Select Committee on Health Written Evidence


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 form—difficult 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 Team—a 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 workforce—not covered by the list—which 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:

    —  pathology;

    —  audiology;

    —  sleep/respiratory physiology;

    —  neurophysiology; and,

    —  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 areas—although 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 CIB;

    —  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,

    —  (where specified) HMT;

    —  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 derogations—all 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





 
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Prepared 25 July 2006