Moray Lifescience Centre

Standard Business Case

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Moray Lifescience Centre

Standard Business Case

V5. September 2010

Table of Contents

1.Executive Summary

1.1.Introduction

1.2.Background

1.3.Case for Investment

1.4.Financial Aspects

1.5.Capital Cost of Preferred Option

1.6.Revenue Cost of Preferred Option

1.7.Recommendation to NHS Grampian Board

2.Background

3.Strategic Context

4.The Vision

5.The future - Key Assumptions

6.Description of Service

6.1The Current Service

6.2The Proposed Service

7.The Options for Achieving the Project

8.The Need

9.Implications of Not Meeting the Need

10.The Project Objectives

11.The Benefits From the Project

12.The Proposed Building Solution

13.Capital Cost

14.Revenue Impact

15.Stakeholder Support

16.Procurement

17.Recommendation

APPENDIX 1 – Design Team Plans

1.Executive Summary

1.1.Introduction

The purpose of thisStandard Business Case (SBC) is to request the approval of the NHS Grampian Board to proceed with the implementation of the preferred option for the provision of aLifescience Centre in Moray.

1.2.Background

The need for enhanced educational, skills development and research capacity in the Moray area has been identified as a priority for action by clinicians, managers. In addition,Highlands and Islands Enterprise (HIE) have included investment and development in this area as a priority within the Moray 20/20 Economic Plan.

NHS Grampian and HIE have the opportunity to provide a grant fund to enable the development of a Lifescience building to meet the future health and care requirements.

The minimal training facilities at Dr Gray’s, and in Moray as a whole, are currently fully utilised. This is impacting on the professional development opportunities for healthcare staff based in Moray. Currently, most new recruits have to travel outside the Moray area to complete their training.

The constrained nature of the Dr Gray’s site means that there is no space for a development of this type; however, working in partnership with the MorayCollege, a site on their campus has emerged as the preferred location.

Moray College UHI is a major player in the UHI Millennium Institute. The College is pledged to maximise the impact in Moray of economic opportunities offered through the creation of a University for the Highlands and Islands. An essential requirement to achieve this is to bring about a significant transformation to the main campus in Elgin, commensurate with a key partner within a new university venture. This proposal for a Lifescience Centre forms a key element within the overarching masterplandrawn up to effect this.

The NHS Grampian Board confirmed its support of the Lifescience Centre at the MorayCollege at its meeting on 1st September 2009, subject to the submission of a SBC to AIG.

1.3.Case for Investment

The development of a Lifescience centre addresses/supports the fact that:

  • There is no purpose built training facility between Aberdeen and Inverness
  • Current facilities do not meet the needs of the services
  • NHS Grampian is committed to sustaining clinical services at Dr Gray’s, as part of its blueprint for the future.
  • Staff have to leave Moray to complete their training
  • Dr Gray’s site is too constrained for this development
  • Land is available at MorayCollege, which has oral support for development from the Local Planning Authority
  • Strategic link to UHI Millennium Institute and Elgin’s future as a university town.
  • Funding is available to support the development from MorayCollege, HIE, European Regional Development Fund grant funding is in place
  • The objectives support the outcomes contained in Moray’s Single Outcome agreement (SOA).
  • NHS Grampian support of this development demonstrates its commitment to economic regeneration, as detailed in the Local Delivery plan, Annexe 6.
  • The development of a Lifescience Centre was identified as a priority by the Government Task Force in the Moray 2020 report as part of the sustaining of the Moray economy following the risk of the closure of the RAF Air Bases, and part of wider regeneration of Elgin and Moray. The risk to sustaining health service remains should the air bases be threatened with closure.

1.4.Financial Aspects

Through a process of value, space and design re-engineering, the total floor is proposed at 1,950m2, whilst the total project costs being £6 million. NHS Grampian will make a Capital Grant of £1m available to the MorayCollege in order that the Lifescience Centre can be delivered.

The project will deliver a facility that will be managed by the MorayCollege, within the Community Planning framework, to improve the overall health and social well being of the local population.

Ownership and legal title will lie with the MorayCollege who will be responsible for the operation of the facility in line with the articles of association

NHS Grampian have no interest (controlling or minority) in the MorayCollege.

1.5.Capital Cost of Preferred Option

NHS Grampian is asked to contribute £1million as a capital grant to support the development of the centre.

1.6.Revenue Cost of Preferred Option

There is no additional revenue cost associated with the development of the Lifescience centre. Any running costs of the building, incurred as part of the occupancy of the building, will be met from existing training and development budgets.

The College will create a facilities management group to oversee the ongoing operational management of the premises. Membership of the management group will be made up all of the users of the building.

Charges for the use of the building will be set at a level to recover actual operating costs. An annual budget will be agreed with the facilities management group and each user will pay a proportionate share of the estimated actual running costs of the facility.

1.7.Recommendation toNHS Grampian Board

It is recommended that NHS Grampian allocate the capital grant to The Moray College for the development of a Lifescience Centre.

2.Background

In December 2005 HIE Moray produced a strategy and action plan, “Moray 2020”, for diversifying the Moray economy. This document describes a vision for Moray in 2020 and an approach to achieving this vision that included a wide range of projects aimed at stimulating sustainable developments in the economy. In relation to healthcare, the document identified a number of specific actions worthy of exploration:

  • International Learning Centre for Health and Community Care in Remote and Rural Areas
  • Realising and marketing Moray’s Health and Social Care potential
  • Promoting Moray as a source of North of Scotland healthcare services
  • Chair in Healthcare Training in Remote and Rural Areas (UHI)
  • Chair in Integrated Health Care Management (UHI)
  • Managing Integrated Health and Social Care (development of a training programme)

A subsequent scoping exercise examined the capacity of the Moray healthcare sector to develop its resources and thereby generate economic activity within the region. This exercise concluded that whilst the healthcare sector in Moray, like the rest of the NHS, is facing considerable challenges (ageing population, diminishing financial and human resources etc), the region has strong competencies and assets which could be leveraged to allow the region to develop its healthcare model and generate more economic activity for the area.

The above led HIE Moray, in partnershipwith local NHS managers and clinicians, to identify the potential for developing a Lifescience building in Elgin. The aim of this building being:

  • To act as a single focus for a co-ordinated response to the actions identified in Moray 2020and aimed at stimulating economic growth in the region through development of the local healthcare model and capacity.
  • To encourage, enable and facilitate developments in the range of healthcare initiativesrelating to Moray that can be broadly categorised as “life Science”.

3.Strategic Context

The Scottish Governments consultative document Better Health Better Care emphasises the principles regarding the need to encourage innovation within a modern health service. It also makes clear the Governments priority for Economic Development as a key issue for all public agencies.

The agenda for redesign and service change in Grampian was set in 2002 when the ‘Healthfit’ planning and redesign process was conceived. In 2002 a range of clinical professionals, managers, public and patient representatives and politicians came together and agreed the way forward for the health system in Grampian. This is described in the Healthfit vision as follows:

  • Grampian will combine the strengths of primary care and acute services with the strong traditions of teaching and research, to provide a system that other NHS areas seek to emulate.
  • Patient flow will be organised to ensure that each element of the system operates effectively and efficiently.
  • The local planning and delivery of health services in Grampian will be central to the success of the health system. Empowered localities and communities will influence and take responsibility for health and social well-being within a Grampian framework for health improvement and development.
  • The focus of services will be on networks of care that fully integrate the contribution of all clinicians. The North of Scotland networks will develop to maximise the sharing of services, facilities and educational opportunities. The formalisation of networks will result in the appropriate organisation of specialist services in Aberdeen, Inverness and Elgin to maintain the highest standards of clinical governance and will provide stability for tertiary services in Grampian and indeed, throughout Scotland.
  • Specialist acute services will concentrate on providing services for defined patient conditions which require specialist skills and facilities that can only be provided in central locations. This clarity of role will enable the reorganisation of services at Foresterhill, Woodend and Dr Gray’s Hospitals to concentrate on the provision of specialist services as part of the Grampian system and has reduced the pressure on these services.
  • The clearer definition of specialist services will stimulate the creation of a range of new intermediate care services that are provided jointly by primary and secondary care clinicians. Intermediate care services will deliver treatment and care for patients who require more support than is normally provided at GP practice level, but do not require the specialist services of the acute hospitals.
  • The development of rapid access, diagnostic and treatment centres will stimulate innovation such as mobile diagnostic facilities and the increased use of telemedicine and result in the reorganisation of services provided to communities, balancing the need to provide clinically safe services, as well as local convenience and accessibility.
  • The development of diagnostic and treatment centres, combined with a shift in the balance from long-term NHS care to more innovative and integrated community-based health and social care services, will change the form of community hospitals across Grampian. The modernisation of services will stimulate a range of different community solutions, including NHS, local authority, voluntary and private sector partnerships, sharing skills and resources and allowing alternative funding opportunities to be exploited to provide improved local services.
  • Joint working between the NHS, local authorities, the voluntary and private sectors will be developed to provide an integrated, joined-up health and social care system for the people of Grampian, based on their individual needs.
  • New roles will be developed in recognition of the need to make best use of existing skills, and the scarcity of others. The contribution which nurses, and the other professions allied to medicine, can make to treatment and care will be extended and supported. The education and training organisations in Grampian and the North of Scotland will also develop integrated approaches to support new ways of working in the health system.

The development of a Lifescienceinfrastructure will facilitate Healthfit for Grampian’s population.

4.The Vision

The vision that underpins the proposal for this project is one of creating a new facility that will provide a focal point for a range of health care learning, education, research and enterprise activities. It will encourage, facilitate and enablegrowth, interaction and innovation in life sciences.

This Lifescience building would be used by:

  • Undergraduate and postgraduate students.
  • A wide range of health and care staff from all clinical and care services.
  • Healthcare practitioners for their continuing professional development and for undertaking research and development work.
  • Commercial partners in life science for real time testing/development of products, ideas, care processes and services.
  • The public as part of their health self care.

5.The future - Key Assumptions

The project is based on some key assumptions in relation to the future:

  • It will increasingly be possible to provide health services safely and effectively in community settings, closer to peoples’ homes.
  • Life Science will become an integral part of health and care.
  • Innovation and enterprise will be key to fostering solutions to Scotland’s health and care issues for the future.
  • Transport services in remote and rural communities cannot realistically improve to the point where access to services in distant population centres becomes convenient and/or preferable.
  • The range of diseases amenable to health service intervention will continue to widen, adding to demands on services. It will be possible to tackle hitherto untreatable diseases with these patients living longer and making greater use of healthcare services.
  • The demand for locally based services will increase and this will mean using facilities and staff in an imaginative way to expand capacity to meet this demand.
  • Peoples’ expectations about the services that they receive and where and when they receive them will continue to increase and meeting these expectations will remain a social policy priority.
  • Significant and sustained improvements in health and well being will be achieved through supported self care and services and facilities are needed to motivate people to look after themselves and to help them to do this.
  • Interagency collaboration, multidisciplinary working and service integration are vital to the effective provision of services and will continue to become the preferred model of service delivery.
  • Medical advances will in the long-term enable significant shifts in the focus of the healthcare services from “treatment of ill health” to the “prevention of ill health”.
  • Advances in medical technology will continue to drive changes in clinical practice and the development of new models of service provision.
  • The current policy to invest in primary and community care services and the “rebalancing” of service provision between local communities and acute centres will continue.
  • The real problems of present hospitals regarding cross infection (HAI) will increasingly drive policy towards maximising the delivery of healthcare outside of acute centres.
  • An evidence base that confirms that treating various groups of hospital patients in alternative settings is better value for money will increasingly emerge.
  • Clinical governance will help to ensure that the available evidence on what works and what doesn’t is disseminated and appropriate guidance is in place.

6.Description of Service

6.1The Current Service

There is currently no Lifescience facility in Moray. There is a Health Sciences Complex at RaigmoreHospital, Inverness and recently completed Suttie Centre for Life Sciences Centre at Aberdeen Royal Infirmary. Travelling to these sites is not a practical option for professionals working in Moray.

Training and education facilities are poorly developed within Moray. Some facilities are in existence at Dr Gray’s Hospital but fall short of modern standards for undergraduate and post graduate education.

6.2The Proposed Service

It is proposed to build a dedicated facility in Elgin to benefit from close proximity to existing educational services at Dr Gray’s Hospital and within the MorayCollege. Elgin is geographically central within Moray and is within half an hour travelling distance from most locations. It is also accessible for professionals in West Aberdeenshire and East Highland.

7.The Options for Achieving the Project

There have been a number of options generated to meet the needs set out in this paper.

Options for the Lifescience Centre: -

  1. Do minimum- this will not meet the project objectives and severely compromise the future development of services in the area.
  1. Refurbish existing Educational Facilities- these are limited in scope due to their type and location.
  1. New Build on Dr Gray’s Site- there no available site which can accommodate the building.
  1. New build in another location within Elgin- This would need to be within easy reach to meet the needs of the Dr Gray’s based staff and not to diminish the scope for connecting activities with the existing training infrastructure.
  1. Lease an existing premises- there is no known available suitable building and has the deficits as per no.4.

8.The Need

HIE and NHS Grampian jointly commissioned a study to determine the need for investment in health and care. The following summary is taken from the study.

It is important to recognise that clinical skills teaching across all health related disciplines at undergraduate and postgraduate level is set to increase exponentially again over the next five to ten years in order to satisfy clinical governance, patient educational demand and patient acceptability.

The European Working Time Directive affecting medical staff has and will cause a significant re-arrangement of postgraduate medical education. Doctors and nurses of the future must be trained on a fewer number of patients over a shorter period, and their educational experience from each real patient must be used to maximum advantage. The accreditation systems to judge competence following training and clinical experience will become increasingly more complex, relying on log books, videos and demonstration of competence on simulators.

Generally, it is projected that the increasing pace of development of healthcare training over recent years will continue for the foreseeable future driven by:

  • Advances in medical technology, related changes in clinical practice and new models of service provision.
  • The roles of healthcare professionals will continue to develop and extend both within professions and across traditional professional boundaries driven by workforce issues (declining working population) which will require fewer numbers of people to take on a wider range of duties.

Currently, most local new recruits to the healthcare professions will need to go outside of Moray to complete their training due to the limited availability locally. This can have a number of disadvantages: