Scottish Ambulance Service Business Case

157 Pages·2008·7.94 MB·English

by  Ian Shanley

Scottish Ambulance Service
EMDC Review Business Case!
!
!
!
!
!
!
!
Scottish Ambulance Service
Business Case

EMDC Review Project

Final Version 1
January 2008
!

Scottish Ambulance Service
National Headquarters
Tipperlinn Road
Edinburgh EH10 5UU
Tel: [phone]
Fax: [phone]
www.scottishambulance.com
EMDC Review Project Business Case Final Version 1 23 January 2008 Page| 1
Scottish Ambulance Service
EMDC Review Business Case!

Acknowledgements
Programme Board
Pauline Moore, Project Sponsor
Sam Kennedy, Project Director
Karen McLachlan, Convenor, UNISON
John Gallacher, Convenor, T&G Scotland
Suzanne Dawson, Non Executive Director
Jonathan Price, Scottish Government
Ian Shanley, General Manager ICT
Mark O’Donnell Executive Team Advisor
George Crooks Medical Director and Clinical Advisor
Alan Lawton Non Executive Director
Dr Lawrence Bidwell NHS Highland
John Morton PR Consultant
Neville Singh Patient Representative
Phase 2 Project Team
Richard Muirhead, Project Manager (PhaseII)
Ian Donald, Project Manager (Phase1)
Ian Shanley, General Manager, ICT
David Kinnaird, ICT Systems Development Manager
Janey Morrison, Telecomms Services Manager
Alan Campbell, ICT Systems Support Manager
Lorraine McAffer, Estates Manager
Jim Dall, General Manager, Finance
Stuart Airey, Project Accountant

Project Support
Loraine Newberry, Projects Coordinator
EMDC Review Project Business Case Final Version 1 23 January 2008 Page| 2
Scottish Ambulance Service
EMDC Review Business Case!
Table of Contents
Topic Section Page
Executive Summary 4
Introduction and Background 1.0 7
Introduction 1.1 7
Background 1.2 7
Objectives 1.3 9
Methodology 1.4 10
Benefits Criteria 2.0 11
Proposed Benefits for Patients 2.1 11
Long List of Options 3.0 12
Short List of Options 4.0 15
The EMDC Technical Team 4.1 15
Technical Team Responsibilities 4.2 16
Technical Workshops 4.3 16
Command and Control Systems 4.4 16
Telephone Systems 4.5 17
Airwave Mobile Radio 4.6 18
Option 1: Status Quo 4.7 19
Option 2: 3 EMDCs Aligned to 3 Divisions 4.8 20
Option 3: 3 EMDCs Augmented by Call Centre at Dundee 4.9 22
Option 4: 3 Call Centres and 6 Dispatch Centres 4.10 23
Option 5: 3 EMDCs Co-located with NHS24 4.11 25
Option 6: 2 EMDCs 4.12 27
Emergency Response Service (Lanarkshire Model) 4a 29
Emergency Response Service 4a.1 29
Emergency Response Service Technical Requirements 4a.2 30
Value for Money Assessment 5.0 31
Value for Money Assessment 5.1 31
Benefits Assessment 5.1.1 31
Economic Appraisal 5.1.2 31
Risk Assessment 5.1.3 32
Value for Money Conclusion 5.1.4 32
Sensitivity Analysis 5.2 34
Affordability 6.0 35
Revenue and Capital Implications 6.1 35
Private Public Partnership / Private Finance 6.2 35
Implementation 7.0 37
Project Management 7.1 37
Project Board and Team 7.2 37
Methodology 7.3 37
Statement of Understanding 7.4 37
Human Resource Issues 7.4 37
Project Plan 7.5 38
Recommendation of the Preferred Option 8.0 39

!
EMDC Review Project Business Case Final Version 1 23 January 2008 Page| 3
Scottish Ambulance Service
EMDC Review Business Case!
Executive Summary

Background
!
i) The Service currently has 3 Emergency Medical Dispatch Centres which were fully
established in March 2004. However an unprecedented increase in 999 and urgent
demand, referral patterns, and changes to service provision have resulted in the present
facilities being overcrowded. In addition, there have been ongoing recruitment and
retention difficulties in the East EMDC. This standard business case sets out the issues,
aims and objectives of the review project and appraises various options for future service
delivery against these aims and objectives.
ii) This case covers the review of the 3 operational EMDCs in Paisley, Edinburgh and
Inverness together with the disaster recovery facility at Dundee. These EMDCs are
responsible for the effective call handling of 999, doctors urgent and air ambulance calls,
and the dispatch of an appropriate and timely ambulance response (or sub contracted first
responder).
iii) The purpose of this business case is to secure Board agreement for the recommended
future service provision and any associated capital and revenue funding required to
implement. Implementation arrangements are also proposed.

Strategic Context and Project Objectives

iv) The project objectives are to:

! deliver an EMDC service which effectively contributes to the management of Accident and
Emergency services and performance;
! ensure a management structure within the EMDCs which improves the relationship between the
dispatch function and operational crews;
! determine the most effective development and support infrastructure which meets staff
expectations;
! review number, location, and role of EMDCs;
! investigate reasons for high staff turnover and recommend a strategy which addresses this;
! investigate the scope for partnership working to ensure accessible and safe patient care
pathways;
! investigate systems and processes to enable enhanced levels of clinical decision making;
! engender specialisation within call taking to maximise call management opportunities, staff
motivation and triage outcome.
Options
!
v) A long list of options was developed by the project board which was shortlisted, by a
stakeholder group to:
Option 1 Status Quo
Option 2 3 EMDCs
Option 3 3 dispatch centres and 1 call taking centre
Option 4 6 dispatch centres and 3 call taking centres
Option 5 3 EMDCs co-located with NHS24
Option 6 2 EMDCs
EMDC Review Project Business Case Final Version 1 23 January 2008 Page| 4
Scottish Ambulance Service
EMDC Review Business Case!
Economic Appraisal (Value For Money)
vi) The appraisal examined the costs, benefits and risks of each option. The costs were built
up using the Service’s specialist property advisors and in house ICT team combined with
detailed technical workshops with telephony, radio and IT suppliers. The benefit criteria
were developed by the project team and endorsed by the project board. A stakeholder
group then scored each option against the benefit criteria. The Service’s Patient Focus
and Public Involvement contact at the Scottish Health Council provided advice and
support to the process. The risk assessments were prepared by the project team. Table
ES/1 shows the value for money assessment:

Table ES/1 Value for Money Assessment
Option Equivalent Benefits Cost per Cost Risk Risk
Annual Score Benefit per Score Rank
Charge Benefit
Rank
1 £14.357m 15,153 £947 3 16 2
2 £15.481m 16,242 £953 4 16 2
3 £15.040m 16,009 £940 2 16 2
4 £17.332m 15,908 £1,090 5 18 5
5 £15.460m 17,696 £874 1 15 1
6 £15.788m 13,685 £1,154 6 19 6

vii) Option 5, co-location with NHS24 is the preferred option, offering best value for money.
The option has been subjected to sensitivity analysis and the assessment shown to be
robust.

viii) Option 5 would comprise: the West EMDC at Paisley moving to a new site at Cardonald at
which NHSGG & C out of hours service, NHSGG & C financial services and NHS24 West
Hub are moving to during 2008; the North EMDC, which already hosts the Inverness
NHS24 spoke, being expanded to accommodate the new operational delivery model of
enhanced clinical supervision of call taking and dispatch during 2009; and the East EMDC
moving to the existing NHS24 East Hub at South Queensferry during 2010. The 3 new
EMDCs would increasingly work as a virtual networked EMDC. Disaster Recovery
facilities will be provided at the existing Paisley location.

Financial Appraisal (Affordability)
!
ix) Option 5 requires the following funding:

Table es/2, Funding Requirements
2007/08 2008/09 2009/10 2010/11 Totals
Capital £0.300m £1,509m £1.306m (£1,759m) £1.356m
New £0.590m £0.382m £0.361m £1.333m
Revenue
Total £0.300m £2,099m £1.688m (£1.398m) £2.689m

x) The capital costs relate to estates costs to relocate Paisley and Edinburgh EMDCs to new
sites within the same areas and to expand the Inverness site, together with upgraded
Command and Control and telephony systems. It is proposed that these capital costs be
funded from capital formula allocation monies and from disposal proceeds.
xi) The revenue costs increases relate to the capital charges associated with the estates and
ICT investments, some of which would be necessarily increased as part of the Service’s
ICT Strategy.
EMDC Review Project Business Case Final Version 1 23 January 2008 Page| 5
Scottish Ambulance Service
EMDC Review Business Case!

xii) The revenue costs have been factored into the Service’s financial plan.

Project Implementation
!
xiii) Arrangements are in place to manage the implementation of the project. PRINCE2
project management methodology will be adopted. The Service has extensive experience
in such an approach. The key stages in implementation are:

Table ES/3, Implementation Timetable
Action Timetable: by
Approval of Standard Business Case 30th January 2008
Consultation & Involvement Feb 2008 to May 2010
Migrate West EMDC to Cardonald Site 22nd September 2008
Refurbish North EMDC March 2009 to September 2009
Commission Refurbished North EMDC October 2009
East EMDC to Norseman House November 2009 – May 2010

xiv) The risks associated with the implementation have been identified and risk management
arrangements put in place. The key risks relate to the new radio system, and appropriate
controls have been formulated.

Post-Project Evaluation

xv) End stage assessments will be undertaken by the project team and the Service’s Internal
Auditors, Deloittes will review progress as part of their annual work plan. A final post
project evaluation will be undertaken, 6 months after full implementation.

Conclusions and Recommendations

xvi) It is recommended the Board approve the implementation of option 5, co-locate with
NHS24 in 3 centres, and authorise the Service to proceed with the procurement and
implementation.
!
EMDC Review Project Business Case Final Version 1 23 January 2008 Page| 6
Scottish Ambulance Service
EMDC Review Business Case!
Section 1: Introduction and Background

1.1 Introduction

The EMDC Review Project emerged as a key work-stream of the Scottish Ambulance Service’s
Operational Performance Improvement Project (PIP) at which the drivers for change were originally
identified. This business case sets out the EMDC Review Project objectives and describes all of the
options that were considered. The short listing process is explained and detailed description is given
for each of the short-listed options. The document then considers and assesses the benefits, risks
and costs of each option by scoring each short listed option using accepted conventions for such
evaluation as prescribed by the Capital Investment Group. From this evaluation, a preferred option is
recommended to the Scottish Ambulance Service NHS Board. The Board is invited to consider and
endorse this recommendation for funding and implementation.

This business case follows Scottish Government guidance for projects of this size and impact and has
been compiled by a small group of specialists who have used the findings of the EMDC Review Phase
1 Project Team and Project Board to populate the document. Emergency Medical Dispatch Centres
are a vital part of Accident and Emergency service delivery so the timescales for the development of
this business case have necessarily been tight. The implementation and migration timeframes
described in the document assume that the Board will return its decision immediately after their
January meeting.

1.2 Background

In April 2000 the Board of the Scottish Ambulance Service established a project to review the
number, function and location of the Service’s Operations Rooms. Operations Rooms managed both
emergency and non-emergency requests and controlled the deployment of staff and vehicle
resources to meet emergency, routine and major incident/event demand. There were eight such
centres in Scotland, one of which (Aberdeen) also served as the air desk, controlling and co-
ordinating patient air transport resources.

The review was commissioned for three main reasons:

! Concerns about the quality and equitable provision of pre-hospital care

! Developments in information technology and systems had significantly enhanced
opportunities to improve dispatch systems

! Reports by the National Audit Office and the Audit Committee of the Scottish Parliament
recommended that a thorough review was required with a view to improving effectiveness and
value for money in the management of ambulance deployment.

As a consequence, the existing Emergency Medical Dispatch Centre model was designed and
implementation was completed in March 2004. The rationalisation of the function into 3 Emergency
Medical Dispatch Centres (EMDCs) and the creation of 30 PTS hospital based centres enabled the
investment in information and communications technology that ensure our command and control and
communications systems are amongst the most advanced in the UK.

EMDC Review Project Business Case Final Version 1 23 January 2008 Page| 7
Scottish Ambulance Service
EMDC Review Business Case!
However, during the past 4 years, there has been a significant increase in demand and this has
placed an ongoing pressure on the Service to meet its performance standards for call pick up and for
its response times to emergency requests. The command & control of an increasing number and
complexity of emergency ambulance resources, an increase in demand, changes in referral patterns
and a limited ability to expand within our existing accommodation were some of the drivers which
prompted a further review of the function, number and location of our EMDCs. In an effort to quantify
the resources required to adequately manage the demand that the Service is now experiencing, two
consultant led resource modelling analysis exercises were conducted. In October 2006, Catalyst, a
Mason Group company undertook an analysis of the call taking function using their sophisticated
resource modelling tools.(1) In a separate exercise, the Service commissioned ORH Limited to
undertake a resource/demand analysis of the dispatching function. Their report highlighted the need
to increase the numbers of dispatch positions at peak demand times across our 3 EMDCs.(2)
Although we are committed to move towards this number, we have experienced significant
challenges due to limitations with the available accommodation and staff facilities. This was also
reflected in comments we received in a recent staff survey. (3) Any further developments within our
existing facilities must be considered a temporary solution and will not take account of any future
requirements.

The drivers for change for this current review include:

! Significant increases in demand
! New sources of demand
! High staff turnover, particularly in the East EMDC
! Limited accommodation availability, particularly in West and North EMDC
! Emerging NHS potential partners (NHS 24 & Out of Hours Hubs)
! Further technical & communications possibilities
! An increasing acknowledgement that the dispatch function is vital to meet performance
targets
! Service Redesign
! Continued and developing need to support Service Resilience
! Advances in available technology

1. Copyright of Mason Group Ltd 2006
2. Dispatching Functions in the Three Controls – ORH Limited, 29 May 2007
3. http://samson/eresponse/run/reportprint.cfm?id=82
EMDC Review Project Business Case Final Version 1 23 January 2008 Page| 8
Scottish Ambulance Service
EMDC Review Business Case!
1.3 Objectives

The objective of the project was to review the role, locations and numbers of Emergency Medical
Dispatch Centres by conducting a thorough, research based analysis of the function as it currently
stands and develop options which will ensure that, in the future, EMDCs are the world class facility
that contribute optimally towards the operational performance of the Scottish Ambulance Service, are
patient focussed, allow for the development of our staff, and ensure that the SAS contributes to the
delivery of high quality healthcare within the wider NHSS.

To deliver this, the following were the key project aims:

To produce a range of options which would deliver an EMDC service which positively contributes
to the management of emergency A&E performance

To review the management structure and responsibilities in the current EMDC service and
produce a model which improves the link between the dispatch function of the EMDC and the
deployment of operational teams

To review current EMDC infrastructure, at all levels, to determine the most effective development
and support strategy which will meet our staff’s expectations

To review the number, location and role of current EMDCs and to produce recommendations on
future configuration

To investigate the reasons for high staff turnover and to recommend a model or strategy which
will address this and ensure that the EMDC Service is safe and sustainable

To investigate the scope for partnership working with NHS partners and produce
recommendations which will allow our EMDCs to facilitate management of all NHS resources
ensuring that appropriate patient pathways exist and are accessible

To investigate systems and processes which will enable an enhanced level of clinical decision
making within the EMDC to support appropriate patient pathways

To engender specialisation within the call taking process, to maximise call management
opportunities, staff motivation and triage outcome

EMDC Review Project Business Case Final Version 1 23 January 2008 Page| 9
Scottish Ambulance Service
EMDC Review Business Case!

1.4 Methodology

Phase1 of the review project considered how the current EMDC service is delivered, taking into
account the number of EMDCs, their location, physical condition and scope for expansion, the
volume of calls handled, and the recruitment and retention situation. This information was used as
part of the option development process when building up a range of options to offer to the Project
Board for consideration. The Project Team also utilised research available in terms of call taking and
dispatch, to ensure that options are fit for purpose and also meet the needs of the Service and its
stakeholders. The team utilised PRINCE 2 methodology, completing a project plan, product log, risk
and issue logs and the project was quality assured.

Progress reports were presented to the Project Board at regular meetings. The Project Board
considered and ratified the shortlist of options which the team then used to compile the business
case.
Project Team and Project Board Structure
The following schematic, details the membership of the Project Board and Project Team.
Project Sponsor
Pauline Moore
Project Board
Project Director
Sam Kennedy
Convenor
Project Team UNISON
Karen McLachlan
Ph(IaaMsnea D n1oa Pngaerolrdje)ct RPichhaMasread n 2Ma Pguerirorhjeecatd PhMaasnea 3g ePrr o(?je)ct CoTn&veGnor
John Gallacher
DeSAAvdy eGsvlotirsepeommernsse nt BobMQ Jauonhaanlgitsyet rone Cli&eR nDot beMRepearuptnt yCrae goPselerbronujterancttiv e ReDpLr eBMSsrceataNnnfutdfa lottyinves RReparye UHseseneptrba utivrnes RisMkM i&kae Rn Haeegsrielriireontce SNuzoanDn-Enireex ceDtcoaurwtivseo n
D Kinnaird P Cook (?) (?) HR Advisor
J Morrison Dorothy
McKinney
Jonathan Pryce
Scottish
Executive
Systems
Development
Role of the Project Board Ian Shanley
Executive Team
Advisor
The Project Board was chaired by the Project Sponsor and the Mark O’Donnel
secretariat was provided by the Project Administrator. The Board
Project Team
received copies of the all Progress Reports. Regular Board meetings Manager
were held to receive reports from the Project Manager and the Quality
User
Assessor and to direct, support & advise the Project Team. Representative
Jim McCafferty
Unscheduled
Care Rep.
C McFarlane-
Slack
Clinical Advisor
G Crooks
Alan Lawton
Non-Executive
Director
Dr Ken Proctor
NHS Highland
Dr Lawrence
Bidwell
Argyll & Clyde
John Morton
PR Consultant
Patient
Representative
tbc
EMDC Review Project Business Case Final Version 1 23 January 2008 Page| 10