5.3 Hospital and Community Health Services
Capital Prioritisation
5.3.1 Could the Department list the criteria
used by the Capital Prioritisation Advisory Group in its assessment
of which projects to prioritise for major investment? Which schemes
were assessed last year, and which were prioritised for investment?
Of these, which have been allocated public and private funding?
Could the Department give examples of schemes which have been
turned down, and explain why? [4.7]
1. Schemes are prioritised on the basis
of health service need. CPAG is responsible for developing the
criteria against which this is assessed, and reporting to Ministers
on each scheme against these criteria. The criteria used to assess
health service need are:
— For better access to services
— For improved clinical quality of
services
— For improved environmental quality
of services
— For development of existing services
and/or provision of new services
— For improved strategic fit of services
— To meet national, regional and local
policy imperatives
— To meet training, teaching and research
needs
— To make effective use of resources
2. CPAG assesses schemes on the basis of
information contained in a document known as the Strategic Outline
Case (SOC) which is developed by the relevant NHS Trust in agreement
with all the key local stakeholders. As part of the assessment
each site with a proposed scheme is visited by a member of CPAG.
3. The decision on private or public finance
does not form part of the prioritisation process. Once prioritised
by Ministers the scheme is subject to the normal business case
approval procedures. Although it has been demonstrated that PFI
offers the public sector value for money, and it is our expectation
that the majority of major projects in the NHS will be funded
using PFI, each project is assessed on an individual basis. It
will have to be demonstrated in a Full Business Case that the
PFI option is affordable to the NHS, meets NHS service needs and
offers value for money when compared to the publicly funded alternative.
These value for money appraisals are carried out by the NHS trust
and the Department of Health, not the private sector.
4. There has not been a capital prioritisation
exercise since the last report to the Health Select Committee.
5.4 Long Term Capital Projects and PFI
5.4.1 Could the Department provide a table
showing all publicly funded capital projects with a total cost
above £10 million which are under construction during 2002-03?
Could this also show the original and current estimated completion
dates along with a percentage figure for any additional time overrun/saving?
Likewise, the original total cost and current estimated out-turn
cost should be provided along with a percentage cost performance
figure.[4.8a]
1. The information requested is contained
in Table 5.4.1
Table 5.4.1
PUBLICLY FUNDED CAPITAL PROJECTS WITH A TOTAL
COST OVER £10 MILLION WHICH ARE UNDER CONSTRUCTION DURING
2002-03
| Project | Institution
| Description of Project | Original Estimated Completion Date
| Current Estimated Completion Date |
% Time Performance | Original Estimated Expenditure
£m
| Current Estimated Expenditure
£m
| % Cost Performance |
| Hull Royal Infirmary Maternity & Acute Development (see note 1)
| Acute | Maternity, Gynaecology, Plastics, Theatres, Children's OPD, Admin, Dining, Main Entrance
| 30/07/2002 | 18/10/2002 |
5.00 | 9.44 | 9.44
| 0.00 |
Newcastle Strategic Review (NSR)—Enabling Schemes (see note 2)
| Acute | Enabling Schemes—15 No. various work packages including New Pharmacy Manufacturing & Stores, New Ante-Natal Clinic, Alterations for various Pathology functions, Wards, Psychology, PGEC, Admin, Demolitions
| 30/09/2002 | 31/03/2003 |
27.27 | 15.30 | 22.88
| 49.50 |
York District Hospital, Reconfiguration of Surgical Facilities (see note 3)
| Acute | Alterations & Extensions for Adult & Children's Wards, Opthalmology,Theatres, Day Unit, ICU, HDU, Diabetes Centre, Children's Assessment Unit.
| 31/07/2006 | 31/12/2007 |
15.00 | 16.44 | 17.95
| 9.18 |
Gateshead Health NHS Trust | Community/Elderly
| Reprovision of Elderly Services from Bensham Hospital
| 30/04/2004 | 30/04/2004 |
0.00 | 15.47 | 15.47
| 0.00 |
Pennine Acute Hospitals NHS Trust
| Acute | A & E, Outpatients, Radiology, Operating Theatres, Adult Acute Wards, HDU, Pathology, Obstetrics
| 31/01/2003 (phased) | 31/01/2003 (phased)
| 0.00 | 23.80 | 22.80
| -4.20 |
Wrightington, Wigan & Leigh Health Services NHS Trust
| Acute | Phase IV. Obs & Gynae, A & E, Imaging at RAEI. Outpatients Dept off site.
| 26/09/2003 | 16/02/2004 |
15.20 | 24.66 | 24.66
| 0.00 |
Preston Acute Hospitals NHS Trust
| Acute | Obs & Gynae, Elderly Rehab, Pharmacy, Orthopaedics, DH, Outpatients, X-ray, Mortuary, Catering, Therapy, Education Facilities. Ward at Chorley
| 30/09/2003 | 31/03/2004 |
29.00 | 28.65 | 40.84
| 43.00 |
Central Manchester & Manchester Childrens NHS Trust
| Acute | Enabling works for redevelopment of adults and childrens services.
| 31/03/2003 | 31/03/2003 |
0.00 | 16.24 | 16.24
| 0.00 |
Northern Lincolnshire and Goole Hospitals NHS Trust
| Acute | A new womens and childrens unit at Diana, Princess of Wales Hospital.
| 06/05/2003 | 06/05/2003 |
0.00 | 13.86 | 13.86
| 0.00 |
Bath Redevelopment | Acute
| Redevelopment of general hospital facilities
| 30/09/2002 | 30/03/2003 |
11.11 | 39.50 | 39.50
| 0.00 |
Royal Berkshire & Battle |
Acute | Consolidation of Acute Services (including predicted contribution from land sales at the Battle Hospital site, £30.5m).
| 31/05/2004 | 30/11/2004 |
6.30 | 105.50 | 114.90
| 8.91 |
Southampton University Hospitals
| Acute | Cancer Care Relocation
| 01/08/2002 | 01/10/2002 |
9.52 | 19.94 | 20.75
| 4.06 |
Thames Gateway | Community
| Sheppey Community Hospital | 09/09/2002
| 09/09/2002 | 0.00 | 13.56
| 13.56 | 0.00 |
Brighton Healthcare | Acute
| Re-provision of Renal Unit | 30/11/2003
| 30/11/2003 | 0.00 | 11.00
| 11.00 | 0.00 |
East London & City Mental Health
| Mental Health | Relocation of Mental Health Services from St Clements to Mile End Hospital
| 30/11/2004 | 30/11/2004 |
0.00 | 21.50 | 26.55
| 23.48 |
Great Ormond Street Phase 1B |
Acute | GOS 2000 and beyond (rebuilding the hospital)
| 25/11/2004 | 25/12/2004 |
2.50 | 63.19 | 62.50
| -1.25 |
Edgware Community Hospital | Community
| Phase 3 of the Edgware Community Hospital project
| 31/03/2003 | 27/03/2004 |
50.98 | 23.81 | 35.70
| 49.93 |
Enfield Medium Secure Unit | Mental Health
| 70 Bed long term medium secure unit | 07/03/2003
| 16/06/2003 | 20.27 | 12.02
| 12.67 | 5.41 |
Camden & Islington Adult Mental Health Unit Highgate Wing
| Mental Health | 140 Adult Mental Health Unit, comprising 128 beds in ward areas, 12 bed PICU + day hospital + mental health OPD.
| 31/01/2003 | 13/10/2003 |
37.00 | 25.00 | 25.20
| 0.80 |
Charing Cross Hospital | Mental Health
| Relocation of Mental Health beds, releasing much needed accommodation for acute use.
| 28/02/2003 | 08/05/2003 |
13.00 | 14.97 | 14.97
| 0.00 |
West London Mental Health NHS Trust
| Mental | Security upgrade at Broadmoor Hospital.
| 21/06/2002 | 21/06/2002 |
0.00 | 14.81 | 14.81
| 0.00 |
Central and North West London Mental Health NHS Trust
| Mental Health | Mental Health facilities at Woodfield Road and St Charles.
| 31/08/2005 | 21/12/2004 |
-23.08 | 29.21 | 29.21
| 0.00 |
| Guy's & St. Thomas' | Acute
| Rationalisation of Acute Services, Women's services and Cancer Services
| 15/06/2003 | 12/05/2004 |
20.71 | 50.00 | 50.00
| 0.00 |
Mayday—New Ward Block |
Acute | 222 Beds and 4 day theatres to replace Victorian stock
| 01/04/2004 | 01/04/2004 |
0.00 | 22.60 | 22.60
| 0.00 |
Royal Wolverhampton Hospitals NHS Trust
| Acute | Cardiac Unit | 30/09/2004
| 30/09/2004 | 0.00 | 52.00
| 52.00 | 0.00 |
Royal Shrewsbury/Princess Royal Hospitals Shropshire
| Acute | Royal Shrewsbury Acute services reorganisation
| 22/09/2004 | 22/09/2004 |
0.00 | 19.00 | 19.00
| 0.00 |
Worcestershire Acute Hospitals NHS Trust
| Acute | Kidderminster Hospital ACAD (Ambulatory Care and Diagnostic Centre)
| 22/09/2004 | 22/09/2004 |
0.00 | 14.90 | 14.90
| 0.00 |
North Staffordshire Hospital NHS Trust
| Acute | Integrated Education Centre
| 30/09/2004 | 30/09/2004 |
0.00 | 14.70 | 14.70
| 0.00 |
South Birmingham Mental Health |
Acute | Forensic Child & Adolescent Unit and Womens Medium Secure Unit
| 30/09/2003 | 30/09/2003 |
0.00 | 19.70 | 19.70
| 0.00 |
Southern Derbyshire Mental Health NHS Trust—Kingsway Reprovision (see note 4)
| Mental | Reprovision of mental health facilities, intensive care and community facilities.
| 31/03/2004 | 31/03/2004 |
0.00 | 14.00 | 14.00
| 0.00 |
United Lincolnshire Hospitals NHS Trust (see note 5)
| Acute | Renovation and associated works at Pilgrim Hospital, including new A & E department, outpatients and pre-assessment unit, adult wards.
| 06/08/2003 | 06/08/2003 |
0.00 | 12.00 | 13.51
| 12.58 |
Nottinghamshire Healthcare NHS Trust
| Mental | New entry building at Rampton Hospital.
| 16/05/2003 | 21/02/2003 |
-15.58 | 10.84 | 10.84
| 0.00 |
Nottinghamshire Healthcare NHS Trust
| Mental | Dangerous and Severe Personality Disorder Unit at Rampton Hospital.
| 08/08/2003 | 08/08/2003 |
0.00 | 20.73 | 20.73
| 0.00 |
Notes
1. Publicly-funded element of a major PFI scheme
2. Increase due to extended briefing of major Pharmacy,
Ante-Natal and Laboratories packages and including University
Funded Element (£1m)
3. A revised Full Business Case has been approved for
this scheme
4. Subject to approval of FBC by Strategic Health Authority
5. The original FB1 cost of £12m has now risen to
a forecast out-turn of £13.51m. The Trust will contribute
£1,329,825 of this additional expenditure.
5.4 Long Term Capital Projects and PFI
5.4.2 Could the Department provide a commentary on cases
where there are significant discrepancies between original estimates
of completion dates and/or expenditures and current estimates?
[4.8a]
Newcastle Strategic Review—Enabling Schemes
1. The significant time and cost overruns are due to
extensive changes by the Trust which have resulted in real increases
to the functional content, design and specification of the scheme.
These changes, along with additional costs due to inflation, have
seen the overall scheme costs rise from an original estimated
expenditure of £15.30 million to a current estimated expenditure
of £22.88 million, representing an increase of 49.50 per
cent.
Wrightington, Wigan & Leigh Health Services NHS Trust
2. Delay in completion of an off-site Out-Patients Centre,
which was the first stage of this sequential project, was due
to the complex nature of the refurbishment and expansion of a
Grade 2 listed building. There is no anticipated cost increase
to the scheme as a result of this delay.
Preston Acute Hospitals NHS Trust
3. There has been a slippage in the programme for the
scheme, due mainly to a review of Orthopaedic services undertaken
by the Trust. It was not possible to tender for the construction
works until the outcome of the Orthopaedic review was known and
the scheme subsequently revised.
4. When the construction works were tendered in February
2002, it became clear that the overall cost would have to increase
for the scheme to be delivered. This was due mainly to building
cost inflation over the prolongated business case process and
subsequent tender period.
East London & City Mental Health
Relocation of Mental Health Services from St Clements to Mile
End Hospital
5. Additional scheme costs have been incurred due to
the requirement to provide en-suite facilities as part of the
Consumerism agenda. Costs have also increased due to additional
inflation costs between the FBC and tender stage, along with extra
funds following a risk assessment of the scheme. These factors
have seen the original estimated cost of £21.50 million rise
to a current estimated cost of £26.55 million, representing
an increase of 23.48 per cent.
Edgware Community Hospital
Phase 3 of the Edgware Community Hospital project
6. The time overrun is due to management decisions to
change some members of the design team and to change the procurement
route to a two stage tender. The enabling works are now complete
and the main contract has commenced following the two stage tender
process.
7. The increase in costs is due to additional inflation
costs, location and site factors, a revised energy/engineering
strategy and inaccurate cost advice. The firm providing Quantity
Surveying advice to the scheme have now been replaced following
poor performance.
Enfield Medium Secure Unit
70 Bed long term medium secure unit
8. The original estimated completion date has slipped
because the design development period was extended to allow for
additional consultation. This meant that the start on site date
was delayed, however the contract duration has remained the same.
Camden & Islington Adult Mental Health Unit Highgate Wing
9. The original estimated completion date has slipped
because the tender period was extended to allow the Trust to negotiate
savings from this design and build scheme. This meant that the
start on site date was delayed.
Charing Cross Mental Health Unit
10. The contract programme has been extended by nine
weeks owing to variations on the original construction works.
This has resulted in a current estimated completion date of 8
May 2003, which represents a time overrun of 13 per cent on the
original estimated completion date.
Central and North West London Mental Health NHS Trust
Mental Health facilities at Woodfield Road and St Charles
11. A significant time saving on the original contract
programme has been achieved by running phase 2 and phase 3 simultaneously,
rather than consecutively as originally planned. The facilities
are currently forecast to be completed on 21 December 2004, some
eight months ahead of the original schedule.
Guy's & St. Thomas'
Rationalisation of Acute Services , Women's Services and Cancer
Services
12. The rationalisation of Women's, Children's and Cancer
Services at the Guy's site and the St Thomas' site is partly publicly
funded and partly funded by Guy's and St Thomas' Charitable Foundation,
the £50 million cost identified in the table being the public
element. Increases in the cost of the Children's Hospital, funded
by the Charitable Foundation, have resulted in £12 million
from the public sector element being vired to the Children's Hospital.
Women's services are near completion and Cancer services are being
reviewed.
5.4 Long Term Capital Projects and PFI
5.4.3 Could the Department provide details of PFI projects
with a capital value of £10 million or over approved since
1992, including their current status? [4.8b]
1. Please refer to the answer provided at 5.4.4.
5.4.4 Could the Department provide tables showing the
planned and actual annual contribution to capital from PFI, and
the forecast level of investment generated by schemes over £10
million plus an aggregate of those below £10 million, since
1997-98? What revenue or transitional support is being given to
support the scheme? Could the Department provide further details
of locally agreed arrangements to provide revenue or transitional
support to schemes? [4.8c]
1. The information requested is provided in Tables 5.4.4(a)
to 5.4.4(i)
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