1. July 2008 3Ts Programme Board Regional Centre for Teaching, Trauma & Tertiary Care: ‘The 3Ts Strategy’

2. BSUH Vision Leading UK Teaching Hospital on two acute campuses, in partnership with BSMS, Deanery & Universities Reputation for excellence in specialist / tertiary care - hub of clinical networks across Sussex and the wider Region. Vital partnerships with QVH, SECAmb, KSSAA and local DGHs Continue to provide excellent secondary care to local populations of Brighton & Hove and Mid Sussex Vision supported by Sussex PCTs and is consistent with LHC long-term strategic vision: –Central Sussex Partnership Programme (2001) –Best Care, Best Place (2004) –Fit for the Future (2007) –Healthier People, Excellent Care (2008) –Highest Quality Care for All (2008) All work underpinned by our core values

3. 3T Business Case Process & Timescales Process follows OGC ‘5 case’ best practice process Stage 0Business Planning - determining the strategic context Ascertaining strategic fit Stage 1Scoping - preparing the Strategic Outline Case Making the case for change Exploring the preferred way forward Stage 2Planning - preparing the Outline Business Case Determining potential VfM Preparing for the potential deal Ascertaining affordability and funding requirement Planning for successful delivery Stage 3Procurement - preparing the Full Business Case Procuring the VFM solution Contracting the deal Ensuring successful delivery Stage 4Implementation - ‘go live’ Stage 5Evaluation / benefits realisation (25 to 50 years)

4. Proposed Timescale MilestoneDate NHS South East Coast approves SOC (assumed date)July 2008 BSUH appoints ProCure21 Principal Supply Chain Partnerby August 2008 NHS South East Coast and DH approve OBC (assumed date)May 2009 Decant programme and enabling works commences (subject to OBC approval) May 2009 NHS South East Coast SHA and DH approve FBC (assumed date)October 2009 Main build programme commencesNovember 2009 Main build periodNovember 2009 to November 2012 Assumes Exchequer-funded procurement programme. PFI procurement route would add 2+ years to timescale. Must be tested against Public Sector Comparator at OBC stage.

5. Proposal for Shared Governance Arrangements for the BSUHT Tertiary Teaching and Trauma Business Case LHC ‘s Strategic Executive Group (West, East Sussex and Brighton and Hove City PCT’s and BSUHT, SDH and SECAMB) Individual Organisations Executive Team’s LHC Programme Board ( Programme and Organisational leads) Strategic Clinical Advisory Forum Lisa Argent Matthew Fletcher Rose Turner PBC LHC Finance Group Michael Schofield Vanessa Harris Neil Ferrelly Workforce Programme Board Ali Mohammed Janet Miller Ruth McCall Communications and Engagement Consultation Claire Pirie Rachel Clinton Sussex Tertiary Commissioning Project BSUH 3Ts Project Board Version 2 6 th June 2008 Individual Organisations Boards (West, East Sussex and Brighton and Hove City PCT’s and BSUHT, SDH and SECAMB) City Wide Estates Group Ian Tate Chris Naylor Andre Demetriades Accountability Relationship BHCPCT Professional Executive Committee Strategic Commissioning Plans SECSCG BSUHT Board Programme Office

6. The Financial Picture (1/3) Activity & Financial Modelling (Base Case) Projected income levels derived from 10 yr activity forecast, agreed with PCTs Modelling shows affordability based on prudent projections of income and expenditure Projected surpluses sufficient to repay DoH loan, with possibility of early repayments There is enough scope to meet double running cost and still repay the DoH loan.

7. The Financial Picture (2/3) The SOC tests sensitivity to: –Impairment and the cost of capital –Activity changes –Managing the optimism bias (currently +41%) The SOC has in-built prudence –Cost of capital –Elective activity levels –PbR tariff and HRG4 –Margin released from activity increases –Non-aggressive assumptions for tertiary work Impairment “Work is underway in NHS Finance ….. to reconcile inescapable impairment charges to NHS Trusts’ revenue accounts with their breakeven duty” (source: NHS Financial Manual, May 2008)

8. The Financial Picture (3/3) Into the future; PCT allocations: 1% movement = £3.6m Market Forces Factor: currently 14.2%, 1% shift would impact £2m Cost improvement flexibility: + 0.5% would generate £2m Cost of PFI to be tested through to OBC Choice agenda FFF and Tertiary care Local DoFs have agreed to take forward further Joint modelling to link World Class Commissioning, the OBC and the Trust’s Long-term Financial Modelling

9. Options Appraisal 72 theoretical permutations reduced to long list of 13 and short list of 5 options Assessed against benefits criteria: –Strategic fit –Clinical outcomes –Modern healthcare facilities –Improved access –Training, teaching & research –Effective use of resources N.B. These will be refreshed and used to assess design options at OBC stage Limited opportunity for realistic ‘reduced scope’ options: –Need to replace inpatient accommodation –Agreement to relocate Regional Centre for Neurosciences –Agreement to expand Cancer Services –Healthier People, Excellent Care and Fit for the Future commitment to Major Trauma Centre Greenfield site discounted at early stage – previously insurmountable obstacles have not changed

10. Summary of BSUH 3Ts Proposals Specialist / Tertiary Care: Relocating the Regional Centre for Neurosciences from PRH to RSCH and increasing its capacity Expanding the Sussex Cancer Centre’s non-surgical services (radiotherapy, chemotherapy, haematology) Improving care for patients with severe injury / trauma, including designation of RSCH as a Major Trauma Centre within a Trauma Network Secondary Care: Re-providing inpatient accommodation from the Barry and Jubilee buildings (RSCH campus) Expanding services following the Fit for the Future consultation Enhancing high-tech / emergency interventions such as the Brain Injury Centre and Interventional Radiology service. Strengthening Academic Links: University Teaching Hospital ‘campus’ BSMS Clinical Research Facility proposal Academic Health Sciences Centre proposal (allied to FT application) Strengthen pre-/post-registration education Propagate research across range of Trust’s clinical activities

11. Royal Sussex County Hospital Campus Proposed Redevelopment Area (red boundary)

12. Royal Sussex County Hospital Campus – Probable Initial Redevelopment Area

13. Artist’s Impression Barry Building (outlined in red): refurbished for non-clinical use or…

14. 6 blocks at 16m x 50m 5 levels. Floor area = 24,000m 2 with basement parking …demolished / replaced

15. Princess Royal Hospital Campus Proposed ring road (orange boundary) Potential redevelopment areas (red boundary)

16. 2° Care: Replacing Inpatient Accommodation Historical Context Barry building (1828), Jubilee building (1887) Florence Nightingale entered nursing in 1845 Rationale for Replacement: Compromises patient privacy and dignity Daily challenge to achieve appropriate cleanliness, managing infection control Insufficient single and negatively-pressured isolation rooms Does not meet the preferred standard for bed spacing Diverts resources into backlog maintenance Includes inefficiently-sized wards Significantly constrains the Trust’s ability to develop novel therapies Deleterious impact on staff morale, recruitment & retention, and on patients’ and visitors’ confidence in services provided from this accommodation SOC Consultation Fully supportive of need to replace this accommodation

17. 2° Care: Fit for the Future Context West Sussex and Brighton & Hove City Teaching PCTs’ consultation (June 2007) Revised model agreed (May 2008) – reduced scope and extent of proposed changes PCT decision to centralise some services at WaSH (June 2008) Confirms ‘the development of a Trauma Centre… at the Critical Care Hospital in Brighton so that people no longer have to travel to Southampton or London for the most serious accidents and emergencies’ Impact on BSUH: Obstetrics: transfer around half of obstetrics from PRH to RSCH, plus some additional activity from ESHT No additional 2° care activity to accommodate at RSCH (as would have been the case with RWS as MGH) SOC Consultation Proposals may be subject to Judicial Review and/or Independent Review Panel West Sussex PCT’s North East Review

18. 2° Care: Emergency & Hi-Tech Interventions Imaging Integrated service: general & neuro-radiology, Nuclear Medicine Service redesign to minimise patient journeys and maximise staff efficiency State of the art technology to support 24/7 Critical Care Hospital / Trauma Centre: CT, MRI, Ultrasound, digital X-Ray, fluoroscopy, Interventional Radiology suites, endovascular theatre Brain Attack Centre 2° Stroke Unit for local population (24/7) 3° service for wider population, eg. severe head injury, 24/7 stroke thrombolysis, 24/7 MRI, angiography for subarachnoid haemorrhage, carotid Doppler, in clinical partnership with neighbouring Trusts Telemedicine links with DGHs SOC Consultation Fully supportive of provision of enhanced 24/7 imaging and ‘brain attack’ services to support local DGHs

19. 3° Care: Regional Centre for Neurosciences Context Best Care, Best Place (2004) confirmed commissioners’ intentions to relocate the Regional Centre from PRH to RSCH Ageing (1938), cramped accommodation Surgical bed occupancy  99% Significant increase in referrals: –Neurosurgery: 31% increase 06/07 to 07/08, 33% increase 07/08 to 08/09 –Neurology: 15% increase 06/07 to 07/08, 13% increase 07/08 to 08/09 Rationale Expansion in capacity enables repatriation of activity from London. Focusing a greater proportion of the Regional Centre’s resources on acute / emergency care, eg. NICE guidance, NCEPOD recommendation re severe head injuries Embedding the Regional Centre with related specialist services Expansion will enable further sub-specialisation, in line with Safe Neurosurgery 2000 SOC Consultation Fully supportive of need to relocate and expand Regional Centre

20. 3° Care: Non-Surgical Cancer Services (1/2) Background Sussex Cancer Centre at RSCH is the hub of the Sussex Cancer Network (SCN) Provides comprehensive cancer treatment service, including radiotherapy and complex chemotherapy Only childhood cancers and exceptionally rare tumours are referred to other centres History SOC updates the Cancer Services SOC for non-surgical oncology services approved in 2004 Proposal developed through the SCN, approved at the Network Executive Board and has the full support of commissioners Proposals respond to, inter alia, NHS Cancer Plan, national Cancer Reform Strategy, national Manual for Cancer Services and SCN’s Strategic Plan 2005-2010, Service Delivery Plan 2007/08 to 2009/10 and Cancer Operating Plan

21. 3° Care: Non-Surgical Cancer Services (2/2) All elements developed in response to national and local standards for access times, treatment pathways and protocols: Radiotherapy 2007 National Radiotherapy Advisory Group (NRAG) report Associated SCN commissioning needs assessment Haematology/Oncology Inpatients Care National Institute for Clinical Excellence IOG for Haematological Cancers Associated cancer services standards and Peer Review Chemotherapy / Haematology Day Unit Cancer access standards SOC Consultation Fully supportive of proposed Cancer services developments

22. 3° Care: Major Trauma Centre (1/3) Background Better Care for the Severely Injured (2000), Trauma: Who Cares? (2007) Healthcare for London - major trauma project Healthier People, Excellent Care: ‘By 2010 all appropriate… major trauma patients will receive their care from 24/7 specialist units… The SEC area currently does not have a regionally based designated trauma centre that meets the criteria set out in the NCEPOD report. NHS SEC is forming plans to develop such a centre for our region.’ Proposal RSCH as hub of designated trauma network for Sussex and the wider region Service modelled on Royal London Hospital’s: trauma ward, three half-time trauma Consultants, helipad TARN database: 200-250 major trauma cases (ie. ISS  18) across Sussex per annum. Minimum catchment/number of major trauma cases not yet determined – likely to be 200-250 cases per annum. NCEPOD Trauma: Who Cares? – helipad essential (but < 12% patients arrived via air ambulance), and likely to extend catchment for appropriate cases

23. Major Trauma Centre – HfL Criteria (2/3) Designating Authority Designation is SHA remit rather than national / DoH programme High Quality Care for All (2008): ‘Each region is therefore pushing forward with the development of specialised centres for their populations with access to 24/7 brain imaging and thrombolysis delivered by expert teams, e.g. by 2010, NHS SEC intends that all strokes, heart attacks and major injuries will be treated in such specialist centres... Once implemented, these plans will save lives.’ HfL preliminary questionnaire for London trauma networks Essential services, must be available 24/7: A&E, designated consultant-led major trauma team General surgery, vascular surgery, neurosurgery, orthopaedic surgery ITU and anaesthesia 24/7 access to ultrasound (in A&E), CT, interventional radiology, emergency operating theatres, laboratory and blood bank facilities Essential services, must be available within 30 minutes: Plastic surgery Cardiothoracic surgery Urology Maxillofacial surgery and ENT Ophthalmology

24. Major Trauma Centre – Next Steps (3/3) Assessment Against Criteria Once the Regional Centre for Neurosciences moves to the RSCH campus, BSUH will meet all the clinical requirements for a Major Trauma Centre Clinical partnership agreement with Queen Victoria NHS Foundation Trust will address plastic surgery (and burns) QVHFT ‘fully committed’ to the vision Interim Steps BSUH assessing whether some neurosurgical capability could be provided at RSCH in advance of the full move Agreement in principal with KSSAAT and Deanery for BSUH to provide medics and clinical governance to the air ambulance from 2009 Agreement to appoint a Director of Trauma a.s.a.p. Agreement with neighbouring Trusts to establish a Sussex-wide Trauma Network Partnership working with SECAmb and SECSCG to improve pre-hospital care and agree pathways

25. Support for BSUH Vision includes… Sussex PCTs: ‘I am writing on behalf of the Sussex PCTs to confirm our support for the Strategic Vision described in the SOC and the high level activity and financial assumptions underpinning the capital requirements.’ WaSH: ‘We wholeheartedly endorse your vision for the development of tertiary and specialist services centred on the Royal Sussex County Hospital site as the most appropriate means of strengthening the provision of these services to our patients and to West Sussex residents in our catchment area.’ SECAmb: ‘We see the developments proposed by BSUH through the 3Ts programme as crucial to the success of our developments. You can be assured of our continued support to realise your vision.’ Brighton & Sussex Medical School: ‘There is obviously considerable enthusiasm in the Medical School for the direction that the Trust is taking and we are fully signed up to the view that our two organisations are ‘joined at the hip’… and need to move forward together for our joint benefit.’

26. “Let me assure you of mine and the SHA Board’s absolute dedication to this project. We share your vision of a modern, totally effective tertiary and trauma hospital up and delivering excellent care at the very earliest opportunity.” Graham Eccles Chairman NHS South East Coast

27. Discussion