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East of England Specialist Commissioning Group PROCUREMENT OF HAEMODIALYSIS SERVICES PROJECT INITIATION DOCUMENT AND PROJECT PLAN

19th May 2008


Table of Contents 1

2.

3

4

Project Definition

Page 1

1.1 1.2 1.3

Page 1 Page 1 Page 1

Background Project Objectives Benefits Expected

Project Scope

Page 3

2.1 2.2 2.3 2.4

Page 3 Page 3 Page 3 Page 3

Exclusions Assumptions Constraints Security

Project Approach

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3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9

Page 5 Page 5 Page 5 Page 6 Page 6 Page 6 Page 6 Page 6 Page 7

Project Approach Stakeholders Project Board Structure Communications Governance and Responsibilities Timescales Costs & Resources Risks Contingencies

Project Plan

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4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9

Page 8 Page 8 Page 9 Page 10 Page 10 Page 12 Page 13 Page 14

4.10 4.11 4.12

Workstreams Consultation and Stakeholder Engagement Interim Solutions Service Specification Procurement and Tendering Patient Transport Workforce Estates and Facilities Cleanliness and the Control of Health care Associated Infections Development of Choice and Planning to Support Services for Home Dialysis Ensuring a Patient Centred Service Transplantation

Appendix A

Project Plan Gantt Chart

Appendix B

Work Stream Structure

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“EoESCG-RenalPID-Appx A� Page 19


1.

Project Definition

1.1.

Background

1.1.1.

The East of England Specialised Commissioning Group (EoESCG) has produced a needs assessment "Future Dialysis Requirements within the East of England" (January 2008) and a subsequent strategy and capacity plan “Renal Strategy for the East of England� (the strategy) to address the need for additional renal replacement therapy capacity and its location.

1.1.2.

Pending agreement of the strategy (anticipated to be at the EoESCG meeting in June) the Group requires a Project Initiation Document (PID) and Project Plan to detail the delivery mechanism for this programme.

1.2.

Project Objectives

1.2.1.

The successful procurement of sufficient renal replacement therapy services for patients in the East of England within the agreed timescale and to a standard that meets those detailed in key national 4policy documents

1.3.

Benefits Expected

1.3.1.

The number of people requiring renal replacement therapy is projected to rise by 5% and those receiving haemodialysis by 6-8% per annum until 2020.

1.3.2.

This project will ensure that adequate capacity is identified and procured to meet the anticipated increase in demand for dialysis whilst also taking account of other modalities. Plans will be drawn up by the EoESCG and procured in conjunction with PCTs, overseen by the EoESCG to ensure both local and national needs are met.

1.3.3.

Successful roll out of the EoESCG Strategy through this project will address the current disparities between the provision of RRT and haemodialysis stations across PCTs. Access to services will be improved through a reduction of travel times. The overall programme will also see greater opportunities for patients to choose from the different available modalities.

1.3.4.

The project details arrangements for wide-reaching stakeholder engagement and consultation on proposed changes. The procurement work stream will maximise potential for value for money and provide the project board and EoESCG with tools to ensure the

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procurement meets Office of Government Commerce (OGC) requirements of non-discrimination, equal treatment, transparency, proportionality and mutual recognition.

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2.

Project scope

2.1.

Exclusions

2.1.1.

The following workstreams are derived from parts 1 and 2 of the National Service Framework. Whilst they are important for the successful implementation of an East of England Renal Strategy, they fall out of the scope of the required procurement plan and are therefore not included in this Project Initiation Document (PID) and plan. • • • • • •

Preparation and Choice Elective Dialysis Access Surgery Prevention and early detection of chronic kidney disease Minimising the progression and consequences of chronic kidney disease Acute renal failure End of life care

2.2.

Assumptions

2.2.1.

This project plan assumes the following: •

That both the needs analysis and subsequent renal strategy have been successfully signed off and that funds are available to meet the identified requirement. That there is effective co-operation between key stakeholder (e.g. providers, patients, commissioners)

2.2.2.

This PID and Project plan are based on national policy as at April 2008. Any significant changes to either clinical or procurement guidance may impact the schedule and, potentially, outcomes.

2.3.

Constraints

2.3.1.

The project is bound by national policy on procurement and tendering and by minimum service standards (e.g. those detailed in the NSF part 1 and 2). Where standards are aspirational or interim milestones have not been specified, every effort has been made to comply.

2.4.

Security

2.4.1.

The PID and project plan are not considered high risk however several elements will need to be treated in strict confidence. This is particularly true of elements detailed in section 21 concerning

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timescales and specifications for the required procurement and tendering process.

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3.

Project Approach

3.1.

Project Approach

3.1.1.

The project places the central requirement of a detailed procurement strategy within a wider context of the renal strategy roll out. As such this document details the deliverables and timescales for procurement and related workstreams and identifying milestones that will impact the critical path.

3.1.2.

The Project Board will oversee progress and ensure plans are meeting national and SHA requirements whilst running parallel workstreams.

3.2.

Stakeholders

Stakeholder EoE SHA EoE PCTs Providers Local RRT user groups Renal Strategy Group Potential new providers Ambulance Trust

Contact Details

Comments

3.3.

Project board structure

3.3.1.

The suggested membership of the Project Board is as follows: • • • • • • • •

PCT CEO Chair Trevor Myers Carolyn Young, Senior AD EoE SCG Catherine Turner, Project Manager Deborah Knight 2 Senior Renal Strategy Group representatives – Clinical A Senior Renal Strategy Group representative – non-clinical 2 Patient / User representatives

A representative from Commercial Directorate will be invited to attend as appropriate

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3.4.

Communications

3.4.1.

Key meeting dates are as yet undecided. They will be added as they become available.

3.5.

Governance and Responsibilities

3.5.1.

EoESCG is the Sponsoring Organisation for this project and is empowered to make the final decision on negotiated issues

3.5.2.

Trevor Myers is the Project Owner and key representative of EoESCG.

3.5.3.

The East of England Renal Strategy Group will act as a reference group for this project and will be represented on the project board.

3.5.4.

The project will be managed by Catherine Turner who will report progress against milestones and deliverables to the project board.

3.5.5.

Work stream leads will report progress to the Project Manager and will be invited to attend board meetings as required

3.6.

Timescales

3.6.1.

The project will commence formally after EoESCG sign-off of this project plan and the strategy, expected 27th June 2008. Further timescales for completion will be added to the plan after the first meeting of the project Board

3.7.

Costs & Resources

3.7.1.

Further details will be included as they become available.

3.8.

Risks

3.8.1.

The table below outlines high level risks. It will be expanded as the project progresses and more are identified

Risk Needs analysis Renal strategy not signed off Capacity Scenarios vary significantly from plan Significant national policy change Significant technology change impacting patient choices

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Probability Low Med Low / Med Low

Impact High Med Med / High Med / High

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3.9.

Contingencies

3.9.1.

The table below outlines contingencies associated with the risks identified. It will be expanded that the project progresses.

Risk Needs analysis or renal strategy not signed off Capacity Scenarios vary significantly from plan Significant national policy change Significant technology change impacting patient choices

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Contingency Review to achieve agreement. Ensure contracts awarded have sufficient flexibility Ensure contracts awarded have sufficient flexibility Ensure contracts awarded have sufficient flexibility

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4.

Project Plan

4.1.

Workstreams

4.1.1.

The project is made up of the following work streams:: • • • • • • • • • • •

Consultation and Stakeholder Engagement Interim Solutions Procurement and Tendering Service Specification Patient Transport Workforce Estates and Facilities Choice and Planning to provide Support Centre(s) and Services for Home Dialysis Cleanliness and Healthcare Associated Infections Ensuring a patient centred service Transplantation

4.2.

Consultation and Stakeholder Engagement

4.2.1.

Purpose: To consult with stakeholders, allowing their views on the planned changes to haemodialysis services within the East of England to be heard, with particular emphasis on ensuring services best meet the needs of patients and carers. To show clearly that this has taken place and how the results have been used. Responsible Person: TBC Responsible To: TBC

4.2.2.

We are advised that a statutory formal consultation is not required; however it is good practice to seek the view of stakeholders when embarking on a significant procurement programme such as this. •

EoE to produce guidance for consultation o Expected outcomes o Target audience and access (e.g. display stands in existing dialysis units, distribution of plans though local user groups) o Sample size o Suggested questions

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Compile the results of local consultation and produce a report for input into procurement process Page 8 of 19


Review results of local consultation against the planned procurement. o Take appropriate action to amend procurement plan if required

Decide how the results of consultation should be disseminated

4.3.

Interim Solutions

4.3.1.

Purpose: To provide solutions consistent with the strategy for those outstanding issues that impact on the successful roll out of the procurement plan and renal strategy. Also to ensure existing facilities are prepared to meet these requirements, and to plan appropriate changes if not. Responsible Person: Catherine Turner Responsible To: TBC Provision of interim solutions •

Identify relevant outstanding issues o Gathered from existing documented issues and conversations with local operational leads

Prioritise specific issues o Prioritisation process based on an impact / resources required grid

Review of existing services •

Link with other work streams to collate information regarding preparedness of existing facilities and services to meet the requirements of the strategic plan

Report where improvements are needed o Specify where changes urgently needed to meet new procurement plan or to bring existing facilities in line with HBN 53 as per strategy

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Develop plan (in partnership with existing service providers) to implement necessary managed changes.

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4.4.

Service Specification

4.4.1.

Purpose: To develop a service specification for all Haemodialysis services across EoE through liaison with other work streams and localities in preparation for procurement and tendering. Also to ensure the planned services meet the standards designated. Responsible Person: Responsible To: •

Identify key contacts across work streams and localities, establish communication process

Sign off strategy and agree which scenario will form the basis for planning1

Share proposed scenario and consult with local stakeholders(ensuring close collaboration with the Consultation and Stakeholder Engagement work stream)

Review total requirements, map the proposed changes

Produce service specification for all changed or enlarged services, pass to Procurement and Tendering Work stream

Review individual documentation to ensure compliance where they differ from standard.

Review bid documents when received to ensure they: o meet the minimum standards as stated above

o Can demonstrate best value for money 4.5.

Procurement and Tendering

4.5.1.

Purpose: To procure sufficient and appropriate haemodialysis services for patients for the period up to 2015 in the East of England, clearly demonstrating best value for money and compliance with all related procurement, tendering and contractual legislation. Responsible Person: Carolyn Young Responsible To: TBC

4.5.2.

1

The project team will develop and implement a plan that delivers high quality clinically appropriate forms of dialysis, designed around

EoESCG Strategy and Capacity Plan for the Expansion of Haemodialysis Services Section 7

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individual needs. The successful bidder(s) will be able to dovetail with other providers to achieve the following: •

• • • 4.5.3.

All dialysis methods available interchangeably for patients, including home haemodialysis and automated peritoneal dialysis. Patients receive an adequate and effective dialysis dose. Patients have their nutritional status monitored and appropriate nutritional support in place. Efficient patient transport services available.

Renal replacement therapy is a clinical service and as such will be classified as Part B of the OJEU tender process. This means that it is not obligatory to carry out a full tender process however EoESCG must still be able to show that procurement is transparent, robust and proportional. The actions under this work stream must therefore demonstrate: • •

fair competition, ensuring no potential supplier is disadvantaged by the process or requirements of the tender that the decision to award any contract is based on clear evaluation criteria that are linked to specification documents – which will contain all technical and professional requirements Proposed timetable for response and actions are reasonable

4.5.4.

The opportunity to bid must be appropriately advertised, and an award notice placed in the OJEU.

4.5.5.

In certain circumstances a non competitive tender may be appropriate, these include an increase in the number of stations at an existing site or where the incumbent can be clearly demonstrated as the only appropriate provider (NB – this is more likely to be the case with provision of transplant services than haemodialysis due to the differing legal environments)

4.5.6.

Any decisions taken as part of the work stream should consider that potential bidders may legally challenge the placement of a contract if they feel they have been prejudiced.

4.5.7.

Contracts will be awarded over a seven year period but must include strong provision for flexibility of service to account for the potential impact of policy (e.g. presumed consent legislation), increasing patient choice or technological advances.

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4.5.8.

The following deliverables and milestones make up this work stream: •

Develop and document procurement process decision tool

Develop a contract mapping / decision process (based on the documented decision tool) o Which solutions need to be tendered o How far down the process to go o Get legal advice

Establish process and timetable for full procurement

Develop tender documentation or contract amendments

The process will vary for each separate bid, however it could include: o Advertisement in appropriate journal o Pre Qualification Questionnaire o Select suppliers o Invitation to submit preliminary offers o Evaluation of preliminary offers o Shortlist o Invitation to submit best and final offers o Evaluation and award o Post-award notification in OJEU

4.6.

Patient Transport

4.6.1.

Purpose: To procure sufficient services to meet the growing numbers and changing patterns of movement of patients receiving haemodialysis up to 2015. To ensure these services meet EoE contracted requirements and can demonstrate efficiency, value for money and high standards of patient care. Responsible Person: Responsible to: •

Liaise with Interim Solution work stream to gain understanding of how existing Patient Transport Services (PTS) relate to planned changes. o Is current service provision satisfactory?

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Discuss planned changes with current providers to identify whether they are willing and able to adapt services in line with the Haemodialysis procurement.

Decide whether to tender ongoing provision of PTS services o If yes draw up formal procurement documentation and timescale o If no draw up documentation to support a change in existing contracts or SLAs.

Develop standard text for input into procurement document o Review of individual documentation to ensure compliance where they differ from standard.

Review bid documents when received to ensure they: o meet the minimum standards as stated above o Can demonstrate best value for money

4.7.

Workforce

4.7.1.

Purpose: To ensure that any future providers of haemodialysis can clearly demonstrate workforce arrangement that have sufficient numbers of appropriately qualified, engaged staff and clinicians able to show excellence in patient and carer support. Also to ensure providers continue to provide staff with ongoing training and development opportunities and engaging them as key stakeholders in the care of patients and carers. Responsible Person: Responsible To: o Clinical requirements o Patient / staff ratio o Staff training and development o Ongoing patient feedback

Review existing facilities to assess whether: o staffing levels, training and support mechanisms are adequate o they will be able to sustain expansion o they can support links with a satellite unit as appropriate.

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Develop standard text for input into procurement document o Review of individual procurement documentation to ensure compliance where they differ from standard.

Review bid documents when received to ensure they: o meet the minimum standards as stated above o Can demonstrate best value for money

4.8.

Estates and Facilities

4.8.1.

Purpose – to determine the final location of facilities and to ensure that all proposed new facilities meet the minimum standards required within national guidance and specifically meets HBN 53. Also to prepare a plan to ensure all facilities reach this standard. Responsible Person: Responsible To: •

Liaise with Interim Solutions work stream to gain an understanding of whether of existing facilities: o Are they currently fit for purpose o Do they meet HBN 53 requirements o Can they be made to meet them o Is there room for expansion of existing units o Can efficiencies be made

Develop standard text for input into procurement document o Review of individual documentation to ensure compliance where they differ from standard.

Review bid documents when received to ensure they: o meet the minimum standards as stated above o Can demonstrate best value for money o they will be able to achieve required outcomes within the planned structure and forecast expenditure

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4.9.

Cleanliness and the Control of Health Care Associated Infections

4.9.1.

Purpose – to ensure that all existing and planned services achieve the standards required in cleanliness and the control healthcare associated infections (HCAI). Responsible Person: Responsible To: •

Prepare input to PCT procurement planning template to cover points pertinent to Cleanliness and HCAI. o Providers to demonstrate compliance with “Safer Practice in Renal Medicine”2 and other subsequent guidance and policy regarding HCAI

Review existing facilities to assess whether: o Standards, training and staffing levels are adequate o The facilities themselves are adequate to support required standards o they will be able to sustain expansion

Develop standard text for input into procurement document o Review of individual documentation to ensure compliance where they differ from standard.

Review bid documents when received to ensure they: o meet the minimum standards as stated above o Can demonstrate best value for money

4.10.

Development of Choice and Planning to provide Support Services for Home Dialysis

4.10.1.

Purpose: To plan the development of a home dialysis training centre or centres and associated service for the East of England to train and support patients and to ensure that patients consistently receive information and support to exercise choice of modality. Responsible Person:

2

DOH 2006 – Gateway Ref 7380

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Responsible To: •

Identify work stream lead and supporting team if required

Develop a renal choice policy

Develop a home dialysis support plan to include: o Number of centres needed o optimal location (s) of support centres o scope and outline of the support to be offered o estates and facilities requirements, o workforce and support services requirements o clinical support requirements

Present the development plan to the project board for agreement

Tender required contracts as detailed in section 21 above

4.11.

Ensuring a patient centred service

4.11.1.

Purpose: To plan to deliver services for patients with chronic kidney disease which comply with Standard 1 of the 2004 NSF: “All children, young people and adults with chronic kidney disease are to have access to information that enables them with their carers to make informed decisions and encourages partnership in decisionmaking, with an agreed care plan that supports them in managing their condition to achieve the best possible quality of life” To ensure that consideration any aspects of this plan that impact the procurement of haemodialysis across EoE are factored into this process Responsible Person: Responsible To: •

Develop a plan that can clearly demonstrate the following indicators: o Provision of high quality, culturally appropriate and comprehensive information and education programmes. o Education programmes tailored to the needs of the individual.

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o Individual care plans, regularly audited, evaluated and reviewed. o Access to a multi-skilled renal team whose members have the appropriate training, experience and skills. o For children and young people, meeting the standards of Getting the right start: National Service Framework for Children, Young People and Maternity Services.

Responsible Person to review bids, contracts and SLAs to ensure, where necessary, services dovetail with those providing the quality indicators detailed above.

4.12.

Transplantation

4.12.1.

Purpose: To plan to deliver services for patients with chronic kidney disease that comply with Standard 5 of the 2004 NSF: “All children, young people and adults likely to benefit from a kidney transplant are to receive a high quality service which supports them in managing their transplant and enables them to achieve the best possible quality of life” To ensure that consideration any aspects of this plan that impact the procurement of haemodialysis across EoE are factored into this process Responsible Person: Responsible To: •

Develop a plan that can clearly demonstrate the following indicators: o Early provision of culturally appropriate information; discussion with and counselling of patients, relatives and carers about the risks and benefits of transplantation with a clear explanation of tests, procedures and results. o Support and development of live donor capability in EoE o Application of a national matching scheme using criteria agreed through UK Transplant to optimise blood group and tissue matching for kidneys from deceased donors. o Effective preventive therapy to control infections. o Timely operating theatre availability to ensure optimal cold ischemia times. o Appropriate immunosuppression and anti-rejection treatment in accordance with forthcoming NICE guidance and effective monitoring and treatment to minimise the risks of adverse effects of immunosuppressive treatment.

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o Clear explanation for patients of tests, procedures and results, and especially information and education about anti-rejection therapy. o Specialist advice from the transplant team available for patients with a renal transplant admitted to hospital, whatever the setting. o Organ procurement and transplantation to follow the principles set out in Saving Lives, Valuing Donors: A Transplant Framework for England. o Patients put on the national transplant list within six months of their anticipated dialysis start date if clinically appropriate.

•

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Responsible Person to review bids, contracts and SLAs to ensure, where necessary, services dovetail with those providing the quality indicators detailed above.

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Appendix A

Project Plan, Gantt Chart. “EoESCG-RenalPID-AppxA”

Appendix B

Work Stream Structure

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