Introduction to the Green Book & Appraisal Process New photo to come Update August 2020 1
Welcome and introductions Louise Halfpenny Director of Communications West Herts Hospitals NHS Trust 2
Purpose of today’s session • Feedback on Investment Objectives and Critical Success Factors • Introduction to the HM Treasury Green Book • Overview of WHHT long list appraisal process 3
Your hosts for this session Duane Passman Helen Brown Acute Redevelopment Deputy Chief Executive Programme Director West Herts West Herts Hospitals NHS Trust Hospitals NHS Trust Louise Halfpenny Communications Director West Herts Hospitals NHS Trust 4
Great Place Programme Helen Brown Duane Passman Paul Bannister Deputy Chief Acute Redevelopment Chief Information Executive Programme Director Officer Clinical Estates Finance and Comms and Digital workstream workstream Activity Engagement Transformation workstream workstream workstream Don Richards Louise Halfpenny Sean Gilchrist Paddy Hennessy Esther Moors Chief Finance Director of Director of Digital Director of Associate Director Officer Communications Transformation Environment of strategy Tim Duggleby Mike Van der Watt Associate Director Chief Medical Officer Strategic Estates Tracey Carter Redevelopment Chief Nursing Officer Freddie Banks Royal Free ATOS Associate Medical Property Ltd Barclay Director PA Consulting & specialist Partnership advisors Deloitte
Critical Success Factors Crtical Success Factors Investment Objectives and Critical Success Factors Investment objectives 6
Investment Objectives and Critical Success Factors • The Investment Objectives (IOs) set out what we are aiming to achieve through the programme. • The Critical Success Factors (or essential criteria ) (CSFs) are used to support a ‘high level’ evaluation of the longlist and arrive at a shortlist to be considered in more detail. • You were asked to feedback on the draft Investment Objectives and Critical Success Factors in June 2020. • Your feedback was published on our website and taken to the Programme Board in August along with an updated set of IOs and CSFs for approval. • We have made some changes based on the feedback we received. 7
Snapshot of your feedback Question Yes (%) No (%) No response or commented instead Q1. Do you think these are the right investment 44% 34% 18% objectives? Q2. Do you think the essential criteria will help 40% 42% 16% us to rule out undeliverable options for the shortlist? Q3. If you answered no, please tell us what other Comments were provided. A summary of key investment objectives we should include and points and our responses has been shared with other essential criteria we could use to reject SRG members. undeliverable options Q.4 44% 22% 32% Do you agree that the investment objectives and essential criteria will help rule out options which do not support what we want for our patients? 8
What is the scope and ambition of the programme? DO EVERYTHING All services + All sites + Condition and suitability to standard ‘A’ + 60 year building life + additional capacity to 2055 = 100% new build = £1bn+ = unaffordable / won’t get the funding . Investment objectives set out what we think are the priority ‘must haves’ from this investment .. DO SOMETHING Emergency care services the highest priority. Minimum Condition B / Suitability B and 30 year life. Capacity to 2035 & flexibility to expand in future. Time line – by 2025 / 2026. Expected capital available = between c£300m and £550m but subject to business case and treasury approval. Planned care (HHGH and SACH). Essential investment only at this stage to support service provision & address poorest condition estate and enable HHGH to be rationalised. Minimum 15 year life. Expected capital available = c £50m BAU and Do Minimum – required by HMT within shortlist. 9
Approved Investment Objectives HM Treasury Investment Description category objective a. Improve patient and staff experience [New] • Providing facilities that support safe care and promote improved patient and staff experience – in line with Health Building Notes (HBNs) (any derogations from HBNs to be clinically approved) [Moved] • Improving patient satisfaction scores in patient surveys and PEAT scores [New] • Improving staff satisfaction scores in the annual NHS survey and recruitment and retention [New] b. Emergency care services 1. Provide fit for • Providing the required capacity to meet forecast growth in demand until at least 2055 2035* [Changed] Effectiveness purpose buildings • Achieving condition B and functional suitability B by 2025/2026 Compliance from which to • Ensuring at least a 30-year lifetime deliver acute Replacement • Providing a resilient core infrastructure which is compliant with applicable regulations and standards healthcare services c. Planned care services • Providing the right capacity to meet forecast growth in demand until at least 2030 2035*† [Changed] • Achieving condition B and functional suitability B by 2030 2025/2026 [Changed] • Ensuring at least a 15-year lifetime d. Improve environmental sustainability of our estate, in line with the Government’s commitment to be carbon neutral by 2050 • Ensuring emergency and planned care services are separated as far as possible by 2025 [Deleted – duplicate] • Ensuring all new/redeveloped facilities support best practice ways of working and exploit new technology • 2. Improve clinical For each specialty (or sub-specialty), provide services from no more than two sites by 2026 (with exception of sustainability of the high-volume specialties (e.g. maternity, diabetes which need to be delivered from a minimum of three locations) Efficiency Trust • Optimise adjacencies in line with clinical strategy, including ensuring appropriate diagnostic provision to support clinical pathways • Ensuring emergency and planned care services are separated as far as possible 3. Support the Trust and the health system to achieve long-term financial sustainability Economy n/a *Growth beyond 2035 will be met by a combination of demand management, new care models and new technology, we will also ensure flexibility for growth in our design and detailed site plans †NB we are prioritising investment in emergency care 10
Approved Critical Success Factors HM Treasury Critical success factor Revised threshold for OBC category • 1. Strategic alignment The option must deliver the objectives and provide flexibility for the future • The option must support an improvement in patient experience from current 2. Patient experience levels Strategic fit and business needs • The option must at least maintain support an improvement in patient service 3. Quality quality and safety at from current levels [Changed] • 4. Access Services must be located to maintain or improve access for the local population • The option must have the potential to provide quantifiable benefits over the Potential value 5. Value for money appraisal period (including both healthcare benefits and operational cost savings) for money that exceed the upfront capital investment Supplier capacity n/a and capability • Potential The option must have the potential to allow the Trust to return to a recurrent 6. Affordability affordability break-even position within three years of completion of the investment • The site locations must have sufficient space to accommodate the requirements of the preferred model of care for the relevant site configuration option, provide flexibility for the future, [New] and be capable of being delivered without undue Potential disruption to clinical service delivery 7. Deliverability achievability • The option must be able to deliver significant improvements to emergency and specialist care facilities by 2025/26 and not be subject to significant planning or delivery risk [New] 11
What is the Treasury Green Book and Business Case Guidance? Stakeholder Reference Group 12
Introduction to the Green Book • The Outline Business Case has to meet the requirements set out in the HM Treasury Green Book guidance on how to develop and appraise investment proposals. • Green Book guidance applies to all proposals that concern public spending. • It provides approved guidance and methods for developing options which are rational and transparent. 13
HM Treasury’s approach to developing business cases The business case is developed in three stages, each aimed at a different decision Case for change Best value for established and a Preferred option money supplier preferred way identified chosen forward identified Strategic Outline Case Outline Business Case Full Business Case Decision to Decision undertake a Decision to proceed to sign thorough appraisal with procurement contract of the shortlist 14
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