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participation.
GOVERNANCE
13.127 Use of Trust Seal
The Board approved the use of the Trust seal.
OTHER
13.128 Questions from the Public
There were no questions from members of the public.
Next Board Meeting: 27 June 2013, Education Centre
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Finance & Resources Committee
19 June 2013
Item 13.150 Enc 02
Report Title
Developing a new CAMHS hospital - a vision for the future
Sponsoring Director
Tim Atack / Georgina Dean
Author(s)
Marie Crofts, Associate service Director
Previously considered by EMT / OLT
Situation
Currently CAMHS Tier 4 inpatient accommodation is not fit for purpose. The feedback from patient, families and
regulators about our care is excellent yet the environment has not been updated for many years. In addition
CAMHS Tier 4 is subject to a competitive market unlike any other service within the Trust and commissioners
have stated that all of their other providers have single bedroom accommodation often with en suite facilities
for children and young people needing inpatient care.
Alongside this environmental upgrading of our facilities to ensure state of the art facilities for our young people
we are developing innovative and alternative models of care to ensure we deliver care at the right time and
place for young people across the region. This may include outreach to other localities as well as day patient
care where appropriate.
Background
We currently provide 34 beds on our Parkview site across three units and 5 beds at Steelhouse Lane. As phase
one of our re-design the service created a specialist eating disorder unit on Irwin ward which has been very
successful. In addition the second phase is to transfer staff from the Steelhouse lane site to Parkview clinic,
thus enabling all our young people to be cared for on one site and all the added value that brings.
This business case is in response to commissioners and regulators (as well as our families) feedback around our
current accommodation. With no access to single bedrooms and en suite facilities we both marginalise
ourselves regarding patient choice (particularly in the EDU market) and fall below expected standards with
commissioners and regulators.
Parkview has had no upgrading to its facilities for many years and the addition of Ashfield acute assessment
unit over 10 years ago results in a facility which is not welcoming or attractive to potential families.
This has been demonstrated recently where we have had instances of families choosing alternative providers
based on our current environment alone.
Assessment
This business case has been developed with all key stakeholders and sits alongside the development and redesign
work currently underway across the Directorate. This looks not to increase our overall bed capacity but
develop new models of care and alternatives to hospital admission.
This includes day care provision where the evidence base exists and outreach models of care, building on our
current home treatment team for Birmingham whilst using our highly skilled expertise within Tier 4.This will
look to therefore create ‘virtual beds’ as opposed to increasing actual inpatient bed spaces.

By making such an investment into our inpatient facilities we are not only ‘future proofing’ our current capacity
and share of the market but ensuring our facilities will be chosen by families as a place to receive the best care
whilst being environmental welcoming and fit for purpose.
By not investing in our environment we are at high risk of losing our current share of the market as
commissioners place children and young people elsewhere in the system and families choosing alternative
providers with better equipped facilities for their children.
Recommendations
For the Committee to support the business case for the investment into the Tier 4 inpatient facilities on the
Parkview site
• The updated business case will have further additions from pages 11-16 and will be circulated prior to
the meeting. The attached latest business case will not be changed except on the pages detailed above.
Key Risks
Risk Description Controls Assurances
Loss of the current market share if
no investment is made through
commissioners sending yp to
alternative providers
Patients and families choosing to be
admitted to other more
environmentally welcoming
providers
Strategic Objectives
Key Impacts
Every child and young person cared for by BCH will be provided with
safe, high quality care and a fantastic patient and family experience
CQC Registration (state
outcome)
NHS Constitution
Other Compliance (e.g.

NHSLA, Information
Governance, Monitor)
Equality, diversity & human
rights
Other

CAMHS TIER 4
Reconfiguration
Business Case
130614 BCH CAMHS Tier 4 Reconfiguration Business Case__Version 1 2- final.docx i
18/06/2013
Version 1.2
14th June 2013

CAMHS TIER 4 RECONFIGURATION
Business Case
DOCUMENT CONTROL SHEET
Version Date File Name Status
0.1 13 th March 2012 120312 BCH CAMHS Tier 4 Ocean
Ward Business Case_Version 0.1
(Draft)
0.2 12 th April 2012 120412 BCH CAMHS Tier 4
Reconfiguration Business
Case_Version 0.2 (Draft)
0.3 1 st October 2012 121001 BCH CAMHS Tier 4
Reconfiguration Business
Case_Version 0.3 (Draft)
0.4 16 th October 2012 121016 BCH CAMHS Tier 4
Reconfiguration Business
Case_Version 0.4 (Draft)
0.5 14 th January 2013 130114 BCH CAMHS Tier 4
Reconfiguration Business
Case_Version 0.5 (Draft)
0.6 12 th February 2013 130212 BCH CAMHS Tier 4
Reconfiguration Business
Case_Verson 0.6 (Draft)
0.7 24 th February 2013 130213 BCH CAMHS Tier 4
Reconfiguration Business
Case_Version 0.7 (Draft)
0.8 14 th March 2013 130313 BCH CAMHS Tier 4
Reconfiguration Business
Case_Version 0.8 (Draft)
1.0 23 rd April 2013 130423 BCH CAMHS Tier 4
Reconfiguration Business
Case_Version 1.0
1.1 2 nd May 2013 130502 BCH CAMHS Tier 4
Reconfiguration Business
Case_Version 1.1
Shell document
Updated shell document
Populated draft
Updated following review
with Project Team / for
workforce figures
Updated draft
Updated draft
Updated draft for review
with Georgina Dean,
Executive Lead
Updated draft
Final draft for review and
sign off by Project Team
Updates following Project
Team meeting of 25 th April
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CAMHS TIER 4 RECONFIGURATION
Business Case
Table of Contents
1. Executive Summary ...................................................................... 1
1.1 Background .................................................................................. 1
1.2 Purpose of the Business Case........................................................ 1
1.3 The Case for Change ..................................................................... 2
1.4 Key Objectives & Benefits............................................................. 2
1.5 Option Appraisal .......................................................................... 3
1.6 Proposed Solution ........................................................................ 3
1.7 Stakeholder Engagement .............................................................. 5
1.8 Financial Impact ........................................................................... 5
1.9 Project Management .................................................................... 7
1.10 Conclusion.................................................................................... 9
2. Background to the Business Case ................................................ 10
2.1 Birmingham Children’s Hospital NHS Foundation Trust ............... 10
2.2 CAMHS ....................................................................................... 10
2.3 Community CAMHS Services....................................................... 11
2.4 Purpose of the Business Case...................................................... 11
3. Case for Change .......................................................................... 12
3.1 Future Strategy & Service Developments .................................... 12
3.2 Meeting current and future demand .......................................... 14
3.3 Fragmentation of Services .......................................................... 15
3.4 Safety & Governance Issues........................................................ 16
3.5 Competition & Patient Choice .................................................... 16
3.6 Ineffective Use of Resources ....................................................... 18
3.7 Barrier to High Dependency Services .......................................... 18
3.8 Accreditation & Commissioner Requirements............................. 18
4. Key Project Objectives & Benefits ............................................... 20
4.1 Integrated Service ...................................................................... 20
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4.2 High Quality, Safe Services ......................................................... 20
4.3 Fit for Purpose / Flexible Accommodation .................................. 20
4.4 Improved Physical Environment ................................................. 21
4.5 Improved Access to Services ....................................................... 21
4.6 Improved Patient and Staff Experience ....................................... 21
4.7 Better Use of Resources ............................................................. 21
4.8 Improved Patient & Staff Flows .................................................. 22
4.9 Increased Income ....................................................................... 22
4.10 Increased Capacity at Steelhouse Lane ....................................... 22
5. Op tions....................................................................................... 24
5.1 Activity & Services Brief.............................................................. 24
5.2 Long List of Options .................................................................... 25
5.3 Short List of Options ................................................................... 26
6. Op tions Appraisal ....................................................................... 32
6.1 Non-Financial Appraisal .............................................................. 32
6.2 Financial & Economic Appraisal .................................................. 34
6.3 Combined Non-Financial and Economic Appraisal....................... 39
6.4 Overall Conclusion...................................................................... 40
7. Proposed Solution ...................................................................... 41
7.1 Services & Activity ...................................................................... 41
7.2 Functional Content ..................................................................... 41
7.3 Design ........................................................................................ 41
7.4 Planning ..................................................................................... 43
7.5 Workforce .................................................................................. 44
7.6 IM&T .......................................................................................... 45
7.7 Equipment.................................................................................. 45
7.8 Equality Impact Assessment ....................................................... 45
7.9 Stakeholder Engagement ............................................................ 45
7.10 Financial Impact ......................................................................... 46
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8. Implementation Plan & Project Management Approach ............. 49
8.1 Project Management & Governance Arrangements .................... 49
8.2 Project Timescales & Plan ........................................................... 49
8.3 Benefits Realisation Plan ............................................................ 49
8.4 Risks ........................................................................................... 50
8.5 Post Project Evaluation............................................................... 50
9. Conclusions................................................................................. 53
Appendix A – Benefits Realisation Plan ............................................. 54
Appendix B – Non Financial Evaluation Criteria................................. 55
Appendix C – Non Financial Appraisal Results ................................... 56
Appendix D – Capital Costs ............................................................... 57
Appendix E – Revenue costs.............................................................. 58
Appendix F – Value for Money assessment ....................................... 59
Appendix G – 1:50 Plans ................................................................... 60
Appendix H - Preliminary BREEAM Assessment ................................ 61
Appendix I – Letter of Support – Planning Officer ............................. 62
Appendix J – Equality Impact Assessment ......................................... 63
Appendix K – Project Plan ................................................................. 64
Appendix L – Risk Register ................................................................ 65
Appendix M – Post Project Evaluation Plan....................................... 66
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CAMHS TIER 4 RECONFIGURATION
Business Case
Table of Tables
Table 1. Non-Financial Evaluation Criteria Weights ....................................................... 33
Table 2. Non-Financial Evaluation - Weighted Scores and Results ................................ 33
Table 3. Capital Cost of Options ..................................................................................... 34
Table 4. Revenue Income Analysis – Forecast 2017/18 ................................................. 35
Table 5. Single Beds and Income Risk – Forecast 2017/18 ............................................ 36
Table 6. Revenue Cost Analysis – Forecast 2017/18 ...................................................... 36
Table 7. I&E Impact – Forecast 2017/18 ........................................................................ 36
Table 8. Economic Cost of Options – 33 Year Appraisal................................................. 38
Table 9. Combined Non-Financial and Economic Appraisal ........................................... 40
Table 10. Proposed Solution - Capital Cost ...................................................................... 47
Table 11. Capital Cash Flow .............................................................................................. 47
Table 12. I & E Impact ....................................................................................................... 48
Table 13. Key Project Milestones ..................................................................................... 49
Table 14. Evaluation Team – Roles and Responsibilities .................................................. 51
Table of Figures
Figure 1. Option 2 ............................................................................................................ 26
Figure 2. Option 3 ............................................................................................................ 27
Figure 3. Option 4 ............................................................................................................ 28
Figure 4. Option 5 ............................................................................................................ 29
Figure 5. Option 6 ............................................................................................................ 30
Figure 6. Option 7 ............................................................................................................ 31
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1. E XE CU TIVE SU M M A RY
1.1 B ac kg ro un d
BCHFT provides inpatient (Tier 4) services and associated outpatient and day care facilities to
children and young people from across the West Midlands and further afield.
Currently the majority of the service is located at the Parkview clinic in Moseley, which
provides 34 beds. Historically, there has been a further 10 beds provided at the Steelhouse
Lane site on Ocean Ward giving a total capacity of 44 beds. However, the capacity has been
reduced to provide 5 beds on this site giving a current total of 39 beds with a plan to close
the remaining beds on the Steelhouse Lane site in 2013/14. The decision to close the beds is
linked to the challenges in managing the service in an acute hospital environment in isolation
to Parkview. The demand for services is still strong and BCH is still unable to accommodate all
children who require a bed.
BCHFT also provides specialist community mental health services to the children, young
people and families of Birmingham who have a registered GP within the City. The teams work
across the city in a multi-disciplinary way which includes, psychiatrists, nurses, psychologists,
family therapists; OTs etc. Within these services operates a single point of access and
emergency response and assessment team and an intensive home treatment team. These
services work in close collaboration with the inpatient service in order to ensure the care
pathway for children requiring differing degrees of service is robust and seamless. There is
currently much work being undertaken to re-design and modernise the community services,
building on current progress.
1.2 Pu rp os e o f th e B usi ne ss C a se
This Business Case seeks to:
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■
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■
■
■
Set out the high level strategy and direction of travel for Tier 4 inpatient CAMHS
through revised models of care based on patient demand profiling, best evidence and
practice;
Set out the case for expanding and reconfiguring the accommodation at Parkview
Clinic to support:
o The transfer of Ocean Ward activity from Steelhouse Lane to Parkview, enabling
all inpatient services to be located on a single site; and
o The creation of single bedrooms throughout Parkview;
Outline the key issues and drivers for this proposal, and the key benefits that are
being sought;
Identify the preferred solution for delivering the project’s objectives, and the financial
impact of this to the Trust;
Describe the preferred solution, the timetable and project plan for implementation;
Set out the future project management and governance arrangements; and
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Seeks the BCHFT Board to approve the proposed solution, which has an associated
requirement for a capital investment of £8.840m.
1.3 Th e C a se fo r C ha ng e
The Trust is recognised as being the leading provider of Tier 4 CAMHS in the region delivering
high quality services. It is a core part of Trust business, delivering care to children and young
people with specialist mental health needs. However it is also recognised that this is a
competitive environment to operate in and whilst there is increased demand there is also
increased provision in the market. To enable the service to remain as the leading provider
continuing to deliver high quality services then the service needs to continue to evolve and
develop. This case focuses on the need for an improved physical environment for delivery of
services but this is only one aspect of the strategy. The service is also considering how it
continues to develop and build on its reputation and the changes already made to ensure it
remains sustainable and fit for purpose in the future. This includes looking at different
models of care so that an inpatient bed is not the only option.
Changing commissioner landscape
Within the West Midlands Tier 4 CAMHS has been commissioned on a regional basis for a
number of years, this was not the case across the rest of the country. Under the new
commissioning arrangements it is defined as a Prescribed Service and so commissioned by
NHS England. This in effect gives us a single contract for the whole of England for these
services.
Prescribed services each have a national service specification which has been developed by
the Clinical Reference Group (‘CRG’). All providers will need to demonstrate compliance with
the specification including independent sector providers. In the future the CRGs will have a
greater influence over commissioning of services and will be key in driving improvements to
services and consistency across the country. The Clinical Director for Tier 4 from BCH is a
member of the CRG.
1.4 Ke y O bj e c ti v es & B e ne fi t s
The following key objectives have been set for this project:
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■
■
■
■
■
■
■
■
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Better integration of services;
High quality and safe services;
Fit for purpose and flexible accommodation;
Improved physical environment;
Improved access to services;
Improved patient and staff experience;
Better use of resources;
Improved patient and staff flows;
An increase in income to the Trust;
Creating spare capacity on the Steelhoue Lane site.
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1.5 Op ti on Ap p rai sal
A number of options have been identified which have been subject to a formal and
structured appraisal in accordance with DH and HM Treasury guidance. The results of this
appraisal are summarised below:
Combined Non-Financial and Economic Appraisal
Economic Costs £000s
Option
2
Option
3
Option
4
Option
5
Option
6
Option
7
Weighted Non-Financial Scores 4.62 5.00 5.57 6.28 6.35 8.40
EAC Impact of Option (£m) 7.794 7.526 7.600 7.456 7.329 6.983
Benefits Points per EAC (£m) 0.59 0.66 0.73 0.84 0.87 1.20
Combined Ranking 6 5 4 3 2 1
% below Option Ranked 1st - 5 0.7 % - 4 4.8 % - 39. 1 % - 30. 0 % - 28. 0 % 0.0%
The results show that Option 7 - the construction of a new first floor extension and the
refurbishment of all wards to create 100% single bedrooms at Parkview - scored highest in
the non-financial appraisal and has the lowest overall economic cost, and is therefore clearly
the preferred option.
These results have been subjected to a number of sensitivity analyses, none of which
materially affect the results.
1.6 P ro po se d Sol uti on
1.6.1 Functional Content
The preferred option seeks to provide an additional 12-bedded unit on the Parkview site to
house the Eating Disorders Unit, and to refurbish the existing wards to provide a 10 bedded
Children’s & Younger Adolescents Unit; a 14 bedded Older Adolescents Unit; and an 8
bedded Assessment & HDU Unit. All 44 beds would be provided through single bedrooms.
This solution in total will provide:
■
■
■
■
■
■
■
■
■
44 single bedrooms with en suite facilities;
An overall increased provision in social spaces, including an external social space;
Treatment Room;
Kitchen, dining and pantry facilities;
Two group rooms;
A music room;
Two quiet rooms;
An Education Room;
Laundry / linen areas;
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■
■
■
■
■
■
■
A shared reception / foyer;
Training kitchen room;
A parents room;
A new fitness room;
Staff office accommodation for the Ward Manager and nurses;
A meeting Room; and
Appropriate WC and storage areas.
Accommodation for the MDT is also included in the brief for the new development. This will
ensure fit for purpose accommodation for all those practitioners involved in the care of
children and young people using inpatient services. This will be on the ground floor and be
re-configured to meet the needs of the MDT.
1.6.2 Planning
Initial discussions have taken place between the Capital Developments Department, the
architects and Planning Officers from Birmingham City Council. Officers were supportive of
the outline plans, and have written to confirm this. A formal planning application is currently
being prepared and is due to be submitted in early May 2013.
1.6.3 Sustainability
A preliminary BREEAM assessment has been carried out, which demonstrates that the
new/upgraded facilities should be able to achieve a rating of “Very Good”, to help support
the delivery of a design that supports a reduction in energy waste and, consequently,
reduced utility bills, whilst demonstrating a commitment to sustainable development.
1.6.4 Flexibility
The use of a framed solution for the building will be considered in the design of the building,
which will enable all internal walls to be of a non-load bearing type. This will allow the
building to be altered at a future date, to meet the changing uses that may be required.
The existing site is sufficiently large that should the building be required to be extended, that
this could be achieved subject to the usual planning processes.
This flexibility will ensure that future directions for care for children and young people with
highly specialised and complex mental health problems can be considered. Thus the delivery
of outreach, day care and other alternatives to inpatient care can be maximised if
appropriate.
1.6.5 Equality Impact Assessment
An Equality Impact Assessment has been carried out, using the standard template issued by
the DH in 2010. The assessment demonstrates that no adverse impacts are expected from
the proposed solution.
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1.7 St ak eh ol d e r E n ga g e me nt
A significant amount of stakeholder engagement has been undertaken through the
establishment of the Project Team which has met regularly throughout the development of
this Business Case, and members of the Team have regularly fed back to colleagues
throughout CAMHS Tier 4 services, and proposals and designs have been widely shared with
staff members.
In addition to this, the Evaluation Panel for the non-financial appraisal of the options
comprised wider members of staff from the Trust, commissioners and patient
representatives.
A number of stakeholder events have taken place to enable views about the proposals to be
raised. These events have been attended by parents of current inpatients, the Trust’s YPAG
group, and inpatient and community staff.
Moving forward, it is acknowledged that there will need to be continued stakeholder
engagement, particularly through the detailed design process. This will involve the Young
Persons Advisory Group (YPAG), an established group of young people who have accessed
services at BCH in the past. YPAG will be asked to seek the views of current young people in
Tier 4 CAMHS regarding the flow and design of the units. Additionally parents will be invited
to evening sessions where their views on each set of plans will be sought. Day time sessions
have also been planned to allow CAMHS staff to attend ‘drop in sessions’ where they can
view the plans and will be asked specifically to input into the designs. Outpatients in the
building during ‘drop in’ sessions will also be invited to give their views.
A formal stakeholder analysis will be undertaken to ensure all key stakeholders are identified
and engaged with through appropriate mechanisms, and at the appropriate times. Particular
attention will be given to external engagement with the public, including local residents to
Parkview in advance of any construction work starting, and the requirements for any public
consultation exercise, as well as links to the local Health Overview & Scrutiny Committee.
1.8 F i nan ci al I mp ac t
1.8.1 Capital Cost
The overall capital cost of the proposed solution has been assessed at £8.840m.
The construction and refurbishment works will be carried out on a phased basis to avoid the
need for existing services to be temporarily decanted. The projected cash flow, based on the
expected timetable for these works, is set out below:
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Capital Cash Flow
Capital Costs £000s 2013/14 2014/15 2015/16 2016/17 2017/18 TOTAL
Works 1,020 2,049 1,611 1,221 34 5,935
Fees 128 257 202 153 4 745
Non-Works 9 17 14 10 - 50
Equipment 60 121 95 72 2 350
Contingencies/Optimism Bias 71 143 113 86 2 416
VAT 231 464 365 276 8 1,343
Total Forecast Spend 1 , 5 1 8 3 , 0 5 2 2 , 4 0 0 1 , 8 1 9 50 8 , 8 4 0
It is possible, therefore, that as the individual phases of work are completed, the
development plan can be reviewed at each stage and the key decision points will be the
commencement of each new phase. The development plan can therefore be reviewed in the
light of:
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■
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The availability of capital;
Commissioner and patient requirements based on available knowledge at each
development point;
Assessment of income risk due to lack of single bed facilities;
Development of the CAMHS service strategy and delivery plan;
Competition and market conditions.
For the purposes of this business case, it has been assumed that the Trust will finance the
capital investment through deployment of internally generated resources. In advance of the
development of the new hospital, the Trust is developing a Medium Term Estates Investment
Plan and it is therefore possible that some or all of the capital investment required may be
financed via capital loans.
Initial discussions within the Trust have also indicated that there is scope for a fund-raising
appeal for some of the CAMHS Tier 4 services, and it is therefore possible that some of the
investment required could be met from charitable funds.
The financing route will be reviewed in advance of the commencement of each phase of
work.
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I & E Impact
The I & E impact of the proposed solution is summarised below:
I & E Impact
I & E Impact £000s 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
INCOME
6,350
6,350
6,350
6,350
7,337
7,779
EXPENDITURE
Pay
Non-Pay
Indirect Costs
Overheads
Capital Charges
3,918
447
707
762
286
3,918
447
707
762
286
3,918
472
711
768
385
3,918
499
716
774
681
4,101
530
750
826
869
4,176
563
768
852
980
6,120 6,120 6,254 6,588 7,076 7,339
NET I & E IMPACT 2 3 0 2 3 0 96 (238) 261 440
The projections set out above show no change in the projected levels of income during the
early years. However, the Directorate is planning to appoint a marketing lead as part of the
implementation stage of the project, with a view to developing a pro-active marketing
strategy and plan for the CAMHS services. The income projections will therefore be reviewed
at the commencement of each of phase of work in light of the emerging marketing plan.
As the financial analysis has shown the potential increase in Trust profitability is minimal as a
result of this development. From a financial perspective the key objective to the investment
is to safeguard existing revenue streams with the potential through new models of care to
increase this in the future. Therefore it does not meet the requirements of the Trust
financial strategy.
1.9 P roj ec t M an ag e me n t
1.9.1 Project Timescales & Plan
An outline project plan for the next stages of the project has been developed and the key
milestones for the implementation are as follows:
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Key Project Milestones
Milestones
Completion By
Business Case approval End May 2013
Planning Permission granted End July 2013
Detailed design and procurement for Phase 1 works End July 2013
Award contracts for Phase 1 works End Sept 2013
Completion of Phase 1 works July 2014
Detailed design and procurement for Phase 2 works End June 2014
Completion of Phase 2 works April 2015
Detailed design and procurement for Phase 3 works End March 2015
Completion of Phase 3 works December 2015
Detailed design and procurement for Phase 4 works December 2015
Completion of Phase 4 works September 2016
1.9.2 Benefits Realisation Plan
An initial draft benefits realisation plan has been developed, identifying the benefits to be
realised by the implementation of the preferred option, and in line with the benefits outlined
in paragraph 1.4 above. This will be developed in more detail and finalised during the next
stage of work.
1.9.3 Risks
Risks for the implementation stage will be managed by the on-going management of a formal
risk register which will be regularly reviewed by the Implementation Team and Executive
Team, and risk mitigation plans will be prepared for all risks quantified as being “high”.
An initial risk register has been produced and there are currently no risks assessed as being
“high”.
1.9.4 Post Project Evaluation
As part of the post-project evaluation, a multi-disciplinary Evaluation Team will be
established, comprising a range of key stakeholders, to evaluate and monitor the benefits of
the preferred solution, and the successful outcome in terms of:
■
■
■
■
Greater assurance of total performance in terms of cost, time and quality;
Clearer definitions of responsibilities;
Reduced exposure to risk; and
Improved value for money.
Set out below is the proposed framework for carrying out the Post Project Evaluation for the
project which will satisfy the requirements of the Good Practice Guide: Learning Lessons from
Post Project Evaluation.
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1.10 Con cl u si o n
This Business Case sets out the case for extending and reconfiguring the Parkview clinic, to
support the transfer of Children & Younger Adolescents activity from Ocean Ward to a new
first floor extension, and to create single bedroom accommodation for all CAMHS Tier 4
inpatient areas.
The Board is asked to approve this Business Case and the associated capital expenditure of
£8.840m.
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2. B AC KG ROU ND TO T HE B U SI NE S S C ASE
2.1 B i rmi n gh am Chi l d r e n’s H os pi t al N HS F o und a ti on T ru s t
Established as the Birmingham and Midland Free Hospital in 1862 on the Steelhouse Lane
site, Birmingham Children’s Hospital NHS Foundation Trust (“BCHFT”) has been offering
medical and surgical services to children for 150 years. It provides general Paediatric care
for south and central Birmingham, as well as being a regional, national and international
centre for specialised treatments, with an international reputation in several areas. It has
circa 230 beds - excluding Child and Adolescent Mental Health Services (CAMHS) - on the
main Steelhouse Lane site.
In addition to this, the Trust has one of the largest CAMHS services in the Country. This
consists of multi-disciplinary Community based services for the city of Birmingham as
commissioned by the local CCGs and other partner organisations, an inpatient facility with
three units on the Parkview site in Moseley and an additional unit on the Steelhouse Lane
site.
2.2 CA M HS
BCHFT provides inpatient (Tier 4) services – and associated outpatient / day care facilities - to
children and young people from across the West Midlands footprint, in additional to children
from outside this area.
The majority of the service is located at the Parkview clinic in Mosley, which provides 34
beds. Historically, there has been a further 10 beds provided at the Steelhouse Lane site on
Ocean Ward giving a total occupancy of 44 beds. However, the capacity has been recently
reduced to provide 5 beds on this site giving a current total of 39 beds.
Therefore the current bed configuration underpinning this Business Case is as follows:
Steelhouse Lane
■
Inpatient facility for children and younger adolescents with 5 beds currently in use, for
children aged between 5 – 18 years old – the only CAMHS unit that admits children of
primary school age.
Parkview Clinic
■
■
■
The Acute Assessment Unit on the Ashfield Ward, with 8 beds;
The Eating Disorders Unit on Irwin Ward, with 12 beds; and
General Adolescents on Heathlands ward, with 14 beds.
In addition to the above, BCHFT provides tertiary CAMHS services which includes hospital
play specialists, Paediatric psychology and liaison psychiatry.
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The wider re-configuration of Tier 4 inpatient services comes after recent work undertaken to
re-design the Eating Disorders Unit in 2011, and in parallel to the re-design of CAMHS
community services that is currently taking place.
2.3 Com mu ni t y C A M HS Se r vi c es
In conjunction with the inpatient units, BCHFT provides specialist community mental health
services to the children, young people and families of Birmingham who have a registered GP
within the City. The teams work across the city in a multi-disciplinary way which includes,
psychiatrists, nurses, psychologists, family therapists; OTs etc. Within these services operates
a single point of access and emergency response and assessment team and an intensive
home treatment team. These services work in close collaboration with the inpatient service
in order to ensure the care pathway for children requiring differing degrees of service is
robust and seamless.
There is currently much work being undertaken to re-design and modernise the community
services, building on current progress, but for the purpose of this business case this work will
be excluded.
2.4 Pu rp os e o f th e B usi ne ss C a se
This Business Case seeks to:
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Set out the high level strategy and direction of travel for Tier 4 inpatient CAMHS
through revised models of care based on patient demand profiling, best evidence and
practice;
Set out the case for expanding and reconfiguring the accommodation at Parkview
Clinic to support:
o The transfer of Ocean Ward activity from Steelhouse Lane to Parkview, enabling
all inpatient services to be located on a single site; and
o The creation of single bedrooms throughout Parkview;
Outline the key issues and drivers for this proposal, and the key benefits that are
being sought;
Identify the preferred solution for delivering the project’s objectives, and the financial
impact of this to the Trust;
Describe the preferred solution, the timetable and project plan for implementation;
Set out the future project management and governance arrangements; and
Seeks the BCHFT Board to approve the proposed solution, which has an associated
requirement for a capital investment of £8.840m.
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3. CA SE F O R CH A NGE
Whilst overall, the Trust is acknowledged to deliver high quality CAMHS services, there are a
number of issues and key drivers underpinning the case for developing a single Tier 4
inpatient unit, with an increased provision of single bedroom accommodation as outlined
below:
3.1 F ut ur e S t r at e gy & S e rvi ce De v el op m en t s
The CAMHS strategy for the future is predicated on continued delivery of high quality and
effective patient care, which is both fit for purpose and provides value for money.
Opportunities for potential new activity and learning from experience are key to the
development of both inpatient and community services. New models of provision have been
successfully piloted - such as the intensive Home Treatment and specialised inpatient Eating
Disorder Multi-Family Therapy - and are being delivered across both community and
inpatient services, and will be built upon over the coming months and years. This may
include a range of services such as specific outreach and day patient care in order to develop
services and expertise to meet the changes in demand and patient need. In addition
development of models of care will be in line with the delivery of services closer to home for
children and young people where appropriate.
Whilst the business case only creates an additional five physical beds on top of the current
39 bedded clinic it will provide the service with significant opportunities for redesigning and
creating an innovative clinical model for the provision of CAMHS services. This will negate
the need for any further beds, despite demographic trends and increasing service demand,
through increased productivity and innovative service delivery which will enable increased
activity to be managed within the available capacity using the most appropriate clinical
model.
On average there are around 120 children and young people from the West Midlands in
psychiatric inpatient care around the Country at any one time. This is an increase which has
taken place over the last 3-5 years. However, the delivery of this kind of care for children's
and young people with highly complex and specialised needs does not always have to take
place within an inpatient unit where appropriate and clinically viable other options can be
utilised. This is illustrated within by the home treatment model.
Our Birmingham City-wide community service has successfully developed an alternative and
complimentary model of care with the Intensive Home Treatment Team and we are now the
approved provider for that service, following the implementation of a successful two year
pilot. We have seen this have a significant impact in terms of the percentage reduction in
occupied bed days and reductions in lengths of stay for Birmingham young people - despite
the context of an overall growing demand across the region. This is an appropriate delivery
model and enables BCH to provide a broad range of services utilising the Home Treatment
Team model and inpatient facility as part of the overall CAMHS strategy. Importantly this
also helps to address some of the concerns flagged by our commissioners regarding the
current length of stay, which is seen as a key priority amongst the commissioners of the
current CAMHS services. This is important as length of stay, innovative treatment models
and the quality of facility being provided for patients requiring inpatient management are all
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seen as key factors for service provision and ensuring that BCH retains a competitive
advantage over other providers.
As we move forward with our CAMHS strategy we wish to expand the offer that is available
across the broader West Midlands region. This is important given the highly competitive
nature of the CAMHS market and the need to therefore maximise opportunities for service
provision and income diversification. Across the broader West Midlands region these
alternative models of treatment have not been developed in line with a previously agreed
regional Tier 4 strategy as rapidly as had been hoped. Going forward our intention would be
to build upon our unique expertise and to work collaboratively with services outside
Birmingham and across the West Midlands in order to be able to deliver alternative
approaches to inpatient care through wraparound support. Should a service model would be
seen as providing a 'virtual' bed model and in particular this service could aid localities in
their care for younger children under 11. Although this age group constitutes a relatively
small proportion of total referrals there is little provision for this group nationally and as a
result local teams have much greater difficulty in addressing the needs of these younger
children.
We have significant expertise with this age group which we can develop and mobilise further
in order to work with other community services so that we can deliver a joined up approach
for these children.
In conjunction with this development BCH CAMHS Tier 4 also has significant expertise in
delivering services for children and young people with Autism. We are currently moving
forward with the Autism Accreditation of our units which is a robust process under the
auspices of the National Autism Society. Very few other Tier 4 units nationally have achieved
this status and this will be a huge unique selling point for our service when fully completed.
Alongside this, in line with the draft national service specifications, we are developing an
Autism second opinion service of which we have a long established history of specialist
knowledge. With this in mind we are aiming to become one of 3-4 national specialist services
providing this care.
Step up and Step Down Provision
All of these different models of care are currently being developed within clinically led work
streams as part of our clinical re- design programme. A particular focus for our inpatient
services is where young people do need timely access to a bed. We are seeking to develop
'step up' and 'step down' care through a managed care pathway model which will increase
the flow and numbers of young people accessing 'actual' beds where appropriate. Children
and young people would be able to move more quickly through inpatient and 'outpatient'
care which will in addition reduce our length of stay further in line with commissioner
expectations.
There is some evidence which exists to support the delivery of day care models for young
people with eating disorders and this again would support our overall strategy for developing
'virtual' beds. Young people could access both inpatient care if indicated and move quickly to
a step down model when appropriate.
As a Specialist Tier 4 provider the primary aim of the development of these innovative
models of delivery is to ensure we act as an advocate for children and young people with
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significant and complex mental health problems and develop delivery of care as close to
home as possible and with as little disruption to children and young people's lives.
We know that as ‘gatekeepers’ of the Tier 4 inpatient service, we do not recommend for
admission around 35% of those children and young people referred. We offer consultation,
advice and local management plans for community CAMHS across the region where inpatient
admission is not indicated and it is this expertise and skill which will help us develop further
alternatives to admission to hospital in the coming years.
With a significant percentage of admissions into inpatient care coming from Birmingham (i.e.
25%), it is relevant to note that Birmingham has a growing population of young people with
forecasts of an increase in the under 16 population of 15.6% by 2020. The city currently has
a population of over 1 million in total (ONS 2012) of which 22% comprise children and young
people aged between 0-15 years. In contrast to the national picture from the recent census,
Birmingham has more children than pensioners, in addition to which, over one third of the
population is of an ethnic origin other than white. It is predicted that in future, Birmingham
will become one of the first cities in the country with a majority population that is non-white.
The child population growth will also mean that there will be a growth of those needing
mental health services which currently stands at 10% of the child population.
As the inpatient service is a regional service, we can anticipate increasing demand given the
current financial austerity. Continuing job loss and financial hardship will impact on the
mental health of families, including that of children and young people. Additionally, for the
first time, the ONS has started predicting an increase in prevalence of mental health
problems for children and young people nationally which again is likely to impact on the
demand for services across the country.
3.2 M e eti ng cu rr e nt an d fu tu r e d em an d
The last three years has seen a significant shift in the numbers and the profile of young
people requiring admission to Tier 4 inpatient services in the West Midlands.
A snapshot survey completed by the then existing West Midlands Specialist Commissioning
Team (WMSCT) in May 2012 demonstrated that 114 children and young people from the
West Midlands footprint were in hospital at that time. This was in line with the noticeable
increase in the number of inpatients from around 90 young people at any one time in 2006
to around 120 in 2012.
During the period April 2011-April 2012, BCH Tier 4 inpatient services admitted 35% of all
children and young people requiring admission. This identifies that the remaining 65% of
young people were admitted to other providers for a variety of reasons. These may have
been owing to a lack of capacity within BCH Tier 4 units or the need for a specialist
placement, such as a low secure environment.
During 2012, the Trust received 298 referrals of which 154 (51%) were assessed as requiring
admission to Tier 4 inpatient services. Only 71 (46%) of these were admitted to BCH, and the
vast majority of the remaining 83 could not be admitted due to a lack of appropriate bed
capacity.
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In parallel, we have seen a changing picture emerging of reasons for admission and levels of
dependency and complexity. Whilst it is accurate to suggest that there is an increase in the
overall numbers of young people requiring admission, we can demonstrate that there has
been an increase in the level of dependency and risk of those presenting for admission and
the age of presentation.
Information from the WMSCT demonstrates that in 2010, around 18 young people over the
age of 11 years were admitted to PICU levels of care. This increased in 2011 and 2012 to over
30 young people per year, nearly half of these being 17 years of age. A third of these young
people presented with ‘psychotic disorder’ and a significant proportion with ‘deliberate self
harm’. This indicates a high level of risk and difficulty managing these young people exists
and is growing and in part may be explained with the changing Mental Health Act and
appropriate admissions for under 18’s legislation.
The SCT’s snapshot survey from 2012 demonstrates that almost 70% of young people in
inpatient care were between the ages of 15-17 years old, with around 42% being 16/17 years
old. This clearly demonstrates that the older adolescent group are those more likely to
present as requiring inpatient care, and indeed are often those with the most challenging
behaviour, whilst not exclusively so.
Although we must be mindful of the growing and changing demand of the young people
presenting for admission, we must also develop complimentary models of care where this
can be delivered safety with the same effectiveness as inpatient care. This can be
demonstrated through the Trust’s delivery of day care services for eating disorders.
Previous audits by the SCT have demonstrated that although children and young people with
Eating Disorders are often not the highest number in terms of admissions at any one time,
they have the longest lengths of stay and the highest costs per case. In line with this, BCH
CAMHS Tier 4 inpatient services developed a specialist Eating Disorder service in November
2011, which has been successful both in terms of outcomes and delivering evidence based
care. This formed the first phase of the re-modelling of services. As part of the longer term
strategic development, CAMHS Tier 4 provision seeks to develop day care and other
innovative models of care for this and other patient groups as described earlier in this
document. The national draft service specifications will now drive the development of such
innovative and alternative models of inpatient care, ensuring care closer to home for children
and young people is delivered.
Although it can be demonstrated that previous and current demand for inpatient care is
almost twice that of the provision within BCH Tier 4 CAMHS proposed in this business case, it
is felt that increasing numbers of children and young people can be treated through the
delivery of services using alternative approaches as described, without admission to hospital.
3.3 F ra gm e nt a ti o n o f S e rvi ce s
Inpatient accommodation is currently provided from two sites across the city. This has
resulted in fragmentation of service delivery, creating safety and governance issues alongside
an inability to meet the current demand of challenging children and young people being
referred to the service.
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The building of a new CAMHS hospital within the current Parkview estate would see a
multitude of benefits for both staff and users of the service. It would create a whole system
of services and an improved pathway for those using inpatient services, ensure efficient use
of resources, and create a sense of belonging for the current isolated Ocean ward team.
Strategically it would give a key message that delivering a high quality effective mental health
service for young people in environments which were fit for purpose was important and a
high priority for the Trust.
3.4 Sa f et y & G ov e rn an c e Is su es
There are a range of safety and governance issues relating to operating a ‘stand alone’ unit
on the Steelhouse Lane site which has become increasingly unsustainable in recent times. In
addition to the ward being standalone from the mental health units at Parkview, it also has
separate day time and sleeping accommodation within Steelhouse Lane site, further
exacerbating the risk issues and creating additional inefficiencies.
As there are no other mental health units or suitably qualified staff on the Steelhouse Lane
site, clinical staff on Ocean Ward currently have no access to emergency help at critical times
when risks increase within their patient group. This has been demonstrated through recent
incidents which have unfortunately escalated and resulted in poor patient / family and staff
experience.
The most recent incident resulted in a decision to reduce the ward occupancy to 5 beds. This
has meant in practice that all accommodation on the Steelhouse Lane site is now in one
location, with sleeping and day time accommodation brought together.
However, having all units co-located in a new hospital facility at Parkview would vastly
improve both the patient experience, the delivery of care and treatment, and ensure robust
governance and safety arrangements are in place for all units. Nursing staff would be close at
hand to assist each other and in planning on a day to day basis, and recognising daily risks
and challenges could occur in a much more systematic and planned way. Added to this,
medical cover for all wards would be readily available on site.
3.5 Com p eti ti o n & P ati en t C hoi ce
The Trust is operating in an increasingly competitive market, with a particular threat from the
independent sector and Foundation Trusts. During the process of developing this Business
Case, Commissioners confirmed that providers have contacted them, expressing an interest
in entering this market. This position will be further exacerbated as a result of the Health
and Social Care Act (2012), which supports and aims to further enforce the principles of both
competition and patient choice.
Robust competition can be demonstrated by the numbers and range of units children and
young people may be placed for care and treatment..
The diagram below highlights the plethora of independent sector units existing (in red)
where children and young people from the West Midlands can potentially be placed.
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Inpatient care and treatment for children and young people with complex mental health
problems is the most competitive market that the Trust operates within, with many
independent sector providers of this type of care across the country that, in total, hold about
40% of the total available capacity. These independent sector providers deliver a range of
services in direct competition to those provided within the BCH CAMHS Tier 4 service, in
addition to a number of specialist services which the Trust does not currently provide and
would not look to providing, such as low and medium secure services.
The service needs to ensure that it is not only delivering excellent care, but that its facilities
are ‘fit for purpose’ and units where families are happy for their children to reside. All other
NHS and independent sector units providing this level of care are doing so within single
bedroom accommodation, many with en-suite facilities attached. The service needs to
ensure delivery of top quality accommodation which can stand alongside its competitors.
We know from experience that parents and young people are exercising their right to choice
through identifying units they wish to be admitted to. This is particularly so for young people
and families where an admission is for an eating disorder. Many independent sector
providers offer this level of care and treatment and often the physical environment is more
aesthetically pleasing then the current specialised Eating Disorder Unit at Parkview. Whilst
our care is excellent as praised during our recent unannounced CQC inspection our
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environment clearly needs improving. If we do not modernise this part of our service we risk
losing a significant part, if not all of the inpatient market over the coming years.
New facilities have come on line in recent years that have been better able to provide more
spacious facilities, including single bedrooms. BCH was the single CAMHS inpatient provider
on the SCT’s commissioning framework for the West Midlands region, that does not wholly
provide single bedrooms, and the Trust has evidence that families have selected to have their
children’s care provided from other providers for this very reason.
3.6 Ine ff e c ti v e U s e of R es ou rc e s
Having inpatient services across two sites does not allow for the best use of resources,
particularly in relation to staff cover. This is most obvious with regards to nursing and medical
staffing but also relates to all the multi-disciplinary team members. By delivering care on one
site, additional help can be gained quickly and team members do not have to factor in
travelling time to and from other off site facilities.
3.7 B ar ri e r t o Hi gh D ep en de nc y S e rvi ce s
The current configuration hinders children on the Ocean Ward from easily accessing high
dependency services, as these are located separately at Parkview. In addition as previously
stated, the demand for inpatient care and treatment has changed over the last 3 years and
the types of presenting problems and levels of challenging behaviour cannot be safely
managed on Ocean Ward owing to its isolation and lack of support on the current site.
Notwithstanding the expertise that exists on Ocean ward with regards to caring for younger
children, with increasing challenges being presented even in this age group these children are
unable to be admitted to Ocean ward currently because of this isolation.
Care pathway driven services will be able to be delivered if all care and treatment is on one
site. Thus if risk and/or dependency issues change for a child or young person they can easily
access the level of care they need at any time. Having a spilt site for inpatient care does not
facilitate this and therefore reduces our ability to admit children with high levels of need
onto Ocean ward currently. This may result in a child or young person being cared for a
greater distance from home.
3.8 Ac c r edi ta ti on & Co mmi s si on e r R equi r e me nt s
The existing accommodation on both Ocean Ward and the Parkview site is not currently fit
for purpose, the main issue being that it does not provide for single bedrooms.
Accreditation requirements and commissioners are increasingly seeking inpatient facilities to
have single bedrooms, or be able to offer children a choice. Whilst there is no specific DH
Estates guidance for Tier 4 CAMHS services, guidance for Adult Mental Health inpatient beds
clearly states that single bedrooms are required.
The current Tier 4 inpatient accommodation across BCHFT only provides for 7 single
bedrooms out of the current total provision of 39 beds. This impacts on the Trust’s ability to
flex the accommodation to take on a different ratio of male / female children, or for
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admitting children with higher acuity needs, as well on the Trust’s ability to provide children
with sufficient privacy and dignity.
BCH was the only provider on the SCT commissioning framework that does not have single
bedrooms for its children and young people. Whilst there is some recognition that not all
children like to be in a single room, the benefits outweigh the disadvantages and by creating
a service with all single bedrooms we can future proof to a large degree the new
environment. Any minor negative impacts of having single bedrooms on all units can be
mitigated against and managed on a case by case basis.
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4. KE Y PR OJ E C T OB J E C TIV E S & B E NE F I TS
The following key objectives have been set for this development:
4.1 Int e g ra t ed S e rvi c e
This project will deliver an integrated Tier 4 inpatient service, operating from a single site,
realising all the benefits outlined in the case for change.
4.2 Hi gh Qu al i t y, S a fe S e rvi ce s
By achieving the above, this development will support the continued delivery of high quality
services that are more clinically robust and safer.
Service delivery will be in line with the national service specifications for each unit and
ensure delivery of safe, effective services based on best evidence and ensuring a positive
patient and family experience.
Integration of the entire service will enhance the delivery of more clinically robust and safer
services. A number of factors which support this are:
■
■
■
■
■
■
Co-location of all services would ensure best use of the entire workforce and
particularly the nursing and medical workforce across the unit. Previous Ocean ward
staff would be integrated into the units using their skills and expertise with younger
children and adolescents and all units would have immediate access to additional
support in a crisis or emergency situation.
Co-location of all units would make improved use of the MDT without the need for
associated travel time and split site working This will therefore increase the clinical
time spent on the wards and available to young people and their families
All senior management support would be located on one site giving additional
support to all the units and the workforce for example Head of Nursing, CNS for Risk
Management and Tier 4 Service Manager
More cross-unit training and rotation opportunities for staff can be implemented
Co-location of services would support more cross-unit training and rotation
opportunities for all staff; and
Incidents could be reviewed in a more timely and efficient manner.
4.3 F i t fo r Pu rp os e / F l e x i bl e Ac co mm od ati on
The CAMHS new hospital development will enable the Trust to deliver services from a
modern estate fit for purpose which provides single bedroom accommodation whilst
embracing new models of service provision.
This will enable the service to be more responsive to the current demand profile of young
people presenting for admission with higher acuity needs and more challenging behaviour. In
addition the service will not be restricted in terms of gender presentation and the ratio of
boys and girls as with current dormitory accommodation.
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The building will be underpinned by a design which supports the flexible use of the
accommodation in terms of the ability to deliver new models of care such as day care options
or development of a High Dependency Unit (HDU).
A flexible design will also ensure that the service continues to meet the changing needs of
patients and commissioners alike.
4.4 Imp ro ve d Phy si c al E nvi ron m en t
In addition to creating additional capacity on the Parkview site, the new hospital will provide
an opportunity to improve other factors and facilities as part of the patients journey whilst
and inpatient.
These include development of a gym for patient use; accommodation on site for parents to
stay whilst designing an environment which is innovative and welcoming, making maximum
use of daylight. Alongside this will be the improved use of the existing courtyard.
Whilst the quality of care and treatment is the most important aspect of any patient
experience the physical environment is fundamental to the patients stay and as we have
described can often the difference between a young person wanting to be admitted to our
facility or another providers in such an open competitive market.
4.5 Imp ro ve d Ac ce ss to Se r vi c es
The Business Case sets out the case for change which will ensure improved access to services
for children and young people needing admission to Tier 4 services. As all capacity will be on
one site the 10 beds currently situated at the Steelhouse lane will ensure better use of the
overall provision. Those young people unable to be admitted to Ocean ward currently owing
to high levels of risk, will have access once all accommodation is on one site. In addition
young people will have access to a range of services from general adolescent services
through to high dependency care together on one site if indicated.
4.6 Imp ro ve d Pa ti en t a nd S t af f E x p eri en c e
Any changes to services must ensure and demonstrate an improved patient experience.
Much feedback from young people and families relates to the environment and the building
and not to patient care. The impressive physical environment improvements, improved flows
and increased functionality alongside the delivery of all care and treatment on one site will
inevitably mean an improved patient experience for all patients.
In addition, these improvements will also mean the staff working at the hospital will benefit
both in terms of the psychical working environment, the ease of delivery of care owing to the
improved flow of the building etc but also feeling part of a single inpatient team for the first
time.
4.7 B e tt e r U s e o f Re so u rc e s
Having all inpatient services and staff on one site, improving the relationships between staff
and social spaces, and centralising shared facilities between each of the Wards, will support
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better use of resources across Tier 4 services. With the entire workforce located on one site
this will increase clinical time through the reduction in travelling time for MDT staff. In
addition, better more effective use of the nursing and medical resource can be applied (such
as a reduction in bank staff) when all on one site creating a much more flexible workforce
whilst reducing risk.
Development of new and innovative models of care for this group of patients through our
clinical re-design work currently being undertaken in parallel with this business case will
mean best use of resources whilst delivering evidence based treatment for example through
day care for those young people with eating Disorders.
Work to look at the improved use of staffing is being addressed in more detail as part of the
overall CAMHS service re-design project, which is seeking to increase clinical patient facing
time by reducing the time staff spend travelling, and reduce the use of temporary staff as a
result of meeting this overall objective.
4.8 Imp ro ve d Pa ti en t & S t af f F l o ws
The re-design of services, and the integration of a single inpatient unit, will support improved
patient and staff flows, and as a result, will improve patients’ experiences of their stay at
BCHFT.
4.9 Inc r ea s ed In co m e
The new CAMHS hospital development is predicated on improving patient experience and
quality of services and effective use of existing resources. In the design the service will have
access to the same capacity as previously available pre December 2011- that is 44 beds.
However, as the capacity will be on site with all the reduced risk associated with this, the
service will be able to ensure higher occupancy levels then previously experienced when
Ocean ward was isolated as described.
In addition, with the development of the single bedroom accommodation higher dependent
young people can be nursed separately and the current acute assessment unit will have the
opportunity to develop HDU status. A distinct service speciation does not exist for this client
group currently but from discussion with commissioners we are looking to develop such as
service using current clinical expertise and ensuring appropriate staffing levels.
4.10 Inc r ea s e d C a pa ci ty a t S te el h ou s e L an e
The transfer of activity from Ocean Ward to Parkview will release much needed capacity on
the Steelhouse Lane site. The annexe on Ocean Ward is already being utilised for other
patients, and as a result of the Bed Reconfiguration project established by the Trust, is being
factored into the Trust’s plans to deal with Winter pressures.
Releasing additional capacity at Steelhouse Lane will help further support the Trust’s Winter
plans. It could also act as a decant facility for when other services are being reconfigured /
relocated within the site, or as part of the Trust’s longer term plans to move off Steelhouse
Lane.
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Birmingham
Children's Hospital
The specific benefits expected to be realised from this scheme are outlined the Benefits
Realisation Plan at Appendix A.
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5. OP TI O NS
5.1 Ac ti vi t y & S e r vi c es B ri e f
The proposed solution is required to continue the delivery of existing inpatient Tier 4 services
whilst enhancing them to support:
■
■
■
■
■
■
■
■
■
The rationalisation of all CAMHS activity onto a single bespoke site;
The improved quality of the physical facility, and to ensure that it is fit for purpose and
meets the needs of patients;
To maintain access to the current school associated to Parkview;
To establish capacity back up to 44 beds, including an emergency bedded area;
To improve patient and staff flows;
To provide improved social spaces (internal and external);
To meet the increase in demand for Tier 4 services, as discussed in Section Error!
eference source not found.;
To meet the changing profile of young people being admitted to Tier 4 services; and
To maximise the availability of single bedrooms, in line with Commissioner
requirements.
Children & Younger Adolescents
This is the activity currently provided on the Ocean Ward. The brief for this project is to
provide an area in Parkview which, in addition to the above, will deliver:
■
■
10 beds; and
3,942 bed days of activity per annum.
Acute Assessment & HDU
Currently provided from the Ashfield Ward at Parkview, a reconfigured Unit is required to
provide:
■
■
8 beds, a number of which may act as HDU beds as required; and
2,628 bed days of activity per annum.
Eating Disorders
Currently delivered from Irwin Ward at Parkview, this project sets out to deliver an area
which will provide:
■
■
12 beds; and
3,285 bed days of activity per annum.
Older Adolescents
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This activity is currently provided from Heathlands at Parkview. This project requires an area
which will provide:
■
■
14 beds; and
4,559 bed days of activity per annum.
5.2 L on g L i s t of Op ti on s
To help deliver the activity and services identified above, an initial long list of 8 options was
identified as listed below.
Of the 8 options identified, 6 (i.e. Options 2 to 7) are all based on developing an extension at
Parkview, and then modifying one or more the existing areas within Parkview, to reconfigure
and improve what is currently provided. It was agreed that these options would seek to
relocate either Children & Younger Adolescents activity (i.e. from Ocean Ward) or Eating
Disorders activity (i.e. from Irwin Ward) to the extension, on the basis that these are most
suited to being located in a more discrete area.
The long-list identified was as follows:
■
■
■
■
■
■
■
■
Option 1 – Do Nothing
Option 2 – Move Children & Younger Adolescents (Ocean Ward) to a new first floor
extension at Parkview
Option 3 – Move Eating Disorders (on Irwin Ward) to new first floor extension at
Parkview; move Children & Younger Adolescents (on Ocean Ward) to an unmodified
Irwin Ward
Option 4 – As Option 3 but with modifications on Irwin Ward
Option 5 – Move Children & Younger Adults to new extension; modify both Eating
Disorders (Irwin) and Acute Assessment & HDU (Ashfield) Wards
Option 6 – Move Children & Younger Adolescents to new extension; modify both
Eating Disorders (Irwin) and Older Adolescents (Heathlands) Wards
Option 7 – Move Eating Disorders to new extension at Parkview and Children &
Younger Adolescents into a modified Irwin Ward; modifyAcute Assessment & HDU
(Ashfield) and Older Adolescents (Heathlands)
Option 8 – Complete new build on an alternative site
Upon further consideration, Options 1 and 8 were discounted on the basis that:
■
■
Option 1 does not meet the Trust’s objectives, namely to provide a single integrated
inpatient facility for Tier 4 services with improved accommodation; and
Option 8 requires a new site. An initial check of surrounding areas found that an
alternative is not immediately available, making the timescales for this option
prohibitive. Relocating Tier 4 services to another site would also break the links to the
school at Parkview.
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5.3 Sho r t L i s t o f Op ti o n s
Having discounted two of the options from the longlist, the shortlisted options deemed to be
worthy of further consideration and development, were agreed as follows:
Option 2 – Children & Younger Adolescents Transfer to New Extension
This option comprises the construction of a new extension on the first floor of Parkview with
10 beds, for the transfer of Children & Younger Adolescents activity (currently delivered on
Ocean Ward).
The option delivers a total of 44 beds (a net increase of 5 on current provision), and a total of
17 single beds, i.e. 10 more than currently. The extension is illustrated below:
Figure 1. Option 2
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Option 3 – Eating Disorders into New Extension; Children & Younger Adolescents into Irwin
Ward
Under this option, a new extension will be constructed on the first floor of Parkview, with
Eating Disorders (currently located on Irwin Ward) being transferred here, and Children &
Younger Adolescents (currently located on Ocean Ward) being transferred to an unmodified
Irwin Ward.
Overall, this option will provide a total of 46 beds (a net increase of 7), of which 17 are single
bedrooms, i.e. an increase of 10 on current provision, and is illustrated below:
Figure 2. Option 3
Option 4 - Eating Disorders into New Extension; Children & Younger Adolescents into
Modified Irwin Ward
Under this option, a new extension will be built on the first floor of the Parkview clinic,
allowing Eating Disorders to transfer from Irwin Ward to the extension. Irwin Ward will then
be modified, allowing Children & Younger Adolescents to transfer from Ocean Ward to Irwin.
This option provides a total of 44 beds (a net increase of 5), of which 26 are single.
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Figure 3. Option 4
Option 5 – Children & Younger Adults to New Extension; Eating Disorders (Irwin) and Acute
Assessment & HDU (Ashfield) to be Modified
This option supports the following works and moves:
■
■
■
■
New first floor extension at Parkview constructed;
Eating Disorders (Irwin Ward) to move to extension whilst Irwin Ward is modified, and
Eating Disorders moved back;
Acute Assessment & HDU (on Ashfield Ward) to move to the new extension whilst
Ashfield Ward is modified, then Acute Assessment & HDU moved back; and
Children & Younger Adolescents to finally transfer to the new extension.
At the end point, this option delivers a total of 44 beds, of which 33 are single (an increase of
26 beds on the current provision).
Both Options 5 and 7 include the reconfiguration of the Acute Assessment & HDU areas on
Ashfield Ward, which offers the Trust an opportunity to relocate its Section 136 Safety Suite –
currently located in an isolated position on the top floor of Parkview – to be relocated to the
Ashfield Ward. The proposal would be to create a dual purpose space which meets the Place
of Safety requirements and includes emergency bed provision.
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Figure 4. Option 5
Option 6 - Children & Younger Adolescents to New Extension; Modify Eating Disorders
(Irwin) and Older Adolescents (Heathlands) Wards
Option 6 comprises the following works and moves:
■
■
■
■
New first floor extension at Parkview constructed;
Eating Disorders (Irwin Ward) to move to extension whilst Irwin Ward is modified,
then Eating Disorders moved back;
Older Adolescents (on Heathlands Ward) to move to the new extension whilst
Heathlands is modified, then Older Adolescents is moved back; and finally
Children & Younger Adolescents to finally transfer to the new extension.
Overall, this option delivers 44 beds, of which 37 are housed in single bedrooms.
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Figure 5. Option 6
Option 7 – Move Eating Disorders to New Extension; Children & Younger Adolescents into
Modified Irwin Ward; Modify Acute Assessment & HDU (Ashfield) and Older Adolescents
(Heathlands)
Finally, option 6 comprises the following works and moves:
■
■
■
■
■
New first floor extension at Parkview constructed;
Acute Assessment & HDU to move to first floor extension whilst Ashfield Ward is
modified, and then move back;
Older Adolescents to move to first floor extension whilst Heathlands is modified, and
then move back;
Eating Disorders to move from Irwin Ward to the new extension permanently, and
Irwin Ward to be modified; and
Children & Younger Adolescents to move from Steelhouse Lane to Irwin Ward at
Parkview.
Overall, this option delivers 44 beds, all of which are provided from single bedrooms.
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As discussed under Option 5, this option offers the potential to relocate the Safety Suite to a
dual purpose area on the Ashfield Ward, which would also provide for other emergency bed
provision.
Figure 6. Option 7
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6. OP TI O NS A P PR AIS A L
6.1 Non -F i n an ci al Ap pr ai s al
A non-financial evaluation of the shortlisted options was undertaken using a systematic and
sequential process that covered:
■ Stage 1 : Selection of the criteria to be used to appraise the options;
■ Stage 2 : Weighting of criteria to reflect their relative importance;
■ Stage 3 : Consideration of the options and scoring against the agreed criteria;
■ Stage 4 : Analysis of the results and sensitivity testing to establish the robustness
of the conclusions.
6.1.1 Evaluation Criteria
The evaluation criteria used to appraise the options was based on the standard set of 9
criteria put forward by the Department of Health. At a high level, these are:
■
■
■
■
■
■
■
■
■
Providing better access to services;
Improving the clinical quality of services;
Improving the environmental quality of services;
Developing existing services and /or the provision of new services;
Improving the strategic fit of services, including regeneration;
Meeting national, regional and local policy imperatives;
Meeting training, teaching and research needs;
Making more effective use of resources;
Ease and timeliness of implementation.
A more detailed summary of the evaluation criteria can be found at Appendix B.
Having agreed the criteria, an Evaluation Panel was established comprising Trust staff (clinical
and management), commissioners and patient representatives, who were invited to a nonfinancial
appraisal workshop to undertake the remainder of the process, i.e. to weight the
criteria, and to appraise and score the options.
6.1.2 Weighting of the Criteria
To help weight the criteria, the Evaluation Panel were initially asked to rank the evaluation
criteria in order of importance, and then to assign scores against each criterion to determine
the relative difference between them. This was done in plenary session, and resulted in the
following agreed weights:
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Table 1.
Non-Financial Evaluation Criteria Weights
Criteria
Weighting
Rank Score Weight
Better access to services 9 5 0.9%
Improved clinical quality of services =1 100 17.4%
Improved environmental quality 3 95 16.5%
Develop existing services / provide new services =1 100 17.4%
Improved strategic fit of services, incl regeneration =4 75 13.0%
Meeting policy imperatives 6 60 10.4%
Meeting teaching, training and resource needs 8 25 4.3%
Making more effective use of resource =4 75 13.0%
Ease of delivery 7 40 7.0%
Total - 575 100.0%
6.1.3 Scoring of the Options
Having weighted the criteria, the Evaluation Panel considered all of the options put forward
and scored them against each criterion, using a 10-point scoring system (10 being the highest
possible score, and 1 the lowest). Scoring was undertaken by members on an individual
basis, and the scores then combined to give the results shown below:
6.1.4 Results of the Non-Financial Appraisal
Having combined the individual Panel member’s scores, the total weighted scores and results
of the non-financial evaluation exercise were as follows:
Table 2.
Non-Financial Evaluation - Weighted Scores and Results
Criteria
Weighted Scores
Option Option Option Option Option Option
2 3 4 5 6 7
Better access 0.03 0.03 0.03 0.03 0.03 0.04
Improved clinical quality 0.74 0.95 1.05 1.16 1.19 1.64
Improved environmental quality 0.76 0.75 0.92 1.07 1.11 1.57
Development of existing/new services 0.72 0.84 0.95 1.16 1.09 1.55
Improved strategic fit of services 0.48 0.52 0.68 0.81 0.82 1.14
Meeting policy imperatives 0.36 0.42 0.52 0.66 0.72 0.93
Meeting teaching, training & resource needs 0.18 0.20 0.20 0.24 0.25 0.31
Making more effective use of resource 0.78 0.77 0.78 0.83 0.83 0.96
Ease of delivery 0.58 0.52 0.42 0.34 0.31 0.25
Total Score 4.62 5.00 5.57 6.28 6.35 8.40
Rank 6 5 4 3 2 1
% Difference 45.02% 40.53% 33.69% 25.29% 24.43% 0.00%
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The results show:
■
A marked preference for Option 7 over Option 6 by a margin of 24%, which scored
just 1% more than Option 5, and with Options 4, 3 and 2 ranked below in that order.
The results demonstrate a clear preference for the option that delivers the most fitfor-purpose
accommodation and the most functionality;
■ Option 2 was the least preferred by a margin of 45% over Option 1;
■
Option 7, the most preferred from a non-financial perspective, scored highest against
each criterion with the exception of Ease of Delivery, for which Option 2 scored
highest.
The following sensitivity analyses were undertaken to quantify the potential impact of
changing weights by:
■
■
■
Applying equal weights to all scores;
Reversing the order of the weights; and
Ease of delivery was given a higher weight.
None of the above factors impacted on the overall scores or on the order of ranking for the
options.
More details of the non-financial appraisal scores are attached at Appendix C.
6.2 F i nan ci al & E c on om i c Ap p rai sal
6.2.1 Capital Costs
A full assessment has been made by the Trust’s external cost adviser of the likely capital cost
for each option and these are summarised in the table below:
Table 3.
Capital Cost of Options
Capital Costs £000s Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
Works 1,525 1,725 3,050 4,325 4,660 5,935
Fees 194 219 385 544 586 745
Non-Works 0 0 0 0 50 50
Equipment 100 100 200 275 275 350
Contingencies/Optimism Bias 100 113 209 299 325 416
VAT 338 381 685 973 1,055 1,343
Total at PUBSEC 173 2,258 2,539 4,529 6,417 6,952 8,840
The capital cost estimates have been calculated using standard NHS Estates costing
guidelines. Works costs are a combination of new build and refurbishment, the proportions
varying between options. It is assumed that a start on site would be made in Q4 2013.
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Other key assumptions that have been made are:
■
■
■
Design fees at 12.5% for all options;
Provision for optimism bias/planning contingency at 6% for all options; and
Equipment provision is based on a QS estimate of the additional equipment needed
for new areas.
Full details relating to the capital costs can be found at Appendix D.
6.2.2 Income Assumptions
The key driver for the levels of income which could be expected in each option is the number
of beds available and the number of those that are single, which would enable a number of
beds to be used as HDU beds. Key income assumptions that have been made are as follows:
■
■
The total number of beds within each option as listed in the tables below;
Option 7 enables 8 beds to be used as HDU beds;
■ Based on current market assessments, HDU beds can be charged on average at £200
per day more; and
■
Income has been assessed across the transition period based on the number of beds
available during construction.
Table 4. Revenue Income Analysis – Forecast 2017/18
Income £000s Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
Beds 44 46 44 44 44 44
Total Income 7,188 7,523 7,188 7,188 7,188 7,779
Increase over baseline +838 +1,173 +838 +838 +838 +1,429
A key determinant for future commissioning intentions is the number of single beds
available. Discussions with commissioners indicate that in the future, it is likely that if the
Trust does not have single beds, activity and income may potentially be at risk. The maximum
risk exposure is summarised in the table below and an assessment of the impact of this has
been factored into the economic appraisal.
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Table 5. Single Beds and Income Risk – Forecast 2017/18
Revenue Costs £000s Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
No of Single Beds 17 19 26 33 37 44
Income at Risk at 100% 4,411 4,415 2,940 1,797 1,143 -
Income at Risk at 25% 1,103 1,104 735 449 286 -
6.2.3 Revenue Costs
Estimates of the costs of each option have been developed using the following methodology:
■
■
■
■
2012/13 budgets have been used as a baseline;
The staffing implications of each option have been reviewed. Option 7 requires an
additional 7.75 staff to meet requirements of an HDU;
An assessment of the impact of each option on estates and facilities costs; and
The capital charge impact of the capital investment in each option, assuming a 25 year
asset life for buildings and 10 year asset life for equipment.
The overall results of the revenue cost assessment are set out in Appendix E and are
summarised below:
Table 6. Revenue Cost Analysis – Forecast 2017/18
Revenue Costs £000s Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
Direct 4,018 4,018 4,018 4,018 4,018 4,281
Indirect 711 713 716 720 721 768
Facilities & Overheads 1,140 1,152 1,174 1,209 1,213 1,310
Capital Charges 464 485 643 792 831 980
Forecast Revenue Costs 6,333 6,368 6,551 6,739 6,783 7,339
Increase over Baseline +213 +248 +431 +619 +663 +1,219
Table 7. I&E Impact – Forecast 2017/18
Revenue Costs £000s Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
Income Increase over Baseline
Cost Increase over Baseline
838
213
1,173
248
838
431
838
619
838
663
1,429
1,219
Net I & E Benefit 625 925 407 219 175 210
Ranking 2 1 3 4 6 5
Income at risk (25%) (1,103) (1,104) (735) (449) (286) -
Risk Adjusted I&E Cost(-) / Benefit (478) (179) (328) (230) (111) 210
Revised Ranking (incl Risk) 6 3 5 4 2 1
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The financial appraisal indicates that:
■
■
■
All options will have a beneficial impact on I&E due to the additional capacity and
income generated, and on this basis Option 3 would provide the best financial return;
However, this position makes no allowance for the potential risk exposure under
Options 2 to 6, arising from the fact that part of the capacity provided is not delivered
through single beds;
Adjusting the I&E forecasts to make allowance for a prudent 25% of the potential risk
exposure would change the rankings to make Option 7 preferred by a significant
margin. Option 3 would become the third ranked option. Furthermore, aside from
Option 7 (which would still deliver a net I&E Benefit), all other options would see the
Trust’s I&E position deteriorate.
6.2.4 Value for Money
The shortlisted options have been fully evaluated in line with the requirements of
Department of Health Business Case Guidance and the HM Treasury Green Book to assess
which option represents potentially the best value for money (VfM).
The economic analysis therefore:
■
■
■
■
■
■
■
■
Covers an appraisal period of 33 years, ensuring that a full 30-year operational use of
new facilities is reflected;
Excludes VAT from all cash flows;
Reflects capital cash flows at PUBSEC 173 levels including contingencies;
Assumes zero residual building asset values at the end of the 33-year appraisal period
and excludes any provision for potential opportunity costs;
Includes lifecycle costs for building and engineering elements based on standard NHS
asset lives and replacement cycles, and for equipment replacement is assumed to
occur every 10 years;
Incorporates cash flows for all revenue costs (excluding capital charges), shown in
Table 6;
Includes an assessment of the cost of risk associated with potential lost income
described in Section 6.2.2. A standard risk quantification approach has been adopted
based on the following key assumptions:
o Risk exposure assessed over 5-yearly periods from 2012/13 with no risk
materialising in the period up to year 5; 25% risk arising between years 6 to 10,
increasing by 5% for each 5 year period up to 50% for the last years of the
appraisal;
o The levels of income at risk based on the figures shown in Table 5;
o Standard distribution between Minimum, Likely and Maximum Probabilities;
In order to ensure a like for like economic comparison, Options 2 to 6 include an
assessment of the cost of the activity (currently undertaken elsewhere) which is
provided under Option 7; and
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■ Assumes a price base of 2012/13.
All these cost inputs have been modelled to establish the following for each option:
■ The Net Present Cost (NPC) of the discounted annual cash flows over the whole 33-
year appraisal period; and
■
The Equivalent Annual Cost (EAC) being an annualised equivalent of the NPC.
The economic assessment of the six options is set out in Appendix F and is summarised in
Table 8 below:
Table 8.
Economic Cost of Options – 33 Year Appraisal
Economic Costs £000s Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
Base Impact Excluding Risk:
Net Present Cost (NPC) 134,164 128,764 137,697 140,580 141,334 140,182
Equivalent Annual Cost (EAC) 6,684 6,415 6,860 7,003 7,041 6,983
Economic Ranking Excluding
Risk
2 1 3 5 6 4
% over Option Ranked 1st 4.2% 0.0% 6.9% 9.2% 9.8% 8.9%
Impact of Risk:
Net Present Cost (NPC) 22,642 22,666 15,092 9,224 5,870 0
Equivalent Annual Cost (EAC) 1,110 1,112 740 452 288 0
Risk Ranking 5 6 4 3 2 1
Economic Impact Including
Risk:
Net Present Cost (NPC) 156,806 151,430 152.789 149,804 147,204 140,182
Equivalent Annual Cost (EAC) 7,794 7,526 7,600 7,456 7,329 6,983
Economic Ranking with Risk 6 4 5 3 2 1
Marginal EAC over Option 7 811 543 616 472 345 0
% over Option Ranked 1st 11.6% 7.8% 8.8% 6.8% 4.9% 0.0%
Economic Switch Value (811) (543) (616) (472) (345) 345
From the analysis that has been undertaken it is clear that:
■
■
Excluding the impact of risk (of income loss), Option 3 would be preferred by a margin
of 4.2% over Option 2 and 8.9% over Option 7;
However, including an element of risk has the effect of changing the ranking by
including potential income risk where there is smaller number of single beds
developed within the option. Making allowance for the potential loss of income under
Options 2 to 6 would leave Option 7 clearly preferred from an economic perspective
by removing the risk of this income loss.
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6.2.5 Sensitivity Analysis
The results of the economic appraisal have been subjected to two specific economic
sensitivity tests.
Test 1 – Shorter Appraisal Period
Clearly, the economic margin in favour of Option 7 would diminish over a shorter appraisal
period to reflect (a) the reducing impact of risk under other options, and (b) a greater relative
impact of capital cash flows, which are highest under Option 7.
By way of illustration:
■ Over an 18-year appraisal period (including 15 years of new facilities), Option 7
remains preferred by a margin of 4.2% over Option 6; but
■ Over a 13-year appraisal period (including 10 years of new facilities), Option 7 would
rank 2 nd behind Option 3 by a margin of 1.8%;
■ However, in both the above scenarios, Option 7 would remain preferred on a
combined non-financial and economic appraisal basis.
Test 2 – Switch Values
The second test applied has been to assess the level of cost driver change (switch value)
required to change the economic preference for Option 7.
This analysis confirms that:
■ There are no realistic circumstances under which the capital cost changes needed to
trigger switch values would arise; and
■ In terms of revenue costs, these would have to increase by approximately £383,000
(5.3%) under Option 7 or fall similarly under the second ranked Option 6 in order for
Option 7 not to be preferred. (A greater reduction in revenue costs would be needed
for any of the other options to be preferred, ranging between 7.1% and 12.4%).
6.3 Com bi n ed No n -F i n a nci al an d E c ono mi c Ap pr ai sal
Since both the non-financial and economic appraisals have identified a preference for Option
7, combining the results, using an equal weighting, to assess the Benefit Points achieved per
unit of economic cost underlines the overall preference for Option 7 as shown in Table 9
below:
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Table 9.
Combined Non-Financial and Economic Appraisal
Economic Costs £000s
Option
2
Option
3
Option
4
Option
5
Option
6
Option
7
Weighted Non-Financial Scores 4.62 5.00 5.57 6.28 6.35 8.40
EAC Impact of Option (£m) 7.794 7.526 7.600 7.456 7.329 6.983
Benefits Points per EAC (£m) 0.59 0.66 0.73 0.84 0.87 1.20
Combined Ranking 6 5 4 3 2 1
% below Option Ranked 1st - 5 0.7 % - 4 4.8 % - 39. 1 % - 30. 0 % - 28. 0 % 0.0%
6.3.1 Combined Appraisal Sensitivity
The combined margin in preference of Option 7 is a function of two main judgements, both
of which have been tested further:
■
■
The non-financial appraisal scored Option 7 some 24% higher than the second ranked
Option 6. Sensitivity confirms that the score for Option 7 would have to fall by 35% (or
increase by 47% under Option 6) in order for Option 6 to be preferred on a combined
appraisal basis;
The economic preference for Option 7 is in part dependent upon allowance being
included within Options 2 to 6 for the impact of potentially lost income. However,
even excluding the impact of risk altogether would have only a negligible impact on
the combined appraisal scores.
6.4 Ov e ral l C on cl u si on
Although the most expensive in terms of capital costs, Option 7 delivers the best quality
solution as evidenced by the non-financial appraisal. Under a straight risk-free appraisal,
Option 3 is the overall preferred option when combining the financial and non-financial
appraisal results, with Option 7 being ranked fourth. However, critical to the appraisal is the
assessment of risk of lost income due to the current inadequacies of the existing facility in
relation to the number of single rooms. The Commissioners’ clear view is that this risk is real
and imminent, and that the Trust needs to ensure its facilities are of equal or better quality to
other providers within an increasingly competitive market.
The risk adjusted financial appraisal accounts for this risk on a staged basis for Option 2 to 6,
all of which have a number of communal beds. When this is taken into account, Option 7 is
ranked first given it provides full protection against this scenario, and is also the only option
that provides financial affordability over the long term.
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7. PR O PO SE D S OL U TI O N
7.1 Se r vi c es & A c ti vi ty
The preferred option seeks to provide a 10-bedded extension on the Parkview site, and to
refurbish the existing wards to provide a 12 bedded Eating Disorders Unit (Irwin Ward); a 14
bedded Older Adolescents Unit (Heathlands), and an 8 bedded Assessment & HDU Unit. All
44 beds would be provided through single bedrooms.
7.2 F unc ti on al Co n te n t
This solution will provide:
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
44 single bedrooms with en suite facilities;
An overall increased provision in social spaces, including an external social space;
Treatment Room;
Kitchen, dining and pantry facilities;
Two group rooms;
A music room;
Two quiet rooms;
An Education Room;
Laundry / linen areas;
A shared reception / foyer;
Training kitchen room;
A parents room;
A new fitness room;
Staff office accommodation for the Ward Manager and nurses;
A meeting Room; and
Appropriate WC and storage areas.
Accommodation for the MDT is also included in the brief for the new development. This will
ensure fit for purpose accommodation for all those practitioners involved in the care of
children and young people using inpatient services. This will be on the ground floor and be
re-configured to meet the needs of the MDT.
7.3 De si g n
7.3.1 Establishing the Design Brief
The Trust established a Project Team to help develop the proposals underpinning this
Business Case, with membership comprising the Clinical Director of CAMHS, lead professional
staff, in addition to Divisional Management and Capital Developments representation.
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Members of the Project Team worked closely with the appointed architects, QA Architecture,
to develop the brief and subsequent proposals, through to 1:50 scale layouts.
7.3.2 Design Philosophy
To support the overall objectives that the Trust set out to achieve by this development, the
design philosophy specifically aimed to:
■
■
■
■
■
■
Provide single bed en-suite bedrooms.
De-institutionalise the environment.
Improve the quality of the patient environment and hence their experience.
Design flexibility in the usage of spaces.
Maximise usage of resources by the design of interspatial relationship.
Rationalise shared facilities and spaces.
As a result, a strategy was developed to macro-manage the clinical spaces at Parkview by
rationalising common and shared facilities. As a result, existing facilities were organised and
new ones created to support:
■
■
■
■
A ‘hub’ accessible to/from all wards which houses the following shared facilities:
o Reception
o Visiting parents’ accommodation
o Indoor fitness room
o Training kitchen
Locating the most autonomous ward (Irwin) in an appropriate position whilst
reinforcing the inter-dependence and shared support of the other three wards;
A separate entrance for emergency admission, accessible externally, self-contained
internally for assessment, and adjacent to the appropriate ward (Ashfield) without
disruption to the rest of that ward;
An education room within the appropriate ward (Heathland), taking into account the
proximity and community relationship with the existing adjacent school to cater for
the other wards.
The overarching design philosophy was based on the importance of:
■
■
■
■
■
Single en-suite bedrooms resolving certain gender issues and enabling flexibility in the
use of bed spaces;
Flexibility in the use of rooms/common areas;
Sightline within the ward, enabling better supervision, security and effective use of
staff;
Internal social space;
The use of natural lighting, colour and decoration to enhance the quality of the space;
and
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■
External social space/facility requiring dedicated supervision and the risk it may not
be used due to pressure on staff resource.
7.3.3 Design Development to Date
1:50 scale floor plans have been produced based on the Trust’s original brief, and the design
philosophy and strategy developed by the architects.
These can be found at Appendix G.
7.3.4 Sustainability
Sustainability and the environmental performance of both new and existing NHS buildings
are a high priority for the NHS, as evidenced by the need to undertake assessments in line
with BRE (Building Research Establishment) requirements.
The BREEAM (BRE Assessment Method) Healthcare XB tool – which complements BREEAM
Healthcare - will be used to assess the Parkview refurbishment and extension, considering
various aspects of the design including the mechanical and electrical performance of the
existing building and of the extension.
An initial assessment using this tool has been carried out by QA Architecture, which
demonstrates that the new/upgraded facilities should be able to achieve a rating of “Very
Good”, to help support the delivery of a design that supports a reduction in energy waste
and, consequently, reduced utility bills, whilst demonstrating a commitment to sustainable
development.
The preliminary BREEAM assessment is attached as Appendix H.
7.3.5 Flexibility
The use of a framed solution for the building will be considered in the design of the building,
which will enable all internal walls to be of a non-load bearing type. This will allow the
building to be altered at a future date, to meet the changing uses that may be required.
The existing site is sufficiently large that should the building be required to be extended, that
this could be achieved subject to the usual planning processes.
This flexibility will ensure that future directions for care for children and young people with
highly specialised and complex mental health problems can be considered. Thus the delivery
of outreach, day care and other alternatives to inpatient care can be maximised if
appropriate.
7.4 Pl anni ng
Initial discussions have taken place between the Capital Developments Department, the
architects and Planning Officers from Birmingham City Council. Officers were supportive of
the outline plans, and have written to confirm this. A letter of support from the Planning
Authority is attached at Appendix I.
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A formal planning application is currently being prepared and is due to be submitted in early
May 2013.
7.5 Wo rkf o rc e
Tier 4 CAMHS units will have multidisciplinary teams which have specialist experience in
treating complex mental health problems in young people. The staffing of the unit should be
compliant with Royal College of Psychiatrists Quality Network for Inpatient CAMHS (QNIC)
essential standards 2011. The staff team will include:
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
Consultant Child & Adolescent Psychiatrist;
Psychiatrists in training;
Clinical Psychologists;
Clinical Nurse Specialists;
Registered mental health nurses;
Registered paediatric nurses where units provide care for young people with eating
disorders;
Healthcare Assistants (experienced in CAMHS);
Occupational Therapist;
Family Therapist;
Social Worker;
Teachers & learning support staff;
Named child protection lead;
Staff skilled in creative therapies;
Staff skilled in group work;
Dietetic advice where services provide care for young people with eating disorders;
Administrative staff;
Domestic Services staff, catering & cleaning;
Appropriate arrangements to be made for physiotherapy for young people with
severe psychosomatic disorders;
An independent IMHA advocacy service will be required; and
Access to general paediatric and medical facilities when caring for young people with
eating disorders
QNIC standards cite a 10-12 bedded unit as an example:
■
1 WTE Band 7 ward manager;
■ Approx 24 WTE nursing staff 60:40 qualified : unqualified ratio (Band 3, 5, & 6);
■
■
■
1 WTE Consultant Child & Adolescent Psychiatrist;
0.5 to 1 WTE social worker;
0.5 WTE occupational therapist;
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■
■
■
■
0.5 WTE family therapist;
Minimum of 1 qualified teacher to 4 students per lesson;
Access to dietician; and
Access treatment from a range of therapists including speech & language and
psychological therapies.
In addition the services will be aligned with the national service specifications to deliver
appropriate care and treatment
7.6 IM & T
The IM&T requirements as a result of this proposal relate to the purchase of IT-related end
user equipment, and the associated costs are included within the equipment costs outlined
below.
7.7 E qui p me n t
A sum of £350,000 has been provided for the purchase of new furniture and equipment, in
all inpatient areas within Parkview. Where existing furniture and equipment is of a suitable
standard and condition, these will be transferred.
7.8 E qu al i t y Imp a ct A ss es sm en t
An Equality Impact Assessment has been carried out, using the standard template issued by
the DH in 2010. The assessment is attached at Appendix J, and demonstrates that no adverse
impacts are expected from the proposed solution.
7.9 St ak eh ol d e r E n ga g e me nt
A significant amount of stakeholder engagement has been undertaken through the
establishment of the Project Team which has met regularly throughout the development of
this Business Case. In addition to this, members of the Team have regularly fed back to
colleagues throughout CAMHS Tier 4 services, and proposals and designs have been widely
shared with staff members.
Additionally, the Evaluation Panel for the non-financial appraisal of the options comprised
wider members of staff from the Trust, commissioners and a patient representative.
A number of stakeholder events have taken place to enable views about the proposals to be
raised. These events have been attended by parents of current inpatients, the Trust’s YPAG
group, and inpatient and community staff.
All groups were shown the proposed design solution in order to ensure that there was
consistency, and all groups were asked the same questions. There were two main areas of
concern highlighted, namely how to manage risk in relation to each young person having
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access to their own ensuite bathroom and how to ensure that ‘social space’ is not used as a
thoroughfare by ‘visiting’ staff/parents to the units.
In addition to these concerns, many suggestions were put forward in relation to colours,
designs of outside space, visiting arrangements and bedroom areas.
As a result of the feedback, significant thought has been given to the flow of the units and
design changes have been made to ensure that social space is located in an area of the units
that is not accessed by ‘visiting’ groups to the units. All nurses offices have been located
near the entrance to each unit, as visitors tend to enter the offices as their first port of call on
each unit, and from that point, they can then be advised which areas of the units they can
access.
In relation to concerns regarding ensuites, this has been discussed at length with staffing
teams on each unit. As in all cases of risk management within CAMHS, each young person
will be risk assessed regarding the use of their ensuite bathroom. Based on the outcome of
these risk assessments, risk management strategies will be implemented and managed via
individual care plans for each young person. There will be an element of change required
within the staff teams in relation to ensuites, and sessions will be held with staff during the
building phase to ensure they have a process in place to manage the new design.
Moving forward, it is acknowledged that there will need to be continued stakeholder
engagement, particularly through the detailed design process. This will involve the Young
Persons Advisory Group (YPAG), an established group of young people who have accessed
services at BCH in the past. YPAG will be asked to seek the views of current young people in
Tier 4 CAMHS regarding the flow and design of the units. Additionally parents will be invited
to evening sessions where their views on each set of plans will be sought. Day time sessions
have also been planned to allow CAMHS staff to attend ‘drop in sessions’ where they can
view the plans and will be asked specifically to input into the designs. Outpatients in the
building during ‘drop in’ sessions will also be invited to give their views.
A formal stakeholder analysis will be undertaken to ensure all key stakeholders are identified
and engaged with through appropriate mechanisms, and at the appropriate times. Particular
attention will be given to external engagement with the public, including local residents to
Parkview in advance of any construction work starting, and the requirements for any public
consultation exercise, as well as links to the local Health Overview & Scrutiny Committee.
7.10 F i nan ci al I mp ac t
7.10.1 Capital Costs
The capital cost of Option 7 has been assessed at £8.840m as summarised in Table 10 below:
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CAMHS TIER 4 RECONFIGURATION
Business Case
Table 10.
Proposed Solution - Capital Cost
Capital Costs £000
Works 5,935
Fees 745
Non-Works 50
Equipment 350
Contingencies/Optimism Bias 416
VAT 1,343
Total Forecast Out-turn Cost 8, 840
The construction and refurbishment works will be carried out on a phased basis to avoid the
need for existing services to be temporarily decanted. The projected cash flow, based on the
expected timetable for these works, is set out in Table 11 below:
Table 11.
Capital Cash Flow
Capital Costs £000s 2013/14 2014/15 2015/16 2016/17 2017/18 TOTAL
Works 1,020 2,049 1,611 1,221 34 5,935
Fees 128 257 202 153 4 745
Non-Works 9 17 14 10 - 50
Equipment 60 121 95 72 2 350
Contingencies/Optimism Bias 71 143 113 86 2 416
VAT 231 464 365 276 8 1,343
Total Forecast Spend 1 , 5 1 8 3 , 0 5 2 2 , 4 0 0 1 , 8 1 9 50 8 , 8 4 0
It is possible, therefore, that as the individual phases of work are completed, the
development plan can be reviewed at each stage and the key decision points will be the
commencement of each new phase. The development plan can therefore be reviewed in the
light of:
■
■
■
■
■
The availability of capital;
Commissioner and patient requirements based on available knowledge at each
development point;
Assessment of income risk due to lack of single bed facilities;
Development of the CAMHS service strategy and delivery plan;
Competition and market conditions.
For the purposes of this business case, it has been assumed that the Trust will finance the
capital investment through deployment of internally generated resources. In advance of the
development of the new hospital, the Trust is developing a Medium Term Estates Investment
Plan and it is therefore possible that some or all of the capital investment required may be
financed via capital loans.
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CAMHS TIER 4 RECONFIGURATION
Business Case
Initial discussions within the Trust have also indicated that there is scope for a fund-raising
appeal for some of the CAMHS Tier 4 services, and it is therefore possible that some of the
investment required could be met from charitable funds.
The financing route will be reviewed in advance of the commencement of each phase of
work.
7.10.2 I & E Impact
The I & E impact of the proposed solution is summarised in Table 12 below:
Table 12.
I & E Impact
I & E Impact £000s 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
INCOME
6,350
6,350
6,350
6,350
7,337
7,779
EXPENDITURE
Pay
Non-Pay
Indirect Costs
Overheads
Capital Charges
3,918
447
707
762
286
3,918
447
707
762
286
3,918
472
711
768
385
3,918
499
716
774
681
4,101
530
750
826
869
4,176
563
768
852
980
6,120 6,120 6,254 6,588 7,076 7,339
NET I & E IMPACT 2 3 0 2 3 0 96 (238) 261 440
The projections set out above show no change in the projected levels of income during the
early years. However, the Directorate is planning to appoint a marketing lead as part of the
implementation stage of the project, with a view to developing a pro-active marketing
strategy and plan for the CAMHS services. The income projections will therefore be reviewed
at the commencement of each of phase of work in light of the emerging marketing plan.
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CAMHS TIER 4 RECONFIGURATION
Business Case
8. IM PL E ME N T AT IO N PL AN & P ROJ E C T M A NA GE ME N T A P PR OA C H
8.1 P roj ec t M an ag e me n t & G ov e rn an c e A r r an g em en ts
The programme of work required to oversee the extension and reconfiguration of Parkview
will be undertaken in line with best practice. The solution will be implemented using
PRINCE2 (Projects in a Controlled Environment) project management methodology; roles and
responsibilities will be clearly defined, and decision making will be transparent and
documented to ensure a robust audit trail.
The Project Sponsor will be Georgina Dean, Deputy Chief Officer / Contracting &
Performance, and the Project Lead will continue to be Marie Crofts, Associate Service
Director – CAMHS.
An Implementation Team will be established comprising representatives from CAMHS (both
clinical staff and service managers), and the Capital Developments Team who will specifically
lead on the work of the Technical Team, i.e. architects, structural engineers, cost consultants
and contractors, to further develop the solution and to undertake the physical works.
8.2 P roj ec t Ti m es c al e s & Pl an
An outline project plan for the next stages of the project has been developed and is attached
as Appendix K. The key milestones for the implementation are as follows:
Table 13.
Key Project Milestones
Milestones
Completion By
Business Case approval End May 2013
Planning Permission granted End July 2013
Detailed design and procurement for Phase 1 works End July 2013
Award contracts for Phase 1 works End Sept 2013
Completion of Phase 1 works July 2014
Detailed design and procurement for Phase 2 works End June 2014
Completion of Phase 2 works April 2015
Detailed design and procurement for Phase 3 works End March 2015
Completion of Phase 3 works December 2015
Detailed design and procurement for Phase 4 works December 2015
Completion of Phase 4 works September 2016
8.3 B en efi t s Re al i s a ti o n Pl a n
An initial draft benefits realisation plan has been developed, as attached at Appendix A,
identifying the benefits to be realised by the implementation of the preferred option, and in
line with the benefits outlined in Section 4 of this Business Case. This will be developed in
more detail and finalised during the next stage of work.
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CAMHS TIER 4 RECONFIGURATION
Business Case
8.4 Ri sks
Risks for the implementation stage will be managed by the ongoing management of a formal
risk register which will be regularly reviewed by the Implementation Team and Executive
Team, and risk mitigation plans will be prepared for all risks quantified as being “high”.
An initial risk register has been produced as attached at Appendix L, and there are currently
no risks assessed as being “high”.
8.5 Po s t P r oj e c t E v al u a ti o n
As part of the post-project evaluation, a multi-disciplinary Evaluation Team will be
established, comprising a range of key stakeholders, to evaluate and monitor the benefits of
the preferred solution, and the successful outcome in terms of:
■
■
■
■
Greater assurance of total performance in terms of cost, time and quality;
Clearer definitions of responsibilities;
Reduced exposure to risk; and
Improved value for money.
Set out below is the proposed framework for carrying out the Post Project Evaluation for the
project which will satisfy the requirements of the Good Practice Guide: Learning Lessons
from Post Project Evaluation.
8.5.1 Evaluation Stages
In line with NHS guidance, 4 stages of evaluation will take place as outlined below.
Stage 1 – Development of an Evaluation Plan
An Evaluation Plan will be developed in close conjunction with the Benefits Realisation Plan
and Risk Management Strategy which will be constantly reviewed throughout the life of the
project.
The Plan will outline:
■
■
■
■
■
■
■
■
The objectives of the evaluation;
The scope of the evaluation;
The outputs to be evaluated and the success criteria against which they will be
measured;
The performance indicators and measures for these criteria;
More detailed information about the Evaluation Steering Group;
Identification of the budget and resources for this work;
A dissemination plan for ensuring the evaluation results are distributed and used to
reappraise the project; and
Clarification on the timings for evaluation.
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CAMHS TIER 4 RECONFIGURATION
Business Case
Stage 2 – Evaluation Requirements for Construction Phase
Progress will be monitored during the construction phase, with outputs evaluated upon
completion of this stage of works. Aspects to be evaluated will cover time, cost, service
performance as well as management procedures, the design solution and contractors
performance etc.
Stage 3 - Evaluation Requirement During Operational Stage
An evaluation covering a wider range of project evaluation criteria and benefits will be
undertaken after a suitable bedding-in period after the construction phase has been
completed. It is anticipated that this will take place circa 6 to 12 months following completion
of construction works.
Stage 4 – Evaluating Longer Term Consequences
Further post-project evaluations will take place at a later stage, to assess the longer term
outcomes of the project, when the full effects have arisen.
8.5.2 Evaluation Team Structure
The evaluation will be driven and undertaken by the Evaluation Steering Group. This will be
multidisciplinary and drawn from sources both within and outside the PCT, as required. It is
planned that the team will have the following membership:
Table 14.
Evaluation Team – Roles and Responsibilities
Member
Evaluation Project Manager
Chief Executive (or nominee)
Director of Finance
Lead Clinician
Design Representative
Directorate staff
Patients & Carers
Role
To manage the evaluation in accordance with the Evaluation
Plan
Input on achieving strategic objectives and project objectives
Input on financial elements, strategic objectives and project
objectives
Input on achieving project objectives and design &
environmental objectives
Input on design & environmental elements
Input on design & environmental elements
Input on design & environmental elements
The stakeholders in the evaluation are as follows:
■
■
■
■
BCHFT and its staff
Service users and carers
Commissioners
External advisors
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CAMHS TIER 4 RECONFIGURATION
Business Case
Birmingham
Children's Hospital
These parties will be involved in the evaluation to varying degrees either as participants or
recipients of the final report.
An initial post project evaluation plan has been attached at Appendix M.
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CAMHS TIER 4 RECONFIGURATION
Business Case
9. CO NCL U
SIO N S
This Business Case sets out the case for extending and reconfiguring the Parkview
clinic, to support the transfer of Children & Younger Adolescents activity from Ocean
Ward to a new first floor extension, and to create single bedroom accommodation for
all CAMHS Tier 4 inpatient areas.
The Board is asked to approve this Business Case and the associated capital
expenditure of £8.840m.
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CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX A – BENEFITS REALISATION PLAN
50

Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Services – Reconfiguration of Parkview
Benefits Realisation Plan
1. IMPROVED ACCESS TO SERVICES
REF DESCRIPTION INDICATOR PERFORMANCE MONITORING
METHOD
1.1 Improved access to those patients
requiring highly levels of care owing to
increased risk issues
Increased admissions for
higher dependent patients
1.2 Improved emergency admission access Increased out of hours
admissions
1.3 Improved access to service in its enterity
as less isolation of staff and more
cohesion across service provision
1.4 Improved access to EDU beds owing to
improved facilities (single bedrooms)
1.5 Improved access to BCH using the space
currently occupied by Ocean ward on the
Steelhouse lane site
Baseline Target
Current To admit 80%
of those
presenting
with high
dependency
levels
Current To admit 80%
of those
young people
presenting out
of hours
Increased admissions Current To reduce
numbers of
refeusals
Reduced EDU admissions to
Independent sector
Current
To increase
admissions to
EDU
Unmet need
report
Gateway
assessment
report
Gateway
assessment
report
Gateway
assessment
report and
admissions
report
REVIEW
DATE
12 months
following
completion
12 months
from
completion
12 months
from
completion
LEAD
RESPONSIBILITY
Clinical lead /
Head of
Nursing/
Clinical lead /
Head of
Nursing/
Head of Nursing
Current Tim Atack
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Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Services – Reconfiguration of Parkview
Benefits Realisation Plan
2. IMPROVED QUALITY OF CLINICAL SERVICES
REF DESCRIPTION INDICATOR PERFORMANCE MONITORING
METHOD
2.1 Much improved clinical space for
children, young people and
families
Baseline Target
Better patient experience Current Improved
narrative
2.2 Reduction in complaints Numbers of complaints Current 25%
reduction
2.3 More young people actively
choosing BCH as a provider of
choice
2.4 Release of additional capacity for
the main site annex and Ocean
ward
2.5 Improved supporting facilities i.e.
parents room / gym etc
Reduced numbers of young
people / families choosing
alternative providers
Increased access and
capacity for main hospital
Current
Increase by
20% in
admissions
Patient
experience
reports
Complaints
report
Unmet need
report /
admissions
report
REVIEW
DATE
LEAD
RESPONSIBILITY
12 months Head of
Nursing/
Associate
Service Director
12 months Tier 4 service
manager
12 months Clinical lead /
Head of
Nursing/ ASD
Current Tim Atack
Better patient experience Current Improved
feedback and
narrative
Patient
experience
reports
12 months Head of Nursing
/ Tier 4 manager
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Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Services – Reconfiguration of Parkview
Benefits Realisation Plan
3. IMPROVED ENVIRONMENTAL QUALITY OF SERVICES
REF DESCRIPTION INDICATOR PERFORMANCE MONITORING
METHOD
3.1 Facilities meet users and
commissioners expectations (i.e.
single bedrooms/ en‐suite
facilities)
Better patient experience
Commissioner feedback and
usage (currently only provider
which does not provide single
bedrooms)
Baseline Target
Current
Improved
patient /
commissioner
feedback
Increased
occupancy
levels
Patient
experience
report /
narrative
Performance
report
REVIEW
DATE
LEAD
RESPONSIBILITY
12 months Head of Nursing
/ ASD
3.2 Facilities are in line with users
requirements (e.g. parents with
pushchairs, visually impaired,
wheelchair users)
Patient / parent
representative
Current
Improved
narrative and
sign off
Patient survey
/ visit
12 months Governance
3.3 Compliance with DDA Act Trust DDA Assessment Current Full
compliance
Trust processes
On
completion
Governance
3.4 Improved clinical space / working
environment for staff
Improved Staff survey Current Improved %
staff
satisfaction
Staff survey 12 months Clinical lead /
ASD
3.5 Reduced reportable incidents
relating to the environment
Reduced incidents reported Current Reduce by
10%
Incident
reporting stats
12 months Governance
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53

Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Services – Reconfiguration of Parkview
Benefits Realisation Plan
4. MORE EFFECTIVE USE OF RESOURCES
REF DESCRIPTION INDICATOR PERFORMANCE MONITORING
METHOD
4.1 Delivering high quality effective
care in an improved environment
for staff and for all children, young
people and families
4.2 Workforce / skill mix changes
owing to improved environmental
factors
4.3 Improved staff environment owing
to less isolation
4.4 Increased ability to move staff
within units and make more
efficient use of staffing levels
4.5 More ‘marketable’ service and
therefore patients choosing to be
admitted – ensuring consistent
bed occupancy levels
Staff satisfaction / patient
experience feedback
Potential reduction in WTE –
better more efficient use of
staff i.e. not staffing a split
site
Improved staff survey and
staff reported feedback
Baseline Target
Current
Current
Current
Increased staff
satisfaction
More efficient
use of skill mix
Improved staff
survey
Less use of bank nursing Current Reduced bank
costs
Increased occupancy levels Current Increased
occupancy
levels and
income
Staff survey
Workforce plan
Staff survey /
supervision
Finance report
Daily/ monthly
performance
information
REVIEW
DATE
12 months
from
completion
12 months
from
completion
12 months
from
completion
12 months
form
completion
12 months
after
completion
LEAD
RESPONSIBILITY
Head of Nursing
ASD / CD
Head of Nursing
/ Clinical Lead
Head of Nursing
/ ASD
Tier 4 manager /
ASD
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54

Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Services – Reconfiguration of Parkview
Benefits Realisation Plan
5. IMPROVED QUALITY OF ACCOMMODATION
REF DESCRIPTION INDICATOR PERFORMANCE MONITORING
METHOD
5.1 Building physical condition Percentage of building graded
A (new: expected to perform
adequately)
Percentage of building graded
B (sound with minor
deterioration)
Percentage of building graded
C (needs major repair soon)
or D (serious risk of
breakdown
5.2 Functional suitability Percentage of building graded
A (high degree of satisfaction)
5.3 Improved working environment for
staff
Percentage of building graded
B (acceptable)
Percentage of building graded
C (below acceptable
standard) or D (unacceptable)
Staff survey satisfaction
REVIEW
DATE
LEAD
RESPONSIBILITY
Baseline Target
100% Trust Survey Annual Head of Estates
Current staff
survey
0
0
100% Trust Survey Annual Head of Estates
0
0
Improved Annual survey Annual HR
5.4 Statutory and Safety Requirements Percentage of facility graded
A (new buildings complying
with statutory and fire‐code
guidance
TBC > 60% Grade A Annual
condition
survey
Construction
completion &
annual
thereafter
Head of Estates
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55

Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Services – Reconfiguration of Parkview
Benefits Realisation Plan
REF DESCRIPTION INDICATOR PERFORMANCE MONITORING
METHOD
5.5 Space utilisation Percentage of facility graded:‐
• 1 (empty)
• 2 (underused)
• 3 (adequate)
• 4 (overcrowded)
Baseline Target
TBC TBC Annual
condition
survey
REVIEW
DATE
Construction
completion &
annual
thereafter
LEAD
RESPONSIBILITY
Head of Estates
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Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Services – Reconfiguration of Parkview
Benefits Realisation Plan
6. IMPROVED CUSTOMER CARE
REF DESCRIPTION INDICATOR PERFORMANCE MONITORING
METHOD
6.1 Improved patient experience Better environment for
young people/ families –
more likely to be provider of
choice
Meets inpatient Mental
Health standards for estates
(Adult)
Meets QNIC standards for
facilities / environment
Baseline Target
Current
Current
Current
Improved
patient
experience
report
Compliant
with adult
requirements
Compliant
Patient
experience
report
Audit
QNIC review
REVIEW
DATE
12 Months
from
completion
and annually
Annually
LEAD
RESPONSIBILITY
Head of Nursing
/ ASD
6.2 Providing easier to use, modern
and convenient facilities
Better patient experience and
feedback
Increased admissions as
provider of choice for families
needing inpatient care
Fit for purpose and market
ready
Current
Current
Improved
feedback
Increased
admissions
Reduced
refusals owing
to patient
choice
Patient
experience
report
Performance
report
12 months Head of nursing
/ Tier 4 manager
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Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Services – Reconfiguration of Parkview
Benefits Realisation Plan
REF DESCRIPTION INDICATOR PERFORMANCE MONITORING
METHOD
6.3 Providing services in line with
what young people / families want
Improved feedback and
provider of choice
Baseline Target
Current
Reduced
refusals on
grounds of not
suitable
environment
or meets the
needs of
young people
Patient
experience and
gateway report
REVIEW
DATE
12 months
LEAD
RESPONSIBILITY
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58

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX B – NON FINANCIAL EVALUATION CRITERIA
59

CAMHS Tier 4 Services
Process for Non Financial Appraisal of Options
CAMHS TIER 4 SERVICES
Better access to services
NON FINANCIAL APPRAISAL ‐ DETAILED EVALUATION CRITERIA
Travelling time by public and private transport for both patients and staff
Availability of car parking / accessibility of public transport
Equality of access (different catchments, ethnic and socio‐economic groups)
Greater responsiveness and choice in the delivery of patients’ health needs
Improved clinical quality of services
Providing the best opportunity to enhance the quality of clinical services and teaching
Providing better health outcomes for patients
Facilitating modernisation, improvement and innovation in clinical practice and teaching
Enabling new methods of providing clinical care and undertaking teaching
Facilitating better configuration of services extending to the local health economy
Addressing existing clinical problems
Improved environmental quality of services
Improving functional suitability and site layout
Meeting patient and staff expectations or conditions conducive to effective working and clinical
care (noise, ambience, specific environmental conditions or specific functions etc)
Providing buildings of architectural merit in line with Government policies
Meeting statutory standards (including fire, hygiene, health and safety)
Addressing backlog maintenance requirements and improving the quality of the estate
Minimising the environmental impact of the solution
Development of existing services and/or provision of new services
Developing or providing services required by commissioners and clinical services
Contributing to an increase in the quantity of clinical services available
Ensuring the widest availability of services locally
Improved strategic fit of services, including regeneration
Meeting strategic needs of the locality and region for clinical services
Contributing to the social and economic regeneration of the local area
Improving the quality of service relationships and departmental links
Realising benefits of inter‐dependence with other services
Promoting opportunities for collaboration and the development of partnerships with other local
facilities and businesses in the delivery of services
Providing flexibility to cope with changes in demand and in the delivery of services
1
60

CAMHS Tier 4 Services
Process for Non Financial Appraisal of Options
Meeting national, regional and local policy imperatives
Promoting new models for delivering services
Increasing the provision of care close to people’s homes
Promoting other national teaching and health priorities
Flexibility to cope with future changes in service models and patterns
Enabling better integration of services including with social and voluntary care
Delivering NHS Plan requirements, including waiting times
Contributing to the Government’s “Green Agenda”
Meeting training, teaching and research needs
Making it easier to recruit staff
Making it easier to retain staff
Enabling the development of a clear “skills escalator” to engage all staff
Meeting or protecting accreditation standards
Improving productivity
Providing social and cultural facilities and environments for staff
Making more effective use of resources
Making better use of cash, human and estate resources
Meeting service needs within available resources
Providing opportunities for generating income, including from research funding and private
practice
Encouraging the development of partnerships that facilitate the development of local businesses
Providing opportunities for transferring risk on a cost‐effective basis
Providing better value for money overall for the public sector
Ease of delivery
Practicality of delivery of physical proposals
Practicality of delivery of service proposals
Timescale for implementation
Impact on other local projects
Acceptability to staff
Planning implications
2
61

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX C – NON FINANCIAL APPRAISAL RESULTS
62

Summary of Results
Birmingham Childrens Hospital NHS FT
CAMHS TIER 4 SERVICES
SUMMARY
NON‐FINANCIAL APPRAISAL WORKSHOP
11th September 2012
OPTION 2 OPTION 3 OPTION 4 OPTION 5 OPTION 6 OPTION 7
Number of
Scorers
Ocean Ward to
new extension
Irwin Ward to
new extension;
Ocean Ward to
unmodified
Irwin
As Option 3,
with
adaptations to
Irwin
As Option 4,
plus
adaptations to
Ashifield
As Option 4,
plus
adaptations to
Heathlands
Adaptations to
all wards + new
extension
OVERALL 6 5 4 3 2 1
17
45.0% 40.5% 33.7% 25.3% 24.4% 0.0%
Service Users & Representatives 6 5 4 3 2 1
2
55.2% 52.3% 51.9% 44.8% 44.0% 0.0%
Commissioners 6 5 4 3 2 1
3
42.7% 41.9% 32.4% 20.2% 16.3% 0.0%
Providers 6 5 4 3 2 1
12
44.0% 38.4% 31.2% 23.4% 23.2% 0.0%
Scores ‐ Summary
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63

Total Scores
Birmingham Childrens Hospital NHS FT
CAMHS TIER 4 SERVICES SCORER : TOTAL
NON‐FINANCIAL APPRAISAL WORKSHOP
11th September 2012
Number of scoring participants 17
WEIGHTED SCORES
Weight OPTION 2 OPTION 3 OPTION 4 OPTION 5 OPTION 6 OPTION 7
Ocean Ward to
new extension
Irwin Ward to
new extension;
Ocean Ward to
unmodified
Irwin
As Option 3,
with
adaptations to
Irwin
As Option 4,
plus adaptations
to Ashifield
As Option 4,
plus adaptations
to Heathlands
Adaptations to
all wards + new
extension
Access to services 0.9% 0.03 0.03 0.03 0.03 0.03 0.04
Clinical Quality 17.4% 0.74 0.95 1.05 1.16 1.19 1.64
Environmental Quality 16.5% 0.76 0.75 0.92 1.07 1.11 1.57
Developing existing/new Services 17.4% 0.72 0.84 0.95 1.16 1.09 1.55
Strategic Fit 13.0% 0.48 0.52 0.68 0.81 0.82 1.14
Meeting Policy imperatives 10.4% 0.36 0.42 0.52 0.66 0.72 0.93
Training, Teaching, Research 4.3% 0.18 0.20 0.20 0.24 0.25 0.31
Effective Use of Resources 13.0% 0.78 0.77 0.78 0.83 0.83 0.96
Ease of Delivery 7.0% 0.58 0.52 0.42 0.34 0.31 0.25
TOTAL 100% 4.62 5.00 5.57 6.28 6.35 8.40
Check Total
6 5 4 3 2 1
45.02% 40.53% 33.69% 25.29% 24.43% 0.00%
Scores ‐ All
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64

Total Scores ‐ Alternative Weight (1)
Birmingham Childrens Hospital NHS FT
CAMHS TIER 4 SERVICES SCORER : TOTAL
NON‐FINANCIAL APPRAISAL WORKSHOP
11th September 2012
Number of scoring participants 17
RAW SCORES
WEIGHTED SCORES
OPTION 2 OPTION 3 OPTION 4 OPTION 5 OPTION 6 OPTION 7 OPTION 2 OPTION 3 OPTION 4 OPTION 5 OPTION 6 OPTION 7
Alternative
Weight 1
Ocean Ward to
new extension
Irwin Ward to
new extension;
Ocean Ward to
unmodified
Irwin
As Option 3,
with
adaptations to
Irwin
As Option 4, plus
adaptations to
Ashifield
As Option 4, plus
adaptations to
Heathlands
Adaptations to
all wards + new
extension
Ocean Ward to
new extension
Irwin Ward to
new extension;
Ocean Ward to
unmodified
Irwin
As Option 3,
with
adaptations to
Irwin
As Option 4, plus
adaptations to
Ashifield
As Option 4, plus
adaptations to
Heathlands
Adaptations to
all wards + new
extension
Access to services 11.1% 3.29 3.35 3.47 3.53 3.65 4.12 0.37 0.37 0.39 0.39 0.41 0.46
Clinical Quality 11.1% 4.24 5.47 6.06 6.65 6.82 9.41 0.47 0.61 0.67 0.74 0.76 1.05
Environmental Quality 11.1% 4.59 4.53 5.59 6.47 6.71 9.53 0.51 0.50 0.62 0.72 0.75 1.06
Developing existing/new Services 11.1% 4.12 4.82 5.47 6.65 6.29 8.94 0.46 0.54 0.61 0.74 0.70 0.99
Strategic Fit 11.1% 3.65 4.00 5.24 6.18 6.29 8.76 0.41 0.44 0.58 0.69 0.70 0.97
Meeting Policy imperatives 11.1% 3.47 4.06 5.00 6.29 6.88 8.94 0.39 0.45 0.56 0.70 0.76 0.99
Training, Teaching, Research 11.1% 4.12 4.53 4.71 5.41 5.76 7.18 0.46 0.50 0.52 0.60 0.64 0.80
Effective Use of Resources 11.1% 6.00 5.88 6.00 6.35 6.35 7.35 0.67 0.65 0.67 0.71 0.71 0.82
Ease of Delivery 11.1% 8.35 7.47 6.06 4.88 4.47 3.65 0.93 0.83 0.67 0.54 0.50 0.41
TOTAL 100% 41.82 44.12 47.59 52.41 53.24 67.88 4.65 4.90 5.29 5.82 5.92 7.54
RANK 6 5 4 3 2 1
DIFFERENCE 38.39% 35.01% 29.90% 22.79% 21.58% 0.00%
Alternative 1‐Equal Weights
120911 BCH CAMHS Non‐Fin Appraisal Results
65

Total Scores ‐ Alternative Weight (2)
Birmingham Childrens Hospital NHS FT
CAMHS TIER 4 SERVICES SCORER : TOTAL
NON‐FINANCIAL APPRAISAL WORKSHOP
11th September 2012
Number of scoring participants 17
RAW SCORES
WEIGHTED SCORES
OPTION 2 OPTION 3 OPTION 4 OPTION 5 OPTION 6 OPTION 7 OPTION 2 OPTION 3 OPTION 4 OPTION 5 OPTION 6 OPTION 7
Alternative
Weight 2
Ocean Ward to
new extension
Irwin Ward to
new extension;
Ocean Ward to
unmodified
Irwin
As Option 3,
with
adaptations to
Irwin
As Option 4, plus
adaptations to
Ashifield
As Option 4, plus
adaptations to
Heathlands
Adaptations to
all wards + new
extension
Ocean Ward to
new extension
Irwin Ward to
new extension;
Ocean Ward to
unmodified
Irwin
As Option 3,
with
adaptations to
Irwin
As Option 4, plus
adaptations to
Ashifield
As Option 4, plus
adaptations to
Heathlands
Adaptations to
all wards + new
extension
Access to services 17.9% 3.29 3.35 3.47 3.53 3.65 4.12 0.59 0.60 0.62 0.63 0.65 0.74
Clinical Quality 2.7% 4.24 5.47 6.06 6.65 6.82 9.41 0.11 0.15 0.16 0.18 0.18 0.25
Environmental Quality 7.1% 4.59 4.53 5.59 6.47 6.71 9.53 0.33 0.32 0.40 0.46 0.48 0.68
Developing existing/new Services 2.7% 4.12 4.82 5.47 6.65 6.29 8.94 0.11 0.13 0.15 0.18 0.17 0.24
Strategic Fit 10.7% 3.65 4.00 5.24 6.18 6.29 8.76 0.39 0.43 0.56 0.66 0.67 0.94
Meeting Policy imperatives 13.4% 3.47 4.06 5.00 6.29 6.88 8.94 0.46 0.54 0.67 0.84 0.92 1.20
Training, Teaching, Research 17.9% 4.12 4.53 4.71 5.41 5.76 7.18 0.74 0.81 0.84 0.97 1.03 1.28
Effective Use of Resources 10.7% 6.00 5.88 6.00 6.35 6.35 7.35 0.64 0.63 0.64 0.68 0.68 0.79
Ease of Delivery 17.0% 8.35 7.47 6.06 4.88 4.47 3.65 1.42 1.27 1.03 0.83 0.76 0.62
TOTAL 100% 41.82 44.12 47.59 52.41 53.24 67.88 4.79 4.88 5.07 5.43 5.55 6.73
RANK 6 5 4 3 2 1
DIFFERENCE 28.84% 27.56% 24.70% 19.36% 17.62% 0.00%
Alternative 2‐Reverse Weights
120911 BCH CAMHS Non‐Fin Appraisal Results
66

Total Scores ‐ Alternative Weight (3)
Birmingham Childrens Hospital NHS FT
CAMHS TIER 4 SERVICES SCORER : TOTAL
NON‐FINANCIAL APPRAISAL WORKSHOP
11th September 2012
Number of scoring participants 17
RAW SCORES
WEIGHTED SCORES
OPTION 2 OPTION 3 OPTION 4 OPTION 5 OPTION 6 OPTION 7 OPTION 2 OPTION 3 OPTION 4 OPTION 5 OPTION 6 OPTION 7
Alternative
Weight 3
Ocean Ward to
new extension
Irwin Ward to
new extension;
Ocean Ward to
unmodified
Irwin
As Option 3,
with
adaptations to
Irwin
As Option 4, plus
adaptations to
Ashifield
As Option 4, plus
adaptations to
Heathlands
Adaptations to
all wards + new
extension
Ocean Ward to
new extension
Irwin Ward to
new extension;
Ocean Ward to
unmodified
Irwin
As Option 3,
with
adaptations to
Irwin
As Option 4, plus
adaptations to
Ashifield
As Option 4, plus
adaptations to
Heathlands
Adaptations to
all wards + new
extension
Access to services 0.8% 3.29 3.35 3.47 3.53 3.65 4.12 0.03 0.03 0.03 0.03 0.03 0.03
Clinical Quality 15.7% 4.24 5.47 6.06 6.65 6.82 9.41 0.67 0.86 0.95 1.05 1.07 1.48
Environmental Quality 15.0% 4.59 4.53 5.59 6.47 6.71 9.53 0.69 0.68 0.84 0.97 1.00 1.43
Developing existing/new Services 15.7% 4.12 4.82 5.47 6.65 6.29 8.94 0.65 0.76 0.86 1.05 0.99 1.41
Strategic Fit 11.8% 3.65 4.00 5.24 6.18 6.29 8.76 0.43 0.47 0.62 0.73 0.74 1.04
Meeting Policy imperatives 9.4% 3.47 4.06 5.00 6.29 6.88 8.94 0.33 0.38 0.47 0.59 0.65 0.84
Training, Teaching, Research 3.9% 4.12 4.53 4.71 5.41 5.76 7.18 0.16 0.18 0.19 0.21 0.23 0.28
Effective Use of Resources 11.8% 6.00 5.88 6.00 6.35 6.35 7.35 0.71 0.69 0.71 0.75 0.75 0.87
Ease of Delivery 15.7% 8.35 7.47 6.06 4.88 4.47 3.65 1.32 1.18 0.95 0.77 0.70 0.57
TOTAL 100% 41.82 44.12 47.59 52.41 53.24 67.88 4.97 5.23 5.62 6.15 6.17 7.95
RANK 6 5 4 3 2 1
DIFFERENCE 37.48% 34.24% 29.37% 22.73% 22.39% 0.00%
Alternative 3‐Ease of Delivery
120911 BCH CAMHS Non‐Fin Appraisal Results
67

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX D – CAPITAL COSTS
68

Birmingham Children's Hospital NHS Foundation Trust
Redevelopment of Parkview Clinic ‐ April 2013
Upper Floor
Admin Areas
Irwin Ward ‐
New Build
Irwin Ward ‐
Refurb
Ocean Ward ‐
New Build
Ocean Ward ‐
Refurb
Ashfield Ward ‐
New Build
Ashfield Ward ‐
Refurb
Heathlands Ward ‐
New Build
Heathlands Ward ‐
Refurb
Upgrade of Rear Car
Park and Access
Road
Total
New Build ‐ 185m2 Refurb ‐ circa 390m2 New Build ‐ 95m2 Refurb ‐ circa 440m2 New Build ‐ 150m2 Refurb ‐ circa 360m2 New Build ‐ 160m2 Refurb ‐ circa 520m2
Mezzanine ‐ circa 85m2
Works Cost £135,400 £510,000 £955,000 £285,000 £940,000 £472,500 £752,500 £450,000 £1,110,000 £125,000 £5,735,400
Inflation/Phasing allowance £0 £0 £0 £25,000 £75,000 £15,000 £35,000 £15,000 £35,000 £0 £200,000
Works Cost £135,400 £510,000 £955,000 £310,000 £1,015,000 £487,500 £787,500 £465,000 £1,145,000 £125,000 £5,935,400
Design Fees @ 12.5% £20,310 £63,750 £119,375 £38,750 £126,875 £60,938 £98,438 £58,125 £143,125 £15,625 £745,310
(15%)
F&E Allowance £0 £0 £100,000 £0 £100,000 £75,000 £75,000 £0 £350,000
Catering/Kitchen Provision £0 £0 £0 £0 £0 £0 £0 £0 £50,000 £0 £50,000
Optimism Bias/Planning Contingency @ 6% £0 £34,425 £70,463 £20,925 £74,513 £32,906 £57,656 £31,388 £84,788 £8,438 £415,500
VAT @ 20%, fees excepted £27,080 £108,885 £225,093 £66,185 £237,903 £104,081 £184,031 £99,278 £270,958 £26,688 £1,350,180
VAT Recovery ‐£6,770 TBA TBA TBA TBA TBA TBA TBA TBA TBA ‐£6,770
Project Cost £176,020 £717,060 £1,469,930 £435,860 £1,554,290 £685,425 £1,202,625 £653,790 £1,768,870 £175,750 £8,839,620
£2,186,990 £1,990,150 £1,888,050 £2,422,660
Notes:‐
Scheme does not allow for window replacement in Refurbished areas
Final structural proposals required to confirm current allowances included are robust
Final drainage proposals required to confirm allowances included are sufficient
Details still required of proposals for vaulted ceiling to Irwin Ward
No allowances are included for any temporary decant/accommodation works
Within Admin Upper Floor costs, no allowances included for F&E or Optimism Bias/Planning Contingency as previous discussions/cost report
Catering/Kitchen Equipment cost is a provisional allowance subject to review upon receipt of actual Trust Requirements
VAT Recovery still to apply on main Works Cost
69

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX E – REVENUE COSTS
70

Birmingham Children's Hospital FT
CAMHS Tier 4 Services ‐ Outline Business Case
Income & Expenditure Projections
Option 1 Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
Income 6,350 7,188 7,523 7,188 7,188 7,188 7,779
Costs
Ward Staffing 3,224 3,224 3,224 3,224 3,224 3,224 3,482
Ward Non Pay 99 99 99 99 99 99 104
Medical Staffing 694 694 694 694 694 694 694
Park View Estates Costs 347 372 382 400 428 431 458
Capital Charges 286 464 485 643 792 831 980
Indirect Costs 707 711 713 716 720 721 768
Total Costs 5,358 5,565 5,597 5,777 5,957 6,000 6,487
Contribution 992 1,622 1,925 1,411 1,230 1,187 1,292
Overheads 762 768 770 774 781 782 852
TOTAL REVENUE COST 6,120 6,333 6,367 6,551 6,739 6,782 7,338
I & E Surplus/Deficit 230 854 1,155 636 449 405 441
Increase from baseline 0 624 925 406 219 175 211
Memorandum:
Income Diverted Elsewhere (1,429) (591) (256) (591) (591) (591) 0
130419 CAMHS Model Update_PELK_DWHE
Summary
71

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX F – VALUE FOR MONEY ASSESSMENT
72

OPTION APPRAISAL
OUTPUTS SUMMARY
Birmingham Childrens Hospital NHS FT
CAMHS
Version 30 YEARS
22nd April 2013
1.0 CAPITAL COSTS AT APPROVALS LEVEL BIS Option 1 Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
BASED ON PUBSEC BIS UPDATE: 26th June 2012
Do Nothing
New 95
Refurb 475
New 185
Refurb 475
New 280
Refurb 915
New 430
Refurb 1,275
New 435
Refurb 1,435
New 590
Refurb 1,795
£000 £000 £000 £000 £000 £000 £000
Departmental Costs 0 1,525 1,725 3,050 4,325 4,660 5,935
On‐Costs 0 0 0 0 0 0 0
Location Adjustment 0 0 0 0 0 0 0
Works Cost Total 0 1,525 1,725 3,050 4,325 4,660 5,935
Fees 0 194 219 385 544 586 745
Non‐Works 0 0 0 0 0 50 50
Land Acquisition 0 0 0 0 0 0 0
Equipment 0 100 100 200 275 275 350
Planning Contingencies 0 100 113 209 299 325 416
Optimism Bias 0 0 0 0 0 0 0
TOTAL CAPITAL COSTS AT APPROVAL BIS 173 0 1,919 2,158 3,844 5,444 5,896 7,496
VAT 0 338 381 685 973 1,055 1,343
TOTAL OB1 CAPITAL COSTS AT APPROVAL LEVEL BIS 0 2,258 2,539 4,529 6,417 6,952 8,840
BIS AT APPROVALS LEVEL 173 173 173 173 173 173 173
TOTAL NEW CAPITAL COSTS AT OUTTURN LEVEL BIS 0 2,258 2,539 4,529 6,417 6,952 8,840
BIS AT START ON SITE 173 173 173 173 173 173 173
TOTAL NEW CAPITAL COSTS AT CURRENT: 2012/13 0 2,258 2,539 4,529 6,417 6,952 8,840
BIS AT CURRENT N/A 173 173 173 173 173 173
130422 CAMHS VfM Model 30 with Income Risk
Outputs Summary
73

OPTION APPRAISAL
OUTPUTS SUMMARY
Birmingham Childrens Hospital NHS FT
CAMHS
Version 30 YEARS
22nd April 2013
2.0 RECURRENT REVENUE IMPACT Option 1 Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
Do Nothing
New 95
Refurb 475
New 185
Refurb 475
New 280
Refurb 915
New 430
Refurb 1,275
New 435
Refurb 1,435
New 590
Refurb 1,795
NET REVENUE CHANGE at 2012/13 prices £000 £000 £000 £000 £000 £000 £000
Baseline Year: 2012/13
Pay and Non‐Pay 4,018 4,018 4,018 4,018 4,018 4,018 4,018
Estates & Indirect 1,055 1,055 1,055 1,055 1,055 1,055 1,055
Overheads 762 762 762 762 762 762 762
Activity undertaken elsewhere 1,429 1,429 1,429 1,429 1,429 1,429 1,429
Capital Charges 0 0 0 0 0 0 0
Net Baseline Expenditure 7,263 7,263 7,263 7,263 7,263 7,263 7,263
Forecast Year 2017/18 2017/18 2017/18 2017/18 2017/18 2017/18 2017/18
Pay and Non‐Pay 4,018 4,018 4,018 4,018 4,018 4,018 4,281
Estates & Indirect 1,055 1,084 1,095 1,116 1,148 1,151 1,226
Overheads 762 768 770 774 781 782 852
Activity undertaken elsewhere 1,429 591 256 591 591 591 0
Capital Charges 286 464 485 643 792 831 980
Net Forecast Expenditure 7,549 6,924 6,624 7,143 7,330 7,374 7,338
Forecast: Change
Pay and Non‐Pay 0 0 0 0 0 0 263
Estates & Indirect 0 29 40 61 93 97 172
Overheads 0 6 8 13 19 20 90
Activity undertaken elsewhere 0 (838) (1,173) (838) (838) (838) (1,429)
Capital Charges 286 464 485 643 792 831 980
Net Addtional Revenue Cost 286 (339) (639) (120) 67 111 75
Affordability Ranking of Development Options 7 2 1 3 4 6 5
Lowest Revenue Cost (639) (639) (639) (639) (639) (639) (639)
MARGINAL AFFORDABILITY IMPACT OVER OPTION RANKED 1 925 301 0 519 706 750 715
130422 CAMHS VfM Model 30 with Income Risk
Outputs Summary
74

OPTION APPRAISAL
OUTPUTS SUMMARY
Birmingham Childrens Hospital NHS FT
CAMHS
Version 30 YEARS
22nd April 2013
3.0 ECONOMIC IMPACT Option 1 Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
Do Nothing
New 95
Refurb 475
New 185
Refurb 475
New 280
Refurb 915
New 430
Refurb 1,275
New 435
Refurb 1,435
New 590
Refurb 1,795
APPRAISAL PERIOD (YEARS) 33 33 33 33 33 33 33
£000 £000 £000 £000 £000 £000 £000
3.1 Base Impact excluding Risk
Net Present Cost (NPC) 145,796 134,164 128,752 137,697 140,580 141,334 140,169
Equivalent Annual Cost (EAC) 7,263 6,684 6,414 6,860 7,003 7,041 6,983
Economic Ranking of Options: Base Impact excluding Risk 2 1 3 5 6 4
MARGINAL EAC IMPACT OVER OPTION RANKED 1 849 270 0 446 589 627 569
DIFFERENCE (% above Preferred Option) 4.2% 0.0% 6.9% 9.2% 9.8% 8.9%
3.2 Impact of Risk
Net Present Cost (NPC) 26,749 22,642 22,666 15,092 9,224 5,870 0
Equivalent Annual Cost (EAC) 1,312 1,110 1,112 740 452 288 0
Economic Ranking of Options: Impact of Risk 5 6 4 3 2 1
3.3 Economic Impact including Risk
Net Present Cost (NPC) 172,545 156,806 151,418 152,789 149,804 147,204 140,169
Equivalent Annual Cost (EAC) 8,575 7,794 7,526 7,600 7,456 7,329 6,983
Economic Ranking of Development Options 6 4 5 3 2 1
MARGINAL EAC IMPACT OVER OPTION RANKED 1 1,592 811 543 617 473 346 0
EAC SWITCH VALUES (811) (543) (617) (473) (346) 346
DIFFERENCE (% above Preferred Option) 11.6% 7.8% 8.8% 6.8% 5.0% 0.0%
130422 CAMHS VfM Model 30 with Income Risk
Outputs Summary
75

OPTION APPRAISAL
OUTPUTS SUMMARY
Birmingham Childrens Hospital NHS FT
CAMHS
Version 30 YEARS
22nd April 2013
4.0 ECONOMIC SENSITIVITY ‐ Change in Costs required to trigger Option 1 Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
switch values
New 95 New 185 New 280 New 430 New 435 New 590
Do Nothing
Refurb 475 Refurb 475 Refurb 915 Refurb 1,275 Refurb 1,435 Refurb 1,795
£000 £000 £000 £000 £000 £000 £000
4.1 Capital Costs
Base Case Capital Costs (at Current, exc VAT & Contingencies) 1,919 2,158 3,844 5,444 5,896 7,496
Flexed Capital Costs (15,241) (9,285) (9,279) (4,742) (1,643) 15,066
Change required (17,161) (11,443) (13,123) (10,186) (7,539) 7,570
Change % ‐894.1% ‐530.3% ‐341.4% ‐187.1% ‐127.9% 101.0%
4.2 Revenue Costs
Base Case Revenue Costs (excluding capital charges) 6,460 6,139 6,703 7,110 7,359 7,242
Flexed Revenue Costs 5,661 5,607 6,078 6,606 6,978 7,626
Change required (799) (531) (625) (504) (381) 383
Change % ‐12.4% ‐8.7% ‐9.3% ‐7.1% ‐5.2% 5.3%
5.0 COMBINED ECONOMIC AND NON‐FINANCIAL APPRAISALS Option 1 Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
Do Nothing
New 95
Refurb 475
New 185
Refurb 475
New 280
Refurb 915
New 430
Refurb 1,275
New 435
Refurb 1,435
New 590
Refurb 1,795
5.1 Weighted Non‐Financial Scores 4.62 5.00 5.57 6.28 6.35 8.40
NON‐FINANCIAL RANKING OF DEVELOPMENT OPTIONS 6 5 4 3 2 1
5.2 EAC Impact of Option 7,794 7,526 7,600 7,456 7,329 6,983
ECONOMIC RANKING OF DEVELOPMENT OPTIONS 0 6 4 5 3 2 1
5.3 Benefit Points per EAC £m 0.59 0.66 0.73 0.84 0.87 1.20
COMBINED RANKING OF DEVELOPMENT OPTIONS 6 5 4 3 2 1
DIFFERENCE (% below Preferred Option on Combined Score Basis) ‐50.7% ‐44.8% ‐39.1% ‐30.0% ‐28.0% 0.0%
5.4
SENSITIVITY NON‐FINANCIAL SCORES to switch 1st and 2nd
ranked Options ‐ MARGINAL CHANGE
Option 1 Option 2 Option 3 Option 4 Option 5 Option 6 Option 7
Do Nothing
New 95
Refurb 475
New 185
Refurb 475
New 280
Refurb 915
New 430
Refurb 1,275
New 435
Refurb 1,435
New 590
Refurb 1,795
Base Weighted Non‐Financial Scores 6.35 8.40
Weighted Non‐Financial Scores needed to switch rankings 9.36 5.47
Equivalent to a change in % 47.4% ‐34.9%
130422 CAMHS VfM Model 30 with Income Risk
Outputs Summary
76

OPTION APPRAISAL
ECONOMIC ANALYSIS
Option 2
Birmingham Childrens Hospital NHS FT 33 YEARS APPRAISAL
CAMHS 3.50% DISCOUNT RATE
Version 30 YEARS
22nd April 2013
A B C D E F G H I J K L M N O P Q R
CAPITAL COSTS excluding VAT
REVENUE COSTS
YEAR
PERIOD
New Capital at
Current
Land Sales
Opportunity
Costs
Residual Value
Lifecycle New
Works
Lifecycle New
Equipment
Lifecycle
Existing
TOTAL CAPITAL
Pay and Non‐
Pay
Estates &
Indirect
Overheads
Activity
undertaken
elsewhere
TOTAL
REVENUE
TOTAL COSTS
Discount
Factor 3.5%
£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000
0 2012 2013 0 0 0 0 0 0 0 0 4,018 1,055 762 1,429 7,263 7,263 3.50% 1.0000 7,263
1 2013 2014 943 0 0 0 0 0 943 4,018 1,055 762 1,429 7,263 8,206 3.50% 0.9662 7,928
2 2014 2015 943 0 0 0 0 0 943 4,018 1,055 762 1,000 6,834 7,777 3.50% 0.9335 7,260
3 2015 2016 33 0 0 0 0 0 33 4,018 1,084 768 591 6,460 6,494 3.50% 0.9019 5,857
4 2016 2017 0 0 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.8714 5,643
5 2017 2018 0 0 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.8420 5,452
6 2018 2019 0 0 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.8135 5,268
7 2019 2020 0 0 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.7860 5,089
8 2020 2021 0 0 0 27 0 0 27 4,018 1,084 768 591 6,460 6,487 3.50% 0.7594 4,926
9 2021 2022 0 0 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.7337 4,751
10 2022 2023 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.7089 4,590
11 2023 2024 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.6849 4,435
12 2024 2025 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.6618 4,285
13 2025 2026 0 141 106 0 247 4,018 1,084 768 591 6,460 6,707 3.50% 0.6394 4,288
14 2026 2027 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.6178 4,000
15 2027 2028 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.5969 3,865
16 2028 2029 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.5767 3,734
17 2029 2030 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.5572 3,608
18 2030 2031 0 105 0 0 105 4,018 1,084 768 591 6,460 6,566 3.50% 0.5384 3,535
19 2031 2032 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.5202 3,368
20 2032 2033 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.5026 3,254
21 2033 2034 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.4856 3,144
22 2034 2035 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.4692 3,038
23 2035 2036 0 420 106 0 526 4,018 1,084 768 591 6,460 6,986 3.50% 0.4533 3,167
24 2036 2037 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.4380 2,836
25 2037 2038 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.4231 2,740
26 2038 2039 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.4088 2,647
27 2039 2040 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.3950 2,558
28 2040 2041 0 156 0 0 156 4,018 1,084 768 591 6,460 6,617 3.50% 0.3817 2,525
29 2041 2042 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.3687 2,388
30 2042 2043 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.50% 0.3563 2,307
31 2043 2044 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.00% 0.3459 2,240
32 2044 2045 0 15 0 0 15 4,018 1,084 768 591 6,460 6,475 3.00% 0.3358 2,175
33 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
70 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
TOTAL 1,919 0 0 0 1,204 212 0 3,335 132,583 35,669 25,320 21,596 215,169 218,505
NPC 33 YEARS 1,821 0 0 0 617 116 0 2,554 80,650 21,666 15,396 13,898 131,610 134,163.8
EAC 33 YEARS 91 0 0 0 31 6 0 127 4,018 1,079 767 692 6,556 20.0738 6,683.5
NET PRESENT
COST
130422 CAMHS VfM Model 30 with Income Risk
Option 2 NPC
77

OPTION APPRAISAL
ECONOMIC ANALYSIS
Option 3
Birmingham Childrens Hospital NHS FT 33 YEARS APPRAISAL
CAMHS 3.50% DISCOUNT RATE
Version 30 YEARS
22nd April 2013
A B C D E F G H I J K L M N O P Q R
CAPITAL COSTS excluding VAT
REVENUE COSTS
YEAR
PERIOD
New Capital at
Current
Land Sales
Opportunity
Costs
Residual Value
Lifecycle New
Works
Lifecycle New
Equipment
Lifecycle
Existing
TOTAL CAPITAL
Pay and Non‐
Pay
Estates &
Indirect
Overheads
Activity
undertaken
elsewhere
TOTAL
REVENUE
TOTAL COSTS
Discount
Factor 3.5%
£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000
0 2012 2013 0 0 0 0 0 0 0 0 4,018 1,055 762 1,429 7,263 7,263 3.50% 1.0000 7,263
1 2013 2014 1,284 0 0 0 0 0 1,284 4,018 1,055 762 1,429 7,263 8,547 3.50% 0.9662 8,258
2 2014 2015 835 0 0 0 0 0 835 4,018 1,055 762 829 6,663 7,498 3.50% 0.9335 7,000
3 2015 2016 39 0 0 0 0 0 39 4,018 1,095 770 256 6,139 6,177 3.50% 0.9019 5,572
4 2016 2017 0 0 0 15 0 0 15 4,018 1,095 770 243 6,125 6,140 3.50% 0.8714 5,351
5 2017 2018 0 0 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.8420 5,181
6 2018 2019 0 0 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.8135 5,006
7 2019 2020 0 0 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.7860 4,837
8 2020 2021 0 0 0 28 0 0 28 4,018 1,095 770 256 6,139 6,167 3.50% 0.7594 4,683
9 2021 2022 0 0 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.7337 4,515
10 2022 2023 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.7089 4,362
11 2023 2024 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.6849 4,215
12 2024 2025 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.6618 4,072
13 2025 2026 0 157 106 0 263 4,018 1,095 770 256 6,139 6,402 3.50% 0.6394 4,093
14 2026 2027 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.6178 3,802
15 2027 2028 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.5969 3,673
16 2028 2029 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.5767 3,549
17 2029 2030 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.5572 3,429
18 2030 2031 0 117 0 0 117 4,018 1,095 770 256 6,139 6,256 3.50% 0.5384 3,368
19 2031 2032 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.5202 3,201
20 2032 2033 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.5026 3,093
21 2033 2034 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.4856 2,988
22 2034 2035 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.4692 2,887
23 2035 2036 0 474 106 0 580 4,018 1,095 770 256 6,139 6,718 3.50% 0.4533 3,045
24 2036 2037 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.4380 2,695
25 2037 2038 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.4231 2,604
26 2038 2039 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.4088 2,516
27 2039 2040 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.3950 2,431
28 2040 2041 0 175 0 0 175 4,018 1,095 770 256 6,139 6,314 3.50% 0.3817 2,410
29 2041 2042 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.3687 2,269
30 2042 2043 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.50% 0.3563 2,192
31 2043 2044 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.00% 0.3459 2,129
32 2044 2045 0 15 0 0 15 4,018 1,095 770 256 6,139 6,154 3.00% 0.3358 2,067
33 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
70 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
TOTAL 2,158 0 0 0 1,307 212 0 3,676 132,583 36,003 25,389 11,361 205,336 209,013
NPC 33 YEARS 2,055 0 0 0 666 116 0 2,837 80,650 21,857 15,435 7,972 125,915 128,752.1
EAC 33 YEARS 102 0 0 0 33 6 0 141 4,018 1,089 769 397 6,273 20.0738 6,413.9
NET PRESENT
COST
130422 CAMHS VfM Model 30 with Income Risk
Option 3 NPC
78

OPTION APPRAISAL
ECONOMIC ANALYSIS
Option 4
Birmingham Childrens Hospital NHS FT 33 YEARS APPRAISAL
CAMHS 3.50% DISCOUNT RATE
Version 30 YEARS
22nd April 2013
A B C D E F G H I J K L M N O P Q R
CAPITAL COSTS excluding VAT
REVENUE COSTS
YEAR
PERIOD
New Capital at
Current
Land Sales
Opportunity
Costs
Residual Value
Lifecycle New
Works
Lifecycle New
Equipment
Lifecycle
Existing
TOTAL CAPITAL
Pay and Non‐
Pay
Estates &
Indirect
Overheads
Activity
undertaken
elsewhere
TOTAL
REVENUE
TOTAL COSTS
Discount
Factor 3.5%
£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000
0 2012 2013 0 0 0 0 0 0 0 0 4,018 1,055 762 1,429 7,263 7,263 3.50% 1.0000 7,263
1 2013 2014 1,286 0 0 0 0 0 1,286 4,018 1,055 762 1,429 7,263 8,549 3.50% 0.9662 8,260
2 2014 2015 2,484 0 0 0 0 0 2,484 4,018 1,055 762 1,408 7,242 9,726 3.50% 0.9335 9,079
3 2015 2016 74 0 0 0 0 0 74 4,018 1,116 774 795 6,703 6,777 3.50% 0.9019 6,113
4 2016 2017 0 0 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.8714 5,677
5 2017 2018 0 0 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.8420 5,485
6 2018 2019 0 0 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.8135 5,299
7 2019 2020 0 0 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.7860 5,120
8 2020 2021 0 0 0 38 0 0 38 4,018 1,116 774 591 6,499 6,538 3.50% 0.7594 4,965
9 2021 2022 0 0 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.7337 4,780
10 2022 2023 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.7089 4,618
11 2023 2024 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.6849 4,462
12 2024 2025 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.6618 4,311
13 2025 2026 0 267 212 0 479 4,018 1,116 774 591 6,499 6,978 3.50% 0.6394 4,462
14 2026 2027 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.6178 4,024
15 2027 2028 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.5969 3,888
16 2028 2029 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.5767 3,757
17 2029 2030 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.5572 3,630
18 2030 2031 0 196 0 0 196 4,018 1,116 774 591 6,499 6,695 3.50% 0.5384 3,604
19 2031 2032 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.5202 3,388
20 2032 2033 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.5026 3,274
21 2033 2034 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.4856 3,163
22 2034 2035 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.4692 3,056
23 2035 2036 0 826 212 0 1,038 4,018 1,116 774 591 6,499 7,538 3.50% 0.4533 3,417
24 2036 2037 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.4380 2,853
25 2037 2038 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.4231 2,756
26 2038 2039 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.4088 2,663
27 2039 2040 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.3950 2,573
28 2040 2041 0 298 0 0 298 4,018 1,116 774 591 6,499 6,798 3.50% 0.3817 2,594
29 2041 2042 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.3687 2,402
30 2042 2043 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.50% 0.3563 2,321
31 2043 2044 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.00% 0.3459 2,253
32 2044 2045 0 15 0 0 15 4,018 1,116 774 591 6,499 6,514 3.00% 0.3358 2,188
33 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
70 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
TOTAL 3,844 0 0 0 1,981 424 0 6,249 132,583 36,637 25,520 22,209 216,949 223,199
NPC 33 YEARS 3,628 0 0 0 994 232 0 4,853 80,650 22,220 15,510 14,463 132,844 137,697.0
EAC 33 YEARS 181 0 0 0 50 12 0 242 4,018 1,107 773 720 6,618 20.0738 6,859.5
NET PRESENT
COST
130422 CAMHS VfM Model 30 with Income Risk
Option 4 NPC
79

OPTION APPRAISAL
ECONOMIC ANALYSIS
Option 5
Birmingham Childrens Hospital NHS FT 33 YEARS APPRAISAL
CAMHS 3.50% DISCOUNT RATE
Version 30 YEARS
22nd April 2013
A B C D E F G H I J K L M N O P Q R
CAPITAL COSTS excluding VAT
REVENUE COSTS
YEAR
PERIOD
New Capital at
Current
Land Sales
Opportunity
Costs
Residual Value
Lifecycle New
Works
Lifecycle New
Equipment
Lifecycle
Existing
TOTAL CAPITAL
Pay and Non‐
Pay
Estates &
Indirect
Overheads
Activity
undertaken
elsewhere
TOTAL
REVENUE
TOTAL COSTS
Discount
Factor 3.5%
£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000
0 2012 2013 0 0 0 0 0 0 0 0 4,018 1,055 762 1,429 7,263 7,263 3.50% 1.0000 7,263
1 2013 2014 1,287 0 0 0 0 0 1,287 4,018 1,055 762 1,429 7,263 8,550 3.50% 0.9662 8,261
2 2014 2015 2,587 0 0 0 0 0 2,587 4,018 1,055 762 1,408 7,242 9,829 3.50% 0.9335 9,176
3 2015 2016 1,536 0 0 0 0 0 1,536 4,018 1,148 781 1,163 7,110 8,646 3.50% 0.9019 7,798
4 2016 2017 34 0 0 15 0 0 49 4,018 1,148 781 632 6,579 6,628 3.50% 0.8714 5,775
5 2017 2018 0 0 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.8420 5,517
6 2018 2019 0 0 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.8135 5,331
7 2019 2020 0 0 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.7860 5,151
8 2020 2021 0 0 0 48 0 0 48 4,018 1,148 781 591 6,538 6,586 3.50% 0.7594 5,002
9 2021 2022 0 0 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.7337 4,808
10 2022 2023 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.7089 4,646
11 2023 2024 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.6849 4,488
12 2024 2025 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.6618 4,337
13 2025 2026 0 373 292 0 664 4,018 1,148 781 591 6,538 7,202 3.50% 0.6394 4,605
14 2026 2027 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.6178 4,048
15 2027 2028 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.5969 3,911
16 2028 2029 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.5767 3,779
17 2029 2030 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.5572 3,651
18 2030 2031 0 272 0 0 272 4,018 1,148 781 591 6,538 6,810 3.50% 0.5384 3,666
19 2031 2032 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.5202 3,409
20 2032 2033 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.5026 3,293
21 2033 2034 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.4856 3,182
22 2034 2035 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.4692 3,074
23 2035 2036 0 1,167 292 0 1,458 4,018 1,148 781 591 6,538 7,996 3.50% 0.4533 3,625
24 2036 2037 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.4380 2,870
25 2037 2038 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.4231 2,773
26 2038 2039 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.4088 2,679
27 2039 2040 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.3950 2,588
28 2040 2041 0 417 0 0 417 4,018 1,148 781 591 6,538 6,956 3.50% 0.3817 2,655
29 2041 2042 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.3687 2,416
30 2042 2043 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.50% 0.3563 2,335
31 2043 2044 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.00% 0.3459 2,267
32 2044 2045 0 15 0 0 15 4,018 1,148 781 591 6,538 6,553 3.00% 0.3358 2,201
33 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
70 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
TOTAL 5,444 0 0 0 2,632 583 0 8,659 132,583 37,604 25,720 22,617 218,525 227,184
NPC 33 YEARS 5,073 0 0 0 1,309 319 0 6,701 80,650 22,774 15,625 14,830 133,879 140,580.3
EAC 33 YEARS 253 0 0 0 65 16 0 334 4,018 1,135 778 739 6,669 20.0738 7,003.2
NET PRESENT
COST
130422 CAMHS VfM Model 30 with Income Risk
Option 5 NPC
80

OPTION APPRAISAL
ECONOMIC ANALYSIS
Option 6
Birmingham Childrens Hospital NHS FT 33 YEARS APPRAISAL
CAMHS 3.50% DISCOUNT RATE
Version 30 YEARS
22nd April 2013
A B C D E F G H I J K L M N O P Q R
CAPITAL COSTS excluding VAT
REVENUE COSTS
YEAR
PERIOD
New Capital at
Current
Land Sales
Opportunity
Costs
Residual Value
Lifecycle New
Works
Lifecycle New
Equipment
Lifecycle
Existing
TOTAL CAPITAL
Pay and Non‐
Pay
Estates &
Indirect
Overheads
Activity
undertaken
elsewhere
TOTAL
REVENUE
TOTAL COSTS
Discount
Factor 3.5%
£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000
0 2012 2013 0 0 0 0 0 0 0 0 4,018 1,055 762 1,429 7,263 7,263 3.50% 1.0000 7,263
1 2013 2014 1,287 0 0 0 0 0 1,287 4,018 1,055 762 1,429 7,263 8,550 3.50% 0.9662 8,261
2 2014 2015 2,486 0 0 0 0 0 2,486 4,018 1,055 762 1,408 7,242 9,728 3.50% 0.9335 9,081
3 2015 2016 572 0 0 0 0 0 572 4,018 1,151 782 1,408 7,359 7,931 3.50% 0.9019 7,153
4 2016 2017 1,508 0 0 15 0 0 1,523 4,018 1,151 782 659 6,610 8,133 3.50% 0.8714 7,088
5 2017 2018 43 0 0 15 0 0 57 4,018 1,151 782 591 6,542 6,600 3.50% 0.8420 5,557
6 2018 2019 0 0 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.8135 5,334
7 2019 2020 0 0 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.7860 5,154
8 2020 2021 0 0 0 51 0 0 51 4,018 1,151 782 591 6,542 6,593 3.50% 0.7594 5,007
9 2021 2022 0 0 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.7337 4,811
10 2022 2023 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.7089 4,648
11 2023 2024 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.6849 4,491
12 2024 2025 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.6618 4,339
13 2025 2026 0 400 292 0 692 4,018 1,151 782 591 6,542 7,234 3.50% 0.6394 4,625
14 2026 2027 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.6178 4,051
15 2027 2028 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.5969 3,914
16 2028 2029 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.5767 3,781
17 2029 2030 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.5572 3,654
18 2030 2031 0 292 0 0 292 4,018 1,151 782 591 6,542 6,834 3.50% 0.5384 3,679
19 2031 2032 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.5202 3,411
20 2032 2033 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.5026 3,295
21 2033 2034 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.4856 3,184
22 2034 2035 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.4692 3,076
23 2035 2036 0 1,256 292 0 1,547 4,018 1,151 782 591 6,542 8,089 3.50% 0.4533 3,667
24 2036 2037 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.4380 2,872
25 2037 2038 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.4231 2,775
26 2038 2039 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.4088 2,681
27 2039 2040 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.3950 2,590
28 2040 2041 0 448 0 0 448 4,018 1,151 782 591 6,542 6,991 3.50% 0.3817 2,668
29 2041 2042 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.3687 2,418
30 2042 2043 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.50% 0.3563 2,336
31 2043 2044 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.00% 0.3459 2,268
32 2044 2045 0 15 0 0 15 4,018 1,151 782 591 6,542 6,557 3.00% 0.3358 2,202
33 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
70 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
TOTAL 5,896 0 0 0 2,802 583 0 9,282 132,583 37,704 25,741 22,890 218,918 228,200
NPC 33 YEARS 5,431 0 0 0 1,392 319 0 7,141 80,650 22,831 15,637 15,075 134,193 141,334.0
EAC 33 YEARS 271 0 0 0 69 16 0 356 4,018 1,137 779 751 6,685 20.0738 7,040.7
NET PRESENT
COST
130422 CAMHS VfM Model 30 with Income Risk
Option 6 NPC
81

OPTION APPRAISAL
ECONOMIC ANALYSIS
Option 7
Birmingham Childrens Hospital NHS FT 33 YEARS APPRAISAL
CAMHS 3.50% DISCOUNT RATE
Version 30 YEARS
22nd April 2013
A B C D E F G H I J K L M N O P Q R
CAPITAL COSTS excluding VAT
REVENUE COSTS
YEAR
PERIOD
New Capital at
Current
Land Sales
Opportunity
Costs
Residual Value
Lifecycle New
Works
Lifecycle New
Equipment
Lifecycle
Existing
TOTAL CAPITAL
Pay and Non‐
Pay
Estates &
Indirect
Overheads
Activity
undertaken
elsewhere
TOTAL
REVENUE
TOTAL COSTS
Discount
Factor 3.5%
£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000
0 2012 2013 0 0 0 0 0 0 0 0 4,018 1,055 762 1,429 7,263 7,263 3.50% 1.0000 7,263
1 2013 2014 1,288 0 0 0 0 0 1,288 4,018 1,055 762 1,429 7,263 8,551 3.50% 0.9662 8,262
2 2014 2015 2,588 0 0 0 0 0 2,588 4,018 1,055 762 884 6,718 9,306 3.50% 0.9335 8,687
3 2015 2016 2,035 0 0 0 0 0 2,035 4,281 1,226 852 884 7,242 9,278 3.50% 0.9019 8,368
4 2016 2017 1,543 0 0 15 0 0 1,557 4,281 1,226 852 722 7,080 8,638 3.50% 0.8714 7,527
5 2017 2018 43 0 0 15 0 0 57 4,281 1,226 852 0 6,359 6,416 3.50% 0.8420 5,402
6 2018 2019 0 0 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.8135 5,185
7 2019 2020 0 0 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.7860 5,009
8 2020 2021 0 0 0 61 0 0 61 4,281 1,226 852 0 6,359 6,419 3.50% 0.7594 4,875
9 2021 2022 0 0 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.7337 4,676
10 2022 2023 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.7089 4,518
11 2023 2024 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.6849 4,365
12 2024 2025 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.6618 4,218
13 2025 2026 0 506 371 0 877 4,281 1,226 852 0 6,359 7,236 3.50% 0.6394 4,626
14 2026 2027 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.6178 3,937
15 2027 2028 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.5969 3,804
16 2028 2029 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.5767 3,676
17 2029 2030 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.5572 3,551
18 2030 2031 0 368 0 0 368 4,281 1,226 852 0 6,359 6,726 3.50% 0.5384 3,621
19 2031 2032 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.5202 3,315
20 2032 2033 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.5026 3,203
21 2033 2034 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.4856 3,095
22 2034 2035 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.4692 2,990
23 2035 2036 0 1,596 371 0 1,967 4,281 1,226 852 0 6,359 8,325 3.50% 0.4533 3,774
24 2036 2037 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.4380 2,791
25 2037 2038 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.4231 2,697
26 2038 2039 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.4088 2,606
27 2039 2040 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.3950 2,518
28 2040 2041 0 567 0 0 567 4,281 1,226 852 0 6,359 6,926 3.50% 0.3817 2,643
29 2041 2042 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.3687 2,350
30 2042 2043 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.50% 0.3563 2,271
31 2043 2044 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.00% 0.3459 2,205
32 2044 2045 0 15 0 0 15 4,281 1,226 852 0 6,359 6,373 3.00% 0.3358 2,140
33 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
70 0 0 0 0 0 0 0 0 0 0 0 3.00% 0.0000 0
TOTAL 7,496 0 0 0 3,453 742 0 11,691 140,473 39,950 27,834 5,348 213,606 225,297
NPC 33 YEARS 6,876 0 0 0 1,708 405 0 8,989 85,167 24,117 16,835 5,061 131,180 140,168.8
EAC 33 YEARS 343 0 0 0 85 20 0 448 4,243 1,201 839 252 6,535 20.0738 6,982.7
NET PRESENT
COST
130422 CAMHS VfM Model 30 with Income Risk
Option 7 NPC
82

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX G – 1:50 PLANS
83

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX H - PRELIMINARY BREEAM ASSESSMENT
89

Healthcare
BREEAM 2011 Tracker
CPW | Birmingham: 0121 709 6600 | Nottingham: 0115 924 3348 | Cambridge: 01480 457 488 | Leeds: 0113 287 1465 |London: 0207 554 8732 RSS 04/10/2011
Bristol: 0117 315 5201 | Leicester: 0116 208 0410 | www.cpwp.com Targeted Achieved Potential
BREEAM SCORE %: 37.51 0.00 58.41
BREEAM % score is sufficient to rate the following classification: Pass Unclassified Credit Status:
Minimum criteria for the following classification have been met: Good - Not Pursuing
Last Updated: 22/4/13 (HA) - Pursuing
Revision: A G √ Possible Target
Date of issue: 22/04/13 P √ Achieved
Job Title: B'ham Childrens Hospital CAMHS Tier 4 New Build: m² %
Job Number: 12423 Refurbishment: m² %
Name Item Responsibility Comment/Action
Pre-Requisite /Min
standard achieved
Potential
Additional
Available
Credits
Targeted Credits
Actions required to secure the points given in the assessment (Y or N) 20.90% 135 49 0 37.51 0.00
Management Weighting: 0.120 2.18% 22 17 0 9.27 0.00
Man 01 Sustainable procurement (Minimum Standard 1 P, 2 OS)
Roles, responsibilities and occupier training Project team 1 1 - Y
BREEAM Accredited Professional appointed Client 1 1 - Y
BREEAM Accredited Professional - reporting and monitoring to stage E Client 1 1 - Y
BREEAM Accredited Professional - reporting and monitoring to stage L Prelims/ Contractor 1 1 - Y
Construction and handover - thermographic survey
N/A
Not targeted as requires thermographic survey and any defects to be
corrected.
1 0 0 R
Construction and handover - commissioning Prelims/Contractor 1 1 - Y
Aftercare - seasonal commissioning Prelims/Contractor 1 1 - Y
Aftercare - energy/water consumption analysis, support Client 1 1 - Y
Man 02 Responsible construction practices (Minimum Standard 1 E, 2 OS)
Contractor achieves compliance in recognised scheme Prelims/Contractor 1 1 - Y
Contractor exceeds compliance
Prelims/Contractor
Not targeted as Considerate Constructors score difficult to achieve.
Potential credit.
1 1 0 0 R
Man 03 Construction site impacts
Construction energy monitored, measured & reported Prelims/Contractor 1 1 - Y
Construction water monitored, measured & reported Prelims/Contractor 1 1 - Y
Construction transport monitored, measured & reported Prelims/Contractor 1 1 - Y
All project timber meets timber procurement policy Prelims/Contractor 1 1 - Y
EMS and pollution prevention Prelims/Contractor 1 1 - Y
Man 04 Stakeholder participation (Minimum Standard - see below)
Consultation Client 1 1 - Y
Inclusive and accessible design Architect 1 1 - Y
Building user information (M.S. 1 E) Main Contractor 1 1 - Y
Post Occupancy Evaluation (POE) and information dissemination
Client
Not targeted as requires a survey 12 months after occupancy. Potential
credit.
1 1 0 0 R
Man 05 Life cycle cost and service planning
Cost analysis performed QS 1 1 - Y
Alternative building element options considered QS Not targted. Potential credit for comparing alternative design options 1 1 0 0 R
LCC model updated, maintenance & management strategy developed
QS
Not targeted. Potential credit for implementing results of life cycle costing
study, updating it and developing a maintenance/ management strategy
1 1 0 0 R
from it.
Health and Wellbeing Weighting: 0.150 2.65% 17 5 0 4.41 0.00
Hea 01 Visual comfort (Minimum Standard - see below)
Pre-requisite - HF gear (M.S. P) M&E Y N/A Y - Y
Not targeted. Unlikely to be achievable - potential credits only - but CPW to
M&E
Daylighting
investigate whether daylight factors will be met.
2 2 0 0 R
Glare control and view out N/A Not available as courtyard less than 10m across. 2 0 0 R
Internal and external lighting M&E/Contractor 1 1 - Y
Visual Arts N/A Not targeted as no arts policy/ strategy/ co-ordinator 1 0 0 R
Hea 02 Indoor air quality
An indoor air quality plan - Minimum standard M&E/Contractor Y N/A Y - Y
Minimising sources of air pollution - ventilation and CO 2 sensors M&E/Contractor Not available due to proximity of car parking 1 0 0 R
VOC standards compliance Prelims/Contractor 1 1 - Y
VOC testing post construction
N/A Not targeted as requires testing post completion but prior to occupancy 1 0 0 R
Potential for natural ventilation N/A Not available 1 0 0 R
Laboratory fume cupboards and Containment areas N/A Not applicable 0 0 0 R
Buildings with Containment Level 2 and 3 laboratory facilities N/A Not applicable 0 0 0 R
Hea 03 Thermal comfort
Thermal modelling carried out Main Contractor 1 1 - Y
The thermal modelling analysis informed the temperature control strategy Main Contractor 1 1 - Y
Hea 04 Water quality (Minimum Standard P - Criterion 1)
Control of legionella bacteria by following ACoP 2000 (minimum standard) Y N/A Y - Y
Minimising risk of contamination and provision of fresh drinking water CPW Spec 1 1 - Y
Hea 05 Acoustic performance
Pre-requisite - Suitably Qualified Acoustician's Advice Y N/A N N Y
Acoustic performance standards N/A Not targeted as unlikely to meet acoustic requirements 2 0 0 R
Hea 06 Safety and security
Safe access - pedestrians and cyclists, deliveries and parking N/A Not available due to lack of cycle paths 1 0 0 R
Not targeted as no consultation with police ALO required. Potential credit
Architect
Security of site and building
only.
1 1 0 - R
Achieved
Credits
Target Score
%
Achieved
Score %
Page 1
90

Healthcare
BREEAM 2011 Tracker
CPW | Birmingham: 0121 709 6600 | Nottingham: 0115 924 3348 | Cambridge: 01480 457 488 | Leeds: 0113 287 1465 |London: 0207 554 8732 RSS 04/10/2011
Bristol: 0117 315 5201 | Leicester: 0116 208 0410 | www.cpwp.com Targeted Achieved Potential
BREEAM SCORE %: 37.51 0.00 58.41
BREEAM % score is sufficient to rate the following classification: Pass Unclassified Credit Status:
Minimum criteria for the following classification have been met: Good - Not Pursuing
Last Updated: 22/4/13 (HA) - Pursuing
Revision: A G √ Possible Target
Date of issue: 22/04/13 P √ Achieved
Job Title: B'ham Childrens Hospital CAMHS Tier 4 New Build: m² %
Job Number: 12423 Refurbishment: m² %
Name Item Responsibility Comment/Action
Pre-Requisite /Min
standard achieved
Potential
Additional
Available
Credits
Targeted Credits
Energy Weighting: 0.190 0.76% 25 4 0 3.04 0.00
Ene 01 Reduction of CO 2 emissions (Minimum Standard 6 E, 10 OS)
C Energy Performance Ratio for New Constructions calculated M&E/Contractor 15 2 - Y
Ene 02 Energy monitoring (Minimum standard- see below) R
Building Monitoring System (BMS) monitors energy consuming systems (MS VG) M&E/Contractor 1 1 - Y
Building Monitoring System (BMS) monitors energy consuming areas
M&E/Contractor Not targeted as departments not currently sub-metered - potential credit. 1 1 0 - R
Ene 03 External lighting
Lamp/luminaire efficiency and lighting control M&E/Contractor 1 1 - Y
Ene 04 Low and zero carbon technologies (Minimum standard 1 E)
Feasibility study OR renewable energy supply contract N/A Not targeted as no renewables 1 0 0 R
Life cycle assessment/low or zero carbon technology specification and installation N/A Not targeted as no renewables 3 0 0 R
Free cooling strategy utilised N/A Not targeted as no renewables 1 0 0 R
Ene 05 Energy efficient cold storage
Low carbon, robust and sustainable system components N/A Not applicable 0 0 0 R
System gives a saving in indirect greenhouse gas emissions N/A Not applicable 0 0 0 R
Ene 06 Energy efficient transportation systems
Transport analysis done and low energy option chosen for lift/escalator N/A Not applicable 0 0 0 R
Lift /escalator/moving walkway - low energy features specified N/A Not applicable 0 0 0 R
Ene 07 Energy efficient laboratory systems
Type and specification selection of fume cupboards N/A Not applicable 0 0 0 R
Where lab is 10% or more of building area, cupboards have efficiency features N/A Not applicable 0 0 0 R
Ene 08 Energy efficient equipment
Standards or control used to minimise consumption or environmental impact N/A Not available as equipment is being reused 2 0 0 R
Ene 09 Drying space R
Sufficient secure area is available for clothes drying N/A Not applicable 0 0 0 R
Transport Weighting: 0.080 1.60% 10 1 0 0.80 0.00
Tra 01 Public transport accessibility
C
0 credits targeted but bus services and bus stop distances to be reviewed in
Architect
The public transport Accessibility Index (AI) is calculated
case 1 potential credit might be available.
1 5 0 0 R
A dedicated bus service is provided for fixed shift pattern buildings N/A Not available 0 0 0 R
Tra 02 Proximity to amenities
Building is 500m or 1000m from a range of amenities N/A Not available 1 0 0 R
Tra 03 Cyclist facilities
Provision of cycle storage, or cycle storage and other cyclst facilities N/A Not available without compliant cycle racks 2 0 0 R
Tra 04 Maximum car parking capacity
Car parking capacity is limited to encourage other forms of transport Architect 1 1 - Y
Tra 05 Travel Plan
A travel survey and plan have influenced project design Client Not targeted. Potential credit for developing travel plan. 1 1 0 0 R
Water Weighting: 0.060 0.00% 9 6 0 4.00 0.00
Wat 01 Water consumption (Minimum standard 1 G, 2 OS)
C Water consumption (litres/person/day) is reduced by use of efficient fittings and recycling M&E/Architect Can only achieve 2 as no rainwater recycling 5 2 - Y
Wat 02 Water monitoring (Minimum Standard G - Criterion 1)
A water meter is specified on the mains to each building (minimum standard) M&E/Contractor Y N/A Y - Y
Consumption is monitored by a suitable meter (and, if appropriate, sub meters) M&E/Contractor 1 1 - Y
Wat 03 Water leak detection and prevention
A system is installed to detect water leaks on the mains water supply Contractor 1 1 - Y
WC water supply is controlled to minimise the impact of leaks Contractor 1 1 - Y
Wat 04 Water efficient equipment
Irrigation and car washes are designed to minimise unregulated consumption Landscape Architetct 1 1 - Y
Achieved
Credits
Target Score
%
Achieved
Score %
Page 2
91

Healthcare
BREEAM 2011 Tracker
CPW | Birmingham: 0121 709 6600 | Nottingham: 0115 924 3348 | Cambridge: 01480 457 488 | Leeds: 0113 287 1465 |London: 0207 554 8732 RSS 04/10/2011
Bristol: 0117 315 5201 | Leicester: 0116 208 0410 | www.cpwp.com Targeted Achieved Potential
BREEAM SCORE %: 37.51 0.00 58.41
BREEAM % score is sufficient to rate the following classification: Pass Unclassified Credit Status:
Minimum criteria for the following classification have been met: Good - Not Pursuing
Last Updated: 22/4/13 (HA) - Pursuing
Revision: A G √ Possible Target
Date of issue: 22/04/13 P √ Achieved
Job Title: B'ham Childrens Hospital CAMHS Tier 4 New Build: m² %
Job Number: 12423 Refurbishment: m² %
Name Item Responsibility Comment/Action
Pre-Requisite /Min
standard achieved
Potential
Additional
Available
Credits
Targeted Credits
Materials Weighting: 0.125 3.85% 13 8 0 7.69 0.00
Mat 01 Life cycle impacts
C
4 credits targeted. Re-used materials score well. 2 potential credits to be
Architect
The Green Guide is used to assess the environmental impact of materials used
determined once building materials specification is confirmed.
2 6 4 - Y
Mat 02 Hard landscaping and boundary protection
The Green Guide rating of 80% of these materials (by area) should be A or A+ Landscape Architetct 1 1 - Y
Mat 03 Responsible sourcing of materials (Minimum Standard P - Criterion 3)
C Materials making up key building elements are assessed using calculator tool Main Contractor Not targeted. Potential credits for contractor. 2 3 0 0 R
All timber sourced in accordance with government policy (minimum standard) Main Contractor Y N/A Y - Y
Mat 04 Insulation
C Pre-requisite - ground floor, external walls, roof and services all assessed Main Contractor Y N/A Y - Y
Embodied impact is assessed using Green Guide and material properties Main Contractor 1 1 - Y
At least 80% of insulation must be certified as responsibly sourced Main Contractor 1 1 - Y
Mat 05 Designing for robustness
Need has been identified and fulfilled for adequate protection of building elements Architect 1 1 - Y
Waste Weighting: 0.075 1.25% 6 3 0 3.75 0.00
Wst 01 Construction waste management (Minimum Standard 1 OS)
Construction resource efficiency - the amount of waste generated Main Contractor 1 3 1 - Y
Diversion of resources from landfill - the amount of material recycled or re-used Main Contractor 1 1 - Y
Wst 02 Recycled aggregates
Minimum percentage targets for local recycled aggregates are achieved N/A Not targeted - difficult and no opportunity to achieve. 1 0 0 R
Wst 03 Operational waste (Minimum Standard 1 E)
Clearly labelled, accessible areas of sufficient size are provided for recycled waste Architect/ Client 1 1 - Y
Wst 04 Speculative floor and ceiling finishes
Floor finishes selected by occupant to reduce chances of premature replacement N/A Not applicable 0 0 0 R
Land Use and Ecology Weighting: 0.100 4.00% 10 2 0 2.00 0.00
LE 01 Site selection
Re-use of land previously 75% developed for the previous 50 years Architect 1 1 - Y
Treatment and re-use of land revealed by site survey to be significantly contaminated 1 0 0 R
LE 02 Ecological value of site and protection of ecological features
Using land of low ecological value, protection of ecology during construction Architect/ Ecologist 1 1 - Y
LE 03 Mitigating ecological impact (Minimum Standard 1 VG)
The reduction in ecological value of the site due to the development is minimised Ecologist 1 2 0 0 R
LE 04 Enhancing site ecology
C Implementaion of an ecologist's recommendations for enhancing site ecological value Ecologist With the appointment of an ecologist these credits may be possible 1 1 0 0 R
Ecologist confirms that number of plant species will be increased by up to six (or more) Ecologist With the appointment of an ecologist these credits may be possible 2 0 0 R
LE 05 Long term impact on biodiversity
C Mandatory: ecologist confirms regulations were observed; management plan produced Ecologist With the appointment of an ecologist these credits may be possible N N/A N N Y
Contractor's effects on biodiversity minimised, new habitat created, wildlife partnership Ecologist With the appointment of an ecologist these credits may be possible 2 2 0 0 R
Pollution Weighting: 0.100 4.62% 13 2 0 1.54 0.00
Pol 01 Impact of refrigerants
C Minimising the adverse effects of refrigerants by avoidance, choice or leak control 3 0 0 R
Pol 02 NOx emissions
1 credit targeted. Potential additional credit but will need to confirm Nox
M&E/ Main Contractor
Minimising NOx pollution by choosing heating & cooling systems with low emissions
emissions of heating system.
1 3 1 - Y
Pol 03 Surface water run off
Flood risk zone: an assessment (FRA) confirms that the site is unlikeley to flood Structural Eng Potential credits - would need flood risk assessment. 2 2 0 0 R
Pre-requisite,surface water run-off: consultant engaged to investigate N N/A N - Y
Surface water run-off: will be no greater after the development than it was before Structural Eng Potential credit - would need flood risk assessment to confirm. 1 1 0 0 R
Surface water run-off: local drainage system failure will not cause flooding Structural Eng Potential credit - would need flood risk assessment to confirm. 1 1 0 0 R
Specified measures are taken to minimise the risk of watercourse pollution Not Targeted Potential credit - would need flood risk assessment to confirm. 1 1 0 0 R
Pol 04 Reduction of night time light pollution
Standards are followed and appropriate switching is employed M&E 1 1 - Y
Pol 05 Noise attenuation
Noise from the building is controlled sufficiently to prevent nuiscance to neighbours Acoustician Not targeted. 1 0 0 R
Innovation Maximum: 10 0.00% 10 1 0 1 0
Inn 01 Man 01 - three year analysis by facilities manager Client 1 1 - Y
Man 02 - contractor achieves scheme's exemplary level Not targeted - unlikely to achieve 1 0 0 R
Hea 01 - higher levels of daylight achieved Not targeted - unlikely to achieve 1 0 0 R
Ene 01 - building is "carbon negative" Not available 5 0 0 R
Ene 04 - reduction in CO2 emissions is 30% or more Not available without renewables 1 0 0 R
Ene 05 - cold storage described as "Future Technology" Not applicable 0 0 0 R
Wat 01 - water consumption improvement by 65% or more on baseline performance Not available 1 0 0 R
Mat 01 - points scored using Mat 1 calculator reach exemplary level Not targeted - unlikely to achieve 1 0 0 R
Mat 03 - 80% of the available responsible sourcing points are achieved Not targeted - unlikely to achieve 1 0 0 R
Wst 01 - exceptional diversion from landfill and low waste production Not targeted - unlikely to achieve 1 0 0 R
Wst 02 - recycled aggregates exceed 35% of total for project Not targeted - unlikely to achieve 1 0 0 R
Page 3
Achieved
Credits
Target Score
%
Achieved
Score %
92

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX I – LETTER OF SUPPORT – PLANNING OFFICER
93

~.... •. h . C·tx C ·1 Planning Management •
~. Inning am I~ ouns. PO Box 28, BinninghamBl lTU IdI ()
INVES10R """ IN PEQPU:
Letter Ref: Pre-app Closing letter
Application Ref: 2012/05753/PA
25 September 2012
Mr J Bench
QA Architecture
12A Wing Yip Centre
278 Thimble Mill Lane
Birmingham
B75HD
Dear Jeremy
Your Contact: Pamela Brennan 0121 464 7792
Proposed Erection of Extensions to Existing Clinic at 60 Queensbridge Road, Moseley.
I refer to your pre-application enquiry submitted on 20 August 2012 and our subsequent site
meeting on 30 August 2012.
The property is a relatively new build hospital clinic building with secure wings set within the
parkland of the Registered Park and Garden of Highbury Hall and I note that the property is not
visible from Queensbridge Road, Highbury Park or its adjacent neighbours due to existing
landscaping and site levels. I understand that the Childrens Hospital wish to relocate some of
its existing bedspaces from Steelhouse Lane to the clinic at Moseley to bring all of the relative
mental health issues together under one roof, and that despite the extensions creating extra
bed spaces these would not actually increase the capacity of the clinic.
--------- -.- -------~-- --- --- ------- -- ------ ._-- -- - -.- ----------- ---------­
As discussed on site, Julie Taylor and I had no objections to the proposal in principle and
subject to detailed design issues including secure boundary treatment on secure wings and
replacement of play facilities; planning permission could be secured for the extensions.
These views are given on the information presently available and represent an informal officer
view only that does not prejudice any future decision Birmingham City Council may wish to
take. If you wish to discuss the above matter please feel free to contact Pamela Brennan on
the above number.
Yours sincerely,
Pamela Brennan
Principal Planning Officer (Moseley, Kings Heath and Hall Green)
94

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX J – EQUALITY IMPACT ASSESSMENT
95

Equality Analysis
Standard template for DH staff
96

v0.3
Equality analysis
Standard template for DH staff
Prepared by the Equality and Inclusion Team, Department of Health
97

v0.3
Introduction
The general equality duty that is set out in the Equality Act 2010 requires public authorities, in the
exercise of their functions, to have due regard to the need to:
• Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by
the Act.
• Advance equality of opportunity between people who share a protected characteristic and those
who do not.
• Foster good relations between people who share a protected characteristic and those who do not.
The general equality duty does not specify how public authorities should analyse the effect of their
existing and new policies and practices on equality, but doing so is an important part of complying
with the general equality duty. It is up to each organisation to choose the most effective approach for
them. This standard template is designed to help Department of Health staff members to comply with
the general duty.
Please complete the template by following the instructions in each box. Should you have any queries
or suggestions on this template, please contact the Equality and Inclusion Team on 020 7972 5936 or
aie@dh.gsi.gov.uk
98

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Equality analysis
Title: Business case for improved CAMHS Tier 4 inpatient facilities and location of all
facilities on one site
Relevant line in DH Business Plan 2011-2015:
What are the intended outcomes of this work? Include outline of objectives and function aims
1. To improve the patient experience
2. To improve patient choice through ensuring modern, up to date facilities and be
the provider of choice
3. To improve the environment for patients and staff
4. To ensure a co-located functional service on one site to improve efficiencies and
better use of resources
5. Reduction in isolation of staff- more cohesive workforce
Who will be affected? e.g. staff, patients, service users etc
All patients admitted to the units and staff
Evidence The Government’s commitment to transparency requires public bodies to be open about the information on
which they base their decisions and the results. You must understand your responsibilities under the transparency agenda
before completing this section of the assessment. For more information, see the current DH Transparency Plan.
What evidence have you considered? List the main sources of data, research and other sources of evidence
(including full references) reviewed to determine impact on each equality group (protected characteristic). This can include
national research, surveys, reports, research interviews, focus groups, pilot activity evaluations etc. If there are gaps in
evidence, state what you will do to close them in the Action Plan on the last page of this template.
• Focus groups with young people who are current inpatients
• Stakeholder meeting with key stakeholders including parents, commissioners,
staff
• Patient experience reports
• Current adult mental health estates legislation pertaining to inpatient wards
• Current commissioner knowledge / feedback / data regarding all other Tier 4
providers on their framework
• Royal College of Psychiatrists ‘Quality Network for Inpatient CAMHS’ peer
reviews and feedback
• Young minds research on what young people want from these facilities
• Feedback from families who have refused admission to our service
Disability Consider and detail (including the source of any evidence) on attitudinal, physical and social barriers.
This business case will improve facilities for those with disabilities as the service will be
able to care and treat young people with physical disabilities in an improved way i.e.
through the use of the single bedrooms and en-suite facilities; better use of space and
open areas for improved access.
99

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Sex Consider and detail (including the source of any evidence) on men and women (potential to link to carers below).
This business case will improve access for both genders as currently the service has
dormitories and this restricts admissions to one sex per dormitory and bed area. With
single bedrooms and en suite bathrooms this will increase access
Race Consider and detail (including the source of any evidence) on difference ethnic groups, nationalities, Roma gypsies,
Irish travellers, language barriers.
Current practice and future practice would not impact
Age Consider and detail (including the source of any evidence) across age ranges on old and younger people. This can
include safeguarding, consent and child welfare.
Current practice and future practice would not impact
Gender reassignment (including transgender) Consider and detail (including the source of any evidence)
on transgender and transsexual people. This can include issues such as privacy of data and harassment.
Current practice and future practice would not impact
Sexual orientation Consider and detail (including the source of any evidence) on heterosexual people as well as
lesbian, gay and bi-sexual people.
Current practice and future practice would not impact
Religion or belief Consider and detail (including the source of any evidence) on people with different religions, beliefs
or no belief.
Current practice and future practice would not impact
Pregnancy and maternity Consider and detail (including the source of any evidence) on working arrangements,
part-time working, infant caring responsibilities.
Current practice and future practice would not impact
Carers Consider and detail (including the source of any evidence) on part-time working, shift-patterns, general caring
responsibilities.
This business case will improve family / carer experience as it includes parents
accommodation which will greatly enhance the provision
Other identified groups Consider and detail and include the source of any evidence on different socio-economic
groups, area inequality, income, resident status (migrants) and other groups experiencing disadvantage and barriers to
access.
Engagement and involvement
Was this work subject to the requirements of the cross-government Code of Practice on
Consultation? (Y/N)
How have you engaged stakeholders in gathering evidence or testing the evidence available?
Yes – there has been a wide range of consultations with staff. Many members of staff and
other stakeholders have been part of the project team developing the business case. This
included commissioners and a range of clinical staff.
How have you engaged stakeholders in testing the policy or programme proposals?
Yes.
• A non financial appraisal with all key stakeholders took place in September 2012
100

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• Young people were consulted with who are current inpatients within the units and
feedback was obtained around the proposals and plans
• Staff have been part of the project team throughout in terms of development of
the proposals
For each engagement activity, please state who was involved, how and when they were
engaged, and the key outputs:
A non-financial appraisal took place in September 2012 which involved; staff; parents
and other stakeholders:
Marie Crofts- Associate Service Director, CAMHS
Dr Linda Cullen, Clinical Director, Tier 4, CAMHS
Paul Elkin, Provex Consultancy
Daljit Sandhu, Provex Consultancy
Renu Bhopal-Padiar, Project Manager, CAMHS
Sandra Wallace, Tier 4 Manager, CAMHS
Peter Hodgkinson, Ocean Ward Manager, CAMHS
Angela Watson, Speech and Language
Sarah Christie, Autism West Midlands
Elaine Kirwan, Lead Nurse, Community CAMHS
Dr Sumi Handy, Consultant Psychiatrist, Tier 4, CAMHS
Kay Insley, Clinical Lead Nurse, Tier 4 CAMHS
Claire Paintain, Commissioner, CAMHS
Julie Barber, CAMHS
Davina Brazier, Head of Therapy Services and AHP Lead, CAMHS
Nikki Cox, SCT Commissioning
Tonita Whittier, SCT Commissioning
Adam Hawker, Commercial Finance Manager, CAMHS
Parent
• The output was a weighted non-financial assessment of all the options and that has
been included in the business case
Summary of Analysis Considering the evidence and engagement activity you listed above, please
summarise the impact of your work. Consider whether the evidence shows potential for differential impact, if so state whether
adverse or positive and for which groups. How you will mitigate any negative impacts. How you will include certain protected
groups in services or expand their participation in public life.
Now consider and detail below how the proposals impact on elimination of discrimination, harassment and victimisation,
advance the equality of opportunity and promote good relations between groups.
Eliminate discrimination, harassment and victimisation Where there is evidence, address each
protected characteristic (age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual
orientation).
Current and future practice would not impact
Advance equality of opportunity Where there is evidence, address each protected characteristic (age, disability,
gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual orientation).
Current and future practice would not impact
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Promote good relations between groups Where there is evidence, address each protected characteristic
(age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual orientation).
Current and future practice would not impact
What is the overall impact? Consider whether there are different levels of access experienced, needs or
experiences, whether there are barriers to engagement, are there regional variations and what is the combined impact?
Current and future practice would not impact
Addressing the impact on equalities Please give an outline of what broad action you or any other bodies are
taking to address any inequalities identified through the evidence.
Current and future practice would not impact
Action planning for improvement Please give an outline of the key actions based on any gaps,
challenges and opportunities you have identified. Actions to improve the policy/programmes need to be summarised (An action
plan template is appended for specific action planning). Include here any general action to address specific equality issues and
data gaps that need to be addressed through consultation or further research.
Current and future practice would not impact
Please give an outline of your next steps based on the challenges and opportunities you have
identified. Include here any or all of the following, based on your assessment
• Plans already under way or in development to address the challenges and priorities identified.
• Arrangements for continued engagement of stakeholders.
• Arrangements for continued monitoring and evaluating the policy for its impact on different groups as the policy is
implemented (or pilot activity progresses)
• Arrangements for embedding findings of the assessment within the wider system, OGDs, other agencies, local service
providers and regulatory bodies
• Arrangements for publishing the assessment and ensuring relevant colleagues are informed of the results
• Arrangements for making information accessible to staff, patients, service users and the public
• Arrangements to make sure the assessment contributes to reviews of DH strategic equality objectives.
Next steps will be set out based on the decision following business case consultation
with the executive management team
For the record
Name of person who carried out this assessment:
Marie Crofts, Associate Service Director, CAMHS
Date assessment completed:
15 th October 2012
Name of responsible Director/Director General:
Tim Atack, Chief Operating Officer and Executive Sponsor
Date assessment was signed:
102

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX K – PROJECT PLAN
103

BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST
CAMHS TIER 4
ID Task Name Duration Start Finish Pred
1
PROJECT SET‐UP 35 days Mon 12/03/12 Fri 27/04/12
2 Prepare draft Project Execution Plan 3 days Mon 12/03/12 Wed 14/03/12
3 Review and approve Project Execution Plan 2 days Thu 15/03/12 Fri 16/03/12 2
4 Prepare project plan for Stage 1 3 days Mon 12/03/12 Wed 14/03/12
5 Approve project plan for Stage 1 2 days Thu 15/03/12 Fri 16/03/12 4
6 Prepare specification of Trust information requirements 5 days Mon 12/03/12 Fri 16/03/12
7 Establish schedule of Project Team meetings 5 days Mon 12/03/12 Fri 16/03/12
8 Establish risk register 10 days Mon 16/04/12 Fri 27/04/12 7FS+20 days
9 Establish issues log 10 days Mon 16/04/12 Fri 27/04/12 7FS+20 days
10
11
Advisors 10 days Mon 19/03/12 Fri 30/03/12
12 Identify/Appoint Technical Advisory Team 10 days Mon 19/03/12 Fri 30/03/12
13
14
STAGE 1 ‐ IDENTIFY PREFERRED SOLUTION 319 days Mon 12/03/12 Thu 30/05/13
15
Service Brief & Activity 50 days Mon 02/04/12 Fri 08/06/12
16 Receive Trust information 30 days Mon 02/04/12 Fri 11/05/12 6FS+10 days
17 Confirm service, activity, workforce and cost baselines 20 days Mon 14/05/12 Fri 08/06/12 16
18 Identify long‐list and short‐list of options 0 days Fri 08/06/12 Fri 08/06/12 17
19
Option Appraisal 129 days Mon 02/04/12 Thu 27/09/12
20 Evaluation process 79 days Mon 02/04/12 Fri 20/07/12
21 Prepare draft Evaluation Criteria 5 days Mon 02/04/12 Fri 06/04/12 3,5FS+10 days
22 Determine Evaluation Panel 0 days Fri 20/07/12 Fri 20/07/12 21
23 Development of Options 49 days Mon 11/06/12 Thu 16/08/12
24 Prepare draft drawings for options 18 days Mon 11/06/12 Wed 04/07/12 18
25 Review draft drawings 2 days Thu 05/07/12 Fri 06/07/12 24
26 Prepare draft 1:200 plans for options 7 days Mon 09/07/12 Tue 17/07/12 25
27 Review draft plans 3 days Wed 18/07/12 Fri 20/07/12 26
28 Prepare updated plans 7 days Mon 23/07/12 Tue 31/07/12 27
29 Review 1:200 plans 3 days Wed 01/08/12 Fri 03/08/12 28
30 Prepare final 1:200 plans 5 days Mon 06/08/12 Fri 10/08/12 29
31 Prepare activity & service projections 5 days Mon 06/08/12 Fri 10/08/12 29
32 Sign off activity & service projections 4 days Mon 13/08/12 Thu 16/08/12 31
33 Workforce 12 days Fri 17/08/12 Mon 03/09/12
34 Prepare workforce projections for each option 5 days Fri 17/08/12 Thu 23/08/12 32
35 Review workforce projections 5 days Fri 24/08/12 Thu 30/08/12 34
36 Finalise workforce projections 2 days Fri 31/08/12 Mon 03/09/12 35
37 Non‐Financial Evaluation 18 days Fri 17/08/12 Tue 11/09/12
38 Prepare & sign off material for workshop 10 days Fri 17/08/12 Thu 30/08/12 29,32
39 Distribute material for workshop 2 days Fri 31/08/12 Mon 03/09/12 38
40 Evaluation workshop 1 day Tue 11/09/12 Tue 11/09/12 39
41 Document results 0 days Tue 11/09/12 Tue 11/09/12 40
2013 2014
Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2
el
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BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST
CAMHS TIER 4
ID Task Name Duration Start Finish Pred
42 Financial Evaluation 30 days Mon 13/08/12 Fri 21/09/12
43 Prepare capital cost estimates 10 days Mon 13/08/12 Fri 24/08/12 30
44 Review capital costs 4 days Mon 27/08/12 Thu 30/08/12 43
45 Finalise & sign off capital costs 13 days Fri 31/08/12 Tue 18/09/12 44
46 Prepare revenue cost projections 8 days Tue 04/09/12 Thu 13/09/12 32,36
47 Review revenue cost projections 3 days Fri 14/09/12 Tue 18/09/12 46
48 Finalise revenue cost projections 3 days Wed 19/09/12 Fri 21/09/12 44,47
49 Economic Evaluation 34 days Mon 13/08/12 Thu 27/09/12
50 Set up evaluation model 10 days Mon 13/08/12 Fri 24/08/12 30
51 Prepare lifecycle costs 5 days Wed 19/09/12 Tue 25/09/12 45
52 Complete economic evaluation 2 days Mon 24/09/12 Tue 25/09/12 48
53 Complete cost/benefit analysis 0 days Tue 25/09/12 Tue 25/09/12 52
54 Complete sensitivty analysis 0 days Tue 25/09/12 Tue 25/09/12 52
55 Sign off financial & economic evaluation 2 days Wed 26/09/12 Thu 27/09/12 52,53,54
56
57
Development of Preferred Option 55 days Mon 04/02/13 Fri 19/04/13
58 Site & Subtronic surveys 2 wks Mon 04/02/13 Fri 15/02/13
59 Review 1:200 plans 6 wks Mon 25/02/13 Fri 05/04/13
60 Sign off 1:200 plans 2 days Mon 08/04/13 Tue 09/04/13 59
61 AEDET Review 1 wk Wed 10/04/13 Tue 16/04/13 60
62 BREEAM pre‐assessment 1 wk Wed 10/04/13 Tue 16/04/13 60
63 Discuss fund‐raising contribution 2 wks Fri 15/02/13 Thu 28/02/13
64 Confirm fund‐raising contribution 10 days Fri 01/03/13 Thu 14/03/13 63
65 Update capital costs 5 days Wed 10/04/13 Tue 16/04/13 60,58
66 Update revenue costs & financial evaluation 3 days Wed 17/04/13 Fri 19/04/13 65
67
68
Equality Impact Assessment 122 days Wed 12/09/12 Thu 28/02/13
69 Undertake screening assessment for preferred option 11 days Wed 12/09/12 Wed 26/09/12 37
70 Review screening assessment 5 days Thu 25/10/12 Wed 31/10/12 69FS+20 days
71 Sign off screening assessment 23 days Tue 29/01/13 Thu 28/02/13 70
72
73
Engagement & Communications Plan 121 days Wed 31/10/12 Wed 17/04/13
74 Prepare draft Eng & Comms Plan for Stage 2 7 days Wed 31/10/12 Thu 08/11/12
75 Review draft plan 3 days Fri 09/11/12 Tue 13/11/12 74
76 Finalise Eng & Comms Plan for Stage 2 7 days Wed 14/11/12 Thu 22/11/12 75
77 Sign off Eng & Comms Plan for Stage 2 3 days Fri 23/11/12 Tue 27/11/12 76
78 Prepare report for HOSC 5 days Fri 29/03/13 Thu 04/04/13
79 HOSC approval 9 days Fri 05/04/13 Wed 17/04/13 78
80
81
Benefits Realisation Plan 150 days Fri 17/08/12 Thu 14/03/13
82 Prepare draft Benefits Realisation Plan 6 days Fri 17/08/12 Fri 24/08/12 32
83 Review Benefits Realisation Plan 4 days Mon 27/08/12 Thu 30/08/12 82
84 Review and update Benefits Realisation Plan 19 days Tue 29/01/13 Fri 22/02/13 40
85 Sign off Benefits Realisation Plan 14 days Mon 25/02/13 Thu 14/03/13 84
2013 2014
Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2
y Lead
Team
t Lead
t Team
ct Lead
ject Team
Estates & Facilities
Project Lead
Project Team
Project Lead
Estates & Facilities
Estates & Facilities
Project Team
Estates & Facilities
Project Team
Trust E&D Lead
Project Lead
Project Lead
Project Lead
Project Team
130422 BCH CAMHS Project Plan_Version 6.5 Page 2 105

BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST
CAMHS TIER 4
ID Task Name Duration Start Finish Pred
86
87
Implementation & PPE Plans 128 days Tue 04/09/12 Thu 28/02/13
88 Prepare draft Implementation Plan 7 days Tue 04/09/12 Wed 12/09/12 32,36
89 Prepare draft Post Project Evaluation Plan 7 days Tue 04/09/12 Wed 12/09/12 32,36
90 Review draft Implementation & PPE Plans 4 days Thu 13/09/12 Tue 18/09/12 88,89
91 Update Implementation & PPE Plans 10 days Tue 15/01/13 Mon 28/01/13 75
92 Sign off Implementation Plan and PPE Plan 23 days Tue 29/01/13 Thu 28/02/13 91
93
94
Business Case 319 days Mon 12/03/12 Thu 30/05/13
95 Prepare shell document 3 days Mon 12/03/12 Wed 14/03/12
96 Prepare Draft #1 3 days Wed 12/09/12 Fri 14/09/12 30,36,41
97 Review Draft #1 2 days Mon 17/09/12 Tue 18/09/12 96
98 Update draft OBC 16 days Thu 18/10/12 Thu 08/11/12 97
99 Review updated draft OBC 3 days Fri 09/11/12 Tue 13/11/12 98
100 Update draft OBC 8 days Fri 01/03/13 Tue 12/03/13 71,92,84
101 Review draft OBC 4 days Wed 13/03/13 Mon 18/03/13 100
102 Prepare final draft 2 days Mon 22/04/13 Tue 23/04/13 101,66
103 Sign off final draft OBC 2 days Wed 24/04/13 Thu 25/04/13 102
104 OLT review of OBC 1 day Mon 06/05/13 Mon 06/05/13 103
105 Executive Team approval 1 day Mon 20/05/13 Mon 20/05/13 104
106 F&R Committee approval 1 day Tue 14/05/13 Tue 14/05/13 103
107 Board approval of Business Case 1 day Thu 30/05/13 Thu 30/05/13 106
108
2013 2014
Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2
m
t Team
Provex
Project Team
Provex
Project Team
Provex
Project Team
Project Lead
Project Lead
Project Lead
BCH Board
130422 BCH CAMHS Project Plan_Version 6.5 Page 3 106

BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST
CAMHS TIER 4
ID Task Name Duration Start Finish Pred
109
STAGE 2 ‐ DESIGN & PROCUREMENT 150 days Mon 25/02/13 Fri 20/09/13
110
Stage Set‐up 10 days Fri 31/05/13 Thu 13/06/13
111 Review and update PEP 1 wk Fri 31/05/13 Thu 06/06/13 107
112 Establish schedule of project team meetings 1 wk Fri 07/06/13 Thu 13/06/13 111
113 Sign off PEP 1 wk Fri 07/06/13 Thu 13/06/13 111
114 Review Risk Register 2 wks Fri 31/05/13 Thu 13/06/13 107
115
Engagement & Communications 10 days Fri 31/05/13 Thu 13/06/13
116 Prepare schedule of Engagement & Comms activities for Stage 2 1 wk Fri 31/05/13 Thu 06/06/13 107
117 Review and sign off Eng & Comms plan 1 wk Fri 07/06/13 Thu 13/06/13 116
118
Planning 111 days Mon 25/02/13 Mon 29/07/13
119 Prepare and sign off planning application 10 wks Mon 25/02/13 Fri 03/05/13
120 Submit planning application 1 day Mon 06/05/13 Mon 06/05/13 119
121 Planning consent granted 12 wks Tue 07/05/13 Mon 29/07/13 120
122
Design & Procurement 125 days Mon 01/04/13 Fri 20/09/13
123 Finalise room ADB data sheets 4 wks Mon 01/04/13 Fri 26/04/13
124 Architect detailed design 6 wks Mon 29/04/13 Fri 07/06/13 123
125 Structural detailed design 6 wks Mon 29/04/13 Fri 07/06/13 123
126 M&E detailed design 8 wks Mon 29/04/13 Fri 21/06/13 123
127 CDM H&S Plan 2 wks Mon 10/06/13 Fri 21/06/13 124,125
128 Prepare tender pack 4 wks Mon 10/06/13 Fri 05/07/13 124,125
129 Issue tender packs 1 wk Mon 08/07/13 Fri 12/07/13 128
130 Receipt of tenders 4 wks Mon 15/07/13 Fri 09/08/13 129
131 Evaluation of tenders 2 wks Mon 12/08/13 Fri 23/08/13 130
132 Confirm capital and revenue costs 2 wks Mon 26/08/13 Fri 06/09/13 131
133 Award construction contract 2 wks Mon 09/09/13 Fri 20/09/13 132
134
Workforce 40 days Mon 08/07/13 Fri 30/08/13
135 Review and confirm workforce impact 4 wks Mon 08/07/13 Fri 02/08/13 128
136 Develop training plans 4 wks Mon 05/08/13 Fri 30/08/13 135
137
Benefits Realisation 20 days Mon 08/07/13 Fri 02/08/13
138 Review and update Benefits Realisation Plan 4 wks Mon 08/07/13 Fri 02/08/13 128
139 Develop Post‐Project Evaluation Plan 4 wks Mon 08/07/13 Fri 02/08/13 128
140
2013 2014
Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2
Project Lead
Project Lead
Project Team
Project Team
Project Lead
Project Team
Technical Team
Technical Team
Technical Team
Planning Authority
Technical Team
Technical Team
Technical Team
Technical Team
Technical Team
Technical Team
Technical Team
Technical Team
Finance
Project Team
Head of Capital
Project Team
Project Team
Project Team
130422 BCH CAMHS Project Plan_Version 6.5 Page 4 107

BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST
CAMHS TIER 4
ID Task Name Duration Start Finish Pred
141
STAGE 3 ‐ CONSTRUCTION & COMMISSIONING 780 days Mon 23/09/13 Fri 16/09/16
142
Construction 780 days Mon 23/09/13 Fri 16/09/16
143 Phase 1 (New Extension) 210 days Mon 23/09/13 Fri 11/07/14
144 Decant Speech Therapy 2 wks Mon 23/09/13 Fri 04/10/13 133
145 Contractor mobilisation 4 wks Mon 23/09/13 Fri 18/10/13 133
146 Construct new extension 36 wks Mon 21/10/13 Fri 27/06/14 145
147 Prepare commissioning plan 4 wks Mon 02/06/14 Fri 27/06/14 146FS‐4 wks
148 Prepare marketing plan 6 wks Mon 02/06/14 Fri 11/07/14 146FS‐4 wks
149 Commission new extension & relocate Irwin Ward 2 wks Mon 30/06/14 Fri 11/07/14 147
150
151 Phase 2 (Irwin Ward) 300 days Mon 10/02/14 Fri 03/04/15
152 Detailed design and tender packs 12 wks Mon 10/02/14 Fri 02/05/14 146FS‐20 wks
153 Procurement and contract award 8 wks Mon 05/05/14 Fri 27/06/14 152
154 Contractor mobilisation 2 wks Mon 30/06/14 Fri 11/07/14 153
155 Modifications & Refurbishment 36 wks Mon 14/07/14 Fri 20/03/15 154
156 Prepare commissioning plan 4 wks Mon 23/02/15 Fri 20/03/15 155FS‐4 wks
157 Commission Irwin Ward & relocate Ashfield Ward 2 wks Mon 23/03/15 Fri 03/04/15 156
158
159 Phase 3 (Ashfield Ward) 300 days Mon 03/11/14 Fri 25/12/15
160 Detailed design and tender packs 12 wks Mon 03/11/14 Fri 23/01/15 155FS‐20 wks
161 Procurement and contract award 8 wks Mon 26/01/15 Fri 20/03/15 160
162 Contractor mobilisation 2 wks Mon 23/03/15 Fri 03/04/15 161
163 Modifications & Refurbishment 36 wks Mon 06/04/15 Fri 11/12/15 162
164 Prepare commissioning plan 4 wks Mon 16/11/15 Fri 11/12/15 163FS‐4 wks
165 Commission Ashfield Ward & relocate Heathlands Ward 2 wks Mon 14/12/15 Fri 25/12/15 164
166
167 Phase 4 (Heathlands Ward) 300 days Mon 27/07/15 Fri 16/09/16
168 Detailed design and tender packs 12 wks Mon 27/07/15 Fri 16/10/15 163FS‐20 wks
169 Procurement and contract award 8 wks Mon 19/10/15 Fri 11/12/15 168
170 Contractor mobilisation 2 wks Mon 14/12/15 Fri 25/12/15 169
171 Modifications & Refurbishment 36 wks Mon 28/12/15 Fri 02/09/16 170
172 Prepare commissioning plan 4 wks Mon 08/08/16 Fri 02/09/16 171FS‐4 wks
173 Commission Heathlands Ward & relocate Ocean Ward 2 wks Mon 05/09/16 Fri 16/09/16 172
174
2013 2014
Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2
Project Lead
Construction contractor
Techni
130422 BCH CAMHS Project Plan_Version 6.5 Page 5 108

BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST
CAMHS TIER 4
ID Task Name Duration Start Finish Pred
175
STAGE 4 ‐ EVALUATION 720 days Mon 14/07/14 Fri 14/04/17
176 Phase 1 150 days Mon 14/07/14 Fri 06/02/15
177 Post construction evaluation 4 wks Mon 14/07/14 Fri 08/08/14 143
178 Operational Phase evaluation 4 wks Mon 13/10/14 Fri 07/11/14 143FS+13 wks
179 Longer‐term evaluation 4 wks Mon 12/01/15 Fri 06/02/15 143FS+26 wks
180
181 Phase 2 150 days Mon 06/04/15 Fri 30/10/15
182 Post construction evaluation 4 wks Mon 06/04/15 Fri 01/05/15 151
183 Operational Phase evaluation 4 wks Mon 06/07/15 Fri 31/07/15 151FS+13 wks
184 Longer‐term evaluation 4 wks Mon 05/10/15 Fri 30/10/15 151FS+26 wks
185
186 Phase 3 150 days Mon 28/12/15 Fri 22/07/16
187 Post construction evaluation 4 wks Mon 28/12/15 Fri 22/01/16 159
188 Operational Phase evaluation 4 wks Mon 28/03/16 Fri 22/04/16 159FS+13 wks
189 Longer‐term evaluation 4 wks Mon 27/06/16 Fri 22/07/16 159FS+26 wks
190
191 Phase 4 150 days Mon 19/09/16 Fri 14/04/17
192 Post construction evaluation 4 wks Mon 19/09/16 Fri 14/10/16 167
193 Operational Phase evaluation 4 wks Mon 19/12/16 Fri 13/01/17 167FS+13 wks
194 Longer‐term evaluation 4 wks Mon 20/03/17 Fri 14/04/17 167FS+26 wks
2013 2014
Qtr 1 Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2
130422 BCH CAMHS Project Plan_Version 6.5 Page 6 109

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX L – RISK REGISTER
110

BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST
CAMHS Tier 4 Services
Risk Register at 9th April 2013
Risk Area
Risk Assessment
Risk Commentary
Ref. Description Impact Likelihood Overall Risk Level Action Required to Mitigate
Project resources / staffing required are not available to meet the
1
required timescales; competing pressures on staff
2 2 4 GREEN
2 Lack of commissioner support 1 1 1 GREEN
3 Lack of support from other stakeholders (internal and external) 1 1 1 GREEN
4 Insufficient user engagement in process 3 2 6 AMBER
Ensure we plan effectively what type of engagement
we think is appropriate and have robust timescales in
place
5 Lack of clarity around project scope and services to be delivered 3 3 9 AMBER
Ensure all signed up to scope and not have
constantly changing agenda. Vision of where we are
going needs to be clear and signed up to.
6 Existing Planning Conditions impact on design development 2 2 4 GREEN
Working with planning dept at City Council to ensure
we get early thoughts on this from them
7 Lack of strategic vision for the service 1 1 1 GREEN
8 Scope continues to change, resulting in delays 2 4 8 AMBER As number 5
Competing demands on space / individual service's requirements
9
cannot be met
2 2 4 GREEN
10 Not able to get Trust Board approval 2 2 4 GREEN
11 Not able to get Planning Permission 3 3 9 AMBER
As number 6. Engage planners early on with
walkbout
12 Scheme is unaffordable to the Trust 2 3 6 AMBER
13 Facility does not meet accreditation standards 3 2 6 AMBER
Delay to this project impacts on Community Services Re‐Design
14
programme / consultation timescales
2 2 4 GREEN
15 Project process is not well managed 1 1 1 GREEN
Options need to be clearly articulated in business
case. MC to brief DE and DM on impact if not
approved eg estate wont meet accreidation
standards; Commissioners wont 'buy' our provsion
111

CAMHS TIER 4 RECONFIGURATION
Business Case
APPENDIX M – POST PROJECT EVALUATION PLAN
112

Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Development
Post Project Evaluation
Post Project Evaluation
1. INTRODUCTION
As part of the project to reconfigure the CAMHS Tier 4 facility on the Parkview site for Birmingham Children’s Hospital, the Trust strongly
supports the evaluation of the project as an important aid in improving project performance by:
♦
♦
♦
♦
♦
Providing greater assurance of total performance in terms of cost, time and quality;
Clearer definitions of responsibilities;
Reduced exposure to risk;
Improved value for money; and
Improving decision making and learning lessons for future schemes.
To this end, the Trust has developed a Post Project Evaluation (PPE) Plan (see Sections 2 – 5) with a view to setting out the criteria that will be
evaluated at the following 4 stages of the project:
♦
♦
♦
♦
Stage 1 – Procurement stage;
Stage 2 – During construction and commissioning;
Stage 3 – Shortly after opening (6‐12 months after the new Pharmacy has been commissioned); and
Stage 4 – Once the Tier 4 facility is well established (2 years after the facility has been commissioned).
The PPE Plan sets in place a framework to assess the management of the project, and gain positive lessons for the future management of
schemes for the Trust and the wider NHS.
130409 BCH CAMHS Tier 4_Post Project Evaluation Page | 1
113

Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Development
Post Project Evaluation
2. EVALUATION OF THE PROJECT : STAGE 1 ‐ PROCUREMENT STAGE
To evaluate how well the project was managed from inception (ie commencement of the Business Case) to the procurement of the facility:
Attribute to be Evaluated Timing Method of Evaluation Evaluators
Effectiveness of the Project Team
• Robustness of the Team
• The right skills were in place
• The team were properly resourced
Within 3 months
of Business Case
approval
• Structured questionnaire
• Face to face interviews
• Trust Executive Team / Board
• Project Sponsor
• Project Team
• Outputs were delivered in a timely way
• External advisors
• Outputs were of a high quality
• Key Stakeholders
• Communication was satisfactory
• Change was well managed
• Reporting on progress was satisfactory
• The internal Trust organisation was supportive of
the Team
• Internal consultation was well managed
• Commercial confidentiality was respected
• Advisors were well managed
• Appropriate feedback was given
• Sufficient contact was provided to users during
the process
• Overall impressions of the project delivery
• Aspects were particularly well managed
• Aspects where there was room for improvement
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114

Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Development
Post Project Evaluation
Attribute to be Evaluated Timing Method of Evaluation Evaluators
Project Documentation
• Content
• Presentation and style
• Substance
• Clarity
• Timeliness of document issue
• Overall usefulness
• Structure
• Aspects which were exemplars
• Aspects where there was room for improvement
Communications and Involvement During Procurement
• Internal consultation well managed
• External consultation well managed
• Timeliness of communications
• Effectiveness of involvement sought
• Aspects which were undertaken well
• Aspects where there were room for
improvement
Effectiveness of Advisors
• Quality of advice
• Timeliness of advice
• Value for Money
• Problem Solving
Within 3 months
of Business Case
approval
Within 3 months
of Business Case
approval
Within 3 months
of Business Case
approval
• Structured questionnaire
• Structured questionnaire
• Structured questionnaire
• Trust Executive Team / Board
• Project Sponsor
• Project Team
• External advisors
• Key Stakeholders
• Trust Executive Team / Board
• Project Sponsor
• Project Team
• External advisors
• Key Stakeholders
• Project Sponsor
• Project Team
130409 BCH CAMHS Tier 4_Post Project Evaluation Page | 3
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Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Development
Post Project Evaluation
Attribute to be Evaluated Timing Method of Evaluation Evaluators
• Accessibility
• Overall contribution
• Areas of exemplary performance
• Areas for improvement
Effectiveness of NHS Guidance
• Comprehensiveness
• Comprehensibility
• User‐friendliness
• Addresses key issues well
• Areas which are exemplary
• Areas for improvement
Support from Strategic Health Authority
• Responsive
• Timely
• Supportive
• Pro‐active
• Facilitative
Procurement Process
• Identify overall costs of procurement process
• Review timetable to achieve financial close
• Review planned development against strategic
objectives
• Production of Business Case and availability
Within 3 months
of Business Case
approval
Within 3 months
of Business Case
approval
Within 3 months
of Business Case
approval
• Structured questionnaire
• Structured questionnaire
• Audit
• Benchmark against plan and other
schemes
• Structured Questionnaire
• Timeliness after financial close
• Project Team
• External Advisors
• Project Team
• External Advisors
• Project Team
• Director of Finance
• Contractor
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116

Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Development
Post Project Evaluation
3. EVALUATION OF THE PROJECT : STAGE 2 ‐ CONSTRUCTION & COMMISSIONING STAGE
To evaluate how well the project was managed during the construction and commissioning stage:
Attribute to be Evaluated Timing Method of Evaluation Evaluators
Construction Preview
• Research construction PPEs from other similar
schemes
Within 3 months
of Business Case
approval
• Collection and collation of key
learning points
• Project Team
• Determine approach to transferring lessons from
other schemes
Within 3 months
of Business Case
approval
• Internal Team Meeting
• Project Team
• Stakeholder Day
Within 3 months
of Business Case
approval
• Workshop with managers of other
similar schemes
• Project Team
Final Design Process Sign Off
• Compliance to full brief
• Analysis of any change controls required during
final design phase, and establish costs
Within 3 months
of Business Case
approval
• Structured Questionnaire (on
completion of design)
• Assessment of design against
Design Quality Indicators
• Project Team
• Clinical Group
• Service Users
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117

Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Development
Post Project Evaluation
Attribute to be Evaluated Timing Method of Evaluation Evaluators
Final Handover of Building
• Compliance to project brief
• Compliance to health and safety regulations
• Compliance to fire regulations
• Compliance to clinical clean requirements
Within 6 months
of completion of
building
programme
• Detailed report
• Independent Advisor
Completion of Commissioning
• Compliance to health and safety
• Compliance to fire regulations
• Compliance to infection control standards
• Clinical and operational risk management
outcomes
• Identify costs, including delays, change controls,
and unforeseen expenditure
Within 3 months
after
commissioning
• Detailed report (for compliance to
statutory requirements)
• Budget reports
• Progress monitoring reports
• Structured questionnaires
• Independent Advisor
• Senior Clinical Staff
• Director of Estates & Facilities
• Patients
• Administrative and Management Staff
• Record overall progress against timetable
• Complete patient satisfaction survey
• Complete staff satisfaction survey
Final Contract Review
• Full lifecycle financial outcomes
• Non financial benefits
• Risk management
• Building maintenance conditions
• Costs to maintain building to 60 year life
• Contractor’s performance
• Contract management costs
12 months from
opening of new
facility
• Full Report
• Benefits Realisation Plan
• Director of Finance
• Independent Advisor
• Lead Clinician
• Director of Estates
• Patients
• Staff
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118

Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Development
Post Project Evaluation
4. EVALUATION OF THE PROJECT: STAGES 3 & 4 ‐ POST COMMISSIONING OF THE HOSPITAL
To evaluate how well the project is managed after the Department is reconfigured (shortly after opening and after two years), and to what
extent the Trust met the brief and delivered the benefits set out in the Benefits Realisation plan:
Attribute to be Evaluated Timing Method of Evaluation Evaluators
Financial Audits
• Progress against annual predictions
• Division’s finances remain in balance
• Achievement of Division’s identified
savings
Annual
• Rolling programme of financial
reviews of benefits
achievements
• Director of Finance
Risk Reviews
• Costs attributed to any identified and
unidentified risks occurring
Annual
• Rolling programme of reviews
of risk management strategy
• Director of Finance
• Analysis of risks identified against
occurrence
• Analysis of unidentified risks against
occurrence
Non Financial Benefits Review
• Analysis of benefits measurement
achievements against targets (see Benefits
Realisation plan for details)
• Identify any unforeseen benefits achieved
Annual
• Rolling programme of review of
benefits achieved against plan
• Structured surveys
• Project Team
• Service Users
• Staff
• Completion of patient satisfaction surveys
• Completion staff satisfaction surveys
130409 BCH CAMHS Tier 4_Post Project Evaluation Page | 7
119

Birmingham Childrens Hospital NHS Foundation Trust
CAMHS Tier 4 Development
Post Project Evaluation
Attribute to be Evaluated Timing Method of Evaluation Evaluators
• Analysis of staff attrition scores
Ongoing Building Maintenance Lifecycle Costs
• Monitor ongoing operating costs against
predicted lifestyle costs
• Identify maintenance or service costs not
within the contract that are value for
money
Review of Operational Performance against Plan
• Activity (actual vs plan)
• Clinical performance (actual vs plan)
• Capacity and throughput
• Appraisal of new service models
Annual
2 years after
opening of new
facility
• Financial cost maintenance
analysis
• Full review against Business
Case projections
• Director of Facilities
• Trust Information Department
130409 BCH CAMHS Tier 4_Post Project Evaluation Page | 8
120

Board of Directors
Public Meeting
Thursday 27 June 2013
Item No: 13.151 Enc 3
Strategic Objective/ Enabler
Every child and young person cared for by
Birmingham Children’s Hospital will be provided with
safe, high quality care and a fantastic patient
experience
Report Title
E vision at Birmingham Children’s Hospital – taking the
hassle out of healthcare
Sponsoring Director
Deputy Chief Executive
Author(s)
Deputy Chief Officer for Contracting and performance
Previously considered by
Presentation to Trust Leadership Team
Situation
This paper provides a more detailed description of the individual elements of the Trust’s IT
strategy that need to be delivered, focusing on:
• What will the solution deliver;
• The approach to delivery;
• Proposed prioritisation and phasing of the plan;
• Supporting work streams;
• What resources are needed for development, implementation and business as usual;
and
• Governance for delivery.
Background
The Board approved a 3 year strategy for moving forward IT in the Trust in July 2012.
This set out a vision to move to a fully electronic patient record and a patient portal by
2015. This drive to embrace technology and use it to improve the quality of care and
productivity has not changed. Our staff are telling us that they want to use technology
and that they can see the benefits it will bring. In addition there is a national initiative with
the Secretary of State setting a target for the NHS to be paperless by 2018.

What did our strategy say?
The strategy was developed after engaging with our staff and stakeholders. IT and
Informatics will be a key enabler for the organisation in delivering its strategic objectives.
The strategy highlighted the key principles of delivery:
• Real time access to information that is of high quality and accessible so that we can
be more patient focused;
• Ensuring technology is easy to use, available and dependable;
• Ensuring that technology is designed to optimise patient safety and care;
• Improving access to information for patients and families so they feel involved in any
decisions;
• Continued development to evolve to meet 21 st century and deliver ‘hospital without
walls’; and
• Development of strategic partnerships , allowing us to build on our existing systems
in a modular way.
Assessment
The strategy sets out ambitious plans to use technology to support clinical decision
making and improve patient care. If fully implemented it will change the way that
clinicians work providing real time information, in one place, to enhance decision making.
From an organizational perspective it will provide more information to support decision
making both on a day to day operational level as well as strategic decision making.
The strategy is in line with a national drive across the NHS to move to paperless
hospitals.
Given the significant challenge the strategy needs to be supported by a robust
governance structure and project management arrangements. Six workstreams have
been identified:
1. Infrastructure: building a robust and resilient infrastructure to ensure reliability and
availability of systems
2. PICS: to include e prescribing and medicines administration
3. EPR: a single place to access all information on a patient, this includes the
systems needed to enable this to happen including digital dictation, electronic
ordering of tests and a patient portal
4. Training and support: this will encompass the training needed on individual
systems but also the engagement and business change needed to maximize the
benefits.
5. Use of information: to look at what information is available, how it is used and by
whom and how can we make improvements so that both clinicians and managers
have the right information available to support decision making.

6. Review and replacement of current national systems: The Trust currently uses a
number of national systems which are supported at no cost to the organisation.
These arrangements will cease in 2015 and so a decision will need to be made to
either stay with the national systems but with a cost attached or procure
something else.
The approach supported by the Trust Board was to work in partnership with UHB. This
makes a lot of sense, and is assumed throughout this paper as:
• UHB have already developed and implemented key products we require
• Use of UHB systems will ultimately allow us to move to a virtual campus.
Costs included are based on UHB estimates, and are still subject to discussion; they will
change based on detailed specifications. The Trust costs have been added; these too
are estimates subject to change in subsequent full business cases.
To deliver this strategy will require significant upfront investment as well as ongoing
recurrent investment. Initial estimates are for £6.9m upfront investment with up to £3.8m
of recurrent additional costs. Clearly the availability of funding will be critical in
determining pace of change as well as prioritisation of schemes.
Recommendations
The Board is asked to support the process and overall framework for delivery. This is
with the assurance that there will be the opportunity for further review and assessment
along the way to ensure it remains fit for purpose and affordable. In addition the
individual workstreams will be subject to business cases where appropriate so that each
element can be scrutinised and benefits and risks clearly identified.
Key Impacts
Strategic Objectives
Staff and patients will have access to real time data in one place
CQC Registration (state
outcome)
N/A
NHS Constitution
N/A
Other Compliance (e.g.
NHSLA, Information
Governance, Monitor)
Improved Information Governance arrangements
Equality, diversity & human
N/A

ights
Trust contracts
Ability to share information with GPs and commissioners in a
timely manner.
Other
N/A

Item No:13.151 Enc 3
Informatics Strategy 2012 - 2015
E-Vision @BCH – ‘taking the hassle out of healthcare’
April 2013
Lead Executive
Authors
: David Melbourne
: Georgina Dean, Deputy Chief Officer, contracting and performance
1

Introduction
E-vision @ BCH – ‘taking the hassle out of healthcare’
The Board approved a 3 year strategy for moving forward IT in the Trust in July 2012. This set out a vision to move to a fully
electronic patient record and a patient portal by 2015. This drive to embrace technology and use it to improve the quality of care
and productivity has not changed. Our staff are telling us that they want to use technology and that they can see the benefits it
will bring. In addition there is a national initiative with the Secretary of State setting a target for the NHS to be paperless by 2018.
What did our strategy say?
The strategy was developed after engaging with our staff and stakeholders. IT and Informatics will be a key enabler for the
organisation in delivering its strategic objectives. The strategy highlighted the key principles of delivery, which will be
summarised on the following slide:
• Real time access to information that is of high quality and accessible so that we can be more patient focused;
• Ensuring technology is easy to use, available and dependable;
• Ensuring that technology is designed to optimise patient safety and care;
• Improving access to information for patients and families so they feel involved in any decisions;
• Continued development to evolve to meet 21 st century and deliver ‘hospital without walls’; and
• Development of strategic partnerships , allowing us to build on our existing systems in a modular way.
“The provision of consistently high quality accessible information and supporting infrastructure and services
to patients, the public, clinicians, managers and planners to allow for the optimum decisions to be made to
improve the health and well being of our patients”
2

Information, its delivery and use is a key enabler to
ensure we secure our strategic ambitions
Delivering excellent care
today….
Striving to make it even better…
Shaping excellent care for
tomorrow…
New Strategic
Goals
Every child and
young person
requiring access to
care at Birmingham
Children’s Hospital
will be admitted in
a timely way, with
no unnecessary
waiting along their
pathway
Every child and
young person cared
for by Birmingham
Children’s Hospital
will be provided with
safe, high quality
care, and a fantastic
patient and family
experience
Every member of
staff working at
Birmingham
Children’s Hospital
will be looking for,
and delivering
better ways of
providing
outstanding care, at
better value
Every member of
staff working at
Birmingham
Children’s Hospital
will be a champion
for children and
young people
We will strengthen
Birmingham
Children’s Hospital’s
position as a
provider of
Specialised and
Highly Specialised
Services, so that we
become the leading
provider of
Children’s
Healthcare in the UK
We will continue to
develop
Birmingham
Children’s Hospital
as a provider of
outstanding local
services: ‘a
hospital without
walls’, working in
close partnership
with other
organisations
People Process Place
Informatics
Enabling
Strategy
An Informatics Strategy that
supports the Trust with its key
objectives which is patient
focused by providing real time
access to information and
develop strategic partnerships
Ensure technology is easy to use,
available and dependable
regardless of care setting and
designed to optimise patient
safety and care
A Strategy that can evolve to
meet the ambitious 21 st
century hospital and deliver
the ‘hospital without walls’
3

Moving forward
This paper provides a more detailed description of the individual elements of the strategy that need to be delivered, focusing on:
• What will the solution deliver
• The approach to delivery
• Proposed prioritisation and phasing of the plan
• Supporting work streams
• What resources are needed for development, implementation and business as usual, and
• Governance for delivery
The aim is to describe how the strategy will become a reality. The approach supported by the Trust Board was to work in
partnership with UHB. This makes a lot of sense, and is assumed throughout this paper as:
• UHB have already developed and implemented key products we require
• Use of UHB systems will ultimately allow us to move to a virtual campus.
Costs included are based on UHB estimates, and are still subject to discussion; they will change based on detailed specifications.
The Trust costs have been added; these too are estimates subject to change in subsequent full business cases.
The Board is asked to support the process and overall framework for delivery. This is with the assurance that there will be the
opportunity for further review and assessment along the way to ensure it remains fit for purpose and affordable. In addition
the individual workstreams will be subject to business cases where appropriate so that each element can be scrutinised and
benefits and risks clearly identified.
It is also clear that alongside the strategy there needs to be a change in how we use information in the wider sense and so an
additional workstream has been added which will focus on how we use information to support decision making both for
operations and to support our strategic planning.
4

What will the strategy deliver?
Improved information for managing the hospital – Hospital Operations Dashboard
NOW
FUTURE
Paper based bed management
White board to highlight and
record live issues
Information on tertiary referrals
on line
Hospital operation centre online
Twice daily report pulled together
manually
Multitude of systems that don’t
link
System data updated overnight
Data available real time
Instant view of bed availability
Instant view of how many people
waiting and for how long in ED
More systems linked and available
to access information
System generated reports
Allows more timely escalation and
action of potential issues
5

What will the strategy deliver?
Improved information for clinical decision making – electronic patient record
The EPR provides one place where clinicians can find all information about their patient,
supporting more informed decision making at the point of patient care.
6

What will the strategy deliver?
Instant access
to real time
patient data
Authorised
access
through
single sign on
Pulls data
from a range
of systems
EPR
Connects to
primary care
Minimises
use of paper
records
Allows mobile
working
supporting
hospital
without walls
7

What will the strategy deliver?
How it could look…all the information through one window
8

What will the strategy deliver?
Electronic Prescribing and Medicines Administration (EPMA)
• Only comprehensive, hospital wide fully integrated EPMA system in any children’s hospital in the world
• More decision support for clinical staff than in any other system
• Safety alerts
• Hospital wide real time patient level drug data
• Up to 80% reduction in drug errors
9

Approach to delivery
USE OF INFORMATION
Outputs
EPR
Patient portal
Hospital Operations dashboard
Enablers
Digital dictation
PACS
Single sign on
Electronic document
management
Order comms
EPMA
Infrastructure
Server capacity Real time data warehouse Disaster recovery
Storage Hardware Messaging
Training and support
PROGRAMME GOVERNANCE
The diagram above summarises the approach to delivery of the strategy. It is shown as a pyramid to demonstrate the need to
have each layer in place to deliver the ultimate goal. Each level is described in more detail later in the document. The strategy
needs to be supported by strong governance to ensure delivery is done in a safe and cost effective way. Alongside there will need
to be training and support for staff to prepare for the change and a separate , complementary work stream that looks at how we
use information in the organisation .
10

Approach to delivery
Key workstreams
Work stream 1
Infrastructure
Work stream 2
PICS
Work stream 3
Electronic
patient record
Work stream 4
Training and
support
Work stream 5
Use of
information
Work stream 6
Future
requirements
Server
replacement
Disaster recovery
Storage
Virtual Desktop
Infrastructure
Messaging
Hardware
E prescribing
Extended
functionality
Digital dictation
Electronic
document
management
Single sign on
PACS (Imaging)
Order Comms (eordering
of tests
and images)
Training
programme
including basic IT
skills
Engagement and
business change
Data warehouse
Reporting
services
Specialty reviews
Data quality
Information
governance
Review and
potential
replacement of
existing systems:
IPM (Patient
administration
system)
ORMIS (theatres)
SystemOne
(palliative care)
Patient portal
+ others
EPR ‘lite’
11

Approach to delivery
Work stream 1 - Infrastructure
Whilst the strategy focuses on delivery of information to clinicians and patients, to deliver this we need a robust and resilient
infrastructure. This forms the foundation of delivery. A significant part of this work would be needed regardless of delivery of the
full strategy. It is about maintaining and updating our IT infrastructure in the same way we maintain our estate or medical
equipment. This should not be seen as a one off investment. This will need increased investment on a recurrent basis not only in
keeping the hardware up to date but staff to support the increased numbers of devices and servers.
Server capacity/Disaster Recovery
The key decision that needs to be made which will impact on future plans is how and where we build our increased server
capacity and disaster recovery. Currently we manage all infrastructure ourselves with some support contracts. The demands will
increase in the future and so this needs to be strengthened and expanded.
A separate business case is being prepared but the key options are:
• UHB to provide fully hosted service on their site
• BCH to continue to host on Trust premises
• Third party facility
• Externally hosted cloud option
The impact on initial capital investment is minimal but the on-going costs will differ.
Hardware
As we move away from paper and become reliant on electronic systems we need to ensure that we have fast and reliable PCs and
other hardware so that clinicians can access data any where and at any time. The investment will need to include a range of
different devices to support the roll out of the EPR and e prescribing. We need to allow staff to be more mobile both on and off
site.
12

Approach to delivery
Work stream 1 - Infrastructure
Messaging/integration engine
The integration engine allows different Trust systems to talk to each other. It is critical in allowing us to get information to move
between systems, and for clinicians and other decisions makers to be able to see data in one place. A small amount of investment
is needed to improve and update the existing integration engine.
Storage
Our storage capacity will need to increase hugely. For example, we will need to be able to store patient notes and images in
volumes orders of magnitude greater than we do currently. Different suppliers can provide different options, which would be
subject to a business case. The proposed approach includes a vendor neutral archive (VNA), an industry standard which would
not commit us in perpetuity to a specific provider, and would also provide a disaster recovery – backup.
Virtual desktop infrastructure (VDI)
With VDI users access their account through a desktop or other device but while they think they’ve logged in as normal, they’re
actually running on a virtual desktop, on a server. This means that the user is able to access all their needs from any machine,
improving their flexibility, device promiscuity, and user configuration for ease of individual use. It allows session persistence
across devices meaning that there is no need to keep logging on and so supporting more mobile working. It also makes it easier
for back up and recovery as the data is not stored on the individual machine. Devices supporting VDI are simpler, don’t need to be
such high specification, and last longer, because the complex bit is at the server end. From an IT perspective it is a more efficient
environment that is easier to maintain.
13

Approach to delivery
Work stream 2 - PICS
The prescribing information and communication system or ‘PICS’ is a system developed by UHB. It is a core part of the EPR. It has
a range of functions:
• E prescribing and medicines administration (‘EPMA’)
• Requesting and results reporting
• Observation charting
• Decision support – Deriving from drug interactions, contraindications, pathology results, comorbidity etc.
• Other Functions:
– Email/SMS triggers based on patient conditions
– Discharge letters
– TTO on discharge
– Alerts and warnings
– Clinical Notes/Configurable Forms
• Audit database
• Business continuity data archive
The BCH charities has donated £2m towards the cost of EPMA. There is a significant amount of development work to do as there
is not currently a paediatric EPMA system in the world and so we are working closely with UHB to develop the supporting drug
dictionary. The implementation of EPMA will be the first phase on PICS and the additional functionality will follow.
14

Approach to delivery
Work stream 3 – Electronic patient record
There are a number of projects which sit under this workstream which, when pulled together, will create an electronic patient
record as demonstrated on page 11. In 2013/14 a more streamlined version would be developed which would pull together
existing systems into one place and this can then be expanded as other systems come on line. The key components are:
Digital dictation
Currently most specialties use tapes for dictation. A move to digital dictation would mean all recording being made digitally onto
a central system. This will bring many benefits : no risk of tapes being lost; visibility over recordings in terms of priority and
workload; ability to share letters with other teams making information accessible across the Trust and the ability to share
electronically with GPs. Some specialties already use digital dictation and a pilot was completed. It is recommended that this is
one of the first priorities to roll out as it can be done within the year and in isolation to the other projects but would be a major
step forward in use of technology and in particular document management.
PACS (picture archiving and communication system)
BCH currently has a contract with Agfa for PACS. This covers radiology, cardiology , laparoscopy and dental. It allows high quality
digital images to be available to clinicians on their desktop or handheld. The system could be rolled out across all specialties
where appropriate and provide a single solution to digital images and other file types eg audiology, neurophysiology. By extending
this across the Trust all images can then be accessible through the EPR for instant access to clinicians.
EPR lite
This would be the streamlined version of the EPR based on current systems in place allowing a single point of access for
electronic patient information. It is important to put this in place rather than waiting until all other systems are in place as it will
support the change in approach for staff and mean that they become more accustomed to using the EPR.
15

Approach to delivery
Work stream 3 – Electronic patient record
Patient portal
This would allow patients and their families access to their information on line . It could be used for a variety of things and would
not simply be access to the patient notes. There would need to be consultation with patients and families over what would be
helpful to them but could include dates of appointments, ability to record information to feedback to the clinical team,
information on admissions. This would be one of the later projects.
Electronic document management
This will be key in supporting the EPR. A system which stores and allows easy access to documentation on a patient as needed
across the Trust. The digital dictation solution can provide some of this functionality but this provides a comprehensive solution
for all types of records including scanned documents from GPs as well as internal documents and correspondence.
Order communications
Good order comms systems allow clinicians to requests for and acknowledge receipt of investigations electronically. Currently
there is a system in place but it only allows requesting, not acknowledgement. It is old, poorly adopted, and in need of upgrade.
Ultimately a single system would allow requests directly from the EPR.
Single sign on
This allows staff to sign on only once and then be able to access all required systems. This speeds up access and means that there
is no need for multiple log ins.
16

Approach to delivery
Work stream 4 – Training and support
Training
Whilst training will be a key part of any scheme implementation it has been separated to recognise the importance of this within
the overall programme. This will cover a number of key areas:
1 – Basic IT skills
In the first phase the focus will be on understanding the skills currently in place for staff. There will need to be training on basic IT
awareness and skills.
2 – System specific training
The project teams for the systems will identify the training requirements for staff. This group in conjunction with the project
teams will support the design and planning of the training. This will need to use different modes of delivery.
3 – On-going training
On-going training requirements will need to be identified and built into regular training programmes.
Engagement and business change
This workstream will also oversee the communication and engagement element of the programme. Key to successful delivery of
any of the projects will be the engagement of staff. Only through this will the full benefits be realised. All projects will need to
work with services to understand the business change needed. This will require local ‘champions’ embedded within services to
be able to identify the impact on the services and work through them.
It is important that during the implementation phase of a project there is sufficient resource available to support staff, this means
having staff ‘walking the floors’ and dealing with issues arising. It is important to note that initially it is likely people will feel that
the new system increases the time taken to do tasks and so it needs to properly embed before efficiencies can be realised.
This workstream will link to the transformation agenda in the Trust so that the potential benefits are factored into their on-going
programme of work. This needs to be explored further and learning gained from other trusts before a final approach is decided.
17

Approach to delivery
Work stream 5 – Use of Information
The overall purpose of this work stream is to look at what information is available, how it is used and by whom and how can we
make improvements so that both clinicians and managers have the right information available to support decision making. The
work programme will develop over time but year one has three key elements:
1 - Real time data warehouse
The Trust has invested in the development of the data warehouse over the last year.
Our current warehouse:
• Is populated overnight and the data within it is therefore always one day behind;
• Contains data from some - but not all – of our key clinical systems - for example patient administration and theatres ; and
• Has poor linkages between data from different systems meaning algorithms are needed to try to match data along a patient
pathway.
It is therefore good for reactive reporting and some analytics but is poor for clinical and operational management
A real time warehouse will:
• Capture data in real time from all required systems, and, with an integration engine, help link all parts of the patient
pathway together;
• Allow us to proactively to manage our services, both clinically and operationally.; and
• Require a major commitment across the Trust to capturing data in real time on the source clinical systems.
A real time warehouse is key to the delivery of the EPR and Hospital Operations Dashboard.
18

Approach to delivery
Work stream 5 – Use of Information
2 - Specialty reviews
This will involve a full review of all systems and databases in use across the trust that hold patient information as well as the
resources in place to support. The aim will be to have a full picture of information to identify the purpose and current use of each
system and to identify if it can and should be added to the data warehouse. At a specialty level it will also look at how data is
used and data quality to provide support and identify improvements.
This work stream will link closely to the Data Quality Group already in place.
3 – Review and upgrade of reporting services
The Trust currently has Vesper Reporting Services available which provides access to a large number of reports and information.
Both the data store and the reports use SQL Server 2008 software. The aim of this work is to review our processes for storing
and reporting upon the data in order to improve usage across the Trust. We will need to assess whether updated reporting tools
can help with both the uptake and the understanding of information. There will be an on-going piece of work to look at the nature
of what is reported and how this can improve over time with more emphasis on outcomes. We will also review how colleagues
access their information, and look at ways to make that easier including reducing the number of different sources so that it is
clear where to go to get what you need.
In the future this will continue to develop to support the information requirements of the organisation and the on-going need to
continuously review and improve our information and data quality.
19

Approach to delivery
Work stream 6 – Future requirements
The Trust currently uses a number of national systems which are supported at no cost to the organisation. These arrangements
will cease in 2015 and so a decision will need to be made to either stay with the national systems but with a cost attached or
procure something else. The aim of this workstream is to develop the specifications required and support the procurement and
then implementation of the new systems if required.
There will also be a need to review the other systems in place to determine when or if replacement is needed. Whilst the systems
are owned by the directorates it is important that any replacements are made fit with the strategy.
The exact costs of this are difficult to quantify at the present but further detail will be provided in the future once scoped.
20

Proposed timescales
Prioritisation
The next slide sets out the proposed timing of the workstreams. In determining the roll out the following has been taken into
account:
• The necessary infrastructure that needs to be in place before new systems can be implemented;
• Recommendations from UHB on the order of implementation;
• Potential impact on quality, safety and efficiency;
• Funding available;
• External drivers;
• The ease of implementation; and
• Charity expectations.
21

Proposed timescales
2013 2014 2015 2016 2017
Infrastructure
Server/DR/VDI/storage
messaging
PICs Development Pilot and Implement Extend functionality
Clinical Portal
Use of information
Real time data
warehouse
Digital dictation/EDM
Order comms
PACS
EPR ‘lite’
Order comms
Full EPR
Training and
support
Replacements Scope Procure Implement
22

Indicative costs
There are two elements to the costs, internal costs and UHB costs. UHB have provided detailed costs but these are subject
to further review and discussion as we progress. It is assumed that a significant part of the costs will be capital, where this is
the case then estimates have been made about the capital charges attached.
At this stage these are estimates only and these will need to be worked through further as the plans are developed and
business cases developed.
Funding sources – up front investment
The BCH charities has provided £2m of funding to support the e-prescribing/EPMA project specifically.
The existing IT project resource is 2 project managers and a senior project manager plus dedicated time of 2 consultants
and a nurse. It will also involve significant engagement of existing IT and Informatics staff as well as Directorate staff. The
costs of existing staff have not been included.
Capital has been allocated to the strategy in 2013/14 of £0.9m. With a further £2m as an indicative figure for 2014/15.
The Government has announced £260m of funding available to support Trusts in moving to e prescribing and EPR and a bid
will be submitted. There is an expectation of the organisation matching funding bid for. Bids have to be submitted by the
end of July with money to be spent in 2013/14 and 2014/15. This is capital funding.
Recurrent costs
Once implemented the recurrent costs are significant as set out on the following page. These costs represent the costs of
maintaining the infrastructure and systems and some on-going development. The speed of implementation will clearly be
dependent on the available revenue funding to support in the future.
23

Indicative costs
Capital
investment
£m
Non recurrent
investment
£m
Recurrent
costs
£m
Workstream 1 2.8 0.2 0.9
Workstream 2 2.2 0.8 0.8
Workstream 3 1.6 0.1 0.9
Workstream 4 0 0 0
Workstream 5 0.2 0 0.2
Workstream 6 0 0 1.0
6.8 1.1 3.8
Notes:
Recurrent costs – includes £1m relating to capital charges, and £1m payable to UHB for support, hosting and licences
and on-going development of systems
Workstream 2 – includes infrastructure of £0.6m
Workstream 4 - No costs have been allocated at this stage and are included in other workstreams
Workstream 6 – costs are based on initial estimates if BCH remains with national systems
24

Programme governance
The diagram below shows the process to be followed from approval through to benefits realisation and review. Any approach will
need to be flexible and the level of project discipline will vary dependent on the scheme, the size, complexity duration,
investment level and risk. This sets out the normal level but a very small scheme may not require this. The strategy group will
determine how it should be managed.
Strategy approved
by Board
Review and refresh
Overall plan and
budget approved
Business as usual
Business cases for
individual schemes
Benefits realisation
Project plan for
scheme
Implementation
Monitoring
Testing
25

Programme governance
Trust Board
Approval of Strategy
Finance and
Resource
Committee
Project Governance and
Assurance
Issue Escalation
Clinical Risk
Committee
Clinical Governance and
Assurance
Operational
Leads
Expert Advice
Other Trust
Committees
Direction and Decissions
Reporting and
Advice
Design
Group
Advice
IM&T
Strategy
Group
Reporting and
Advice as Required
Project/Programme Board
– may include suppliers etc external to
the Trust
Project Group
1
Project Group
2
Project Group
3 etc
Project/Delivery Groups
26

Programme governance
Responsibilities:
• Trust Board: The Trust Board is responsible for approving the overall strategy and allocating resources for delivery. The
Board is also responsible for ensuring the strategy is in line with the Trust’s strategic objectives. The Board will approve
business cases dependent on value.
• Finance and Resources Committee: The committee will approve the detailed plans and business cases and receive quarterly
updates from the IMT strategy group.
• Trust Leadership Team: Responsible for testing whether this is a credible plan and would have clinical support.
• IMT strategy group: This group will provide assurance to the F&R committee on the progress of the strategy. It will review
each scheme in detail and look at risks and issues arising. It will have a multi-disciplinary membership with clinical
involvement as well as technical and corporate support. The group will make decisions around corrective actions and
recommendations. It will feed into Clinical Risk and Quality Committee and Operational Leadership team or other
committees as needed.
• Clinical design group: This will be a key advisory group for the strategy and on-going IT and Informatics work. The group will
be chaired by a clinician with primarily clinical membership. The group will inform and advise the IMT strategy group on the
design and priorities for the strategy. This will include reviewing and prioritising the requests for new systems, dashboards
etc.
• Project groups: Project group will be established for key workstreams. These will be time limited groups focused on delivery
and implementation. The groups will have multi disciplinary membership with a project manager leading the group and a
clinical champion to support.
• Deputy Chief Officer – contracting and performance will be the overall lead for delivery of the strategy and main link with
our partners at UHB.
• Chief clinical information officer – Senior clinician who will support delivery of strategy, focusing on engagement of
clinicians and design of solutions
27

Risks
A high level risk assessment of the strategy has been completed. This will be further developed and updated throughout the
process with more detailed risk registers in place for individual projects.
Risk identified Controls Assurances
Staff do not engage meaning systems are
not properly used and full benefits not
realised.
Clinical risks due to change in systems
particularly during implementation
phase when there is a mixed economy..
• Senior clinical input into the projects
with dedicated time allocated.
• Systems already in use at another
provider and so are ‘tried and tested’
and some staff already familiar due to
cross site working.
• Communications and engagement
plan to be put in place.
• Risk assessments to be completed and
updated throughout the project at
both an individual and programme
level.
• All risks reviewed on a weekly basis by
project team and monthly at the IMT
strategy group. This will also look at
potential conflicts across projects.
• Implementation process to follow
recommended guidance to ensure
feasibility and testing completed prior
to full roll out.
• Benefits realisation plan to be
monitored through IMT strategy group
with updates to FRC.
• Risk register to be reported through to
CRAQ on a monthly basis and other
relevant committees.
28

Risks
Risk identified Controls Assurances
Insufficient funding available in future
years to deliver full strategy
Cost overruns due to time delays or
other unforeseen circumstances
• Each element of the strategy will be
subject to business case and will be
built up in a modular way. Therefore
the affordability and appropriateness
can be tested on a regular basis.
• Detailed scoping and costing to be
done before project commencement.
• Change control process to be put in
place
• Finance support during the
preparation and delivery of projects
Reliance on partnership with UHB • Supported by contractual
documentation for delivery.
• Each project reviewed and
consideration of alternative options
where appropriate.
• Governance structure in place
• Regular reporting to identify potential
issues and the impact at an early stage
• Senior level commitment from both
organisations to make the
arrangement work.
• Clear benefit for both parties to make
a success.
29

Board of Directors
Meeting in Public
27 th June 2013
Item: 13.152 Enc 04
Strategic Objective
Strategic Priorities
Report Title
Sponsoring Directors
Contributors
Previously considered by
Every child and young person cared for by Birmingham Children’s
Hospital will be provided with safe, high quality care, and a fantastic
patient and family experience
3. Further develop our approaches to gaining feedback from staff,
children, young people and families to ensure that their voice is heard
at every level of the organisation.
4. Further innovate our systems to promote and enhance patient safety
and reduce avoidable harm.
Quality Report
Dr Vinod Diwakar, Chief Medical Officer &
Michelle McLoughlin, Chief Nursing Officer
Governance Services, Corporate Nursing, Education, Infection
Prevention and Control, PICU & Cardiac Services
Quality Committee, Clinical Risk & Quality Assurance Committee
Situation
The enclosed report provides a monthly update on key clinical safety and quality topics.
Background
The report is collated from a number of information sources and provides assurance that key risks are
being escalated and monitored until sufficient action has been taken to address the concerns.
The report includes information on key risks, serious incidents, mortality data, cardiac arrest, respiratory
arrest, other acute life threatening events, infection control data, Safety Thermometer data, Net
Promoter Question results, and data from the PED database. Information on Never Events and other
safety information is included by exception.
The report has begun to align information against Trust Priorities and measures.
Assessment
Please see the enclosed report for a discussion of the key risks.
Review the enclosed report.
Recommendations
Key Risks
Risk Description Controls Assurances
Failure to correctly identify the
greatest risks to the quality of care
and safety of our patients.
• Directorate Governance
systems
• Board Assurance
Framework
• Risk Register
• Safety Strategy
• Monthly Board Safety Report
• Mortality Review
• Monitoring of incident trends
• Monitoring of complaints
trends

Strategic Objectives
CQC Registration (state outcome)
NHS Constitution
Other Compliance (e.g. NHSLA,
Information Governance, Monitor)
Equality, diversity & human rights
Other
• Safety Dashboard
Key Impacts
The information provided in this report contributes to the delivery
of our strategic objective that Every child and young person
cared for by Birmingham Children’s Hospital will be provided with
safe, high quality care, and a fantastic patient and family
experience.
Standard 16 Assessing & monitoring the quality of service provision
could be affected by a failure to manage risks highlighted by the
report.
None.
This report includes key safety information which should be
reported to Trust Board. Failure to do so could impact on
maintaining NHSLA level 3 compliance for Standard 1
(Governance).
None.
None.

Performance Report
Month 2 2013/14
May 2013
Georgina Dean
Deputy Chief Officer for Contracting and Performance
1

Performance issues
Cancelled operations on the day ED – time to triage (ambulance) Diagnostic waits over 6 weeks
Cancelled operations by the hospital ED – Left without being seen Tertiary referrals sent elsewhere
Patients cancelled more than twice ED – Unplanned readmissions Tertiary patients waiting over 24 hours for
a BCH bed
Cancellations due to equipment
failures or admin errors
18 weeks performance PICU – WM patients not supported
Patients postponed CAMHS 18 weeks performance PICU – non WM patients not supported
ED - time in ED Patients not treated within 18 weeks PICU – WM patients supported
ED – time to seen Patients not treated within 30 weeks CAMHS patients that were not admitted
ED – Time to triage (all) Patients waiting over 52 weeks Patients with delayed discharges
Ambulance turnaround
Indicates strategic objective measure
2

Cancelled operations SPC trend
Using SPC charts enables the separation of natural variation from special cause variation over a period of time.
The SPC graph below illustrates the statistical variance of all hospital cancelled operations, since April 2010.
60
Monthly cancelled operations (DoH
definition)
Cancelled operations are subject to natural variation and seasonal trends.
Whilst all cancellations by the hospital has reduced since autumn 2012, it
still remains above the statistical mean and has increased since April 2013.
50
40
30
20
10
0
A M J J A S O N D J F M
2011/12
2012/13
2013/14
100
90
80
70
60
50
40
30
20
10
0
Apr-10
Jun-10
Aug-10
Oct-10
Dec-10
Feb-11
Apr-11
Jun-11
Aug-11
Oct-11
Dec-11
Feb-12
Apr-12
Jun-12
Aug-12
Oct-12
Dec-12
Feb-13
Apr-13
3

Cancelled operation hot spots
YTD in 2013/14 a total of 109 operations were
cancelled by the hospital. The speciality breakdown
for these is below
Cardiac surgery and
cardiology 36.7%
Plastic surgery 13.8%
Orthopaedics 10.1%
Surgery 7.3%
YTD in 2013/14, 36.7% (40) of all hospital cancelled
operations have been in cardiac surgery and cardiology.
Excluding cardiology postponements (which were 13
patients)
•78% of these were due to no PICU bed
•11% to more complex patients
•4% to no ward beds
•4% to more urgent patients
•4% were cancelled by clinician.
Other specialities include
Burns, Hepatology,
Neurosurgery, Respiratory,
Dermatology, audiology,
cranio facial and
gastroenterology, individually
accounting for 2 or less %)
ENT 6.4%
Radiology
6.4%
Urology
4.6%
Max fax
2.8%
Other
specialities
11.9%
Cardiac services and plastic surgery account for 50% of all operations cancelled
by the hospital. In these specialities combined, the highest reasons for
cancellations, excluding postponements were
•50% No ITU bed
•17% t more urgent patient
•14% no ward beds
•10% more complex patients.
23 hour ward is helping reduce the number of cancellations due to no ward
bed. However, year to date there have been 11 hospital cancellation due to no
ward beds accounting for 10% of total hospital cancellations.
4

Cancelled operations – by cancellation
reason
YTD cancelled
operations (national
definition) reason by
weighted number
Total patients 60
No ITU bed 25%
More urgent patient
21.7%
More complex patient
16.7%
No ward bed 15%
Operation
overrun 10%
Liver 5%
Staff
shortage
5%
Admin
error
1.7%
109 patients had their
operation cancelled by BCH
YTD in 2013/14 (right
pyramid) and 60 of these were
included in the figures
reported to the DoH (left
Pyramid)
In May, 39 were included in
the national reported figure
The most common reason for cancellation is
no PICU bed and more urgent patient
accounting for over a third of all hospital
cancellations (right pyramid)
Strategic objective 1: All cancelled operations was
21% lower than YTD in May 2012
No ITU bed 19.3%
More urgent patient 17.4%
Postponement 13.8%
No ward bed 10.1%
Operation overrun 9.2%
More complex patient
9.2%
Staff shortage 8.3%
Admin error
4.6%
Medical
reasons 3.7%
Liver
2.8%
DNA
0.9%
Equip
ment
failure
0.9%
YTD cancelled
operations (all those
cancelled by the
hospital) reason by
weighted number
Total patients 109
5

Capacity and non capacity cancellations
No ITU bed 19.3%
More urgent patient 17.4%
Postponement 13.8%
No ward bed 10.1%
Strategic objective: In May, 4 patients were cancelled
due to admin error
• Radiology – Not aware interpreter was required
• Surgery - An evening list was booked for both theatres 5 and the
Lap theatre with only enough staffing for one of these sessions
• Orthopaedics – unknown detail
• Plastic surgery – unknown detail
Operation overrun 9.2%
More complex patient
9.2%
Staff shortage 8.3%
Admin error
4.6%
Medical
reasons 3.7%
Liver
2.8%
DNA
0.9%
Equip
ment
failure
0.9%
Using all 109 operations cancelled by
the hospital, these can be broken
down into capacity and non capacity
reasons for cancellations.
68% of cancellation by the hospital are
due to capacity reasons. 18% are due
to non capacity reasons including staff
shortages, equipment failure, medical
reasons and administration errors.
Capacity 68%
Non capacity
18%
Postponement
14%
6

Operations cancelled more than once
12
10
8
6
4
2
8
2
Patients who have had their operation cancelled more than
once by the hospital
5
2
3
2
1 1 1
10
2 2 2
1
3
2
2
3
5
4
1 1 1
1
5
Twice
3 times
4 times
Strategic objective: No patient was
cancelled more than twice in May
In May 5 patients had their operation
cancelled twice by the hospital. YTD
in 2013/14, 10 patients have had
their operation cancelled more than
once by the hospital..
Of note, in our contract 2013/14 a
national quality requirement is that
no urgent operation should be
cancelled a second time.
Consequences of breeching this
target is non payment of cost
associated with cancellation and non
payment/reimbursement of costs of
rescheduled episode of care
0
M -
2012
J -
2012
J -
2012
A -
2012
S -
2012
O -
2012
N -
2012
D -
2012
J -
2012
F -
2012
M -
2012
A -
2013
M -
2013
All 5 of these patients were in cardiac
services
7

Cancelled more than once stories
(3 of 5 multiple cancellations)
Patient 1 x 2 times (cardiac)
Patient 2 x twice (cardiac)
Patient 3 x 2 times (cardiac)
3 rd May
• Cancelled by the hospital
on the day due to no PIC
bed
• Included in the national
figures
2 nd May
• Cancelled by the
hospital on the day
due to no PIC bed
• Included in national
figures
20 th May
• Cancelled on the day
by the hospital due to
no PIC bed
• Included in national
figures
7 th May
• Cancelled by the hospital
on the day due to no PIC
bed
• Included in the national
figures
3 rd May
• Cancelled by the
hospital on the day
due to no PIC bed
• Included in national
figures
21 st May
• Cancelled by the
hospital not on the
day due to no PIC bed
• Not included in the
national figures
10 th May
• Patient treated
7 th May
• Patient treated
23 rd May
• Patient treated
8

Cancelled Operations
Ethnicity
Patients from a mixed, African or Caribbean
background were amongst the highest proportion
of ethnic group with an elective procedure
cancelled in May. Of note, these are very small
numbers with 1, 3 and 2 patients cancelled.
The largest number of patients cancelled was white
British where 37 patients had their operation
cancelled, accounting for 3.4% of total white British
elective procedures.
7.0
6.0
5.0
4.0
3.0
2.0
1.0
% of all elective procedured cancelled by
ethnicity
6.7 6.5
6.1
4.9
3.6 3.5 3.4 3.4
1.6
1.2
Number
Ethnicity
cancelled %
Mixed-any other mixed background 1 6.7
Black/Blk Brit - African 3 6.5
Mixed-White & Black Caribbean 2 6.1
White - any other White b/g 2 4.9
Not stated 1 3.6
Asian/Asian Brit - Pakistani 11 3.5
White - British 37 3.4
Asian/asian brit-any other asian background 2 3.4
Any other ethnic group 2 1.6
0.0
Mixed-any other mixed
background
Black/Blk Brit - African
Mixed-White & Black Caribbean
White - any other White b/g
Not stated
Asian/Asian Brit - Pakistani
White - British
Asian/asian brit-any other asian
background
Any other ethnic group
Asian/Asian Brit - Indian
Asian/Asian Brit - Indian 1 1.2
9

Cancelled Operations Ethnicity
May 2013/14 cancelled operations
ethnicity
May 2013/14 elective procedures ethnicity
Mixed-any
other mixed
background
Asian/Asian Brit -
Bangladeshi
Asian/Asian Brit - Indian
Black/Blk Brit
- African, 5%
Asian/Asian
Brit -
Pakistani,
18%
Black/Blk Brit -
African
Mixed-White &
Black
Caribbean
White - any
other White
b/g
Not stated
White -
British, 57%
Asian/Asian
Brit - Indian,
4%
Asian/Asian
Brit -
Pakistani, 17%
Asian/Asian Brit -
Pakistani
Asian/Asian Brit-any oth
Asian b/g
Black/Blk Brit-African
Black/Blk Brit-Any oth
Blk b/g
Black/Blk Brit-Caribbean
White -
British, 60%
Asian/Asian
Brit - Pakistani
Mixed-any oth mixed
background
Mixed-White & Asian
White - British
Mixed-White & Black
African
Asian/asian
brit-any other
asian
background
Mixed-White & Black
Caribbean
10

Emergency Department
Time in A&E:
3.95
Time to triage
(all): 34
Time to triage
(ambulance): 14
Time to be
seen: 64
Left without being
seen: 3.01%
Unplanned
readmissions: 2.46%
Time to Triage
Standard ≤ 15 minutes (95th Percentile) (Ambulance Only)
Time to be Seen
Standard ≤ 60 minutes (Median)
16
15
14
13
12
11
10
A M J J A S O N D J F M
2012-13
2013-14
Target
90
80
70
60
50
40
30
20
10
0
A M J J A S O N D J F M
2012-13
2013-14
Target
4.70
Total Time Spent in A&E
Standard ≤ 240 minutes / 4 hours (95th Percentile)
7.00
6.00
Left Without Being Seen
Standard ≤ 5%
4.50
5.00
4.30
4.10
3.90
3.70
2012-13
2013-14
Target
4.00
3.00
2.00
1.00
0.00
2012-13
2013-14
Target
3.50
A M J J A S O N D J F M
A M J J A S O N D J F M
11

18-weeks
Admitted
• 90.2%
Non admitted
• 97.6%
Incomplete
• 96.1%
64 patients were not treated within
18 weeks due to insufficient capacity
94.0%
93.0%
92.0%
91.0%
90.0%
89.0%
88.0%
87.0%
86.0%
85.0%
18 weeks admitted performance
A M J J A S O N D J F M
8 patients over 52 weeks
(8 still waiting with a pause to be applied)
(National quality requirement contract
consequence of £5000 per patient waiting over
52 weeks)
2012/13
2013/14
Target
0 1 1 4
43 45 44 42 38 44 42
May-
12
Patients not treated within 18 weeks due to
insufficient capacity
Jul-12
2
Sep-12
Admitted
4 14
Nov-
12
Non admitted
25 29
18 weeks admitted performance was 90.2% in May and, whilst still
high, the total patients waiting over 18 weeks due to insufficient
capacity has reduced to 64.
8 patients were waiting over 52 weeks. All 8 are still waiting but have
a pause applied on their pathway.
4
8
Jan-13
3
41
2
54
Mar-
13
7
83
3
61
May-
13
12

Inpatient waiting list and long waits
2102 2161
2134
2114
09/07/2…
2213 2285
30/07/2…
2148 2197
2126
20/08/2…
Active inpatient waiting list
(Surgical and Cardiac)
2079
2030 2083
2030
2010
2034
1996
10/09/2…
01/10/2…
1936
1932
1932
1934
1946
1959
1965
1918 19572004
2,066
2,047 2,082
2,076 2,1142,160
2,093 2,129
2,132
2121
2,138
2,127
2,120
2,087
2,055
2,033
2,053
2,057
2,063 2,118
2,089 2,113
22/10/2…
12/11/2…
03/12/2…
24/12/2…
In May, the total inpatient waiting list for surgical
and cardiac has increased
14/01/2…
04/02/2…
25/02/2…
18/03/2…
08/04/2…
29/04/2…
20/05/2…
10/06/2
60
50
40
30
20
10
0
5 patients (T&O 3,
Urology 1, Plastics 1) had
their clock stopped over
30 weeks with their delay
being due to:
- Patient choice and
hospital cancellation (1)
- Patient unwell and
hospital cancellation (1)
- DNA (1)
- DMT/PAT (2)
Patients waiting over
30 weeks
39 patients were waiting over 30 weeks
32 39 35 47 53 47 41 39
Oct…
Nov…
Dec…
Jan-…
Feb…
Mar…
Apr…
Ma…
Of the 34 patients still waiting over
30 weeks
• 23 included following recent
guidelines change
• 4 T&O
• Staff shortage(3)
• Pause not applied(1)
• 2 ENT
• Patient unwell (1)
• Validated breach (1)
• 2 Dentistry
• Cancelled by hospital twice(1)
• Validated breach (1)
• 1 Urology
• Patient unwell(1)
• 1 General surgery
• Combination of unwell, and
cancelled by hospital and parent (1)
• 1 Neurology
• Patient choice (1)
13

18-weeks - CAMHS
92
CAMHS 18 weeks Performance
18 weeks
performance
• 90.3%
90
18 weeks performance
88
86
84
82
2012/13
2013/14
Target
18 weeks performance in CAMHS
was above target at 90.3% in May.
80
A M J J A S O N D J F M
14

Diagnostic waiting list - MRI
400
350
300
250
200
150
100
MRIs added per month by Creation
Date (Active - Not Planned)
213 204
222
161
255
191 188
247
280
317
268
208
351
296
215
Number of patients waiting over 6 weeks
for MRI
19
29
67
97 97
Jan-13 Feb-13 Mar-13 Apr-13 May-13
New additions to the MRI waiting list fell in May to 215 a
drop from it’s peak in March.
50
0
49
There has been a continued inability to meet the 6 week
diagnostic target for all patients. In May there were 97
patients not seen within the target.
February 2012
March 2012
April 2012
May 2012
June 2012
July 2012
August 2012
September 2012
October 2012
November 2012
December 2012
January 2013
February 2013
March 2013
April 2013
May 2013
Whilst actions are being taken to mitigate this it is
expected that there will be further breaches in 2013/14.
15

Tertiary Referrals
176 referrals
for specialist
beds
5 in region
patients unable
to get a bed
1 out of region
patients unable
to get a bed
13 in region
patients waited
over 24 hours to
get a BCH bed
1 out of region and
home patient waited
over 24 hours to get
a BCH bed
24 patients no
longer required
a BCH bed
Patients waiting over 24 hours for a bed
3
1-2 days 2-3 days 3-4 days 4-7 days
2
1 1 1 1 1 1 1 1 1
Paediatric
Neurology
220
Total
Paediatric
Cardiology
General
Medicine
Paediatric
Clinical …
Paediatric
Ear Nose …
Paediatric
Gastroente…
Paediatric
Medical …
Inpatient tertiary referral patterns
Paediatric
Surgery
Paediatric
Urology
Number of patients
200
180
160
140
120
2011-12
2012-13
2013-14
100
A M J J A S O N D J F M
16

PICU Demand
2 West midlands patients could
not be supported
• Leicester (1) – No beds at BCH
• Bristol (1) – No beds at BCH
4 non west midlands patients
could not be supported
• Queens medical centre (2)
• Unknown destination (2)
7 additional non west midlands
patients were supported by BCH
• 4 BCH PICU
• 2 BCH wards
• 1 UHNS
The new PICU is now operating on
26 beds. Further expansion to 31
beds in 2013 is planned.
The numbers of patients not
supported by BCH remains lower
than prior year.
13
Number of patients unable to get a
BCH/Stoke network PICU bed
2012/13 All Patients 2013/14 All Patients
2012/13 WM Patients 2013/14 WM Patients
15
24
18
11
11
250
200
150
Year on year comparison of total referrals to KIDS
2011/12
5
6
3
5
4
8
3
5
100
2012/13
50
2013/14
A M J J A S O N D J F M
0
A M J J A S O N D J F M
17

CAMHS Referrals
Delayed Discharges
10
8
CAMHS Patients that requested a T4 bed and were
not admitted (month trend)
Fit for discharge days of patients still
waiting
Fit for discharge days
Total LOS days in month
6
Patient 4
2
4
2
Patient 3
15
21
0
A M J J A S O N D J F M
Patient 2
81
31
2012/13 2013/14
Patient 1
148
14
A total of 1 patient was not admitted to tier 4 in
May.
There were 4 patients waiting for discharge in May. All 4
have been delayed for housing and social care issues, 3
of which were presented in last months figures. Patient
1 and patient 3 have now been discharged with total
length of stay of 256 and 92 days. Patient 2 has been fit
for discharge since February 2013 and patient 4 from
the end of May.
18

Board of Directors
Public Meeting
Thursday 27 th May 2013
Item 13.153 Enc 05
Strategic Objective/ Enabler
Every child and young person requiring access to
care at BCH will be admitted in a timely way, with no
unnecessary waiting along their pathway
Report Title
Performance – May 2013 Performance Report
Sponsoring Director
Georgina Dean, Deputy Chief Officer Contracting
and Performance
Author(s)
Deputy Chief Officer Contracting and Performance
Previously considered by
n/a
Situation
This report provides the May update on this month’s Trust Performance supporting
improving our patient experience. The report highlights where performance is not
being met and any concerns or improvements.
The attachments provide:
• Further details on our current and comparative performance

Background
May has been a busy month in terms of emergency activity seeing ‘winter peak’
levels of demand, this is however still behind plan.
Cancelled operations
Cancelled Operations performance in May was 39 patients or 1.91% of all operations
cancelled on the day due to hospital reasons, and remains as a key performance
concern. This is above the national 0.8% standard.
The reasons for this are broken down as:
More urgent patient 10
No ITU bed 10
More complex patient 6
No ward bed 6
Operation would have/did
overrun
4
Staff shortage 2
Administration error 1
0 patients with Learning Disabilities had their operation cancelled
The ethnic breakdown of the 39 cancellation patients is:
White - British 26
Asian/Asian Brit - Pakistani 5
Black/Blk Brit - African 3
Mixed-White & Black
Caribbean
2
Any other ethnic group 1
Asian/Asian Brit - Indian 1
Any other white b/g 1
A further 23 patients had their operation cancelled by the hospital before the day of
the operation.
5 March patients (cardiac surgery) had their operation cancelled more than once
by the hospital. These were due to the lack of available PICU beds.
4 patients was cancelled due to admin error from Orthopaedics, Plastics, Radiology
and Surgery.
5 patient was postponed, but 0 of these had been postponsed more than once.
0 patients breached 28 days in March.

Diagnostic waits
There were 97 patients who at the end of May had waited over 6-weeks for a MRI
diagnostic test. This is 9.2% of all diagnostic waits and above the 1% NHS standard
(decrease from 10.2% last month). This is driven by a 40% increase in demand which
has been sustained since November and March saw a record level of diagnostic
demand. The Imaging service is working on interim and long term solutions. The
overall MRI WL size has continued to grow and a similar level of breaches are
expected in May. Additional capacity has been secured in June through a mobile
scanner and this is expected to lead to a reduction in the waiting list and the
number of breaches in June. Of note all cases on the total planned & diagnostic
MRI waiting list are clinically prioritised to ensure all urgent cases are seen within the
required timeframe.
Emergency Department
Emergency Department (ED) standards not met were:
• The local ED triage objective (all within 15 minutes), the 95 percentile
performance being 34 minutes (previous month was 34).
• All patients seen by decision making clinician

wait over 24 hours before a BCH bed was provided. Of note, one out of region
patient did not get a BCH bed.
PICU (Paediatric Intensive Care Unit) referrals
The West Midlands (WM) PICU service is provided by BCH, University Hospitals of
North Staffordshire NHS (UHNS) Trust and the KIDS (Kids Intensive care Decision
Support) service run by BCH.
2 West Midlands (WM) patients could not be supported due to hospital reasons who
went out of region to Leicester (1) and Bristol (1).
4 non-WM requests were not supported, and was sent to Queens Medical Centre (2)
and unknown destination (2). 7 additional non-WM requests were supported; 4 by
BCH PICU, 2 on BCH wards and 1 at UHNS.
CAMHS referrals
The CAMHS Tier-4 (Child & Adolescent Mental Health Service) West Midlands service
is provided by BCH and other providers (some private) with BCH providing the
assessment of all requests. 1 patient could not be supported by BCH CAMHS in April
due to no capacity.
Assessment
Increasing demand has led to an increase in the waiting times for MRI and a
reduction in operating capacity has meant the WL size has not reduced.
Plans to reduce delays include:
Emergency Department (ED):
• The Emergency Care Pathway project is progressing;
• Additional Advanced Nurse Practitioners are in training.
• Development of the ED estate, including expansion (+3 cubicles) and
improvements to treatment rooms and waiting areas. This is due to start in April
and will take 5 months to complete.
• Regular review of the Ambulance Turnaround data to identify the causes behind
delays and identify actions to improve performance
PICU Capacity:
• We are expecting some delays to increase beds from 26 to 28 beds in May (and
currently flex up over 26 beds), and to 31 beds in September. This is
predominantly due to staffing issues.
Theatre Capacity:
• The Surgery and Specialised Directorates are working on a plan to increase
regular evening and weekend working.
• A Theatre Working Group is in place with a focus on improving staffing levels to
maintain and increase theatre capacity.
• A Cancellations Working Group is in place which is running a series of pilots to

educe total cancellations. A project is underway to ensure all elective patients
undergo pre-admission which will help reduce the risk of cancellation.
MRI capacity:
• A medium term capacity plan for Imaging is being produced which includes
new ways of working
• Mobile scanner in June
The Medium Term Clinical Estates Strategy is being developed to identify future
demand and solutions to meet demand.
Recommendations
Trust Board is asked to note the performance and plans for further improvement.
Key Risks
Risk Description Controls Assurances
Insufficient capacity in
place to meet service
demands
Key Impacts
Appropriate escalation
systems in place
Capacity plans being
renewed and developed.
This includes modelling
capacity/demand
between now and 2020
(new hospital)
Winter plan implemented
providing additional bed
capacity & flexibility
Daily, weekly and monthly
reporting in place.
Revised capacity plans
being produced.
Strategic Objectives
This reports covers progress against meeting the
strategic objectives linked to supporting improving our
patient experience.
CQC Registration (state
outcome)
4: Care and welfare
NHS Constitution
Yes – treatment within 18-weeks is a requirement within
the NHS Constitution.

Other Compliance (e.g.
NHSLA, Information
Governance, Monitor)
Many of the indicators are local or national standards
monitored by the Department of Health, Monitor and
our Commissioners.
Equality, diversity & human
rights
The report considers any particular impact on patients
with learning disabilities, and on different ethnic groups.
Trust contracts
Some of the planned improvements support delivery of
QIPP initiatives and non-delivery of NHS standards can
result in financial penalties
Other
Meeting the strategic objectives raises the profile of
Trust locally, regionally and nationally

Board of Directors
Public Meeting
Thursday 27 June 2013
Item 13.154 Enc 6
Strategic Objective/ Enabler
Every child and young person requiring access to care at
BCH will be admitted in a timely way, with no unnecessary
waiting along their pathway
Report Title Resources report period 1 st April 2013 – 31 st May 2013
Sponsoring Director
Interim Chief Finance Officer
Author(s)
Interim Chief Finance Officer, Chief Officer for
Workforce, Deputy Chief Officer for Performance and
Contracting and Interim Deputy Chief Finance Officer
Previously considered by
Finance and Resource Committee
Situation
This report is to communicate the various aspects of Trust performance in the financial
year to date, period ending 31 May 2013, and to identify any key risks that are evident
within the organisation.
The Trust is also required to report its predicted status for Governance and Mandatory
Services.
Background
The Trust is required to comply with the finance related legal issues contained within our
Terms of Authorisation as well as other key financial targets. This includes:
• Not breaching the Private Patient Cap (a legal requirement);
• Not breaching the Prudential Borrowing Limit (a legal requirement);
• Not utilising the Working Capital Facility;
• Performing at or above plan for Monitor’s financial metrics leading to an overall
Financial Risk Rating of 4 or 5;
• Minimising triggering the additional financial indicators; and the
• Compliance Framework, which may result in formal discussions with Monitor.
Delivery against these targets is driven by:
• The volume and mix of demand experienced by the Trust; and
• How the Trust uses its most valuable resource, its staff, in responding to that demand.
The report explores each of these areas in turn and the impact on the financial position

and performance.
Assessment
Monitor Declarations
The key ongoing governance issue for the Trust is the performance against the 18 week
target for admitted patients. Performance in month was 90.2% ie just above the 90%
threshold, which was a better than predicted performance. The failure to meet this target
in April has triggered an Amber/Green rating for Q1. The Board should note that 3
consecutive quarters of such performance will result in a Red Governance Rating and the
triggering of the exception reporting process.
From a financial perspective the ratings will be a 4 under the present Compliance
Framework methodology which is in place for Q1 and Q2 and a 4 under the Risk
Assessment Framework methodology which commences in Q3. These are both strong
performances.
Activity
Emergency inpatient and ED activity both performed above plan in May and were both
higher than the equivalent period last year. This has generated a stronger income
performance but with the added financial consequence of increasing the income level
lost through the 30% MRET level.
Elective activity in May was above plan and May 2012 levels. Year to date this is now
fractionally below plan. Despite this, the aforementioned 18 week issue remains a major
concern.
Although Outpatient levels fell below May 2012 totals, these still exceeded plan in the
month and they remain above plan in the year to date.
Workforce
Demand remains high and this has brought into sharp focus the short to medium term
capacity issues faced by the Trust. Despite this sickness levels fell by 0.59% to below the
3% target and this has also reduced the cumulative 12 month rate to 3.12%.
The Workforce section of this month’s Resources Report has a particular focus on staff
turnover, recruitment and sickness with an emphasis on the recent Stress Audit.
The combined substantive and bank staff level increased In May with the combined
staffing numbers once again exceeding 3,200wte.
Engaging with staff, especially during periods of pressure, is important and appraisals are
one indication of how well this is working in the Trust. The reported appraisal rate has
decreased slightly from 81% to 78% in the last month and remains short of the 90% target.
There is a continued focus through the performance management system to improve this.
Finance
The Trust performed marginally above plan but at £15k there is little scope for slippage. As

per the message in April, the Trust must be mindful that it cannot trade its way out of
financial difficulties and in May the CIP shortfall was once again offset by a strong clinical
income performance. This cannot be sustained.
Expenditure pressures have continued across all Directorates, mainly as a result of CIP
delivery. Overall CIP performance is 11% below plan on planned schemes. However,
planned schemes only account for 76% of the overall target so an inherent shortfall has
been built in. This combined CIP deficit is £442k, of which £101k relates to performance
against actual schemes, and this needs to be the key financial focus of the Executive and
Board in 2013/14.
The Trust’s cash position remains strong. With limited capital expenditure in the month due
to the delayed agreement of this year’s programme, combined with commissioner
payments up to the required contract value, the cash balance has remained at £41m
(up from £36m at the end of March). In line with the expansive capital programme, this
will reduce from Q2 onwards.
Recommendations
The Board review, discuss and approve the Resources Report.
Key Impacts
Strategic Objectives
Staff and finance are key enablers to meeting the Trust’s
strategic objectives.
CQC Registration (state
outcome)
N/A
NHS Constitution
NHS Constitution has a pledge regarding 18-week waits.
Other Compliance (e.g.
NHSLA, Information
Governance, Monitor)
Monitor metrics are considered in the report.
Equality, diversity & human
rights
N/A
Trust contracts
N/A
Other
N/A

Resources Report
June 2013
Phil Foster
Theresa Nelson
Georgina Dean
Interim Chief Finance Officer
Chief Officer for Workforce
Deputy Chief Officer for Contracting and Performance
1

Reporting on resources use
1. Summary of Monitor Declarations
2. Volume and mix of activity
3. The impact on our workforce
4. Financial Performance Summary
2

Summary for the month.
May 2013
Activity in May was above plan in most categories. Performance against the prior period was mixed
with Outpatients lower for both new and follow-up referrals. This has once again delivered a strong
income performance in the month and year to date.
Overall Workforce figures are higher in May than April and remain 5.2% higher than the same time last
year. During May the Trust once again employed more than 3,200 staff after the fall in April. Bank usage
increased with 9% more wtes required through this source. Sickness dropped a further 0.59% in the
month (April) which was the third consecutive monthly reduction.
The financial performance in May was strong and marginally above plan. However, the strength of the
clinical income performance was negated by the shortfall against the CIP target, which remains the key
financial risk this year.
The Trust remains on track to achieve the planned £4.653m surplus although the achievement of its CIP
target is crucial to that.
3

Monitor assessment and declarations.
Quarter 4
Our Monitor Q4 ratings have been confirmed.
Month 2 and Quarter 1
18 weeks has been achieved at 90.2% in May.
This is an improvement on the 87% reported
in April which has triggered an Amber/Green
rating for Q1.
Monitor Quarter 4 2012/13 (Confirmed)
Finance risk rating
Governance risk rating
Mandatory Services risk rating
Safety Assurance System in place risk rating
G(4)
G
G
G
In Oncology, the 31 day from diagnosis to first
treatment target achieved 93.3% against the
96% standard. This is 1 patient who breached,
as it is only 1 patient this does not count as a
breach for the governance rating.
Financially, a FRR of 4 will be reported.
Monitor Quarter 1 2013/14 (Predicted)
Finance risk rating - Compliance Framework
G(4)
Finance risk rating - Risk Assessment Framework G (4)
Governance risk rating
Amber/Green
Mandatory Services risk rating
G
Safety Assurance System in place risk rating
G
4

Emergency activity profile
5500
5000
4500
4000
3500
3000
2500
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
ED attendance
A M J J A S O N D J F M
2013/14 Emergency department
activity against plan
A M J J A S O N D J F M
2011/12
2012/13
2013/14
2013/14
2013/14
plan
Emergency department activity
has increased by 3.6% YTD
compared to May last year and
3.5% compared to last month,
April 2013. It was also the
busiest May in the last 6 years.
Emergency activity was also the
busiest May in the last 6 years
and has shown a 1.8% increase
from May last year. YTD is 5.5%
higher.
As a result of this increased
activity, activity against plan for
both emergency department
and emergency admissions is
above target. Emergency
Department is 1.1% above plan
and emergency activity is 5.7%
ahead of plan YTD
1800
1600
1400
1200
1000
800
600
400
200
2000
1800
1600
1400
1200
1000
0
800
Emergency /Non Elective admissions
A M J J A S O N D J F M
2013/14 Emergency/non elective
admissions activity against plan
A M J J A S O N D J F M
2011/12
2012/13
2013/14
2013/14
2013/14
plan
5

Planned activity profile
2600
2400
2200
All elective admissions
700
600
500
2013/14 Elective admissions activity
against plan
2013/14
2000
1800
1600
1400
1200
A M J J A S O N D J F M
2011/12
2012/13
2013/14
400
300
200
100
0
A M J J A S O N D J F M
2013/14
plan
Elective activity in May is the same as it was in May 2012. YTD activity has shown a 4.0% increase from
the same point last year. Against plan May was slightly above planned activity but YTD is only 0.2%
behind plan.
Weekend working continues but given the lower activity levels there has been an increase in the
overall waiting list.
Indicative contracted activity levels for 2013/14 are at the 2012/13 outturn level.
challenge if emergency activity continues to increase.
This will be a
6

Outpatients (OP)
11,000
10,500
10,000
9,500
9,000
8,500
8,000
7,500
3,800
3,600
3,400
3,200
3,000
2,800
2,600
2,400
2,200
2,000
Follow up OP attendance
A M J J A S O N D J F M
New OP attendance
A M J J A S O N D J F M
2011/12
2012/13
2013/14
2011/12
2012/13
2013/14
May 2013 saw a decrease in
month for both follow up and
new outpatient appointments
compared to May 2012. OP
activity was 2.6% lower than
May 2012 and follow up was
5.5% lower. Follow up has
however increased by 2.2% from
the previous month and 7.3%
YTD. New OP appointments have
fallen by 1.6% from the previous
month and is 5.2% higher YTD
than at May 2012.
Outpatient activity was 4.6%
above plan in May and is 4.1%
above plan YTD.
Waits in some specialties are
increasing although overall levels
of referrals have remained static.
Directorates are working through
plans in each specialty to
understand the challenges and
identify actions for
improvement.
14000
12000
10000
8000
6000
4000
2000
0
2013/14 outpatient activity
against plan
A M J J A S O N D J F M
2013/14
2013/14
plan
7

Workforce Dashboard
Indicator
Trust Target
Clinical Support
Services
Medical Directorate Specialised Services Surgical Directorate CAMHS Corporate Trust (Previous Month) Trust (Current Month)
Sickness % (YTD)

Implications on our workforce
WTE
WTE has remained above 3000 since November 2012
and has increased slightly between April and May by
2.13
3100.00
WTE
3050.00
3000.00
2950.00
2900.00
2850.00
2800.00
2750.00
BCH WTE
12/13
13/14
Our annual workforce forecasts for the next
5 years show WTE rising, in line with
planned/ expected service developments
and increases in the child hood population.
Concerns are that WTE continues to
rise and we are reviewing processes
for measuring productivity
Actions - Workshops are arranged for
workforce planning against clinical strategies.
Total
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
Activity Levels 6 Month Comparison (Dec 11 to May 12 & Dec 12 to May 13)
Dec 11 Jan 12 Feb 12 Mar 12 Apr 12 May-12 Dec 12 Jan 13 Feb 13 Mar 13 Apr 13 May 13
Month
ED Attendances Inpatient Outpatients Contacts Total
9

Implications on our workforce
The table below is pulled from our Finance data to illustrates the comparison of our established WTE, our staff in post WTE, Worked WTE
(excluding maternity leave), sum of vacancies, and WTE Bank Usage.
Includes overtime
Established WTE
and enhancements
(excluding APAs) Staff in Post WTE Worked WTE Sum of Vacancies Bank Usage
Surgery (inc APAs) 431.5 406.04 390.42 17.15 15.72
Medicine 686.36 660.08 664.23 26.28 30.73
CSS 443.45 409.28 394.36 34.17 5.52
Specialised Services
(inc APAs) 811.06 742.03 759.02 63.03 58.77
CAMHS 327.69 300.51 289.96 27.18 19.40
Corporate 465.16 448.67 449.19 15.97 47.82
Total 3165.22 2966.61 2947.18 183.78 177.96
Excludes medical
locums – Accuracy
of data is around
95%
Area over establishment
(Worked WTE + vacancies) – Bank usage
All Directorates are showing as under
established.
In some areas staff in post plus vacancies do not add
up to establishment because of maternity leave, fixed
term contracts & or secondments.
However in contrast when adding Worked WTE to
vacancies and then subtracting Bank usage for many
directorates this is below establishment therefore
maintaining productivity levels.
10

Turnover
May 13 HC WTE Starters Leavers
WTE – In
Month
Leavers WTE
(12 Months)
YTD Turnover % May 2013
Turnover %
BCH Total 3348 3038.96 34.37 32.51 285.80 8.01% 1.15%
Clinical Support
Services
487 430.32 2.80 1.00 39.34 8.60% 0.24%
Medical Directorate 753 685.02 10.57 6.53 49.62 6.49% 1.05%
Specialised Services 799 732.83 11.00 10.91 60.13 7.10% 1.49%
Surgical Directorate 448 408.04 5.00 3.40 24.45 4.94% 0.93%
CAMHS Services 339 303.97 1.00 2.00 37.69 9.64% 0.34%
Corporate 522 478.78 4.00 8.67 72.57 12.48% 1.42%
Medical Directorate has seen
6.53 WTE leavers during May –
2.00 WTE consultants came to
the end of their fixed term
contract, 4.00 WTE Nurses left
due to relocation & voluntary
resignation and a HCSW 0.53
WTE left with reason voluntary
resignation
Specialised Services has seen 10.91
WTE leavers during May of which
9.91 WTE were nurses 7.00 of which
were from PICU* – all voluntary
resignation.
Continues to have the highest
rolling turnover rate, however for
CAMHS the in month turnover is
only 1.00 WTE. Corporate has
seen an increase (8.67 WTE). 3.67
WTE were in domestics/porters
of which 2.00 WTE was dismissal
. There has also been 2.00 WTE
lost due to redundancy in the
Capital Development and Estates
departments.
* See high recruitment – hard to recruit staff group/areas
areas slide
A large proportion of the Corporate
Directorate leavers left the Trust during
June to August 2012 so in the coming
months we expect to see the rolling
turnover % decrease.
11

12 month turnover drill down
From the 9 staff groups within the
Trust the below breakdown is those
that have seen the highest leavers
FTE in the last 12 months.
24.47 WTE (28.78)
had less than 12
month service of
which 14.00 WTE left
due to voluntary
resignation – Not
Known
Nursing and Midwifery
made up 31.36% of
leavers (87.75 WTE)
15.00 WTE (17%) had
less than 12 month
service of which 10.60
left due to voluntary
resignation – Not
Known
Main Reasons for
leaving
•47.6% of leavers
were voluntary
resignation – Not
known
•21% relocation.
Actions
• Managers to
be reminded of
importance of
data recording
– using the
correct
termination
reason
Admin & Clerical
made up 29.65%
of leavers (85.03
WTE)
Main Reasons for
leaving
•45.8% of leavers
were voluntary
resignation – Not
known
•16.6% promotion.
Additional
Clinical
Services made
up 9.44% of
leavers (27.26
WTE)
6.4 WTE (17%) had
less than 12 month
service of which all
left due to voluntary
resignation – Not
Known
Main Reasons for
leaving
•58.7% of leavers were
voluntary resignation –
Not known
•19.5% Retirement.
•E-forms
introduced in
October 2013
•Training on e-
forms
•Exit interview
process to be
reviewed
12

Bank usage
WTE
60.00
50.00
40.00
30.00
20.00
10.00
0.00
4.95
D1 Clinical
Support Services
Directorate Bank Usage Comparison April and May 2013
5.52
27.92
D2 Medical
Directorate
30.73
53.86
D3 Specialised
Services
58.77
Directorates
15.03 15.72 15.76
D4 Surgical
Directorate
D5 CAMHS
Services
19.40
46.39
D6 Corporate
47.82
Apr-13
May 13*
Top 3 reasons for bank usage
1. Vacancies
2. Sickness Absence
3. Backlog
The bank usage in every directorate has
increased on last month.
Bank usage by Directorate
Admin bank and agency usage = 73.51 FTE
to cover vacancies , back log and sickness
Dec 12 Jan 13 Feb 13 Mar 13 Apr 14 May 13
Clinical
Support
5.20 5.50 6.01 7.48 4.95 5.52
Medical 31.50 28.90 37.74 49.33 27.92 30.73
Specialised 49.60 53.10 58.64 70.35 53.86 58.77
Surgical 12.50 13.00 14.91 16.50 15.03 15.72
CAMHS 12.70 15.30 16.96 24.43 15.76 19.40
Bank Usage May 2013
13.90%
41.31%
44.79%
Corporate 33.30 43.20 42.18 46.95 46.39 47.82
Total 144.80 159.00 176.44 215.04 163.91 177.96
* The latest month is an indicative figure and about 95% accurate. The previous month
figure will be updated each month
A&C Reg Nurse Non Reg
See Slide 7 for
breakdown
13

Bank Usage - Admin & Clerical Breakdown
Top 3 Departments by
Directorate using Admin Bank
Admin & Clerical
(41.31% of Total
Bank Usage)
Clinical Support Services
1.82 WTE (2.48%*)
Medical Directorate
10.45 WTE (14.21%)
Specialised Services
6.34 WTE (8.62%)
Surgical Directorate
8.45 WTE (11.49%)
CAMHS Services
2.37 WTE (3.22%)
Corporate
44.09 WTE (59.97%)
Clinical Support – Pre
Admissions, Radiology &
Outpatients.
Medical Directorate –
Medical Secretaries, MCRN &
Diabetic Home Care.
Specialised Services –
Medical Secretaries, PICU &
Liver Research.
Surgical Directorate – Medical
Secretaries, ENT &
Management Team.
CAMHS Services – HOB, LD &
Psychology Admin.
Top 3 Reasons for bank
usage:
Clinical Support
Vacancy**, Backlog &
WLI
Medical Directorate
Vacancy, Maternity &
Backlog
Specialised Services
Vacancy, Back log &
Sickness
Surgical Directorate
Vacancy, Back Log &
Sickness
Corporate – Health Records,
Finance & Estates.
CAMHS – Backlog &
Vacancy
Corporate – Vacancy,
Restructure & Backlog
•Directorate % is based on Admin & Clerical Usage only
**Vacancy reason is used by departments as a default reason. It does not necessarily mean that there are vacancies in the
department. Work continues to be done to ensure managers choose the correct reason for bank usage.
14

PDRs / Appraisals
Staff Group - Table 1
Add Prof Scientific & Technical
Additional Clinical Services
Admin & Clerical
AHP's
Estates & Anciliary
Healthcare Scientists
Medical & Dental
Nursing
Students
Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13
86.17% 85.64% 84.46% 83.94% 84.46% 86.08%
87.00% 88.41% 87.50% 84.29% 82.99% 80.77%
84.21% 83.87% 82.83% 78.70% 75.14% 71.06%
85.12% 88.03% 87.83% 88.70% 86.09% 80.53%
83.58% 81.48% 81.75% 81.88% 80.74% 60.00%
89.08% 90.00% 90.68% 89.92% 86.44% 83.76%
77.72% 85.95% 85.64% 87.70% 87.83% 86.39%
84.94% 83.99% 83.13% 81.39% 80.83% 81.79%
100.00% 100.00% 100% 100% 100% 100%
Table 1 shows via staff group the PDR compliance, we
can see a worsened position in every staff group this
month apart from Scientific & Technical. Estates has had
the highest decrease in % by approx 20%.
The data in table 2 shows overall the Trust PDR
rate has reduced further in May 2013.
Clinical Support has gone from green to amber in
May 13. Medical, Specialised and Surgical remain
amber. Corporate departments have remained
flagged as red and the departments have been reissued
departmental breakdown with a clear
improvement target to bridge the 20 % gap. A
further breakdown will be provided to Chief
Officers to raise awareness of this issue.
BCH
Clinical Support Services
Medical Directorate
Specialised Services
Surgical Directorate
CAMHS Services
Corporate
Dec Jan Feb Mar Apr May
84.86% 85.00% 84.25% 82.22% 80.61% 78.43%
87.53% 90.61% 89.77% 88.04% 86.55% 83.03%
89.88% 87.30% 86.90% 85.92% 80.96% 77.29%
86.88% 87.31% 86.84% 84.71% 84.43% 83.86%
81.75% 83.79% 83.67% 80.74% 80.27% 79.19%
80.00% 79.60% 78.63% 76.71% 82.14% 92.89%
78.50% 77.81% 75.88% 72.98% 68.84% 58.46%
This table shows the PDR %. Each months totals is for PDR’s that have taken place and
recorded on ESR during the last 12 months, so for May the PDR period is June 12 to May
13.
15

Staff Absence
4.50%
BCH Monthly Sickness %
4.00%
3.50%
Sickness %
3.00%
2.50%
2.00%
1.50%
1.00%
0.50%
Work is currently being done across the Trust to capture all doctors
(including junior doctors) sickness on ESR. As we now include this data the
WTE days available has increased which has an affect on the overall %.
12/13
13/14
Trust Target
0.00%
April May June July August September October November December January February March
Month
12/13 BCH Sickness Comparison
April May June July August September October November December January February March
2.53% 3.10% 3.31% 3.03% 2.79% 3.32% 3.78% 3.82% 3.89% 4.13% 3.57% 3.32%
13/14
2.73%
BCH Sickness Absence - April 2013
Number of Episodes Monthly Sickness %
BCH Total 386
2.73%
2.96%
Clinical Support Services 76
2.71%
Medical Directorate 84
2.81%
Specialised Services 56
1.95%
Surgical Directorate 58
4.29%
CAMHS Services 60
2.09%
Corporate 52
Cumulative 12
Month Sickness %
3.12%
2.98%
3.52%
3.16%
2.35%
3.95%
2.95%
Sickness Absence has decreased by 0.59% in April 2013, and
the sickness % is higher than 2012 by 0.20%. While we have
seen a slight reduction in long term sickness cases in some
directorates, CAMHS remains high, however this is
expected to reduce.
In April 2013, 2484.19 FTE days were lost due to sickness
absence, this is an decrease of 230.39 FTE compared to
March 2013 data.
The approximate cost of absence for this period was
£188,291.36. (based on basic pay only)
16

Sickness Deep Dive
Hotspot Areas
Home Treatment
East Locality
Complex Care
Emergency Department
Ward 9
NSW
Paediatric Surgery
Areas of concern
CAMHS - Home Treatment
Sickness - 5.76%
PDR rate – 66.67%
Bank Usage – 0%
Turnover - 8.33%
% of incidents causing reported harm – 100%
CAMHS - East Locality
Sickness – 35.71% (1 long term sick work and home related
stress)
PDR rate – 100%
Bank Usage – 0%
Turnover – 33.33%
Complex Care
Sickness – 6%(33 members of staff on formal stages of absence
mgt)
High Maternity
Employment Relations Case
73% PDR Compliance
Emergency Department
4 complaints in last 3 months
2 SIRI’s in last 3 months
PDR – 67.39%
Sickness – 27%
High Maternity Leave
Ward 9
Sickness – 4.83% (11 members of staff on formal stages of
sickness)
4 PALS contacts in last 3 months
NSW
1 SIRI in last 3 months
1 complaint in last 3 months
4 PALS contacts in last 3 months
PDR – 68.57%
Paediatric Surgery
1 SIRI in last 3 months
1 Complaint in last 3 months
5 PALS contacts in last 3 months
Sickness – 0%
Sickness review meetings, referral to occupation health,
Addressed work related stressors. Phased return to work
implemented.
Beginner and refresher training on ESR including PDR
inputting.
A PDR completion strategy has been agreed and this
includes emails being sent to staff members and
managers on a monthly basis via the Action Tracking
Meetings, this will be reviewed and monitored over an
initial three month period and then continued on a
regular basis.
Monthly support meetings
with managers. Ad hoc
training for band 6’s –
absence. Aware of
potential changes in future
so HR will continue to
support mgt team
Monthly support meetings
with managers
Concern around accuracy of
sickness reporting. To be
reviewed
Ongoing support with ED
continues , senior medical
and nursing away day
attended with action plan
agreed
Monthly support meetings
with managers. PDR’s
discussed and validation
exercise underway
17

Hotspot Areas
PICU
Theatres
Surgical Day Care
Microbiology
Pharmacy
Reasons of concern
PICU
Sickness – 3.15% (38 formal stage 1, 2 formal stage 2 and 6
employees off sick with stress)
Bank Usage – May 20.32
Safety dashboard data – 343 incidents, 40 incident reported
harm and 2 PALS contacts
Theatres
Sickness – 6.75% (19 formal stage 1 cases and 4 employees off
sick with stress)
PDR rate – 74.07%
Bank Usage – May 25.94
Safety Dashboard - Theatres 1-9, there has been 21 incidents,
5 incident reported harm and 1 PALS contact
Theatres general area – 13 incidents, 1 reported harm and 1
PALS contact
Surgical Day Care
Sickness – 6.59%, 3 formal stage 1 cases and 1 employee off
sick with stress
Safety dashboard – 9 incidents, 1 incident of reported harm
and 5 PALS contacts.
Microbiology
PDR – 64.29%
Sickness – 6.02%
Pharmacy
Sickness – 2.39% (7 members of staff on formal stage 1 cases, 1
employee of sick with stress)
Safety Dashboard – 8 incidents, 1 incident reported harm
Review of stress sickness cases. Stress
management is planned as a work item at the
PICU meeting. Identification of training needs
for band 6 sickness absence. Confirm &
challenge with HON & HR. Further review
taking place of bank usage
Identification of training needs
for ward management team.
Confirm & challenge sessions.
Regular meetings in place to
review the sickness absence;
these meetings are focussed on
the number of formal cases.
Confirm & challenge sessions
Confirm & challenge with HON and HR.
Review of occupational health services advice
currently being undertaken. Bank usage
being reviewed. Issues with cancellation of
non clinical time for PDR’s to be completed.
Dates are in the diary.
Confirm & challenge sessions
and escalation of PDR’s to HON
18

Stress Audit - January to May 2013
Directorate
Number of
employees off
sick with stress
in each
Directorate
Clinical Support 10 381
Medical 34 831
Specialised 23 703
Surgical 11 215
CAMHS 10 246
Corporate 9 275
Calendar Days
lost due to
Stress from Jan
to May 2013
Hotspots
Ward 14
PICU
ED
Ward 10
Cleft
Med Sec – ENT
Ward 9
Education Admin
HR
Learning Disabilities
East Locality
Causes
Departments have experienced high
levels of activity over recent months
which have contributed to stress
related illnesses.
Increased pressure on staff as a result
of high sickness over prolonged winter
months.
Stress due to bereavement, terminally
ill family members and work and
home related stress
Actions
Stress Risk Assessments are in place and managers are
being encouraged to have open discussions with staff
regarding stress. Managers are being coached to
identify early warning signs of personal stress and
considerations of flexible working options are to be
used where available.
Managers are to promote the support mechanisms
available to staff through occupational health,
chaplaincy and the Resolve staff support service.
Meetings and action plans are being developed to
resolve work related stress.
19

Recruitment Activity 1 st May to 31 st May 2013:
Reasons for Vacancy
Number of posts
Vacancy Reasons - May 2013
Gap in Rota 4
Maternity Cover 4
New Post 19
No reason provided 1
Pool Recruitment 6
Reduction in hours 2
Replacement 27
Secondment Cover 3
Vacancy 3
no. of posts advertised
80
70
60
50
40
30
20
10
0
May 2013 saw 69 jobs being
advertised compared to 48
this time last year. An
increase of 21 posts
39%
4% 4%
3%
6% 6%
Recruitment Activity Yearly Comparison
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
9%
1%
28%
Gap in rota
Maternity Cover
New post
No reason provided
Pool Recruitment
Reduction in hours
Replacement
Secondment cover
Vacancy
2012/13
2013/14
Month

Recruitment – Hard to recruit staff groups/areas
Staff Group
Medical
Nursing/HCA
Physiologists
Medical Staff – Emergency Department
is currently having difficulty recruiting.
Candidates have been shortlisted but
withdrawn at last minute and some
adverts have received no applicants.
Theatres and PICU - Due to these areas
being so specialised people are afraid to
work in them. NQN’s prefer to work in
other areas. Expansion to take place in
both areas.
Cardiac Physiology - Specialised area so
not many people apply for roles.
People with these skills tend to work
for agencies so that they can be paid
more. Recruitment in the past has
tended to be from abroad, however
their skills are not transferable and they
also take longer to get into post due to
employment checks .
Actions
Medical staff posts in ED -
Recruitment have been taking
out bigger/bolder
advertisements but these are
still not attracting enough
people. (Junior doctor posts in
this area are recognised as
national shortages)
The Trust operate a successful
nursing pool to reduce the cost
of bank, agency usage and plans
are developing to set up similar
system for doctors
Good succession plans,
developing and extending roles.
Good mentoring plans in place.
21

Financial Performance Summary
FINANCIAL PERFORMANCE REPORT
Monitor Financial Performance Framework
Criteria Metric Plan Actual Status Direction
of Travel
Financial Performance
Underlying Performance EBITDA margin 3 3 Income and Expenditure 1,246 1,262 15
Achievment of Plan EBITDA, % achieved 5 5 Cash Balance 40,643 41,264 620
Financial Efficiency Return on Assets 5 5 Capital Programme 855 890 35
Financial Efficiency I&E surplus margin 4 5 CIP 1,270 828 -442
Liquidity Liquidity ratio 4 4
Overall 4 4 Surplus is marginally above target.
The Monitor Risk Rating is per the Plan of 4. This is forecast to continue through to year-end
(Monitor assesses financial risk on a scale from 1 (high risk) to 5 (low risk)
Monitor Risk Assessment Framework
Criteria Plan Actual Status Direction
Issue
Plan
£'000
Actual
£'000
Variance
£'000
Status
Direction of
Travel
Cash Balance
At the end of May the cash balance w as 1.5% above plan but £5m higher than at the end of March 201
Capital Programme
of Travel
The Capital Programme w as only set in May so no new commitments w ere expected in the period.
Capital Service Capacity 4 4 Minor spends w ill have taken place during April and May as residue from 2012/13 schemes.
Liquidity 4 4 CIP
The new Risk Assessment Framew ork seeks assurance regarding w hether the Trust is a going concern. This is and w ill remain the key concern. The deficit is greater than w ould have been expected at this
(Monitor assesses financial risk on a scale from 1 (high risk) to 4 (no evident concerns)
stage of the year. Of the deficit £340k relates to the general gap in identified schemes.
Foundation Trust Requirements
Issue Measure Plan Actual Status Direction
of Travel
Prudential Borrow ing Limit to be determined £2m £2m
Private Patient Cap Not to exceed 49% 0.4% 0.1%
Working Capital Facility Not to use Not Used Not Used
All categories are performing to or w ithin plan although from an I&E perspective a close w atch needs to
be maintained on Private Patient income
Income and Expenditure
22

Income and Expenditure against Plan
This is the first full report of the new financial year with
the financial performance reported following a similar
pattern to 2012/13.
The progress made on the 2013/14 contracts has
enabled income and activity performance against plan
to be reported. June 3 saw the submission of our
Annual Plan to Monitor and this now forms the basis of
our comparative performance during the course of the
year.
However, the headlines are:
• Overall performance is marginally above the revised
plan at £15k;
• Against the Monitor Plan performance is £31k above
plan;
• Strong income, especially inpatient, performance;
• PICU income remains below plan. A prudent
estimate of WIP has been assumed however the
delay in opening additional beds will also impact;
• Outpatient income is on track;
• ED income again looks low for the level of activity
undertaken and this is expected to improve with
coding;
• Pay expenditure is higher than plan although this is,
in part, down to CIP shortfalls;
• The key expenditure issue is the shortfall against the
CIP target.
`
Annual
Plan per
LTFM
Revised
Annual Plan
YTD Plan
per LTFM
Revised
YTD Plan
YTD Actual
Variance
£'000 £'000 £'000 £'000 £'000 £'000
Income from activities 210,989 211,619 35,668 35,655 35,960 304
Other Income 20,034 21,515 3,264 3,547 3,774 227
Operating Expenses -217,499 -219,427 -36,250 -36,667 -37,173 -506
EBITDA 13,525 13,707 2,682 2,535 2,561 25
Interest Receivable 230 230 41 38 22 -17
Depreciation -6,107 -6,288 -1,018 -828 -826 2
Profit/(Loss) on Asset Disposal 0 0 0 0 0 0
Impairment 0 0 0 0 0 0
PDC Dividend -2,670 -2,670 -445 -445 -445 0
Interest Paid -325 -326 -30 -54 -49 5
Net Surplus/(Deficit) 4,653 4,653 1,231 1,246 1,262 15
Brackets indicate adverse
variance
Income
Variance
Pay
Variance
Non-Pay
Variance
Total
Variance
Clinical Support Services -19 -42 -178 -238 0 -238
Medical Directorate 39 -29 -284 -274 0 -274
Specialised Services -69 -71 -96 -235 0 -235
Surgical Directorate -8 102 -139 -44 0 -44
CAMHs 39 20 -48 10 0 10
Corporate 320 -124 -158 37 0 37
Total Operational Budgets 302 -144 -903 -744 0 -744
Bad Debts 0 0 0 0
Donated Assets -75 -75 0 -75
Operating Leases 4 4 0 4
Teaching & Research 0 0 0 0
Reserves and Provisions 538 -2 536 0 536
Total Other Budgets -75 538 2 465 0 465
Total Budgets 227 395 -901 -279 0 -279
May
April
Variance
£000
In-month
Movement
£000
23

Profitability against Target
The EBITDA (Earnings Before Interest, Taxation, Depreciation
and Amortisation) Margin is marginally below
target at Month 2 (6.4% compared with
6.9%). In monetary terms EBITDA is also
below the Monitor Plan, which is the
measure of efficiency used in the Financial
Risk Rating calculation. The cause of this is, in
the main, CIP delivery. The EBITDA
performance is anticipated to improve in
future months.
7.5%
7.0%
6.5%
6.0%
5.5%
5.0%
4.5%
4.0%
EBITDA Margin
6.4%
5.7%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Actual
Plan for
Year
The I&E Surplus Margin, is on plan as the
deficiency in the EBITDA performance is
cancelled out by reduced depreciation
expenditure arising out of the 2012/13
valuation.
3.5%
3.0%
2.5%
2.0%
1.5%
2.0%
3.2%
I&E Surplus Margin
Actual
1.0%
0.5%
Plan for
Year
0.0%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
24

CIP
CIP delivery is 10.9% below plan at Month 2. However, there remains in excess of a £2.0m gap (£2.5m at Month 1) in formalised
plans for 2013/14 so 1/12 of this has been factored into the target. The improved plan position is primarily a result of schemes in
Medicine. Achievement against target is therefore only 65.2% (59.1% at Month 1). This equates to a final year-end deficit of £3.0m.
Work continues in numerous Directorates to bridge CIP gaps. The planned position below only includes those schemes where a PID
has been provided. Completion of outstanding PIDs will improve the position further.
Non-recurring solutions are available in some Directorates and as yet these have not been factored into the position.
Having undertaken recent quarterly performance reviews the specialty with the most concerning position is Specialised Services.
The current shortfall here is £1.0m (£1.1m at Month 1) with limited schemes to be worked up. This will be a focus of the Executive
Team in the coming weeks.
In-month the key issue arising is the performance of Clinical Support Services. Month 2 year to date performance was 43% down
from 72% in April with an in-month delivery of only 16% of planned schemes.
Directorate
Clinical Support Services
Medical Directorate
Specialised Services
Surgical Directorate
CAMHs
Corporate
Total
all figures £k
Against Plan
Against Target
Target Plan Actual Variance % Achieved Variance % Achieved
157.0 146.5 68.2 -78.3 46.6% -88.7 43.5%
310.1 236.4 203.0 -33.4 85.9% -107.1 65.5%
365.5 194.2 193.2 -1.0 99.5% -172.2 52.9%
141.2 146.2 174.0 27.7 119.0% 32.8 123.2%
87.8 69.9 89.0 19.1 127.3% 1.2 101.4%
208.2 136.0 100.3 -35.6 73.8% -107.9 48.2%
1,269.7 929.2 827.8 -101.4 89.1% -441.9 65.2%
The next slide highlights specific Directorate performance over the first 2 months as well as the phasing of schemes.
25

CIP
£400,000
Year To Date Status
£350,000
£300,000
£250,000
Actual
£200,000
Plan
£150,000
Target
£100,000
£50,000
£-
Clinical Support Medical Corporate Specialised Services CAMHS Surgery
26

Cash and Capital
Cash is 1.5% above plan at 31 May. At £41.3m the
cash balance has remained on a par with April
which is £5m greater than the March position. This
is principally a result of low levels of capital
expenditure, the receipt of expected contract
income and lower expenditure levels for provisions
and reserves.
This level of cash provides the Trust with a strong
liquidity rating.
£k
45,000
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
2013/14 Cash Position and Rolling Forecast
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Actual 2013/14 Plan Rolling Forecast
The Capital performance in May is all based on
residual schemes from 2012/13. The Capital Plan
was agreed at the Finance and Resources
Committee on May 14. Expenditure will start to be
committed against this from June onwards at which
time an accurate phasing profile will be completed.
Performance against plan to date is at 104%, which,
when compared to prior years reflects favourably
on a more realistic phasing of the plan.
£k
20,000
18,000
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
-
2013/14 Cumulative Capital Expenditure against Plan and Monitor
Margins
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
13/14 Actual 13/14 75% 13/14 125% 13/14 Plan - Original
27

Debtors and Creditors
Debtors over 90 days have remained
constant in May compared to April 2013.
There has been minimal movement in the
top 5 over 90 day debts.
The Creditors position has remained at a
similar position to that at the end of March
2013.
14%
12%
10%
8%
6%
4%
2%
0%
% Debtors and Creditors over 90 days
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Debtors>90 days % Creditors>90 days % Target
Top 5 Debts Over 90 Days Old 31st May 2013
Customer
Age
(Days)
Value
(£k)
Royal Orthopaedic Hospital
Private Patient - MK
30th April 2013
Age Value
(Days) (£k)
244 234 213 234
668 139 637 139
National Services Scotland 216 43 185 43
Private Patient - MK
South East Essex PCT (DH) 92 28
625 35 594 35
National Services Scotland 131 24
480 476
28

Financial summary.
May 2013
The Monitor Financial Risk rating is 4 per plan, with liquidity remaining strong. This 4 is per the Compliance
Framework and the Risk Assessment Framework.
The I&E position is marginally above plan at £1.262m.
The EBITDA and Income Surplus margins are within 0.5% of the plan.
Clinical Income performance improved in May. Income was considerably ahead of that generated in the
same period in 2012/13 and was also ahead of plan.
CIP remained a key concern with only 89% of the plan achieved. However, when the gap for which no
schemes exist is built in this decreases to 65%. Going forward this will be the primary area of focus.
Cash balances are slightly above plan in Month 2. This is £5m above the cash position recorded at the end of
March and was assisted by the full receipt of contract income in April and May. Lower levels of Capital have
impacted on the cash balance and this will continue into Quarter 2 as the capex spend builds following the
agreement of the plan in mid-May.
The Forecast position for the Trust is to achieve the planned surplus of £4.653m, excluding any benefit of
donated asset income.
29

Board of Directors
Meeting in Public
27 June 2013
Item 13.155 Enc 07
Report on the Use of the Trust Seal
Report Title
Author(s)
Gwenny Scott, Company Secretary
Situation
The Trust’s Standing Orders require that the use of the seal is authorised by the Board of Directors and
entered in the Register of Sealings. The seal is used to execute deeds (e.g. conveyances of land) or where it may
be required by law.
The Company Secretary is Custodian of the Trust Seal.
The seal was used on the following document:
Licence for Alterations to Steelhouse Lane.
The Board is asked to endorse the use of the Trust seal.
Background
Recommendations