Minutes of the Extraordinary Board Meeting of NHS Telford and by dfsiopmhy6

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									Minutes of the Extraordinary Board Meeting of NHS Telford and Wrekin (NHS T&W)
                   held in The Ironbridge Suite, Park Inn, Telford
                    at 4.00 p.m. on Tuesday 22 September 2009


Present :             Mr Brian Taylor – Chair
                      Mr Simon Conolly – Chief Executive
                      Cllr Louise Lomax – Non Executive Director & Vice Chair
                      Mr David Ward – Non Executive Director
                      Mr Andrew Mason – Non Executive Director
                      Ms Brenda Thomas – Non Executive Director
                      Mrs Margaret Blackmore - PEC Board Member
                      Mr Robert Hill – Non Executive Director
                      Dr Andy Inglis – PEC Chair
                      Mrs Claire Old – Director of Commissioning & Service Development
                      Mr Dylan Harrison – Non Executive Director
                      Rev. Pam Bickley – Director of Patient and Community Engagement
                      Mrs Marie Harrison – Non Executive Director

In Attendance:        Mrs Sarabjit Kaur – as Minute Secretary
                      Mr John MacDonald – Programme Director
                      Mr Gregory Pike – Provex SHP
                      Mark Pritchard MP
                      David Wright MP

114.09      Welcome

            Mr Taylor welcomed 158 members of the public to the meeting. Mr Taylor
            explained that this was a meeting of the Board in public, and not a Public
            Meeting. Nevertheless, given the degree of interest in such an important issue,
            it was his intention to give the members of the public present an opportunity to
            ask questions following the presentation of the 2 items listed on the agenda.

            Mr Taylor referred to the transparent process which the PCT had followed in
            respect of the development of the Strategy for Shropshire, Telford and Wrekin.
            He commented that the Board had received regular progress reports relating to
            the strategy in public at its meetings for the past 2 years. The development of
            the strategy had sought to engage patients, public and stakeholders
            throughout. This had included 25 public meetings including road shows and
            workshops. Citizens Panel, clinicians, managers, local authority
            representatives had been involved throughout. The Joint Health Overview
            Scrutiny Committee, the Office of Government and Commerce and the National
            Clinical Advisory Team had all been involved in the process.

115.09      Apologies for Absence


                         NHS Telford and Wrekin – Minutes – 22 September 2009
                                            Page 1 of 13
         Mrs Jo Smith – PEC Nurse Member
         Mr Peter Price – Director of Finance & Performance Management
         Dr Catherine Woodward – Director of Health Improvement

116.09   Members’ Declaration of Interests


            Mr Hill declared membership of the Community Healthcare Provider
             Services Committee and that Mrs Hill is employed by Shropshire County
             PCT in APCS on a one year contract and this is part funded by NHS Telford
             and Wrekin
            Cllr Lomax reported that she was a member of T&W Council
            Mr Harrison reported that he was a member of the Community Healthcare
             Provider Committee
            Mrs Harrison reported she was a member of the Community Healthcare
             Provider Committee

117.09   Local Health Economy Action Plan following the SHA Quality Review Visit
         regarding Urgent Care

         Mrs Old advised that the report had been developed jointly by the Trust and
         PCTs in the local health economy and had been received by the Shropshire
         and Telford Executive Group (STEG). The report was also due to be received
         by the Board of SaTH (24 September) and by Shropshire County PCT Board
         (22 September). Mrs Old provided an outline of the report.

         Clarification was sought relating to the top-slicing of commissioning budgets
         and how outcomes would be measured. Members were informed that this was
         an ‘invest to save’ initiative and GPs were being encouraged to treat patients
         closer to home and avoid admission. Specific pathways relating to treatment of
         deep vein thrombosis (DVT) and pulmonary embolism were being developed
         for GPs to refer patients to the ultrasound service. As part of the CCG urgent
         care model, a LES payment was being developed which would have DVT
         admission avoidance as a component.

         The Care Co-ordination Centre would be involved in recording data and the
         Director of Commissioning Intelligence was also involved in discussions
         regarding data analysis.

         Concern was highlighted in relation to patients being admitted through A&E to
         the Medical Assessment Unit (MAU) and GPs being unable to admit patients
         directly to the MAU. Members were informed that this issue had been
         discussed in detail by the Urgent Care Network which agreed that this was not
         the most appropriate pathway and plans were being developed to redesign the
         MAU pathway at SaTH.

         The Board:
          Received and noted the report from the Strategic Health Authority (SHA)
            regarding a visit to SaTH.
          Received and approved the action plan prepared by the Urgent Care
            Network in response to the SHA report.
                      NHS Telford and Wrekin – Minutes – 22 September 2009
                                         Page 2 of 13
            Agreed that further reports should be requested from the Urgent Care
             Network to detail progress against the action plan and would also be
             reviewed by the PEC. These reports to include data from the walk in centre
             now based at PRH and any effect this may have had on numbers through
             A&E.

118.09   Developing Health and Healthcare: The Shropshire and T&W Strategy for
         Health and Health care: Outcome of the option appraisal (for 2012/13)
         and feasibility study (for 2020)

         Mr John MacDonald (Programme Director) and Mr Gregory Pike (Director of
         SHP/Provex) were invited to attend the meeting for this item.

         The Board received a presentation from Mr Conolly. Members were informed:
          That over the past 18 months the local health economy (NHS Telford and
            Wrekin, Shropshire County PCT, SaTH and RJAH) had asked their most
            senior doctors and senior nurses to advise them on shaping future high
            quality health services for the population of Shropshire and Telford and
            Wrekin. From NHS Telford and Wrekin Rev. Pam Bickley (Director of
            Patient and Community Engagement), Dr Andy Inglis (PEC Chair), Dr
            Catherine Woodward (Director of Health Improvement), Dr Jo Leahy (Acting
            Medical Director) and their counterparts from the 3 other organisations had
            been involved in the process through the Clinical Leaders Forum (CLF).
          The CLF had reviewed evidence, considered the options and made
            recommendations
          The work led by the CLF was based on 2 principles; to make sense
            clinically and to make sense to the communities we serve. One key aspect
            of meeting this second principle was to ensure a high degree of patient
            public and stakeholder engagement over the past 18 months
          The programme of work was divided into 8 phases, and currently the team
            were coming the end of phase 3 (social, governance and feasibility
            assessments carried out over a period of 9 months)
          The CLF had taken into consideration key strategic issues facing the NHS.
            Some of these issues were in tension with each other, but all represented
            key features of context in which the NHS was working e.g. the health of the
            population, access to services, clinical viability and financial viability
          The CLF determined 3 strategic objectives to guide future service
            development:
                - the prevention of disease and the promotion of health lifestyles and
                    independent living
                - services at home or as close to home as possible
                - sustainable and accessible acute hospital services
          The CLF considered that in the longer term (2020) the population of
            Shropshire and Telford and Wrekin would be best served with a single
            hospital bringing together all acute and emergency services in a single
            location. Many clinical specialties rely upon one another to deliver high
            quality care. A single site would give the optimum linkages between clinical
            services. They concluded that a hospital could be based either at RSH,
            PRH or somewhere in the middle.
          At the same time the CLF recognised that there were immediate challenges
            which could not wait until 2020 to be resolved. These related to ensuring
            safe, high quality services in emergency surgery and paediatrics and doing

                       NHS Telford and Wrekin – Minutes – 22 September 2009
                                          Page 3 of 13
   Phase 3 of the project looked at 2020 and 2012/13 in more detail:
    - a feasibility study for the 2020 option had been undertaken
    - a detailed non financial and a financial appraisal had also been
    undertaken for the 2012/13 options
    - an equality and diversity impact assessment had been commissioned
    through an external independent provider
    - the process also included external reviews by the National Clinical
    Advisory Team (NCAT) and the Office of Government and Commerce
    (OGC). NCAT advised that options 3 and 4 (splitting services between 2
    sites) did not make clinical sense and advised that for 2012/13 that it was
    appropriate to move ahead on the basis of options 1 or 2.
    - The OGC Team had made some recommendations to strengthen the
    process of programme and project management, and these had been
    implemented. It was the OGC team’s view that there was advantage in
    consulting on both solutions e.g. 2020 and 2012/13 at the same time.
   Summary of findings for 2020: A broad feasibility study had been
    undertaken of all 3 options (focussing services at PRH, RSH or a new
    hospital). This had concluded that all 3 options were potentially feasible
    from a technical and financial perspective. This process would take 18
    months.
   A non financial option appraisal of the 2012/13 options had shown:
        - options 3 and 4 score very poorly e.g. 40% lower than options 1 and
            2 and one could assume that these were out of the ‘running’
        - there was a difference of 9% between the scoring of options 1 and 2
            (concentrating services at RSH or PRH). Non Financial Option
            Appraisal gave a structured, but not scientific process for considering
            the relative merits of options. They inevitably included a degree of
            subjectivity. On this basis, a difference of 9% did not, in his opinion,
            represent a significant difference.
        - A financial option appraisal led by Provex SHP had identified that
            implementation of Option 1 (concentrating services at RSH) would
            incur a capital cost of £18m and the cost of Option 2 (concentrating
            services at PRH) would be £47m.
   The conclusions from the equality and diversity impact assessment failed to
    differentiate between the 2 options.
   A case had been made that a single consultation, giving the public a clear
    picture of the preferred longer term (2020) solution, together with proposals
    for addressing the challenged services (2012/13), as a ‘stepping stone’
    towards 2020, would be appropriate. But this would only be possible if it
    could be demonstrated that there were clinically robust and affordable
    measures which could be put in place for a period of circa 5 years.
   It was important to note that SaTH were developing a proposal which might
    demonstrate a safe and good quality clinical service. NHS T&W and
    Shropshire County PCT would receive a plan from SaTH and will need to
    consider whether the plans could achieve robust sustainable services. The
    report would be considered at a ‘special’ Board in October 2009. The
    Strategic Health Authority would also seek views from clinical advisers
    regarding these arrangements.

Mr Taylor thanked Mr Conolly and opened the meeting to the public:

              NHS Telford and Wrekin – Minutes – 22 September 2009
                                 Page 4 of 13
Mark Pritchard MP:
 thanked Mr Conolly for the succinct and clear presentation.
 commented that it appeared that unless SaTH were in a position to fund
  safe clinical services, that the PCTs would jointly move to a swift public
  consultation at the end of October/November 2009. The consultation would
  normally take a period of 12/14 weeks with an agreement in early 2010.
 highlighted his concerns relating to paediatric services and emphasised that
  Telford and Wrekin required a fully functioning in-patient paediatric unit to
  meet the needs of the local population. He commented that ‘time costs
  lives’ and the impact that this may have for parents and children having to
  travel to RSH.
 emphasised the potential implications of not having a fully functioning A&E
  service at PRH if option 1 was selected e.g. level 3 A&E service dealing
  with medical emergencies but not major trauma and a level 2 A&E service
  being provided at RSH dealing with medical emergencies and major
  trauma.
 on behalf of the constituents in Telford and Wrekin he highlighted the need
  for a level 2 A&E unit and a fully functioning paediatric in-patient unit

Mr Conolly:
 referred to Mr Pritchard’s comments relating to A&E services and advised
   that the differentiation between level 2 and level 3 related primarily to issues
   regarding emergency surgery. Both the CLF and the national team of
   clinical advisors had highlighted the need to move rapidly towards a
   separate vascular surgery rota and a separate breast surgery rota which
   would significantly deplete the current general surgery rota leaving it
   unsustainable to cover emergency surgery across both sites

David Wright MP:
 commented that the local population were tired of having to respond to the
  challenge to their local hospital services
 sought clarification regarding whether the significant growth in the local
  population over the next 20 years had been factored in to the proposal as it
  was not simply a case of looking after the health needs of the existing
  population.
 asked if service models took into account the population base and
  deprivation in south Telford
 highlighted the impact of a fully functioning paediatric service being moved
  to RSH and the implications on young mothers having to travel to RSH to
  see their children
 commented that the report referred to bringing care closer to home but the
  options did not reflect this.
 favoured a single consultation and highlighted concerns that if services
  were moved to RSH they would not be brought back to PRH
 reported that a fully functioning paediatric unit and A&E service should be
  retained at PRH.

Mr Pike referred to Mr Wright’s comments relating to population growth and
reported that long term population growth would be considered as part of the
2020 option appraisal which had yet to be undertaken. He confirmed that the
criteria to appraise the options took into account access, travel and

              NHS Telford and Wrekin – Minutes – 22 September 2009
                                 Page 5 of 13
demography issues.
Mr Taylor referred to the previous Strategic Service Plan which had reviewed
paediatric services at PRH. At the end of that consultation exercise NHS T&W
had funded paediatric inpatient services at an additional cost of £200,000 per
annum. However there were now additional pressures including the European
Working Time Directive (EWTD) and it was important that action was taken in
the short term to ensure the provision of safe, sustainable and affordable
clinical services.

Cllr. Andrew Eade:
 reported that the public attendance at the meeting demonstrated the level of
    concern in the local community
 commented that it was his view that the 2020 single site option would never
    happen and once a decision had been taken to move services to RSH they
    would not return to PRH
 referred to option 1 in the report and the comment relating to option 1 being
    preferred by most groups except GPs, other clinical staff and residents from
    T&W. It was clear therefore that clinicians preferred the PRH option.
 did not agree with the comment in the report relating to the £47m cost of
    implementing the 2012/13 option at PRH and advised that further evidence
    was required to demonstrate this.
 reported that the PCT had declared an under-spend over the last few years
    and suggested that it may be possible for the PCT to make the required
    investment to retain a fully functioning A&E and paediatric unit.
 Advised that he was happy to be involved in discussions to identify a way to
    fund these services.

Mr Conolly advised that the PCT would need to consider the proposals from
SaTH in relation to immediate action to see whether the proposals were
clinically safe, viable, and deliverable before it could take any decision relating
to investment.

Mr Pike referred to Cllr Eade’s comment relating to the £47m costs for
transferring services to PRH and commented that the team had used a
Department of Health methodology to calculate the costs relating to capital
schemes. The document relating to the calculation was available for scrutiny.
Members were informed that it was not a case of moving ‘like for like’ services
from one site to another as different clinical services had close links with others
e.g. maternity, neonates etc Also there were underlying costs relating to
services which were provided only on one site e.g. obstetrics. There was also
an issue relating to the numbers of paediatric and surgical inpatient beds and
at RSH and PRH. Mr Pike assured members that the team had carefully
thought through the solutions.

Mr Chris Hinton, Consultant Breast Surgeon:
 reported that SaTH employed 3 breast surgeons accredited in general
   surgery and 5 vascular surgeons. It was his view that there was enough
   capacity in place to cover an emergency surgical rota and no need to recruit
   further surgeons.

Members commented that advice had been sought from SaTH in relation to
covering the immediate challenges in A&E and paediatrics and a response was

              NHS Telford and Wrekin – Minutes – 22 September 2009
                                 Page 6 of 13
awaited.

Cllr Keith Austin:
 reported that currently T&W had a population of nearly 170,000 which was
    due to increase to 200,000 by 2026. This was a significant increase and it
    was his view that health services were not working towards meeting the
    needs of the local population.
 commented that he thought that the proposals in the report were focussing
    more on ‘bricks and mortar’ and not the patient.
 highlighted his concerns relating to access issues for families if paediatric
    inpatient services were moved to RSH.
 suggested some of the weighting and methodology in the non-financial
    appraisal of 2012/13 options was flawed and it needed reviewing. He
    asked how many of the clinicians involved in the process lived in
    Shrewsbury.

Mr Taylor advised that the report did take into account population size and also
catchment area information. The two hospitals served a broadly similarly
catchment population and it was the PCT’s objective to ensure that the local
population received a good quality clinical service that met its needs.

Mr David Sandbach:
 reported that he supported Mr Hinton’s comments. He also supported the
   single site option. It was an option which he himself had suggested when
   he was Chief Executive at PRH.
 It was his view that the PRH could accommodate the additional services
   and doubted the £47m costs detailed in the report.
 He advised that he was working on his own alternative proposal.

Cllr Jacqui Seymour:
 referred to the £47m costs to move services to PRH and commented that
    the PRH was a modern hospital designed with a flexible layout to allow
    further development. It was her personal experience that a large amount of
    space was occupied by non clinical use and she suggested that utilising this
    space for clinical services would significantly reduce the costs identified in
    the report.

Cllr Sean Kelly:
 sought clarification relating to whether SaTH had taken a decision to
    withdraw services from one site if it felt the service was unsafe, thus
    removing the need for any consultation. Mr Conolly advised that in an
    emergency if any organisation was unable to deliver a safe service, then it
    had no option but to put in safety measures to deliver a safe service. It had
    a responsibility to implement safe services. In such exceptional
    circumstances he would still expect the Trust to engage with the Overview
    and Scrutiny Committee.

David Evans (LINKS and T&W Senior Citizens Forum):
 advised that he had been involved in the fight for Telford to have its own
  hospital and since that time fighting to retain services at PRH. He reported
  that planning permission had been given to build 7,000 new homes in
  Telford and the need to ensure that the population had access to health

              NHS Telford and Wrekin – Minutes – 22 September 2009
                                 Page 7 of 13
Mr Taylor advised that the PCT was taking into account population growth and
had already invested millions of pounds in the development of general
practices. The practices would be in a position to provide more care closer to
home and reduce the need for patients to be treated in hospital.

A member of the public:
 asked why SaTH were not replacing nurses when they retire from the
   paediatric service at PRH. Also why the paediatric OPD service was
   relocating within PRH.

Mrs Old advised that the movement of the paediatrics OPD was about making
the best use of the total space available at PRH, and accommodating an
additional 30 medical beds. She added that the PCT was not aware of the
issue regarding recruitment to the posts of retiring staff, and would discuss this
with management at SaTH.

A member of the public
 expressed concern in relation to whether a single A&E unit providing a full
   service could cope with the additional number of patients from a different
   site.
Mr Taylor commented that he agreed with Mr Evans sentiments and assured
him that the Board would ensure that the local population had access to high
quality, sustainable and affordable services. He added that the Board could
not determine the outcome until a full appraisal had been undertaken for the
long term option and until a report had been received from SaTH in relation to
addressing the immediate challenges.

Mr John Barber:
 commented that during the consultation period for the development of
   Lawley and the Millennium Village in Ketley, residents had received
   assurance that health needs of the local population would be met and the
   hospital ‘will grow’ to accommodate the increase in population. They
   sought clarification regarding who would take responsibility in the event of a
   patient passing away due to access issues whilst travelling to RSH if
   services were downgraded at the PRH.
A member of the pubic:
 sought clarification relating to whether a cost benefit analysis could be
   undertaken as he perceived that a scoring process could potentially be
   flawed, particularly as there was only a difference of 9% between options
   one and two. Mr MacDonald explained that there were 3 different elements
   involved in the appraisal process for 2012/13 and this included a non-
   financial appraisal, a financial appraisal, and an equality and diversity
   assessment. The pros and cons were extremely finally balanced and
   although he shared some of the cynicism expressed by the public in relation
   to the degree of objectivity in the scoring element of the non-financial
   appraisal, the organisations were required to follow this process in the NHS.
   It was the conclusion of the Programme Board that there was little to divide
   the two options on non-financial grounds.



              NHS Telford and Wrekin – Minutes – 22 September 2009
                                 Page 8 of 13
Mr George Dixon:
 Gave a personal testimony to the excellent services provided at PRH.

Mr Taylor closed the discussion with members of the public and thanked the
public for attending the meeting and for their diligence and courtesy.

Mr Taylor invited members of the Board to comment on the report and
recommendations:

Dr Inglis:
 advised that he agreed with many of the comments made by members of
    the public.
 referred to recommendation 7 and suggested that the word ‘preferred’ be
    removed from the paragraph as a preferred option had yet to be identified.
 referred to recommendation 8 and commented that reference to
    ‘implementation’ in the paragraph should be removed or the wording
    amended as he believed that plans for the ‘children’s hospital at home’ and
    the development of the paediatric assessment services at RSH and PRH
    could be drawn up but should not be implemented until the plans are
    considered and approved by the Board.
 referred to recommendation 12 and suggested that it required further
    clarification.
 reported that he had advised the CLF that there needed to be a single
    consultation on the 2012/13 and 2020 options as they were inseparable
    from a clinical point of view.

Mr MacDonald:
 agreed to amend recommendation 7 to take into account options 1 and 2.
 agreed to reword recommendation 8
 agreed to look at a form of words for recommendations 12.1 and 12.2 which
   would make it clear that there were two separate issues e.g. 2012/13 and
   2020 requiring consultation, and the paragraph would make clear links
   between the two. The changes would then be discussed with Mr Conolly
   and Mrs Chambers (CEO Shropshire County PCT).
 He referred to the surgical rota and the vascular rota.It was clear that
   vascular surgery outcomes in England were low compared to other
   countries. He pointed out that if SaTH were in a position to appoint an
   additional 5-8 surgeons to cover the emergency rota, they may not have
   work for them during the day. Therefore SaTH may need to look at a
   different way of organising the rota. It was important that SaTH provided a
   robust plan as otherwise the PCTs would need to look at a consultation
   exercise for the 2012/13 option in 2009 to ensure safe services prior to the
   2020 option appraisal.

Mr Harrison reported that it was imperative to have a single consultation and
supported comments relating to expanding the information in recommendation
in 12.1 to reflect the risks of sustainability and robustness to the current service
during that period.

Members were informed that the main risks related to emergency surgery and



              NHS Telford and Wrekin – Minutes – 22 September 2009
                                 Page 9 of 13
paediatrics. It was unclear whether creating a separate vascular surgery rota
covered by 5 surgeons could be achieved whilst maintaining an emergency
admission service for general surgery on both sites. If 5 further surgeons were
proposed there was an issue relating to whether they would have enough work
during the day. In relation to paediatrics there was a question regarding
whether the current two units could continue to maintain safe and robust
assessment and inpatient services particularly within the context of the
European Working Time Directive. Issues relating to recruiting middle grade
staff were also being looked at.

Members were informed that if the 3 organisations across the local health
economy failed to agree a way forward the SHA would consider putting in place
a process to ensure the safety of services.

Mr Ward sought clarification as to whether additional capacity could be brought
in to condense the length of time taken to undertaken the 2020 option appraisal
process to reduce the length of time before a single consultation. Mr
MacDonald replied that this could be considered.

Members emphasised the need to ensure that the over arching principles of
making sense clinically and making sense to the communities we serve was
clear in any documentation available to the public.

Mr Donohue commented that it was important to recognise that clinicians had
preferred option 2 rather than option 1 in the non-financial scoring process, and
he asked why option 1 had been identified as the preferred option. Reference
to clinical preference and evidence to demonstrate the capital costs had not
been included in the recommendation. Therefore it was difficult to accept
recommendations 2 and 6 as it was his view that the scoring process was
flawed and the financial difference between options 1 and 2 was debatable. He
also reported that the equality and diversity impact assessment referred to an
analysis but no supporting evidence had been provided.

Mr Donohue referred to recommendation 11 and 12.2 and suggested that a
decision should be deferred to a later date when further information from SaTH
was available.

In response to Mr Donohue’s comment relating to options 2 and 6, Mr Conolly
advised that option 1 had the lowest capital cost and shortest construction
period based on information commissioned through an external, independent
and reputable provider.

Members referred to the comments made by Mr Hinton in relation to his view
that the current surgical rota provided safe emergency cover. Clarification was
sought in relation to whether the report from SaTH would include information
relating to providing safer emergency cover. Mr MacDonald advised that there
was clear evidence that moving to a vascular rota would mean a safer and
improved service.

Members highlighted the importance of close public engagement and the need
to communicate and demonstrate the reasons why clinicians supported a
single acute hospital.


              NHS Telford and Wrekin – Minutes – 22 September 2009
                                 Page 10 of 13
Recommendations:

Recommendation 1: To RECEIVE the reports from the Programme Board
including 2020 Technical and Financial Feasibility Study, 2012/13 Option
Appraisal and Equality Impact Assessment.

Approved by the Board unanimously

Recommendation 2: To NOTE that the 2012/13 Option 1 scored more highly
than the other options on non-financial implications, had the lowest capital cost
and the shortest construction period.

Approved by the Board unanimously

Recommendation 3: To NOTE that all three options for the 2020 single site
have the potential to be technically and financially feasible.

Approved by the Board unanimously

Recommendation 4: Plans for implementing immediate measures to mitigate
risk to providing sustainable and safe services should be presented to the
Board at a special Board meeting before the end of October. The plans should
be presented together with an external assessment of the plans detailing
clinical quality, deliverability and sustainability over a five year period,
affordability and monitoring and contingency arrangements.

Approved by the Board unanimously

Recommendation 5: To AGREE not to consider further 2012/13 Options 3 and
4.

Approved by the Board unanimously

Recommendation 6: To NOTE that on the basis of the 2012/13 Option
Appraisal, Option 1 ranks the highest on both a financial and non-financial
basis.

Approved by the Board unanimously

Recommendation 7: To AGREE that capital costs of the preferred 2012/13
option should be reviewed to ensure that it provides facilities which are fit for
purpose at the lowest possible cost.

The Board asked that this recommendation be amended to read:

‘To AGREE that the capital costs of 2012/13 options 1 and 2 should be
reviewed to ensure that they provide facilities which are fit for purpose at the
lowest possible cost’.

The Board unanimously approved the amended recommendation




              NHS Telford and Wrekin – Minutes – 22 September 2009
                                 Page 11 of 13
Recommendation 8: To AGREE that detailed plans for children’s hospital at
home and the development of the paediatric assessment services at RSH and
PRH should be drawn up and implemented.

The Board asked that this recommendation be amended to read:

‘To AGREE that detailed plans for children’s hospital at home and the
development of the paediatric assessment services at RSH and PRH should be
drawn up by SaTH and the PCTs and commissioned’.

The Board unanimously approved the amended recommendation

Recommendation 9: To AGREE that a full option appraisal should be carried
out on all three options for a single site within the context of the wider health
and healthcare strategy across Shropshire, Telford and Wrekin.

Approved by the Board unanimously

Recommendation 10: To AGREE further, detailed discussions on care closer to
home with primary care, social care, the voluntary and independent sectors
and other key partners to develop and agree detailed planning assumptions to
inform the further assessment of the options for a single site.

Approved by the Board unanimously

Recommendation 11: To AGREE that 2012/13 Option 1 is compatible with all
three 2020 single site options (2020 options 2, 3 and 4). Option 2 is compatible
with 2020 single site option 3 (PRH).

Approved by the Board unanimously

Recommendation 12: To APPROVE consultation on the following basis:
12.1 If the immediate measures proposed to mitigate risks and sustain
     services are judged to be robust and are affordable (Recommendation
     4) then proposals for 2012/13 and a single site should be consulted
     upon in 2011.

12.2   If the immediate measures proposed to mitigate risks and sustain
       services are judged not to be robust or affordable (Recommendation 4)
       then 2012/13 Option 1 should be consulted on in late 2009 together with
       the principle of a single site. Specific proposals for a single site should
       be consulted upon in 2011.

The Board asked that this recommendation be amended to read:

12.1   If the immediate measures proposed to mitigate risks and sustain
       services are judged to be robust and are affordable (Recommendation
       4) then proposals for both 2012/13, delayed until 2014/15, and a single
       site should be consulted upon in 2011.




              NHS Telford and Wrekin – Minutes – 22 September 2009
                                 Page 12 of 13
         12.2   If the immediate measures proposed to mitigate risks and sustain
                services are judged not to be robust or affordable (Recommendation 4)
                then 2012/13 Option 1 and 2 should be consulted on in late 2009
                together with the principle of a single site. Specific proposals for a
                single site should be consulted upon in 2011.

         The Board unanimously approved the following amended
         recommendations:

119.09   Date of Next Meeting – 2.00 p.m. Tuesday 13 October 2009 in the Quaker
         Room, Meeting Point House, Telford Town Centre




                      NHS Telford and Wrekin – Minutes – 22 September 2009
                                         Page 13 of 13

								
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