Building the Commercial Case for Digital

The Princess Alexandra Hospital NHS Trust is working on an exciting project to create a new healthcare campus as part of the government’s Health Infrastructure Plan. When opened, the campus will transform how care is delivered across the Hertfordshire and West Essex Integrated Care System; to enable this transformation the trust’s board has stated that ‘it wants to be the most digitally advanced hospital in the UK’. To help form a business case to achieve its ambitions, the trust has been working with Gemserv Health.

The Princess Alexandra Hospital NHS Trust serves a population of 350,000 people living around the M11 corridor just north of London. It provides general acute, outpatient and diagnostic services from three sites, including its main hospital in Harlow.

Princess Alexandra Hospital is a classic ‘hospital building programme’ facility opened in phases from 1958 to 1966. In August last year, the trust confirmed exciting plans to create a new healthcare campus, supported by the government’s Health Infrastructure Plan (HIP) to build or refurbish 40 hospitals.

The Department of Health and Social Care’s outline for the HIP makes it clear that “it is not just about bricks and mortar” but about making sure that the “digital technologies and data sharing capabilities” are in place to provide better care to the public.

Digital agency NHSX has developed a blueprint for what these might mean; and it is very ambitious. So, as Helen Davis, the deputy programme director for the new Princess Alexandra Hospital explains, it will use elements of the blueprint to make sure it is one of the most digitally enabled in the country.

“We have the advantage of being one of the few hospitals in the programme to be working on a complete new build,” she says. “So, we are able to plan to transform all elements of the patient journey using digital.

“That means everything from the moment people arrive at the hospital to the way they move through the building, to how their treatment is provided, to the way in which the building itself is managed. All of this will be supported by new technology and digital solutions.”

Building up the business case

Significant work has been undertaken by the trust in developing its business case and roadmap for achieving its ambitious goal, and this has been shared with the HIP’s New Hospital Programme executives, NHSE/I and NHSX, with positive feedback. As such a project is vast and complex, the trust has engaged specialist expertise from Gemserv Health to create a commercial case for the digital elements.

Mike Entwistle, managing consultant, specialising in commercial and procurement support to organisations like Princess Alexandra, says: “The NHSX Blueprint for Digitally Advanced Hospitals covers all aspects of digital; not just clinical systems, but systems that affect how the hospital operates. Everything from how reception is run to how the air conditioning is controlled.

“Princess Alexandra’s plans are based on the blueprint, so it needed some commercial expertise to support the digital business case that will feed into the bigger outline business case. We put together a small team of experienced consultants to do that.”

The Gemserv team helped the trust to think through how it wanted to deliver the technology, taking account of the resources available to support different delivery options. Then, it helped the trust to work out how best to procure the preferred delivery options.

One of a number of ideas that was explored in some detail was whether the trust could collaborate with national digital and procurement bodies and other HIP hospital trusts to create a specific set of framework arrangements for any of the 40 organisations in the HIP to use.  Although carefully considered, the timing and a limited capacity within the organisations to bring this all together meant it was not viable for the trust to pursue this option.

In the end the key issue became whether the trust should look to work with many suppliers on the different elements of the blueprint, or whether it should look to work with one or two lead contractors to secure them.

“A lot of what is in the blueprint is very new technology,” Entwistle says. “Most of it is in use somewhere in the world, but no organisation is using all of it anywhere. That means the trusts in the HIP are going to need to find the right suppliers; the people who don’t just deliver the component parts but make it all work together in an integrated way.

“In the end, we produced a commercial case that took account of the trust’s capacity to manage its suppliers and its appetite for risk.”

Questions for trusts with digital ambitions, everywhere

Ian Carr, director of healthcare, at Gemserv Health, says these basic questions – what do trusts really want to achieve with digital technology, and what is the best way for them to procure, integrate and manage that – will need to be asked by all organisations in the HIP.

In fact, these questions will need to be asked by all organisations with big ‘digital hospital’ or ‘hospital of the future’ ambitions. “This is not just a traditional system procurement,” he says. “It is proper, digital architecture. Admin, clinical and management systems. Robots delivering things around the hospital.

“It is really cutting-edge stuff. If it all works, these hospitals will be fantastic. But to make it all work, trusts are really going to have to think through their commercial cases and to make sure they reflect their capacity for procuring, integrating and managing the relationships that will be involved.”

Another interesting aspect of the building programme is that it will be done against the backdrop of the NHS’ ambitious targets to become the first health service in the world to achieve net zero. “All 40 hospitals in the HIP will have to think net zero, and that’s something else we can help them with,” Carr says.

The next steps for Princess Alexandra is to complete the outline business case (OBC). Davis says that once the OBC has been approved by the trust’s board, the intention is to submit the case to NHSE/I this autumn, for approval.

In the meantime, the trust plans to push ahead with the procurement and deployment of clinical IT systems, starting with e-prescribing, so it has a full electronic record in place and in use before the move into the new hospital. As things stand, the aim is for this to happen in 2026.

“At the moment, our hospitals have limited digital maturity, so we will be implementing new IT in waves, as the new hospital is developed,” Davis says. “The work that Gemserv Health did for us is a small but important part of the picture.

“The big picture is about transforming the way in which healthcare is delivered for our communities and creating a much more modern, much more welcoming place for our clinicians to work and our patients to be treated.”

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