Modernisation and redesign of primary and community health ...Aug 30, 2010 · Mrs Velda Middleton...

Modernisation and redesign of primary and community health services for Possilpark

Outline Business Case September 2010

NHS Greater Glasgow & Clyde of 143

Outline Business Case FINAL 30 August 2010


Project Particulars

Project ID Modernisation and redesign of primary and community health services for Possilpark

Project Sponsor Mr Alex McKenzie

Phone number 0141 201 4207

E-mail [email protected]

OBC Co-ordination Mr Eugene Lafferty Mrs Velda Middleton

Contact Details [email protected] 0141 232 2082 [email protected] 0141 221 0313

Document Name Outline Business Case for the Modernisation and redesign of primary and community health services for Possilpark

Document Reference Saracen Street OBC

Version FINAL

Date 30 August 2010

Initial Agreement Approval dated 18 December 2009 Reference F2647151

Synopsis:

This document is the Outline Business Case for NHS Greater Glasgow & Clyde’s Modernisation and redesign of primary and community health services for Possilpark and highlights:

The preferred option for taking the project forward Supports and justifies the case for investment and change Demonstrates Value for Money (VfM) The SCIM 5-Case model

Copyright: The information in this document is proprietary to NHSGG&C and is supplied on the understanding that it shall not be copied, stored in a retrieval system, or transmitted in any form, by any means, electronic, mechanical, photocopying, recording or otherwise or supplied to a third party without prior written consent of the author. The electronic form of this document or controlled paper copies is available from the author.

mailto:[email protected]






CONTENTS EXECUTIVE SUMMARY 1. PROJECT INTRODUCTION 1.1 Section Overview 1.2 Purpose and Objectives of the Outline Business Case 1.3 Outline Business Case Preparation 1.4 Project Background 1.5 Project Governance 1.6 Project Structure 1.7 Key Roles and Responsibilities 1.7.1 External Advisors 2. THE STRATEGIC CASE 2.1 Section Overview 2.2 Profile of North Glasgow 2.3 Strategic Context and Organisational Overview 2.4 Strategic Objectives 2.5 SMART Investment Objectives 2.6 Project Stakeholders 2.7 Property Strategy 2.8 Current Arrangements 2.9 Desired Scope and Service Requirements 2.10 Key Benefits and Benefits Criteria 2.11 Strategic Risks 2.12 Constraints and Dependencies 3. THE ECONOMIC CASE 3.1 Section Overview 3.2 Critical Success Factors 3.3 Options Considered 3.3.1 Long list of Options 3.3.2 Short list of Options 3.3.3 Rationale for the rejection of the other three options 3.4 Benefits Appraisal 3.4.1 Benefits Criteria and Weighting 3.5 Capital Costs 3.6 Revenue Operating Costs 3.6.1 Capital Charges 3.6.2 Facilities Costs 3.6.3 Decontamination Costs of Dental and Podiatry 3.6.4 Detailed Revenue Costs 3.7 Summary of Financial Appraisal 3.8 NPC / NPV Findings 3.9 Value for Money Analysis 3.10 Risk Assessment




3.10.1 Risk Rating Matrix 3.10.2 Risk Types 3.10.3 Risk Management 3.10.4 Key Risks associated with the Options on the Short List 3.11 The Preferred Option 3.12 Sensitivity Analysis 4. THE PREFERRED OPTION 4.1 Section Overview 4.2 Option Description 4.2.1 The Site 4.2.2 Site Context 4.2.3 Application of the 3P’s 4.3 Key Selection Factors 4.4 Expected Benefits 4.5 Service Continuity 4.6 Migration and Workforce Strategy 4.7 Facilities Management 4.8 Human Resource Issues 4.8.1 Workforce Planning and Development 4.9 Clinical Commissioning 4.10 Use of Retained / Surplus Estate 4.11 Clinical Brief 4.12 Schedule of Accommodation 4.13 Design Concept 4.13.1 Infection Control

5. THE SUSTAINABILITY CASE 5.1 Section Overview 5.2 Introduction 5.3 Promoting Sustainability 5.4 The Cost of Sustainable Development 5.5 Summary 6. THE COMMERCIAL CASE 6.1 Section Overview 6.2 Required Services 6.3 Risk and the Commercial Framework 6.4 Change Control Procedures 6.5 Key Contractual Arrangements 6.5.1 Open Book Philosophy 6.5.2 Construction Share Percentage and Share Range 6.5.3 Priced Activity Schedule 6.5.4 Defined Costs 6.5.5 Recording and Collation of Costs Information 6.5.6 Compensation Events and their Application 6.6 Accountancy Treatment




7. THE FINANCIAL CASE 7.1 Section Overview 7.2 Funding Model and Board Participation 7.3 Capital Requirement 7.4 Impairment 7.5 Net Effect on Prices 7.6 Impact on Balance Sheet 7.7 Impact on Income and Expenditure Account 7.8 Impact on Existing Facility 7.9 Cost of Service Continuity 7.10 Overall Affordability 8. THE MANAGEMENT CASE 8.1 Section Overview 8.2 Project Milestones 8.3 Procurement 8.4 Project Management Approach 8.4.1 Project Phases 8.4.2 Project Framework 8.4.3 Consultation and Engagement 8.4.4 Key Project Appointments 8.5 Change Management 8.6 Benefits Realisation 8.7 Risk Management 8.8 Post Project Evaluation 8.8.1 Purpose 8.8.2 Pre-requisites for Successful Evaluation 8.8.3 Stages of Evaluation 8.8.4 How we will Evaluate 8.8.5 Feedback and Dissemination of Findings from Evaluation 8.9 Management Case Summary CONCLUSION




APPENDICES EXECUTIVE SUMMARY NIL Section 1: PROJECT INTRODUCTION NIL Section 2: THE STRATEGIC CASE NIL Section 3: THE ECONOMIC CASE A Site Options Appraisal Report B Risk Register C Frameworks Scotland Guidance Notes for the Joint

Project Risk Register D OB1 – 4 Forms for the shortlisted options including

Optimism Bias calculations E NPV Tables F Life Cycle Modelling Section 4: THE PREFERRED OPTION A Design Statement B Schedule of Accommodation Section 5: THE SUSTAINABILITY CASE A BREEAM Assessment Section 6: THE COMMERCIAL CASE NIL Section 7: THE FINANCIAL CASE as per appendix 3 D

OB1 – 4 Forms for the Preferred Option

Section 8: THE MANAGEMENT CASE A Combined Design and Construction Programme CONCLUSION NIL General Glossary




List of Tables and Diagrams Table 1: Comprehensive List of Tables Table

Description

Table 1 Comprehensive List of Tables Table 2 Comprehensive List of Diagrams Table 3 SCIM Checklist Table 4 Summary of Document Structure Table 5 Shortlisted Options Summary including Scores and Rank Table 6 Economic Appraisals for the Shortlisted Options Table 7 Financial Appraisal for the Preferred Option Table 8 Value for Money Analysis Comparing Qualitative Benefits to Costs Table 9 Summary of Key Dates Table 10 SCIM steps 4-7 Table 11 The 18 Most Deprived GP Practices in Scotland 2010 Table 12 Summary of Roles and Responsibilities relating to the Project

Structure Table 13 The 18 Most Deprived GP Practices in Scotland 2010 Table 14 SMART Investment Objectives Table 15 Desired Scope Table 16 Key Benefits Table 17 Definition of Terms Relating to the Benefits Criteria Table 18 High Level Project Risks Table 19 Key Critical Success Factors Table 20 Long List of Site Options Table 21 Shortlisted Options Table 22 Indicative Capital Costs for the Shortlisted Options Table 23 Key Assumptions relating to the Lease Option. Option 7 Table 24 Indicative Capital Costs for Option 2 Table 25 Indicative Capital Costs for Option 5 Table 26 Indicative Capital Costs for Option 6 Table 27 Indicative Capital Costs for Option 7 Table 28 Optimism Bias Summary Table 29 Capital Charges Table 30 Facilities Costs Table 31 Detailed Revenue Costs per Option Table 32 Capital & Revenue Requirements Table 33 Net Present and Equivalent Annual Costs Table 34 Economic Appraisal Table 35 Value for Money Analysis Comparing Qualitative Benefits to Costs Table 36 Key Risks Associated with the Options on the Shortlist Table 37 Value for Money Analysis Comparing Qualitative Benefits to Costs Table 38 BREEAM Credits Table 39 Potential Risk Allocation Table 40 Response to Changes during Construction Table 41 Capital Requirements for the Preferred Option




Table 42 Revenue Impact of the Preferred Option Table 43 Value for Money Analysis Comparing Qualitative Benefits to Costs Table 44 Project Framework Table 45 Descriptions of Roles & Responsibilities Table 46 Key Project Milestones

Table 2: Comprehensive List of Diagrams Diagram

Description

Diagram 1 Satellite Photograph showing current location of Possilpark Health Centre

Diagram 3 Project Team Diagram 2 Outline Business Case Flowchart Diagram 4 Governance Structure Diagram 5 Project Structure Diagram 6 Economic Appraisal Process Diagram 7 Probability and Impact Risk Matrix Diagram 8 Traffic Light Risk System Diagram 9 Site Layout Diagram 10 Site Context Diagram 11 Summary of BREEAM “Excellent” Rating Diagram 12 Notification and Management of Compensation Events Diagram 13 Target Price Costing Elements Diagram 14 Pain Share / Gain Share Model Diagram 15 Compensation Event Sequence Diagram 16 Project Management Processes Diagram 17 RIBA Outline Plan of Work




Scottish Capital Investment Manual (SCIM) Compliance This OBC has been prepared in accordance with the requirements of the Scottish Capital Investment Manual and presents the project’s objectives, benefits, risks, costs and other relevant information.

A checklist has been compiled to facilitate ease of reference in accordance with the SCIM. The checklist can be viewed below: Table 3: SCIM Checklist Phase/Action Activity Reference in

OBC Phase 2 – Planning

Preparing the Outline Business Case (OBC)

Step 4 Determining Value for Money (VFM) Action 4.1 Revisit IA and determine short-list

including reference project (outline CPAM)

Section 2

Action 4.2 Prepare the economic appraisals for short-listed options

Section 3

Action 4.3 Undertake benefits appraisal Section 3 Action 4.4 Undertake risk assessment /

appraisal Section 3

Action 4.5 Select preferred option and undertake sensitivity analysis

Section 3

Step 5 Preparing for the Potential Deal (Commercial Case)

Action 5.1 Determine procurement strategy Section 6 Action 5.2 Determine service streams and

required outputs Various

Action 5.3 Outline potential risk apportionment Section 6 Action 5.4 Outline potential payment

mechanisms Section 6

Action 5.5 Ascertain contractual issues and accountancy treatment

Section 6

Step 6 Ascertaining Affordability & Funding Requirement (Financial Case)

Action 6.1 Prepare financial model and financial appraisals

Section 7

Step 7 Planning for Successful Delivery (Management Case)

Approach, Routes and Information Section 8




Document Control

Version Date Reason for issue Issued To Issued By Draft 1 24 June 2010 Reading and

comment Stephen G Baker for: Group Members, Capital Planning Sub – Group

Velda Middleton

Draft 2 9 July 2010 Draft for CPG sub group pre CIG submission

CPG Sub Group & Project Board

Stephen Baker

Draft 3 29 July 2010 Added: PSCP role, change control diagram Updated: Financial information, included post-mitigation risk scores Clarification: several items and comments, paragraph in table 2.10

Stephen G Baker Velda Middleton

Draft 4 5 August 2010 Implementation of changes requested by NHSGG&C

Stephen G Baker Joseph Ferguson

Draft 5 9 August 2010 Implementation of changes requested by NHSGG&C


Draft 6 10 August 2010

Re-issue following comments and amendments on draft 5



Re-issue following amendments to draft 6 (Tables 7, 23, 29, 31, 33)



Re-issue following amendment to draft 7 (Table 22)

Stephen G Baker

Velda Middleton

FINAL 30 August 2010

Final issue post Board CPG

CIG Stephen G Baker

Document Review and Approval

Activity Person/Group Organisation Date Reviewed and Approved subject to minor amendments to NPV tables

Board Capital Planning Group (CPG)

NHSGG&C 16 August 2010




Diagram 1: Satellite photograph showing current location of Possilpark Health Centre

Current Health Centre




EXECUTIVE SUMMARY

Introduction

This Outline Business Case (OBC) introduces NHS Greater Glasgow & Clyde’s project, The Modernisation and redesign of primary and community health services for Possilpark and provides evidence that the proposed project is robust, affordable and deliverable. It also provides clear guidance with regards to objectives, timescales, measurability and governance. The project was first introduced in the project’s Initial Agreement; Modernisation and redesign of primary and community health services for Possilpark and, as stated in the Initial Agreement, the purpose of this project is much more than the simple replacement of the existing facility and services North Glasgow experiences the greatest intensity of poverty and deprivation in the whole of the area covered by NHS Greater Glasgow and Clyde (with nearly 60% of the population living in the worst 15% areas of deprivation in Scotland making North Glasgow the second most deprived CHP area in Scotland.) The project has been identified by NHSGG&C as an opportunity to enable and facilitate fundamental change in the way in which healthcare is delivered to the people of Possilpark thus satisfying a critical business need. The underlying aim is to tackle health inequalities by improving the delivery of health and social care services in an area of extreme poverty and deprivation. Health care services will be shaped around the needs of patients and clients through the development of partnerships and co-operation between patients, their carers and families and NHS staff; between the local health and social care services; between the public sector, voluntary organisations and other providers to ensure a patient-centred service. It is anticipated that service users will see an improvement in the following: Physical environment and patient pathway Access to a range of services not previously available locally One door access to integrated community teams; this will improve service

co-ordination and ensure that service users receive the best possible care from the professional with the skills best suited to their needs

A more co-ordinated approach to rehabilitation Speedier referral pathways between professionals The project will ensure that local services are driven by a continuous cycle of quality improvements, not just restricted to clinical aspects of care but to include quality of life and the entire patient experience. The project will build on our experience gained through Keep Well and will focus on preventing as




well as treating ill health by providing information and support to individuals in relation to health promotion, disease prevention, self-care, and rehabilitation and after care. The project will enable service re-design and development that will ensure that wherever appropriate and safe, services and care will be delivered as close as possible to the point of need. Similarly, it will enable responsibility for decisions about patient care to be devolved to as close to the point of delivery as possible. Throughout the design process, our approach has been founded on the clear application of the 3P’s – Practice, Principles and People. This application is discussed further in section 4. New health facilities not only have to support and facilitate the clinical needs of patients in a safe and quality environment, but they also have to deliver this in a supportive therapeutic environment. The proposed design creates a truly therapeutic environment that is responsive to the needs of patients, staff and visitors by creating a calm and uplifting building. The development of the Health Centre will be led by NHS Greater Glasgow & Clyde (NHSGG&C) but it forms a significant part of a wider regeneration project led by Glasgow North Regeneration Agency (GNRA) entitled Saracen Exchange. In terms of its fit within a wider urban development plan, Glasgow City Council has advised that the Glasgow and Clyde Valley Structure Plan identifies Possilpark as a “Town Centre to be safeguarded” and a priority location for investment. Possilpark Town Centre is identified in both the adopted City Plan 1 and the Finalised City Plan 2 as a Tier 3 Centre fulfilling a valuable local function. The replacement of Possilpark Health Centre presents a unique opportunity to demonstrate in a very tangible and high profile way NHS Greater Glasgow and Clyde’s commitment to tackling health inequalities, improving health and contributing to social regeneration in areas of deprivation. Document Structure The OBC Framework allows the benefits, costs and risks to be identified and evaluated in a structured and systematic manner. The document has been divided into 10 sections as follows:




Table 4: Summary of Document Structure Section

Contents

Executive Summary Section 1:

Introduction Provides the background and the methodology followed in the preparation of this OBC.

Section 2:

The Strategic Case Revisits the Initial Agreement and provides an overview of the organisation, its investment objectives, current accommodation and circumstances, desired scope, strategic risks and constraints on future service delivery.

Section 3:

The Economic Case Provides detail on the costs of each of the shortlisted options, provides insight into the assessment of options, benefits and project risks.

Section 4:

The Preferred Option Describes the preferred option, key benefits, service continuity, human resources and change management implications, commissioning, design and clinical delivery.

Section 5:

The Sustainability Case Outlines the delivery and associated costs with regards to the procurement and construction through the provision of construction materials and a facility capable of sustaining growth.

Section 6:

The Commercial Case Details the charging mechanisms, key contractual arrangements, implementation timescales and accountancy treatment.

Section 7:

The Financial Case Examines the funding model, impact on the balance sheet and income & expenditure account and comments on the overall affordability.

Section 8:

The Management Case Demonstrates the approach to procurement, project management, risk management, benefits realisation, post project evaluation and the project timetable.

Conclusion




Summary of shortlisted options Table 5: Shortlisted Options Summary including Scores and Rank Option Score Rank

2: Do Minimum (includes minor interior upgrade works to improve the building)

91 4

5: New Build, Alternate site 735 2

6: New Build, Saracen Street (Self) 916 1

7: Third party developer led Health Centre at Saracen Street with GNRA

718 3

The Preferred Option Selection of the preferred option, Option 6: New Build, Saracen Street (Self), has been undertaken via a balanced assessment of financial indicators and non-financial benefits. Section 4 discusses the site options in more detail. Results of economic and financial appraisal/s The following tables are explained fully in section 4, but provide a snapshot of the economic and financial appraisals at this point. The results of the economic appraisal of capital and revenue costs for each option are summarised in the table below: Table 6: Economic Appraisals for the Shortlisted Options Element Option 2:

Do Minimum

£ 000’s

Option 5: New Build

on alternate site

£ 000’s

Option 6: New Build at Saracen

Street (Self)

£ 000’s

Option 7: Third party developer

led Health Centre at

Saracen Street with GNRA

£ 000’s Capital Receipts

0 0 0 0

Capital Costs 1,477 10,973 8,795 756 Life Cycle 19,378 23,303 19,539 0 Other Revenue

-5,192 -4,855 -4,855 22,738

Net Present Value

6,540 15,336 12,254 14,431

Ranking 1 4 2 3




The results of the financial appraisal of the capital and revenue cash flows for the preferred option are summarised in the table below: Table 7: Financial Appraisal for the Preferred Option Option 6: New Build Saracen Street (Self)

2010/11

£,000

2011/12

£,000

2012/13

£,000

2013/14

£,000

Total

£,000 Capital Funded by: Existing Capital 1,500 7,292 1,408 10,200 Additional 198 198 Total 1,500 7,292 1,606 10,398 Revenue Funded by: Existing Revenue Additional 34 68 68 Total 34 68 68

The results of the value for money analysis identifying the optimum solution when comparing costs to qualitative benefits are summarised in the table below: Table 8: Value for Money analysis comparing Qualitative Benefits to Costs Value for Money Analysis – comparing qualitative benefits to costs Option Qualitative

Benefits Score

Equivalent Annual

Cost (£000)

Cost per Benefit

point (£000)

VfM Economic

Ranking 2. Do Minimum 91 248 £2.725 4 5. New Build on alternate site

735 581 £0.79 2

6.New Build at Saracen Street (Self)

916 465 £0.508 1

7. Third party developer led Health Centre at Saracen Street with GNRA

718 789 £1.099 3

Project Support / Mandate

This OBC was reviewed and approved by NHSGG&C's Capital Planning Group (CPG) on 16 August 2010 and will be submitted for presentation to the NHSGG&C Performance Review Group (PRG) on 21 September 2010.




Project Approach This project is to be delivered under the auspices of Frameworks Scotland. This requires a co-ordinated team approach from the outset and timely inclusion of all key stakeholders from the NHSGG&C and any external advisors. There are a number of roles that are vital to the successful implementation and delivery of Frameworks Scotland Projects, these include: Project Director Project Manager Cost Advisor Principal Supply Chain Partner (PSCP) CDM Co-ordinator Clinical Manager NEC3 Supervisor The options for the replacement of Possilpark Health Centre are presented in the form of an Outline Business Case (OBC) consistent with the requirements of the Scottish Government Health Department’s Capital Investment Manual. Summary of Key Dates

A summary of the key project dates is provided in the table below:

Table 9: Summary of Key Dates Activity Date

Review by NHSGG&C CPG 16 August 2010

Submission of OBC to CIG 31 August 2010

Review by NHSGG&C PRG 21 September 2010

CIG Meeting Date 28 September 2010

FBC development period 3Q 2010 to 1Q 2011

Submission of FBC to CIG 1Q 2011

CIG Meeting Date 1Q 2011

Anticipated construction start (anticipated 52 week construction programme)

2Q 2011

Construction completion 2Q 2012

Post Project Evaluation The PPE will commence no later than 12 months after occupation.




Implications of the project not going ahead

A number of implications have been identified. These include:

The envisaged clinical model will not be delivered in accordance with new operational policies

The energy efficiency and carbon footprint reduction targets will be at risk Access to the conditional funding from the SGHD Primary and Community

Care Premises Modernisation Programme may be lost The local support for the new facility will be lost Failure to expand range of services provided to patients in the community

and to benefit from collocation of multi-disciplinary staff teams Dental facilities would not be improved and could therefore not meet

national standards of care NHSGG&C will still require to consider the investment required for the ‘Do

minimum’ option to address access issues such as disabled access and backlog maintenance

The urban regeneration of this particular site will be stalled and limited

The Saracen Exchange project addresses a long term market failure in the North of Glasgow and will become the focal point for the regeneration of the Possilpark community. The Master plan includes the new Health Centre, a local housing office and a Business, Employment and Learning Centre. The experience gained in North Glasgow from the Keep Well Anticipatory Care pilot emphasised the need for much closer connection between health, social care and other community services to meet the complex needs of patients in deprived areas. Should the project not proceed, it will limit the viability of the investment in the urban and social regeneration of this area.




1. PROJECT INTRODUCTION 1.1. Section Overview

This Outline Business Case (OBC) introduces NHS Greater Glasgow & Clyde’s proposal for the Modernisation and redesign of primary and community health services for Possilpark and provides evidence that the proposed project is not only robust, affordable, deliverable and sustainable, but also that it is essential for the delivery of a modern health service. An Initial Agreement (IA) was prepared for this project. This is In line with the activities outlined in Phase 1a and 1b – Determining and Scoping of the Scottish Capital Investment Manual (SCIM). The project is founded on the service requirements, project objectives and anticipated benefits outlined in the Initial Agreement. This consolidated output is reviewed in this section.

1.2. Purpose and Objectives of the Outline Business Case

The business case process illustrates the plan for the outcome of the project and provides an insight into the expected benefits that the investment will deliver. The Outline and Full Business Case provides clear guidance with regards to objectives, timescales, measurability and governance. The emphasis of the OBC is on what has to be done to meet the strategic objectives (the strategic case) identified in the Initial Agreement (IA) and it prepares the road for the FBC which will demonstrate that the overall impact of an investment will be beneficial and will maximise the ratio of benefits to cost.

This OBC will identify the preferred option for taking the Modernisation and redesign of primary and community health services for Possilpark forward. Furthermore, it will evidence and justify the case for investment. Detail is provided as to the selection of site options, the options appraisal criteria, methods and impacts. An analysis of the costs, benefits and risks of the short listed options is included. The OBC will also demonstrate the preferred option based on the outcome of the benefits scoring analysis, a risk analysis and a financial and economic appraisal.

The OBC’s objectives are therefore to: Revisit the IA in more detail, in particular the strategic case Reduce the short list of options presented in the IA by identifying a

preferred option which meets the agreed criteria and optimises value for money (VfM)




Present an analysis of the benefits, costs and risks for the short list of options by: ▫ illustrating the (non-financial) measureable benefits to patients,

staff and public ▫ providing a financial appraisal and an economic appraisal thus

demonstrating value for money (VFM) and affordability) Consider the implications of sustainability Prepare the project for procurement Put in place the necessary funding, management and implementation

arrangements for the successful delivery of the preferred option

The OBC specifically covers Steps 4 – 7 in the SCIM as outlined below:

Table 10: SCIM Steps 4 – 7 Step 4

Determining Value for Money (VFM) Economic Case

Step 5

Preparing for the Potential Deal Commercial Case

Step 6 Ascertaining Affordability and Funding Requirement

Financial Case

Step 7

Planning for Successful Delivery Management Case

Once the OBC has been approved, the project will move into Phase 3 – Procurement during which a Full Business Case (FBC) is prepared. The purpose of the FBC will be to: identify the ‘market place opportunity’ which offers optimum value

for money (VfM) set out the negotiated commercial and contractual arrangements for

the deal demonstrate that it is ‘unequivocally’ affordable Put in place the detailed management arrangements for the

successful delivery of the scheme

1.3. Outline Business Case Preparation

This OBC has been prepared as a collaboration between the project team and NHS Greater Glasgow & Clyde (NHSGG&C) to deliver the Modernisation and redesign of primary and community health services for Possilpark; this collaboration is illustrated in diagram 2.




Diagram 2: Project Team

Preparation of this OBC has followed the steps outlined in the figure below:

Diagram 3: Outline Business Case Flowchart Establish Strategic Context

Define Objectives andBenefits Criteria

Present theOutline Business Case

Select the Preferred Option

Assess Sensitivity to Risk

Identify & Quantify Costs

Generate Options

Measure Benefits

Establish Strategic Context

Define Objectives andBenefits Criteria

Present theOutline Business Case

Select the Preferred Option

Assess Sensitivity to Risk

Identify & Quantify Costs

Generate Options

Measure Benefits




1.4. Project Background

The current Possilpark Health Centre is the base for three GP practices. The facility was built in the 1970’s and serves a GP population of 8,000. The existing centre is functionally unsuitable and does not have the space to deliver the services that are expected from a modernised National Health Service. A fourth practice, the Balmore Road practice (CHI-nr: 4325-6) will join these three practices in the new facility. A premises audit, conducted in July 2008, identified the GP premises as lacking in providing patient confidentiality and inadequate for a three doctor practice. The current Health Centre also hosts a dentist practice and community dental services. The current accommodation severely restricts the potential for the dental services to expand or improve their facilities to meet new standards for example, sterilisation of equipment. The West of Scotland has profound health challenges that resonate at the top of UK and European indices. Possilpark, where the new health and social-work hub is planned, represents the most deprived community in Glasgow with an SIMD (Scottish Index of Multiple Deprivation) ranked nationally second only to Ferguslie Park in Paisley. From information distributed by Professor Watt, a list of the 18 most deprived GP practices in Scotland (2010) was prepared. There are 5 Possilpark practices in the top 10 and 6 in the top 20 with Keppoch (CHI nr: 4323-7) the most deprived, Balmore Rd (CHI-nr: 4325-6) is the third most deprived, Dr Alguero (CHI nr: 4354-2) is fifth most deprived and Dr Langdridge (CHI nr: 4353-8) is the eighteenth most deprived in Scotland. These four practices will operate within the new Health Centre and collectively demonstrate the concentration of deprivation within the area in comparison to other parts of Scotland.

Table 11: The 18 Most Deprived GP Practices in Scotland (2010) Rank

Practice

Location

SIMD

1 Keppoch Medical Practice Keppoch Medical Practice 88.29

2 Dr Robert M Trollen & Dr Pamela Geddes Milton Medical Centre 86.21

3 Drs Reid, Crawford & Myers 138 Balmore Road 82.68

4 Dr Wilson, Dr Mcginley & Dr Sheppard

Easterhouse Health Centre 81.49

5 Drs Erich Lamb & Luis Alguero

Possilpark Health Centre 81.24

6 Newhills Medical Practice Easterhouse Health Centre 80.09




7 Drs Andersen, Dawson, Mutch & Smith


8 Castlemilk Group Practice Castlemilk Health Centre 76.59

9 Drs Mckenzie & Burns Drs Mckenzie & Burns 76.58

10 Drs Craig, Douglas, Cherry & Mckean 191 Denmark Street 74.39

11 Dr Grieve Drumchapel Health Centre 72.46

12 Dr D.S.Dhami Easterhouse Health Centre 71.91

13 Drs Lafferty, Macphee & Dames

Drs Lafferty, Macphee & Dames 71.8

14 Drumchapel Medical Practice Drumchapel Health Centre 71.36

15 Dr Turner Drumchapel Health Centre 71.22

16 Craigmillar Medical Group Craigmillar Medical Group 71.12

17 Westmuir Medical Centre The Westmuir Medical Practice 70.8

18 Dr S J Langridge Possilpark Health Centre 70.78

The message about the deprivation levels of the patients attending the new Health Centre is evident from these current figures and their needs are appreciably different from those in less deprived areas thus needing more clinical and office space to implement the health interventions necessary from the Scottish Government initiatives. In this context, the replacement of Possilpark Health Centre presents a unique opportunity to demonstrate in a very tangible and high profile way NHS Greater Glasgow and Clyde’s commitment to tackling health inequalities, improving health and contributing to social regeneration in areas of deprivation. A number of specific considerations are worth noting at this point:

Clinical need and the benefits to patients which would result from

implementation of the project Implications of not meeting the need e.g. reduced service, under-

capacity, inappropriate facilities, failure to meet recognised standards

Services required together with a description of the existing assets to be replaced, altered or refurbished to allow efficient service delivery




Existing accommodation is poor and space restricted, leaving the accommodation unfit for purpose

Saracen Exchange will be developed in two distinct phases. Phase 1 will be the Health Centre and GNRA’s Business and Learning Centre along with the creation of a Town Square from which both buildings will take access. Phase 2 plans to bring forward the new housing office for North Glasgow Housing Association

1.5. Project Governance

NHSGG&C has a governance structure in place which seeks to ensure that there is a dedicated management focus for the project, visibility and accountability at the highest levels in the organisation and the involvement of a wide range of stakeholders in the project process. The production of this OBC has been subjected to the following approval process (diagram over the page) with the final step resting with the SGHD Capital Investment Group:




Diagram 4: Governance Structure




1.6. Project Structure

The project structure within NHSGG&C is applied as follows: Diagram 5: Project Structure

1.7. Key Roles and Responsibilities

In accordance with SCIM, NHSGG&C has followed a Frameworks Scotland procurement option for this project as HUBCo is not yet in operation in the West of Scotland. Frameworks Scotland requires a co-ordinated approach from the outset and timely inclusion of all key stakeholders from NHSGG&C and any external advisors. There are a number of roles that are vital to the successful implementation and delivery of Frameworks Scotland Projects. These include but are not specifically restricted to:

Project Director Project Manager Cost Advisor PSCP Healthcare Planner (part of the PSCP team) CDM Co-ordinator

SGHD Capital Investment Group

NHS Board

Capital Planning Group

Project Board

Project Task Teams




Clinical Manager NEC3 Supervisor CAT Administrator HFS Advisor The roles and responsibilities are discussed briefly below with the external advisors discussed in more detail in section 8. Table 12: Summary of Roles and Responsibilities relating to the Project Structure Group Roles and Responsibilities

NHS Board The overall purpose of the unified NHS Board is to

ensure the efficient, effective and accountable governance of the local NHS system and to provide strategic leadership and direction for the system as a whole, focusing on agreed outcomes.

The role of the unified NHS Board is to:

To improve and protect the health of local people To improve health services for local people To focus clearly on health outcomes and people's

experience of their local NHS system To promote integrated health and community

planning by working closely with other local organisations

To provide a single focus of accountability for the performance of the local NHS system

The functions of the unified NHS Board comprise:

Strategy development - to develop a single Local Health Plan for each NHS Board area, which addresses the health priorities and healthcare needs of the resident population, and within which all aspects of NHS activity, in relation to health improvement, acute services and primary care will be specified

Resource allocation to address local priorities - funds will flow to the NHS Board, which will be responsible for deciding how these resources are deployed locally to meet its strategic objectives

Implementation of the Local Health Plan and Local Delivery Plan

Performance management of the local NHS system, including risk management




Capital Planning Group

The role and remit of the group will include the responsibility to:

Establish priorities for the allocation of capital resources, preparing the Capital Plan and submitting this for approval to the NHS Board

Oversee the allocation of capital resources to projects in line with Board approval(s)

Allocate any residue of available capital resources, including slippage which is identified by Directorates/CHPs/other partnerships during the course of the financial year

Monitor capital expenditure compared to plan, preparing revised forecasts and report progress to PRG/NHS Board on a quarterly basis

Review business cases, as required, prior to submission for PRG approval

Project Board The advisory board comprising key stakeholders in the development including senior representatives of North Glasgow Community Health & Care Partnership, the Mental Health Partnership, GPs and the Project Management team.

The Project Board represents the wider ownership interest of the project and maintains co-ordination of the development proposal.

The Project Board will be supported by a series of task teams (as below). The Project Board is also the forum to address strategic issues and major points of difficulty and enable the Project Sponsor to take the necessary decisions to allow the project to proceed.

Task Teams Specialist working groups will be formed to support the Project Steering Group, Project Core Team and Project Manager with detailed information through the life of the project. These include: IM&T: Chaired by IT Accounts Manager Facilities/Equipment: Chaired by CHCP

Business Support Manager Public Involvement/Transport: Chaired by

CHCP Head of Planning & Health Improvement

Commercial: Chaired by CHCP Head of Finance




Clinical & Departmental User Group: Chaired by CHCP Clinical Director

Commissioning: Chaired by CHCP Business Support Manager

Project Director The Project Director is an individual, usually an

employee of the Board, who represents and has the authority of the Board to act on their behalf in respect of the delivery of a specific programme, in this case, the replacement of Possilpark Health Centre. All instructions by the Project Director are deemed to be given by the Board, all communication passed to the Project Director is deemed to have been given to the Board. The project director will lead the whole process from the outset of the project by providing strategic direction, leadership and will ensure that the business case reflects the views of all stakeholders.

1.7.1 External Advisors

A number of external advisors have been appointed and sit on the core team. In keeping with Frameworks Scotland, professional advisors are required to learn about the specific mechanisms of Frameworks Scotland, understand the skills and techniques that need to be applied under Frameworks Scotland and ensure that all key staff have the appropriate levels of awareness and skills e.g. project manager competency in administering requirements of the scheme contract process and NEC3 procedures; cost advisor knowledge of cost forecasting, risk management and target price setting process. Finally, all external advisors are expected to understand and adhere to the core principal of Frameworks Scotland, which requires a collaborative culture and for all professional advisors to adhere to these principles.

The Project Core Team represents the users and includes key representatives from the Principal Supply Chain (PSC) and the Principal Supply Chain Partner (PSCP) who will be delivering the project. The team will be led by the Project Manager and their primary roles include:

Review key documents and provide feedback to the Project

Manager Seek/manage the clinical/service input. Monitor finance including revenue implications Provide feedback on design development and must be aware

of design approvals at key stages Ensure that the clinical brief and service plan requirements are

delivered




The following disciplines have been appointed and sit on the core team with the specific remit under Frameworks Scotland:

PSCP: Interserve PSC Project Manager: Currie & Brown PSC Cost Advisor: Cyril Sweett CDM Co-ordinator: This role will be appointed when required

The roles and responsibilities for the advisors listed above are described in section 8.




2. THE STRATEGIC CASE

2.1. Section Overview

The preparation of the Initial Agreement (IA) provided the Board with an opportunity to:

Set SMART objectives Define business needs Develop clear design quality and sustainability guidelines Understand the potential project scope and procurement methods Define the benefits, risks, constraints and dependencies. Continuing with the case set out in the IA, during the preparation of the OBC both national and local policies and strategies were considered and ongoing guidance from these will be sought in an effort to realise the objectives, service provision and benefits set out for this project. This section revisits the strategic case outlined in the IA.

2.2. Profile of North Glasgow

North Glasgow experiences the greatest intensity of poverty and deprivation in the whole of the area covered by NHS Greater Glasgow and Clyde (with nearly 60% of our population living in the worst 15% areas of deprivation in Scotland making North Glasgow the second most deprived CHP area in Scotland.)

The new population health profiles, published by the Glasgow Centre for Population Health, confirm the situation of North Glasgow as one where people’s difficult circumstances result in poor quality of life, high rates of ill-health and low life expectancy. The profiles also highlight the differences between different neighbourhoods in North Glasgow, and will therefore help us to target our services to greatest impact.

The average male life expectancy is 63.4 (14% below Scottish average) while female life expectancy is 75.4 (5% below Scottish average). However this figure masks considerable variation across different communities. In Ruchill and Possilpark male life expectancy is 63.4 (more than 12 years less than the average in Kelvindale and Kelvinside) and female life expectancy is 72.1 (9 years less than Kelvindale and Kelvinside).




Health related behaviour and hospitalisation Over 1,300 people from North Glasgow are admitted to hospital

each year for alcohol related causes 158 North Glasgow residents are admitted to hospital each year for

drug related causes (almost twice the national average) An estimated 30,000 people in North Glasgow smoke, 37.5%

compared to 27% nationally There were over 130 suicides in the North area during the period

2001-5 and there are nearly 400 new in-patient admissions to psychiatric specialties annually

Poverty in North Glasgow North Glasgow is characterised by a high concentration of poverty and deprivation. Within the population of 99,669 served by North Glasgow CHCP: Nearly 28,000 people are defined as income-deprived (28% of local

population) Over 8,500 children (41.2%) live in workless households 58.8% of the population live in the worst 15% areas of deprivation in

Scotland, making North Glasgow the second most deprived CHP area in Scotland

As a result, people in North Glasgow experience a range of health and social problems that are related to living in circumstances of deprivation: Average male life expectancy is 63.4 (12% below Scottish average) Female life expectancy is 75.4 (5% below Scottish average) 30,287 people are estimated to be smokers (giving a rate of 37.5%

of the population) Ruchill/Possilpark, Sighthill and Springburn all have smoking rates in excess of 42%

30.4% of pregnant women smoke (This figure rises to 45.2% in Ruchill/Possilpark)

The prevalent rate of problem drug use amongst people aged 15 – 64 in North Glasgow has been estimated at 3.64% (compared to 3.27% for Glasgow City and 1.62% for Scotland). This equates to 19% share of the figure for Glasgow City

North Glasgow CHCP has the highest prevalence of problematic alcohol users in Glasgow with estimated 3,678 people (23.5% share of Glasgow City)

Over a 10 year period to February 2008, there were 204 drug related deaths in (a rate of 204 per 100,000 population) which was 223% above the Scottish average

The suicide rate in North Glasgow is 26.8% (71% above the Scottish average)




The rate of premature deaths from Coronary Heart Disease and Cancer ( less than 75 years) is 175.8 and 271.7 per 100,000 population (80% and 130% respectively above the Scottish average)

It is estimated that 27.8% of our population suffer a long term limiting illness.

North Glasgow CHCP has a teenage pregnancy rate of 62.7 per 1000 young women under the age of 18, which is 55% above the Scottish average

Health and Social Problems This level of health and social problems results in high demand for health services: Glasgow City demographic report estimates that 10,735, the

majority of children in North Glasgow (54.5%) while not necessarily requiring Social Work intervention would be considered vulnerable

North Glasgow CHCP records the highest proportion of children as Social Work clients (2128 children.-more than 1 in 8 children in our area)

In December 2009, 2738 adults, young people and children were supported by North Community Addiction Team, representing 23% of the total in Glasgow City. Of these, 1030 are parents to children under 16

3876 people (3.9% of our population) experience a learning disability (the second highest concentration among Glasgow CHCPs)

North Glasgow is consistently the CHCP with the highest rate of A&E attendances. In the period 1 April – 31st. August 2009 there were 4999 emergency admissions involving patients from North Glasgow CHCP, resulting in a total of 32,329 bed days

92.1% of the population in North Glasgow are categorised as White Scottish or other White British. In the remaining 7.9% the biggest groups with a specified ethnic category are Chinese (1018 people), Pakistani (682), Indian (651), other southern Asian (580) and African (469)

The Glasgow City Asylum Induction Centre is based in North Glasgow. The changes to the asylum process have led to more people being given leave to stay, many of whom then move to other parts of the city or the UK – but North continues to house large numbers of asylum seekers and refugees. North is the CHCP with highest proportion of social work clients from a Black ethnic category (30% of Black Social Work clients in the city)

A significant proportion of our population is vulnerable to homelessness. One third of all the temporary accommodation in Glasgow City is situated in the North. Many of these tenants will then choose to settle in North Glasgow - but will need considerable support to sustain their tenancies and cope with other difficulties




such as mental health or addictions problems that have contributed to their homelessness in the past

On average each year 34 children from Possilpark are admitted to hospital for dental procedures (74% above the Scottish Average). Poor dental health is also a particular issue for Addiction clients being treated with methadone.

From information distributed by Professor Watt, a list of the 18 most deprived GP practices in Scotland (2010) was prepared. There are 5 Possilpark practices in the top 10 and 6 in the top 20 with Keppoch (CHI nr: 4323-7) the most deprived, Balmore Rd (CHI-nr: 4325-6) is the third most deprived, Dr Alguero (CHI nr: 4354-2) is fifth most deprived and Dr Langdridge (CHI nr: 4353-8) is the eighteenth most deprived in Scotland. These four practices will operate within the new Health Centre and collectively demonstrate the concentration of deprivation within the area in comparison to other parts of Scotland. Table 13: The 18 Most Deprived GP Practices in Scotland (2010) Rank Practice Location SIMD

1 Keppoch Medical Practice Keppoch Medical Practice 88.29

2 Dr Robert M Trollen & Dr Pamela Geddes Milton Medical Centre 86.21

3 Drs Reid, Crawford & Myers 138 Balmore Road 82.68

4 Dr Wilson, Dr Mcginley & Dr Sheppard


5 Drs Erich Lamb & Luis Alguero

Possilpark Health Centre 81.24

6 Newhills Medical Practice Easterhouse Health Centre 80.09

7 Drs Andersen, Dawson, Mutch & Smith


8 Castlemilk Group Practice Castlemilk Health Centre 76.59

9 Drs Mckenzie & Burns Drs Mckenzie & Burns 76.58

10 Drs Craig, Douglas, Cherry & Mckean 191 Denmark Street 74.39

11 Dr Grieve Drumchapel Health Centre 72.46

12 Dr D.S.Dhami Easterhouse Health Centre 71.91

13 Drs Lafferty, Macphee & Dames

Drs Lafferty, Macphee & Dames 71.8

14 Drumchapel Medical Practice Drumchapel Health Centre 71.36

15 Dr Turner Drumchapel Health 71.22




Centre

16 Craigmillar Medical Group Craigmillar Medical Group 71.12

17 Westmuir Medical Centre The Westmuir Medical Practice 70.8

18 Dr S J Langridge Possilpark Health Centre 70.78

2.3. Strategic Context and Organisational Overview

The IA was approved on 18th December 2009 following a meeting of Scottish Government Health Directorate Capital Investment Group (CIG). NHSGG&C provides strategic leadership and direction for all NHS services in the Glasgow & Clyde area. It works with partners to improve the health of local people and the services they receive. At a more local level the implementation of strategic policy objectives, including service integration has been given added impetus by the establishment of Community Health and Care Partnerships. North Glasgow CHCP has been established as a partnership which is responsible for the planning and delivery of all health services for the 100,000 people who live in North Glasgow. This includes the delivery of services to children and adult community care groups and health improvement activity. Delivery of the objectives of the CHCP Development Plan as it reflects the NHS Greater Glasgow and Clyde Local Delivery Plan will be enabled by the development of the proposed facility. The key development objectives will centre on the NHSGG&C’s following key corporate themes:

Improve Resource Utilisation: making better use of financial, staff

and other resources Shift the Balance of Care: delivering more care in and close to

people’s homes increasing the emphasis on prevention, early intervention and enablement

Focus Resources on Greatest Need: ensure that the more vulnerable sectors of the local population have the greatest access to services and resources that meet their needs

Improve Access: ensure that service organisation, delivery and location enable easy access

Modernise Services: provide services in ways and in facilities which are as up to date as possible

Improve Individual Health Status: change key factors and behaviours which impact on health

Effective Organisation: be credible, well led, organised and meet statutory duties




2.4. Strategic Objectives

The national policy context has a critical influence on the development of health and care services in Possilpark. The following list identifies some of the key national policies which influenced the preparation of the Initial Agreement: Delivering for Health and associated guidance Better Health, Better Care Getting it right for every child Hidden Harm Changing Lives Health and Homelessness Standards Equality Legislation Improving Health in Scotland: the Challenge Respect and Responsibility – the national sexual health strategy. Equally Well – report of ministerial task force on health inequalities Each of these policies seeks to improve the health and social care service response to the people of Scotland. NHSGG&C consider it worth highlighting the key messages in some of these policies.

The vision set out in Delivering for Health and reaffirmed in Better Health Better Care requires an increasing shift in the balance of care from hospitals to providing as much care and treatment as possible in the local community, close to people’s homes and meeting their needs with a holistic and integrated response. It is difficult to translate this vision into reality and improve access to new services, when staff are working in a number of different buildings, the existing Health Centre is at full capacity and the poor state of most premises provides an unacceptable environment for both staff and service users. The increasing demands of providing services for an ageing population, managing long term conditions and supporting a population who experience high levels of co-morbidity along with difficult and challenging life circumstances means that we need not just to expand our facilities but also design them to enable us to provide new, more effective and flexible service responses, with the close cooperation of multiple agencies: health, social services, training, employment and housing. Changing Lives places the emphasis on service redesign, workforce training and leadership and a shift towards early intervention and prevention. It focuses on building the capacity of the workforce to deliver personalised services and create sustainable change. Equally Well highlights that tackling health inequalities is vital to Scotland’s future and that the resources should therefore be targeted at those in greatest need.




Although each strategy focuses on different aspects of transformation, they are based on a common set of principles: Community capacity building Whole-systems approaches Focus on prevention and early intervention Reducing health inequalities User involvement Carers as partners Self management of care Systematic approach to long-term conditions management A competent workforce

Better Outcomes also calls for a stronger focus on service integration to provide a range of enabling, rehabilitative and treatment services in community settings. The Draft Framework for Rehabilitation identifies six main themes for the development of rehabilitation services. These are:

1. Rehabilitation services should be more accessible to those who

use services, including direct access when essential. 2. Rehabilitation services need to be provided locally, with a strong

community focus. 3. A systematic approach to delivering rehabilitation to individuals is

required, promoting independence and self-management. 4. Rehabilitation services should be comprehensive and evidence-

based, should reflect patient needs at distinct phases of care, and should identify models to ensure seamless transitions.

5. Practitioners and providers in health and social care need to be better informed about current and evolving roles and expertise within rehabilitation teams.

6. Health and social care professionals need to critically review staff resource deployment through service redesign and skill-mix review.

2.5. SMART Investment Objectives

The Initial Agreement introduced the investment objectives as stating that the proposed investment will make a significant contribution to the achievement of the wider policy agenda and the local corporate objectives by providing modern and fit for purpose facilities for the provision of services across health and social care. The investment objectives were reviewed during the preparation on the OBC and are listed below:

Table 14: SMART Investment Objectives

Specific Investment Objective

Measured By Actionable Realistic Time Related

1 Enable speedy access to modernised and integrated Primary Care and Community Health Services that are progressing towards the achievement of national standards.

Reduced waiting times for GP appointments

Reduced

waiting times for AHP services

Yes, by improved consulting space

Yes Review of research outcomes on annual basis post completion Review of performance data on annual basis following completion

2 Promote sustainable primary care services and support a greater focus on anticipatory care.

Numbers of CHD health checks ( as per new government guidance) Increase in dental registrations

Yes, by improved space and more welcoming environment for patients

Yes Review of performance data on annual basis following completion

3 Improve the convenience of access to primary care services for patients.

Increased working hours linked to GNRA project to promote access Better

access for people with disability

Yes, more space allows increased volume and range of treatment sessions in primary care.

Building will be DDA compliant

Building will

Yes Yes

Survey by PPF annually on patients’’ views on services in Health Centre




be welcoming for patients

Yes

4 Sustain the

progress made towards establishing a culture of partnership that is an essential foundation for the Community Health and Care Partnership in line with “Partnership for Care”.

Increase in IAFs Increase in

referrals to carers support team Increase in

referrals to local community health improvement services

Yes, co-location of staff and proximity of other services will encourage better partnership to provide more holistic services for patients

Yes, builds on our experience gained through Keep Well

Review of performance data on annual basis following completion

5 Deliver NHSGG&C wide planning goals by supporting strategies for service remodelling and redesign that have been the subject of extensive public engagement and involvement.

No delayed discharges Reduction in

admission and bed days for LTCs Reduction in

emergency readmission of people aged 65+

Yes, will support implementation of Primary Care Strategy, LTC strategy, ASR and RES redesign

More people supported at home

Better management of LTCs

Prevention of delayed discharges

Yes Yes Yes Yes

Review of performance data on annual basis following completion

6 Deliver a more energy efficient building within the NHSGGC estate, reducing CO2 emissions and contributing to a reduction in

Reduced energy costs and emissions

Yes, by modern building design

Yes Annual review post occupation and compliance with technical standards




whole life costs.

7 Achieve a BREEAM Healthcare rating of ‘Excellent’.

Independent BREEAM Assessor

Yes, but with capital investment

Yes, but difficult due to the BREEAM Healthcare Assessment Process.

Post construction

8 Achieve a high design quality in accordance with the Board’s Design Action Plan and guidance available from A+DS and CABE.

Compliance with Design Statement, Master plan and legal consultation

Yes Yes During design development and construction period

9 Meet statutory requirements and obligations for public buildings e.g. with regards to DDA.

Independent DDA review during design stages

Yes Yes, as compliance with legislation

Through project lifecycle

2.6. Project Stakeholders

NHSGG&C has involved a broad range of stakeholders in respect of the new Health Centre. These stakeholders are listed below:

4 GP Practices Children and Families Patients General Dental Practitioner Physiotherapy Podiatry Enablement Team




2.7. Property Strategy The current NHSGG&C Property Strategy for CH(C)Ps highlights the following two points:

All CH(C)Ps are aiming to integrate their services as far as

possible in new fit for purpose centres but this is proving challenging due to limited availability of additional capital and revenue funding to support their aspirations

Local Authorities generally are experiencing similar capital and

revenue funding challenges to support property management and development

In January 2009 and May 2009 respectively Audit Scotland issued the two following reports:

Asset Management in the NHS in Scotland Asset Management in Local Government

The key recommendations to the SGHD were to:

Provide policies and guidance for all types of assets and update its

current policies and guidance to reflect changes in the NHS and the development of new health policies

Routinely collect information from NHS bodies on the performance of all their assets

Ensure momentum is maintained in the development of the new national estate computer system

Ensure momentum is maintained in developing the hub initiative to support joint working across the public sector

The key recommendations to the NHS bodies were to:

Develop strategies for each type of asset and then develop a

corporate asset management strategy and plan which links with their clinical strategies

Ensure they assess estate condition, statutory compliance, functional suitability and space utilisation on a regular basis

Ensure all information on assets is held electronically Review their performance management arrangements and, where

required, develop performance measures and targets for assets

NHSGG&C are actively involved in the compilation of up to date survey information for its estate and the preparation of a revised property strategy for Community and Primary Care premises due for completion by summer 2011.




NHSGG&C worked together with Glasgow City Council and its consultants to assess the current status and the premise aims for the five Glasgow City CHCPs.

The principle aim is to articulate an evolving plan for the estate which will determine the options for rationalisation and the resulting implications for capital and revenue planning. The overall long-term goals for the North CHCP estate are summarised below:

A new Health Centre potentially at Saracen Street to replace

facilities at the Possilpark Health Centre and potentially longer term opportunities for increased integration with community/non-health facilities in the area as part of the wider regeneration of the area

Three high quality social work facilities fit-for-purpose to integrate health and social care teams in Springburn, Maryhill and Royston

Three high quality integrated Health Centres with flexible/sectional space, information, initial assessment and redirection through purpose-built reception facilities similar to the existing area in Springburn Health Centre

A series of customer contact sites providing advice, information, initial assessment or redirection from a number of locations.

Enhanced co-location of teams with service benefits and related cost savings enabling the CHCP to maximise the use of its current assets, supported by IT solutions and opportunities for agile working for appropriate services

Increased use of community and school buildings to further enhance local service delivery through further discussions with potential partner organisations

2.8. Current Arrangements

The current services, workload and facility are outlined in this sub-section. Current provision of services

The following services are currently provided in the Health Centre: Adolescent Mental Health

Team Alcohol Counseling Antenatal Care Anti-coagulant Clinic Audiology Child Development Centre Child Health and Family

Psychiatry Child Health Clinics

Enuresis Clinics - (Bedwetting) Sexual Health Services General Dental Practitioners GP Services Hearing Aid battery

replacement Learning Disability service Ophthalmology Orthotics Pediatric Clinics




Child Mental Health Team Community Dental Services Continence Services Counseling Services Dietitian Drug Counseling Ear Nose and Throat clinics

Physiotherapy Podiatry Psychiatry Psychology Stop Smoking Service Treatment Room services Weight Clinic

Staff Workload We are providing care in the community to increasing numbers of people, many of whom experience chronic illness at a younger age and have more complex needs than other less deprived areas: 34.5% of the population in the Possilpark area have a long term

limiting illness (70% above the Scottish average) 12.3% of children in North Glasgow are Social Work clients (with

even greater concentration in some areas – e.g. 18.1% in the Sighthill, Royston and Germiston neighbourhood)

Our Community Addictions Teams are supporting 2,876 people, a quarter of the overall caseload in Glasgow City. Our North Community Addiction Team is currently working with 26 GPs in delivering 26 Shared Care Clinics – this is the highest number in any area in the city

Our Criminal Justice Team has the highest ratio of workload to staff in Glasgow

North has a disproportionate number of homelessness tenancies. Generally these individuals are in greater need, have lived a fairly transient lifestyle and have poorer physical and mental health and as such need greater input. (Well over a quarter of the city’s homelessness accommodation is located in the North)

There are over 300 new referrals each month to our Mental Health Services

The Facility The current fabric of the existing Health Centre building is poor and space is restricted. As a result the building is barely fit for purpose at present and is not suitable for the provision of 21st century health and social care services. The existing building is not DDA compliant and was originally designed and constructed to overcome difficulties in the ground conditions. As a result it has been designed ‘on stilts’ with most services provided on the first floor. Access however is difficult, with the single lift being too small to accommodate wheelchairs and the access ramp being too long and too steep to provide an acceptable means of access to anyone whose mobility is compromised which therefore presents a difficulty to most Health Centre users.




Previous property studies of Possilpark Health Centre have concluded that there is no potential for expansion on the current site. NHS aspirations to develop more local multi-disciplinary teams working in the community (e.g. through the dispersal of specialist child health staff to support more local partnership working) cannot be supported without additional space being made available. A DDA survey of the existing property in 2003 and a maintenance survey in 2006 identified costs of £620,000 and £640,000 respectively, indexed up to BCIS TPI for 3Q 2009, to carry out the statutory and fabric maintenance works on the building. These suggested works do not include works for delivering service benefits. The Commission for Architecture and the Built Environment (CABE) believes that the quality of the local environment can contribute to each phase of healthcare through prevention (by providing opportunities for exercise, promoting personal safety, and reducing stress), intervention (by ensuring that all healthcare buildings are designed around the needs of the patients and the staff, as an integral part of the therapeutic effort) and recovery (by producing high quality environments that assist and accelerate healing). CABE also believes that there are a set of 10 key elements that help to create a good healthcare building. These are: Good integrated design, Public open space, A clear plan, A single reception point, Circulation & waiting areas, Materials, finishes and furnishings, Natural light and ventilation, Storage, Adapting to future changes, Out of hours community use. In recognition of this the designers will be instructed to consult with clinical users and patients to achieve a good design that: fosters access to social support , seeks to lower reduce stress levels so that patients reach the point of consultation feeling as calm and relaxed as can be expected; offers an early welcoming point of orientation for moving around the building; delivers well planned waiting rooms to reduce fear and increase confidence; uses material that are robust as well as attractive; can capture the use of natural light and ventilation to help contribute to good energy efficient and environmental conditions throughout.

2.9. Desired Scope and Service Requirements The core elements of the business scope for the project identified in the IA as the minimum requirements are tabled below. Changes made during a review as part of the OBC process have been highlighted. Intermediate and maximum elements will continue to be considered during development in line with costs or expected benefits.




Table 15: Desired Scope Minimum Inter-

mediate Maximum

Potential Business Scope To enable the CHCP to provide an integrated service spanning primary care, community health, social care and hospital services in the Possilpark area

To maximise clinical effectiveness and thereby improve the health of the population

To improve the quality of the service available to the local population by providing modern purpose built facilities

To provide accessible services for the population of Possilpark and surrounding areas

To provide flexibility for future change thus enabling the CHCP to continually improve existing services and develop new services to meet the needs of the population served

To provide a facility that meets the needs of patients, staff and public in terms of quality environment, functionality and provision of space

To provide additional services that are complimentary to the core services provided by the CHCP

To be part of the delivery of an integrated community facility contributing to the social, economic and physical urban regeneration of a deprived area

Key Service Requirements GP practices A new dental health suite Health visitors and district nurses working in integrated teams

Social Work staff particularly those associated with vulnerable Children and Families on site

Allied Health Professional




services (AHPs), including a physiotherapy gym which will be available for local community use in the evenings Specialist children's evaluation and disability services *

Child and adolescent mental health services *

Community mental health services *

Personal care facilities in the community to support independent living for local disabled people (allowing them access to shopping and other community activity in the Possilpark area)

Youth health services Sexual Health services Training accommodation for primary care professionals including undergraduate and postgraduate medical and dental students

Secondary care outreach clinics including the Glasgow Women's Reproductive Service and a Community Addiction Team clinic

Community health services and community-led rehabilitation and health improvement activity

Local Stress Centre services Money advice services Employability advice and support Housing advice and support Opportunities for volunteering Community café and crèche/nursery facilities

Retail, including a neighbourhood supermarket

* These services have been re-prioritised since approval of the IA in line with the statement regarding costs or benefits.




2.10. Key Benefits and Benefits Criteria

The key benefits identified with the project are listed below: Table 16: Key Benefits Class Relative

Value Relative Timescale

Benefits Criteria

Short-term: 1 – 3 Years Medium-term: 3 – 5 Years Long-term: 5+ Years Strategic Services designed around the needs of patients & clients so that they work well and are convenient for them. Patients and clients will be asked for their views on what is convenient, what works well and what could be improved. The pathway or route that a patient or client takes from start to finish will be continuously examined to see how it can be made easier and swifter. Unnecessary stages of care or service delivery will be removed, more tests and treatments will be done on a “one-stop” basis and patients will be able to access a wider range of services in fewer locations.

High Long-term Qualitative Direct Indirect Economic

Improved localisation of access to services through having all services on the same site will enable the delivery of “one-stop shop” services and single point of access for patients to all services they might need which at present is either very difficult or impossible to achieve.


Improved clinical effectiveness through removing the artificial boundaries between secondary, primary and community care and enabling further progress to be made in improving the scope and range of local health care delivery.

High Long-term Qualitative Direct Economic

Integration of health and social services to provide best value to

High Medium-term

Qualitative Direct




patients based on the “one-stop shop” principle. This states that as many services as possible should be provided at each visit especially for those with long term health needs, combined with recognition that each patient contact should be the only contact needed to access all the services needed.

Indirect Economic

Better communication between multi-disciplines i.e. Community and Hospital Care, Midwifery, Community Nursing Teams and Social Care Services. Hence, from a patient perspective a seamless service.

High Medium-term

Qualitative Direct Indirect Economic

Improved clinical quality will be achieved by service redesign allowing team working to develop, joint ownership and clear management responsibility of both services and budgets. The realisation that service development depends upon constant re-examination of current working practices to ensure that best value is always being obtained from available resources frees staff to “think the unthinkable” when considering priorities and the balance between what has always been done and what developments are desired from the patients, public and professionals perspective. Examples of the expected improved clinical quality through teamwork are:


General Practitioners and Clinical Pharmacy improving patient prescribing.

High Medium-term

Qualitative Direct Economic

Clinical Pharmacy and Nursing promoting improved use of medicines at home.





Better interaction and joint working between General Practitioners, Health Visitors and General Dentists can prevent dental decay in children.

High Medium-term

Qualitative Direct Indirect Economic

General Practitioners and Consultants can improve inpatient and outpatient care through regular liaison and the sharing of the wider Primary Care Team in educational sessions and topical discussions.


Primary, Secondary and Social Care Services will have the opportunity to better co-ordinate care to prevent admission and improve rehabilitation.


“One Stop Shop” service for Diabetic Service involving General Practitioners, Opticians, Nurses, Prescribing Advisors, and Dieticians working together can prevent visual loss from Diabetes.


Improved arrangements for delivering and managing out of hours services.


Opportunities to develop intermediate care within the primary care setting for example within Dermatology where intermediate specialists can treat a wider range of patients in Primary Care thereby improving the profile of patients referred to Acute services which will impact on waiting times and improve accessibility to specialist services.


Improved quality of physical environment through the

High Medium-term

Qualitative Direct




development of building design solutions that get the best clinical performance from the diverse teams operating in the health and social services. It is intended that the Project Group will be extensively involved in the design stage of planning the new building, which will be much more than simply the same services in a new building.

Indirect Economic

Enhancing the provision of investigation, rehabilitation & outreach services in close partnership with Primary Care.


Operational Physical environment and patient pathway.

Medium Medium-term

Qualitative Quantitative Direct Economic Financial

Access to a range of services not previously available locally.

Medium Medium-term

Qualitative Quantitative Direct Financial

One door access to integrated community teams; this will improve service co-ordination and ensure that service users receive the best possible care from the professional with the skills best suited to their needs.

Medium Medium-term

Qualitative Quantitative Direct Financial

A more co-ordinated approach to rehabilitation.

Medium Medium-term

Qualitative Quantitative Direct Economic

Speedier referral pathways between professionals.

Medium Medium-term

Qualitative Quantitative Direct Economic

Energy efficient & sustainable build.

High Long-term Qualitative Quantitative Direct Economic

Statutory compliant build eg DDA

High Short-term Qualitative Quantitative Direct




Table 17: Definition of Terms relating to the Benefits Criteria Term Description

Qualitative The benefit descriptions or distinctions based on quality

rather than on quantity, when referring to data, it means data that is not quantified

Quantitative Implies that there is something about this benefit that can be measured, whether financially, over time or research

Direct Direct benefit to the patients and the NHS Board in improving the quality of care.

Indirect Indirect benefits to others in the public service through an aim to address the high deprivation statistics.

Economic Non cash releasing but measurable

Financial Cash releasing

2.11. Strategic Risks

A number of high level project risks have been identified and categorised into business, service and external risks. These risks are listed below: Table 18: High Level Project Risks Description Mitigation

Business Risks 1 Commercial – eg land

acquisition Early engagement with landowner / development partner

2 Financial Robust business case & procurement process

3 Political Encompass current legislation

4 Environmental Early sustainability briefing

5 Strategic Joint development agreement with partners

6 Cultural Develop public engagement process

7 Quality Detailed briefing & monitoring

8 Procurement method Adopt NHS Framework Scotland

9 Funding Robust business case model

10 Organisational Develop early project management framework and




delegated authority limits

11 Projects Develop within Framework Scotland

12 Security Document control strategy

Service Risks 13 Personal Manage within Framework

Scotland

14 Technical Employ strict change control management processes

15 Cost Employ strict change control management processes

16 Programming Plan & monitor with reference to an early warning strategy

17 Operational support Manage service User input effectively

18 Quality Share QA responsibility with PSC & PSCP teams

19 Provider failure Develop a Commissioning programme

20 Resource Manage for resource / succession planning

External Environmental Risks 21 Secondary legislation Plan within timescales with

development team

22 Tax Manage within change control process where possible

23 Inflation Manage within change control process where possible

24 Global economy Manage within change control process where possible

During the build-up to producing the OBC, a number of risk workshops were held. A review of the identified risks has led to the quantification of risks and therefore a reduction in Optimism Bias. Risk and the management thereof will remain an ongoing action into the development of the FBC and during construction.




2.12. Constraints and Dependencies

A number of constraints and dependencies are apparent at this stage, all of which will have a significant impact on the way the project is procured and delivered. The following key constraints have been identified: Funding: ▫ Development is contingent of FBC approval and

confirmation of funding Programming

and phasing: ▫ Maintaining vehicular access and egress during

the course of construction to the existing Post Office. Construction phasing will be pre-agreed with GNRA, the Post office and NHSGG&C

▫ Existing Services require to be retained in the existing Possilpark Health Centre until completion of the new centre

Quality: ▫ Achieve a minimum target score of 4/6 in the AEDET categories under the AEDET review process

▫ Compliance with all current health guidance Sustainability: ▫ Achievement of BREEAM Health ‘Excellent’ for

the new build

Review of the potential dependencies associated with the proposed investment has been undertaken by key individuals within the senior management team. The following key dependencies have been established: Site: ▫ Planning Permission: Development is contingent

on the PSCP and design consultants obtaining detailed planning consent

Saracen Exchange:

▫ A dependency of particular importance is that the replacement Possilpark Health Centre cannot be viewed in isolation. The joint Master plan developed by NHSGGC & Glasgow North Regeneration Agency (GNRA) aims to provide a social, economic and physical urban regeneration of an area of Glasgow that has suffered from a lack of investment over a number of years. GNRA has been successful in obtaining ERDF grant funding for the development of Saracen Exchange thus providing an opportunity for sustained development and investment in the area.

3. THE ECONOMIC CASE 3.1. Section Overview

This section provides detail on the costs of each of the shortlisted options, provides insight into the assessment of options, benefits and project risks.

3.2. Critical Success Factors

In section 7 of the IA, critical success factors were explored as part of the way forward. These critical success factors were revisited during the preparation of the OBC to confirm whether they are still valid. The agreed critical success factors are listed below:

Table 19: Key Critical Success Factors Key Critical

Success Factors Broad Description

1 Strategic fit & business needs

How well the option: Meets the agreed investment objectives, business needs and service requirements & provides holistic fit & synergy with other strategies, programmes & projects.

2 Potential VfM How well the option: Maximises the return on investment in terms of economic, efficiency, effectiveness and sustainability & minimises associated risks.

3 Potential achievability

How well the option: Is likely to be delivered & matches the level of available skills required for successful delivery.

4 Supply-side capacity and capability

How well the option: Matches the ability of service providers to deliver the required level of services and business functionality & appeals to the supply side.

5 Potential affordability

How well the option: Meets the sourcing policy of the organization and likely availability of funding & matches other funding constraints.




The National Policies that significantly influenced the Initial Agreement deliver the following key drivers for the project:

Improving equitable access to services through the availability of an

increased range of services in community settings Tackling health inequalities by targeting resource to greatest need Community and public participation in service design and provision Seamless care through tailor-made integrated care pathways

supported by a range of agencies working in partnership Staff partnership based on involvement and support to provide new

flexible and effective ways of working Improved care for the elderly and younger people The use of technological advances in information and

communications technology generally to benefit service users and reduce the professional isolation of its staff

The high priority attached to the improvement of people’s health and improvement of community services

Breaking down of barriers between primary and secondary care and health and social care organisations and professions through a whole systems approach to planning and delivering services

The creation of sustainable and flexible services and facilities which can absorb rising expectations and demand, especially to meet needs for increased programmed care for chronic disease

Tackling health inequalities and focussing more resource on anticipatory care

These key drivers were revisited during preparation of the OBC and the following addition key driver was added to the list above: Tackling health inequalities and focussing more resource on

anticipatory care

3.3. Options Considered

As required, the Board identified a long list of potential site options. This activity was undertaken during preparation of the IA. The long list was then evaluated and shortened into a short list of options. What follows is an outline of both the long and short lists, together with other relevant information.

3.3.1 Long list of Options

The IA identified a proposed way forward for the project. The proposed way forward came under scrutiny on 11th January 2010 when a (non




financial) Site Options Appraisal Workshop which was attended by a wide range of stakeholders. The objectives of the workshop were to: Provide an overview of the Long and Short List of Site Options

contained within the Initial Agreement Confirm Short listed options Review defining criteria Rank the short listed options Weight the criteria Appraise the options Review next steps

The long list of options is listed below: Table 20: Long List of Site Options Option Description 1. Do Nothing:

Maintaining the status quo within the existing Health Centre is an unrealistic option and unsustainable in terms of achieving any of the strategic & investment objectives of the scheme.

2. Do Minimum:

This option would include minor interior upgrade works to improve the building. While this option would fail to meet the service and project objectives, it has been included as an option to provide a baseline so that the extra benefits and cost of the other options can be measured against it.

3. Extend existing Health Centre:

Previous property studies of Possilpark Health Centre have concluded that there is no potential for expansion on the current site. NHS aspirations to develop more local multi-disciplinary teams working in the community (e.g. through the dispersal of specialist child health staff to support more local partnership working) cannot be supported without additional space being made available. There is no alternative accommodation available in North Glasgow where staff from different health disciplines could co-locate, along with colleagues in social care.

4. Refurbish existing Health Centre and develop smaller new build on another site:

GPs or community health services would move to purpose-built premises & the existing Health Centre would be refurbished - This option would go some way towards addressing issues associated




with limited space and the ability to deliver new, expanded and modern services however, would be contrary to the delivery of strategic benefits which would be delivered by co-location of services providing integrated care.

A smaller site within the Saracen Street development could be considered but may deliver a reduced value for money solution dependant on the land take required.

5. New Build Health Centre on another site:

There are other vacant sites in the area, with the most likely alternative being a, Glasgow City Council owned, former school site on Hawthorn Street. This however, is a much bigger site. It is being considered by GCC for use as a new residential development for older people, but it also has much greater potential for housing development and so would represent a greater opportunity cost to GCC and the local area.

No preparatory work has been done in assessing this site.

6. New Build Health Centre at Saracen Street:

This option allows the replacement of the current poor quality Health Centre premises and the relocation of key health and social care staff to work together on one site. It has the added advantage of promoting integrated working with other local agencies and voluntary organisations to provide new, more effective services to meet the needs of a population at the extreme edge of vulnerability. This will support more focus on prevention, particularly parenting and nutrition, and early intervention with one example being childhood dental services for a population with some of the worst dentition in Western Europe.

This option would enable the CHCP, working in partnership with local agencies and voluntary organisations, to provide a range of integrated and holistic services to meet the complex needs of this population. The master plan for the development would be led by Glasgow North Regeneration Agency (GNRA) so that there will be a focus on recovering the heart of the community, and empowering the population with health, housing, training and job placement. Sharing the costs of the development is a cost effective means of developing new accommodation. GNRA as the lead development partner has done all the planning work in bringing the local partners together to develop a shared plan for the development of the site. Saracen Street is a high profile site in Possilpark and its redevelopment will have symbolic importance for the whole community and bring hope for future regeneration of the area. Not




progressing with this development will make the GNRA development less viable as a regeneration project.

7. Third party developer led Health Centre at Saracen Street with GNRA:

This option is similar in content to Option 6 but would be a developer led arrangement with GNRA as a co-client. The service and strategic objectives could be met by this option. However, in recent times the long term revenue affordability and value for money of third party developments to NHS Boards has been questioned. Further detailed affordability reviews would be required at Outline Business Case to assess this option fully.

3.3.2 Short list of Options

The long list of 7 options was evaluated and a short list of 4 options compiled. The rationale for rejecting certain options is discussed further on in this section. The following options were shortlisted in the IA and appraised in greater detail during the above non-financial Options Appraisal workshop 11th January 2010: Table 21: Shortlisted Options Option

Score Rank

Option 6: New Build, Saracen Street (Self) 916 1

Option 5: New Build, Alternate site 735 2

Option 7: Third party developer led Health Centre at Saracen Street with GNRA

718 3

Option 2: Do Minimum (includes minor interior upgrade works to improve the building)

91 4

The workshop appraisal report has been attached.




3.3.3 Rationale for the rejection of the other three options The rejected options and rationale thereof are listed below:

Option 1 Do nothing: This option does not provide the service

objectives which are required from the project Option 3 Extend Existing Health Centre: This option cannot be

realised as the size of the centre is already maximised for the available land footprint

Option 4: Refurbish existing Health Centre and develop smaller new build on another site: this option would provide significant challenges around decant to maintain the current service provisions once a smaller complimentary centre was built. A two site option is also likely to increase staff travel time and reduce the amount of integrated service working that has been developed and encouraged

3.4 Benefits Appraisal Following engagement with key stakeholders during preparation of the IA and during the OBC, it is expected that service users will see an improvement in the following:

Physical environment and patient pathway Access to a range of services not previously available locally One door access to integrated community teams; this will improve

service co-ordination and ensure that service users receive the best possible care from the professional with the skills best suited to their needs

A more co-ordinated approach to rehabilitation Speedier referral pathways between professionals

Taking analysis of the policy context further, the key assumptions underlying the analysis of the strategic context for the changes proposed in these plans and this business case are:

It will increasingly be possible to provide services safely and

effectively closer to people’s homes and this will benefit people who use the services by improving access

Interagency collaboration, multidisciplinary working and service integration are vital to the effective provision of services for many groups in the population

Medical, information and communications technology will continue to improve and create opportunities for improving local access especially to diagnostic services




People’s expectations about the services which they receive and where and when they receive them will continue to increase and meeting these expectations will remain a social policy priority

Nurses, Allied Health Professionals and Social Care Professionals, in particular, will continue to develop their roles in providing care in the context of extended primary care teams

Improvement of service through the design of integrated care pathways for people with complex health and social problems will remain national priorities. This will also apply to the improvement of services for people with a range of diseases which cause premature death or reduce people’s functioning or quality of life (e.g. CHD, cancer and diabetes)

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

Significant and sustained improvements in health and well-being are 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

3.4.1 Benefits Criteria and Weighting

The criteria used to measure the long list of site options for the Initial Agreement was reviewed and amended at a Site Options Appraisal Workshop held on 11th January 2010. As a result of the review, the original list of 14 was reduced to 11.

The amended criteria are listed below:

1. Enable speedy access to modernised and integrated Community

Health & Social Care Services that achieve national standards. 2. Promote sustainable Primary Health & Social Care Services and

support a greater focus on anticipatory care. 3. Improve the experience of access and engagement to primary

health care services for people within one of the most deprived areas in Scotland.

4. Continue to develop the culture of partnership that is an essential foundation for the CHCP in line with Partnership for Care.

5. Deliver NHS GGC wide planning goals and support service strategies

6. Deliver a more energy efficient building within the NHSGGC estate, reducing CO2 emissions and contributing to a reduction in whole life costs through achievement of BREEAM healthcare rating of excellent

7. Improve and maintain retention and recruitment of staff. 8. Achieve a high design quality in accordance with the Board’s

Design Action Plan and guidance available from A+DS and CABE.




Creation of an environment people want to come to, work in and feel safe in

9. Meet Statutory requirements and obligations for public buildings e.g. with regards to DDA

10. Contribution to the physical and social regeneration of the whole area

11. Potential achievability for long and short term within realistic timescale and future flexibility.

The following criteria were omitted on the basis of unsuitability: 1. Potential VfM was deleted as the workshop was a non-financial

workshop 2. Potential affordability was deleted for the same reason as potential

VfM 3. Supply-side capacity and capability was omitted as this specifically

relates to the PSCP and is not required to assess the site options.

3.5 Capital Costs

The following sections present the capital and revenue (recurring and non-recurring) assumptions used to derive the cash flow for the short-listed options. All current guidance has been followed in constructing the financial and economic appraisal, principally the latest Scottish Capital Investment Manual (SCIM). The economic appraisal process utilises a number of key outputs from other parts of the OBC process, namely workforce planning, capacity planning and design in establishing the capital and revenue implications of each option. The general approach to the economic appraisal is summarised below:

Diagram 6: Economic Appraisal Process

The table below summarises the indicative capital costs for the options on the short list:

Table 22: Indicative Capital Costs for the Shortlisted Options Option

Estimate (£,000)

2. Do Minimum (minor refurbishment)

1,747

5. New Build on alternate site

12,995


10,398


13,310

The capital cost under Option 7 above relates only to equipment, which the NHS will procure and own. This option is predicated on a third party developer building the new facility and leasing it back to the NHS. Assumptions are made that the third party developer costs of build reflects a mark up of 10%, reflecting their cost of capital, profit margins etc. This calculation gives an estimated capital cost for the third party developer of £13.310m. The following table show the key assumptions which have been made around the lease option:




Table 23: Key Assumptions relating to the Lease Option, Option 7 Key Assumptions £,000

Capital cost 3PD £13,310 Term of lease 25 years Annual lease cost to NHS £1,000 5 yearly Rental review +10% NPV £17,313 Ratio NPV to fair valuation 123% Asset value £17,313 Lease Creditor £17,313 Creditor - Lease payment £692 Finance charge-revenue - Lease payment £308 Depreciation on assets over 25 years £692 Equipment cost to NHS £907 Depreciation on Equipment £90

The following tables show the key factors in compiling the capital cost of each option:

Option 2: Do Minimum Table 24: Indicative Capital Costs for Option 2 Project component

Estimate

Building Square metres 2,860 Building cost per square metre (excl VAT) £350 Fees 12.5% Equipment 0 Optimism Bias 23.46% Land 0 VAT Rate 20% Depreciation Buildings: refurbishment 25 years Lifecycle costs prepared by S Baker Sign convention: all savings are minus -

Option 5: New Build on alternate site Table 25: Indicative Capital Costs for Option 5 Project component

Estimate

Building Square metres 3,124 Building cost per square metre (excl VAT) £2,200 Fees 12.5% Equipment 10% Optimism Bias 16.25% Land £1,200,000




VAT Rate 20% Depreciation Buildings: refurbishment 60 years Depreciation: Equipment 10 years Lifecycle costs prepared by S Baker Sign convention: all savings are minus -

Option 6: New Build at Saracen Street (Self): Table 26: Indicative Capital Costs for Option 6 Project component

Estimate

Building Square metres 3,124 Building cost per square metre (excl VAT) £1,996.41 Fees 12.5% Equipment 10% Optimism Bias 9.12% Land £480,000 VAT Rate 20% Depreciation Buildings: refurbishment 60 years Depreciation: Equipment 10 years Lifecycle costs prepared by S Baker Sign convention: all savings are minus -

Option 7: Third party developer led Health Centre at Saracen Street with GNRA Table 27: Indicative Capital Costs for Option 7 Project component

Estimate

Building Square metres 3,124 Building cost per square metre (excl VAT) £2,200 Fees 12.5% Equipment 10% Optimism Bias 23.31% Land £480,000 VAT Rate 20% Estimated Capital Cost to 3rd Party Developer £13,310,000 Estimated lease back cost to NHS £1,000,000 Period of Lease 25 years Lifecycle costs prepared by S Baker Sign convention: all savings are minus -

It should be noted that the change in building costs per square metre between Option 6 and options 5 and 7 is a result of greater detail being known about this option from investigations to date and the costs used reflect other comparable projects tested in the current market. For options 5 and 7 there is a greater level of uncertainty around issues




such as remedial ground works and this reflects a slightly higher potential cost. The Treasury’s Green Book published in 2003 introduced a requirement for an adjustment to be made for optimism bias for all investments. Optimism bias refers to the known tendency for the costs of projects to be underestimated, particularly in the early stages of developing and costing projects. The adjustment for optimism bias is a requirement to make explicit, upward adjustments to costs to counteract this known tendency. The optimism bias applied for each option is as follows:

Table 28: Optimism Bias Summary Option Optimism Bias %

2. Do Minimum

23.46


16.25


9.12


23.31

The optimism bias calculated for each of the options is contained within the appendices and has followed the standard proformas to establish the Upper Bound percentile and the Mitigation scores. The optimism bias for Option 6 is significantly lower than the other options for a number of reasons which include the following:

The current land owner, GNRA has undergone extensive site

investigation works, ground remediation and services identification to reduce the site development risk. This information is not available for the other alternative options

GNRA and NHSGG&C have an agreed site masterplan with outline planning consent granted from Glasgow City Council

NHSGG&C has utilised the Frameworks Scotland procurement process to select a skilled and experienced design, construction and management team to deliver the project

The local community have already been engaged in the development potential for the site due to the links between GNRA and NHSGG&C

NHSGG&C has significant experience in the delivery of similar capital projects and of joint working with other partner agencies




3.6 Revenue Operating Costs

For the purposes of the OBC the revenue cost analysis focuses on the additional costs that would be incurred under the different short listed options. These fall into three categories, capital charges, facilities costs and decontamination of Dental and Podiatry. Following the Glennie report, the Scottish Government requires that all new build facilities address issues around decontamination of both Dental and Podiatry services.

3.6.1 Capital Charges The NHSScotland Capital Accounting Manual has been followed in preparing these figures. The calculation of asset depreciation is based on the following asset lives:

New build: 60 years Refurbishment: 25 years Equipment: 10 years

As from 1st April 2010, NHSScotland policy is not to apply interest charges in capital assets. This was previously applied at a rate of 3.5% under Treasury guidance. The calculations in this OBC therefore reflect only the implications of depreciation on the costs of each option. The following table shows the impact on capital charges of each option: Table 29: Capital Charges Option Proposed

£000s Current

£000s Change

£000s 2. Do Minimum

158 88 70


266 88 178


228 88 140


782 88 694

The above table reflects depreciation charges only for comparison. It is assumed that the 2009/10 budget held for capital charge interest is returned to centre under this policy change.




3.6.2 Facilities Costs The table below sets out the impact on facilities cost of each option:

Table 30: Facilities Costs

Running Costs of short listed options Option Estimated

Facility Running

Costs £000s

Estimated revenue

contributions

£000s

Net annual additional

revenue costs £000s

2. Do Minimum

191 191 0


210 204 6


210 204 6


143 204 -61

Note: 3rd party developer (Option 7) assumes property maintenance and rates are covered in lease.

3.6.3 Decontamination Costs of Dental and Podiatry

The recurring annual revenue cost for implementing the findings of the Glennie report for this project are assessed at £60,000 per annum. These costs are taken from an equivalent service based at Inverclyde.

3.6.4 Detailed Revenue Costs

The table below shows the detailed revenue costs including capital charges for each option:




Table 31: Detailed Revenue Costs per Option Revenue Spend Option 2:

Do Minimum

Option 5: New Build

on alternate

site


Street (Self)

Option 7: Third party

developer led Health Centre

at Saracen Street with

GNRA

Capital Charge Proposed 158 266 228 782 Less: Current 88 88 88 88 Net Cost – Capital Charges

70 178 140 694

Facilities Costs Heat, light, power 36 39 39 39 Cleaning Services 63 70 70 70 Property Maintenance

23 26 26 0

Water and General rates

37 41 41 0

Telephones 32 34 34 34 Sub-total Proposed 191 210 210 143 Less: current costs Heat, light, power 36 36 36 36 Cleaning Services 63 63 63 63 Property Maintenance

23 23 23 23

Water and General rates

37 37 37 37

Telephones 32 32 32 32 Sub-total Current 191 191 191 191 Change to Facilities

0 19 19 -48

Income from GPs 0 13 13 13 Current income GPs 0 0 0 0 Change in GP income

0 13 13 13

Other income 0 0 0 0 Net change in Facilities

0 6 6 -61

Decontamination cost

60 60 60 60

Directorate Funding

-138 -138 -138 -138

Finance Charge Lease

- - - 308

Total Change Revenue

-8 106 68 863

The above table shows that the most cost neutral option, if we exclude Option 2: Do Minimum which does not address the service needs, is Option 6: New Build at Saracen Street (Self) with a 68k revenue cost increase.




3.7 Summary of Financial Appraisal

The following table shows the capital and revenue requirements for Option 6, which is the preferred option, over the period of design and construction through to the post commissioning stage and first full year in operation. Table 32: Capital and Revenue Requirements Option 6: New Build Saracen Street (Self)

2010/11

£,000

2011/12

£,000

2012/13

£,000

2013/14

£,000

Total

£,000 Capital Funded by: Existing Capital 1,500 7,292 1,408 10,200 Additional 198 198 Total 1,500 7,292 1,606 10,398 Revenue Funded by: Existing Revenue Additional 34 68 68 Total 34 68 68

NHSGG&C has made the necessary provision within its agreed financial plans for both the capital and revenue impact of the project and the on going costs. The additional capital sum of £198,000 will be funded from NHSGG&C's management of the impact of the increase in VAT charges from 17.5% to 20% across its overall capital programme. No specific assumptions have been made around potential capital receipts on disposal of the existing Health Centre. Clarification is being sought with regards to a VAT saving of £80,000 for the land purchase. The resultant requirement for additional revenue funding arises from the new facility being slightly greater in size than the existing Health Centre. This results in increased facilities and capital charge costs. The decontamination issue is being addressed within this new build at a recurring cost of £60k per annum. Against these, Directorate savings have realised £138,000, leaving an annual recurring revenue shortfall of £68,000. This minor revenue shortfall will be funded from within NHSGG&C's management of its existing revenue budgets. Non Recurring Cost of disposal of existing site This outline business case is predicated on the basis that the existing Health Centre will be disposed of once the new facility becomes available. There will therefore be a non recurring impairment cost to reflect the run down of this facility. The building Net Book Value at 31 March 2010 is




£1.567m with a credit held in revaluation reserve of £0.436m. This would give a net impairment to be met between 2010/11 and 2012/13 of £1.131m. Land has a valuation currently of £0.330m with a revaluation reserve credit of £0.292m. It is not known at this point if the disposal of the land will attract capital receipts.

3.8 NPC/ NPV Findings (for the short listed options)

The short listed options were subjected to investment appraisal using the Discounted Cash Flow (DCF) technique. The DCF calculation takes account of:

Capital development costs and other non-recurrent expenditure Annual revenue costs Lifecycle costs SCIM Guidance on the use of DCF has been followed and the General Economic Model (GEM) has been used to analyse the forecast cash flows of the short listed options. As per the guidance, capital charges and VAT are excluded from the calculations. Risk is included as optimism bias. The final cost analysis must be discounted at the appropriate real rate to give the present value. The GEM uses 3.5% for the first 30 years and 3% beyond this. Costs have been assessed over a 60 year operational period.

The results of the discounted cash flow calculations, shown as Equivalent Annual Cost (EAC), are summarised in the table below: Table 33: Net Present and Equivalent Annual Costs Option Net Present

Cost £ 000’s

Equivalent Annual Cost

£ 000’s

Economic Ranking

£ 000’s 2. Do Minimum

6,540 248 1


15,336 581 3


12,254 465 2


14,431 789 4

Although Option 2 presents the most attractive result in terms of equivalent annual costs, the fact that it does not provide the service




objectives which are required from the project prevents this option from being considered further. It is only therefore included for comparison purposes. Table 34: Economic Appraisal Element Option 2: Do

Minimum

£ 000’s

Option 5: New Build

on alternate site

£ 000’s


Street (Self)

£ 000’s

Option 7: Third party developer led Health Centre at Saracen

Street with GNRA

£ 000’s Capital Receipts

0 0 0 0

Capital Costs 1,477 10,973 8,795 756 Life Cycle 19,378 23,303 19,539 0 Other Revenue

-5,192 -4,855 -4,855 22,738

Net Present Value

6,540 15,336 12,254 14,431

Ranking 1 4 2 3

3.9 Value for Money Analysis

Value for money (VfM) is defined as the optimum solution when comparing qualitative benefits to costs. An analysis has been carried out on an economic annual costs basis in line with HM Treasury guidance. The VfM analysis compares the cost per benefit point of the short listed options. The option that is preferable is the option that demonstrates the lowest cost per benefit point.




Table 35: Value for Money analysis comparing Qualitative Benefits to Costs

Option Qualitative Benefits

Score

Equivalent Annual

Cost (£000)

Cost per Benefit

point (£000)

VfM Economic

Ranking

2. Do Minimum 91 248 £2.725 4 5. New Build on alternate site

735 581 £0.79 2


916 465 £0.508 1


718 789 £1.099 3

The VfM calculation of the cost per benefit point shows that Option 6 is the best option in value for money terms.

3.10 Risk Assessment

The objective of performing a risk assessment is to:

Allow the Board to understand the project risks and put in place mitigation measures to manage those risks

Assess the likely total outturn cost to the public sector of the investment option under consideration

Ensure that the allocation of risks between the Board and the private sector is clearly established and demonstrated within the contractual structure.

A risk may or may not occur and is defined as an event which affects the cost, quality or completion time of the project. There are a number of such events that could arise during the design, construction and commissioning of the new facilities. A full risk analysis was undertaken to identify and assess the impact of risks during all stages of the project. This comprised a series of reviews involving the core team comprising the PSCP, PSCs and the Board's client representatives.

The first risk workshop was held on 2 June 2010.The outcome of the workshop is a detailed risk register for the project in line with Health Facilities Scotland’s (HFS) template. It is being developed with the




PSCP, provides a clear picture of the expected risks and is reviewed regularly with the team.

The risk register, which is appended to this document, identifies: The risk and provides a description of it The score (probability x impact) per risk The risk type (as per SCIM guidelines) The potential impact indicating whether it is a time or cost impact The proposed mitigation strategy per risk The risk owner or manager The project’s risk register has been set up in accordance with the standard format for the Frameworks Scotland Joint Project Risk Register. The risk register will drive the ongoing management of the project risks throughout the remaining phases, namely FBC and construction. The guidance notes have been taken into account during the preparation of the risk register and have been attached as an appendix. Operational risks identified during the various risk workshops will be transferred to the Board’s risk register as the Board will manage operational risks prior to conclusion of the FBC.

Quantification of the cost of project risks is included within the assessment of optimism bias for each shortlisted option.

3.10.1 Risk Rating Matrix

A 'five by five' probability and impact matrix will be used in association with the Joint Risk Register on all Frameworks Scotland Programmes as this is the basis of assessing seriousness of the risk exposure. The matrix is illustrated below: Diagram 7: Probability and Impact Risk Matrix A traffic light system (below) is used to illustrate the priority of risks. Again, this reflects the requirements for all Frameworks Scotland Programmes.

Impa

ct

5 5 10 15 20 25 4 4 8 12 16 20 3 3 6 9 12 15 2 2 4 6 8 10 1 1 2 3 4 5

1 2 3 4 5 Likelihood




Diagram 8: Traffic Light Risk System Likelihood Impact Almost Certain 5 x 5 Catastrophic Likely 4 x 4 Major Possible 3 x 3 Moderate Remote 2 x 2 Minor Rare 1 x 1 Insignificant

3.10.2 Risk Types

The project’s strategic risks (section 2.11) have been categorised according to SCIM guidelines: Business: remain within the public sector and cannot be transferred Service: occur within the design, build and operational phases of a

project and may be shared between the public and private sector External: environmental risks which relate to society and which

impact on the economy as a whole

3.10.3 Risk Management

All capital projects carry a degree of risk. Project risks that are not identified at the appropriate stage in the project life cycle cannot be effectively managed. Often this results in time and cost overruns and a reduction in the quality of the built facility. Risk management has been used extensively throughout the development of this project. The approach has been to ensure successful project delivery, by seeking to: Foster increased understanding of the project amongst project

partners Ensure focussed consideration of project objectives and risks by

all project partners Produce more realistic project budgets, timescales and scope; Provide robust justification for contingency allowances Provide a framework or basis for the agreement of commercial

terms Develop the partnering ethos by providing transparency where all

issues are ‘on the table’ 3.10.4 Key Risks associated with the Options on the Short List

The key risks associated with each of the options are listed in table 36:

Risk Rating

High

Medium

Low




Table 36: Key Risks associated on the shortlisted option Option 2: Do Minimum Continued (high) risk of infection Public health and safety Increased costs of maintenance Reduced medical care Option 5: New Build on alternate site Potential lack of adequate or suitable public transport to facility Delayed start Timely acquisition of suitable land Option 6: New Build at Saracen Street (Self) (based on rev 3 dated 8 July 2010) Risk Description

Pre-mitigation

Post-mitigation

Increase in VAT rate beyond 17.5% or other changes 16 8

Additional costs associated with achieving BREEAM excellent 16 4

May encounter unforeseen events - other local security company issues

15

4

May fail to realise the expected contributions, (Land sale, other asset sales, Grants and VAT Recovery)

12 9

Political changes 12 4 Funding 12 3 Costs of discharging conditions of planning consent may be greater than allowance provided for

12 4

Insufficient Capital Funds to deliver the full clinical requirement 12 4

May fail to comply with Utilities regulation 12 4 Board may fail to include allowances for Compensation Events, (Changes to Works Information, failure to meet Approval Periods etc.)

12 6

The utilities may provide sub-standard service 12 9 Acquisition of land Additional Impact on GNRA development if HC does not proceed Additional 7. Third party developer led Health Centre at Saracen Street with GNRA Dependency on third party funding being approved Dependency of third party planning and other project implications Delayed start Lose the benefits and expertise of Frameworks Scotland procurement Insufficient control over sustainability and related issues




3.11 The Preferred Option

Option 6: New Build at Saracen Street by Self (with a non-financial score of 916) is the preferred option. The preferred option will be discussed in more detail in section 4.

3.12 Sensitivity Analysis

A Sensitivity Analysis is defined as the effects on an appraisal/option of varying the projected values of important/selected variables. A business case is built upon estimates which can lead to inaccuracies. The preparation of a sensitivity analysis will help assess whether the business case is heavily dependent on a particular cost or benefit.

In economic terms the following table demonstrates the best value for money per benefit point is Option 6.

Table 37: Value for money analysis comparing Qualitative Benefits to Costs Option Benefits

score Equivalent

Annual cost

£,000

Cost per Benefit

point £,000

VfM Rank

Option 2: Do Minimum

91 248 £2.725 4

Option 5: New Build on alternate site

735 581 £0.79 2

Option 6: New Build at Saracen Street (Self)

916 465 £0.508 1


718 789 £1.099 3

If we test Option 5 for changes in land price and if the building developmental rate per square metre was to be comparable to Option 6, this would reduce the capital cost for Option 5 to £10.141m. In economic terms the effect is to reduce the equivalent annual cost per benefit point to £0.72. This option still remains in 3rd place in value for money ranking and reflects the higher optimism bias associated with the unknowns of this option.

Assuming that the benefits scoring remains unchanged then, in order to make Option 5 more favourable in cost per benefit point terms than




Option 6 there would need to be a reduction in capital cost of £9.495m in Option 5 to produce a more favourable cost per benefit point than Option 6. This is unrealistic in capital build terms.

Conversely, were Option 6 to increase in capital costs by £6.244m then this would then be unfavourable in comparison to Option 5. Given that optimism bias has been provided for and the departmental costings are viewed as strong, then this increase to Option 6 is seen as unlikely.




4.0 THE PREFERRED OPTION 4.1 Section Overview

This section introduces the Board’s preferred option and outlines the associated considerations such as: Expected Benefits and Benefits Realisation Service Continuity Human Resource Issues Clinical Brief Design Concept

4.2 Option Description As identified previously, the preferred option is Option 6: New Build at Saracen Street by Self (with a non-financial score of 916). The preferred option will be discussed in more detail in this section. The site sits within the wider area masterplan known as Saracen Exchange. This is a regeneration project which has been developed and is being run by Glasgow North Regeneration Agency (GNRA). The Health Centre represents a significant first phase of this development and it is anticipated that this will be the anchor for further development of the wider site. The site is viewed as a ‘gateway’ to the Possilpark area. The design proposals that have been developed for the Health Centre align with and support the aspirations for the masterplan. The masterplan received Outline Planning Consent in February 2010. This includes the Health Centre proposal. The wider area Saracen Exchange masterplan requires the formation of the civic square at the junction of Saracen Street and Stonehurst Street. This fixes the main entrance to the Health Centre as being from this point.

4.2.1 The Site The site for the proposed replacement of Possilpark Health Centre is bounded by Saracen Street to the east, Stonyhurst Street to the north, Killearn Street to the South and Carbeth Street to the West (as per the diagram below). The site is currently a vacant derelict site with the existing post office located midway along the site’s Stonyhurst Street Boundary. The site is generally level along the frontage with the




Stonyhurst Street and Killearn Street sloping gradually westwards. The level change is marked at the Western boundary outwith the site.

The site is within Possilpark Town Centre and has been identified as a key site within the wider regeneration area. The Health Centre site and the adjacent sites to the north and west are part of the wider master plan called the Saracen Exchange which has been developed by Glasgow North Regeneration Agency (GNRA). The development of the Health Centre is a key anchor to the formation of a civic square at the junction of Saracen Street and Stonyhurst Street and the subsequent formation of a new pedestrian route along Stonyhurst Street to the wider area. Diagram 9: Site layout

4.2.2 Site Context

Saracen Street is the main shopping street for this area and is lined with 4 storey tenements with retail at ground level. This occurs 1 block to the north of this site. The site is abounded by vacant derelict sites immediately to both the north and the south with single sandstone civic buildings at the corner of these blocks – the library and former school. Historically a large part of the site and the surrounding area consisted of 4 storey tenements creating a consistent street frontage, particularly




to Saracen Street. Recent demolitions and subsequent low level redevelopment to the surrounding area have eroded the density of the urban grain. The site context is illustrated below:

Diagram 10: Site Context

4.2.3 Application of the 3Ps

Throughout the design process, the approach has been founded on the clear application of the 3P’s – Practice, Principles and People. Practice The application of current best practice is critical to the success of any project. The PSCP has ensured that this has been applied to this proposal. Healthcare is a continually evolving process and experience has demonstrated that evolution can occur even during the design process, with constant changes to clinical models and procedures. The proposals are designed to have enough in built flexibility to respond and adapt to change. Principles The key principles in the design approach are: Sustainability is a fundamental consideration in the design

proposals. The building will be sustainable by firstly being a functional and fine building that can evolve with the evolving clinical needs; secondly it will utilise both passive and active sustainable




design principles as evidenced by the BREEAM Excellent rating that it aims to achieve

The building will reflect best value and wherever possible, added

value. People A people-centred design aspires to the following: A welcoming and secure exterior Attractive social spaces internally and externally An inspiring and inviting civic presence An community centred civic space creating a new focus for the area

and a catalyst for regeneration A modern, spacious and healthy environment Therapeutic quality Staff needs and aspirations have been fully considered in the design. Their new work environment will be of the highest standard with lots of natural light and ventilation, and local environmental controls that are responsive to individuals needs. Patient and visitor experience of the building will be enhanced by the positive use of open space natural light and open views in and out. The building will be a fully integrated part of the Possilpark Community not only as a healthcare building but as a community building.

4.3 Key Selection Factors

The development of the new Health Centre will take place in the context of the Scottish Government stated purposes of:

HEALTHIER – Help people to sustain and improve their health,

especially in disadvantaged communities, ensuring better, local and faster access to health care

SAFER & STRONGER – Help local communities to flourish,

becoming stronger, safer places to live, offering improved opportunities and a better quality of life.

4.4 Expected Benefits

The benefits have been categorised into strategic and operational. The strategic and operational benefits are listed below;




Strategic Benefits Services designed around the needs of patients & clients so that they work well and are convenient for them. Patients and clients will be asked for their views on what is convenient, what works well and what could be improved. The pathway or route that a patient or client takes from start to finish will be continuously examined to see how it can be made easier and swifter. Unnecessary stages of care or service delivery will be removed, more tests and treatments will be done on a “one-stop” basis and patients will be able to access a wider range of services in fewer locations. Improved localisation of access to services through having all services on the same site will enable the delivery of “one-stop shop” services and single point of access for patients to all services they might need which at present is either very difficult or impossible to achieve. Improved clinical effectiveness through removing the artificial boundaries between secondary, primary and community care and enabling further progress to be made in improving the scope and range of local health care delivery. Integration of health and social services to provide best value to patients based on the “one-stop shop” principle. This states that as many services as possible should be provided at each visit especially for those with long term health needs, combined with recognition that each patient contact should be the only contact needed to access all the services needed. Better communication between multi-disciplines i.e. Community and Hospital Care, Midwifery, Community Nursing Teams and Social Care Services. Hence, from a patient perspective a seamless service. Improved clinical quality will be achieved by service redesign allowing team working to develop, joint ownership and clear management responsibility of both services and budgets. The realisation that service development depends upon constant re-examination of current working practices to ensure that best value is always being obtained from available resources frees staff to “think the unthinkable” when considering priorities and the balance between what has always been done and what developments are desired from the patients, public and professionals perspective. Examples of the expected improved clinical quality through teamwork are: General Practitioners and Clinical Pharmacy improving patient prescribing; Clinical Pharmacy and Nursing promoting improved use of medicines at home. Better interaction and joint working between General Practitioners, Health Visitors and General Dentists can prevent dental decay in children. General Practitioners and Consultants can improve inpatient and




outpatient care through regular liaison and the sharing of the wider Primary Care Team in educational sessions and topical discussions. Primary, Secondary and Social Care Services will have the opportunity to better co-ordinate care to prevent admission and improve rehabilitation. “One Stop Shop” service for Diabetic Service involving General Practitioners, Opticians, Nurses, Prescribing Advisors, and Dieticians working together can prevent visual loss from Diabetes. Improved arrangements for delivering and managing out of hours services. Opportunities to develop intermediate care within the primary care setting for example within Dermatology where intermediate specialists can treat a wider range of patients in Primary Care thereby improving the profile of patients referred to Acute services which will impact on waiting times and improve accessibility to specialist services. Improved quality of physical environment through the development of building design solutions that get the best clinical performance from the diverse teams operating in the health and social services. It is intended that the Project Group will be extensively involved in the design stage of planning the new building, which will be much more than simply the same services in a new building. Enhancing the provision of investigation, rehabilitation & outreach services in close partnership with Primary Care.

Operational Benefits Physical environment and patient pathway Access to a range of services not previously available locally One door access to integrated community teams; this will improve service co-ordination and ensure that service users receive the best possible care from the professional with the skills best suited to their needs. A more co-ordinated approach to rehabilitation Speedier referral pathways between professionals Energy efficient & sustainable build Statutory compliant build eg. DDA

4.5 Service Continuity

As the facility will be a new build, decant is not a consideration, however, the following items are being considered with regards to service continuity and migration: Staff issues (ie training, orientation, parking, dining)




ICT (computers, telephones, connectivity) Communication to residents Services The above items require planning and to this end, NHSGG&C will review on an ongoing basis while developing a strategy for the FBC.

4.6 Migration and Workforce Strategy

The close proximity of the proposed new Health Centre to the existing Health Centre and other CHCP offices will minimise disruption to staff, most of who will already work in the Possilpark area. If there are staff members facing increased travel to and from work as a result of the move to the new building, staff will be reimbursed for a period of four years. It is recognised however that, change, even when positive, needs to be proactively managed. The migration will be managed in line with the NHS Staff governance standard (as detailed in paragraph 5.8). There has already been involvement with staff in preparing the plans for the new Health Centre and this will continue as the plans become more detailed and opportunities for local decision making increase. Changes in practice as a result of moving to the new building will be in line with ongoing workforce change programmes (detailed in paragraph 5.8.1) and will therefore be supported by the ongoing Organisational Development programme to support these changes.

4.7 Facilities Management

The new Health Centre will be supported by the in house resources of NHSGG&C for the delivery of all Facilities Management (FM) services.

In a new development designed with flexibility but to meet its primary purpose, it is more straightforward to apply the National Cleaning Standards specifications and comply with the latest HA Infection Control requirements. The Board’s FM team will input to the design specification around the most efficient routes in and out of the building for clean and dirty waste, mail and other deliveries. The Operational Estates team will input to the design from the ongoing maintenance, replacement and energy strategies perspective and also with a view to long term sustainability and reducing revenue costs for running modern & more efficient buildings. The IT and Telecoms team will utilise existing contract strategies adopted by the Board to obtain the greatest service provision for users' requirements at the most efficient price.




4.8 Human Resource Issues

Adherence to the Staff Governance Standard will be implicit for the current and future, Possilpark Health Centre workforce with the expectation that positive benefits will be realised from the development in ensuring staff are: Well informed Appropriately trained Involved in decisions which affect them Treated fairly and consistently Provided with an improved and safe working environment

As the development will involve the transfer of services, the ‘Framework for Managing Workforce Change’ will be applied.

Application of the framework will be led by HR Managers in collaboration with operational managers and staff side representatives.

4.8.1 Workforce Planning and Development

‘Better Health, Better Care: Planning Tomorrow’s Workforce Today’ provides the context against which all workforce planning within NHSGG&C is undertaken and encompasses specific legal, regulatory and wider policy influences that will impact upon the workforce.

The overall vision is to ensure we have the right staff in the right place with the right skills and competences to deliver high quality care and services to our patients.

In order to realise this vision our workforce needs to be aligned with both service and financial plans to ensure affordability and sustainability over the long term.

The specific benefit from service and role development should be improvement in service accessibility and realising a shift in the balance of care towards more local, community focused care.

4.9 Clinical Commissioning

The clinical or operational Commissioning of the project will follow the guidance from the manuals in SCIM. It will be the Board's intention to nominate a Commissioning Manager from either its own resources or as an external consultant. The main duties of the Commissioning Manager will be:

Establish the migration programme for each department going into the new facility




Establish a communications plan Liaise with the Project Manager during the construction phase Assist with the procurement, delivery and installation of equipment Coordinate training needs Manage the transfer of patients and staff to the new facility Coordinate security arrangements post construction completion Manage staff orientation visits

The Commissioning Manager's direct line of responsibility will be to the Project Director and thereafter to the Project Owner.

4.10 Use of Retained / Surplus Estate

NHSGG&C will vacate the current Health Centre on completion of the new Health Centre. It is planned that NHSGG&C will dispose of the current Health Centre on completion of the new Health Centre. The options to do this are currently being explored and will be detailed further within the FBC.

4.11 Clinical Brief

The clinical brief for the programme was developed through an inclusive process that included a detailed review of all of those clinical services who will feature within the new facility and/or or be impacted upon by it. This structured process included undertaking a review of existing service models and accommodation before identifying how these should change in reflection of current and future thinking in the context of national and local strategic considerations, policy and thinking. Key changes implemented as a result of this review process included reorganisation of existing general medical practices, community health services and administrative accommodation as well as fundamental changes to the way that care will be delivered through the new facility/amended services in future. The following is a summary of services to be delivered from the centre: Community Dental Services Physiotherapy Podiatry Treatment Suite Community Health Facilities General Medical Practices Enablement Services Accommodation Children & Families Services Accommodation Diabetes Services




4.12 Schedule of Accommodation

The Schedule of Accommodation has been issued as a component of the Clinical Brief and contains more detailed information related to clinical service delivery issues and specified accommodation. The overall area of the facility is 3,124m².

The Clinical Brief notes that, although areas to be provided are as specified in the schedule of accommodation, it is important that: Every opportunity to appropriately rationalise scheduled areas

through design should be identified Accommodation should be as flexible as possible

The current version is dated 16 June 2010 and is attached as an appendix.

4.13 Design Concept

The current development for the new Possilpark Health Centre represents the embodiment of the desire to create a vibrant and welcoming Health Centre that is at the heart of the community. The Health Centre and the adjacent development of the civic square, represents the first stage of the regeneration of the wider area to revitalise this broken part of Possilpark. The Design Concept has been developed to meet the following key design principles: Creation of a strong civic presence on the street

The form along Saracen Street is strong and bold in scale. The material quality and scale will be carefully selected to enhance the civic presence. The transparent frontage will visually connect the activity within the building to the street beyond

Formation of a civic square at the intersection of Saracen Street and Stonyhurst Street The building line at the new civic square is set back from the original kerb line in accordance with the masterplan proposal

Formation of entrance off the civic square The entrance opens out to both Saracen Street and the civic square to ensure a highly visible focal point. The design of the square will be as pedestrian friendly as possible




Reinstatement of the street line of Saracen Street and Killearn Street The building form follows the existing street line of Saracen Street and turns the corner at Killearn Street to reinforce the block

Separate vehicular and service access to the rear of the

building from Killearn Street All service and vehicle access will be away from the front entrance and to the rear of the Health Centre. Thus allowing secure and independent access from the main entrance

Formation of secure staff access and disabled vehicular

access from the carpark The access to the Health Centre needs to be as direct and secure as possible for the staff and visitors arriving by car. This dual access is promoted in the masterplan as an enhancement of the general security for the area with all open spaces to be designed to be overlooked

Creation of a buffer zone between Saracen Street and the

main building functions The challenges of the site are from traffic noise and pollution whilst at the same time allowing all consulting rooms to have natural ventilation via opening windows. The formation of a buffer zone to the Saracen Street frontage shields the clinical accommodation from these issues

These key principles have been developed by a combination of site aspirations, responses and constraints as defined by the Saracen Exchange masterplan, the functional brief and the aspirations defined in the high level information pack (HLIP). Lessons learned from the current accommodation: The existing Health Centre was analysed to determine if there were any lessons that could be learned. The current accommodation identified the following key issues to be considered in the new design: Security of the building

There is a longstanding history of vandalism to cars and problems with the building perimeter. This requires a secure perimeter and elimination of any recesses. The issue of security also extends to the interior design of the building

Security for reception staff Reception staff experience regular incidents that cause stress. The design of the reception areas needs to offer as much passive security as possible in terms of high visibility from other areas as well as the considered design of the desk and screen




Views out / ventilation The street facing windows to GP rooms on the upper floors have been subject to vandalism. This prevents opening of the windows for ventilation and the views out have been restricted by the use of polycarbonate to replace the broken glass. The design of the new GP rooms can be located to protect them from vandalism and allow them to be opened

GPs located on 1st floor The GP’s are currently located on the 1st floor and this appears to be an arrangement that all are happy with.

NHSGG&C will make use of the Achieving Excellence Design Evaluation toolkit (AEDET) to assist with determining and managing their design requirements from the initial proposals through to post project evaluation. AEDET evaluates the design by posing a series of clear, non-technical statements encompassing the three key areas of impact, build quality and functionality. The review will be scheduled for late August 2010 which provides sufficient time for the drawings to be finalised.

The ground, first and second floor layouts have been included in the appended Design Statement.

4.13.1 Infection Control

Both the location and the design have been evaluated in terms of Infection Control by using the HAI Scribe (Healthcare Associated Infection System for controlling risk in the built environment). HAI Scribe has been designed as an effective tool for the identification and assessment of potential hazards in the built environment and the management of these risks. HAI Scribe, when applied to the built environment is intended to be: Appropriate to the subject Straightforward in its application Manageable and practical in terms of maintenance in monitoring

records Comprehensive in its provision of “due diligence” defence Effective in minimising hazards and their impact. Stage 1 and 2 of the HAI Scribe process was co-ordinated by Currie & Brown and attended by members of the project team on Wednesday 16th June 2010. Those in attendance were as follows:




Eugene Lafferty - Client Representative, NHS GGC Joseph Ferguson – Project Manager, Currie & Brown Kirsty Ferguson - Infection Control Advisor, NHS GGC Susan Goodfellow - Project Architect, Aedas Architects Ron McPhee, Principal Contractor, Interserve (PSCP) Raymond Kelly - M&E Consultant, Wallace Whittle Velda Middleton – Business Case Co-ordinator, Currie & Brown A further review will be held with the above team and NHSGG&C Estates department.

Stage 3 will be carried out when construction commences and Stage 4 will be carried out when the building has been commissioned and is fully operational.




5. THE SUSTAINABILITY CASE 5.1 Section Overview

This section outlines the delivery and associated costs with regards to procurement, construction and operation of the facility, location of the facility and through the provision of facilities capable of sustaining growth. The case for sustainability is embedded in the delivery of the programme and in the life of the development. NHSGG&C recently completed the pilot for the Good Corporate Citizen and have registered to continue with the initiative. The Good Corporate Citizen model has been used to assess the new Health Centre. Furthermore, there is a commitment from the Board to continue to use the model to reassess the development regularly.

5.2 Introduction

Like all public sector bodies in Scotland, NHSGG&C is committed to the Scottish Government’s purpose: “to create a more successful country where all of Scotland can flourish through increasing sustainable economic growth”. The Board and the PSCP team are taking an integrated approach to sustainable development by aligning environmental, social and economic issues to provide the optimum sustainable solution for the Board’s estate. The replacement of Possilpark Health Centre at Saracen Street will promote NHSGG&C’s commitment to providing a sustainable estate that meets the needs of the present without compromising the ability of future generations to meet their needs in all of its activities. To this end the new facility is seeking to obtain a BREEAM ‘Excellent’ rating. The current BREEAM assessment (dated 28 May 2010) is attached as an appendix indicating an anticipated “potential” score of 74.85%% which indicates that an Excellent rating is achievable. A BREEAM pre-assessment estimate for the project was co-ordinated by Wallace Whittle and attended by members of the project team. Those in attendance were as follows: Eugene Lafferty - Client Representative, NHS GGC Martin Johnston - Client Representative (Student Placement), NHS

GGC Joe Ferguson - Project Manager, Currie & Brown Susan Goodfellow - Project Architect, Aedas Architects Amy Kerr - Project Architect, Aedas Architects




Ron McPhee - Principal Contractor, Interserve (PSCP) Raymond Kelly - M&E Consultant, Wallace Whittle Individual credits considered achievable were selected by the project team in order to achieve a targeted ‘Excellent’ BREEAM Healthcare Design and Procurement Assessment. The following credits are mandatory for an ‘Excellent’ rating and have been included: Table 38: BREEAM Credits BREEAM Issue

BREEAM Rating/ Minimum number of

credits Excellent

Man 1 - Commissioning 1 Man 2 - Considerate Constructors 1 Man 4 - Building user guide 1 Hea 4 - High frequency lighting 1 Hea12 - Microbial contamination 1 Ene 1 - Reduction of CO2 emissions 6 Ene 2 - Sub-metering of substantial energy uses

1

Ene 5 - Low or zero carbon technologies 1 Wat 1 - Water consumption 1 Wat 2 - Water meter 1 Wst 3 - Storage of recyclable waste 1 Le 4 - Mitigating ecological impact 1

In addition a second conservative Pre Assessment was undertaken which demonstrated a potential ‘Very Good’ rating. This is included for information purposes in the assessment which is attached as an appendix. The table below is an excerpt from the appended pre-assessment and illustrates the BREEAM Rating of Excellence:




Diagram 11: Summary of BREEAM “Excellent” rating

BREEAM Assessments will be carried out regularly to monitor progress towards achieving the best possible score with regular interim feedback and updates from the PSCP client team stakeholders. Where necessary, the project team has sought clarity from external agencies such as Health Facilities Scotland. This has allowed a more optimistic view to be taken with regard to maximising points available at the earliest stages of the process and allowed the team to take corrective action at the earliest opportunity. NHSGG&C has taken cognisance of the principles laid down both locally and nationally for the promotion of sustainability. Due regard is given to the framework set out in A Sustainable Development Strategy for NHSScotland.

5.3 Promoting Sustainability

In order to achieve BREEAM Excellent the project will initially target the credits naturally afforded by the selected site – such as proximity to public transport. Following this, the project will focus of achieving the maximum number of points possible in the most heavily weighted categories: Energy, Health and Wellbeing, Materials followed by Management.




The project will focus on energy reduction targeting passive design strategies initially before introducing energy efficiency and low carbon generation technologies. Metering will be included to allow the building users to manage energy usage during operation. Artificial lighting will be effectively controlled through automatic means and complimented by daylighting on the perimeter.

The indoor environment quality will be optimised through effective facade design to provide views, daylight, limit glare and manage overheating in order to provide a thermally comfortable environment. Local zoning and control will be provided to ensure occupants have easy and accessible control over their own environment. Acoustic performance will be managed to ensure the appropriate standards are met.

The building will adhere to best practice commissioning standards to ensure the intended design performance is achieved. Additionally the management of the site and design process will adhere to best practice guidance including public consultation processes.

Finally the construction materials will be selected in order to minimise environmental impact and follow guidance for responsible resourcing.

This project will promote sustainability across three fronts, these are:

A: Through the procurement, construction and operation of the new facility

The design of the new facility will be developed to provide a comfortable and stimulating environment for the occupants whilst minimising the impact of the building on the environment both during construction and in operation. A number of measures, outlined below, have been considered in order to improve the sustainability of the building; these aspects will continue to be developed throughout the design process.

Passive Energy Saving Measures

By careful consideration of the location, orientation, form, extent of solar shading and construction type of the building (both opaque and translucent elements), a comfortable internal environment will be maintained with minimal energy input.

Daylighting

Natural light can make an important contribution to sustainability by reducing the electrical energy used for artificial lighting. It also contributes to the well-being of visitors and staff, aesthetics and the general “feel” of the space. This is further improved by the use of




simple, but effective lighting control measures (such as daylight control in highly glazed areas and PIR control of transiently occupied spaces) as well as energy efficient artificial lighting design and luminaire selection. By making the best use of the final site chosen and minimising the number of storeys in the building, daylight penetration to the lower levels of the building has been optimised. North facing glazing will be maximised to allow good quality diffused daylight to enter the building whilst minimising the potential for glare and overheating. Effective solar shading and control will be provided to the other main elevations.

Natural Ventilation

The outline proposals aim to maximise the use of natural ventilation to provide a comfortable internal environment. Generally the layouts will allow for effective natural ventilation of space by means of opening windows. In addition, where mechanical ventilation is required in order to meet clinical or statutory requirements, high efficiency/low energy fans will be used and ventilation heat recovery will be maximised.

Building Envelope

The building will include a high level of thermal insulation and careful detailing to minimise unwanted heat loss and uncontrolled infiltration.

Efficient Building Services Installations The building services systems within the facility will be designed and controlled so that they operate at maximum efficiency and only operate when required thus minimising energy consumption. Some examples of ways in which building services may be designed to reduce energy consumption are as follows: The artificial lighting will utilise low energy fluorescent or

discharge lamps and luminaires with high light output ratio. Automatic lighting controls, with manual override, should be

used to ensure lights are switched off when sufficient natural daylight is available or when rooms are unoccupied.

All air handling units will incorporate variable speed fans.

Automatic controls will ensure the fans only deliver the volumes or air required to suit the requirements of the space




at any particular time. This will reduce energy consumption for both fans and heating of fresh air.

Other Low and Zero Carbon Technologies will be applied as appropriate in order to achieve the expected planning requirement of a 15% reduction in predicted Carbon Emissions when compared against the Notional Building criteria within the latest Technical Standards.

Water Conservation Water consumption will be reduced by using low water use fittings, flow restrictors and timed flow control to reduce wastage. Rainwater/Greywater harvesting will also be considered where appropriate.

Materials Construction materials will be selected on grounds of their suitability for the job and their sustainability. Choosing sustainable construction materials involves consideration of environmental impacts throughout their life cycle and the avoidance of non-renewable materials where possible. The following has been considered during the selection process:

Impact of the material’s production on the environment Hazards to health or local environment during construction or

use Life span of the material Nature of the resources involved, renewable or non-

renewable, scarce or abundant Emission of CO2 during production and consideration of

embodied energy How far and by what modes the material will be transported The use of recycled material

Eventual destination of the material after the building’s life; where possible materials and construction methods should be employed that will allow building components to be reused at the end of the building’s life, or recycled where reuse is not possible.

The methodologies set out in “The Green Guide to Specification” (bre: August 2007) will be used to assess different materials and determine the most sustainable material for each element of the buildings. Where possible A +/A rated materials or their nearest equivalent will be used.




Landscaping & Ecology The following items have been considered in respect of how the facility will interact with its surroundings:

Biodiversity before and after the build Use of native species Use of a scheme that avoids artificial irrigation or fertilizers Trees for shading Retention of existing vegetation Avoidance of disturbing the water table and watershed Integrated pest management

Management/ Methodology

The following proposed procedures will help to develop a sustainable construction methodology for the contractor:

Using lean construction methods with minimum waste Minimising energy use during construction Separation of construction waste (and avoidance of waste in

the first place) and the careful disposal of toxic waste to prevent pollution of the local environment

Preserving local biodiversity through careful and compact zoning of construction activities

Conserving water resources Developing good relationships with local people in order to

safeguard particularly important features of the local environment

Careful monitoring of the construction process Responsible sourcing through identification of the supply chain

and product stewardship

B: Through the location of the new facility

There is one major positive contribution to the overall sustainability of the project that the choice of site can make and that is its location. The Board are aware that one of the overriding objectives for the new facility, that of “accessibility”, inherently corresponds to sustainable outcomes. Accessibility of the site was one of the key criteria in the options appraisal exercise. Green Travel

The Board are currently preparing a travel plan for the new Health Centre, the aim being to ensure that pollution from transportation is minimised.




C: Through the provision of facilities capable of sustaining

growth

The overriding objective of this project is to provide a modern, fit for purpose, Health Centre that meets the Clinical brief and allows future flexibility to meet the changing needs of the NHSGG&C. The ideas of ‘growth’ and ‘sustainability’ could be regarded as potentially opposing forces. Consideration is being given to sustaining growth by providing a facility with a: Long Life Low Maintenance Flexible Layout Capability of Extension Potential for re-use/ adaptation of the premises by other

functions

5.4 The Cost of Sustainable Development

While the Board acknowledge that it is a common misconception that sustainable development is more expensive or too expensive, the Project team are working within the constraints of fixed capital budget. A whole life cost approach has been taken to this project and sustainable development has been viewed in the longer term or holistic sense, however, this has to be balanced with the affordability of the initial capital cost and the competing priorities of the benefits criteria outlined in chapter. The Board at present aspires to an Excellent BREEAM rating; however, it is important to note that the current ratings will only be achieved if the design team and the Board submit the relevant information for each credit counted within the ‘possible’ score. The cost vs benefits will be kept under review as the design develops.

5.5 Summary

The project team has given careful consideration to the ongoing sustainability of the facility post completion. After procuring a building that is designed and constructed with sustainability as one of the key priorities it is then essential that the ongoing management of the facility continues these principles. Operational policies are already being developed to ensure resources are utilised to their maximum and waste is minimised. A Building Management System installed in the building




will help staff control light, ventilation, temperature and monitor energy usage and allow targets to be set regarding reducing consumption. This new facility will lead NHSGG&C’s journey in reducing their carbon output by making it one of the most environmentally aware buildings in their estate. By providing this facility and doing so across the three fronts described, the provision of the services within the new facility will be sustainable for the foreseeable future.




6. THE COMMERCIAL CASE

6.1 Section Overview This section provides relevant information regarding the charging mechanisms, key contractual arrangements, implementation timescales and accountancy treatment. It also outlines the procedures that will be utilised to control all changes or other events which may arise during the construction stage of the project.

6.2 Required Services NHS GGC has appointed several external advisors who sit on the core team with the specific remit under Frameworks Scotland. The roles and responsibilities for the advisors are described in more detail in section 8. This team will see the project through to completion: PSCP: Interserve Project Manager: Currie & Brown Cost Advisor: Cyril Sweett CDM Co-ordinator: To be appointed

6.3 Risk and the Commercial Framework

The key features of the New Engineering and Construction Contract (NEC 3 - Option C) contract are: The parties are encouraged to work together as partners in an

open and transparent approach and to ensure that this partnering ethos is maintained

There is a ‘Gain/Pain share’ mechanism to act as an incentive to the delivery team, by rewarding good performance and penalising poor performance

A clear and transparent system is ‘on the table’ to enable negotiation to take place on prices

A level of ‘price certainty’ is determined All price thresholds are set using quantitative risk analysis It is a variant of Maximum Price/Target Cost (MPTC) approach In accordance with the Frameworks Scotland guidance notes, NHS Greater Glasgow & Clyde and Interserve (PSCP) act as joint owners of




the Project Risk Register. The Board and its professional advisors will ensure that there is an appropriate allocation of risks between themselves and Interserve. Risks are allocated to the party best able to manage the risk. The table and an indicative allocation is shown below:

Table 39: Potential Risk Allocation Potential Risk Category Potential allocation of risk

NHSGG&C Interserve Shared

Design √ Development and Construction

√

Transition and Implementation

√

Performance √ Operating √ Revenue √ Termination √ Technology and Obsolescence

√

Control √ Financing √ Legislative √ During the ongoing risk management workshops, allocation and ownership of risks will be monitored throughout the project.

6.4 Change Control Procedures

Change Control is not intended to prevent change but to ensure that all parties are in a position to make informed decisions based upon a position of certainty of commitment at all times and with a high degree of predictability of outcome.

The change control process will manage the issuing, approving or rejecting of changes. This process will be managed by the Currie & Brown Project Manager using the CAT proformas and in accordance with the NEC3 contract terms. The NEC3 contract requires early and prompt consideration of any matters which may affect the price paid by the Board. The procedures detailed in this section will be used to control all changes or other events, which may arise during the construction stage of the project. Change may arise as a result of the following:




Changes identified as a result of proposed responses to Requests for Information (RFI’s)

Changes initiated by the Design Team (and Project Manager) including drawing revisions and Provisional Sums

Changes arising from NHSGG&C representatives

The NEC3 Early Warning and Compensation Event procedure has been implemented as follows: Diagram 12: Notification and Management of Compensation Events




The application of compensation events has discussed in the next sub-section.

6.5 Key Contractual Arrangements

The preferred option is being procured under the new Frameworks for Scotland. This Framework is founded on collaborative working principles and the NEC3 form of contract is used to support these principles. Following the SGHD’s methodology for tendering work through the new Framework for Scotland, Interserve has been appointed as Principal Supply Chain Partner (PSCP) to work with the NHSGG&C Team to finalise design, work up the target cost for the scheme and to construct the building. The current design status which accords with RIBA Stage C reflects the results of this collaborative approach between the Board and the PSCP in defining the scope and financial envelope of the project.




As noted above, the mechanism for ensuring that this partnership ethos is carried through to the construction of the new facility is through the use of the NEC3 form of contract. The main principles of this procurement methodology are outlined below:

6.5.1 Open Book Philosophy

A key principle of the NEC3 Option C contract is the payment of ‘Defined Cost’ and an open book accounting philosophy. These require a robust, reliable and transparent system to record staff time and manage the invoicing process. This allows the Cost Advisor not only to identify costs but also to establish that the costs have been properly expended on the project and that they are allowable under the NEC3 Option C contract as defined under the “schedule of cost components”.

Project costs must be referenced to items on the activity schedules with

detail added against 5 main headings of; labour, plant, materials, sub contractors and preliminaries. Orders, deliveries, invoices for payment, external plant hires and sub-contracts also have to be cross-checked against Goods Received Notes.

The target price is key to the cost operation of the contract and is set

during the pre-construction phase. This process concludes when the PSCP’s proposals are completed for costing and the risk register has been agreed. The target price costing is made up of the following elements:

Diagram 13: Target Price Costing Elements

6.5.2 Contractor’s Share Percentage and Share Range

Within clause 53 of the NEC 3 contract, the pain share/ gain share payment mechanism is set-out. This clause requires to be read in conjunction with Contract Data part 1 which defines the share percentages and share ranges. The table below outlines the share ranges on Frameworks Scotland:

Contractors Overheads & Profit Within the NEC 3 Option C contact, there is provision to adjust the target price (upwards and downwards) via the compensation event process.




Diagram 14: Pain Share / Gain Share Model

6.5.3 Priced Activity Schedule

The activity schedule is defined in Clause 11.2(20). Clause 54.1 states that ‘information in the activity schedule is not works or site information’. The activity schedule under NEC 3 option C is provided by the PSCP in contract data part 2 as part of the pre-construction phase conclusion.

The activity schedule gives a breakdown of the work to be done under the contract and this covers the entire contract price. A key interface within NEC 3 is that the activity schedule must be related to the accepted programme as defined under Clause 31.4. The principle objective of having the activity schedule and accepted programme linked under NEC 3 option C is not to assess the contractor’s payments (these are made on defined cost), but to assist in the assessment of compensation events and contractors share.

6.5.4 Defined Costs

Defined cost is outlined in Clause 11.2(23) and is made of up 3 key elements:

The amount of payments due to sub-contractors for work which is

subcontracted without taking account of amounts deducted for; retentions, payments to employer for failure to meet key dates, correction of defects after completion, payments to others and supply of equipment etc.

The cost of components in the Schedule of Cost Components for other work

Less, Disallowed cost (as defined under Clause 11.2(25))

>100%

100%

95%>100%

<95%

• Contractor takes 100% of the Pain

• Target Price

• Contractor & Employer share the gain 50:50

• Employer takes 100% of the Gain below the 95%

The key benefit of the introduction of the target price with a pain share / gain share mechanism is the incentivisation on the team and PSCP to control cost.




6.5.5 Recording and Collation of Costs Information Clause 52.2 requires the PSCP to keep records of: Accounts of payments of Defined Costs Proof of payments being made Communications about and assessments of compensation

events for Subcontractors Other records required by the works information

The PSCP will ensure that the Cost Advisor has full and unrestricted access to accounts and records that are required to be maintained in accordance with Clause 52.3.

6.5.6 Compensation Events and the Application thereof

Clause 60.1 details 19 compensation events for which the PSCP is entitled to compensation if they occur. The object of the NEC 3 contract is to ensure that all compensation events are listed in one place, expressed clearly to avoid disagreement and to allocate the events in line with modern risk allocation principles.

An important aspect of the compensation event (CE) process is that both the Project Manager and PSCP are required to notify them. The Project Manager raises C.E’s for instructions or changing decisions. The PSCP notifies a CE if he believes that the event is a compensation event or if the Project Manager has not notified the PSCP.

Once compensation event notifications are accepted by the Project Manager, quotations are provided in accordance with Clause 62 and submitted for consideration. These quotations cover cost and time and must be linked to the accepted programme.

The Project Manager makes the assessment in accordance with Clause 63 or 64 and they are then implemented in accordance with Clause 65. The key to the entire process within NEC3 is that the process has time constraints to ensure that decisions are made, preventing the process dragging on, allowing the Project to move forward without protracted negotiations. The compensation event process can be simply defined as per the diagram below: Diagram 15: Compensation Event Sequence




6.6 Accountancy Treatment

It is assumed that public funding will be allocated to this project and therefore the new Health Centre will be included on the Board's balance sheet.




7. THE FINANCIAL CASE 7.1 Section Overview

Option 6: New build on Saracen Street (Self) has been identified as the preferred option which meets the overall benefits, affordability and economic tests to produce the best Value for Money solution. The detailed OB 1 – 4 forms and the Optimism Bias for this option are attached to the OBC as appendices.

7.2 Funding Model and Board Participation

This is a project proposed to be funded by public capital comprising funds from the Scottish Government Primary Care Division’s Primary and Community Care Premises Modernisation Programme and the Capital Resource Limit (CRL) of NHS Greater Glasgow and Clyde.

7.3 Capital Requirement

The following table shows the capital requirements for Option 6, the preferred option, over the period of design and construction through to the commissioning stage. Table 40: Capital Requirements for the Preferred Option Capital Funded by:

2010/11 2011/12 2012/13 2013/14 Total £,000 £,000 £,000 £,000 £,000

PCCPMP 1,500 7,292 208 9,000 Board CRL 1,398 1,398 Total 1,500 7,292 1,606 10,398

7.4 Impairment

This OBC is predicated on the basis that the existing Health Centre, which is not fit for purpose, will be disposed of once the new facility becomes available. There will therefore be a non recurring impairment cost to reflect the run down of this facility. The building Net Book Value at 31st March 2010 is £1.567m with a credit held in revaluation reserve of £0.436m. This would give a net impairment to be met between 2010/11 and 2012/13 of £1.131m. Land has a valuation currently of £0.330m with a revaluation




reserve credit of £0.292m. It is not known at this point if the disposal of the land will attract capital receipts.

7.5 Net Effect on Prices

There is a forecast minor revenue gap which is of minimal value and it is envisaged would be locally managed and have no impact on price.

7.6 Impact on Balance Sheet

The project is funded via public capital and is within the affordability of the Board’s current CRL. The facility will be treated as a public asset on completion in addition to being noted on the Board’s asset register. There is no impact of PPP as this is a solely capital scheme.

7.7 Impact on Income and Expenditure Account

The following table shows the revenue requirements for Option 6 over the period from the post commissioning stage to the first full year in operation.

Table 41: Revenue Impact of the Preferred Option Revenue Funded by:

200/10/11 2011/12 2012/13 2013/14 Total £,000 £,000 £,000 £,000 £,000

Existing Revenue Additional 34 68 68 Total 34 68 68

7.8 Impact on Existing Facility

NHSGG&C will vacate the current Health Centre on completion of the new Health Centre. It is planned that NHSGG&C will dispose of the current Health Centre on completion of the new Health Centre. The options to do this are currently being explored and will be detailed further within the FBC.

7.9 Cost of Service Continuity

The existing services will continue to be provided from the existing site until such time as the new facility is completed and commissioned




allowing a safe transfer of operations. There are no additional costs arising from the provision of service continuity.

7.10 Overall Affordability

Option 6, as the preferred option, is the most affordable option and the option that delivers the best value for money solution as identified in the table below. The preferred option has the lowest cost per benefit point. Table 42: Value for Money analysis comparing Qualitative Benefits to Costs

Value for Money Analysis – comparing qualitative benefits to costs Option Qualitative

Benefits Score

Equivalent Annual

Cost (£000)

Cost per Benefit

point (£000)

VfM Economic

Ranking 2. Do Minimum

91 248 £2.725 4


735 581 £0.79 2


916 465 £0.50 1


718 789 £1.099 3




8. THE MANAGEMENT CASE 8.1 Section Overview

In order to manage and deliver programmes effectively it is necessary to apply a range of knowledge, skills, tools and techniques which are recognised as programme management processes. In preparing for the successful delivery of this project, guidance was sought from Frameworks Scotland, SCIM and the RIBA Plan of Works stages. This section sets out the proposed approach to the overall management of the project.

8.2 Procurement

The preferred option is being procured via Frameworks Scotland. The Framework has given the Board the opportunity to appoint an accredited Principal Supply Chain Partner (PSCP) and Professional Services Consultants (PSCs), alongside a pre agreed commercial arrangement. This allowed the team to immediately focus on the programme requirements rather than be involved in a lengthy selection process, costing the Programme both in time and money. The Frameworks have been established to achieve the following key benefits (taken from The Guide Issue 1.0 December 2008): Fast track start: short PSCP selection process and availability of

experienced support Shared Savings: transparent pricing structure, potential to

generate and share cost savings Distils the best of earlier projects: best practice techniques and

learning from other projects Best VfM: addresses design quality issues and the needs of end

users Target Price Certainty: agreed target price, pre-agreed rates as

well as overhead and profit for PSCP and Vat recovery rules with HMRC

Time Certainty: joint programming Optimum Project Environment: predefined overhead and profit

levels, joint risk management, proactive approach to problems, SCSP incentives, collaborative working

No OJEU Process: time and cost saving

The benefits listed above are of particular interest to the Board as the skills and experience to achieve these sorts of benefits is not available in house. Procuring via Frameworks Scotland provides the Board with an invaluable opportunity to make use of the PSCP’s team to realise




best value for money and in so doing, meet or exceed the project’s expected benefits. In addition to the key benefits listed above, the added value obtained by adhering to Frameworks Scotland as a procurement process, particularly during the development of the OBC is outlined below: Development of functional brief Affordability reviews Outline Programming Option Appraisals Outline Planning Approval High level risk register Sustainability Whole Life cycle costing NHSGG&C has appointed Interserve as their Principal Supply Chain Partner (PSCP) to work with the Board to develop the design, work up the target cost for the scheme and to construct the new Health Centre. This appointment was undertaken as early as possible so as to maximise the opportunity to realise the Frameworks key benefits and to take advantage of the opportunity to add value to the project in terms of cost and quality. The project has effectively reached RIBA Stage C which embodies 1:500 scale departmental relationships together with the strategy for massing and elevations to allow the work stream associated with the planning process to progress more robustly. Design development has now moved in to the 1:200 scale Room Relationship stage on the basis of the signed-off Departmental Relationship Strategy.

8.3 Project Management Approach

The Modernisation and redesign of primary and community health services for Possilpark is one of several projects currently being undertaken or planned by NHSGG&C and is therefore part of a wider programme. The project management approach is guided by the principles of both programme and project management, but is also guided by the following principles that will support the collaborative environment that the NEC3 contract sets out to create: Efficient and effective communication Early establishment of clear guidelines in terms of project structure

and documentation, communication channels and administrative processes

Identification of core competencies and agreement of roles and responsibilities

Assessment and management of project associated risks Concise planning and subsequent execution




Initiating Processes

Initiating Processes

Controlling Processes

Executing Processes

Closing Processes

8.3.1 Project Phases The effective conclusion of a project is based on understanding the project’s unique personality and correctly anticipating the dynamic nature of each phase. The project manager will be required to effectively communicate the message that the outcome/s of one phase are the input/s to the next phase and to ensure that the various activities inherent in each of the phases below is conveyed at the right time and in the right manner. The figure below is taken from the Frameworks Scotland Guide: Diagram 16: Project Management Processes

The Outline Plan of Work developed by Royal Institute of British Architects (RIBA) is the standard project framework used by the construction industry and is referred to with regards to delivery and outputs. The Plan of Work organises the process of managing and designing building projects and administrating building contracts into a number of key Work Stages from A to L. The sequence or content of work stages may vary or overlap to suit a particular project. The work stages are illustrated below: Diagram 17: RIBA Outline Plan of Work

Preparation Stage

(Stages A – B)

Appraisal

Design Brief

Construction Stage

(Stages J - K)

Mobilisation

Construction to Practical

Completion

Use (Stages L)

Post Practical Completion

Design Stage (Stages C - E)

Concept

Design Development

Technical Design

Pre-Construction Stage

(Stages F - H)

Product Information

Tender Documentation

Tender Action




8.3.2 Project Framework

In order to align the principles outlined in the project approach with the project phases above, the following framework has been created to ensure understanding and manage expectations: Table 43: Project Framework SCIM OGC Gate Frameworks

Scotland (see diagram 16)

RIBA (see diagram 17)

Determining the Strategic Context

Gate 0: Strategic Fit

Initiating A

Initial Agreement

Gate 1: Business justification

Initiating A, B

Outline Business Case

Gate 2: Procurement Strategy

(Initial) Planning C, D,

Full Business Case

Gate 3: Investment Decision

(Review and Conclude) Planning

D,E,F,G,H

Implementation Gate 4: “Go Live”

Executing, Controlling, Closing

J, K

Post Project Evaluation

Gate 5: “Benefits Realisation”

Closing L

This framework will form the basis for the project team to prepare for and manage this project and will be concluded for inclusion in the FBC.

8.3.3 Consultation and Engagement

The Board recognises the need for efficient, timely and relevant communication with stakeholders and other parties. North CHCP Public Partnership Forum Public involvement in the development of the new centre will be led by the North CHCP Public Partnership Forum (PPF).

The PPF was established as part of the Scheme of Establishment for CHCPs, as the main vehicle for public involvement. The aim of the PPF is to:




Inform local people about the range of health and social care services that are provided locally

Engage local service users, carers and the public in discussion about how to improve CHCP services

Support wider public involvement in planning and decision making about CHCP services, removing barriers that prevent equal access to these services

Broaden and deepen public involvement through working with existing groups and developing new communication networks

The work of the PPF informs the plans of the CHCP and helps to identify local priorities for service improvement. Membership of the PPF is open to anyone who lives in, works in a local community organisation or cares for someone who lives in the area covered by North Glasgow CHCP. A PPF database has been developed comprising over 120 contacts. Members of the forum are kept informed of CHCP developments through e-mail, letters and invites to PPF events. The PPF is supported by a PPF Officer and the CHCP’s Community Engagement and Development team (a team of 4 officers with specific responsibility to encourage community engagement and particularly to support the participation of vulnerable or disadvantaged groups whose voices might otherwise not be heard.) A PPF Executive Group comprising 15 – 20 representatives is appointed annually at the annual general meeting of the PPF. This forum meets regularly (every 4 – 6 weeks) and comprises representatives from: Local community groups ( e.g. North West Women’s Centre,

North Glasgow Healthy Living Centre, North Glasgow Transport Association (NATA) )

Support Groups ( e.g. the Disability Community, Alzheimer’s Scotland)

Self help Groups ( e.g. Carers All Stand Together (CAST) ) Two members of the PPF Executive Group are appointed to the North Glasgow CHCP Committee. Two members of the PPF Executive Group are also appointed to the 2 Local Community Planning Partnership Boards (one to each). The PPF Executive Group has already received reports and presentations about the proposed centre and included a discussion workshop on the proposal as part of their annual public event in October 2009. In 2008 the PPF gathered the views of users in Maryhill and the existing Possilpark Health Centres. The results were reported to the




CHCP committee and the comments relating to poor waiting and reception areas have been taken into account in planning the new centre. A sub group of the PPF, led by the Head of Planning and Health Improvement will take responsibility for wider public engagement as the project progresses. The CHCP will also participate in the wider public involvement activity for the whole Saracen Exchange site, led by Glasgow North Regeneration Agency (GNRA). This will enable the CHCP to reach a wider audience, working in partnership with GNRA and other community planning partners (e.g. Articles about the proposed centre have appeared in ‘Connect’ – the local community planning newsletter that is delivered to every household in North Glasgow). This engagement activity will also link with the wider engagement of residents in Possilpark in connection with the proposed Town Centre Regeneration plan that is being developed for the whole Saracen Street area. Pre-planning consultation As required, substantial pre-application consultation will be undertaken. NHSGG&C will be applying to Glasgow City Council for planning permission to begin construction on the new Health Centre. The Planning Etc (Scotland) Act 2006 has made significant changes to the way in which planning applications are dealt with. All national and major applications registered will need to have already undertaken pre-application consultation. Communication during Construction A Communications Plan will be prepared which will detail the actions to be taken by NHSGG&C to disseminate information and to encourage effective two-way communication with staff, partners, patients and public.

8.3.4 Key Project Appointments

The NHSGG&C Frameworks Scotland team comprises key stakeholders from the NHS and several external advisers. There are a number of roles that are a vital ingredient in the successful delivery and implementation of Frameworks Scotland projects. These are listed below along with a brief description of their roles and responsibilities. A description of the role of the Project Director is included below as it is the Project Director who is directly accountable to the Board and who is responsible for building a team with the required skills and experience to suit the project:




The Board has appointed a Project Director, who in turn will appoint the various advisors, namely: Project Manager (PM) is the Employer’s key person Cost Advisor (CA) Principal Supply Chain Partner (PSCP) Supervisor Construction Design Management (CDM) co-ordinator (still to be

appointed) Table 44: Descriptions of Roles and Responsibilities Description Project Director: NHSGG&C The Project Director is an individual, usually an employee of the Board, who represents and has the authority of the Board to act on their behalf in respect of the delivery of a specific programme, in this case, the replacement of Possilpark Health Centre. All instructions by the Project Director are deemed to be given by the Board, all communication passed to the Project Director is deemed to have been given to the Board. The project director will lead the whole process from the outset of the project by providing strategic direction, leadership and will ensure that the business case reflects the views of all stakeholders. Role of the Project Director: Be aware of the business objectives and corporate management

culture Lead the development of the business case and budget for the

project Produce the brief and project plan Ensure that all work is defined in a manner suitable for purposes of

control Lead and direct the efforts of the project team towards the successful

delivery of the project objectives as determined by the project owner Ensure that adequate communication mechanisms exist within the

project between the project and external organisations, and between the project and the rest of the Board

Let contracts and monitor performance of external contractors Ensure that adequate procedures are in place to monitor and control

cost, time and quality Provide a regular progress report to the project owner identifying cost,

time and quality performance Provide decisions to contractors and ensure that procedures exist to

identify and resolve issues which will affect cost, time or quality performance

Ensure that procedures are in place to handle any changes that are requested by the project team users

Make sure that the project is completed handed over to the Board in




accordance with the project plan Ensure that all work is planned, resources are made available and

work is carried out in accordance with the project plan Make sure that the project is completed and handed over to the

Board in a managed way and arrange the post-project evaluation of the scheme

Key Responsibilities: Managing the Board interest in the project, including co-ordination of

user interests and the production of the brief for the contractors Appointing consultants and contractors who will undertake the design

and construction activity and ensuring that they deliver according to the construction project programme

Acting as the point of contact in all dealing with contractors, consultants and other external organisations involved in the construction project and providing all decisions and directions on behalf of the Board.

Project Manager: Currie & Brown Project Manager’s key deliverables to PD: Key Employers management person Manage the delivery of the project Control project activities (pro forma templates)

o Early warnings o Compensation Events o Instructions o Assessments o Communications

CAT Administrator ECC places considerable authority in PM hands PM applying managerial and technical judgement Assumed to have employers authority Only PM can change Works Information

o Issue of Instruction o Issue of Compensation Events

With external appointment usual for PD to be identified within contract and delegate responsibility to PM

Responsible for the delivery of the project through Stages (1-4) Named individual under the NEC3 Contract Assumes a number of defined duties Manages the project within the business case parameters of time,

quality and cost Single point contact for both Board and PSCP Manages change Contract administrator May delegate duties Project Manager Duties: Issue of Certificates to the Employer and the PSCP




Notify the PSCP of any delegate actions e.g. to Cost Advisor Accept replacement persons Give instructions to change the works information Accept/Reject the PSCP programmes for each stage Accept/Reject the PSCP design from non technical view Decide completion Certifies completion Assess and certify payment within the contract timescales Give early warning of any matters with delay, costs or performance

implications Administer compensation events Cost Advisor: Cyril Sweett Cost Advisor key deliverables to PD/PM: Prepare/validate ECC contract – Not named in the contract, only has

responsibility if delegated by the PM Advise on contractual matters Advise and prepare (in conjunction with PM and SCP)

o Works and Site Information o Contract documentation

Cost control records and advice leading to early settlement of the final accounts for PSCP and other Professional Advisors.

Assessment of Monthly Payments Open Book Audits Assessment of Compensation Event Monthly Cost Report Monitor the Cash flow Supervisor: Still to be appointed, this role is not yet required Named and defined within NEC3 The Supervisor reports to the Project Manager Appointed to ensure the works are constructed in accordance with the

contract – Works Information May have different Supervisor for Building, Mechanical & Electrical Expertise is vital in drafting the Works Information The Supervisor witnesses or carries out tests and inspections Can specify test certificates in WI The Supervisor also notifies Defects but may not accept a Defect The Supervisor may not give site instructions or otherwise change the

Works Information (only the Project Manager can do this) CDM Co-ordinator: Still to be appointed, this role is not yet required The CDM Co-ordinator appointed to the project will: give suitable and sufficient advice and assistance to clients in order to




help them to comply with their duties, in particular: ▫ the duty to appoint competent designers and contractors; and ▫ the duty to ensure that adequate arrangements are in place for

managing the project notify the Health & Safety Executive about the project co-ordinate design work, planning and other preparation for

construction where relevant to health and safety identify and collect the pre-construction information and advise the

client if surveys need to be commissioned to fill significant gaps promptly provide in a convenient form to those involved with the

design of the structure; and to every contractor (including the principal contractor) who may be or has been appointed by the client, such parts of the pre-construction information which are relevant to each

manage the flow of health and safety information between clients, designers and contractors

advise the client on the suitability of the initial construction phase plan and the arrangements made to ensure that welfare facilities are on site from the start

produce or update a relevant, user friendly, health and safety file suitable for future use at the end of the construction phase

PSCP: Interserve As the Principal Supply Chain Partner; the PSCP is responsible for: Completing the project on time, within budget and to agreed quality

standard as set out in contract Appointing and managing the PSCM (Principal Supply Chain

Members) and other sub-contractors to deliver the scheme The management, design and construction of the works The provision of all deliverables as detailed in the Scheme Contracts

and as generally included under the NEC 3 contract Preparation and maintenance of the planning, design and

construction programme Issue of regular progress reports to an agreed format Management of site safety Preparation of a handover plan for agreement by the Project

Manager Implementation of the agreed plan Provision of satisfactory operation and maintenance documentation Preparation and maintenance of a Health & Safety Plan Preparation of a proposed final account for agreement with the Cost

Manager Making good all defects Attending or chairing meetings The following is an outline of the range of potential services available from the PSCP under Frameworks Scotland during the IA, OBC and FBC stages. It is not envisaged that NHSGG&C will make use of all of these services as some services may not be required and some services can




be provided by NHSGG&C: Stage: Pre Initial Agreement Strategic advice, planning, Service/Estate strategies, Business Planning, assistance with strategy, high level affordability reviews, outline programming, option identification and evaluation and sustainability. Stage: Outline Business Case Development of functional brief, affordability reviews, outline programming, option appraisals, outline planning approval, high level risk register, sustainability and Whole Life Cycle costing. Stage: Full Business Case Detailed design development of preferred option, cost verification leading to agreed Target Price, detailed programming, VAT savings (as a result of a Customs and Excise agreement) can be reinvested in the project, detailed and cost/time valued risk register, planning approval, sustainability, Whole Life Cycle costing and commissioning. Generally, the list of services offered by the PSCP include Construction, M&E Engineering, Project Management, Architectural Design, Civil & Structural Engineering, Cost Management, Healthcare Planning, Facilities Management advice, Master Planning, CDM Co-ordination, Fire Engineering, Medical & Non-Medical Equipment Advice, Acoustic Specialism and Landscaping.

The Capital Projects Advisor from Frameworks Scotland will play a significant role in the project in terms of implementing the principles of Frameworks Scotland as they will provide support to the Board in the implementation and ongoing application of the required Frameworks Scotland principles and procedures. Post project, the Capital Projects Advisor will capture lessons learned during the project and this information will be added to the best practice and lessons learned database from other projects. A Capital Projects Advisor has been appointed by Frameworks Scotland and has been involved since the appointment of the PSCP.

8.4 Change Management

Change Management refers to both organisational change and managing change during construction. The change control mechanism during construction has been discussed at section 6.4 Organisational change will be planned for and managed according to the NHSGG&C’s Organisation Development Plan.




8.5 Benefits Realisation

Benefits can be defined as the positive outcomes, quantified or unquantified, that a project will deliver.

The benefits outlined in section 4.4 have been analysed and measured with a view to preparing a benefits realisation plan. This plan is currently in the process of being prepared in the form of a SMART matrix and will be concluded for the FBC

8.6 Risk Management

The project’s risk register has been set up in accordance with the standard format for the Frameworks Scotland Joint Project Risk Register. The risk register will drive the ongoing management of the risk register throughout the remaining phases of the project, namely FBC and construction. The risk register has been attached as an appendix. Operational risks identified during the various risk workshops will be transferred to the Board’s risk register as the Board will manage operational risks prior to conclusion of the FBC. Risk has been discussed in section 3, with the management of risk discussed in 3.10.3

8.7 Project Milestones

The key milestones for the project are summarised below:

Table 45: Key Project Milestones Stage Activity aligned with SCIM phase Date

SCIM Phase 1a Determine Strategic Context Concluded SCIM Phase 1b – Scoping

Prepare the Initial Agreement Concluded

SCIM Phase 2 – Planning

Prepare the Outline Business Case Conclude Technical Brief Stage C Design Freeze NHSGG&C Board Approval of OBC Submit to Scottish Government CIG Scottish Government CIG meeting

2Q 2010 - 3Q 2010 Submit :31 August 2010 Meeting: 28 September 2010

SCIM Phase 3 – Procurement

Prepare the Full Business Case Agreement to proceed to Stage 3 Submit Planning Application Commence Staged Building Warrant

Applications Agree Target Price

3Q 2010 - 1Q 2011




NHSGG&C Board Approval of FBC Submit to Scottish Government CIG Scottish Government CIG meeting

Submit: 1Q 2011 Meeting: 1Q 2011

Construction Construction on the main work is scheduled

over an estimated period of 52 weeks. 2Q 2011 - 2Q 2012

Post Project Evaluation

As per section 9.8 PPE will commence no later than 12 months after occupation

8.8 Post Project Evaluation

NHSGG&C is aware that in order to assess the impact of the project, an evaluation of activity and performance must be carried out post completion. This is an essential aid to improving future project performance, achieving best value for money from public resources, improving decision-making and learning lessons for both the Board and others. Sponsors of capital projects in NHSScotland are required by the Scottish Government Health Directorates to evaluate and learn from their projects. This is mandatory for projects with a cost in excess of £1.5 million and should be applied as best practice for all projects.

8.8.1 Purpose

The Board has an evaluation framework in place as follows: A post project evaluation will be carried out no later than 12

months after occupation. The benefit realisation register detailed in this FBC will be used to

assess project achievement. Clinical benefits through patient and carer surveys will be carried

out and prescribing trends will be assessed. 8.8.2 Pre- requisites for successful evaluation

To ensure maximum pay-off from evaluation, the following criteria are deemed as important: The evaluation is viewed as an integral part of the project and it is

planned for at the outset. The evaluation will be costed and resourced as part of the project.

There is commitment from senior managers within the organisation.

All key stakeholders are involved in its planning and execution.




Relevant criteria and indicators will be developed to assess project outcomes from the outset of the project.

Mechanisms will be put in place to enable monitoring and measurement of progress.

A learning environment will be fostered to ensure lessons are heeded.

Feedback to Framework Scotland monitoring groups. 8.8.3 The stages of evaluation: when should evaluation be undertaken?

Although evaluation will be carried out continuously throughout the life of a project to identify opportunities for continuous improvement, evaluation activities will be undertaken at four main stages: Stage 1: at the project appraisal stage the scope and cost of the work will be planned out. This will be summarised in an Evaluation Plan. Stage 2: progress will be monitored and evaluation of the project outputs will be carried out on completion of the facility. Stage 3: there will be an initial post-project evaluation of the service outcomes 6 to 12 months after the facility has been commissioned. Stage 4: there will be a follow-up post-project evaluation to assess longer-term service outcomes two years after the facility has been commissioned. Beyond this period, outcomes will continue to be monitored. It may be appropriate to draw on this monitoring information to undertake further evaluation after any market testing or benchmarking exercise – perhaps at intervals of 5-7 years. At each of these stages, evaluation will focus on different issues. In the early stages, emphasis will be on formative issues. In later stages, the main focus will be on summative or outcome issues. Formative Evaluation – As the name implies, is evaluation that is carried out during the early stages of the project before implementation has been completed. It focuses on ‘process’ issues such as decision-making surrounding the planning of the project, the development of the business case, the management of the procurement process, how the project was implemented, and progress towards achieving the project objectives. Summative Evaluation – The main focus of this type of evaluation is on outcome issues. It is carried out during the operational phase of the project. Summative evaluation builds on the work done at the formative stage.




It addresses issues such as the extent to which the project has achieved its objectives; how out-turn costs, benefits, and risks compare against the estimates in the original business case; the impact of the project on patients and other intended beneficiaries; and lessons learned from developing and implementing the project. What will be considered in the evaluation plan? 1. A clear view of the

objectives and purpose of the evaluation.

Who is the audience for the evaluation? What are their information needs? What decisions will the evaluation inform?

2. Consideration of the structural context

What is the baseline situation (status quo)? What are the internal and external constraints? What are the desired outcomes?

3. Inclusion of a comparative element

Are there plans to conduct a ‘before and after’ assessment?

Is it clear what would have happened in the absence of the project?

4. Coverage of all relevant project impacts (outcomes and processes)

Is there a plan to assess immediate, intermediate and ultimate outcomes?

Does the plan take into account the processes by which the outcomes are generated?

Does the plan consider the impact of the project on patients, staff and other stakeholders?

5. An emphasis on learning

What are the lessons? Is there a plan to disseminate the lessons

learnt? Is there an action plan to ensure the lessons

are used to inform the project or future projects?

6. Recognition of need for robustness and objectivity

Is the evaluation team equipped with the skills and resources to undertake the evaluation?

Should the evaluation be conducted by external contractors? What should be the role of in-house staff?

Are there suitable arrangements to quality-assure the findings?

7. Sound methodology What methods of data collection will be used to undertake the study?

Are the proposed methods appropriate to meet the objectives of the evaluation?

Factors to consider in judging the importance of evaluation Likely benefits: Is there scope to feedback any lessons from evaluation into the improvement of the project? Does the project have the potential to provide useful lessons to the wider NHS?




Interest: Is the project of major interest to senior managers, policy-makers, ministers, and the public? Is it likely to attract much media coverage? Are there signs or risks of something going wrong? Ignorance and novelty: Do we have comprehensive and reliable information about the performance and results of the project? Corporate significance: How important is the project to stakeholders? Is it likely to have a major impact on how services are delivered?

8.8.4 How we will evaluate: some technical considerations Government recommendation is that the Logical Framework should continue to be used for evaluation of NHS capital schemes. This is a matrix listing project objectives against indicators and measures for assessing outcomes. The underlying assumptions and risks are also considered. The technical issues arising from application of the Logical Framework include: the merits and demerits of different data collection methods the role of different participants in the data collection process sampling methods sample size questionnaire design (types of questions, etc) piloting how to achieve a satisfactory response rate security and confidentiality of data data analysis and report writing

8.8.5 Feedback and dissemination of findings from evaluation

The potential value of an evaluation will only be realised when action is taken on the findings and recommendations emanating from it. We will require the adoption of processes to ensure that this happens. To promote consistency, the content of the evaluation report should, as far as possible, address the following issues: Were the project objectives achieved? Was the project completed on time, within budget, and

according to specification? Are users, patients and other stakeholders satisfied with the

project results? Were the business case forecasts (success criteria) achieved?




Overall success of the project – taking into account all the success criteria and performance indicators, was the project a success?

Organisation and implementation of project – did we adopt the right processes? In retrospect, could we have organised and implemented the project better?

What lessons were learned about the way the project was developed and implemented?

What went well? What did not proceed according to plan? Project team recommendations – record lessons and insights for

posterity. These may include, for example, changes in procurement practice, delivery, or the continuation, modification or replacement of the project.

Evaluation results will then be signed off by senior management or at Board level. The results from the evaluation should generally lead to recommendations for the benefit of the Board or for further use. The results will be disseminated to staff concerned with future project design, planning, development, implementation and management.

8.9 Management Case Summary

It is recognised that the management of any project is perceived as a logical sequence of events. In order to maintain that sequence, it is necessary to implement controls in addition to providing opportunity for review during and post construction. The management case will be further developed and expanded on in the FBC.




CONCLUSION The proposals for the new Possilpark Health Centre represent the aspiration to provide a modern, flexible and attractive building that makes a positive contribution to the community of Possilpark both physically and socially. The Health Centre will meet the challenges required of any healthcare building of the 21st century. It will also meet the considerable challenge of creating a civic heart to this part of Possilpark, thereby providing a catalyst for wider urban regeneration. The vision is that this building will have a transformative effect on this part of Possilpark in terms of the physical environment and in terms of the wellbeing of the residents.

This vision supports the values of the NHS GGC in its welcoming and civic appearance, creating a reassuring sense of purpose and professionalism. The proposal represents the increasingly high expectations of health professionals and the community they serve. The building is a significant opportunity to create a much needed positive and optimistic image for Possilpark by:

Addressing the need for a suitable Health Centre Offering efficient and functional clinical accommodation accessed

through bright, open and welcoming reception and circulation areas Creating a building with suitable civic presence that is welcoming and

modern Repairing the damaged urban fabric of the derelict site with a suitable

response to the constraints and opportunities that the site presents.




APPENDICES

Executive Summary NIL Section 1: PROJECT INTRODUCTION NIL Section 2: THE STRATEGIC CASE NIL Section 3: THE ECONOMIC CASE A Site Options Appraisal Report B Project Risk Register C Frameworks Scotland Guidance Notes for the Joint

Project Risk Register D OB1 – 4 Forms for the shortlisted options including

Optimism Bias calculations E NPV Tables F Life Cycle Modelling Section 4: THE PREFERRED OPTION A Design Statement B Schedule of Accommodation Section 5: THE SUSTAINABILITY CASE A BREEAM Assessment Section 6: THE COMMERCIAL CASE NIL Section 7: THE FINANCIAL CASE as per appendix 4 D

OB1 – 4 Forms for the Preferred Option

Section 8: THE MANAGEMENT CASE A Combined Design and Construction Programme Section 9: CONCLUSION NIL General Glossary




APPENDIX 3 A

Site Options Appraisal Workshop Report

The Report can be viewed by double-clicking on the icon below:

Report on Options Appraisal workshop.doc




APPENDIX 3 B

Project Risk Register

The Risk Register can be viewed by double-clicking on the icon below:

Risk Register Saracen Street Rev 3 080710.xls




APPENDIX 3 C

Frameworks Scotland Guidance Notes for the Joint Project Risk

Register




Frameworks Scotland Guidance Notes for the Joint Project Risk Register: The NHS Client Project Director is the overall owner and champion of the

Frameworks Scotland Joint Risk Register for a Frameworks Scotland Project The NHS Client and the PSCP shall act as joint owners of the Frameworks

Scotland Joint Project Risk Register for a Frameworks Scotland Project and they will collate and co-ordinate inputs from the NHS Client, Professional Advisors appointed by the NHS Client, and the Frameworks Scotland Principal Supply Chain Partner (PSCP) and their Supply Chain members. There should be no single risks with shared ownership i.e. ownership is allocated to both NHS Client and PSCP. In the event that a risk is identified and has actions or effects whose ownership can be allocated to NHS Client and PSCP then separate items must be identified on the Frameworks Scotland Joint Risk Register.

The Frameworks Scotland Joint Project Risk Register should incorporate all risks associated with the various aspects of an NHS Frameworks Scotland Project i.e. Land Purchase/ Design/Construction/Business/ Clinical/Operational/ Staffing/Equipment Risks

Whilst Health and Safety may not be identified as a risk separately in it’s own right on the Frameworks Scotland Joint Risk Register because it is covered by Statutory Legislation any Health and Safety items that may result in a cost or time risk may be added to the Register

Whilst the NHS Client Project Director and the PSCP will act as joint owners of the Frameworks Scotland Joint Project Risk Register for a Frameworks Scotland Scheme responsibility for risks identified in it will be allocated and identified on the Register

The Frameworks Scotland Joint Project Risk Register should be subject to continuous review and updating by the whole Project Team/Supply Chain as provided for in the Risk Management requirements/process identified within the Frameworks Scotland NEC2 Contract Template and Frameworks Scotland NEC2 Works Information Template

The Frameworks Scotland Joint Project Risk Register is a key Project control document. It should be an agenda item at every Frameworks Scotland Project Team meeting. All high priority risks should be reviewed with a general overview provided on all other risks to ensure that either individually or cumulatively their impact on the Project is not escalating in respect of their effects on the Project to the extent they become a high priority

Each version of the Frameworks Scotland Joint Project Risk Register should be given a version number, identify when it was last reviewed and identify the author/collator of the document together with a record of those who participated in the review

Each risk identified should be given a unique reference, which must not be changed during the life of the Project. Even if a risk is cleared the reference should be retained on the Register. This will allow the history of each risk to be traced by comparison of various versions of the Frameworks Scotland Joint Project Risk Register




APPENDIX 3 D

OB1 – 4 Forms for the shortlisted options including Optimism Bias calculations

This information can be viewed by double-clicking on the icon below:

NHS GG&C Possilpark Health Centre\OBC\OBC Appendices\Possilpark OBC 9 Aug 2010 ob1-4 final.xls




APPENDIX 3 E

NPV Tables


N:\Common\Estates\Partnerships - Live Projects\North Glasgow CHCP\Saracen St\1. CONTROL FILE\1.5 Outline Business Case\OBC Final\Possilpark NPV 's 26 aug MAIN FINAL FILE PG.xls




APPENDIX 3 F

Life Cycle Modelling


N:\Common\Estates\Partnerships - Live Projects\North Glasgow CHCP\Saracen St\1. CONTROL FILE\1.5 Outline Business Case\OBC Final\Possilpark lifecycle 26 aug MAIN FINAL FILE PG.xls




APPENDIX 4 A

Design Statement





APPENDIX 4 B

Schedule of Accommodation


Possilpark SoA 3124sqm.pdf




APPENDIX 5 A

BREEAM Assessment


20100528 Saracen Health Centre BREEAM Pre Assessment.pdf




APPENDIX 8 A

Combined Design and Construction Programme


Possilpark Health Centre Programme.pdf




APPENDIX

Glossary




Benefits Benefits can be defined as the positive outcomes, quantified

or unquantified, that a project will deliver. Cost Benefit Analysis

Method of appraisal which tries to take account of both financial and non-financial attributes of a project and also aims to attach quantitative values to the non-financial attributes.

Design and Development Phase

The stage during which the technical infrastructure is designed and developed.

Discounted Cash Flows

The revenue and costs of each year of an option, discounted by the respective discount rate. This is to take account of the opportunity costs that arise when the timing of cash flows differ between options.

eHealth The eHealth Programme aims to change the way in which information and related technology are used within NHSScotland in order to improve the quality of patient care. http://www.ehealth.scot.nhs.uk/

Economic Appraisal

General term used to cover cost benefit analysis, cost effectiveness analysis, investment and option appraisal.

Equivalent annual cost

Used to compare the costs of options over their lifespan. Different lifespans are accommodated by discounting the full cost and showing this as a constant annual sum of money over the lifespan of the investment.

Full Business Case (FBC)

The FBC explains how the preferred option would be implemented and how it can be best delivered. The preferred option is developed to ensure that best value for money for the public purse is secured. Project Management arrangements and post project evaluation and benefits monitoring are also addressed in the FBC.

Initial Agreement (IA)

Stage before Outline Business Case, containing basic information on the strategic context changes required, overall objectives and the range of options that an OBC will explore.

Net Present Cost (NPC)

The net present value of costs.

Net Present Value (NPV)

The aggregate value of cashflows over a number of periods discounted to today's value.

Optimism bias Optimism bias refers to the known tendency for the costs of projects to be underestimated, particularly in the early stages of developing and costing projects.

Outline Business Case (OBC)

The OBC is a detailed document which identifies the preferred option and supports and justifies the case for investment. The emphasis is on what has to be done to meet the strategic objectives identified in the Initial Agreement (IA). A full list of options will be reduced to a short list of those which meet agreed criteria. An analysis of the costs, benefits and risks of the shortlisted options will be prepared.

http://www.ehealth.scot.nhs.uk/




A preferred option will be determined based on the outcome of a benefits scoring analysis, a risk analysis and a financial and economic appraisal.

Principal Supply Chain Partner (PSCP)

The PSCP (Contractor) offers and manages a range of services (as listed in this document) from the IA stage to FBC and the subsequent conclusion of construction works.

Risk The possibility of more than one outcome occurring and thereby suffering harm or loss.

Risk Workshop

Held to identify all the risks associated with a project that could have an impact on cost, time or performance of the project. These criteria should be assessed in an appropriate model with their risk being converted into cost.

Scope For the purposes of this document, scope is defined in terms of any part of the business that will be affected by the successful completion of the envisaged project; business processes, systems, service delivery, staff, teams, etc.

Sensitivity Analysis

Sensitivity Analysis can be defined as the effects on an appraisal of varying the projected values of important variables.

Value for Money (VfM)

Value for money (VfM) is defined as the optimum solution when comparing qualitative benefits to costs.

Modernisation and redesign of primary and community health ...Aug 30, 2010 · Mrs Velda Middleton...

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