Introduction to the Green Book & Appraisal Process Update - August 2020 New photo to come
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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
Helen Brown Duane Passman
Deputy Chief Executive Acute Redevelopment
West Herts Programme Director
Hospitals NHS Trust West Herts
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
Esther Moors Paddy Hennessy Don Richards Louise Halfpenny Sean Gilchrist
Associate Director Director of Chief Finance Director of Director of Digital
of strategy Environment Officer Communications Transformation
Tim Duggleby
Mike Van der Watt
Associate Director
Chief Medical Officer
Strategic Estates
Tracey Carter
Redevelopment
Chief Nursing Officer
Freddie Banks
Associate Medical Royal Free ATOS
Director Property Ltd Barclay
PA Consulting
& specialist Partnership
advisors DeloitteCritical Success Factors
Crtical Success Factors
Investment Objectives and Critical Success Factors
Investment objectives 6Investment 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.
7Snapshot 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?
8What 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.
9Approved 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
deliver acute • Ensuring at least a 30-year lifetime
Replacement
healthcare services • Providing a resilient core infrastructure which is compliant with applicable regulations and standards
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 10Approved 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
Strategic fit and levels
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]
11What is the Treasury Green Book
and Business Case Guidance?
Stakeholder Reference Group
12Introduction 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.
13HM 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
14Overview of the OBC appraisal process
Part 1: Economic
Determines by how much the
clinical benefits (expressed in
economic terms) outweigh
costs and risks. We try to
capture as many of the benefits
to patients, staff and the NHS as
Filter: pass/fail
possible in the economic
appraisal against appraisal.
critical success factors
Filter: detailed
appraisal in two parts
• Clinical model Long list of options in Short list of c.4–6
• Investment objectives each of 5 dimensions options covering all
•
FILTER
FILTER
Constraints covering: dimensions which must Preferred option
• Dependencies • Scope include for comparison:
• Service solution • ‘Business as usual’
• Service delivery • ‘Do minimum’
• Implementation
• Funding
Part 2: Non-economic
Where we cannot quantify
benefits in economic terms we
undertake a quantitative and
qualitative appraisal to sit
alongsideKey steps in the OBC option appraisal process
• Agree the scope of the investment and clear investment objectives - what are the key things
1 that the investment is expected to deliver?
• Agree critical success factors; these are pass / fail criteria that help exclude unviable options to
2 create a shortlist of options
• Use the ‘options framework’ to explore the full range of possible options
3
• Use the critical success factors to evaluate the different elements of the options framework
4 and from this agree a short list of options for more detailed development and appraisal.
• Detailed appraisal of a shortlist of options and choose the preferred option using an economic
5 appraisal and a separate appraisal of the non-economic benefits
• Detailed work up of the preferred option, including 1:200 designs and outline planning and
6 detailed capital and revenue costs, workforce requirements and implementation plans.
16The longlist options framework helps us to
consider optionality in five different dimensions
Dimension Description
For our programme, we have defined this as the
The ‘what’, in terms of the potential coverage
Scope scope of acute services for which the facilities are
of the project
required
For our programme, we have split this into two
The ‘how’ in terms of delivering the aspects: the site(s) from which the acute services
Service solution
‘preferred’ scope for the project will be provided; and the quality/lifetime of
facilities to be provided for those services
For our programme, we have defined this as the
The ‘who’ in terms of delivering the organisation(s) which will provide the required
Service delivery ‘preferred’ scope and service solution for the services (e.g. design, construction) required to
project achieve desired quality/lifetime of facilities and
how they will be procured
For our programme we have defined this as the
The ‘when’ in terms of delivering the
implementation approach for the required works
Implementation ‘preferred’ scope, solution and service
required to achieve desired quality/lifetime of
delivery arrangements for the project
facilities
The ‘funding’ required for delivering the For our programme we have defined this as the
Funding ‘preferred’ scope, solution, service delivery source of capital investment necessary to
and implementation path for the project undertake the required works
17Options framework for emergency care: options in each domain
will be assessed (vertical) separately as having failed or passed
the CSFs
Category of
choice 4. Service
1. Service scope 2. Service solution 3. Service delivery 5. Funding
implementation
(HMT guidance)
Who is best placed to
do this
Coverage of the service How this may be done
Definition How this may be done When and in what form
to be delivered (a) Organisation(s) to
(b) can it be implemented
(For WHHT provide services (e.g. Source of capital
Scope of acute services Site(s) from which the
acute Quality/lifetime of design / construction) Implementation
for which the facilities acute services will be
redevelopment) facilities to be provided required to achieve approach
are required provided
desired quality / lifetime
of facilities
Watford Business as usual
Core emergency
WHHT Public dividend funding
services only ‘Big bang’ build
i.e. c.3-year
Resolve priority issues construction period
only, providing Mixed funding model
St Albans Single private sector
Core emergency minimum 15yr lifetime
services and associated across entire estate partner e.g. Energy Efficiency
Emergency care Financing Section 106
clinical dependencies e.g. procured through
options funding, Managed
and adjacencies Provide fit for purpose ProCure 2020
(clinical) Equipment Service
facilities, providing framework
Hemel Hempstead (MES)
minimum 30yr lifetime
across the estate Phased build
All clinical and non- Multiple private sector
providers i.e. c.10-year b uild
clinical services Optimise facilities for programme
required for an long term, providing i.e. separate providers Private Finance*
emergency and Greenfield site
minimum 60yr lifetime for design, b uild, and
specialist care site across the estate maintenance services
Columns show available options within each dimension. Each column should be reviewed independently, there is no left-to-right read across
*Private financing is not likely to be an option for this scheme
18Options framework for planned care: options in each domain will
be assessed (vertical) separately as having failed or passed the
CSFs
Category of
choice 4. Service
1. Service scope 2. Service solution 3. Service delivery 5. Funding
implementation
(HMT guidance)
Who is best placed to
do this
Coverage of the service How this may be done
Definition How this may be done When and in what form
to be delivered (a) Organisation(s) to
(b) can it be implemented
(For WHHT provide services (e.g. Source of capital
Scope of acute services Site(s) from which the
acute Quality/lifetime of design / construction) Implementation
for which the facilities acute services will be
redevelopment) facilities to be provided required to achieve approach
are required provided
desired quality / lifetime
of facilities
Diagnostics, urgent Watford
Business as usual
care and core capacity / WHHT Public dividend funding
‘Big bang’ build
compliance only
i.e. c.3-year
St Albans Resolve priority issues construction period
only, providing Mixed funding model
minimum 15yr lifetime Single private sector
Diagnostics, urgent across entire estate partner e.g. Energy Efficiency
Planned care Financing Section 106
care, core capacity and Hemel Hempstead e.g. procured through
options funding, Managed
outpatients Provide fit for purpose ProCure 2020 Equipment Service
facilities, providing framework (MES)
minimum 30yr lifetime
St Albans and Hemel Phased build
across the estate
All planned care Hempstead Multiple private sector
providers i.e. c.10-year b uild
(Diagnostics, urgent Optimise facilities for programme
care and outpatients long term, providing i.e. separate providers Private Finance*
plus theatres and Greenfield site minimum 60yr lifetime for design, b uild, and
inpatient beds) across the estate maintenance services
Columns show available options within each dimension. Each column should be reviewed independently, there is no left-to-right read across
*Private financing is not likely to be an option for this scheme
19Indicative (longlist) estate options emergency care
1 2 3 4 5 6 7
WGH WGH WGH WGH WGH WGH New site
All clinical All clinical
SOC Option
2019 SOC All clinical and non and non
Business as 2019 SOC One +
Option One services in clinical clinical
Usual Option One replace
Enhanced new build services in services in
PMOK
new build new build
10% 40% 45% 80% 90% 100% 100%
£75m £300m c£370m c£540m c£600m - £750m
Capital costs increasing
New clinical
SOC Option One
block to
New clinical block ~ theatres, Includes
incorporate Please note: options, %
critical care, maternity, new build
all clinical
paediatrics, neonatal, acute ED in new and costs indicative
services in
assessment + additional beds. clinical block
PMOK + only. Draws from 2019
+ all PMOK
Refurbish PMOK to address key women’s &
beds SOC where applicable.
infrastructure issues & improve children’s
upgraded
inpatient ward accommodation services (but
not AAU) 20Indicative (longlist) estate options planned care
1 2 3 4 5 6
HHGH & HHGH & HHGH &
SACH HHGH New site
SACH SACH SACH
Consolidate Consolidate
Enhanced New single
Business as 2019 SOC all services all services
SOC Option site planned
Usual Option One from Hemel from SACH
One care hospital
to SACH to Hemel
10% 25% 35% 70% 100%
Excluded
as unviable
£17m £52m c£80m c£130m c£180m(+)
Capital costs increasing
SOC Option One These are the same options &
HHGH: new clinical block with
costs from 2019 SOC & have not
UTC and diagnostics, some been updated.
refurbishment of Verulam.
SACH: new diagnostic facilities + The ‘capital £ envelope’ has not
refurbishment of theatres. changed for planned care. 21What happens next?
• An assessment is undertaken to RAG rate the components of the long list
generator – RED if fail a CSF, GREEN for preferred way forward and AMBER for
others.
• This helps rule out options that don’t meet IOs / CSFs and to identify a preferred
way forward.
• The programme team is collating evidence to support this assessment. The site
survey will be a key input in determining the deliverability of new site options vs
Watford options.
• The assessment will be undertaken by the Programme Team work stream leads
with input from the regional estates team & Healthwatch representation.
• We will then share the outputs (and inputs) with stakeholders and provide an
opportunity for comments – this is scheduled for early September.
• The proposed shortlist and preferred way forward will be presented for approval
by the WHHT and HVCCG at joint public Board meeting (1st October 2020). The
Board will be presented with a summary of feedback received from stakeholders
and will take this into account in their decision making.
• Detailed work then starts to define and appraise the shortlist of options, including
1:500 designs and detailed capital and revenue costs.
22Thank you
westherts.redevelopment@nhs.net
23You can also read
