NHS GRAMPIAN
Infrastructure investment Programme
Replacement of the PET/CT Imager and the Carbon Energy FundScotland
1.Aim
The purpose of this paper is to request approval from the NHS Grampian Board to proceed with the following two major infrastructure projects:
- Replacement of the PET/CT Imager at Aberdeen Royal Infirmary (ARI).
- Investment in replacement energy efficient plant at ARI, Dr Grays and Royal Cornhill Hospital (RCH) in partnership with the Carbon Energy Fund Scotland (CEFS).
2.Strategic Context
Both of the planned projects fit clearly with NHS Grampians strategic theme of delivering high quality care in the right place through providing safer, effective and sustainable services. In addition each project fits national strategy as follows:
- PET/CT replacement
The replacement of the existing PET/CT[1] Imager is consistent with HDL (2003) 63 which sets out the actions to be taken by NHS Scotland to secure access to PET services and plan for the medium and longer term.
- Carbon Energy Fund (Scotland)
The Scottish Government’s commitments under the Climate Change Act 2009 and associated HEAT performance targets require all NHS Boards to reduce energy consumption and associated greenhouse gas (GHG) emissions across their estates.
3.Discussion
- PET/CT replacement
The Standard Business case for replacement of the existing PET/CT equipment is attached at Appendix 1 for Board consideration and approval.
Key points to highlightin relation to the business case are as follows:
- Demand for access to PET is forecast to continue growing having reached the stage in development and application where it is a cost effective clinical diagnostic tool that is firmly embedded in almost all cancer pathways.
- The replacement of the PET/CT Imager is part of a nationally agreed programme and Scottish Government Health and Social Care Directorate have confirmed that the required level of capital funding (£2.07m) will be allocated to NHS Grampian in 2014/15 in line with our Local Delivery Plan.
- The current machine will be fully life expired when the replacement is due.
- There are additional revenue costs of £97,000 per annum relating to increased service costs and depreciation on the new equipment and this has been fully provided within our existing financial plans.
- Carbon Energy Fund (Scotland)
The Initial Agreement for replacement energy efficient plant at ARI, Dr Grays and RCH in partnership with the CEFS is attached at Appendix 2 for Board consideration and approval. Key points to highlightin relation to the business case are as follow:
- NHS Grampian requires toimprove its performance in terms of energy consumption and GHG emissions. The 2011/12 HEAT Target report showed that NHS Grampian’s energy consumption had increased by 5.8% from the baseline year, and that GHG emissions had increased by almost 11% over the same period.
- NHS Grampian has the third highest energy-consuming hospital in Scotland (Aberdeen Royal Infirmary) and has a number of hospital sites with energy consumption well in excess of the Scottish national average (including AberdeenMaternityHospital and Dr Gray’s Hospital).
- The CEFS has been established as a joint venture partnership between the Carbon and Energy Fund andNHS National Services Scotland (National Procurement and Health Facilities Scotland) to allow health boards in Scotland to progress large-scale energy investment opportunities.
- Following an independent feasibility study, significant opportunities for energy efficiency improvements at three NHS Grampian sites have been identified: Foresterhill Campus, RoyalCornhillHospital and Dr Gray’s Hospital.
- The CEFS offers a competitive procurement route that will encourage innovation and result in the best solution – both economically and technically – for NHS Grampian. The CEFS provides the option of a third party service financing and owning any installed equipment. Ongoing operation can be carried out by the third party, or by NHS Grampian staff.
- The third party service provider will supply, and possibly maintain, the plant under a service contract with NHS Grampian, the costs of which will be covered by guaranteedsavings from reduced energy consumption and GHG emissions.
- The terms of the service contract obligate the third party provider to deliver guaranteed net cash savingsthrough a mixture of reduced energy consumption and GHG emissions.
4.Key Risks
Failure to progress either of the planned projects will result in existing infrastructure being no longer fit for purpose (Strategic Risk number 855).
PET/CT
- More modern PET facilitieshave enhanced imaging functionality which improves the quality of diagnosis.
- Downtime is likely to increase as equipment becomes obsolete with the machine eventually taken out of use if not replaced.
- Without replacement and access to PET/CT scanning there would be a delay in access to treatment.
- CEFS
- The purchase of allowances from central Government to cover GHG emissions currently costs NHS Grampian circa £0.5m per annum. Carbon emission targets and therefore the cost of allowances will increase incrementally in future years in order to encourage active reduction in GHG levels. Failure to significantly reduce emissions on our major sites, will not only mean that we do not comply with national targets, but will also result in increased costs associated with the purchase of carbon allowances, diverting resource from direct patient care.
5.Recommendation
The NHS Grampian Board is asked to:
- Approve the Standard Business Case for replacement of the PET/CT Imagerat ARI and
- Approve the Initial Agreement to proceed with investment in replacement energy efficient plant at Foresterhill Campus, Dr Gray’s and RoyalCornhillHospitalin partnership with the CEFS and NHS National Services Scotland.
Alan Gray
Director of Finance
17 May 2013
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[1]A positron emission tomography (PET) scan is used to produce a detailed, three-dimensional picture of the inside of the body. The images clearly show the part of the body that is being investigated and can also highlight how effectively certain functions of the body are working. For example PET scans are used to help diagnose a range of different cancers and work out the best ways of treating them. The information provided by a PET scan can show how far a cancer has spread or how well it is responding to treatment