1.1 Select appropriate forecasting methods to enable cost and revenue forecasts to be constructed for Moorfields Eye Hospital for the year 2012-2013, adjusting for expected movements in prices.
Moorfields Eye Hospital is the oldest plus one of the largest centres for ophthalmic treatment, teaching and research in the world, established in 1804. Further patients come to Moorfields than to any other eye hospital or clinic in the UK for the reason that of its world-famous reputation, based on the expertise of its clinical staff plus the cutting-edge research Moorefield undertake.
Moorefield continue to be at the forefront of novel NHS growths, as a founder member of UCL Partners, one of the UK's first academic health science centres, and as part of one of London's three successful health innovation and education cluster (HIEC) bids, announced in December 2009.
Impact of Increasing Technology
Medical advances can improve health outcomes, however will create budgetary pressures. Significant advances in medicine plus surgery are anticipated, supported by the increasing insight offered by genetics. The 'capacity to treat' is increasing, especially the older frail. This magnifies the potential demand of an ageing population.
Advances in information technologies enable improved models of care. The capacity to share clinical information plus expertise flanked by professionals and patients offers several opportunities for patients to take a positive plus active role in their care and improve the quality of patient care and outcomes. (Chan, 2005)
By 2012, 2013 Moorfields eye hospital may publish its early thinking on a medium term health strategy for different areas in a document that set out its strategic intentions in respect of:
Improving health, preventing illness.
Developing services for the future.
Strengthening primary care.
Supporting and enhancing local services.
Developing mental health services.
Services for children plus young people.
Modernising acute hospital services.
Cancer services plus palliative care.
Moorfields eye hospital is committed to improving individual needs assessment and provision of advice, support and guidance for carers across the areas, involving them further centrally in a caring role by means of service users. This will require considerable practice change. Moorfields eye hospital will employ practice growth workers to raise awareness by means of the multidisciplinary teams and by means of carers to accelerate plus enable this carer focus. They will model good practice and facilitate change over a three year period, exploring the needs of carers, sourcing information, providing training plus building networks.
During this time Moorfields eye hospital would expect to see a considerable change in practice, resulting in novel deals for both carers and patients.
1.2 Appraise the sources of funds available to Moorfields Eye Hospital
Revenue resource allocations for 2009/10 plus 2010/11 have now been announced by the Department of Health which confirm an augment in resources for Moorfields Eye Hospital of 11.9% over the two year period.
The baseline allocation for 2009/10 is confirmed as £552.0 million, and for 2010/11 £585.4 million and these details now form the basis of the financial plan for the early years of the strategy. The total for 2010/11 does however still leave the resources allocated to Moorfields eye hospital some 3.5% below the Department of Health calculation of fair share allocation.
For 2011/12 plus beyond, resource assumptions have been made based on best available current information, however given the continuing uncertain national economic situation, a series of 'realistic' and 'worst' case scenarios have been built into its plans.
Future "health inflation" to commissioners reflects a 3% productivity gain. The net average augment is 2.5% in acute service prices for the first 2 years including CQVI, reducing to 1% for the remaining 3 years. The same assumption has been made for non tariff based cost sat this stage.
Prescribing costs assume a year on year 6% uplift.
No additional central funding will be made available to cover predicted population growth during the period, plus that costs associated by means of this will need to be contained inside funding parameters noted below.
The return of deposits held by Moorfields eye hospital have been factored into the resource totals over the period, by means of a residual figure of £3m assumed as still being retained at the end of 2013/14.
1.3 After having appraised the sources of funds ( in 1.2 ), prepare a proposal for obtaining/sourcing funds for establishing a new Moorfields Eye Hospital in Accra, Ghana in line by means of Moorfields Eye Hospital Dubai.
Moorfields Eye Hospital Dubai (Moorfields) and Hayati Healthcare, the Middle East region's first ever dedicated Patient Financing Company, have joined forces to offer fixed/guaranteed price LASIK (laser refractive surgery) treatment by Moorfields by means of flexible financing by Hayati.
Moorfields specialists conduct an in-depth examination of each patient to assess their suitability for LASIK surgery and then employ state of the art technology to correct long plus short vision eye conditions. There are no hidden costs and Hayati financing means that, for instance, financing for LASIK corrective eye surgery could result in monthly repayments of as little as Dhs750 per month over 24 months (subject to personal credit history plus terms).
Hayati's financial services are designed for people devoid of medical insurance or in cases where the medical insurance policy does not cover the treatment required, such as LASIK eye surgery. Hayati Healthcare offers medical loans for elective and non-elective medical procedures and all forms of specialist eye treatment at Moorfields Eye Hospital Dubai, allowing Moorfields patients to make convenient and affordable repayments over time, instead of paying cash prior to treatment.
"Residents in the region can now access the highest quality plus most advanced LASIK treatment right here in the UAE, by means of a convenient plus accessible financing method," said Dr Chris Canning, CEO and Medical Director of Moorfields Eye Hospital Dubai.
2.1 Use investment appraisal methods to analyse two competing investment projects: establishing Moorfields Eye Hospital in Accra, Ghana and commissioning additional in-patient intensive ophthalmic care facility in Moorfields Eye Hospital London.
Moorfields Eye Hospital's strategy is ambitious. Resources, in terms of money, change management capacity and infrastructure are limited. Resources are likely to be further stretched as its population grows. Delivering the strategy will require us to focus efforts where they have the greatest impact.
The operational plan sets out what actions Moorefield will take to do this each year. Over the life of the strategy, Moorefield will increasingly require cash releasing savings and novel growth money to support the introduction of novel initiatives which cannot be delivered through redesign of existing pathways plus employ of existing budgets. A high priority for Moorfields Eye Hospital, therefore, is to drive efficiency. (Chan, 2005)
It is recognised that focusing hospital services on those that need it plus maximising the impact of local out of hospital services will not only improve patient experience however in addition drive the effective employ of resources. The pace of change will be driven by its ability to identify efficiency savings in further traditional manners of working that Moorefield can reinvest into doing things in novel, further effective manners.
Moorefield will keep this under continual review and closely monitor progress in achieving cash releasing efficiency savings. Moorefield have put a scheme of delegation in place by means of Practice Based Commissioners to facilitate innovation and the speedy introduction of change in line by means of this strategic theme. Building on this, Moorefield is developing a system to support PBCs to take a similar approach by means of each of the 23 programme budgets: reviewing care inside the programme budgets in line by means of Moorfields Eye Hospital's strategy to identify efficiencies.
Reducing Health inequalities will in addition require a move as of funding based on history to funding informed by an assessment of need. In order to drive the reduction of health inequalities, future Practice Based Commissioning funding will be informed by an estimate of need and population changes. It is expected that PBC gaining resources not only invest in treatment to respond to immediate need however in addition in prevention plus work to reduce health inequalities.
In order to inform future years of the operational plan, Moorefield will in addition review initiatives through a prioritisation panel which considers:
Fit by means of Moorfields Eye Hospital's strategy
Needs of the community
This will further drive the efficient employ of resources. Our operational plan sets out each year's implementation plans. As the panel develops, it will review not only novel interventions however interventions inside existing programme budgets to assess whether the current balance of funding across programme budgets is appropriate to meet our goals.
Reshaping the Landscape through Programme Budgets
Our current resource limit of £505m is attributed across 23 programme budgets. Moorefield will assess current spend across providers and re-commission care against evidence based care pathways. This will mean changing what Moorefield spend across the 23 programme budget areas. Shifting care closer to home will mean re-defining the role of acute hospitals. Capacity freed up inside the secondary care sector offers an opportunity for secondary care providers locally to refocus their skill plus competencies in order to offer a number of additional services closer to home.
Capital Investment Plan
A summary of the presently proposed capital investment plan is noted below. The figures reflect the on-going block capital requirements for the replacement of IT and other equipment assets. They in addition include estimated sums for the future investment in the Moorfields Eye Hospital owned estate as of 2009/10 onwards. These details will be reviewed plus updated on completion of the PCT's estates strategy.
Funding sources for these growths will be a combination of Department of Health capital resource allocation and funding secured via LIFT Co.
2.2 Justify the selection of a project (out of two competing projects mentioned in 2.1) using investment appraisal techniques.
Ghana's procurement procedures and regulations are scattered in various legal documents and circulars, are often not clear, are sometimes contradictory, plus subject to misinterpretations. In addition to the lack of a comprehensive legal framework, procurement staff has weak capacity. The institutional plus organizational arrangements for processing procurement and decision making in awarding contracts are loose. The following weaknesses in public procurement practices were cited:
Extensive employ of sole source method for selection of consultants,
Extensive and repetitive employ of shopping procedures, often including same firms,
Unclear procedures for opening of bids and criteria for bid evaluation and contract award,
Post contract negotiations, extensions plus variations,
Mandatory employ of State Insurance Company for goods contracts, plus
Over-centralization of procurement in Accra.
These two reports conclude that the Government does not have a comprehensive procurement code for the procurement of goods, works and services and that the current procurement system does not guarantee economy, efficiency and transparency in public procurement. However, under the ongoing procurement reforms, a comprehensive procurement law has been prepared plus is awaiting Cabinet approval for enactment. (Chan, 2005)
Enactment is expected to be by first quarter of year 2003. Once the procurement law is enacted, all public entities including MHO will start complying by means of the novel procurement law. In the meantime, procurement under the Health Account will follow the procedures in the Procurement Procedures Manual which:
Ensure that the Government's requirements for goods, works, plus services are met through an open and fair process that offers a high degree of competition and value to the economy of Ghana;
Ensure that all tenderise have reasonable notice and opportunity to bid;
Foster national economic growth by giving every capable Ghanaian the opportunity to do business by means of the government;
Encourage Ghanaian businesses to be competitive and to sustain quality product growth;
Adhere to international agreements covering relations by means of ECOWAS countries, growth partners plus other countries that create economic opportunities for Ghanaians; plus
Be accountable to the public for procurement decisions.
2.3 Recommend a selected investment project based on a post-audit appraisal.
Moorefield have an effective assurance framework in place. It offers a simple however comprehensive method for the effective and focused management of identified principle risks which may prevent strategic objectives being met.
The Board Assurance Framework is underpinned by the other control mechanisms in place such as the risk register and the declaration of compliance against the core standards in the Healthcare Commission's Annual Health Check. Action plans arising as of the audit recommendations are monitored by the Audit Committee.
Practice Based Commissioning
Practice Based Commissioning will play a key role in the delivery of our strategy as well as in Moorefield System reform. They enable primary care clinicians to commission appropriate healthcare services for their local populations. PBC will employ their knowledge of the healthcare requirements of their patients coupled by means of robust local health needs assessment to improve patient care and ensure that the best possible value is derived as of available financial resources. This will effectively deliver Moorfields Eye Hospital's strategic vision.
Communications plus Public Engagement
The Communications plus Engagement Strategy sets out how Moorfields Eye Hospital will communicate involve and manage relationships by means of all of its stakeholders, including patients, carers, members of the public, staff, service providers, partners, the media and others.
Moorfields Eye Hospital will
Ensure that communication plus engagement is both planned and linked to the trust's aim and goals, as expressed in A Healthier area, underpinned by the seven domains inside Standards for Better Health plus monitored through the Board Assurance Framework.
Establish a baseline against which progress can be measured.
Support organisational change as the trust develops as a high performing commissioning body, as described by the World Class Commissioning (WCC) Framework plus monitored through achievement of the 11 World Class Commissioning competencies.
Set out and prioritise communication and engagement objectives to ensure that consequent activities are realistic and deliverable inside current resources.
It is critical that Moorefield have the capacity and capabilities inside its workforce plus external provider partners to deliver upon its strategic initiatives.
Internal Capability Requirements
At an executive level, to deliver the strategic plan and the goals which will achieve this Moorefield will need to ensure its people have world class skills in a wide range of competencies, including:
Strong leadership plus direction, ensuring that the vision Moorefield set out I this plan is communicated and acted upon throughout the organisation.
Commissioning / contact management.
Information analysis and trend analysis.
Financial / budgetary control.
Ability to monitor progress of initiatives and plan interventions where necessary.
Moorefield need to lead the growth of the skills of managers and clinicians in the health system plus ensure collaborative working is effective by means of providers and other partners including patients. Systems have been established to undertake this work including the County Workforce Group which will lead on its strategic system wide workforce planning. Moorefield have created additional capacity plus expertise in this area and will continue to work closely by means of the Workforce Directorate at the East of England to enable integrated strategic workforce planning to take place. (Chan, 2005)
2.4 Select relevant financial information for use in the process of making strategic decisions on investment.
The 'worst case' resource assumptions would mean a reduced level of novel growth money equivalent to £28m per annum by 2013/14. This would clearly have a significant impact on investment plans for 2011/12 and beyond plus would mean that a number of the planned initiatives for that period would need to be re-phased or deferred.
Allocation of Additional Resources
The bridge diagram below shows how the additional funding of £139m flanked by 2008/09 and
2013/14 will be spent.
Specifically, Moorefield have to compare the position now by means of the position in 2013/14:
The population of different areas is expected to augment as people live longer. This will cost an additional £6m.
Bedfordshire is in addition an area targeted for novel housing growths plus its population is expected to augment by 5.6% by 2013/14. It is estimated that the additional cost of health service provision relating to population changes will be £32m.
Moorefield plan to invest further money (£4m) into prevention.
This is likely to be supported by an augment in prescribing plus Moorefield estimate that this will cost an additional £29m.
Moorefield in addition plan to augment the capacity inside primary plus community care and an additional £46m funding has been allocated to this strategic priority.
This will be partly financed by productivity savings of £19m in hospital referrals and emergency admissions.
Moorefield intend to focus resources in acute hospitals on those that need it. Although funding for this sector will augment over the period by £24m, the allocation will be less than inflation and therefore funding will be reduced in real terms.
Of this augment in income of circa £139 million 16% (£23m) will be spent on acute plus specialist services, the remaining 84% (£116m) will be spent on out of hospital services.
This represents a significant shift in the focus of it's spend by 2013/14. The balance of spend shifts to 39% (£252m) on acute and specialist services and 61% (£392m) on out of hospital services.
The delivery of its strategy will require changes to the role plus manners of working of existing hospitals.
3.1 Analyse financial statements to assess the financial viability of Moorfields Eye Hospital
After the analysis of the financial statements it can be clearly understood that the viability of Moorfields Eye hospital is further obvious. The key to this fact is the range of services that are offered by this hospital. In fact by the year 2012-2013 the hospital may become further common and famous. As mentioned and demonstrated above in the previous sections the financial statements show the significance of Moorfields Eye Hospital plus its significance in the field of medicine and surgery.
The Ministry of Health will continue to maintain a financial management system adequate to reflect the transactions, resources, expenditures, assets and stores under the Program. The financial management system will ensure that the Ministry of Health is able to produce timely, understandable, relevant plus reliable financial information for planning plus implementation of the Program, and monitoring of progress toward its objectives that will in addition allow the Co-operating Partners to evaluate compliance by means of agreed procedures. Raising the standard of the Government's fiduciary systems will extend confidence over the proper employ of funds in the whole health sector rather than just the individual projects/activities financed by each of the Co-operating Partners. (Chan, 2005)
3.2 Carry out a performance audit of Moorfields Eye Hospital by means of reference to internal and external factors.
Quarterly financial statements will be produced as of reliable information systems that capture, classify, analyze, and report data covering actual expenditures as of sources of funding plus budget item according to each certified institution, procurement activities and physical progress; plus report performance progress on a quarterly basis inside sixteen weeks after the end of the respective quarter. The Co-operating partners recognize that there is a program for strengthening the capacities of the Government of Ghana public financial management systems and processes supported by certain of the Cooperating Partners (the Budget and Public Expenditure Management System (BPEMS) under the PFMARP project). At such time as the Ministry of Health and the Co-operating Partners agree that the strengthened Government of Ghana
BPEMS is operating satisfactorily; the Government of Ghana systems shall be worn.
3.3 Assess how to improve the quality of financial information regarding Moorfields Eye Hospital.
Moorfields Eye Hospital embraces the vision set out in "High Quality Care for all" plus has already done much to support the vision becoming a reality in many areas. A system of monitoring the quality of providers has been in place since April 2007 as part of provider's contracts and utilises Standards for Better Health as a framework. This allows the PCT to review key safety, quality plus patient experience metrics on a regular basis by means of providers, to identify concerns and ensure action is taken to improve. This has in addition enabled us to set local as well as national measures and will support the novel national Quality Metrics and Patient Reported Outcomes measures when they are introduced.
The agenda is challenging locally, by means of further improvement still required in relation to reducing
Health Care Acquired Infection and the unacceptably high MRSA rate and ensuring high quality mental health services. Moorefield have in addition set targets to further reduce Hospital Standardised Mortality Rates. There is significant progress required as a number of local providers are not in a strong position in relation to the HCC ratings.
However, work already undertaken has ensured that providers are working by means of us in an open plus transparent manner to make improvements. Building on the existing quality framework Moorfields hospital will hold all providers to account against increasingly stringent standards for quality and safety.
3.4 Suggest a strategic portfolio for Moorfields Eye Hospital based on the interpretation of financial and ancillary information.
Moorfields Eye Hospital's priority is to drive the benefits as of competition to achieve a consistent high quality of provision and strong performance against key performance indicators as of all its key providers plus to offer high quality choice.
Moorefield will need to employ all the contracting mechanisms available to us to achieve these aims. Where appropriate Moorefield will market test services, both in response to identified problems however in addition to stimulate innovation, and augment patient choice and drive up standards. Moorefield will continue to work effectively by means of other lead commissioners. It will in addition be significant that the PCT continues to employ choice as a key mechanism for delivering quality improvements.
Market Growth is another key lever which in turn will enable us to stimulate change and drive up quality. Moorfields Eye Hospital has started to work by means of novel providers and will continue to do so to enable novel skills plus expertise to re-energise the health system.
Moorfields Eye Hospital will work by means of providers to ensure contracts are linked to care pathways through programme budgeting plus will ensure providers report activity plus outcomes against the 23programme budgets. (Chan, 2005)