JHO10 – page 1
OUTLINE BUSINESS CASE
HENLEY HEALTHCARE VILLAGE, HENLEY ON THAMES
Introductory paper for the Overview and Scrutiny Committee on the OBC for the proposed Henley Healthcare Village
Presented by Jackie Adams Director of Clinical Services and Quality and Mark Bristow Project Director
Version:Draft 2
Date:25.05.05
Author:Mark Bristow
(1) Introduction
This Outline Business Case (OBC) is for the re-development of the Community Hospital in Henley on Thames, currently on the Townlands site. This is supported by the development of associated domiciliary services for the Townlands catchment population.
Extensive patient and public involvement has occurred to date, including two open public meetings. Furthermore the service model, delivery options and an introduction to the site appraisal exercise included in the OBC have been developed in partnership with the Townlands Steering Group of local stakeholders and presented to stakeholders in Wallingford, Harpsden and the League of Friends. This ownership will however be widened to ensure all stakeholders have the opportunity to comment on and steer proposals as they progress to FBC stage. Initial responses have as anticipated been positive, since this OBC aims to improve service delivery. It is acknowledged that a formal 3 month consultation exercise will be needed but it is considered that it would be most appropriate to undertake this exercise during the Full Business Case preparation stage.
Financial summary
Costs over 30 years.
Option 1 Option 2 Option 2a Option 3
(Do min) (20 beds) (20 beds) (20 beds)
Net present value of costs over
30 years (40% social housing)
Existing site£m 36.3 36.3 35.8 35.0
Allotments site£m - 34.9 34.3 33.5
Annual revenue costs £0002,8082,2192,3652,192
Up-front public sector capital requirement
net of land sale (40% social housing)
Existing site£m 4.4 7.5 (4.3) 4.5
Allotments site£m - 5.9 (5.1) 3.3
Current services
Townlands is one of six community hospitals managed by the South East and South West Oxfordshire Primary Care Trusts. The minimum catchment population for Townlands is 26.600, and this includes residents of Henley, Sonning Common, Shiplake and Nettlebed, together with a proportion of Watlington and Goring population.
Services currently provided at Townlands include:
Outpatient peripheral clinics run by Royal Berkshire and Battle Hospital and Nuffield Orthopaedic acute Trusts
Outpatient physiotherapy, speech and language therapy and podiatry
X-ray department providing plain film x-ray
Minor Injuries Unit
Out of Hours Medical Centre
Mental Health outpatient clinics for child and adolescent mental health and adult mental health services, together with a staff base for community nursing and medical staff.
20 bedded Intermediate Care Ward (Peppard Ward) providing a mix of ‘step up’ and ‘step down’ care and palliative care
Services currently provided at Townlands include a five partner GP practice on the site which provides support to the Intermediate Care Ward
15 bedded (12 open) Younger Disabled Unit providing a mix of respite, continuing and sub acute care to a group of patients with progressive neurological conditions such as Multiple Sclerosis.
A home based Intermediate care service is provided for residents in the Henley catchment area by the Intensive Community Support Service, which is based at Wallingford Hospital. This service was extended to cover the Henley catchment area in autumn 2003. The service provides the umbrella for both the community Rehabilitation Service and the Rapid Re-enablement Response Service.
Strategic context & drivers for change
The re-development to provide Henley Healthcare Village proposed in this business case sits comfortably within a national and local strategic context and will help to provide the level of Healthcare the PCT and its stakeholders are aspiring too. It will also help to maintain and improve clinical standard through effective local management, recruitment and retention.
The recent development of enhanced services at Townlands has increased the viability of the site as a lively hub for provision of ambulatory care services. These include a hub for the Out of Hours service, an expanded minor injuries unit and a commitment by the Oxfordshire Mental Health care Trust for the continued use of the Townlands site as a base for outpatient and community mental health services.
Independent study undertaken on behalf of Oxfordshire County Council Department of Health and Social Care not only supports this Business Case in terms of demographic trends but also illustrate the clear need for a 60 bed nursing home and point to this being commercially viable.
Future activity requirements
Detailed activity modelling has subsequently been completed for the Townlands catchment population for home and hospital based intermediate care services. This indicates that including a planning contingency allowance for future proofing, by 2018 the local population will require upto 20 inpatient intermediate care beds.
Henley Healthcare Village Model
Service Delivery
The strategic context and drivers for change work has resulted in a model of service which provides Local Ambulatory Care centre, Intermediate Care beds plus increased home based intermediate care services and the need for a 60 bed Nursing Home in Henley.
The clinical services included in this model are as follows:
Intermediate Care Unit (ICU) to be physically constructed to accommodate up to 20 beds
Community Support Unit (CSU) it is anticipated that this will provide the facilities for a number of services as listed below together with providing the flexibility referred to above.
Services to be provided:
- Outpatients physio – including a falls clinic
- Outpatients clinic
- Outpatients toilets and changing facilities
- Outpatients medical records
- Outpatients podiatry
- Outpatients Speech and Language Therapy
- District Nurse/Health Visitor
- Dental services
- Minor Injuries Unit }
- Out of Hours service } Integrated Emergency Care Service
- Diagnostic Radiology services
- Hospital admin and management
- Mental Health Services (current)
The services specifically excluded from this business case are the following:-
Younger Disabled Unit Ward
Older People Day Services – single day room currently provided, with no additional facilities
Intensive Community Support Service (Admin Unit)
The rationale behind exclusion of these services being as follows:-
The picture concerning the future of the YDU is currently unclear since it is funded and commissioned by Berkshire and there are indications that they wish to support their patients in a different location. If, however, decisions are made to retain then YDU, jointly by commissioners and the PCT then there is space on the site for its construction.
Older People Day Services as existing (single day room) are not deemed to be an absolute necessary provision for this site since there is already an excellent Day Hospital providing more extensive facilities available locally at Wallingford. Intermediate Care Support Services (ICSS) are currently provided for Henley and the surrounding area. This provision is based at Wallingford and it is proposed to continue providing this service from its current Wallingford base.
The above Service Delivery Model is consistent across all Project and Site Delivery options and this Outline Business Case proposes that this model is agreed.
Project Delivery
There are a range of delivery options for this service option. These options are differentiated by the degree to which the NHS builds and runs services compared to the degree to which the private sector is involved as a partner to the NHS in building and running services.
The preferred service delivery in the OBC is for the site ownership to be retained by the PCT/or other charitable organisation, the buildings to be funded and constructed by a private developer and the PCT to then lease the buildings over 30 years
Site Delivery
Alternative sites have been investigated and to take this work forward a planning application on the Townlands site needs to be made together with traffic assessment. A flow chart and timetable to take this work forward during the FBC stage has been identified.
The preferred site is therefore the existing Townlands Site.
Key Areas of Further Work
- Review the discrepancy between the District Valuers Valuation of the Townlands site and the Commercial Valuer.
- On the Townlands site lodge a Planning Application
- Clarify with Bracknell Forest PCT if they are to cease commissioning the YDU.
- Engage nursing home provider(s) in delivery option discussions.
- Test leasing assumptions in delivery option 2a.
- Further explore opportunity offered by Henley Town Council in their setting up of a Charitable Trust in support of this Business Case.
- Test SLA assumptions in delivery option 3.
- Review possible effect of Healthcare village on Acute Hospital referrals
- Receive feedback from TVHA on their requirements following their letter of 27th April requesting the resubmission of the OBC
Timescale and deliverability
The project timetable is as follows:
March 2005OBC completed (Decision by PCT 24th March)
May/June2005OBC formally considered by TVHA Capital Review Group (20th April) TVHA Requested resubmission.
July 2005Resubmission of OBC detail and date to be confirmed
June 2005 toTake forward appraisal of Site Delivery Options for decision.
April 2006
Sep 2005 toOBC approved by TVSHA
Nov 2005
Oct 2005 toFormal public consultation of Henley Health Care Village
April 2006
Sept 2005 toMarket testing for private partner + further development of
July 2006 comparator
September 2006Completion of Full Business Case
December 2006Full Business Case approval, by PCT & TVSHA
January 2007 Award of contract
April 2007 Construction work starts
January 2009 Construction work completed
A robust project management structure has already been put in place by the PCT. This adheres to both NHS Capital Investment Manual and PRINCE methodology, and will be able to see the project through the Full Business case and construction stages of development.
JHO_JUN0905R10.doc