level 3 investment proposal template revenue funding … · 2017-05-17 · approval of investment...

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LEVEL 3 Investment Proposal Template REVENUE FUNDING £250k - £1m

Complete this section if bid is for new funding i.e. funding is not currently in

the Trust baseline

BID FOR NEW FUNDING

Is this bid for new funding (Y/N) Yes

How much total funding required?

£1,650,851

How much funding required per year?

As above

HSCB IPT Ref No IPN 161 Professional Staff (AHP, Pharmacy and

Social Work) to Support ED Patient Flow

Source of Funding (Year /

ref)

HSCB 2015/16

Allocation value

HSCB Representative name

and contact details

Mr Iain Deboys, Commissioning Lead, Belfast LCG

Trust Representative name

and contact details

Mr Shane Devlin, Director Planning, Performance

and Informatics

Project Title

ED Patient Flow – Embedding professional support

staff to improve team work and communications

Total Cost

£1,650,851

Start date

Can be covered initially by overtime arrangements in a

phased approach to implementation

Completion date

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Is this funding to be made recurrent? Yes

Complete this section if funding available within existing allocation i.e. funding

is currently in the Trust baseline

Funding available within existing

allocation (Y/N)

Total cost of proposal

Cost of proposal per year

Is this cost within recurrent

allocation?

Is this business case Y/N

(a) Standard Yes

(b) Novel

(c) Contentious

(d) Setting a precedent

If “yes” to (b) or (c) or (d), requires

Departmental & DFP approval

Is Departmental / DFP approval

required

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Approval & submission by Trust/s

This section to be completed by Trusts for all submissions

This section to be completed by Trusts for all submissions

Prepared by (required)

Name Printed: ANNE HAZLETT (signed)

Grade/ Title: PPM

Date: 03.06.15

Responsible Director Signature (required for all submissions)

Name Printed: JENNIFER THOMPSON (signed)

Grade/ Title: Co-Director Performance and Service Delivery

Date: 12.06.15

For Trust Director of Finance Signature (required if bid is over £100k)

Name printed STANLEY TAGGART (signed)

Grade/ Title: Co-Director Finance (Commissioning)

Date: 12.06.15

Trust Chief Executive Signature (required)

Name printed (signed)

Date:

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Approval of Investment Proposal Template by HSCB

Approval by Commissioning Lead (LCG or regional) – required for all

submissions

I confirm that all relevant parties – including, as appropriate, LCGs / regional leads,

professional leads etc. – have been consulted and have confirmed in writing their

support for the proposed investment.

Approved by

Name printed Mr Iain Deboys (signed)

Grade / Title Commissioning Lead

Date

Approval of Investment Proposal Template by HSCB Director(s) / Chief

Executive Officer – required for all submissions

Responsible Director Signature (required)


Grade / Title

Date

HSCB Director of Finance Signature (required)


Date

HSCB Chief Executive Signature (required)


Date

Approval of Investment Proposal Template by Commissioning Board (required

for all submissions)

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Date approved by Commissioning Board

Date

Complete this section if Department / DFP approval required

Date submitted to Department

Department/ DFP approval (y/n)

Date approved

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SECTION 1(a): Commissioner Specification to include strategic context and need (to be

completed by the Commissioner).

In July 2014 the Health Minister announced to the Assembly his intention to establish a Regional Task Group to take forward the RQIA’s recommendations in relation to Unscheduled Care. The Task Group was placed under the leadership of the Chief Medical Officer, Dr Michael McBride, and the Chief Nursing Officer, Charlotte McArdle. The Task Group established 7 work streams to mirror the principal thematic findings of the RQIA. One of the work stream groups was tasked with Improving Patient Flow. Through this IPT Belfast Trust is asked to bring forward proposals to improve patient flow and thereby reduce the length of time patients wait in the RVH Emergency Department following a decision to admit, including the number that wait for more than 12 hours. The Task Group’s recommendations are wide ranging therefore to initiate implementation from this work the HSCB SMT agreed five key priority tasks to be progressed in the immediate term. These priorities are: 1) To ensure radiology services are available 7 days a week that enable same day/next morning

investigation and reporting (to include CT, MRI & Non Obstetric Ultrasound Scans). This applies to all radiological work including GP, ED and inpatient referrals.

2) To ensure there is twice daily senior decision making for inpatients 3) To establish a dedicated minor injury stream in main Emergency Departments (9am-9pm, 7/7)

4) To embed Physiotherapy, Occupational Therapy, Pharmacy and Social Work support within

main ED’s and Short Stay Wards (9-5, 7/7)

5) To organise ward rounds to ensure clinical priority patients are seen first followed by potential discharges to facilitate early discharge.

SECTION 1(b): DEMONSTRATE THE NEED FOR THE PROJECT

Part of the approach to embedding multidisciplinary staff in the main ED, including the Short Stay Observation Unit, is to ensure Social Work, Pharmacy, Physiotherapy and Occupational Therapy work as part of the ED team i.e. are embedded and dedicated to ED to enable good team relationships, communication and working. These professions are recommended to be available in the main ED 9am-5pm 7-days a week. The Commissioner invites proposals from Belfast Trust to secure the presence of these professions in such a way that maximise their potential.

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Deployment should also maximise opportunities for good team relationships, communication and working. It is not expected that the proposals would meet the full potential demand for each profession but that the beginning of 7 day consistency is achieved. WTE requirements should be based on the agreed assumption that 430 sessions equates to 1 WTE Mon to Friday, 520 sessions are required for a full year and that annualised weekends require a further 208 sessions of cover. Social Work There are currently 19 WTE across the RVH acute, USC and ED service. These are mainly Band 6 posts. There are 3 teams each led by one Band 7( 2.5 WTE), reporting to Assistant Service Manager/Professional Lead, through to Service Manager Integrated Care Teams . The present service relies on a pool of experienced staff being willing to work additional hours at weekends. The Commissioner invites proposals that build a sustainable rota, relying less on bank staff. The preference is for additional 3 WTE Band 7 positions. This will support senior practitioner decision making and autonomous working. Some bank input will continue to be required but at a reduced level. Proposals should ensure that 2 staff are on duty at weekends and more hours provided (via a third session) on Thursdays, Fridays and Mondays. This will ensure a more consistent level of input to the service with full day cover at weekends instead of mornings only. The improved cover should provide rapid access social care discharge planning for older people in unscheduled care admissions and presentations to ED. Pharmacy Current baseline week day cover is provided to Short Stay by 0.5 WTE Band 8a. There is also an element of non-recurrent ATO support to undertake daily top-up service to ED writing orders and stock control. The NI clinical pharmacy standards indicate a ratio of one pharmacist and one technician post per 100,000 attendances. RVH attendances are in the region of 84000. On this basis it is recommended to plan for one post of each type. This translates into the following WTE when taking 7 day working into account:

1.1 WTE Pharmacist to add to the existing 0.5 WTE

Band 5 Technical 1.6 WTE

Band 2 – make current 0.5 WTE recurrent Allied Health Professions

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The current baseline line equates to 1.0 WTE OT embedded in ED / 5 days a week / 43 weeks per year. A second Band 6 OT is in service but unfunded (similar schedule to above). No Physiotherapy staff are in place. The Commissioner will consider a range of options from one member of each profession 7 days a week / 52 weeks per year to 2.0 WTE from each profession for the same duration. Other options based on this theme can be included. Proposals should also incorporate a mix of Band 6 and 7 positions to provide for autonomous working and a flexible skill-mix across the service.

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SECTION 2(a): OBJECTIVES

Project Objectives Measurable Targets

1. To provide rapid access to social care discharge

planning, pharmacy and allied health professional

assessment, 8 hours per day, 7 days per week, 52

weeks per annum to the RVH Emergency

Department

1.1 No of referrals made per day and

turnaround times to aid flow

2. To ensure that the investment in social work,

pharmacy and allied health professionals leads to

an improvement in the flow of patients


turnaround times,

2.2 Measurement of patients referred to social

work and AHP services where the patients

were not admitted

3. To provide rapid access to social care discharge

planning, pharmacy and allied health professional

assessment, 8 hours per day, 7 days per week, 52

weeks per annum to the RVH Emergency

Department and AMU


turnaround times to aid flow

SECTION 2(b): CONSTRAINTS

Constraints Measures to address constraints

Recruitment of staff to populate permanent

weekend rotas in all three professional areas

This will have to be addressed in the

recruitment process

SECTION 3: IDENTIFY AND SHORTLIST OPTIONS

Option Number/ Description

1.0 Option one

Status Quo - continue with a 5 day service

The service would continue to be delivered as per recurrent funding arrangements. This option

would have no impact on improving patient flow or developing a 7 day service.

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2.0 Option two – Provide Professional Staff support to the RVH Emergency Department 8

hours per day, 7 days per week, 52 weeks per annum

This option proposes that there should be Social work, Pharmacy and Allied Health Professional

presence (Physiotherapy and Occupational Therapy) in the RVH Emergency department 8 hours per

day, 7 days per week, 52 weeks per annum. This would assist in the flow of patients through the

Department and prevent admission of patients who would have been previously admitted for social

work and AHP assessment. Each of the proposals within these 3 areas are detailed below:

2.1 Social work

In AMU and ED there is a need for a mainstream constant, consistent and coordinated Social work

service across all seven days. The Emergency department and the short stay unit are the areas of

highest demand Monday to Friday and at weekends this shifts to AMU. This is in relation especially

for Older people admitted from ED for short medical admissions and is vital to ensure the timely flow

of discharges to support the capacity of AMU to admit patients. Staff should be embedded in AMU

and attached as ED liaison as a whole system to managing demand.

It is proposed that the service recruits an additional 3 wte social workers would be rostered across

seven day cover inclusive of the Emergency department, short stay and AMU to provide rapid

access social care discharge planning. These posts would be Band 7 as this is in line with the level

of autonomous experienced decision making required to undertake safe and effective weekend

discharges.

The 3 WTE would provide a total of 27 sessions per week to AMU and ED across seven days (8 to

12 sessions every weekend)

2.2 Pharmacy

The RVH ED pharmacy service currently has 0.5 Band 8a who provides support to the short stay

ward in the Emergency Department. There is also an element of non recurrent ATO support at the

moment who undertakes daily top up service, writing orders and stock control. The table below

identifies and highlights the role of staff required to carry out a 7 day dedicated service to the RVH

ED. This resource would provide 2 pharmacists and 1 technician in ED each day with one

pharmacist based in ED and the other in short stay.

Roles which pharmacy staff identified in the bid for RVH ED will carry out

Band 8a Pharmacist – Required 0.5, This post would provide a full time 1.0WTE strategic and

operational pharmacy lead and undertake the clinical duties below.

Band 7 Pharmacist – Required 2.36. These posts would provide medicines reconciliation on

attendance, prescribing advice to medical staff, support nursing staff treating patients using patient

group directions and act as non-medical prescribers for specific patient groups

Band 5 Technician – Required 1.68. These posts would provide a dispensing service in ED, supply

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urgently required medicines, assess patients own medicines for on-going use supporting admission

and ensure medicines move with the patient

Band 2 Pharmacy support – Required 0.5. This post would maintain the stock of medicines on a

daily basis in ED ordering, collecting and putting away.

Table one

The table below summarises the resource required for pharmacy to support 7 day working,

52 weeks per annum, 8 hours per day.

RVH Emergency

Department

Pharmacist 8a 0.5 wte

Pharmacist band 7 2.36 wte

Technician band 5 1.68 wte

Pharmacy support band 2 0.5 wte

2.3 Allied Health Professionals

There is currently one full time Occupational Therapist dedicated to the RVH Emergency Department

with all other staff providing service on a non recurrent/overtime basis. At the moment a 2 day

session Monday to Friday is provided (43 weeks per annum) by 2 WTE physios and 2 WTE OTs.

Referral levels are approximately 120 new patients per month to each of the 2 Professions. The

range of new patients per day is 7 to 8 on average with a maximum capacity of 9 new patients per

day seen per profession.

The patient categories presenting include:

Occupational Therapy – patients requiring mobility/functional assessments (generally undertaken in

conjunction with Physio) and Upper limb soft tissue injuries

Physiotherapy – patients requiring mobility assessments (as above) and MSK/Minor injuries (soft

tissue and factures)

The minor injuries work encompasses some fracture work which allows patients to be treated and

discharged rather than be sent for medical management via the facture clinic services. For this

group of patients the professions also offer a limited review service where clinically appropriate (150

slots per annum).

Treatment time ranges from one to two hours across the spectrum of patients presenting. The

higher end of the treatment pathway relates to complex functional/mobility/social assessments as

these are undertaken by the 2 AHP professions alongside Social work staff. Response time for the

service is typically 0 to 2 hours. An analysis of the previous years activity would demonstrate that

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the discharge destination for the patients assessment and treated by the AHPS is > 80% non

admission.

The table below indicates the resource required to provide a 8 hour service 7 days per week, 52

weeks of the year with 2 OTS and 2 physios in place to the RVH Emergency Department.

Table two

RVH Funded

resource Resource

required for Gap in

sessions WTE Gap

sessions 2 Ots and 2

Physios Band

7s

sessions

Occupational Therapy 430 1716 1286 3.0

Physiotherapy 0 1716 1716 4.0

3.0 Option three - Provide Professional Staff support to the RVH Emergency Department and

AMU 8 hours per day, 7 days per week, 52 weeks per annum

This option proposes that there should be Social work, Pharmacy and Allied Health Professional

presence in the RVH Emergency department and AMU 8 hours per day, 7 days per week, 52 weeks

per annum. This would assist in the flow of patients through the Departments and in the

improvement of the assessment and discharge process in AMU. Each of the proposals within these

3 areas are detailed below:

3.1 Social work

In AMU and ED there is a need for a mainstream constant, consistent and coordinated social work

service across all seven days. The Emergency department and the short stay unit are the areas of

highest demand Monday to Friday and at weekends this shifts to AMU. This is in relation especially

for Older people admitted from ED for short medical admissions and is vital to ensure the timely flow

of discharges to support the capacity of AMU to admit patients. Staff should be embedded in AMU

and attached as ED liaison as a whole system to managing demand.

The proposed additional 3 wte social workers would be rostered across seven day cover inclusive of

the Emergency department, short stay and AMU to provide rapid access social care discharge

planning. These posts would be Band 7 as this is in line with the level of autonomous experienced

decision making required to undertake safe and effective weekend discharges.

The 3 WTE would provide a total of 27 sessions per week to AMU and ED across seven days (8 to

12 sessions every weekend)

3.2 Pharmacy

The RVH ED pharmacy service currently has 0.5 Band 8a who provides support to the short stay

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ward. There is also an element of non recurrent ATO support who undertakes daily top up service,

writing orders and stock control. The table below identifies the staff required to carry out a 7 day

dedicated service to the RVH ED. This resource would provide 2 pharmacists and 1 technician in ED

each day with one pharmacist based in ED and the other in short stay

AMU is the busiest inpatient area for pharmacy as activity is related to patient throughput. The

resources listed below would provide 3 pharmacists and 2 technicians on a 7 day basis

Table three

Summary of Resource required for ED and AMU

ED AMU Total

Pharmacist 8a 0.5 0.5 1

Pharmacist band 7 2.36 3 5.36

Pharmacist band 6

1.04 1.04

Technician band 5 1.68 2 3.68

Technician band 4

1.36 1.36

Pharmacy support band 3

0.2 0.2

Pharmacy support band 2 0.5

0.5

The detail below indicates what the job roles identified in the table above will deliver in each of the

areas.

Resource for ED

Band 8a Pharmacist – Required 0.5, This post would provide a strategic and operational pharmacy

lead and undertake the clinical duties below.

Band 7 Pharmacist – Required 2.36. These posts would provide medicines reconciliation on

attendance, prescribing advice to medical staff, support nursing staff treating patients using patient

group directions and act as non-medical prescribers for specific patient groups

Band 5 Technician – Required 1.68. These posts would provide a dispensing service in ED, supply

urgently required medicines, assess patients own medicines for on-going use supporting admission

and ensure medicines move with the patient


daily basis in ED ordering, collecting and putting away.

Resource for AMU

Band 8a Pharmacist – Required 0.5. This post would provide a strategic and operational lead for the

AMU pharmacy team and undertake the clinical duties below

Band 7 Pharmacist – Required 3. These posts would provide medicines reconcilation on admission,

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daily review to optimise treatment, prepare the prescription aspect of discharge letter, medicines

reconciliation on discharge, pre-empt issues regarding compliance aids, work with patient to reduce

risk of reattendance/admission, counsel patients on changes to medicines, support patients

transferring to other facilities

Band 6 Pharmacist – Required 1.04. These posts would undertake the above duties under the

direction of a senior pharmacist

Band 5 Technician – Required 2 – These posts would provide one-stop dispensing including the use

of patients own drugs, minimising waste. They would order newly prescribed medicines supporting

timely treatment. They will ensure medicines move with the patient reducing duplication and waste

Band 4 Technician – Required 1.36 – These posts would undertake the above duties under the

direction of a senior technician


weekly basis ordering, collecting and putting away.

3.3 Allied Health Professionals

RVH Emergency Department

There is currently one full time Occupational Therapist dedicated to the RVH Emergency Department

with all other staff providing service on a non recurrent/overtime basis. At the moment a 2 day

session Monday to Friday is provided (43 weeks per annum) by 2 WTE physios and 2 WTE OTs.

Referral levels are approximately 120 new patients per month to each of the 2 Professions. The

range of new patients per day is 7 to 8 on average with a maximum capacity of 9 new patients per

day seen per profession.

The patient categories presenting include:

Occupational Therapy – patients requiring mobility/functional assessments (generally undertaken in

conjunction with Physio) and Upper limb soft tissue injuries

Physiotherapy – patients requiring mobility assessments (as above) and MSK/Minor injuries (soft

tissue and factures)

The minor injuries work encompasses some fracture work which allows patients to be treated and

discharged rather than be sent for medical management via the facture clinic services. For this

group of patients the professions also offer a limited review service where clinically appropriate (150

slots per annum).

Treatment time ranges from one to two hours across the spectrum of patients presenting. The

higher end of the treatment pathway relates to complex functional/mobility/social assessments as

these are undertaken by the 2 AHP professions alongside Social work staff. Response time for the

service is typically 0 to 2 hours. An analysis of the previous years activity would demonstrate that

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the discharge destination for the patients assessment and treated by the AHPS is > 80% non

admission.

The table below indicates the resource required to provide a 8 hour service 7 days per week, 52

weeks of the year with 2 OTS and 2 physios in place to the RVH Emergency Department.

AMU – RVH

There are currently 2 OTs and 3.8 Physios working within the AMU in RVH and all other staff

providing service on a non recurrent/overtime basis. At the moment a 2 day session Monday to

Friday is provided (43 weeks per annum).

The role of Occupational Therapy in AMU is to provide an on the day response to referrals with

Expected date of discharge so that an individual patient’s optimal functional and cognitive abilities

are assessed, appropriate interventions are completed to ensure patients gain maximum benefit

from their hospital stay and to ensure safe and timely discharge. This is delivered by assisting in the

discharge planning through participation at the “white board” meetings, by prioritising assessments

to ensure greatest benefits to patients identified as fit for discharge, and provide focussed acute

rehabilitation to enable patients (< 2 midnights) to regain their optimum level of independence so that

the most appropriate care arrangements are put in place on discharge.

Treatment time ranges from 2 ½ hours to 4 ½ hours across the spectrum of patients presenting. The

higher end of the treatment pathway relates to complex functional and cognitive assessments.

The role of the physiotherapy service in AMU will provide a rapid assessment, treatment, discharge and/ or transfer for acute medically patients admitted to the medical assessment unit within the RVH. The physiotherapy service will work as part of the multidisciplinary team to assist in early identification of appropriate patients engaging in ward white board meetings/patient flow meetings and contribute to the discharge or transfer planning for patients referred. Currently the weekend service is supported by staff working additional hours for Sat /Sun and will depend on availability of staff if there is one or two physiotherapy staff available on any given day. Current clinical prioritisation criteria for Physiotherapy weekend is as follows:

Respiratory condition requiring input to prevent deterioration outside of emergency protocol

Mobilisers to include falls, general debility, fractures

Reviews where input maintains progress towards discharge

Outside of these hours, emergency respiratory input will be provided through the out of hours

Physiotherapy service.

The table below shows the resource required to provide 8 hours per day, 7 days per week, 52 weeks

cover to the Royal Emergency department as in Option 2 and provide this cover to the Acute Medical

Unit for the same period.

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Table four

RVH

Funded resource

Resource required for

Gap in sessions

WTE Gap

sessions 2 Ots and 2

Physios Band 7s

sessions

Occupational Therapy (ED)

430 1716 1286 3

Physiotherapy 0 1716 1716 4

AMU OT 860 2052 1192 2.8

AMU Physio 1634 2548 914 2.2

Shortlist of Options

Objective

Option Number/

Description

1 2 3 Shortlist

(S)

Reject (R)

Comment

Option 1:

Do nothing

N

N

N

S

This is the base case and

as per guidelines has to

be shortlisted

Option 2:

Professional staff

support to RVH ED,

8 hours per day, 7

days per week, 52

weeks

Y

Y

N

S

This is shortlisted as it is a

step towards covering 7

day services

Option 3:

Professional staff

support to RVH ED,

8 hours per day, 7

days per week, 52

Y

Y

Y

S

This is shortlisted as

provides 7 day service to

RVH ED and RVH AMU

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weeks

SECTION 4: MONETARY COSTS AND BENEFITS OF OPTIONS

Please see attached costing template at Appendix 1. A summary of the revenue

costs for each option is given below.

Option Description Annual Revenue

Costs

Option 1:

Do nothing

Base case

Option 2:

Professional staff support to RVH ED, 8

hours per day, 7 days per week, 52

weeks

£874,094

Option 3:

Professional staff support to RVH ED, 8


weeks

£1,650,851

Cost Assumptions

Cost assumptions based on professional staff working 430 sessions per annum.

That equates to 10 sessions per day, 5 days per week, 43 weeks of the year.

SECTION 5: NON MONETARY COSTS AND BENEFITS

Benefits Assessment

This section sets out the results of the benefits assessment of each of the short

listed options.

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In order to do this the Project Team has applied a weighting and scoring system (the

approved methodology for option appraisal in the Health Service) based on the

following approach:

(a) Identification and description of the major benefits to be achieved (the relevant

qualitative performance indicators (“QPI’s”));

(b) Allocation of weighting factors to each QPI resulting in a total score of 100;

(c) Scoring each option against the selected QPI’s;

(d) Calculation of a weighted score (score x weighting factor) for each option;

(e) Ranking and evaluation of results.

Benefit Criteria

Based on the objectives identified the following benefits have been identified and will

be used to evaluate the options.

Safety & Quality

Deliverability

Access

Sustainability

A description of the rationale behind each criteria and the relevant weighting is

outlined in the table below.

Weighting of Benefit Criteria

The weighting of the individual benefits determines their relative importance. The

more significant benefits will achieve higher weighting while those of lower impact

will achieve lower weighting.

Weighting was apportioned to the benefit criteria as follows:

Criterion Description Weighting

Safety &

Quality

Ensure compliance with clinical

guidance and standards. Ensure

staff have required experience to

undertake the patient decisions

and treatments required

40

Sustainability Ensure that services are

supported by sufficient staffing

and remain resilient in future.

20

Deliverability This considers readiness for

implementation and delivery of

30

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additional proposed activity and

impact on patient flow

Access

This considers the ability to

improve timely access senior

decision making thereby

improving the patient journey

and flow.

10

Total 100

Explanation of the Weighting Scores

Safety and Quality

This criterion is weighted at 40/100 and reflects the need to assess the options in

respect of the ability to deliver quality outcome measures and comply with guidance

to meet the required professional standards.

Sustainability

This criterion is weighted at 20/100 and will reflect the need for adequate number of

staff with the appropriate skill mix to ensure a resilient service within the respective

areas

Deliverability

This criterion is weighted 30/100 and reflects the requirement for the service to

deliver additional activity within expected timeframe and impact on existing services.

Access

Weighted at 10/100 this criterion reflects the ability of the service to provide timely

access to the service to meet clinical access standards and reduction in hospital

length of stay.

Scoring of Options

The short-listed options were scored on each of the benefit criteria on a scale of 0 to

10. The short-listed options were considered in relation to how well they fulfilled the

non-monetary criteria. A score out of 10 was allocated to each of the options. This

demonstrated the ability of an option to achieve the full quality of a criterion. A higher

score indicated that an option met the criterion to a higher degree. The following

guide reflects the basis for each score. Total points available = 10.

10/10 Applied where the option provides the ideal solution in respect of each

criterion heading

8/10 Applied when the option significantly achieved compliance in respect of

each criterion heading

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5/10 Applied when the option achieved an acceptable level of compliance in

respect of each criterion heading

3/10

Applied when the option will achieve only the basic level of compliance

and possibly with a degree of difficulty or a compromise in levels of

expectation

0/10 Applied when the option will not readily achieve the minimum level of

compliance.

When all qualities were assessed for each option, the score out of 10 was multiplied

by the weight attributed to each of the benefit criteria — the resultant weighting

scores were then totalled for each option, thus giving a set of figures that reflect the

relative non-financial merits of each option. The agreed scores are displayed below.

Criteria

Weig

ht

Option 1

Option 2

Option 3

Scor

e

Weighte

d Score

Scor

e

Weighte

d Score Score

Weight

ed

Score

Safety & Quality 40 5 200 8 320 10 400

Sustainability 20 3 60 8 160 10 200

Deliverability 30 3 90 8 240 10 300

Access

10 3 30 8 80 10 100

Total 100

380 800 1000

An explanation of the various scores awarded to each option against the benefit

criteria is outlined below:

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Criterion 1 - Quality and safety

Option 1 scored 5 out of 10 against this benefit, as the “do nothing” option

suggests continuing with the 5 day service that is currently in place. This service

does offer quality and safety but does not contribute to this 7 days per week. 52

weeks of the year. Therefore delays in decision making take place.

Options 2, scored 8 out of 10 against this benefit as this offers more resource over

the 7 days for the RVH Emergency department but does not provide the extended

resource for AMU

Option 3 offers the extended Professional staff service to both RVH ED and AMU

thereby ensuring that staff are there to carry out the duties and treatments in both

these areas over the required hours seven days per week.

Criterion 2 – Sustainability

Option 1 scored 3 out of 10 against this benefit. This option would only have a

small pool of staff available covering the service 5 days per week and would not

be adequately able to extend the service to meet the demands of 7 day working.

Option 2 scored 8 out of 10 against this benefit as this offers more resource over


resource for AMU

Option 3 scored 10 out of 10 against this benefit as it offers the extended

Professional staff service to both RVH ED and AMU thereby ensuring that staff

are there to carry out the duties and treatments in both these areas over the

required red hours seven days per week

Criterion 3 - Deliverability

Option 1 scored 3 out of 10 against this benefit. This option would only have a

small pool of staff available covering the service 5 days per week and would not

be adequately able to extend the service to meet the demands of 7 day working.

Option 2 scored 8 out of 10 against this benefit as this offers more resource over


resource for AMU

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Option 3 scored 10 out of 10 against this benefit as it offers the extended

Professional staff service to both RVH ED and AMU thereby ensuring that staff

are there to carry out the duties and treatments in both these areas over the

required hours seven days per week.

Criterion 4 – Access

Option 1 scored 3 out of 10 against this benefit as “do nothing” does not facilitate

additional capacity and therefore does not improve service.

Option 2 scored 8 out of 10 against the benefit criteria. This option would improve

access to Professional staff for patients within the RVH ED but not to AMU.

Option 3 scored 10 out of 10 against the benefit criteria. This option would

improve access to Professional staff for patients within the RVH ED and RVH

AMU.

Conclusion of Non-Monetary Ranking of Options

The ranking of the Options, as a result of the non-monetary analysis, is outlined in

the table below as follows:

Weighted Scores

Option Description Weighted

Score Ranking

1 Continue with a 5 day service 380 3

2

Provide Professional Staff support to

the RVH Emergency Department

AMU 8 hours per day, 7 days per

week, 52 weeks per annum

800 2

3


the RVH Emergency Department and



1000 1

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The preferred option from the non-financial analysis is:

Option 3:

Provide Professional Staff support to the RVH Emergency Department and AMU 8

hours per day, 7 days per week, 52 weeks per annum

SECTION 6: ASSESS RISKS AND UNCERTAINTIES

A risk management approach was adopted to identify, assess and control the risks

that could emerge in the preparation of the business case and during the course of

the project. The aim of this approach was to:-

a) identify possible risks in advance and if necessary consider mechanisms to

minimise the likelihood of their having a material impact on the process

b) ensuring processes are put in place to monitor potential risks

c) having a decision making process supported by a framework of risk analysis and

evaluation

A review of the potential risks was carried out by the project team and details are

included in the table below:

Risk Description

State how the

options compare and

identify relevant risk

management /

mitigation measures

Opt

1

Opt 2

Opt 3

Recruitment of staff into 7

day rotas covering RVH

ED and AMU

L

H

H

This risk will have to be

mitigated through the

recruitment process. Then

into the planning of rotas to

ensure that resource is

available.

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Overall Risk (H/M/L):

L

H

H

SECTION 7: PREFERRED OPTION AND EXPLANATION FOR SELECTION

Non-Financial Analysis

The summary of scores and ranking of the non-financial analysis is detailed below.

Option Description Weighted

Score

Ranking

1 Continue with 5 day service 380 3

2


the RVH Emergency Department 8


weeks per annum

800 2

3 Provide Professional Staff support to

the RVH Emergency Department and



1000 1

Financial Analysis

The summary of costs from the financial analysis is detailed below.

Option Description Annual

Revenue Costs

Ranking

1 Continue with 5 day service Base case 3

2 Provide Professional Staff support

to the RVH Emergency

Department 8 hours per day, 7

days per week, 52 weeks per

annum

£874,094 2

3 Provide Professional Staff support £1,650,851 1

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to the RVH Emergency

Department and AMU 8 hours per

day, 7 days per week, 52 weeks

per annum

The preferred option from the financial analysis is:

Option 3: Provide Professional Staff support to the RVH Emergency Department

and AMU, 8 hours per day, 7 days per week, 52 weeks per annum

Preferred Option and Reason for selection

The Preferred option for the purposes of meeting the objectives is Option number 3.

This would provide a social work, pharmacy service, Occupational Therapy and

Physiotherapy service to the RVH Emergency Unit and the Acute Medical Unit 8

hours per day, 7 days per week and 52 weeks of the year. Therefore assessments,

treatment and discharge could take place more effectively and delays in these

patient pathways would be minimised. The cost of this option is £1,650,851. Option

number two is a first step towards this option in delivering the extended service for

the RVH Emergency Department and would provide the above benefits to that area

only. The cost of this option is £874,094.

SECTION 8: ASSESS AFFORDABILITY AND FUNDING ARRANGEMENTS

This section of the business case considers the potential impact on the recurring

revenue position for the Trust and the initial capital investment required to deliver the

preferred option.

To proceed with the preferred option requires the below investment:

Additional Capital Investment Nil

Additional Revenue Costs £1,650,851

Full costings are available in Appendix 1.

SECTION 9: PROJECT MANAGEMENT

The delivery of this business case will be managed through the respective service

areas. The Post Project evaluation will be carried out 6 months after the services

have been put in place but outcomes will be monitored monthly.

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SECTION 10: MONITORING AND EVALUATION

(To include post project evaluation)

The implementation of a recurrently funded service will be led from within the

BHSCT Unscheduled and Acute Care Service Group. It will be managed by the

Service Manager.

The following table demonstrates how the monitoring and evaluation will be

undertaken.

SECTION 11: ADDITIONAL ACTIVITY

Activity levels expected for each of the 3 Professional areas will need to be set

dependent on the investment made.

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SECTION 11: ADDITIONAL ACTIVITY

Specify the additional activity commensurate with the value of the Investment Proposal Template (expand as required where more service

lines are involved.) Please ensure that any changes in activity arising from productivity and efficiencies associated with the investment are

also recorded. See example.

Activity From

(previous SBA

baseline)

Activity To

(New SBA Baseline)

Please specify if

activity relates to

Investment or

Productivity /

Efficiency Gains

PoC Service line

descriptor 1

Service line

descriptor 2

Currency

use existing SBA

currency e.g. (FCE / OP

atts / Daycase / contacts

/ caseload / Occupied

Beddays / Hours etc

Full Year Effect Total Current Year

Effect Total

Full Year Effect

Total

I - Investment

P - Productivity

Acute Gen Surgery Vascular FCE 1200 500 2000 P

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level 3 investment proposal template revenue funding … · 2017-05-17 · approval of investment...

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