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Name of Meeting Board Date of Meeting 28 March 2019 Agenda item: 9.2.280319 Development of a Mid and South West Wales Regional Centre of Excellence Cellular Pathology Laboratory, Regional Diagnostic Immunology Laboratory & Regional Medical Microbiology Facility at Morriston Hospital, Swansea Executive lead: Dr Quentin Sandifer, Executive Director of Public Health Services and Medical Director Author: Ms Heather Edwards, Business Planning Manager, Abertawe Bro Morgannwg University Health Board, with amendment where necessary by Dr Quentin Sandifer, Executive Director of Public Health Services and Medical Director Approval/Scrutiny Business Executive Team, 18 March 2019 route: Purpose To seek Board approval on the Strategic Outline Case (SOC) prior to submission to Welsh Government. Nationally NHS Pathology services face a number of challenges. Within the Mid and South West Wales’ region, Hywel Dda University Health Board (HDUHB), Abertawe Bro Morgannwg University Health Board (ABMUHB) and Public Health Wales NHS Trust (PHW) are struggling to manage workforce and sustainability pressures, to maintain quality and safety issues and to meet clinically driven targets. Without investment in sustainable services we cannot deliver essential improvements and fit for purpose laboratories. Investment would allow us to co-locate and develop regionalised services and to support more innovative and sustainable service models which could be future-proofed, and be flexible enough, to respond to changing demand, new technologies and innovations. In 2017 a South West Wales Regional Pathology Reconfiguration Project Board was established to draft a Strategic Outline Business Case (SOC) to address these regional challenges in line with the national direction of travel for regional pathology services. Date: 15 March 2019 Version: 1.0 Page: 1 of 13 The purpose of this SOC is to: a) Confirm the strategic context of the proposal b) Present a case for change c) Outline, with indicative costs only at this stage, a short-list of options indicating a preferred way forward. At OBC stage these will be subject to a detailed economic analysis to include costs, benefits and risks. Recommendation: APPROVE CONSIDER RECOMMEND ADOPT ASSURANCE The Board is asked to: • Note the development of business continuity plans. • Note the short-listed options with estimated capital and revenue costs and identification of the preferred way forward (Option 3). • Approve this SOC and agree it can be submitted to Welsh Government to support this project progressing to Outline Business Case stage. Appendices: SOC attached for information with embedded appendices. Date: 15 March 2019 Version: 1.0 Page: 2 of 13 Link to Public Health Wales Strategic Plan Public Health Wales has an agreed strategic plan, which has identified seven strategic priorities and well-being objectives. This report contributes to the following: Strategic 5 - Protecting the public from infection and Priority/Well-being environmental threats to health Objective Strategic 6 - Supporting the development of a Priority/Well-being sustainable health and care system focused Objective on prevention and early intervention Strategic Choose an item. Priority/Well-being Objective Summary impact analysis Equality and Health An Equality and Health Impact Assessment is Impact Assessment included as Appendices A and B to the SOC. These will be reassessed during the OBC. The investment will provide new technology which will improve diagnostic services e.g. molecular testing, improve quality systems and reporting structures in pathology (including microbiology) services, and provide all patients in community, primary and secondary care requiring microbiological/infectious disease diagnosis with more reliable/ timely and equitable services. Facilities will be designed that are cognisant of the needs of the privacy and dignity of staff and the needs of disabled staff and visitors. Risk and Assurance The establishment of regional specialist microbiology services linked to other pathology services and in the setting of a teaching hospital with close links to higher education will make the service more attractive for recruitment and retention of staff. Health and Care This report supports and/or takes into Standards account the Health and Care Standards for NHS Wales Quality Themes Theme 3 - Effective Care Date: 15 March 2019 Version: 1.0 Page: 3 of 13 Theme 5 - Timely Care Choose an item. Financial implications Yes, as set out in the report. It should be noted that the costs presented refer to the whole project and for all three organisations presenting this report. The estimates will be validated in the OBC stage. People implications A detailed workforce plan is being developed for the OBC stage Date: 15 March 2019 Version: 1.0 Page: 4 of 13 1. Purpose / situation This paper presents a proposal for the development of a regional centre of excellence for pathology services, including microbiology and infectious disease diagnostics, to the population of South West Wales. It has been developed by Public Health Wales NHS Trust (PHW), Abertawe Bro Morgannwg University Health Board (ABMUHB) and Hywel Dda University Health Board (HDUHB), working together as a South West Wales Regional Pathology Re-configuration Project Board. The approval of the Boards of all three organisations on a Strategic Outline Case (SOC) is sought prior to submission to Welsh Government; all three Boards are meeting on the same day. The SOC recommends four options for further more detailed evaluation at the Outline Business Case (OBC) stage. Nationally NHS Pathology services face a number of challenges including: • Workforce and sustainability pressures - ensuring the service has ‘the right staff with the right skills’; • Quality and safety issues (including estate and facility constraints); • Technological innovations (including automation, digital technology and innovative technologies/equipment/diagnostic methods) - this is a significant driver for change and is the catalyst for policy and strategy responses; • Major growth in demand, both demographically (ageing population with more complex investigations; antibiotic resistance and control of infection issues) and in cancer services e.g. Single Cancer Pathway, and; • Changing models of care – moving from traditional models of care towards personalised treatment. Within the Mid and South West Wales’ region, Hywel Dda University Health Board (HDUHB), Abertawe Bro Morgannwg University Health Board (ABMUHB) and Public Health Wales NHS Trust (PHW) are struggling to manage workforce and sustainability pressures, to maintain quality and safety issues and to meet clinically driven targets. Without investment in sustainable services we cannot deliver essential improvements and fit for purpose laboratories. Investment would allow us to co-locate and develop regionalised services and to support more innovative and sustainable service models, which could be future-proofed, and be flexible enough, to respond to changing demand, new technologies and innovations. Date: 15 March 2019 Version: 1.0 Page: 5 of 13 2. Background and Option assessment In 2017 a South West Wales Regional Pathology Reconfiguration Project Board was established to draft a Strategic Outline Business Case (SOC) to address these regional challenges in line with the national direction of travel for regional pathology services. The Project Board agreed the case for change could be supported by developing a Mid and South West Wales Regional Centre of Excellence Cellular Pathology Laboratory, a Regional Diagnostic Immunology Laboratory and a co-located Regional Medical Microbiology Facility at Morriston Hospital, Swansea. The Project Board has identified the key investment objectives of this project as follows: • To develop more sustainable South Wales Regional Cellular Pathology, Regional Diagnostic Immunology Laboratory and Regional Medical Microbiology services • To improve the quality and safety of South Wales Regional Cellular Pathology, Regional Diagnostic Immunology Laboratory and Regional Medical Microbiology services • To improve the efficiency and productivity of South Wales Regional Cellular Pathology, Regional Diagnostic Immunology Laboratory and Regional Medical Microbiology services • To improve the effectiveness of South Wales Regional Cellular Pathology, Regional Diagnostic Immunology Laboratory and Regional Medical Microbiology services • To improve economies within South Wales Regional Cellular Pathology, Regional Diagnostic Immunology Laboratory and Regional Medical Microbiology services To meet these key challenges, satisfy the project’s investment objectives and to support development of a ‘one-site’ Cellular Pathology solution a potential range of options were identified by Project Board (Option 1, the ‘Business As Usual’ option was rejected for further detailed analysis but will be included as a baseline comparator for detailed economic appraisal at OBC stage). These potential options were as follows with Option 3 identified as the Preferred Way Forward at this stage: • Option 2 - ‘Do Minimum’: Development of ‘core’ regionalised services, i.e. development of a Regional Cellular Pathology (Cytology and Histopathology) & Regional Diagnostic (Laboratory) Immunology service; Co-location of Singleton‘s Body Store at Morriston Hospital service (future proofed capacity) & a 500 m² ATTC, i.e. Cell and Gene Therapy indicative shell and core area; • Option 3 Intermediate: Development of 'core’ regionalised services plus relocation of ABMUHB’s
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