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NHS GRAMPIAN Item 5.3
Linear Accelerators Replacement – Outline Business Case
1. NHS Grampian has developed plans for the improvement of facilities for cancer
services in Aberdeen as part of the network of services and facilities across the
North of Scotland. Interim improvements to clinic facilities have been implemented
and plans have been made for inpatient services for oncology and haematology to
relocate to modern accommodation in the Emergency Care Centre in 2012.
2. NHS Grampian has worked closely with the Scottish Government on these
improvements to ensure that the replacement and development of radiotherapy
equipment, which is funded directly by the Government, is consistent with outline
plans for a future Cancer Centre and the overall development framework for the
3. This paper submits the outline business case for the development of radiotherapy
facilities and the replacement of linear accelerators at Foresterhill to the NHS
Grampian Board for formal approval. Board approval will result in submission to
the Scottish Government for final approval.
4. Over the past 18 months NHS Grampian, in conjunction with the Scottish
Government, has agreed a broad strategy for improvement of facilities for
Haematology and Oncology services currently delivered from the Anchor Unit. The
aim is to provide a Cancer Centre on a staged basis in the coming years and the
facilities proposed in the submitted business case would represent the first stage of
the Cancer Centre.
5. The existing radiotherapy department delivers radiotherapy treatment from three
linear accelerators at the east end of Aberdeen Royal Infirmary (ARI). Decisions on
the number and specification of linear accelerators in Grampian are determined as
part of a Scotland wide radiotherapy equipment programme organised by the
Scottish Government Health Directorate (SGHD). The proposals contained in the
business case are therefore funded entirely from a specific allocation from the
6. The business case sets out details of the option appraisal for the replacement of
the radiotherapy department at ARI. A range of options were considered and a
new build option (option 9) was selected as being best value for money. This
option is consistent with the Foresterhill Development Framework – the
“masterplan” for Foresterhill which will see the development of a Cancer Centre
adjacent to the east end of ARI. Option 9 was subsequently aligned with the
funding available for radiotherapy from the SGHD up to 2012/13 resulting in the
formulation of option 9a.
7. The cost of the preferred way forward of £14.598m includes two new linear
accelerator bunkers and the three replacement linear accelerators. Two of the
replacement linear accelerators will be installed in the new bunkers in 2012 and
2013. The third linear accelerator will be installed in an existing bunker in the
radiotherapy department in 2014 in accordance with the national replacement
programme. The total national programme funding available up to 2013 is
£12.367m therefore NHS Grampian and the SGHD has agreed to defer the
cost/funding decision of the third linear accelerator to ensure that the cost of the
project matches the funding available.
8. The business case indicates that the cost of the third linear accelerator will require
to be funded from the NHS Grampian capital programme in 2013/14. This will be
offset by savings that will accrue from a national procurement exercise currently
being undertaken by the SGHD, further cost reductions anticipated when the
detailed planning of the project is undertaken at full business case stage, and
funding identified in the revised national funding programme which will be issued
early in the new financial year.
9. Subject to approval the programme set out in the business case will result in the
new facilities being operational in May 2012 subject to formal approval in October
2010. The project has been and will continue to be developed under the
Frameworks Scotland partnership arrangements. The Principal Supply Chain
Partner (PSCP), Laing O’Rourke, has worked on the project since May 2009 and
has prepared the outline business case and supporting plans. Subject to the
agreement of final costs for the project as part of the full business case Laing
O’Rourke will support the preparation of the full business case and subsequently
construct the facilities.
10. As with any major capital project there is a risk of cost and time over-runs.
However, as with other Frameworks Scotland projects, a detailed risk register and
risk mitigation plan will be maintained. A risk register has already been prepared
for the outline business case stage and this is supported by a risk contingency of
11. A risk exists in relation to the funding arrangements for the third linear accelerator
replacement required in 2014. However, as indicated above, this will continue to be
discussed with the SGHD with regard to funding from the revised national
programme funding plan.
12. NHS Grampian has developed proposals for the development of radiotherapy
facilities at Foresterhill consistent with the long term plan for a Cancer Centre, the
Foresterhill Development Framework and the national radiotherapy replacement
13. The proposals have a good strategic fit and have been shaped to ensure that the
costs are supported by the levels of funding available through earmarked funding
from the Scottish Government up to 2012/13.
14. The completion of the project will result in the provision of two new linear
accelerators and two replacement linear accelerators with capacity for the third
linear accelerator replacement in 2014.
15. The outline business case as submitted has been approved by the NHS Grampian
Asset Investment Group and is recommended for approval by the Board. Subject
to approval by the Board the business case will be submitted to the SGHD for final
approval. SGHD approval of the outline business case will result in the completion
of the full business case in accordance with the programme set out in the business
Paper submitted by:
Head of Service Development
Director of Public Health and Planning