Report to NHS Halton and St Helens Trust Board

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                          Report to Merseyside Cluster Board

Date:                                29th September 2011

Accountable Executive:               Clare Duggan, Director of Strategic Change/QIPP

Report title:                        The Cheshire and Merseyside Treatment Centre Consultation
                                     Outcome and Recommendations
Report prepared by:                  Simon Banks, Operational Director – Planned Care, Halton
                                     and St Helens
Purpose:                              Report to the Board the outcomes of the public consultation on
                                        the future utilisation of The Cheshire and Merseyside
                                        Treatment Centre (The CMTC).
                                      Inform the Board’s decision making process in regard to The
                                        CMTC.

Recommendations:                        Confirm that existing and successor commissioning
                                         organisations have no existing or foreseeable operational or
The Merseyside Cluster Board             business requirements that necessitate the retention of a
is asked to:                             purpose built orthopaedic hospital on their balance sheet

                                        Give delegated authority to the Chair, Chief Executive, Director
                                         of Finance and Director of Strategic Development/QIPP to
                                         explore mechanisms through which the leasehold interest of
                                         NHS Halton and St Helens can be divested subject and
                                         subsequent to the outcome of the Cooperation and
                                         Competition Panel investigation and Department of Health
                                         (DH) policy guidance on the future ownership and
                                         management of the PCT Estate.


The NHS Constitution

The right to expect your local NHS to assess the health requirements of the local community and to
commission and put in place the services to meet those needs as considered necessary.

The right to be involved, directly or through representatives, in the planning of healthcare services, the
development and consideration of proposals for changes in the way those services are provided, and
in decisions to be made affecting the operation of those services

The pledges to (i) make decisions in a clear and transparent way, so that patients and the public can
understand how services are planned and delivered and (ii) provide you with the information you need
to influence and scrutinise the planning and delivery of NHS services.

Merseyside Cluster Objective
Sustaining management capacity
Ensuring delivery of Quality, Finance, QIPP and Performance                                          
Development of GP Commissioning Consortia                                                            
Development of commissioning support arrangements
Supporting the development of Health and Wellbeing Boards
Assignment and alignment of staff to new health system
Supporting provider reform

National Policy, Guidance, Standards or Legislation

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Any disposal of the leasehold interest in the CMTC would have to be to open, transparent and follow
current guidance from the DH on the future ownership and management of the PCT and reflect the
legal position of the land lease.

Equality and Diversity and Human Rights

An Equality Impact Assessment has been prepared as part of this process and will need to be
completed when the final decision is made in regard to The CMTC.


Resource implications

The annual cost of maintaining The CMTC in a state of operational readiness is £1,053,537.
Professional advice will be required on the legal and estates issues arising from any decision by the
Board.


Stakeholder consultation

The report provides details of the outcome of a formal public consultation that took place between 6th
May and 29th July 2011. In total 1,113 people completed a questionnaire, 21 presentations were given
and 16 items of other correspondence were received as part of the consultation process.



Risks
Financial – continued expenditure on facility, mitigation to be investigated by Director of Finance.
Legal – status of restrictive covenants, definitive legal advice to be sought.
Reputational – high profile facility and significant public interest, communication plans in place.



Summary Report

The report sets out the outcomes of the public consultation on the future utilisation of The CMTC. It
provides detail on the key financial and legal issues the Board needs to consider. The paper clarifies
the role of current and successor commissioning organisations. The impact of the Phase II
investigation by the CCP is also discussed. Finally, the options set out in the public consultation are
reviewed and a recommendation made that the Chair, Chief Executive, Director of Finance and
Director of Strategic Change/QIPP, obtain appropriate advice to explore and expedite mechanisms
through which the leasehold interest in The CMTC can be divested whilst ensuring the facility is used
for healthcare purposes.




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 The Cheshire and Merseyside Treatment Centre Consultation Outcome
                       and Recommendations

1.    Purpose of the report

1.1   The purpose of this paper is to report to the Board the outcomes of the public
      consultation on the future utilisation of The Cheshire and Merseyside
      Treatment Centre (The CMTC). The paper, with supporting information and
      evidence, also provides recommendations to inform the Board’s decision
      making process in regard to The CMTC as well as detailing the obstacles to
      making a formal decision prior to 30th September 2011.

1.2   The paper concludes by requesting that the Board grants delegated authority
      to the Chair, Chief Executive, Director of Finance and Director of Strategic
      Development/QIPP, to obtain appropriate advice and subsequent to 30th
      September 2011, to explore and expedite mechanisms through which the
      leasehold interest in The CMTC can be divested whilst ensuring the facility is
      used for healthcare purposes.

2.    Background

2.1   The CMTC is located on a site adjacent to Halton Hospital in Runcorn - the
      site is owned by Warrington and Halton Hospital NHS Foundation Trust
      (WHHFT) - and is subject to a 60 year lease arrangement, with 55 years
      remaining. The CMTC was built as part of the GC5W Project Agreement to
      provide a limited range of orthopaedic services across Cheshire and
      Merseyside. This commercially binding contract between the Department of
      Health (as the Authority), the primary care trusts in Cheshire and Merseyside
      and the provider, Interhealth Care Services (UK) Ltd was for a five year fixed
      term that ended on 31st May 2011.

2.2   On 1st June 2011 the leasehold interest in the land, building and equipment
      transferred from the Secretary of State for Health to NHS Halton and St
      Helens. The asset is currently included on the Halton and St Helens’ Primary
      Care Trust’s (PCT’s) balance sheet at Depreciated Replacement Cost (Net
      Book Value) of £18,102,125.

2.3   On 19th April 2011 the Halton and St Helens Primary Care Trust Board
      received an options appraisal and business case for the future utilisation of
      The CMTC produced with Finnamore. The Board approved a formal, public
      consultation to gather views of patients, the public and other stakeholders on
      the options set out in the business case. This consultation ran from 6th May to
      29th July 2011.

      The four options set out in the consultation document were:

         A: Do nothing – included only to provide a benchmark for cost comparison
          purposes.
         B: Divest - sell the building on the open market guided by an assessment
          by the District Valuer.
         C: Lease - seek through a procurement process an organisation that is
          willing to take on a lease for the building.
         D: Utilisation - use the asset for local health care provision, if costs
          including capital charges, depreciation and running costs can be
          recouped.

      Option D was expanded to include four utilisation options:

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         Option D1: Orthopaedic centre.
         Option D2: Surgical centre with Urgent Care Centre and direct access
          diagnostics.
         Option D3: Dedicated day surgery centre, plus Health Care Resource
          Centre (primary care / community services).
         Option D4: Health Care Resource Centre only (primary care / community
          services) with no / very little surgery.

2.4   With the formation of the Merseyside PCT Cluster the issue of the future
      utilisation of The CMTC is now an issue to be addressed by the Cluster
      Board. The future ownership and management of The CMTC needs to be
      consistent with recent guidance from the Department of Health (DH) on the
      PCT Estate which currently negates Option B.

3.    Outcomes of public consultation

3.1   The Patient Experience Team of NHS Halton and St Helens was asked to
      carry out a community consultation on the future use of the building formerly
      known as The CMTC between 6th May and 29th July 2011. The full
      consultation report will be published on ‘Talk To Us’ subpages of the NHS
      Halton and St Helens website after the Board meeting. The general themes
      and findings from this consultation are summarised below and in Appendix 1.
      The Board are asked to take these into account in their discussions on the
      future use of The CMTC.

3.2   The consultation included formal presentations with individuals and
      organisations, an online and paper based questionnaire and the active
      encouragement of open dialogue with key stakeholders, service users and
      the wider community. In total 1,113 people completed a questionnaire, 21
      presentations were given and 16 items of other correspondence were
      received as part of the consultation process. Correspondents included:

         Cheshire Primary Care Provider CIC
         Derek Twigg MP
         Halton Borough Council Executive Board
         Halton Borough Council Health Policy and Performance Board
         Halton Local Involvement Network
         Interhealth Care Services (UK) Limited
         Runcorn Practice Based Consortia (Shadow Clinical Commissioning
          Group)
         Warrington and Halton Hospitals NHS Foundation Trust
         St Helens Council

      It should be noted that there is evidence in some of the written consultation
      returns that assistance may have been given to respondents to complete
      questionnaires. This may be indicative of a potential lobbying mechanism or
      attempt to influence the final outcome. However such activity has not had a
      detrimental impact upon the overall outcomes of the consultation.

3.3   Overwhelmingly, respondents expressed support for the retention of The
      CMTC. Respondents reported high satisfaction levels with the activity of The
      CMTC, and many respondents stated their great disappointment in the
      closure of the service provided by Interhealth.




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3.4   Over 55% of respondents to the survey stated that they did not wish to see
      the facility sold on the open market, (although 27% felt that this was a
      possibility to recoup the original investment, or stated that they would like to
      see the building sold to the previous tenant).

3.5   Over 80% of respondents agreed or strongly agreed that the option to lease
      the facility to provide NHS services provided a sensible option for the future.

3.6   When asked which of the options for further utilisation respondents preferred:

         64% expressed that they strongly agreed with the centre remaining as an
          Orthopaedic Centre (D1)
         66% expressed that they strongly agreed with the provision of a Surgical
          Centre and Health Care Resource Centre including an Urgent Care
          Centre (D2)
         54% felt that the centre should provide Day Surgery i.e. pre-planned day
          cases only, a Health Care Resource Centre on 2 floors and Intermediate
          Care i.e. inpatient beds for elderly patients who have left hospital but need
          extra help before returning home (D3)
         Of the responses, 35% either strongly agreed or agreed that the Centre
          should be used as a Health Care Resource Centre only (D4), making this
          the least popular option.

3.7   Other engagement routes – including presentations to Halton Borough
      Council’s Local Area Committees, Policy and Performance Board and
      Executive Board –indicated that there is an overall recommendation that the
      facility be further utilised in the future for the provision of NHS services.

3.8   The Board is asked to note the outcomes of the public consultation and the
      support for utilisation of the building for surgical, principally orthopaedic,
      provision. It is recommended that the Board considers the outcomes of the
      public consultation in making an informed final decision on the future
      utilisation of The CMTC.

4.    Financial considerations

4.1   Since 1st June 2011 The CMTC has been closed pending the outcome of the
      public consultation, the publication of the findings from the Cooperation and
      Competition Panel (CCP) Phase 2 investigation and a decision being made to
      determine its future use. Whilst the building is closed for operational use it
      still has to be maintained in an operational state. Whilst the cost of this is
      significant at £1,053,537 per annum, it is far less than fully de-commissioning
      the centre and then re-commissioning it at a later date. This figure may need
      to be revised as the land lease cost was set to rise with the Retail Prices
      Index (RPI) and empty business rates may also need to be considered.

4.2   To ensure the building and its contents are maintained to an appropriate
      standard, a structured plan of maintenance and monitoring has been effected.
      This includes building maintenance both ‘hard’ and ‘soft’ facilities
      management (FM) and monitoring of the specialist medical equipment
      housed at the centre. In addition to FM costs there is also depreciation and
      land lease costs associated with the asset itself that will be incurred on an on-
      going basis.

4.3   NHS Halton and St Helens has engaged OCS, who provided FM for the
      duration of the GC5W contract, to supply the on-going building maintenance
      whilst the building remains empty. Multi Health Solutions has also been

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      appointed to provide a maintenance service for the medical equipment
      housed at the centre. This service will ensure the operational state of the
      medical equipment during the period of inactivity.

4.4   Appendix 2 shows a breakdown of the estimated annual costs of maintaining
      the CMTC in an operational state. An agreement has been reached with the
      former counterparties to the GC5W contract that they will support the on-
      going costs of maintaining the building until such time as its future use is
      known – although this cannot be an open ended commitment. The continued
      period of closure is likely to run up to at least the end of the financial year
      2011/12 (effectively 7 months since it was last utilised). Following
      correspondence with the DH it has been made clear that there will be no
      additional financial support to the Merseyside PCT Cluster to cover holding
      costs.

4.5   To reduce the depreciation figure, which contributes £424,864 to
      maintenance costs, the possibility of declaring The CMTC “surplus to
      operational requirements” should be actively explored. Such a declaration
      cannot be expedited until the outcome of the Cooperation and Competition
      Panel investigation (q.v.) is known. It is possible that the PCT may have
      recourse to introduce this option retrospectively and backdate to the 1st June
      2011 subject to legal/audit opinion.

4.6   As stated in 2.2, the Depreciated Replacement Cost (DRC) or Net Book
      Value (NBV) of The CMTC as recently valued by the District Valuation
      Service (DVS) is £18,102,125. The DVS has also provided an estimation of
      the Open Market Value (OMV) of The CMTC and the Annual Market Rent
      (AMR). The OMV may be affected by particular clauses in the lease
      agreements relating to sub-leasing, type of use and the rights of the landlord,
      which are discussed below. Definitive legal clarification is required on the
      position in regard to the impact of the lease agreements on OMV.

4.7   Any sale at a value in excess of the DRC would realise a profit to the PCT
      whilst a sale at a value lower than DRC would result in a loss to the PCT in
      the financial year of sale. The PCT has taken precautions in respect of a
      potential reduction in the OMV of The CMTC arising from the terms attached
      to the (restrictive) covenant held by WHHFT and has included an estimated
      impairment figure within its recent financial returns to the SHA / DH. This
      figure needs to be confirmed in time for the DH “Spring Supply” exercise
      which sets departmental expenditure limits for the financial year and is
      normally confirmed by mid-November at the latest. It is therefore important
      that the PCT has a clear plan in terms of whether it is likely to retain or sell
      the building during the 2011/12 financial year by this stage of the year.

4.8   The Board is asked to note the costs of maintaining The CMTC in an
      operational state and the assessments by the DVS of DRC and OMV. It is
      recommended that the Board asks the Director of Finance to investigate,
      subject to the outcome of the CCP investigation, the possibility of declaring
      The CMTC “surplus to operational requirements” to reduce the maintenance
      cost of The CMTC.

5.    Legal considerations

5.1   The lease between NHS Halton and St Helens, as transferred on 1st June
      2011 to the organisation by the Department of Health (DH), and WHHFT
      contains a restrictive covenant which prevents any lessee from sub-letting the
      land AND buildings thereon at more than the agreed ground rent (which is

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      £50,000 p.a. plus 5 years indexation to be applied at 1 June 2011). This
      would prevent the PCT from recovering the full costs of capital charges and
      other buildings related costs that it will incur if the option of sub-leasing the
      building was pursued unless the terms of the ground lease can be re-
      negotiated with WHHFT, a position that the Board may wish to explore.

5.2   The leasehold interest in the land and the buildings can only be transferred or
      sold to another organisation if the building is to be used for healthcare
      purposes. It is this clause that the DVS have viewed as restrictive in their
      valuation of OMV. Advice from NHS Estates suggests that there is a further
      clause in the lease that needs to be considered.

5.3   Clause 3.2, Schedule 5 states that the Tenant:

      “Notwithstanding the provisions of clause 3.1 upon any Determination
      occurring on or after the expiry of the twenty sixth year of the Term the
      Tenant shall at the option of the Landlord yield up the Premises as bare land
      and (subject to the provisions of clause 3.4) with vacant possession which
      shall for the purposes of this clause be taken to include an obligation upon the
      Tenant at the expense of the Tenant to procure the Demolition of any
      buildings which have been constructed for the purposes on any Project
      Agreement existing on the Premises as at the date of Determination as the
      Landlord shall notify to the Tenant in writing.”

      Given that this agreement began on 1st June 2006, and five years of the lease
      have expired, in twenty-one years time, i.e. on or around 1st June 2032 the
      Tenant may be asked to remove The CMTC building from the site by the
      Landlord. It is the view of NHS Estates that this may have an adverse impact
      on the OMV of the facility and advise this provision be discussed with the
      DVS in further detail. At the time of writing we are awaiting the view of the
      DVS on the impact of this clause.

5.4   Any disposal of the leasehold interest would have to be to open, transparent
      and follow current guidance from the DH on the future ownership and
      management of the PCT and reflect the legal position of the land lease. The
      leasehold interest cannot simply be transferred due to procurement and
      competition rules.

5.5   The recent DH guidance, PCT Estate: Future ownership and management of
      estate in the ownership of Primary Care Trusts in England, states at
      paragraph 5.2:

       “PCT interests in ISTC buildings should be retained by PCTs for the time
      being. Any queries relating to these properties should be referred to Ben
      Masterson (ben.masterson@dh.gsi.gov.uk).”

      Appendix B suggests that further guidance will follow in regard to buildings
      such as The CMTC from the DH.

5.6   Planning permission was given for an orthopaedic hospital to be built on the
      site. It was stated in the consultation documents that if the building were to
      be utilised by a healthcare provider for anything other than for orthopaedic
      surgery they would need to obtain a change of use from Halton Borough
      Council’s Planning Department. NHS Estates advise that the use of class for
      a hospital is generic and it may be that The CMTC can be used for any form
      of medical or healthcare services carried out in a hospital. They suggest that
      further advice is taken on this aspect.

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5.7   Any healthcare provider would also have to obtain Care Quality Commission
      registration to deliver services from the building, which could take up to three
      months.

5.8   The Board is asked to note the legal considerations set out above. It is
      recommended that a definitive view on the impact of Schedule 5, Clause 3.3
      on OMV is sought as a matter of urgency from the DVS. It is recommended
      that sub-leasing is an option for the Board to consider if the sub-letting
      provisions of the lease can be renegotiated with WHHFT along with the
      removal of the conditions in clause 3.2, Schedule 5. It is recommended that
      further legal and estates expert opinion is engaged to further inform any
      decisions and recommendations on the utilisation of The CMTC.

6.    Role of a commissioning organisation

6.1   NHS Halton and St Helens, the Merseyside PCT Cluster and successor
      commissioning bodies have not identified operational or business
      requirements that would require the retention of a leasehold interest in The
      CMTC. Since the Transfer of Community Health Services (TCS) the
      Merseyside PCT Cluster has not been in the business of direct service
      provision. Successor bodies to NHS Halton and St Helens, subject to
      legislation, will be solely focused on commissioning and not service provision.

6.2   The transfer of responsibility for service provision is being followed by a
      transfer of the estate associated with that provision. However, as cited in 5.5,
      the transfer of The CMTC is specifically excluded from this process at present
      although the issues relating to the leasehold interest and potential future use
      need to be determined prior to further direction from the DH on the future
      ownership and management of The CMTC.

6.3   In light of the above, the Board is asked to confirm that existing and
      successor commissioning organisations have no existing or foreseeable
      operational or business requirements that necessitate the retention of a
      purpose built orthopaedic hospital on their balance sheet.

7.    Cooperation and Competition Panel Investigation

7.1   On 17th March 2011 Interhealth Care Services (UK) Limited asked the
      Cooperation and Competition Panel (CCP) to assess whether NHS Western
      Cheshire (who represented all Cheshire and Merseyside PCTs in GC5W
      Project Agreement) acted inconsistently with the Principles and Rules for
      Cooperation and Competition in its commissioning of the Cheshire and
      Merseyside NHS Treatment Centre. This complaint was accepted on 7th April
      2011.

7.2   The outcomes of Phase 1 were reported on 9th June 2011, after the
      consultation commenced. The CCP has considered that further analysis is
      warranted with regard to the issues raised by Interhealth and has proceeded
      to an in-depth Phase II investigation.

7.3   In Phase II the CCP will complete its analysis and decide whether the conduct
      of Western Cheshire PCT is likely to be inconsistent with the Principles and
      Rules and whether the commissioning decisions of Western Cheshire PCT on
      behalf of the commissioners in the Cheshire and Merseyside area were
      reasonable and consistent with the relevant provisions of the Procurement
      Guide. The deadline for completion of Phase II is 30th September 2011.

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7.4   The Board is asked to note the CCP investigation and that this fetters their
      ability to make a firm decision on the future of The CMTC as any actions
      taken prior to 30th September 2011 should not impact upon or prejudice the
      outcome of the CCP investigation.

8.    Analysis of the consultation options

8.1   Based on the information above, Option A (Do Nothing) in which The CMTC
      is mothballed is not a practical solution financially, politically or in terms of
      public opinion. It is not recommended that the Board should support Option
      A.

8.2   Option B, to divest the leasehold interest in the land and buildings of The
      CMTC would not be congruent with the outcomes of the public consultation or
      be consistent with current guidance from the DH on the future ownership and
      management of the PCT estate.. However, as stated above, the Merseyside
      PCT Cluster and successor commissioning organisations have no legitimate
      business interest in retaining The CMTC. There are outstanding financial,
      legal and estates issues to be resolved but, following further advice in these
      areas, the Board should seek further guidance from the DH on divesting the
      leasehold interest in The CMTC and the financial and other responsibilities
      that go with these arrangements.

8.3   Option C, to assign the leasehold interest to another organisation, would
      actually require a similar process to that required from Option B. As
      described in the paper a sub-lease arrangement would not be advantageous
      due to the existence of the restrictive clause in regard to the ground rent
      unless this restriction could be re-negotiated or varied following discussions
      with WHHFT. At this stage it is not recommended that the Board should
      support Option C without the sub-leasing clause being renegotiated with the
      WHHFT.

8.4   Option D, to utilise the asset for service delivery is the option most favoured
      based on the outcomes of the public consultation. The two most favoured
      sub-options for utilisation were D1, for The CMTC to continue as an
      orthopaedic centre, and D2, for The CMTC to provide elective surgical care
      alongside an Urgent Care Centre and direct access diagnostics. In their
      consultation response Interhealth Care Services (UK) Ltd expressed an
      interest in and support for Options D1 and D2. Warrington and Halton
      Hospitals NHS Foundation Trust, Runcorn Practice Based Commissioning
      Consortia/Shadow Clinical Commissioning Group and Halton Borough
      Council’s Health Policy and Performance Board and Executive Board all
      expressed interest in and support for Option D2. Halton Borough Council and
      Derek Twigg MP also asked that Option D3 (day surgery only plus other
      services) be considered.

8.5   The report in April 2011 by Finnamore identified that, taking into account the
      overall mix of benefits, costs (see Appendix 3) and risks, recommended that
      further work should be undertaken to develop the implementation detail for
      Options D2 and D3. It was suggested that Options D2 and D3 could:

         Provide a good balance of urgent care centre, primary care, intermediate
          care services and surgery, with a “community hospital” feel.
         Potentially reduce the risk of reliance on finding a single provider for the
          whole facility.


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       These recommendations were made prior to the issue of recent guidance on
       the future ownership and management of PCT estate which also require
       further work to be undertaken before any decision can be made on The
       CMTC.

8.6    The public consultation has shown that there is an interest in the market and
       in the local population for service provision to be resumed at The CMTC.
       However, this is distinctly different to there being a healthcare need for
       service provision from the facility. There has been work locally with the
       emerging Runcorn Clinical Commissioning Group (CCG) that suggests the
       range of services in Option D2, including an Urgent Care Centre, may be
       commissioned in the future. Further work, led by the local CCG from a
       commissioning and not a provider perspective is required to develop these
       plans. Even if these commissioning ambitions become intentions this does
       not necessarily mean that any commissioned services will be provided from
       The CMTC or by any provider operating therein.

8.7    To summarise, whilst shadow CCGs supported by the Merseyside PCT
       Cluster may wish to commission some or all of the services in Option D it is
       not their business to provide these services. Again, this draws the discussion
       back to the position that the Merseyside PCT Cluster and successor
       organisations have not identified any legitimate business interest in retaining
       a purpose built hospital on the balance sheet. It is therefore recommended
       that the Board supports further evidence-based commissioning work led by
       the local shadow CCG with appropriate support in regard to Options D2 and
       D3 on the basis that this does not delay the delivery of a solution based on
       Option B, subject to further guidance from the DH on the future ownership of
       the facility.

9.     Conclusion

9.1    The Merseyside PCT Cluster and successor commissioning organisations
       have not identified any legitimate business interest in retaining the CMTC on
       their balance sheet. The DH guidance on the future ownership and
       management of the PCT Estate currently determines that ownership must be
       retained until further guidance is issued. It is therefore recommended the
       Board gives delegated authority to the Chair, Chief Executive, Director of
       Finance and Director of Strategic Development/QIPP to explore and expedite
       mechanisms through which the leasehold interest of NHS Halton and St
       Helens can be divested subject and subsequent to the outcome of the CCP
       investigation and in light of the DH guidance on the future ownership and
       management of the PCT Estate.

9.2    Appropriate legal and estates advice to inform this decision making process
       should be obtained and the Executive Team should be supported by staff
       from the Cluster with experience and knowledge of the issues pertaining to
       The CMTC. The shadow Halton CCG, who are in the process of formation
       from the shadow Runcorn and Widnes CCGs, have also indicated that they
       would wish to be an integral part of the decision making process.

10.    Summary of recommendations

10.1   The Board is asked to note the:

          outcomes of the public consultation and the support for utilisation of the
           building for surgical, principally orthopaedic, provision.


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          costs of maintaining The CMTC in an operational state and the
           assessments by the DVS of DRC and OMV.
          legal considerations set out above, particularly the restrictive clauses in
           the lease agreement that may impact on the asset valuation.
          CCP Phase II investigation and the impact on decision making.
          Current guidance on the future ownership and management of the PCT
           Estate.

10.2   The Board is asked to;

       Confirm that existing and successor commissioning organisations have no
       existing or foreseeable operational or business requirements that necessitate
       the retention of a purpose built orthopaedic hospital on their balance sheet

       and

       Give delegated authority to the Chair, Chief Executive, Director of Finance
       and Director of Strategic Development to explore mechanisms through which
       the leasehold interest of NHS Halton and St Helens can be divested subject
       and subsequent to the outcome of the CCP investigation and in light of the
       DH guidance on the future ownership and management of the PCT Estate.
       Appropriate legal and estates advice to inform this decision making process
       should be obtained and the Executive Team should be supported by staff
       from the Cluster with experience and knowledge of the issues pertaining to
       The CMTC.




Simon Banks
Operational Director – Planned Care
14th September 2011
Amended 22nd September 2011

Contributions from:

Simon Bell, Patient and Public Involvement Manager
Carolyn Berry, Strategic Estate Adviser, NHS North West
Ken Jones, Senior Financial Accountant
Martin McDowell, Deputy Director of Financial Strategy
Graham Rose, Head of Commercial and Contracts, NHS North West
Chris Webb, Business Manager, Runcorn Shadow GPCC




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Appendix 1   Key issues from public consultation




 Talk to us … about the future
      of the Cheshire and
 Merseyside Treatment Centre
                           Public Consultation

                             September 2011




   Summary Consultation Report




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Executive Summary

The Patient Experience Team of NHS Halton and St Helens was asked to carry out a
consultation on options for the future use of the building formerly known as the Cheshire and
Mersey Treatment Centre.
                                               th            th
The consultation which took place between 6 May and 29 July 2011 and the findings and
recommendations from this consultation are reported here and will feed into the overall
decision making process for the future use of the facility.

The consultation sought to understand the local perception of a number of options for the
facility. These included:

         A: Do nothing – included only to provide a benchmark for cost comparison purposes.
         B: Divest - sell the building on the open market guided by an assessment by the
District Valuer.
         C: Lease - seek through a procurement process an organisation that is willing to take
         on a lease for the building.
         D: Utilisation - use the asset for local health care provision, if costs including capital
         charges, depreciation and running costs can be recouped.

Option D was further expanded to include four utilisation options:

        Option D1: Orthopaedic centre.
        Option D2: Orthopaedic Surgery with in-patient beds and Health Care Resource
        Centre on 1 floor i.e. services that you might attend at a GP practice such as blood
        tests, physiotherapy, counselling, baby clinics, lifestyle advice etc.
        Option D3: Dedicated day surgery centre, plus Health Care Resource Centre (primary
        care / community services).
        Option D4: Health Care Resource Centre only (primary care / community services)
        with no / very little surgery.

The consultation included formal presentations with individuals and organisations, an online
and paper based questionnaire and the active encouragement of open dialogue with key
stakeholders, service users and the wider community. In total 1,113 people completed a
questionnaire, 21 presentations were given and 16 items of other correspondence were
received as part of the consultation process.

It should be noted that there is evidence in some of the written consultation returns that
assistance may have been given to respondents to complete questionnaires which may be
indicative of a potential lobbying mechanism or attempt to influence the final outcome.
However such activity has not had a detrimental impact upon the overall outcomes of the
consultation.

As part of the consultation, correspondents included:

           Cheshire Primary Care Provider CIC
           Derek Twigg MP
           Halton Borough Council Executive Board
           Halton Borough Council Health Policy and Performance Board
           Halton Local Involvement Network
           Interhealth Care Services (UK) Limited
           Runcorn Practice Based Consortia (Shadow Clinical Commissioning Group)
           Warrington and Halton Hospitals NHS Foundation Trust
           St Helens Council

Overwhelmingly, respondents expressed support for the retention of this facility, with great
satisfaction levels reported in the activity of the Independent Sector Treatment Centre. Many
respondents stated their disappointment in the closure of the service provided by Interhealth
Canada.


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                                                                                    CB 11 09 16
Over 55% of respondents to the survey stated that they did not wish to see the facility sold on
the open market, (although 27% felt that this was a possibility to recoup the original
investment, or stated that they would like to see the building sold to the previous tenant).

Over 80% of respondents agreed or strongly agreed that the option to lease the facility to
provide NHS services provided a sensible option for the future.

When asked which of the options for further utilisation respondents preferred:

            64% expressed that they strongly agreed with the centre remaining as an
             Orthopaedic Centre (D1)
            66% expressed that they strongly agreed with the provision of a Surgical Centre and
             Health Care Resource Centre (D2)
            54% felt that the centre should provide Day Surgery i.e. pre-planned day cases only,
             a Health Care Resource Centre on 2 floors and Intermediate Care i.e. inpatient beds
             for elderly patients who have left hospital but need extra help before returning home
             (D3)
            Of the responses, 35% either strongly agreed or agreed that the Centre should be
             used as a Health Care Resource Centre only (D4), making this the least popular
             option.

Other engagement activity included presentations to Halton Borough Council’s Local Area
Committees, Policy and Performance Board and Executive Board indicated that there is an
overall recommendation that the facility be further utilised in the future for the provision of
NHS services.

Three organisations also expressed an interest in providing services from the facility in future.
 Popular consensus saw the value in the provision of surgical procedures (based more on a
greater understanding of local need) as well as the full utilisation of the building to provide a
range of services to local people.

A full version of the Consultation Report is available via www.haltonandsthelenspct.nhs.uk or
                  contact talk2us@hsthpct.nhs.uk / Telephone 0151 495 5187.

1. Introduction

The Cheshire and Merseyside Treatment Centre (CMTC) is located on a site adjacent to
Halton Hospital in Runcorn - the site is owned by Warrington and Halton Hospital NHS
Foundation Trust (WHHFT) - and is subject to a 60 year lease arrangement, with 55 years
remaining. The CMTC was built as part of the GC5W Project Agreement to provide a range
of orthopaedic services for the people of Chester, Crewe, Ellesmere Port, Knowsley,
Macclesfield, Liverpool, Runcorn, Sefton, Southport, St Helens, Warrington and Wirral.

Under a commercially binding contract between the Department of Health (as the Authority),
the Primary Care Trusts in Cheshire and Merseyside and the provider, Interhealth Care
Services (UK) Ltd the contract was for a fixed term of five years.
        th
On 19 April 2011, the Strategy Development Committee of the NHS Halton and St Helens
PCT Board discussed an options appraisal and business case for the future utilisation of The
CMTC building and agreed to explore options for the use the asset for local health care
provision, if costs including capital charges, depreciation and running costs can be recouped
and subject to further engagement with patients, public and other stakeholders. The Board
approved a formal, public consultation to gather views of patients, the public and other
stakeholders on the options set out in the business case.

Under Section 42 of the NHS Act 2006 a Primary Care Trust’s (PCT) statutory responsibility
to consult and engage should be “proportionate to the level of change involved” and a general
view is “that anyone affected by a decision should have an opportunity to give their views”
                                                                                           th
(p7, Real Accountability, DH, 2009). It was agreed that this consultation would run from 6
           th
May to 29 July 2011 and the information gathered from this consultation would enable PCTs
across Cheshire and Merseyside to make informed decisions when planning health services
for their patients locally.

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          st
On 31 May 2011, the five-year fixed term contract with the orthopaedic surgery healthcare
provider (Interhealth) ended. For the last 15 months, under the guidance and supervision of
NHS Western Cheshire and the Department of Health (DH), NHS Halton and St Helens and
other Cheshire and Merseyside PCTs have been preparing for the closure of this contract,
seeking to minimise service disruption and ensure patient continuity of care.
     st
On 1 June 2011 the leasehold interest in the land, building and equipment transferred from
the Secretary of State for Health to NHS Halton and St Helens.

The purpose of this report is to give detail of the activity undertaken during the consultation
period. The consultation exercise has sought the views of patients and the public on future
options for the use of The Cheshire and Merseyside Treatment Centre in Runcorn, as well as
engaging with other strategic partners to inform future decision making.

The information gathered will enable NHS Halton and St Helens to make an informed final
decision and influence planning for the future utilisation of the building. The consultation has
encouraged extensive and useful feedback through a variety of communication methods.



2. Aims and objectives

The aims of the consultation were to:
    To encourage constructive feedback from a variety of stakeholders between 6 May
                                                                                    th
             th
       to 29 July 2011.
    To ensure a wide range of stakeholders provide opinions and views on what is
       contained within the ‘Talk to us about the future of The Cheshire and Merseyside
       Treatment Centre’ summary consultation document’.

The following key messages were reflected in the consultation document, press releases and
consultation questions:
    The 5 year fixed term contract for orthopaedic services has ended.
    The activity associated with the 5 year fixed term contract has been re-commissioned
         through an Any Willing Provider (AWP) accreditation process.
    The consultation focuses on the future of the building.
    Options on the future of the building are limited by the presence of a restrictive
         covenant in the lease on the land between Warrington and Halton Hospitals NHS
         Foundation Trust and the Department of Health.
    The options for the future use of the building have been developed via a rigorous and
         inclusive process.
    The preferred option will be chosen based upon considerations of local need, patient
         benefit, financial affordability and sustainability and relevant Law.


3. Methodology

3.1 Pre-consultation methodology
Before the formal consultation period began, a number of meetings with key stakeholders
took place to focus on the complex issues encountered in the run up to the ending of the
current contract. This included the Halton Policy and Performance Board, the PCT Board and
a briefing for the local Members of Parliament.

A consultation document was written, based on a reduced version of the business plan and
this was shared with a number of colleagues, including PALs (Patient Advice and Liaison)
staff, other PCT staff, the two local LINks (Local Involvement Network) and senior
communication and engagement leads from the PCT areas affected by the closure of the
facility.

A list of local stakeholders was created, with particular focus placed upon the Halton Local
Authority Area Committee structure as it was felt that this demonstration of partnership activity
was a positive step forward in creating a greater understanding of local need.

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3.2 Online / Paper based questionnaire methodology
To accompany the production of the consultation document, a simple questionnaire was
created using the survey tool “Survey Monkey”. This document was also made available in a
paper based version for those unable to access the internet. Copies in alternative formats and
languages would have been made available, although there were no requests for this.
Information relating to the consultation was circulated via the PCTs Primary Care Bulletin
(Issue 37 May 2011) to all local GP practices, and was also circulated through partner
organisations such as the two LINks, the two Local Authorities and also included in press
releases from the PCT which featured in the local media.

As well as the above, colleagues within the PCT areas served by the centre were provided
with a ‘briefing pack’ containing ‘frequently asked questions’, copies of the consultation,
information packs and background information, and were encouraged to circulate through
their own internal and external networks.

The questions were based upon the options – “sell, lease or utilise”, with a further exploration
of the options for utilisation. Respondents were also given the opportunity to justify their
statements through the provision of “free text” boxes.

Finally, in an attempt to reach a balanced and representative sample of the local population,
monitoring information was requested from each respondent (age, sex, ethnicity, disability
status and post code). In order to ensure that a representative sample was achieved for the
local population, it was calculated that a minimum of 385 respondents would be required,
(which would provide a 95% confidence level (+/- 5%) for a population of 300,000).

The questionnaires were made available through a number of routes – primarily through the
PCT website (where background materials such as the business case and consultation
document were also available). Questionnaires were also sent directly to The Cheshire and
Mersey Treatment Centre, where a large number were completed by existing service users /
patients in the time period running up to the closure of the facility. Other copies were sent out
to partnership organisations, with links on appropriate websites, as well as responding to
individual or group requests via the PCTs Patient Experience Team.

3.3 Consultation Presentation Methodology
As well as the online survey, a presentation was developed and offered to all local
stakeholders, either through specially arranged events or through attendance at existing
meetings.
The consultation initially focused upon three public events – one each in Runcorn, Widnes
and St Helens, to which press information, online advertising and general invites were used to
generate interest and attendance.

All of the Area Committees in Halton were offered a presentation as part of the exercise, as
well as an open invitation to the LINks, Shadow Clinical Commissioning Committees and
other partner organisations.

As well as providing a clear rationale on how and why the current contract was coming to an
end, the presentations also provided an opportunity for participants to help shape the future
use of the building. The presentations encouraged local people to discuss the options and all
participants were encouraged to complete a questionnaire so that their views could be further
taken into account as part of the consultation.

3.4 Post-consultation analysis and reporting methodology

These consultation findings are reported by the PCTs Patient Experience Team following an
independent analysis by a partner organisation. The findings contained within this report will
be presented along with the final business case for the use of The Cheshire and Merseyside
Treatment Centre. A more detailed report will be made available on the NHS Halton and St
Helens website www.haltonandsthelenspct.nhs.uk following the completion and approval of
the final options.


4. Summary of findings
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4.1 Summary of Online / Paper based questionnaire activity

In total, 1,113 responses were received to the questionnaire, and of those who answered the
questions, 42% were male and 58% female and 96% stated that their ethnic origin was
“white”. From an age perspective 8% were under 34, 57% were 35 -64 years old, and 35%
stated their age was 65 and over.

Respondents were also asked to state whether or not they considered themselves to have a
disability. 19% stated that they did, with 80% stating that they did not.

                                                                Response          Response
 Answer Options
                                                                 Percent           Count
 I am a local resident, patient or carer                     82.1%                    883
 I am a member of NHS Staff                                  16.9%                    182
 I am responding on behalf of an organisation
                                                              0.9%                    10
 (please specify below)
 For instance, if you are responding on behalf of a group or
 department, please say the name of the group. Please note that our
                                                                                      557
 policy is to publish organisation responses to consultations on our
 website.
                                                   answered question                        1075

Within the responses, a large number of respondents stated that they were responding on
behalf of Interhealth Canada, but also indicated that they were a “local resident, patient or
carer”. It can be assumed that the responses generated in this way are not necessarily those
of Interhealth Canada, but rather reflect those questionnaires that were completed by patients
at the Centre.

The only responses to be specifically generated on behalf of an organisation can be seen
listed below.

Organisation                                                Number of Respondents
St Helens Council                                                     1
Ragheed Group, St Edwards Parish, Runcorn                             1
Halton LINk                                                           1
British Red Cross                                                     1
Halton Council Liberal Democrat Group                                 1


1)     “To what extent do you agree or disagree that The Cheshire and Merseyside
Treatment Centre should be ‘sold’ on the open market (and perhaps outside the
NHS)?”

 To what extent do you agree or disagree that The Cheshire and Merseyside Treatment Centre should be
 ‘sold’ on the open market (and perhaps outside the NHS)?

                                                                 Response
 Answer Options                                                                    Response Count
                                                                  Percent

 Agree strongly                                                    27.7%                   296
 Agree                                                             2.2%                     24
 Neither agree nor disagree                                        3.1%                     33
 Disagree                                                          10.9%                   116
 Disagree strongly                                                 55.4%                   592
 Don’t know                                                        0.7%                     8
                                                           answered question                       1069




                                                  15
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        T o wha t e xte nt d o y o u a g re e o r d is a g re e tha t T he Che s hire a nd
           Me rs e y s id e T re a tme nt Ce ntre s ho uld b e ‘s o ld ’ o n the o p e n
                        ma rk e t (a nd p e rha p s o uts id e the N H S )?




                                                                       Agree strongly
                                                                       Agree
                                                                       Neither agree nor disagree
                                                                       Disagree
                                                                       Disagree strongly
                                                                       Don’t know




The above figures demonstrate a slight discrepancy in local opinion with over 55% of
respondents indicating that they “disagreed strongly” that the Centre should be sold
compared to nearly 28% who “agreed strongly” that it should be sold.

However, closer examination of the free text sections that accompanied many of such
responses can provide some clarity. Many of those who responded positively to this question
also indicated that they wanted the existing provider to remain in position and as such felt it
should be an easy option to sell the Centre directly to them.

 “Again it is essential that centres of excellence such as the centre at the location be sold so
          that the superb care offered and given should continue without hindrance.”

 “So the Treatment Centre can be run exactly as it is today. It is a centre of excellence - why
                              close it? Staff are all fantastic.”

A large number of the respondents who indicated that they disagreed strongly with the sale of
the centre did so because of the quality of service they had personally received.

“I think it is a travesty for a centre like this to be closed. The treatment I received when I had
my knee replacement operation was second to none - aftercare treatment excellent, staff very
   friendly and make you feel at ease. Why do we have to lose this facility? It’s a disgrace!”

“I disagreed with the centre being sold because they have been doing a great job and when it
is shut down who will be able to fit all of the patients in without making the waiting time for an
                                 operation months or years?”




2)    “To what extent do you agree or disagree that The Cheshire and Merseyside
Treatment Centre should be ‘leased’ and used to provide NHS services?”

 To what extent do you agree or disagree that The Cheshire and Merseyside Treatment Centre
 should be ‘leased’ and used to provide NHS services?
                                                                                        Response
 Answer Options                                                                                     Response Count
                                                                                         Percent
 Agree strongly                                                                    65.8%                 689
 Agree                                                                             17.0%                 178
 Neither agree nor disagree                                                         6.1%                  64
 Disagree                                                                           3.4%                  36
 Disagree strongly                                                                  5.7%                  60
 Don’t know                                                                         1.9%                  20
                                                                         answered question                           1047



                                                                  16
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        T o wha t e xte nt d o y o u a g re e o r d is a g re e tha t T he Che s hire a nd
         Me rs e y s id e T re a tme nt Ce ntre s ho uld b e ‘le a s e d ’ a nd us e d to
                                   p ro v id e N H S s e rv ic e s ?




                                                                          Agree strongly
                                                                          Agree
                                                                          Neither agree nor disagree
                                                                          Disagree
                                                                          Disagree strongly
                                                                          Don’t know




Over 82% of respondents indicated that they “agreed” or “agreed strongly” that the Centre
should be leased and used to provide NHS services, but again, many of those who replied
indicated that the centre should be leased directly to the previous user.

 “This facility is clean, modern and provides excellent services and the staff are wonderful. It
                       would be a travesty if it was removed from the NHS.”

 “Whilst a 'NHS dedicated' facility the fact that the Treatment Centre is a stand alone facility
appears to allow it space to operate its systems and services with more of a 'customer' focus
             and a degree of efficiency often not possible in NHS mainstream.”


3)     “To what extent do you agree or disagree that services should not be provided
from The Cheshire and Merseyside Treatment Centre?”

 To what extent do you agree or disagree that services should not be provided
 from The Cheshire and Merseyside Treatment Centre?
                                                                                                   Response   Response
 Answer Options
                                                                                                    Percent    Count
 Agree strongly                                                                            4.5%                  45
 Agree                                                                                     1.6%                  16
 Neither agree nor disagree                                                                3.9%                  39
 Disagree                                                                                 12.1%                 122
 Disagree strongly                                                                        75.5%                 762
 Don’t know                                                                                2.5%                  25
                                                                                  answered question                   1009

       T o wha t e xte nt d o y o u a g re e o r d is a g re e tha t s e rv ic e s s ho uld no t
           b e p ro v id e d fro m T he Che s hire a nd Me rs e y s id e T re a tme nt
                                             Ce ntre ?




                                                                          Agree strongly
                                                                          Agree
                                                                          Neither agree nor disagree
                                                                          Disagree
                                                                          Disagree strongly
                                                                          Don’t know




87% of respondents indicated that the disagreed or disagreed strongly with the stopping of
services from the centre.


                                                                          17
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 “What sense is there in closing this excellent centre? Having had 2 operations here, I have
   nothing but praise for the excellent service I had received. This service from this centre
     should be allowed to continue. There is absolutely no sense in closing this centre!”

“This is a state of the art hospital fully equipped with modern facilities and it would be criminal
not to use these facilities for the full benefit of the community. Either administered by the NHS
                                     or run by an organisation.”

4)             Utilisation options

 To what extent do you agree or disagree that the following NHS services should be available at The Cheshire and
 Merseyside Treatment Centre…
                                                       Neither
                                    Agree                                    Disagree      Don’t     Response
 Answer Options                               Agree   agree nor   Disagree
                                   strongly                                  strongly      know       Count
                                                      disagree
 Orthopaedic Surgery Only i.e.
                                     689       101         63        53         24           4          934
 in-patient surgical services
 A)Orthopaedic Surgery with
 in-patient beds AND B) Health
 Care Resource Centre on 1
 floor i.e. services that you
 might attend at a GP practice       715       134         58        35         29           8          979
 such as blood tests,
 physiotherapy, counselling,
 baby clinics, lifestyle advice
 etc.
 A)Day Surgery i.e. pre-
 planned day cases only AND
 B)Health Care Resource
 Centre on 2 floors AND
 C)Intermediate Care i.e.            582       128         72        50         57           7          896
 inpatient beds for elderly
 patients who have left hospital
 but need extra help before
 returning home
 Health Care Resource Centre
                                     95        29          67       113         338         56          698
 only (no surgery)
                                                                               answered question           1076


Many respondents considered each of the options and rated whether they felt the individual
suggestion of facilities should be considered.

The most popular overall, with 715 individuals stating that they “agreed strongly” with the
utilisation option was for Option D2 – “Orthopaedic Surgery with in-patient beds and Health
Care Resource Centre on 1 floor i.e. services that you might attend at a GP practice such as
blood tests, physiotherapy, counselling, baby clinics, lifestyle advice etc.” When the “agrees”
are also included, this brings the preferred option up to 849 or 79%.
This was closely followed with Option D1: Orthopaedic centre with 689 individuals stating that
they “strongly agreed” with that as the preferred option for the future use of the facility. When
the “agrees” are also included, this brings the preferred option up to 790 or 73%.
With regards to Option D3: “Dedicated day surgery centre, plus Health Care Resource Centre
(primary care / community services)”, 582 stating that they “agreed strongly” with the
utilisation option. When the “agrees” are also included, this brings the preferred option up to
710 or 63%.

Option D4: “Health Care Resource Centre only (primary care / community services) with no /
very little surgery” was not considered to be a popular option with only 682 of the 1091
respondents completing this section, of which 332 (49% of those who responded) stated that
they strongly disagreed with the option. When the “disagrees” are also included, this brings
the response rate up to 443 or 66%.

When asked, via the free text box, to state why they preferred a particular option, a large
number of respondents indicated, again, that they wanted to see the building continue to be
used as an Orthopaedic centre. Many could not understand the justification in closing what
was perceived to be a successful service.



                                                      18
                                                                                                                 CB 11 09 16
“I WOULD LIKE THE CENTRE TO CONTINUE TO PROVIDE HIGH QUALITY CARE WHICH
 IS EVIDENCE BASED AND INVOLVES THE PATIENT IN ALL ASPECTS OF TREATMENT.
     AS A NURSE I WAS VERY IMPRESSED BY THE CENTRE ESPECIALLY ITS 100%
             RECORD OF COMBATING HOSPITAL BASED INFECTIONS.”

 “I AGREE WITH DIFFERENT TREATMENT CENTRES HAVING A SPECIALISED AREA,
 SUCH AS ORTHOPEADICS. THIS WORKS THEORETICALLY - ALLOW OATIENTS TO
GET THE BEST TREATMENT AND CARE. HOWEVER THE HIGH QUALITY IN ALL AREAS
 EXIBITED BY THE CHESHIRE AND MERSEYSIDE TREATMENT CENTRE WOULD BE
           IDEAL FOR PATIENTS NO MATTER WHAT THEIR AILMENT.”

“It makes good sense to provide a one stop shop for all services, some sense just to continue
             with only surgery, but would be costly just for GP surgery service.”

However, worthy of note is that a large number of respondents returned hard copy
questionnaires with the words “D2 Planning” inserted in the free text. In the majority of cases,
this was written in a different pen, or in different hand writing to the rest of the questionnaire.
This does not necessarily affect the overall results of the consultation but does provide a
discussion point to influence the final decision.

5)     “How far would you be would be willing to travel to go the hospital of your
choice?”
 How far would you be prepared to travel to go the hospital of your choice?

                                                                                                         Response      Response
 Answer Options
                                                                                                          Percent       Count
 1 – 5 miles                                                                                               9.2%           98
 5 – 10 miles                                                                                             19.7%          209
 10 – 15 miles                                                                                            14.8%          157
 15 – 20 miles                                                                                            25.1%          266
 More than 20 miles, please specify                                                                       31.2%          331
                                                                                                   answered question           1061

       H o w fa r wo uld y o u b e p re p a re d to tra v e l to g o the ho s p ita l o f y o ur
                                             c ho ic e ?




                                                                          1 – 5 miles

                                                                          5 – 10 miles

                                                                          10 – 15 miles

                                                                          15 – 20 miles

                                                                          More than 20 miles, please
                                                                          specify




Over 31% of respondents indicated that they would be willing to travel over 20 miles, although
this number was enhanced by the number of existing patients from other PCT areas who
were already using the Treatment Centre through the Interhealth Canada contract. Of interest
is the fact that there is a direct correlation between those who listed a Runcorn / Widnes
postcode and stated that they would only be willing to travel 5 miles or less. This reflects the
importance of having “local” services for many of the respondents.

A number of respondents stated that they would be prepared to travel any distance as long as
it was for the service they had been given by the centres previous tenants.

 “TRAVELLED FROM FORMBY BUT WOULD BE PREPARED TO TRAVEL FURTHER TO
                   OBTAIN THIS STANDARD OF CARE.”



                                                                        19
                                                                                   CB 11 09 16
“I travelled 35 miles each way to attend this hospital - by choice as its extremely clean, helpful
                                         and efficient!”


4.2 Summary of presentations / partnership meetings

Three public presentation events were organised – one in Runcorn (within the grounds of
Halton Hospital, one in Kingsway Learning Centre, Widnes and the other in Tontine House, St
Helens.

In total, 28 participants attended (19 to Runcorn, 7 to Widnes and 2 to St Helens)
representing service users, locally elected members, the community and voluntary sector and
members of the general public.

Attendees were shown a brief presentation which reinforced the messages and information
from the consultation document and were given the opportunity to ask questions. Many of the
participants questioned why the centre had to close, and expressed an opinion that they could
not understand why such a decision was made. Particular emphasis was placed on explaining
both the financial and contractual constraints of the existing contract and how the decision to
close was not a local decision, but rather the end of a formal contractual agreement.

In general, participants were supportive of the future utilisation of the building with a strong
emphasis on providing NHS services.

As well as the three public events, a number of presentations to existing groups and meetings
took place. In general, these events were to further promote the consultation activity and to
seek an understanding of whether local people felt that the facility should be utilised in the
future, and if so, for what purposes.

        Date                                          Meeting/Event
      07.06.11                  Halton Borough Council Policy and Performance Board
      08.06.11                        Runcorn: LINK and Public Consultation Event
      09.06.11                    Widnes: LINK Patient and Public Consultation Event
      12.07.11                  St Helens: LINK Patient and Public Consultation Event
      03.06.11                         Castlefields Community Centre Open Event
      11.05.11                            Patient Experience and Safety Council
      11.05.11                                Commissioning Team Meeting
      20.05.11                              Castlefields Digging the Turf Event
      25.05.11                              St Helens Social Inclusion Network
      16.05.11                                       Healthcare for All
      20.07.11                                   Disability Awareness Day
     13-19.06.11                                       Carers Week
      13.07.11                        Beechwood and Halton Lea Local Area Forum
      20.06.11                                  Widnes Local Area Forum
      22.06.11                     Birchfield, Farnworth and Halton View Area Forum
      27.06.11                   Mersey, Heath, Grange and Halton Brook Area Forum
      05.07.11                       Riverside, Appleton and Kingsway Area Forum
      06.07.11                    Halton and St Helens Division Management Meeting
      06.07.11               Castlefields, Norton North, Norton South and Windmill Hill Area
                                                            Forum
      18.07.11                                    Daresbury Area Forum
      21.07.11                                  Halton LINK Board Meeting
4.3 Correspondence

As well as the engagement activity linked to the consultation, the PCT also received
correspondence from service providers, including Interhealth Canada, Warrington and Halton
Hospitals Foundation Trust, Runcorn Clinical Commissioning Group, Bridgewater Community
Health Trust, Halton Housing, Cheshire Primary Care Provider CIC and St Helens and
Knowsley Hospital Trust who expressed an interest in providing services in the future.




                                                20
                                                                                 CB 11 09 16
Correspondents were thanked for their interest but informed that the PCT could not enter into
any discussions regarding providers until the results of the formal consultation were known,
and the results of a Cooperation and Competition Panel investigation were complete.

However, what the interest did reinforce was a desire to see the building utilised for the
delivery of NHS health services for the local community.

Halton Councils Health Policy and Performance Board, following a presentation, wrote to
state that the “Board supported the recommendation that further work be undertaken to
develop the D2 and D3 implementation options.” In addition the board requested that “the
option which is progressed by the PCT would deliver the best patient experience and the long
term needs of the people of Halton”. They also asked that “any services in the treatment
centre should not be at the detriment of the current provider” and stated that “it was an
excellent facility and must be retained for health purposes.”
                                                                        th
In addition, the Halton Council Executive Board Committee, on the 14 July 2011, wrote to
state “in response to the consultation and after taking into account the benefits, costs and
risks of each option and also the needs of the local population, the Councils Executive Board
agreed to support options D2 and D3.”

St Helens Council, in their formal response to the consultation stated “St Helens Council
would support the retention of the CMTC as a health care facility ONLY if it can be
demonstrated that it genuinely optimises the use of existing facilities and resources and
provides appropriate services for the benefit of local residents that cannot be provided
elsewhere within the adjacent hospital site.” They further suggested “future service provision
and the utilisation of existing assets must be linked to current and projected services and
healthcare needs. However, if a robust business case demonstrating that there are
community health care needs which remain unmet and are unable to be met through use of
the existing hospital facilities the CMTC should be considered as a facility as a facility for
future service provision as outlined within option D.

If option D is progressed, St Helens Council would support further consideration of options D2
and D3 as set out within the existing business plan as these seem to offer the greatest
potential benefit in terms of financial viability, manageable risk and mixed service provision.”

Other correspondence received included a letter from Derek Twigg MP, who stated that “I
support an option that fully utilises the building for the benefit of the local community, by
improving access to a range of health provision, including surgery. I therefore support option
D3.”


5. Conclusions

The future utilisation of the building was strongly supported with the most strongly supported
option being D2 – Surgical provision and the provision of a Health Care Resource Centre and
additional services.

A number of providers have already expressed an interest in providing services from the
venue. Whilst any further discussion on the future use of the building is determined by the
decision of the PCT Board and the outcomes of a Co-operation and Competition Panel (CCP)
investigation, and the PCT cannot enter into any further correspondence at this time, such
expressions demonstrate that there is the potential for the future delivery of services.

The two Local Authorities are interested in working with the PCT to develop services and to
be part of the decision making process with regards to the future use of the facility. However
both have expressed the need for reassurance that new developments will not adversely
impact upon other local providers within the health economy.




                                               21
                                                                   CB 11 09 16
Appendix 2       Estimated annual costs of maintaining The CMTC in a
                 state of operational readiness

                                                                  £
OCS Cleaning                                                           49.000
OCS Hard FM                                                           134,000
OCS Security                                                          117,000
Hard FM Subcontractors                                                 59,248
Multihealth Solutions QA Maintenance                                   10,000
Specialist Medical Equipment Maintenance Contracts                     17,142
Lift Maintenance                                                        6,198
Air Conditioning Maintenance                                            4,900

Sub-Total Maintenance Costs                                           397,488

Utilities – Gas                                                        81,175
Utilities – Electricity                                                50,000
Utilities – Water                                                      50,000

Sub-Total Utilities Costs                                             181,175

Depreciation (Post contract 2011-12)                                  424,864
Land Lease                                                             50,000

Sub-Total Other Costs                                                 474,864

Overall Total                                                     1,053,527




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                                                                                                                                            CB 11 09 16



Appendix 3 Afforability implications of each consultation option, April 2011


                                          Option A         Option B         Option C         Option D1      Option D2       Option D3        Option D4
                                           £’000            £’000            £’000             £’000          £’000           £’000            £’000

     With restrictive covenant in force
     2011/12 part year effect
     Net additional costs                            873              580              940           940             942             954             955
                 rd
     Projected 3 party income                          -                -              317           317             226             195             114
     Potential savings                                 -                -                -             -              55              96              96
     Net cost pressure/(surplus)                     873              580              623           623             660             663             746

     2012/13 full year effect
     Net additional costs                            905                -          1,434            1,434          1,442           1,490            1,497
                 rd
     Projected 3 party income                          -                -            419              419            299             258              150
     Potential savings                                 -                -              -                -            219             477              477
     Net cost pressure/(surplus)                     905                -          1,015            1,015            924             755              870

     With no restrictive covenant
     2011/12 part year effect
     Net additional costs                            873              581            940              940            942             954             955
                 rd
     Projected 3 party income                          -                -          1,542            1,542          1,028             848             385
     Potential savings                                 -                -              -                -             55              96              96
     Net cost pressure/(surplus)                     873              581          (602)            (602)          (141)              10             475

     2012/13 full year effect
     Net additional costs                            905                -          1,434            1,434          1,442           1,490            1,497
                 rd
     Projected 3 party income                          -                -          1,884            1,884          1,256           1,036              471
     Potential savings                                 -                -              -                -            219             477              477
     Net cost pressure/(surplus)                     905                -          (450)            (450)            (33)            (23)             549




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