Select Committee on Treasury Minutes of Evidence


Annex

CHART OF "CENTRAL" IM&T BUSINESS CASES

FBC Approved:

Project
Status
Value (Whole Life Costs- £ million)
Project Connect
FBC approved 11-00
£340 approx
NHS CDSS
FBC approved 9-00
NPC £18
NHS Number for Babies
FBC approved 10-00
£1
Project Connect clinical messaging
FBC approved 01-01
£41
Shared Services pilots
HMT approval imminent
£21
Microsoft deal
FBC approved 10-01
£139
HR/Payroll (now renamed "Electronic Staff Record")
Contract signed 5-12-01
£325
Rationalisation of NHS arrangements for procurement from Novell
FBC approved 3-02
£10
Online System for Comparative Analysis and Reporting (OSCAR)
FBC approved 3-02
£2
Total
  
£897

Scheme still in procurement/approval process

Project
Status
Value (Whole Life Costs- £ million)
National Ambulance Radio Project—digitising all NHS ambulance radio
OBC due shortly
£134
Booked Admissions
OBC approved 12-01, FBC next.
£468
Dental Practice Board
OBC approved 1-02, FBC next
£45
Digital TV
Pilots, OBC next
£100 for national rollout [ballpark figure]
EDI Electronic Prescribing
Pilots, OBC next
£88 for national rollout [ballpark figure]
Financial Systems and e-procurement [part of Shared Services]
OBC expected soon
£450
Shared Services call centres
OBC awaited
£220 approx
General Ophthalmic Services centralisation
OBC awaited
£20 broad figure
Infrastructure: emails and directory services OBC
OBC approved 10-01, FBC next
£148 NPC, no funding requirement [to be met from existing budgets]
National electronic Library for Health
OBC received and under consideration
£40 approx
NHS Direct intelligent phones
FBC received and under consideration
£24
European Computer Driving Licence
OBC approved 1-02, FBC next
£10 central costs, £46 NHS costs
National Breast Screening System Redevelopment Project
FBC received and under consideration
£2
Total
  
£1,795


  Information in support of several of the answers given by Mr Douglas, can best be given by supplying the attached tables, listing:

    —  One table listing the major PFI schemes by financial close and operational dates;

    —  Three tables listing all PFI schemes, banded between £1-10 million, to £10-25 million and over £25 million. These tables show the value of each project and, where information is held centrally, the anticipated or actual dates for FBC approval, financial close, first operational day for the new hospital and the date the contract expires. If available, the annual unitary payment is also disclosed.[11]

    (i)  These tables show that the NHS currently has in progress the following numbers and value of PFI projects:

Value of schemes
No
Total value £m
£1-10 million
80
342
£10-25 million
39+
599
Over £25 million
64+
7,494
Total:
183
8,435


        +  The reason for the slight variation between the two tables and the detail provided by Richard Douglas is that one of the announced major schemes is below £25 million (Hull, actual value £22 million) and one scheme (Hexham) originally estimated to cost less than £25 million has risen to £29.7 million.

    (ii)  The total capital spend in the NHS in the period 1997-98—2001-02 is estimated to be £10,644 million in cash terms. In the same period, PFI projects with a total capital value of £4,933 million reached financial close. PFI projects signed therefore represents 31.6 per cent of total capital and PFI investment spend in this period.

    (iii)  The table shows that the date the last major contract was signed was Dudley, in May 2001. However, contracts at Gloucester, Blackburn, Barking and Havering, Walsgrave and Central Manchester should all sign in the next six to seven months.

      Schemes at Bromley, Barnet and Chase Farm, Worcester, Hereford, South Durham, South Tees, Swindon and Marlborough, Kings, Leeds Community, Brighton, St Georges, UCLH, Hull, West Middlesex, Berkshire Healthcare, Dudley, Gloucester, Blackburn, Avon and Wilts Mental Health and NW London will all be operational by the end of June 2005. Thus, four schemes which have yet to sign should be operational by June 2005.

Major PFI Schemes by financial and operational (defined as first patient day) date

RegionNHS Trust
Financial Close date
Operational Date
South EDartford and Gravesham
30-07-97
11-09-00
N and YCarlisle Hospitals
03-11-97
29-05-00
South ESouth Buckinghamshire
14-12-97
17-10-00
EasternNorfolk and Norwich Health
09-01-98
21-09-01
N and YNorth Durham Health Care
31-03-98
02-04-01
North WSouth Manchester University
08-06-98
25-07-01
LondonGreenwich Healthcare
01-07-98
01-03-01
N and YCalderdale Healthcare
31-07-98
08-04-01
LondonBromley Hospitals
19-11-98
30-04-03
LondonBarnet and Chase Farm
01-02-99
19-04-02
West MidsWorcestershire Acute
18-03-99
01-04-02
West MidsHereford Hospitals
31-03-99
01-03-02
N and YSouth Durham Health Care
28-05-99
01-07-02
N and YSouth Tees Acute Hospitals
16-08-99
01-04-03
South WSwindon and Marlborough
05-10-99
15-01-03
LondonKing's Healthcare
06-12-99
31-01-03
N and YLeeds Community and Mental
01-03-00
01-12-02
LondonSt George's Healthcare
17-03-00
01-04-03
LondonUniversity College London
12-07-00
01-04-05
N and YHull and East Yorkshire hospitals
08-12-00
30-01-03
LondonWest Middlesex University
30-01-01
01-04-03
South EBerkshire Healthcare
01-04-01
09-03-03
West MidsDudley Group of Hospitals
08-05-01
01-06-04
South WGloucestershire Royal
01-03-02
01-09-04
North WBlackburn Hyndburn and Ribble Valley
01-03-02
01-09-04
LondonBarking Havering and Redbridge Hospitals
01-03-02
30-09-05
West MidsUniversity Hospitals Coventry and Warwickshire*
01-06-02
01-03-06
TrentSouthern Derbyshire Acute
01-06-02
01-12-07
North WCentral Manchester Healthcare*
01-09-02
30-06-06
N and YNewcastle upon Tyne
01-02-03
01-10-05
South EPortsmouth Hospitals
15-02-03
15-10-06
South EOxford Radcliffe Hospitals
15-03-03
30-01-07
LondonNorth West London Hospitals
01-05-03
01-05-05
South EEast Kent Hospitals
01-06-03
01-07-06
South WUnited Bristol Healthcare
01-06-03
01-01-07
LondonBarts and the London
01-06-03
01-09-13
N and YHull and East Yorkshire Hospitals
01-08-03
01-10-05
South EMaidstone and Tunbridge Wells*
01-08-03
01-09-06
N and YLeeds Teaching Hospitals
01-08-03
01-02-07
LondonSt Mary's (Paddington Basin)
14-08-03
16-04-08
LondonNorth Middlesex Hospitals
01-09-03
01-01-07
EasternPeterborough Hospitals
01-09-03
01-03-07
West MidsUniversity Hospital Birmingham*
01-09-03
01-07-08
West MidsWalsall Hospitals*
01-10-03
01-03-06
North WSalford Royal Hospitals
01-10-03
01-12-06
South WAvon and Western Wiltshire Mental Health
01-12-03
01-06-05
EasternMid Essex Hospitals
01-12-03
01-10-06
South EBrighton Health Care
01-12-03
01-04-05
North WSt Helens and Knowlsey Hospitals
01-12-03
01-07-08
LondonBarnet and Chase Farm Hospitals
01-01-04
15-06-05
LondonWhipps Cross Hospitals
01-02-04
15-06-07
South EOxford Radcliffe Hospitals
01-03-04
01-11-06
N and YBradford Hospitals
01-03-04
01-07-07
West MidsRoyal Wolverhampton Hospitals
01-03-04
01-05-08
TrentSherwood Forest Hospitals
01-03-04
01-01-10
LondonLewisham Hospital
01-04-04
01-12-05
EasternEssex Rivers Healthcare
01-04-04
01-12-06
N and YPinderfield and Pontefract Hospitals*
01-04-04
01-04-07
South WPlymouth Hospitals
01-04-04
01-09-07
West MidsNorth Staffordshire Hospital
01-04-04
01-03-08
South WSouth Devon Healthcare
01-08-04
01-01-06
North WTameside and Glossop Acute Services
01-09-04
01-07-07
South ESouthampton University Hospitals
01-06-05
01-06-07
TrentUniversity Hospitals of Leicester
01-06-05
01-07-10
  Total
  
  

Public Schemes

Region NHS Trust
Tender Award date
Operational Date
North WRochdale Healthcare
14-08-98
01-08-00
TrentCentral Sheffield University Hospitals
19-09-98
01-02-01
South ERoyal Berkshire and Battle Hospital
08-01-97
2002
LondonGuys and St.Thomas
19-09-98
2004
  Total
  
  
  Total PFI and Public
  
  

wave 4-6 scheme

* scheme progressing with more than one lead trust

GATEWAYS AND THE NHS CAPITAL INVESTMENT PROGRAMME

Background

  Procedures for Capital Investment Projects in the NHS have for some years encompassed both a series of mandatory approval gateways at various stages of the life cycle of a Capital Investment Project eg Strategic Outline Case, Outline Business Cases, Full Business Case etc together with requirements for Post Project Evaluation. NHS capital Investment procedures are contained within the Capital Investment Manual (CIM) which is currently being reviewed to take account of current best procurement practice and this includes the continuous review of the performance of projects to identify lessons learned and ensure the NHS benefits from them both on the project under consideration and future projects which is the objective of the Gershon Gateway Reviews.

Current Situation

  The current situation in respect of evaluating Capital Investment Projects in the NHS and applying learning lessons to the NHS Capital Investment Programme is based on Post Project Evaluation and the dissemination of feedback to the NHS.

  NHS Estates have established is a Capital Project Evaluation Section on the NHS Estates website—this provides an opportunity for NHS Trusts to provide feedback and the dissemination of lessons learned to the whole NHS and other bodies who access the website. Information on the key lessons learned from this are included in Appendix 1 of this response.

  Both the implementation of NHS ProCure 21 and the review of the Capital Investment Manual will address the above together with recommendations that have been made in any National Audit Office (NAO) Reports on NHS projects for example, recommendations from the report on Guys Hospital Phase III Development are also identified in Appendix 1 of this minute.

  Steps have already been taken in some cases in respect of addressing the lessons learned that are identified in Appendix 1, for example, the establishment of the Diploma in Project Leadership Course at Lancaster University to provide skilled Project Directors. Also we already have approval gateways to ensure appropriate funding is available for projects before they progress ie SOC, OBC, FBC.

The Future—NHS ProCure 21 and Review of NHS Capital Investment Manual

  The key objective of the Gershon Gateway review process is to review projects at various gateways to identify areas were improvements have been achieved or are required and disseminate the lessons learned to all. NHS Estates will address this objective through the implementation of NHS ProCure 21 and the review of NHS Capital Investment Manual.

  NHS ProCure 21 is the Department Health response to implementing "Achieving Excellence", HM Treasury's policy response to the Egan Report (Rethinking Construction by Sir John Egan). It comprises the following key elements:

    —  Partnering—establishing long term relationships with carefully selected suppliers and applying supply chain management techniques to achieve continuous improvements in value for money;

    —  Best Client—this is based upon the establishment of proper client briefing and the accreditation of Project Directors;

    Design Quality—this is based upon the requirement to create the best environment for visitors, patients and staff;

    —  Benchmarking and Cost Intelligence—this enables us to demonstrate progress, manage performance, identify lessons learned and deliver continuous improvements.

  Under NHS ProCure 21 there is a requirement for Project Directors to review the performance of projects against a set of Key Performance Indicators (KPI's) at the Approval Gateways identified in the Capital Investment Manual, and more frequently if the project team requires it on specific projects. This will enable the identification and dissemination of lessons learned through the identification of improved or poor performance. The KPI's being used as part of NHS ProCure 21 have been established as a result of NHS Estates leadership of the OGC Benchmarking Action Group and will be applied to all public sector projects in the future.

  The NHS Capital Investment Manual (CIM) is currently being reviewed and will incorporate requirements for the continuous review of projects against KPI's at Approval Gateways as required for under NHS ProCure 21 (see above).

  If a project requires an external peer review then a Project Director not involved in the scheme would be selected from the Register of Accredited Project Directors to provide this.

Application of Gershon Gateway Review "Process" to all NHS projects

  As stated earlier there is already a mandatory requirement for Post Project Evaluation on all NHS projects and information from this is available on the NHS Estates website. The implementation of NHS ProCure 21 and the review of the Capital Investment Manual will ensure that all capital investment projects within the NHS will be reviewed at the Approval Gateways identified in the NHS Capital Investment Manual. The establishment of a register of accredited Project Directors provides us with a readily available and highly qualified resource to provide peer reviews of projects when needed.


11   Not printed. A copy has been placed in the Library. Back


 
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Prepared 23 May 2002