Further supplementary memorandum submitted
by the Department of Health (ISTC 01H)
FOLLOW-UP TO 28 JUNE 2006 EVIDENCE SESSION
1. INFORMATION
ON WHY
SEVEN SCHEMES
ARE NOT
PROCEEDING
1.1 West Yorkshire Elective Scheme
Independent Sector provision for
contestability and choice not needed at level envisaged initially.
Local needs better met by SHA undertaking
local procurement to replace spot purchasing activity, and using
the existing wave 1 facility more intensively.
1.2 West Yorkshire Plastic Surgery Scheme
Review of capacity requirement concluded
it was not viable.
1.3 South West Peninsula Multi Specialty
Final review of scheme proposal concluded
it would be unlikely to secure value for money bids in its original
formdifficult to balance value for money and providing
a sufficiently localised service in such a rural area.
1.4 South Yorkshire General Surgery
Local needs better met by SHA undertaking
a local procurement to replace spot purchased activity with longer-term
contractual arrangements that comply with national policy developed
for the ISTC programme (eg additionality).
1.5 South Yorkshire Cardiology
Rotherham Foundation Trust decided
not to proceed with the scheme and the impact on the casemix meant
the scheme was no longer commercially viable.
1.6 County Durham and Tees Valley Multi Specialty
Enough existing IS Capacity (if exploited)
to meet the 18 weeks requirement.
1.7 Birmingham and Black Country
Affordability Gap resulting from
the PFI unitary charge and the assessed potential financial loss
by the Trust meant this scheme was not commercially viable.
2. PROFESSIONS
COVERED BY
THE ADDITIONALITY
POLICY FOR
THE NEXT
PHASE OF
DIAGNOSTIC AND
ELECTIVE PROCUREMENTS
2.1 The list of shortage professions has
been drawn up based on the results of qualitative and quantitative
analysis by the Workforce Review Teama body attached to
Hampshire and Isle of Wight SHA, responsible for analysing NHS
workforce data. The list will be the basis of the Additionality
clause in the relevant diagnostic and Elective Services Agreements.
This clause is a form of restrictive covenant. As such, the clause
and the list must go no further than is demonstrably necessary
to protect the interests of the NHS. However, there are other
sections of the NHS workforcenot covered by the listwhich
may raise risks to NHS capacity. In relation to them, proper caution
and risk management is also required. For example, Agenda for
Change Band 6 covers a wide range of clinical staff and skills,
some of which are very specialist and are key to delivering service
in both the NHS and the IS.
2.2 Because Band 6 is very broad, it is
not appropriate to include people within it in the list of shortage
specialisms or the restrictive covenant. However, bidders are
specifically reminded of their contractual obligation to participate
in good faith in NHS workforce planning. This will include the
obligation to liaise closely with the relevant Strategic Health
Authority and to co-operate in ensuring fair access to these key
elements of the workforce, avoiding predatory recruitment practices
and co-operating with NHS employers in ensuring adequate resourcing
and succession planning across the local health economy.
2.3 The shortage professions covered by
the wave 2 elective and diagnostic procurement additionality policy
are:
2.4 All the professions involved in:
sleep/respiratory physiology;
Cardiac physiology, including echo-cardiology.
2.5 Professions involved in anaesthetics
and clinical radiology including anaesthetists, anaesthetic and
critical care nurses, clinical radiologists, therapeutic radiographers
and diagnostic radiographers.
2.6 In addition to the nursing groups already
highlighted, all the bands 7 and 8 within the registered nursing
workforce.
2.7 Biomedical scientists at all bands.
2.8 In addition to the healthcare scientists
groups already highlighted, all the bands 7 and 8 within the healthcare
scientists profession.
2.9 In addition to the medical groups already
highlighted, trauma and orthopaedic surgeons and consultants in
nuclear medicine.
2.10 In addition, the following health professionals
are also identified: occupational therapists, pharmacists, qualified
practitioners working in operating departments, and very specialist
physiotherapists.
3. UPDATE ON
THE WILL
ADAMS NHS TREATMENT
CENTRE, GILLINGHAM
3.1 This treatment centre opened in October
2005, since then local NHS sponsors and the provider have been
working in partnership to maximise the utilisation of the contract
over the full term of the contract.
3.2 In particular, the NHS and the provider
have implemented the following to improve activity levels:
improved marketing to local GP referrers
and the local population. This has included treat centre based
GP events, education events and hospital visits by TC clinicians
to meet local clinicians in their workplace;
transfer of relevant non-breach waiting
list activity from the acute trust to the centre. Transferred
activity has been successfully delivered; and,
transfer of non-breach activity from
surrounding PCT areasalthough subsequent investigation
failed to identify a demand for this.
3.3 The NHS now consider that there is a
need for increased partnership working between the centre and
the local acute Medway NHS Trust. A local Executive Group has
been set up including CEOs from Medway PCT, the Acute Trust and
senior representatives from Mercury Health. The Group will focus
on:
re-distributing workload and facilitating
the transfer of additional elective activity from Medway NHS Trust
to the centre;
rationalising the use of available
staff resources, to include medical staff secondment from Medway
NHS Trust to the centre;
improving clinical working relationships
between the centre and the Medway NHS Trust;
pro-actively managing and jointly
reconfiguring referral processes and clinical pathways to improve
patient comfort, convenience and continuity of care;
applying the necessary legal and
HR processes for secondment, including staff consultation; and,
reconfiguring the case mix, where
this will sustain activity at the required levels and is both
clinically and financially viable.
4. PHASE 2 BUSINESS
CASE APPROVAL
PROCESS
4.1 The process for the development, review
and approval of full business cases (FBCs) includes the following:
oversight and guidance by HMT and
subject to Gateway Review by the Office of Government Commerce
(OGC);
use of a template based on HMT and
Departmental standard guidelines;
review of each scheme-level FBC by
the Department's Capital Investment Branch (CIB), operating as
an HMT-appointed "independent unit within DH's finance team";
approval of each FBC by:
workstream leads in the procurement
team;
the Commercial Director General;
the Finance Director General;
the IS Programme Board (which includes
the Department's Policy & Strategy Director General, Workforce
Director General, and Commissioning Director General); and,
provision to HMT of written assurances
on key issues by the Department's Accounting Officer prior to
Financial Close.
4.2 Phase 2 scheme FBCs follow on from,
and are consistent with, two programme-level outline business
cases (OBCs) for electives and diagnostics (approved by the Secretary
of State for Health and HMT), and a series of scheme-level OBCs.
4.3 The development and approval of business
cases correspond with key successive stages in the procurement
process:
|
Business case/Other stage | Procurement stage
|
|
Programme-level OBC (including analysis and selection of procurement strategy based on VfM) approved before:
| Advertisement |
Scheme-level OBC (including investment appraisal and preferred procurement option, stakeholder involvement) approved before:
| ITN issue |
Report confirming scheme still commercially viable and required and recommending Bidder selection prior to:
| Preferred Bidder appointment
|
FBC (including confirmation of OBC requirement, demonstration of VfM, documentation of affordability, assurance of policy and commercial fit) approved before:
| Contract signature and Financial Close
|
|
4.4 The FBC Template has been shared with and commented
on by the CIB. The FBC Template complies with the DH's "Five-Case
Model" comprising "strategic case", "economic
case", "financial case", "commercial case"
and "management case".
4.5 he basic template has been developed into "FBC
Template + Generic text" documents for both Electives and
Diagnostics schemes, which are also subject to further comment
by CIB and approval by the IS Procurement Board. These documents
are used by scheme teams to prepare their scheme-specific FBCs.
4.6 Scheme-level FBCs are subject to detailed review
by a) the procurement team's Subject Matter Expert (SME) Reviewers
(two rounds of review) and b) DH's Capital Investment Branch.
4.7 CIB's reviews of FBCs are complemented/informed by
briefings, documentation relating to the appointment of Preferred
Bidder and scrutiny of Services Agreements (ie contracts) and
related derogationsall of which are provided to CIB by
the procurement team.
4.8 The proposed activity included in Diagnostics FBCs
and that in SHA-led Electives FBCs is subject to written confirmation
by SHAs. Proposed activity in Centrally-led Electives schemes
is discussed with SHAs and is also subject to the Policy &
Strategy-commissioned "Capacity Mapping" exercise.
4.9 The IS Phase 2 programme is subject to Gateway Reviews
by the Office of Government Commerce (OGC). Scrutiny of FBCs by
OGC is a significant feature of these reviews. The Gate 3 Review
of the IS Phase 2 Programme is scheduled for September 2006.
5. IMPERIAL COLLEGE
ASSESSMENT OF
REGISTERED UK SURGEONS
(ICARUS)
5.1 The Commercial Framework Agreement for provision
of the ICARUS tool as part of a surgical assessment to be undertaken
by all ISTC Providers was signed on 10 February 2006 between the
Secretary of State and Imperial College London.
5.2 ICARUS is based on an independent, objective third
party review of videos of procedures, generic skills assessment
in a bench top environment, and generic surgical proficiency assessment
in a standardised "mock" theatre environment at Imperial
College London.
5.3 Surgeons appointed to ISTCs will be assessed for
competence using the ICARUS tool which will be mandated for Phase
2.
Department of Health
July 2006
|