Colocation: How will it work

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Co-location How will it work?
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What is Co-Location?

• Co-location is a health service reform initiative
  undertaken by the HSE on behalf of the Government
  to generate extra Public Patient Capacity in
  Public Hospitals thus creating greater equity of
  access to public hospital beds
• This is the fundamental point the policy is
  there to generate Public Capacity, not Private
  capacity
• To quote Mary Harney in a Parliamentary Debate
  The essential idea underlying the co-location
  initiative is to free up capacity for public
  patients and deliver new public acute beds in the
  quickest and most efficient manner. The
  initiative was founded on the principle that all
  patients ordinarily resident in the State should
  have access to public hospitals based on medical
  need and the possession of private health
  insurance should not influence timeliness of
  access or treatment.
• All Private Patients and overflow public patients
  treated in co-located facility

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Background to Co-location
Current Irish Population - just over 4.2m and
relatively young..BUT population is growing
aging rapidly Current issues Perception that
the Healthcare system in crisis - Pressure on
Budgets, accessibility concerns with long waiting
lists, deficit of facilities and resources,
overcrowding. Approx. 53 hold private health
insurance Private bed designation in Public
Hospitals out of kilter with Privately Insured
Fewer hospital beds now than in 1960s Health
infrastructure creaking at the seams
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2nd worst health service in Europe 2006 Euro
Health Consumer Index Ireland ranked 24th out of
25 European countries 2020 - ageing population
of gt 5.2m with 1.25m gt 60 yrs old Given lengthy
lead time in developing Healthcare facilities
infrastructure, action is needed now to provide
for our future requirements The future lies in
public private partnership Co-location is one
example
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Some of the Benefits

• Rapid delivery of 1000 beds (likely total 1,700)
• New facility will add much needed bed and
  operational capacity
• Land leased from State at full market value
• Efficient utilization of public resources
• Public hospital benefits financially
• State derives a net gain of many multiples of any
  opportunity cost
• Significant investment and job creation at no
  cost to the State
• Consultant staff on-campus
• Reciprocal arrangements in place SLAs
• Economies of scale for both facilities
• No 'Cherry-Picking - private facility must
  mirror public hospital case-mix
• Additional Research and Educational opportunities
• Benefits brought by input of internationally
  renowned UPMC not-for-profit, academic

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Socio-Economic Impact
The new co-located hospitals will each provide
over 500 full time jobs with additional part-time
jobs The proposed developments are each
anticipated to create an additional 700 indirect
jobs provided by healthcare suppliers, equipment
companies and service agencies It is also
anticipated that during construction of the
co-located hospital there will be up to 500 full
time workers and skilled labourers needed, as
well as a number of part time positions. It is
expected that the proposed development will
enhance the areas ability to attract further
investment by improving the level of services
available
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About BMG

• Beacon Medical Campus established 2002
• Beacon Renal opened June 04
• Beacon Dermatology, April 06
• Beacon Hospital opened Oct. 06
• Most successful co-location bidder won 3 sites
• Tallaght Co-location tender due next month - (one
  of two preferred finalists)
• Only bidder to have signed Co-location Project
  Agreements and lodged planning applications
• Planning appeal lodged for Womens and Childrens
  Hospital

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Operating Partner - UPMC

• Largest integrated healthcare enterprise in
  Pennsylvania
• Not-for-profit, academic institution
• Renowned for innovation in patient care, research
  and health care management.
• Revenues of 6.3Bn.
• Over 48,000 employees.
• 20 tertiary, specialty and community hospitals,
  400 outpatient sites and doctors offices,
  retirement and long term care facilities.
• Insurance Subsidiary - over 1.2m members.

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Background and key milestones
Summer 2006, HSE choose sites, Tenders issued
July 2007 BMG win Limerick Cork Beaumont
May 17th 2007 Bidders submit Final tenders
July 2005, DoHlaunch co-location plan
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Key Hospital Stats
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• Beaumont Co-Location
• BMG propose to build a 297m, 31,012sqm, 170
  in-patient bed, 6 theatre high- tech facility at
  the Beaumont Hospital.
• 30 Months construction
• Hi-tech, state-of-the-art facility, incorporating
  new generation equipment, amounting to 26.8
  million

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• Cork Co-location
• BMG propose to build a 242m, 25,429sqm, 175
  in-patient bed, 6 theatre high-tech Hospital at
  the Cork University Hospital.
• We will deliver an operational Hospital within 26
  months of the commencement date.
• The delivery of a hi-tech state-of-the-art
  facility, incorporating new generation equipment
  amounting to 26.9m.

North-west view
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• Limerick Co-location
• BMG propose to build a 245m, 25,133sqm, 150
  in-patient bed, 6 theatre high-tech Hospital at
  the Mid-West Regional Hospital.
• 28 months construction, 2 month commissioning
  period. Open 30 months from start of construction
• The delivery of a hi-tech state-of-the-art
  facility with new generation medical equipment
  amounting to 25.8 million.

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Phase 1
Phase 2
Phase 3

• Demolish existing Building 11Month 6-9
• Set up site hoarding
• Move departments to temporary building
• Demolish existing building
• Construct New Shared Entrance Month 5-18
  
• Construct new Main Entrance, Concourse
• Construct and fit out new Beaumont Accommodation
• Build New Link to AEMonth 6-18
• Build double storey link to existing AE
• Commence Co-Located HospitalMonth 4 -22
  
• Commence construction for main building
• Complete main envelope construction

• Remove Temporary BuildingMonth 19-21
• Move temp accommodation to new front entrance
• Remove temporary accommodation
• Complete new car parking and landscaping
• Complete Co-Located HospitalMonth 22-28
  
• Main focus on internal Fit Out
• Complete all departments and integrate with
  existing Hospital
• Operational CommissioningMonth 29 30

• Mid-West Regional Hospital
• Co-Location Build Schedule.
• Enabling worksMonth 1-5
• Create new staff car parking adjacent
  multi-storey
• Re-Locate Road to perimeter
• Create new car parking layout to front of
  Consultants
• Create new set down area for Main Entrance
• Service Diversions
• Build Temporary AccommodationMonth 4-6
• Construct 3 storey temp building
• Build temp link to existing hospital

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Key points about the hospital operations

• The co-located hospital will mirror the public
  hospital case mix, 24/7 admission
• There will be one AE - Private patients that
  present to the public AE department and require
  admission will be accommodated in the Co-Located
  Hospital plus any public patients as required
  24/7
• Capacity in the co-located hospital will be
  available for public patients if required by the
  public hospital through service level agreements
• BMG / UPMC view its operation of the co located
  hospital as an opportunity to develop synergies
  with the public hospital to the mutual benefit of
  both operations.
• The operational interface between the public and
  private hospitals will require detailed workshops
  with each speciality to develop the optimal
  clinical pathways and patient journeys

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Strategic Partnering Board (ISPB)

• An Interim Strategic Partnering Board
  (transitioning to the Strategic Partnering Board
  on practical completion) will be created as a
  joint decision making body to agree structural,
  operational planning and potential clinical
  issues arising during the construction,
  development and subsequent operational phases.
  This board will facilitate input from each
  discipline to ensure seamless interface of
  service to all patients
• The SPB will oversee clinical governance,
  performance improvement, risk management, HIQA
  participation, patient safety and appointment of
  consultants
• The board will comprise of representatives from
  the public and private hospital. The general
  manager of the public hospital will be chairperson

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Consultants

• The consultants have a choice- the public
  hospital cannot commit them to work in the
  private hospital
• The co-located Hospital will ensure that a
  consultant appointed by the public hospital and
  entitled to work in the private hospital will
  have first right of refusal to administer
  treatment in the co-located hospital
• The co-located Hospital will provide monthly
  reports to the HSE regarding the full clinical
  workload of each consultant in the co-located
  hospital
• The co-located hospital must comply with all
  legal requirements relating to quality and
  standards.

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Challenges to work through

• Case mix monitoring
• Research and education agenda
• Lack of role model in Irish health care
• Meeting deadlines
• Minimizing disruptions to staff and patients

• Joint governance
• Integration of private and public hospitals
• Managing expectations
• Staffing and employment
• Consultant contract

The Interim Strategic Partnering Board and its
supporting subcommitteeswill manage issues and
risks at all stages of the project
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Thank-you