APPENDIX 1
SUPPLEMENTARY MEMORANDUM SUBMITTED BY
NHS EXECUTIVE (PAC 1999-2000/152)
QUESTION 48
The NHS Chief Executive drew attention to the
work of the National Booked Admissions Programme and agreed to
give details of its evaluation and plans to extend it further.
The programme began in 1998-99 with a £5 million investment
in 24 pilots. In 1999-2000 it was extended with a further £20
million to 60 more projects, plus the Cancer Services Collaborative
which aims to extend the benefits to cancer patients. Each of
these pilots remain in pilot phase for 18 months. A third wave
was announced in April 2000.
The 24 pilots were independently evaluated by
the Health Service Management Centre at the University of Birmingham.
Their first interim report is available via the HSMC website www.bham.ac.uk/hsmc
and on the DH website under www.doh.gov.uk/bookedadmissions. One
of the 24 pilots was the Royal Shrewsbury Hospital which extended
its Clinical Applications for Logistics Management (CALM) system
to encompass outpatient and day case booking (Sir Alan Langlands
is writing separately to the PAC Chairman with an assessment of
CALM).
Several of the other pilots and many of the
second and third wave schemes include inpatient booking within
their scheduling capability, notably Dorset (which covers the
beds of several hospitals) and the Homerton Hospital.
The Minister of State for Health, John Denham,
recently announced the third wave. This requires every acute trust
in England to introduce the benefits of pre-booked hospital appointments
and operations in at least two specialties by March 2002. The
initiative is supported by an investment of £40 million which
includes ongoing support for the 60 pilots continuing from last
year.
University Hospital Aintree
University Hospital Aintree developed their
system in parallel with Shrewsbury's and the two Trusts have visited
and learned from each other during their development phases. Aintree's
system attempts to address many of the same issues as that in
Shrewsbury and has a 95 per cent success rate in predicting the
number of admissions and discharges to within plus or minus five.
The Trust is seeking to improve upon this still further.
The possibility of using the technology of CALM
at Aintree was considered but rejected because it was not technically
possible without replacing the entire Patient Administration System
(PAS). The Trust has just replaced its PAS and could not therefore
justify using CALM. However, CALM is not about technology alone
and Aintree has already benefited from exchange of ideas through
contact with Shrewsbury; this has helped them develop their own
solutions. The Aintree system has been independently evaluated
by the University of Manchester Institute of Science and Technology.
The results of the evaluation were presented at a recent conference
and as a consequence several trusts have approached Aintree with
a view to learn from their experience and develop their own solutions.
QUESTION 53
How many beds have been lost because of PFI Schemes?
The tables below show, for each first and second
wave PFI scheme:
— the number of beds currently provided;
— the number of beds proposed in the
Outline Business Case (OBC) for a new facility (irrespective of
whether funded publicly or by a PFI solution);
— the number of beds provided by the
PFI solution.
English Schemes: First Wave PFI schemes (Prioritised
in 1997)
| Trusts | Total number of
beds at present
| Total number of
beds proposed
in the Outline
Business Case
| Total number
of beds provided
by PFI solution
|
| Norfolk & Norwich | 955
| 809 | 953[9]
|
| South Bucks | 577
| 537 | 537
|
| Calderdale | 796
| 614 | 614
|
| South Manchester | 1,229
| 881 | 881
|
| Wellhouse | 406
| 406 | 459
|
| Dartford & Gravesham | 451
| 400 | 400
|
| Worcester | 483
| 390 | 474[10]
|
| Bromley | 619
| 525 | 507
|
| Swindon & Marlborough | 608
| 513 | 516
|
| North Durham | 539
| 565 | 477
|
| Carlisle | 467
| 474 | 444[11]
|
| Hereford | 414
| 340 | 340
|
| South Durham (Bishop Auckland) | 308
| 351 | 347
|
| Greenwich | 575
| 621 | 565
|
| South Tees | 1,051
| 955 | 980
|
English Schemes: Second Wave (Prioritised in 1998)
| Trust | Total number of
beds at present
| Total number of
beds proposed
in the Outline
Business Case
| Total number of
beds provided
by PFI solution
|
| Central Manchester/Manchester Children's (1)
| 1,332 | 1,309
| (Not yet out to procurement)
|
| Dudley Hospitals | 932
| 773 | 773
|
| West Berkshire | 237
| 203 | 203
|
| Newcastle | 1,858
| 1,878 | (Not yet out to procurement)
|
| Walsgrave | 1,217
| 1,106[12]
| (Not yet out to procurement)
|
| West Middlesex | 400
| 400 | 400
|
| UCLH | 750
| 670 | 628
|
| King's | 891
| 895[13]
| 902 |
| St George's | 1,013
| 1,017[14]
| 1,013 |
| Bart's and London | 1,039
| 1,200 | (Not yet out to procurement)
|
(NB: Table for second wave schemes in Hansard (2 February
1999 Volume 596 Column 202-206) noted that many bed number figures
were still provisional: this is reflected in a number of changes
in the table below).
QUESTION 148
What is a sensible Bed Occupancy Rate?
The transcript of the hearing indicates that the NHS Chief
Executive thought that a reasonable figure was between 80 and
85. His answer was based on work undertaken in the NHS Executive
in support of the Emergency Services Action Team (ESAT).
This work undertaken by the Department of Health's Economics
and Operational Research Division showed a clear relationship
between high occupancy and the risk of cancellation of elective
admissions. It established that at occupancies higher than 83
per cent the risk becomes very pronounced, and that this was particularly
true of smaller hospitals with smaller bed bases. The work was
issued to the service through ESAT's 1998 report and further disseminated
through conferences, seminars, presentations and discussions.
The authors of the article cited by the NAO, based in the
University of York, repeated this analysis with slightly different
methodologies but very similar results. Unfortunately the University
of York did not reference the Department's work since the latter
had not been published in detail in academic journals.
The Chief Executive gave a range of 80 to 85 per cent as
a sensible level of occupancy, for a typical acute hospital, because
there is no one "magic number"; different hospitals
have different circumstances and demands place upon them. For
example, hospitals with a high proportion of short-stay, high
turnover specialties (such as ENT or paediatrics) will not be
as able to operate as efficiently at the higher end of the range
as those with more complex cases, with a higher average length
of stay and with less turnover.
NHS Executive
17 April 2000
9
Differs from figure given in Hansard (2 February 1999 Volume
596 Column 202-206): 144 beds are being added as part of PFI scheme
following a service review after the PFI contract was signed. Back
10
Differs from figure given in Hansard (2 February 1999 Volume
596 Column 202-206): 84 beds were added prior to financial close
following a review of acut in-patient services in South Worcester
which led to the closure of Kidderminster hospital. Back
11
Differs from figure given in Hansard (2 February 1999 Volume
596 Column 202-206): Final total number of beds was reduced from
465 to 444 due to change in planning for the provision of rehabilitation
services. Back
12
Envisaged that 1,046 general and acute beds will be provided
as part of the PFI scheme: another 60 community beds to be provided
separately. Back
13
This is the number required as set out in the Lambeth, Southwark
and Lewisham HA consultation document of February 1995. This scheme
configuration was the preferred option in the OBC which followed. Back
14
This is the number required as set out in the Lambeth, Southwark
and Lewisham HA consultation document of February 1995. This scheme
configuration was the preferred option in the OBC which followed. Back
| 
