Proton Beam Therapy - Outline Business Case (OBC) - Volume 2

UniversityCollegeLondonHospitals 

 

ProtonBeamTherapy 

OutlineBusinessCase 

 

Volume2of4:Appendices 

 

 

COMMERCIALINCONFIDENCE 

Version2 31 st May2013

Contents: 

APPENDIX 1A CIB AND MONITOR CHECKLIST........................................................... 3 

APPENDIX 2A: OVERVIEW OF PROTON BEAM THERAPY ........................................ 4 

APPENDIX 2B: UCLH SERVICE STRATEGY............................................................... 16 

APPENDIX 2C: EQUALITY IMPACT ASSESSMENT ................................................... 19 

APPENDIX 2D PROJECT RISK REGISTER ................................................................. 21 

APPENDIX 3A: UCLH AND THE CHRISTIE PBT THROUGHPUT MODELLING ........ 28 

APPENDIX 3B: PBT QUALITATIVE BENEFITS ANALYSIS........................................ 30 

APPENDIX 3C: ECONOMIC ASSESSMENT WITH QALY ANALYSIS ........................ 31 

APPENDIX 3D: BENEFITS REGISTER......................................................................... 36 

APPENDIX 3E: FINANCIAL APPRAISAL ..................................................................... 38 

APPENDIX 4A PROPOSED TARIFF ARRANGEMENTS ............................................. 68 

APPENDIX 4B: EQUIPMENT PROCUREMENT STRATEGY....................................... 71 

APPENDIX 4C: CONSTRUCTION PROCUREMENT STRATEGY ............................. 115 

APPENDIX 4D: CABINET OFFICE ICT SPEND CONTROL FORM (V2.18) .............. 127 

APPENDIX 4E: PBT MILESTONE TRACKER ............................................................ 134 

APPENDIX 6A: PROJECT RESOURCING SCHEDULE............................................. 135 

APPENDIX 6B: STAKEHOLDER MANAGEMENT PLAN........................................... 136 

APPENDIX 6C: LETTERS OF COMMISSIONER AND STAKEHOLDER SUPPORT. 141 

APPENDIX 6D: CONTINGENCY IN THE EVENT OF ACCELERATOR / PBT CENTRE 

FAILURE....................................................................................................................... 154 

APPENDIX 6E: RISK POTENTIAL ASSESSMENT ................................................- 156 - 

 

 

 

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Appendix2A:OverviewofProtonBeamTherapy 

DepartmentofHealth’soverseasprogramme 

1.1. Overall250patientshavebeenreferredintotheDH’soverseasprogrammesinceitsstarted 

in2008and160patientshavebeenreferredforprotontreatmentabroadincludingnearly 

100paediatriccases.50patientstravelledoverseasfortreatmentin2010/11atacostof 

£5m. For 2011/12, in the first 7 months, 42 patients from England had begun treatment 

overseas. The panel is currently carefully managing the programme, recognising that the 

overseascapacitytotreatpatientsislimited.Itwasplannedthat120patientswouldreceive 

treatment overseas in 2011/12 at a cost of £9m; however, the programme is currently 

estimating80patientsasUScostshaveincreasedtakingtheaveragecostthisyearto£110k 

perpatient(anincreaseontheplanningfigure).Forthesereasons(capacityandcost),the 

expert reference panel is being deliberately cautious in the cases it sends overseas for 

treatment.InOctober2010,thegovernmentannouncedanadditionalfundingoverthenext 

Spending Review period so that all high priority patients have access to this treatment 

benefitting400patientsperyearbytheendoftheSpendingReviewperiod.Estimatedspend 

onoverseasPBTtreatmentby2014/15is£30mperannum 

 

1.2. In 2011/12, the average cost per patient sent overseas is currently around £90k with the 

majoritybeingtreatedattheJacksonvillecentreinFlorida.CapacitytodeliverPBTfornon 

eyecancersinEuropeisstillverylimited.Difficultiesinintegratingothertreatmentsandthe 

quality of patient experience have led to France not being used currently 1 . There is a 

recognised need to increase capacity in Europe and existing services are under increasing 

pressuretotreattheirowncases 

 

Marketanalysis 

1.3. The only proton facility in the UK is a low energy facility at the Clatterbridge Centre for 

Oncology,Liverpool;thisissuitableforeyetumoursonly.Ittreatsaround100patientsayear 

with excellent outcomes and over 90% permanent control (effective local cure and saves 

enucleatingtheeye). 

 

1.4. Fromourmarketintelligence,therearecurrentlysixmanufacturersofferingPBTequipment 

solutions with only a few centres in operation or in development around the world. This 

implies that in general manufacturers have relatively sparse experience of equipping and 

installingcurrentoperationalcentres,butalsothatthetechnologyprocuredwillberelatively 

untestedinaclinicalenvironment. 

• 

 

• 

• 

• 

• 

 

1 OrsayisastandalonePhysicsresearchlabandtherewererestrictionsonthebeamusefor 

treatment. The lack of a clinical setting and language barriers also impacted on patient 

experience 

 

 

 

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Fig.1LocationofhighenergyPBTfacilities 

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PBTsystemsinothercountries 

1.6. Discussionswiththeprivatehealthcaremarketinthe haveestablishedthat 

thereislittleappetiteforcapitalinvestmentinaPBTfacilityorwillingnessonthepart 

of private healthcare insurers to pay for treatment. Private patients in the UK would 

thereforebeselffunders 

 

1.7. OtherEuropeanhealthsystemswhichhavesystemsofevaluatingthecosteffectiveness 

orrationingofcarehavedevelopedindicationlists. 

 

1.8. Facilities are currently under construction or planned in Austria, the Netherlands, 

Sweden,Germany,Italy,PolandandFrance. 

 

ManagingPBTTechnologyRisk 

PBT involves a highly technical solution with cutting edge technology that leads to complex 

design solutions. PBT remains a relatively novel healthcare treatment with only a handful of 

clinicalcentresintheworldandrelativelyfewmanufactures.Whenaddedtothehighcostofthe 

equipment and design and build costs, this emphasises the importance of getting the 

procurementoftheequipmentright. 

 

Wehaveapproachedtheissueoftechnologyselectioninsomedepth.Ourfocusthroughoutour 

wholeinvolvementwithPBThasbeenonbeingfullypreparedtoprovidetheserviceassoonas 

the Department of Health sees fit.This clearly involves not just thinking conceptually about 

issuessuchastechnologyselectionandfinancing,butformallyprogressingdifferentoptionsand 

reachingsomefirmconclusionsandpreferences. 

 

WiththerelativeimmaturityofthePBTmarket,andthelongleadintimefromprocurementtoa 

facilitybeingoperational,thechosentechnologysolutionisunlikelytohavebeenoperationalin 

manycentresifatall.Asaresult,wehaveputaparticularemphasisontechnologyselection. 

Unlikeinotherclinicalareas,technologyselectioninformsboththecapabilityofacentretotreat 

its patients, but also the process of testing the feasibility of a PBT centre fitting onto an 

organisation’sdesiredsite.Therearealsokeydecisionstomakeaboutemergingtechnologies 

andmodalities. 

 

Ourprocess,whichisoutlinedbelow,hasbeento: 

 

• Analysethebasicspecificationofrequiredfacility(i.e.numberoftreatmentandresearch 

rooms;highlevelspecificationofinroomequipment) 

• Analysetheoptimumtechnicalspecificationofasystemindetail 

• Submit our requirements to vendors and on the basis of their responses assess our 

‘preferredvendors’ 

• BegindesigningaPBTfacility(upto1:200stage)onourchosensiteonthebasisofour 

‘preferredvendors’ 

 

ProtonBeamTherapyoverview 

 

ThesetupofaPBTcentrehassimilaritiestoastandardphotonRadiotherapyfacility.However, 

thecurrentsolutionsinthemarketprimarilyofferseparateequipmentfortheacceleratorand 

 

 

 

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treatmentroomwithbothoftheseatconsiderablesizeandcost.AlongsidethePBTequipment, 

aPBTfacilitywouldalsorequireimagingequipmentandsoftwareintheformofRadiotherapy 

Management Systems (including Treatment Planning Systems). Although both of these are 

standardforaRadiotherapyfacility,duetotherelativenoveltyofPBT,therearecurrentlyfew 

solutionsinthemarket. 

 

Marketanalysisontechnologyobsolescence 

 

UCLHhastheopportunitytobecomeoneoftherelativelyfewPBTfacilitiesaroundtheworld.As 

would be expected in a relatively immature, hightechnology market, we also have the 

opportunitytoinstalltechnologyatahigherspecificationthaninanyothercentreintheworld. 

But due to the long leadin time from procurement to an operational facility, the technical 

solution will be a balance between what is tested and can be delivered, and what will limit 

obsolescence risk. There are three scenarios that need to be considered on technological 

obsolescence. 

 

• Due to microlevel developments in PBT systems, the system we procure becomes 

outdated and does not represent the highest clinical quality system for UK patients. 

Thiswouldresultinpatients,orcommissioners,choosingothercentresoverUCLH 

• PBT is superseded by technological developments – either within the field of 

radiotherapy(i.e.heavyiontherapy),orbya“silverbullet”cureforcancer.Thiswould 

resultinalossofpatients,income,andtheviabilityofthewholeservice. 

• RefinementsintechnologyleadtoPBTbeingdeliveredinsmallerandcheaperways. 

Thiswouldresultinmorecentresenteringthemarket,andresultantpressureonboth 

ourpatientnumbersandperpatientincome. 

 

Wehaveanalysedallthreescenariosonthebasisof: 

 

• Theimpactoftherisk 

• Thelikelihoodoftheriskoccurring 

• Actionswecantaketomitigateagainsttherisk 

ThePBTsystemweprocurebecomesoutdated 

 

PBT technology is constantly developing. It is therefore imperative to ensure any system 

purchasedwillbecapableoftreatingpatientsnotjustinthenext35years,butinthenext1020 

and beyond.The impact of procuring an inadequate system would be severe.Competitors 

wouldbeabletosupplyaclinicallysuperiorsystem,andwe wouldlosepatientsandincome. 

Systemsaredevelopingrapidly,andthereareseveralsignificantinnovationsonthehorizonthat 

onedayallPBTcentreswillprovide(e.g.spotscanning).Thisriskcouldbemilitatedagainstby 

procuringasystemwhichmatchesthefollowingbroadspecifications.Thiswouldensurethatthe 

currentlyavailableequipmentwillnotbeobsoletein1015yearstime. 

 

• Sufficientpenetrationtotreatanywhereinthebody 

• Reliability–uptimebetterthan97% 

• Workload–sufficientcapacityforanticipateddemand 

• VersatilitySpotscanningandIMPT 

• Excellentimmobilizationandpositioning 

• Flexiblebeamentryoptions 

• Shortbeamontimeperfield 

• Fastchangefromonefieldtothenext 

 

 

 

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• Fastchangefromonepatienttothenext 

• Lowneutroncontamination(importantespeciallyforchildren) 

• AvailabilityofaresearchroomforRadiobiologyandPhysics 

• StateoftheartInRoomImagingforpositionandtreatmentverification 

 

To further mitigate against obsolescence, current research and development requires the 

followingadditionalspecifications: 

 

• Sufficientpenetrationforprotonradiography 

• InroomInvivodosimetry 

• Abilitytoretrofitorreplaceequipmentwithnewerdevelopments 

 

TechnicalDevelopmentsduringlifetimeoffacility. 

 

Thetendershallincludetherequirementofaservicecontractthatguaranteestheavailability 

and implementation of all future hardware and software upgrades over the lifetime of the 

equipment.Replieswillneedtoincludespecificationsofthebuildingandlayoutrequirementsto 

ensurehardwarecanberetrofittedwhennecessary. 

 

In addition, and in parallel, research and development projects undertaken jointly with UCL 

Academic Departments will ensure that the capabilities of the proton therapy system and its 

associatedimagingandplanningtoolswillkeepabreastofthestateoftheartintheirfields. 

 

PBTissuperseded 

 

Bya“silverbullet”cureforcancer 

 

ThispossibilitywasalsoanalysedwithinthePhase3FinalInvestmentCase, 2 andthescientific 

andclinicalbackdroptothediscussionremainsverymuchunchanged.Whilsttherearemany 

new modalities in development (such as gene therapy, immunological therapy, photodynamic 

therapy etc), none of these represent a cure for cancer.A reduction in demand for cancer 

treatmentisthereforehighlyunlikelyinthenearfuture. 

 

Byheavyiontherapy 

 

TheonlyformofradiotherapywhichcouldbeprovensuperiortoPBTisheavyiontherapy.It 

usesthesametechnologyasPBT,butonalargerscaletoaccelerateheavierparticles,suchas 

Helium and Carbon. They have similar physical deposition patterns, but different biological 

properties, which may prove advantageous for certain tumours. Further research needs to be 

undertaken to prove these advantages, as only three active facilities currently exist – two in 

JapanandoneinGermany.ThereareafewmoreinplanninginEuropeandAsia,butnonein 

planningintheUS. 3 

 

TheimpacttoUCLHwouldbelow.Ifheavyionsareclinicallyprovenandsuchafacilityislocated 

nearLondon,therewouldcertainlybeareductionintheflowofPBTeligiblepatientstoUCLH.It 

isestimated,however,thatonlyaround1020%ofthosepatientswhobenefitfromPBTwould 

 

2 

CancerCentreFinalInvestmentCaseforPhase3(2008),p87 

3 

TheParticleTherapyCooperativeGroupwebsite(Accessed:14.03.2012) 

URL:http://ptcog.web.psi.ch/ 

 

 

 

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ebetter treatedwithheavyiontherapy.Significantly,thereislittleconfidence inheavyion 

therapybeingusedtotreatchildren, 4 whichwouldformalargeproportionofUCLH’scaseload. 5 

Thelikelihoodofthishappeningwith510yearsisverylow.HeavyIonsarestillattheresearch 

stage because of their different radiobiology, whilst PBT is considered a stateoftheart 

modality.ThecostofheavyionfacilitiesisalsouptodoublethatofaPBTfacilities,meaning 

even when heavy ions are clinically proven (as they are likely to be), it will be exceptionally 

difficult for organisations to provide a service.There are few developments on the horizon 

suggestingheavyiontherapywillbecomecommerciallyviablewithinthenext1020years.The 

costinensuringnowthattheUCLHfacilitycouldbelaterupgradedtoHeavyIonsishigh.Larger 

accelerators,magnetsandgantrieswouldberequired(roughly170%to230%thefootprintand 

thecost).However,itislikelythatin10yearstime,technologywillhaveadvancedtothepoint 

thatnew(superconducting)magnetscouldberetrofittedintheoriginalfacilitytoprovidethe 

choiceofheavierions,ifdeemednecessary.Thereforethereislittletobegainedby‘future 

proofing’thefacilityagainstheavyiontherapydevelopment. 

 

SmallerandcheaperPBTsystemsaredeveloped 

 

The main technological developments around particle therapy are not those which make PBT 

redundantorsuperseded –theyarearoundmakingPBTsmallerandcheaper.Therearetwo 

relevant technologies which are currently under development but are more than 510 years 

awayfromclinicalavailability(evenlongerforcommercialavailability). 

 

 

 

 

 

 

 

 

 

TheimpactofthesedevelopmentswouldbetomakePBTcheapertodeliver,whichwouldlower 

theoveralltariffprice.Itislikelythesetechnologies,orsimilarones,willbecomeavailableat 

somepoint.However,itishighlyunlikelythatthiswillbecomeavailableonthemarketfor1015 

years. By the time these technologies become available on the market, UCLH will have 

establisheditselfasaleadingPBTexpertintheUK.Wewillbeseenasacentreofexcellencefor 

patients,staffandcommissionersalike.Anysignificantimpactondemandisthereforelow. 

 

ThekeytechnologicalrisktoPBTisthereforenotobsolescence(thisishighlyunlikely),norfuture 

unreliability/unsuitability(thekeyspecificationsofafutureproofedsystemareclear).Rather, 

the key risk is around systems becoming smaller and cheaper in future. However, from our 

 

4 

AddressofStephanieCombs(UniversityofHeidelberg)totheParticleTherapyCooperativeGroupAnnualMeeting,2009. 

5 

DuetothepartnershipwithGOSH 

 

 

 

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Appendix2B:UCLHServiceStrategy 

TheUCLHBoarddiscussedtruststrategyatitsawaydayon9 th November. 

SPBagreedthefollowingnextstepsatitsmeetinglaterthatmonthtobeginimplementationof 

theconclusionsoftheBoardawayday: 

• Produceashortsummarydocumentupdatingthetruststrategicplan 

• UpdatetheStrategicProgrammeBoardTermsofReference 

• DevelopanddiscussatSPBthestrategyforeachofthekeyprioritiesidentifiedby 

theBoard: 

o 

o 

o 

o 

o 

Neurosciences 

Cancer 

Women’sHealth 

Providerpartnerships 

Integratedcare 

• Developaforwardworkprogramme(byDecemberSPB)thatalignstheSPBagenda 

withkeydecisionscomingtotheBoardin2012 

Setoutbelowisadraftsummaryupdateofthetrust’sstrategicprioritiesfor2012.Theintention 

ofthisdocumentwouldbetouseitasthebasisforcommunicationmorewidelybothinsideand 

outsidethetrust. 

UCLHServiceStrategy–2012/13 

1.1. Background 

TheBoardreviewedthetruststrategicserviceprioritiesfor2012/13atitsawaydayin 

November.Thispapersummarisestheconclusions. 

TheBoardlastrevieweditsservicestrategyin2008.Sevenserviceareaswereidentifiedwith 

fourspecifiedascoreresearchspecialities.Theywere:neurosciences,cancer,cardiac,women’s 

health,dental,paediatricsandacuteservices. 

Threeyearsonwehavemadeconsiderableprogressagainstthestrategicprioritiesweidentified 

atthetimeforeachserviceincludingworkingwithUCLtosecurethebidforanew 

neurosciencesresearchcentre(SainsburyWelcome),successfullymovingwomen’shealthintoa 

newfacilityinPhase2in2008andcompletingthedevelopmentofanewCancercentreand 

cancerpartnershipwithMacmillan. 

Wehavedeliveredthesechangeswhilstcontinuingtomaintainandbuilduponourreputation 

forexcellentpatientcare,recognisedbyDrFosterin2009and2011. 

WehavecontinuedtogrowUCLHasanorganisationwiththeacquisitionoftheRoyalNational 

ThroatNoseandEarHospitalin2012whichwillformtheplatformforthefurtherdevelopment 

ofHead&NeckservicesatUCLH. 

Wehavealsocontinuedourfocusonresearchandacademicexcellence.UCLHwasafounding 

memberofUCLPin2009,theUKslargestandarguablyleadingAcademicHealthScienceCentre. 

In2011,togetherwithUCLwesuccessfullysecuredCBRCfundingof£100mtowardsourjoint 

clinicalandtranslationalresearchagenda. 

 

 

 

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1.2 Thechallengeahead 

Lookingforwardhowever,wefaceachallengingenvironment: 

• WefacearealtermsflatNHSbudgetforpossiblyaslongasto2020(accordingtothe 

KingsFund) 

• WehavebetterfacilitiesthanthemajorityoftrustsinLondonbutcapacitywithin 

thebuildingisnowconstrained(e.g.A&E,maternity).Furthergrowthcouldrequirea 

stepchangeininvestmentoramajorchangeinworkingpractices 

• Commissionershavesignalledtheirintenttocontinuesupportingashiftofcareout 

of hospital into the community whilst centralising some specialist services to 

improvequality 

• Wehavefurtherworktodotodevelopourpartnershiprelationshipswiththelocal 

DGHandprimarycarecommunity 

• Theproviderlandscapearoundusischangingrapidlywithplansformergersinmost 

sectorsinLondon 

• Arrangementsforthecommissioningofmedicaleducationarechanging 

• BRC funding is now directed towards Experimental Medicine and we have been 

challengedtonarrowourareasoffocus. 

1.3 Ourvision 

TheBoardagreedourvisionremainsunchangedfrom2008;UCLHiscommittedtodelivering 

topqualitypatientcare,excellenteducationandworldclassresearch. 

Underpinningthiscorporatevisionisourcommitmenttocontinuetoprovidebothaserviceto 

ourlocalpopulationalongsidespecialistservicesforthepopulationofLondonandbeyond. 

1.4 Strategicdevelopmentpriorities 

TheBoardreviewedourcurrentservicesagainstarangeofcriteria.Theyincluded: 

• LinkwiththeBRCstrategyforthenext5years 

• Competitivepositionatalocal,Londonandnationallevel 

• Extenttowhichtheservicehascriticalmassandacomprehensiveoffer 

• Availabilityofcapacity 

TheBoardagreedthreestrategicservicedevelopmentprioritiesandfourareasofpartnershipto 

focusonintheyearahead.Theywere: 

Services 

• Neurosciences; where priorities include securing further neurooncology and 

neurosurgeryactivity 

,ensuringacademicandclinical 

priorities and strengths are aligned where possible, building on the successful 

Wolfsonbidtodevelopexperimentalneurologyandincreaserecruitmenttoclinical 

trials,anddevelopingplansfornewcapacityincludingworkingupa“QueensSq@” 

deliverymodel 

• Cancer;whereprioritiesincludesuccessfulcommissioningofthenewCancerCentre, 

delivering a step change in patient experience, securing Proton Beam Therapy, 

 

 

 

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Partnerships 

supportingthedevelopmentoftheLondonCancerpartnershipandsupportingthe 

expansionofacademiccancertocompetenationally 

• Women’s health; where priorities include developing plans for expansion of 

maternity in line with women’s choice, and to further develop UCLH’s role as a 

network,Londonandnationalproviderofcomplexcareforwomenandneonates, 

andinadditionsupportingthecanceragendaingynaecologicalcancersandbreast 

cancersurgery. 

• DevelopthepartnershipwithBLTforthefuturejointprovisionofcardiacservices 

• DevelopanapproachtoIntegratedCarebasedoneffectivepartnershipswithlocal 

primaryandcommunitycareproviders 

• FurtherdevelopthepartnershipwithGOSHforcancercareforchildrenandyoung 

people,andtertiarypaediatricspecialties. 

• Considerwherethetrustcanworkwithlocalacutepartnerstodevelopservices 

• Work with UCL to align the trust and university strategies in order to successfully 

competeinanincreasinglyglobalmarketplace 

Inaddition,wehavealreadyhighlightedaboveontheinterrelationshipbetweenourstrategic 

servicedevelopmentprioritiesandlocalhospitalcommitment. 

Ourvisionofsuccessfuldevelopmentofspecialistservicesrequiresaplatformofexcellencein 

surgery,emergencymedicineandacutepaediatrics.Thismeansinvestingindevelopmentof 

surgeryparticularlyinareaswhichsupportourobjectivesandensuringthatnewcommissioner 

standardsforacuteservicequalityandsafetyaremet. 

1.5 Nextsteps 

TheExecutiveBoardandtheTrustBoardhaverequestedthatplansarenowdevelopedto 

achieveourobjectivesforeachprioritiesidentified.Thesewillbedevelopedanddiscussed 

duringthefirsthalfof2012. 

 

 

 

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Appendix2C:EqualityImpactAssessment 

UCLHProtonBeamTherapyEqualityImpactAssessment 

Whatistheobjective(s)ofthisactivity? 

DevelopmentofNationalProtonBeamTherapyServiceonUCLHOdeon/Rosenheimsite 

Whowillbeaffectedbythisactivity? 

Patients,Carers,Staff 

Is there any evidence or potential that affected people might have different experiences or 

needsinrelationtothisactivity? 

AGEYes 

Basedonthecurrentindicationlist,around20%patientswillbechildren,andwithasignificant 

proportionrequiringGAs. 

The needs of this group of patients have been built into the PBT plans. UCLH has the largest 

paediatricandyoungadultcentreforradiotherapyintheUKandwithaclosepartnershipwith 

GreatOrmondStreetHospital.PBTwilltakeforwardthemodelalreadysuccessfullybeingused 

inUCLH’sRadiotherapyservice. 

 

DISABILITY–Yes 

Enablingdisabledpatients’fulluseofthePBTfacilityhasbeendevelopedintothedesigns.The 

facility will be built to legal requirements regarding disability access. Information will also be 

developed to enable access for all patients. Providing the appropriate transport and 

accommodationwillalsobebuiltintotheplans. 

TheDHcurrentlyreferpatientsabroadsoUCLHwillbeabletotapintotheresourcescurrently 

usedtounderstandthewiderrequirementsofdisabledgroups. 

 

SEXYes 

Theextendedworkingdaywillaffecttheshiftpatterns;somewillneedtoworkearlyshiftsand 

late shifts. This could adversely impact upon those with childcare responsibilities (which are 

more commonly females). The working day is a business requirement and there is a need to 

ensure there are sufficient staff to work unsocial shift patterns. The shift patterns can not be 

avoided, but the project will be working with HR to appropriately develop new employment 

contracts. 

 

RACEYes 

AsPBTisanationalservice,patientsfromavarietyofbackgroundswillbetreatedatUCLH.The 

PBT service will build on UCLH’s current approach to diversity and will use local translation 

serviceswhereappropriate.ThePBTteamwilllearnfromtheexistingDHProtonBeamTherapy 

programmetoreferpatientstooverseascentres. 

 

 

 

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RELIGIONORBELIEFNo 

StandardNHSpolicieswillapplytotreatmentsensuringnodiscrimination. 

 

SEXUALORIENTATIONNo 

 

GENDERREASSIGNMENTNo 

 

MARRIAGE,CIVILPARTNERHSIPNo 

 

PREGNANCY,MATERNITYNo 

 

Basedontheabove,isafullequalityimpactanalysisrequiredforthisactivity? 

No 

• The service will be delivered in a new centre. This will be designed to meet all 

equalityrequirementsassetoutinlaw. 

• Accesstotheservicewillnotberestrictedduetoage.Theservicewillbuildonthe 

currentmodelinRadiotherapy 

• Access to the service through insufficient communication will not occur as 

appropriate comms materials will be provided to disabled groups and to their 

referringcentres. 

• Access will not be restricted to through language issues as appropriate comms 

materialswillbeprovidedinnecessarylanguagesandtotheirreferringcentres. 

• The service is being coordinated by DH at the moment (as they refer patients 

abroad).Thereexperienceofcommunicatingtovariousgroupswillbeinvaluable. 

• The extended working hours will impact staff groups, and could adversely affect 

thosewithchildcareresponsibilities.Thiscannotbeavoidedasthereisabusiness 

needtoworkthelongerhours. 

 

 

 

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Appendix3A:UCLHandtheChristiePBTthroughputmodelling 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Appendix3B:PBTQualitativeBenefitsAnalysis 

 

 

 

 

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Appendix3C:EconomicAssessmentwithQALYAnalysis 

TheOBCNetPresentValueanalysisinTable14onpage63oftheUCLHOBCwaspredicatedona 

40 year appraisal period. Notwithstanding this, the Trust has responded to the challenge of 

considering the proposal over a 20 year period. The following sections update the economic 

assessmentacross20years. 

Following the Green Book guidance, the Trust has updated the Economic Analysis of the PBT 

OBC. The Trust has included an assessment of QALY analysis within its presentation, which is 

derivedfromtheanalysispresentedintheDepartmentofHealthStrategicOutlineCase;thisis 

includedinAppendix3A.TheQALYassessmentpresentstheUCLHoptionsanalysiswithinthe 

QALYanalysisframeworkdevelopedforDepartmentofHealthStrategicOutlineCase. 

EconomicAppraisalupdate 

This economic assessment focuses on the economic impact of the UCLH PBT Service. The 

followingcostsandbenefitswereconsidered: 

Capitalcosts 

Revenuecosts 

Overseascosts 

Radiotherapy 

costs 

Opportunity 

costs 

Costofrisk 

ResidualValueof 

assets 

Building designs have been developed with our design team led by 

architects 

, and Construction costs have been 

providedbytheteam’scostadvisors, . 

Equipmentcostshavebeendevelopedfromthemarketsoundings. 

Contingencyat10%andOptimismBiasof14.3%hasbeenincludedin 

thecosts. 

Capitalisedprojectmanagementcostshavebeendeterminedinternally 

bydefiningthestaffingandsupportrequirementsoftheservice. 

Revenuecostshavebeendeterminedinternallybydefiningthestaffing 

and nonpay operational requirements of the service, including 

overheads. 

Costs of continuing to treat patients at overseas centres, source DH 

StrategicOutlineCase(SOC). 

Costsofcontinuingtotreatpatientswithradiotherapy,sourceSOC. 

Opportunitycoststypicallyrepresenttheassociateduseofthelandto 

development the centre. The Trust has plans to develop the site on 

whichtheproposedPBTfacilitywillbelocated.AssuchtheTrusthas 

no intention to dispose of the site and so it considers that the land 

thereforehasnodirectopportunitycostforthePBTOBC 

Anumberofriskitemswerequantifiedincluding: 

Costchanges:Equipment,Construction,ProjectManagement,Staffing, 

VAT,andnonPay. 

Delay costs from procurement, design work, equipment delivery, 

construction, commissioning impact on both extending Project 

Management costs and reducing the number of patients treated 

thereforereducingthelevelofQALYs 

Theestimatevalueofthebuildingafter20yearsofoperation 

 

 

 

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Developrelationshipswithcharitiesthathaveexistingassociationwithservicestobeprovidedin 

Phase4 

Philanthropy: raisedforPBT 

Research&innovationobjectives 

Technicalsolutionensuresfutureproofing 

100%PBTpatientsenrolledinclinicaltrials(DHpolicy) 

Partnerships 

ResolutionoffutureworkingarrangementswithinUCLPonLondonCancer 

EstablishmentofNationalProtonBeamTherapyServicewithDH,NCBandTheChristie 

Patientexperience 

ReviewpatientinformationserviceanddeterminewhatisrequiredtomakeserviceatUCLH 

thebestinthecountrywhenthePhase4opens 

 

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DHStrategicOutlineCase 

(January2012)

Appendix3E:FinancialAppraisal 

PHASE4DEVELOPMENTOUTLINEBUSINESSCASE 

CONTENTSOFFINANCIALMODELLINGAPPENDIX 

Section Appendixdetail 

1 PBTFinancialmodel–keyassumptions 

2 EconomicCase 

Keyfinancialextracts 

3 FinancialCase 

Keyfinancialextracts–I&E,balancesheetandcashflow 

4 CommentaryonProtonBeamRecurringandnonrecurringrevenuecosts 

5 Reconciliation of capital costs – Quantity Surveyor magnitude of cost to 

financialmodelcapitalcost 

6 OptimismBiasCalculation 

 

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SECTION2–ECONOMICCASE–FINANCIALEXTRACT(REAL) 

 

 

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SECTION3–FINANCIALCASEEXTRACTSI&E,BALANCESHEETNADCASHFLOW(NOMINAL) 

PROTONBEAMFINANCIALSTATEMENTS 

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SECTION4CommentaryonProtonBeamRecurringandnonrecurringrevenuecosts 

1 ProtonBeamRevenueCosts 

RecurringFacilityinfrastructurerunningcosts 

The revenue infrastructure costs for the new build have been estimated based on the size and configuration of the proposed facility with the recurring 

revenuecostsforthenewbuildoptionsbeingestimatedtakingaccountofthefollowing: 

• CapitalChargesandfundingmechanism 

• UtilitieswithseparatecalculationsforPBTelectricityconsumption 

• Rates(basedonPhase3) 

• HardandSoftFacilitiesManagement(basedonPhase3) 

• AllrevenuecostsincludenonrecoverableVAT 

The project team is mindful of the fact that cost estimates included with the Strategic Investment Framework for the Cancer Centre turned out to be 

substantiallyunderestimatedwhencomparedtoactualcoststhatarosepostopening. 

ComparisonshavebeenmadebetweentheestimatedrunningcostsforPhase4facilityascomparedtotheactualcostsofbothPhase3andPhase1and2. 

WherethishasidentifieddeficienciesinthePhase4runningcostestimatesthesehavebeenanalysedandwhereappropriatePhase4costadjustmentshave 

beenmade. 

Thetrustcurrentlyhasoutsourcedfacilitiesmanagement(FM)servicesacrossitssites,includingtherecentlyopenedcancercentre.Inthefirstinstanceitis 

feltthatthatthefacilitiesmanagementservicesinPhase4willagainbeprovidedbyanoutsourcedsolution.AccordinglyFMcostsestimatesforthePhase4 

facilityhavebeenbasedonthecurrentlyoutsourcedsolutionforboththetower/podiumandthecancercentre. 

The final cost consideration was the PBT utility costs which represent one of the key operating costs for the PBT facility. In order to provide a robust 

electricitycostestimatethetrustpreviouslyworkedwithaUSoperationfacility toidentifyamethodologyofderivingarobustutilitycosts 

estimate.Thiscostestimatewasvalidatedby in2010asbeingreasonableforPBTfacilityandsothecostshavebeenupdatedtocurrentutility 

costswithinthecurrentfinancialmodel. 

Accordinglytheprojectteamfeelsthatitnowhasrobustestimatesforthefacilitycostsidentifiedabove. 

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• Directandindirectnonpaycosts 

• Corporateoverheads 

PBTstaffcosts 

Duringyearoneofoperation,thePBTfacilitywillbecommissionedattherateof1roomperquarter,resultinginthreeroomsbeingfullyoperationalbythe 

endofquarter3andwhereappropriatefourroomsbeingfullyoperationalbytheendofthefirstyear.Thiscommissionofrooms,coupledwithshortworking 

daysof8hourssubstantiallylimitspatientthroughputinyear1ofoperation. 

AsidentifiedundernonrecurringPBTcostsitwillbenecessarytorampupstaffinthefinalyearofconstructionsothatstaffareabletobefullytrainedas 

wellasbeinginvolvedwithtestingthePBTequipmentandestablishingtheclinicalpathway. 

BasedonexperiencefromtheUS,itisanticipatedthattypicallyitwillbetheendofyearthreebeforethesiteisfullyoperational,atwhichstageithasbeen 

projectedthatitwilloperateona16hourday5daysaweekbasis(8hoursperdayinyear1and11hoursperdayinyear2).Theopeninghoursofthefacility 

andtotalquantumofstaffcostshavebeencomparedwiththeChristie’sstaffingmodelandfoundtobewhollyconsistent. 

Equipmentmaintenance 

AsidentifiedinthecapitalcostsectionthePBTsolutionishighlycapitalintensivewithPBTequipmentandsupportdiagnostictechnologycostingintheregion 

of for a 3 room solution. Broadly speaking NHS experience is that in general maintenance of clinical equipment costs in the region of 

 

• Treatmentplanningsystem 

• Datamanagementsystem 

• Imagingsystems 

• CorePBTequipment 

Corporateoverheads 

TheprojectteamhasrecognisedthatthePBTproposalrepresentsasubstantialsteppedchangetothetrust’sactivity.Anestimateofclinicaladministrative 

resources has been included in the PBT staff cost estimate, including such roles as general manager, business manager and data management staff. In 

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addition, the financial model includes a cost estimate of . to cover an increase in other indirect trust cost representing approximately 5.0% of 

projectedRealincomeofcirca . 

Otheroperatingcosts 

The exact scope of the PBT service has yet to be definitely agreed with DH. By way of example although such costs as patient transport and patient 

accommodationwillbeanimportantpartoftheoverallPBTpathway,thetrusthasconsistentlynotedthatitisunabletoincludeacostestimateofsuch 

activitiesunlessDHareabletoconfirmwhetherthiscostshouldbebornecentrally,locallyorbythePBTcentres.Thetrusthasclearlynotedanumberof 

exclusionsfromitsprojectedcostbasewhichwillbeincludedwithintheSIF. 

Notwithstandingthesespecificexclusions,thetrusthasmadespecificcostallowanceswithinthefinancialmodelforadministration,marketingandother 

nonpropertyrelatedcontractedoutservicesat orabout ofincome. 

ItisfeltthatthesecostestimatesshouldrepresentaprudentestimateofPBTcostsbasedonbothU.S.APBTandlocalradiotherapyexperience. 

 

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OBForm1–SummaryofCapitalCosts. 

 

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OBForm2SupplierAWorksCosts 

 

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OBForm2SupplierBWorksCosts 

 

 

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OBForm3SupplierAOnCosts 

 

 

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OBForm3SupplierBOnCosts 

 

 

 

 

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OBForm4SupplierAFeesandNonWorksCosts 

 

 

 

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OBForm4SupplierBFeesandNonWorksCosts 

 

 

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SECTION6OptimismBiasCalculation 

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Programme opportunities in the PBT equipment procurement process 

Introduction 

The purpose of this paper is to outline the selected procurement process, the timescales, the level of 

commitment on the part of the Trusts to proceed, and provide recommendations for the appropriate timing of 

the procurement phases. 

The equipment procurement is on the critical path for the PBT project (See Annex A for current agreed 

programme milestones 7 ). As a result, any opportunities for time savings in the procurement process will lead 

to efficiencies in the overall programme with any delays similarly feeding into the overall programme. Under 

the current programme, the Expression of Interest phase with a Pre-Qualifying Questionnaire is launched at 

the end of January 2013 (Line 8). However, this is linked to full Government approval of the Trusts’ Outline 

Business Cases (Line 7). It is estimated that there is a minimum of a two month period for this phase, which is 

prior to launching the tender phase with the Invitation to Participate in Dialogue (ITPD) (Line 9). This paper 

makes the following recommendations: 

Keep to the current programme and launch the Expression of Interest phase in early 2013 

Launch the tender phase at the point of full Government approval of the Trusts’ Outline Business 

Cases (OBC) 

Procurement Route 

Due to the complexity of the equipment procurement, it has been determined that Competitive Dialogue (CD) 

is the most appropriate procurement route to ascertain the technical means of meeting the Trusts’ 

requirements. As such, there are two main phases for the procurement: 

1. Expression of Interest (EoI) phase 

Process 

The Expression of Interest (EoI) phase is launched with the publication of three documents in the supplement 

to the Official Journal of the European Union (Line 8): 

 

 

 

 

A Contract Notice (CN). This will define the procurement route and the single lot procurement of PBT 

equipment and services for both Trusts. The Contract Notice will define the maximum and minimum 

number of Bidders to be taken through to CD. 

A Pre-Qualification Questionnaire (PQQ). This will define the range of data (financial, insurances, 

policies, previous relevant experience, case studies and testimonials) that Bidders need to make 

available as part of their expression of interest submissions. 

A Memorandum of Information (MoI). This document provides information on the background to the 

project, an overview of the procurement process, evaluation criteria and weightings, commercial 

principles and guidelines for the Bidders. 

Expressions of interest will be then be evaluated. Bidders who pass through the two pass/fail gateways 

covering eligibility and financial standing will then be considered in terms of their technical and professional 

ability. Marks will be awarded based on bidders’ experience, case studies and testimonials. At the end of this 

stage the Bidders will be ranked to determine who will be invited to tender for the equipment procurement and 

participate in the CD. 

Level of commitment 

 

7 N.B. The Programme Milestones tracks the key activities and does not provide the full details on 

the PBT equipment procurement and wider PBT programme. There is also a difference in 

terminology used 

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Up to this point in the process, no future commitment – financial or otherwise – has been made by the Trusts. 

The process to this point merely seeks expressions of interest from Bidders who wish to be considered. The 

MoI referred to above will make it clear to Bidders that the Trusts will be under no obligation to pay for any 

costs incurred by Bidders or to award a contract as a result of the procurement process. This can be mirrored 

in the CN as well. If at this point, the project does not continue, whilst there will be a reputational impact on the 

Trusts, the only costs incurred by the Trusts will be in relation to the procurement and legal advice provided. 

There would be no further known Trust-related liabilities and none in relation to the DH. 

Time Period 

There is a minimum 30 day period from issue of CN, PQQ and MoI to receipt of expressions of interest and a 

further 30 days for the evaluation of expressions of interest. As such, this phase is currently programmed in 

for a minimum of a two month period. 

Recommendations 

To maintain the current programme requires the launch of the EoI phase at the end of January 2013. As the 

level of commitment to the Trusts is minimal, and does not involve a tender for solutions, the recommendation 

is the current programme is maintained. This could be linked to the approval of the Strategic Investment 

Framework to give all parties sufficient formal support for the overall PBT project. 

2. Tender phase 

Process 

The CD procurement route provides a high degree of flexibility in relation to how the dialogue is phased and 

the time period the dialogue is conducted within. An indicative timetable for the CD will be indicated in the MoI 

and the Trusts will reserve the right to adjust this timescale. The following process is based on the 

assumption that the CD will comprise two stages: 

Invitation to Participate in Dialogue (ITPD) (Line 9) 

The Invitation to Participate in Dialogue document will be issued to shortlisted Bidders at the commencement 

of the dialogue phase. It will set out the Trusts’ requirements, define how the dialogue will be conducted and 

confirm the number of down selection phases. It will also include the criteria and weightings for the rest of the 

process and the indicative timetable. 

1st stage dialogue 

In this first stage of the dialogue the focus will be on the technical solutions and some of the key commercial 

considerations. Prior to commencement of the 1:1 first stage dialogues there is the option of holding a Bidders 

open day to talk through the process. 

Invitation to submit outline solution (ISOS) 

At the end of the first stage dialogue Bidders will be invited to submit their outline design solutions. Bidders 

can be requested to include indicative costs at this point. These bids will be evaluated against the agreed 

criteria to down select to the Bidders taken through to the 2nd stage dialogue. 

2nd stage Dialogue (Line 10) 

In the second stage dialogue the focus will be on refining proposals and the development of commercial and 

contractual aspects. It needs to be remembered that all aspects of the contract have to be agreed 

substantially before the dialogue phase is concluded. 

Submission of final tenders 

When the Trusts consider that the competitive dialogue can be drawn to a close the Bidders will be asked to 

submit their final tenders. These final tender submissions will then be evaluated in accordance with the 

published procedure to determine the successful bidder. 

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Evaluation, clarification and fine tuning 

There will then be a period of post-tender dialogue. 

Contract award notification and standstill period 

At the appropriate time Bidders will be notified of the contract award decision and it is at this point that the 

mandatory 10 day standstill period commences. 

Level of commitment 

The ITPD document issued to Bidders at the commencement of the CD phase will indicate that the Trusts will 

be under no obligation to pay for any costs incurred by Bidders or to award a contract as a result of the 

procurement process. 

Time Period 

The programme currently indicates that the period of competitive dialogue will be a minimum of 12 months. 

Recommendations. 

As the ITPD will issue the Trusts’ requirements and tender process, this requires formal approval of the 

project to proceed. As such, the recommendation is that the ITPD is linked to full Government approval of the 

Trusts’ OBCs. 

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1. This paper outlines the requirements for external technical advisors for the procurement of PBT 

equipment. 

Background 

2. A range of external advisors will be required to ensure the Proton Beam Therapy (PBT) programme 

delivers the required outcomes: 

Financial 

Legal 

Procurement 

Design 

Technical 

Clinical 

Beyond the procurement stage the trusts would require further advice and support during the 

mobilisation and ramp-up stages which may include a comprehensive training package for clinicians, 

physics staff and radiographic staff. Depending on the supplier of the final equipment, the trusts may 

choose to select different technical advisors at the two different stages of the project (procurement 

and mobilisation). 

Recommendation 

3. We recommend that: 

the selection of the technical advisors for the trusts for the initial procurement stage be 

selected first, 

the appointment of the second set of advisors, for mobilisation and ramp up, is completed 

once the procurement stage is complete and the preferred proton equipment supplier(s) are 

known. 

The Steering Committee is asked to endorse the above recommendations. 

Procurement Stages 

4. The Christie and UCLH will be the first trusts in the UK to procure high energy PBT equipment. The 

procurement of proton therapy will be a complex process as: 

PBT equipment represents a significant amount of the considerable capital required for the 

development of the clinical service. 

PBT technology is progressing rapidly with several vendors bringing new products to market. 

PBT procurement decisions have often been challenged. 

There are four stakeholders DH, NHS Commissioners, UCLH and Christie involved in the 

process. 

5. It is important to ensure that the PBT equipment procurement results in the purchase of the correct 

equipment to deliver the proton therapy programme and importantly: 

 

 

 

is performed in compliance with EU procurement legislation; 

is conducted without bias to any particular manufacturer and 

is completed expediently to facilitate timely opening of the centres. 

Subject Areas for Advice 

6. The areas where a need for external advice has been identified are: 

 

Technical advice proton beam therapy – Proton treatments are significantly different to photon 

radiotherapy treatments that the Christie and UCLH are used to planning and delivering. 

Consequently the trusts lack knowledge about PBT treatments that will dictate requirements 

for proton therapy equipment. Technical advice from physicists accustomed to proton therapy 

equipment will strengthen the procurement team. 

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Technical advice proton equipment – The progress of proton therapy technology means that 

the procurement process will need to evaluate technology that may not have been clinically 

implemented. This will require assessment of the development timeline for manufacturer’s 

equipment and analysis of the impact of changes to PBT equipment. There is considerable 

expertise from the particle physics accelerator community in designing and building proton 

accelerators and this expertise could assist in assessing potential developments tendered by 

PBT vendors. 

Contract Negotiation – During visits to PBT centres the importance of contract negotiation 

with proton beam manufacturers has been stressed by several centres. PBT requires an 

ongoing relationship with the equipment supplier and attaining the correct contractual 

framework to enable constructive working practices for the trusts and the equipment suppliers 

is essential. 

Type of advice, Commitment and Cost 

7. The procurement process is likely to take more than twelve months and the roles of those 

participating, internally and externally, need to be clearly defined. The key areas that have been 

identified for external advice are: 

 

 

 

 

Advising on detailed specification for PBT equipment. 

Advice on evaluation criteria for PBT equipment. 

Clarification of technical detail in the PBT tenders from manufacturers. 

Advice on scope and detail of contracts with PBT manufacturers. 

8. It should be noted that external advisors act in a purely advisory role and will not be involved in the 

evaluation of tender responses. Acting in an advisory role, rather than being involved in the primary 

evaluation, should reduce the liability of individuals, trusts and DH, should the process be challenged. 

As advisors they cannot be involved in the actual scoring of the tender responses again reducing the 

possibility of a challenge during the procurement stages. The evaluation of tender responses will be 

taken forward by the Trusts’ teams. 

9. The PBT Technical Advisory Group should be consulted at all the key steps of the procurement 

process and in particular should advise on (See #17 on group governance): 

 

 

 

 

Content for pre qualification questionnaires. 

The technical specification for proton therapy equipment. 

Returns from manufacturers at all stages in the procurement process. 

Discussions at contract stage with the two preferred bidders. 

10. The particular requirements will depend on the procurement process employed and should be 

mapped out as part of planning the PBT procurement. 

11. The Trust appointed technical advisors will be required to give advice at several points in the process 

and the time commitment has been estimated at 50hrs over the procurement process. An estimated 

market rate for specialist technical advice has been estimated at per hour but cost may vary. 

Travel for advisors will be kept to a minimum and importantly they will not be required to attend site 

visits with potential suppliers. So the cost of additional advisors will be in the order of split 

between the trusts. 

12. Given this estimated costs, market testing will be conducted whereby two quotations will be sought for 

each advisory role. The trusts will then decide on the most suitably-qualified person for each role 

including a value-for-money analysis. 

Selecting Advisors 

13. The trusts have established links with many potential advisors in the PBT community and the DH 

have commissioned advice from through the development of the proton 

beam programme. The route for procurement of further advice will need to be agreed by the trusts 

and the DH. Market testing may be of limited effect in an area with few specialized advisors and care 

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would need to be taken that an open selection process did not disenfranchise important proton links 

nationally or internationally. It is important that the process will provide the required advice to the 

trusts and the DH. 

14. Through established links developed during the proton programme the trusts and DH have identified 

potential advisors who could provide advice in the required areas: 

Technical advice proton beam therapy - continues to serve as a 

member of the PBT Steering Committee, it is suggested that Professor Lomax is asked to 

chair the PBT Technical Advisory Group, 

Technical advice proton equipment - Both UCLH and The Christie have established links with 

proton accelerator scientists and have suggested advisors. UCLH have proposed 

and The Christie . It is envisaged that they will 

advise both Trusts as they bring different knowledge and skill-base to the Trusts. 

has extensive knowledge on accelerator design, beam optics and beam transport whilst 

offers expertise on beam diagnostics and dynamic beam simulations. They will be 

appointed individually through the separate trusts due to existing relationships 

Contract Negotiation – The Christie and UCLH have both recommended 

of who has experience of contract negotiation for a large and complex 

proton therapy project. The s econd proposed advisor to approached, for market 

testing purposes, would be Dr Al Smith, formerly of 

who has extensive 

Physics experience in one of the longest-running clinical centres. 

15. The Trusts shall draw up a joint contract between Trusts and the individual advisor, as opposed to 

their organisations. The length of this contract shall extend through the procurement process through 

to final signing of contracts with the preferred PBT supplier. This is expected to be approximately 30 

months. 

16. Contracts between the trusts and the advisors shall abide by terms and conditions as set out in the 

NHS Conditions of Contract for the Supply of Services (September 2010). 

Proposed Governance 

17. It is suggested that the advisors appointed form a trust advisory group (Technical Advisory Group) 

which 

will be invited to chair. The DH may also require technical advice to the 

wider programme and the trust advisory group would also be able to advise where appropriate should 

the DH wish to commission them. 

18. Members of the Technical Advisory Group would be expected to sign Non-disclosure Agreements 

(NDA) with both trusts which would also include the NDA agreements signed between trusts and 

suppliers. 

19. The commitment required for the role should be clear and it is important that the advisors see their 

role as advising the national programme as well as individual trusts and in particular contracts should 

be arranged through the trusts. Any conflicts of interest with particular manufacturers should be 

declared and any resultant restrictions to the scope of the advice given will be discussed with 

procurement and legal advisors. 

Non-Disclosure Agreements (NDA) 

20. Currently, The Christie and UCLH have signed three way non disclosure agreements with the 

suppliers. During the procurement process, information forwarded under these agreements will be 

disclosed to the advisory panel. Currently the three way NDA signed by The Christie and UCLH would 

not allow them to disclose information to the DH proton team. The procurement process must set 

suitable NDA arrangements to ensure a free flow of information between all parties participating and 

advising procurement. 

Trust requirements from the Technical Advisory Group to procurement completion 

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21. Once appointed, the Trusts would call on the Technical Advisory Group for support and advice as 

follows: 

to hold an initial series of meetings with all interested parties at UCLH and Christie to be 

briefed on issues, requirements, priorities and methods of communication etc. 

to review technical specifications for upcoming procurements of technical equipment. 

the development of technical documentation for procurement equipment 

review and support the development of evaluation criteria for supplier tender responses 

to contribute towards the assessments tender responses 

to advise on the tender responses from equipment suppliers 

to contribute towards the working up of the competitive dialogue documents 

to provide advice on the Trusts’ evaluations of the tender responses following the Trusts’ 

assessments 

assist in contract negotiation in technical advice on, but not exclusively: 

• Maintenance requirements 

• Deliverability and KPI 

To provide advice on build designs for functionality and radiation protection 

22. The technical advisors will not be expected to take part in the formal evaluation of the tender 

responses or the final selection of suppliers. This will remove any risk of challenge from suppliers on 

the basis of any bias towards suppliers familiar to advisors. 

will be able to bring 

valuable technical experience to the process, but they do not have any direct clinical experience, 

hence would not be well placed to evaluate against the requirements of the two Trusts. 

have relevant clinical experience but have pre-existing relationships with 

manufacturers that are likely to be involved in the procurement process. 

Trust requirements for advice for commissioning and ramp-up (Mobilisation Stage) 

23. Support from the Technical Advisory Group as described should see the Trusts through to the 

completion of the contractual stages of the procurement where the final chosen supplier(s) are 

selected. Beyond this stage, the Trusts would seek to commission further or new advisors to assist 

through the commissioning and ramp-up stages of the project. The advice and support during the 

mobilisation and ramp-up stages would include a comprehensive training package for clinicians, 

physics staff and radiographic staff. This role would be provided by an existing PBT centre with the 

choice of centre dependent on selection of the preferred proton equipment supplier(s) and include 

representatives from a clinical team experienced in delivering PBT to paediatric and complex adult 

indications to include Clinicians, Physicists, radiographers and facility administrators 

24. At this stage, the Trusts will draw up a joint contract between Trusts and the advisory team from the 

chosen clinical centre. The length of this contract shall extend through the acceptance and 

commissioning phase through to the initial ramp-up clinical stage. This is expected to be 

approximately 12-18 months. 

 

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Annex D 

Document no 2 

Purpose 

REQUIREMENTS DOCUMENT 

Technical Advice to Support the Procurement of Proton Beam Therapy Delivery Systems 

UCL Hospitals NHS Foundation Trust and The Christie NHS Foundation Trust (the Trusts) seek 

expressions of interest to provide Medical Physics technical advice to both Trusts and Department 

of Health (DH) to support the procurement of Proton Beam Therapy delivery equipment for the UK 

National Service through to the completion of contracts with the chosen PBT supplier. 

Introduction 

The UK Department of Health has announced the development of two facilities to provide a National 

Proton Beam therapy (PBT) service. The two selected sites are University College London 

Hospitals NHS FT in London and The Christie NHS FT in Manchester. 

The Christie and UCLH will be the first Trusts in the UK to procure high energy PBT equipment. 

Proton treatments are significantly different to photon radiotherapy treatments that the Christie and 

UCLH are used to planning and delivering. Consequently the Trusts lack knowledge about PBT 

treatments that will dictate requirements for proton therapy equipment. Technical advice from 

physicists accustomed to proton therapy equipment and its clinical use will strengthen the 

procurement team. 

The procurement of proton therapy will be a complex process as: 

 

 

 

 

PBT equipment represents a significant amount of the considerable capital required for the 

development of the clinical service. 

PBT technology is progressing rapidly with several vendors bringing new products to market. 

PBT procurement decisions have often been challenged. 

There are four stakeholders DH, NHS Commissioners, UCLH and Christie involved in the 

process. 

It is important to ensure that the PBT equipment procurement results in the purchase of the correct 

equipment to deliver the proton therapy programme and importantly: 

 

 

 

is performed in compliance with EU procurement legislation; 

is conducted without bias to any particular manufacturer and 

is completed expediently to facilitate timely opening of the centres. 

The two Trusts are therefore seeking to procure Medical Physics technical advice to assist in the 

procurement and contractual stages of the project. 

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Proposed Governance 

The DH has appointed 

as their technical advisor. The Trusts have also secured 

accelerator technology advisors in the persons of 

. It is proposed that all the technical advisors, including the one(s) appointed 

through this bid, form a Technical Advisory Group which 

will be invited to chair. 

The DH may also require technical advice to the wider programme and the Technical Advisory 

Group would also be able to advise where appropriate should the DH wish to commission them. 

The PBT Technical Advisory Group should be consulted at all the key steps of the procurement 

process and in particular should advise on: 

 

 

 

 

Content for pre-qualification questionnaires. 

The technical specification for proton therapy equipment. 

Returns from manufacturers at all stages in the procurement process. 

Discussions at contract stage with the two preferred bidders. 

Members of the Technical Advisory Group would be expected to sign Non-disclosure Agreements 

(NDA) with both Trusts which would also include the NDA agreements signed between Trusts and 

suppliers. Currently, The Christie and UCLH have signed three way non-disclosure agreements with 

the suppliers. During the procurement process, information forwarded under these agreements will 

be disclosed to the advisory panel. It is anticipated that appropriate NDA will be in place to allow the 

free-flow of information with the advisory group. 

The commitment required for the role should be clear and it is important that the advisors see their 

role as advising the national programme as well as individual Trusts and, in particular, contracts 

should be arranged through the Trusts. Any conflicts of interest with particular manufacturers should 

be declared and any resultant restrictions to the scope of the advice given will be discussed with 

procurement and legal advisors. 

Contracts between the Trusts and the advisors shall abide by terms and conditions as set out in the 

NHS Conditions of Contract for the Supply of Services (September 2010). 

Instructions to Potential Advisors 

Potential advisors are required to insert a narrative under each of the numbered points in the Trusts 

requirement from the Technical Advisory Group section of this document, in order to 

demonstrate their understanding of the requirement and to indicate the expertise and added value 

potential advisors can contribute towards it. The attached Offer Schedule (Document no. 5) must 

also be completed with man days and costs inserted against each numbered point in the brief. The 

attached Form of Offer (Document no. 4) and Assumptions Sheet (Document no. 6) must also be 

completed and returned. 

Note on Fees and Expenses 

It is hoped that several meetings can take place via teleconference and electronic communication 

but there may be a need for some face-to face meetings. Therefore, in applying for the advisory 

role, the applicant is required to provide proposed details of the number of meeting attendances 

they would expect to complete in the UK with total expenses indicated in the Offer Schedule 

(Document no. 5). 

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Any potential advisors’ assumptions associated with their quotation must be detailed in the attached 

‘List of Assumptions’ document. 

Scoring of Tenders 

Tenders will be evaluated on the basis of the following award criteria and weightings: 

The narratives provided against requirements 1- 12 only of the ‘Trusts’ requirements from the 

Technical Advisory Group’ section of the Requirements Document (Document no. 2) will be marked 

out of 5 for a) understanding, b) added value. This allows for a total potential score of 10 for each of 

the 12 scored requirements. 

The 0 to 5 scoring methodology for the 12 scored requirements is as follows: 

 

 

0 

1 

2 

3 

4 

5 

Fails to provide evidence of their ability to meet requirements 

Evidences limited ability to meet some but not all of the requirements 

Evidences limited ability to meet all requirements 

Provides good evidence of the ability to meet all requirements 

Provides good evidence of the ability to meet all the requirements and 

exceeds them in some areas 

Provides good evidence of the ability to meet all the requirements and 

exceeds them in the majority of areas 

Total marks awarded for the 12 scored requirements will be multiplied by the quality weighting 

(100%) to arrive at a weighed score for the quality criteria. 

The total offer price will be divided by the weighted score for the quality criteria to arrive at a total 

score. The contract will be awarded to the potential provider with the lowest total score. The Trusts 

reserves the right not to award a contract against this Invitation to Tender. 

Type of Advice and Time Commitment 

The procurement process is likely to take from twelve to eighteen months, starting around October 

2012.The roles and commitments of those participating, internally and externally, need to be clearly 

defined. 

The technical advisors will not be expected to take part in the formal evaluation of the tender 

responses or the final selection of suppliers. This will remove any risk of challenge from suppliers 

on the basis of any bias towards suppliers familiar to advisors. As advisors they cannot be involved 

in the actual scoring of the tender responses, again reducing the possibility of a challenge during 

the procurement stages. The evaluation of tender responses will be taken forward by the Trusts’ 

teams. 

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Trusts requirements from the Technical Advisory Group 

Once appointed, the Trusts would call on the Technical Advisory Group for support and advice up to 

procurement conclusion as follows: 

1. to hold an initial series of meetings with all interested parties at UCLH and Christie to be 

briefed on issues, requirements, priorities and methods of communication etc. 

2. to review content for pre-qualification questionnaires 

3. to review technical specifications for proton therapy equipment. 

4. to support the development of technical documentation for procurement equipment 

5. to review and support the development of evaluation criteria for supplier tender responses 

6. to support review of returns from manufacturers at all stages in the procurement process 

7. to contribute towards the assessments tender responses 

8. to advise on the technical trustworthiness of tender responses from equipment suppliers 

9. to contribute towards the working up of the competitive dialogue documents 

10. to provide advice on the Trusts’ evaluations of the tender responses following the Trusts’ 

assessments 

11. to assist in contract negotiation with the final two suppliers, with technical advice on, but not 

exclusively: 

a. Maintenance requirements 

b. Deliverability and KPI 

c. Delivery and installation priorities 

12. to provide advice on build designs for functionality and radiation protection 

13. A breakdown of proposed expenses should be supplied as part of the application with any 

assumptions clearly identified in the attached ‘List of Assumptions’ document. 

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Annex E 

Procurementsupport/adviceforProtonBeamTherapyProjectforUCLHospitalsNHSFoundationTrust 

andtheChristieNHSFoundationTrust 

Revisedbrief 

Thispapersetsoutthebriefforthejointlyappointedprotontherapyequipmentprocurementadvisorsfor 

UCLHandTheChristie.Theoriginalbriefhasbeenupdatedtoreflectdevelopmentsintheprogrammeata 

nationallevel,inparticulartheprovisionofpublicfundingandtheconfirmationoftwositesfordeliveryof 

the national service will require the current drafted procurement documentation to be refreshed.The 

timescalehasbeenextendedfollowingslippageinthenationalprogramme–theequipmentprocurementis 

expectedtobelaunchedfollowingagreementoftheOutlineBusinessCasebyHMTreasury(estimatedearly 

2013).Shouldtheprogrammeslipfurtherflexibilitywillberequiredtodeliverthebrief.Theinvolvementof 

the Department of Health, National Commissioning Board and Major Projects Authority create additional 

stakeholdersandexternalscrutiny.Finallyshouldtheprotontherapyprogrammenotbeapprovedtomove 

forwardtheactivitiesrequiredfromOBCapprovalwillnotberequired. 

 

Introduction 

UniversityCollegeLondonHospitalsNHSFoundationTrust(UCLH)andTheChristieNHSFoundationTrust 

(Christie)havebeenselectedbytheDepartmentofHealth(DH)asthetwocentrestoprovideProtonBeam 

Therapy(PBT)servicesinEnglandfromtheendof2017.UCLH,onbehalfofbothTrusts,isseekingsupport 

for the development and coordination of the equipment procurement.The equipment procurement is 

expected to commence immediately HM Treasury approval of the OBC is secured.Documentation is 

expectedtobedraftedinadvanceofOBCapprovalinlinewithMajorProjectsAuthorityassuranceprocess. 

Theprocurementsupportrequiredisadedicated,flexibleresourceforthisperiodonan‘asrequired’basis. 

Whilst full time support is not necessary for the duration of the procurement it is envisaged that the 

resource will be required for several days per week in the precompetitive dialogue phase of the 

procurementandthatthiswillfluctuatethroughoutthevariousphasesofthecompetitivedialogueprocess. 

 

InstructionstoBidders 

Biddersarerequiredtoinsertanarrativeundereachofthenumberedpointsinthebriefforprocurement 

support to demonstrate their understanding of the requirement and to indicate the expertise and added 

valuebidderscancontributetowardsit.TheattachedOfferSchedulemustalsobecompletedwithmandays 

andcostsinsertedagainsteachnumberedpointinthebrief. 

Any bidders’ assumptions associated with their quotation must be detailed in the ‘List of Assumptions’ 

document. 

Anybidders’questionsonthebriefitselfmustbesubmittedusingtheattached‘QuerySheet’. 

Fulldetails,includingskillsandabilities,ofthededicatedresource(s)whowillundertaketheservicesinthis 

briefaretobeprovidedineachbidders’response. 

 

Overviewforprocurementsupport/advice 

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Tocoordinatetheproductionofthedocumentationincludingprocurementmethod(currentlyassumedto 

becompetitivedialogueprocess),ContractNotice,PreQualificationQuestionnaire(PQQ),Memorandumof 

Agreement(MoI)andcompetitivedialoguedocumentsincludingevaluationstrategy,criteriaandweightings 

andjustificationsasrequired. 

To coordinate the equipment procurement process from issuing contract notice to conclusion of 

challenges. 

To work closely with both trusts’ project teams and trusts’ appointed legal advisor to coordinate 

procurement advice to the trusts and all other advisors to the procurement process including financial, 

technicalandclinicalasrequired. 

 

Briefforprocurementsupport/advice 

1. Hold briefing meetings with all interested parties at UCLH and Christie to be updated on the project, 

issues, requirements, priorities, methods of communication etc. Reaffirm appropriate procurement 

approach. 

2.ToworkcloselywithTrusts’appointedlegaladvisortocoordinateprocurementadvicetotheTrustsand 

all other advisors to the procurement process including financial, technical and clinical as required to co 

ordinate the production of the documentation and procurement process including procurement method 

(currently assumed to be competitive dialogue process), and coordinate production of all procurement 

documentation including Contract Notice, PreQualification Questionnaire (PQQ), Memorandum of 

Agreement(MoI)andcompetitivedialoguedocumentsincludingevaluationstrategy,criteriaandweightings 

andjustificationsasrequired. 

3. Develop/Refresh Contract Notice for purchase of PBT equipment/services and seek legal sign off via 

Trusts’appointedlegaladvisorandagreementbybothTrusts. 

4. Develop/Refresh previously prepared procurement documents (using DoH or Trust standard PQQ 

templateasastartingpoint)forPBTequipmentandseeklegalsignoffandagreementbybothTrusts. 

5. Develop/Refresh Memorandum of Information (MoI) detailing high level requirements and the 

methodology for evaluation the PQQs) and seek legal sign off via Trusts’ appointed legal advisor and 

agreementbybothTrusts. 

6.SubmitContractNoticeforpublicationinEuropeanJournal. 

7. Coordinate and contribute towards assessment of PQQs by both Trusts and compile 

assessment/recommendationreport. 

8.Coordinateandcontributetowardstheworkingupofcompetitivedialoguedocuments(ordocuments 

relevanttotheprocurementprocessifcompetitivedialoguenolongerappropriate)andissuetoselected 

potentialproviders. 

9.Provideprocurementadvice,andseeklegaladviceviaTrusts’appointedlegaladvisorasrequired,onany 

relevant commercial aspects of the scheme during the course of the competitive dialogue with potential 

providers. 

10.Participateinbiddersopenday(ifheld). 

11. Coordinate and contribute towards the working up of offer documents, seek legal advise via Trusts’ 

appointedlegaladvisorasrequired,signoffbybothTrustsandissuetoselectedpotentialproviders. 

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12. Coordinate and contribute towards the evaluation of offers from potential providers seeking legal 

adviceviaTrusts’appointedlegaladvisorifrequired. 

13. Coordinate and contribute towards postoffer clarification dialogue with potential providers seeking 

legaladviceviaTrusts’appointedlegaladvisorifrequired. 

14.Coordinateandcompileassessment/recommendationreport. 

15.Issuecontractawardnotificationtopotentialproviders. 

16.Awardcontracttosuccessfulsupplieratendofstandstillperiod. 

17.Leadandcoordinatesupplierdebriefs. 

18.Compileperiodicandadhocreports(includingamonthlyupdate)andattendmeetingsasrequired. 

19.Coordinateandcontributetowardsresponsetoanylegalchallengespresented. 

 

Other 

20.TraveltoUCLHandtheChristieatManchesterwillberequired.Ahotdesk,PCandtelephonewillbe 

providedatbothlocationsasneeded. 

21.Liaisewithotherparallel/relatedprocurementsasrequired,forexamplebuild,externaladvisors(5days 

maximum) 

22.Toprovideprocurementsupport/advice(preworkandfollowup)toanyfurthersoftmarketsoundings 

thatareundertakeninadvanceoftheprocurementlaunch(2daysmaximum) 

23.ToworkwiththetruststoestablishadocumentmanagementapproachandITsolutiontofacilitatethe 

jointprocurement. 

24. To provide information where necessary for any supporting documentation required by other key 

stakeholderssuchastheDepartmentofHealthandNationalCommissioningBoard.(5daysmaximum) 

25. To work constructively to assure any external assurance/approval processes as required (for example 

GatewayReview).(5daysmaximum) 

 

Contractmanagement 

Thecurrentprocurementadvisorsareinvitedtosubmitarevisedproposaltomeetthespecificationsetout 

above. 

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Annex F 

 

UCLH and Christie proton therapy equipment procurement technical meeting 

25 October 2012 

Present: 

Actions 

1 Procurement strategy 

Draft procurement strategy and identify 

gaps/circulate 

2 Joint procurement advisors 

 

by 12 Nov 

Reinstate procurement advisors by 12 Nov 

3 Joint financial and legal advisors 

Procure financial and legal advisors asap 

4 Joint external technical advisors 

Procure external technical advisors by 12 Nov 

5 Trust technical advisors 

Finalise paperwork for Hywel asap 

6 

PQQ 

6.1 

Review existing PQQ documentation. 

 

by w/c 12 Nov 

6.2 

Once procurement advisors appointed – meet with 

procurement advisors for briefing 

 

w/c 12 Nov (or 

19 Nov) 

6.3 

Procurement advisors to refresh PQQ 

documentation excluding technical specification. 

 

 

by 30/11/12 

7 Technical specification 

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7.1 

Assign criteria in to categories for review and 

distribute. 

 

by 2 Nov 

7.2 

Sections to be reviewed as follows: 

Introduction and up to criteria 52 

Safety 

Throughput 

Dose distribution 

Imaging 

Sections to be reviewed and suggested changes 

made as follows: 

 

 

 

 

 

by 9 Nov 

 

 

 

 

 

 

Ensure specification is a question for the 

supplier i.e. produces an answer that can be 

evaluated. 

Remove any duplication/ensure consistency in 

statements. 

Identify if criteria are mandatory or scored and 

suggest types of responses/scores. 

Weightings. 

Ensure is supplier neutral. 

Degree of confidence. 

7.3 

Produce composite revised specification and 

circulate/discuss at second meeting to be held w/c 

12 Nov or w/c 19 Nov. 

Further iterations/revisions and discussions as 

required. 

 

Meeting date 

to be 

confirmed w/c 

12 Nov or w/c 

19 Nov 

8 Evaluation criteria and weightings 

Meeting of group with procurement advisors. 

Production of first draft evaluation criteria. 

Meeting of group and procurement advisors to 

work through draft. 

Further revisions and discussions as required. 

9 Further meetings 

Establish availability for further 

teleconference/meetings: 

 

 

 

w/c 12 Nov or 

19 Nov 

w/c 3 Dec 

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w/c 12 Nov or w/c 19 Nov 

- Review revised technical specification 

- Brief procurement advisors on technical 

specification for 1 st draft evaluation criteria 

to be produced by procurement advisors 

- Brief procurement advisors on revised 

PQQ for procurement advisors to refresh 

PQQ documentation. 

w/c 3 Dec 

- Review first draft evaluation criteria 

- Develop weightings 

- Sign off refreshed PQQ 

Next meeting: 

Details to be confirmed – meeting/teleconference to be arranged for w/c 12 November or w/c 19 

November. 

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Annex G 

University College London Hospitals NHS Foundation Trust (UCLH) and The Christie NHS 

Foundation Trust (The Christie) 

National Proton Therapy Service Programme 

Competitive Dialogue Procurement Law Issues and Conclusions 

1. Availability of the Competitive Dialogue Procedure 

On 31 March 2004 the European Parliament and the Council of Ministers adopted a new 

consolidated public/"classical" sector procurement Directive: Directive 2004/18/EC on the coordination 

of procedures for the award of public works contracts, public supply contracts and public 

services contracts (the "Consolidated Directive"). This Directive has been implemented in England, 

Wales and Northern Ireland by The Public Contracts Regulations 2006 (the "Regulations") which 

came into force on 31 January 2006. 

The Regulations specify the procedures to be followed by regulated procuring authorities 

("contracting authorities") in respect of the award of regulated public works, supply and services 

contracts. These procedures include those which are already well-established in public procurement 

practice: the open, restricted and negotiated procedures. A new contract award procedure was, 

however, also provided for: the competitive dialogue procedure. 

Key points to note: 

 

A contracting authority can always follow either an open or a restricted procedure as of right. 

The more flexible competitive dialogue and competitive negotiated procedures are only 

available, in contrast, where the relevant contracting authority could justify their use by 

satisfying particular conditions. 

The open and restricted procedures are, however, relatively inflexible and are, most 

significantly, subject to a prima facie prohibition on post-tender negotiations. Commercially 

this would often pose substantial difficulties for complex projects and may not always be 

conducive to producing the best value solution for a contracting authority. 

Whilst the (well-established) competitive negotiated procedure is still available under the 

procurement legislation, the risks of legal challenge in respect of use of this procedure are 

now significantly higher following introduction of the new competitive dialogue procedure. 

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Both the EU Commission and the European Court of Justice are likely to take a very 

restrictive approach to the interpretation of the grounds for using the competitive negotiated 

procedure and the Commission is far more likely to take action than has historically been the 

case. In practical terms, this procedure should therefore now be avoided save in exceptional 

circumstances. 

 

Whilst the restricted procedure may be the technically safest procedure to use, and should 

therefore be used for relatively straightforward procurements, the competitive dialogue 

procedure will probably be the most suitable procedure for a contracting authority's complex 

procurements (where previously a competitive negotiated procedure would have been used) 

in view of the greater flexibility that it will afford. 

2. When may the Competitive Dialogue Procedure be Used? 

No automatic right of use 

The Regulations provide that a contracting authority shall use either the open or the restricted 

procedure in all circumstances except where it may use either the negotiated procedure or the 

competitive dialogue procedure on the basis of satisfying the particular conditions provided for the 

use of those procedures. Put another way, whilst a contracting authority can always use an open or 

a restricted procedure, and indeed is generally expected to do so, it may only use a negotiated or a 

competitive dialogue procedure when it can justify this on the basis of the particular conditions 

provided for the use of those procedures. 

Circumstances for using the competitive dialogue procedure 

As indicated above, a contracting authority has no automatic right to use the new competitive 

dialogue procedure. In order to do so, the authority will need to justify use of the procedure by 

satisfying the particular conditions provided for in regulation 18 of the UK Regulations which 

implements article 29 of the Consolidated Directive. 

Under the legislation, the competitive dialogue procedure may be used where: 

(i) a contracting authority wishes to award a "particularly complex contract"; and 

(ii) the authority considers that the open or restricted procedure will not allow the award of that 

contract. 

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A "particularly complex contract" is specifically defined as being a contract in respect of which a 

contracting authority is not objectively able 8 to: 

(i) define the technical means 9 capable of satisfying its needs or objectives; or 

(ii) specify either the legal or financial make-up of a project or both. 

It is helpful to read this legal definition in the context of the first sentence of recital 31 of the 

Consolidated Directive which states that: 

"Contracting authorities which carry out particularly complex projects may, without this being 

due to any fault on their part, find it objectively impossible to define the means of satisfying 

their needs or of assessing what the market can offer in the way of technical solutions and/or 

financial/legal solutions." 

Recital 31 of the Consolidated Directive provides some limited guidance in respect of the type of 

projects that the EU legislature had in mind as being examples of appropriate cases for using the 

competitive dialogue procedure. The recital refers in particular to the implementation of: 

 

 

 

integrated transport infrastructure projects; 

large computer networks; and 

projects involving complex and structured financing, the financial and legal make-up of which 

cannot be defined in advance. 

The OGC, in its January 2006 Guidance on the Competitive Dialogue Procedure in the New 

Procurement Regulations appears to take a relatively wide approach to the interpretation of the 

requirements for technical, legal or financial complexity, although it does not analyse the conditions 

in any real detail. 

In respect of technical complexity, the OGC guidance makes the observation that "in many complex 

contracts, contracting authorities will seek to explore what the best solution might be to fit its needs". 

The guidance then concludes that "as a result, the contracting authority would not be able to define 

 

8 Regulation 18(1) and article 1(11)(c). Recital 31 of the Consolidated Directive, however, refers instead to contracting 

authorities finding it "objectively impossible" to define the matters referred to and this concept of "objective impossibility" 

(emphasis added) has been picked up by the EU Commission in its January 2006 Explanatory Note on the competitive 

dialogue (at section 2.1). 

9 Whether this is by reference to performance or functional requirements and/or by reference to technical specifications. 

Version4 Page107

the technical means of satisfying their needs at the outset and consequently the use of the 

competitive dialogue procedure is justified as technical complexity exists." 

The OGC guidance identifies the legal and financial complexity conditions as being particularly 

relevant to PPP/PFI projects, pointing out that for such contracts "it is often the case that the 

financial or legal make-up cannot be defined in advance, because issues such as risk allocation, 

how the project is going to be carried out and financed and who is going to be responsible for which 

services, will be the subject of discussions with the potential providers." The OGC considers that 

the competitive dialogue final text of the Consolidated Directive "fitted better with existing UK PFI 

practice" and that "the end result is a structured negotiated procedure, which is similar in many 

ways to the existing practice of letting PFI contracts." 

In its January 2006 Explanatory Note on the competitive dialogue, the Commission appears to have 

taken a relatively broad interpretation of the technical complexity condition. The Commission states 

that the most usual situation in which the condition will apply is where "the contracting authority 

would not be able to determine which of several possible solutions would be best suited to satisfying 

its needs." The example is given of a contracting authority wanting to create a connection between 

the shores of a river: it cannot determine whether the best solution would be a bridge or a tunnel, 

even though it would be able to establish the specifications for either possibility. The Commission's 

view is that the competitive dialogue would be justified in such a case on grounds of technical 

complexity. 

In respect of the legal or financial complexity condition, the Commission, like the OGC, states that 

this will frequently apply to PPPs. Although this will "very, very often" be the case, the Commission 

does point out that PPPs will not automatically be covered by the condition and that it is necessary 

to consider this on the merits of each procurement "even though that will most often be the case." 

3. Overview of the Structure of a Competitive Dialogue Procedure 

A competitive dialogue procedure can be structured in such a way as to reflect, to a very large 

degree, a previous "best practice" structured negotiated procedure. It offers a high degree of 

flexibility. That flexibility ends, however, at the point at which final bids are sought. Following 

submission of final bids, there is very little scope to make changes and certainly the practice of 

substantive preferred bidder negotiations which has been a feature of many negotiated procedures 

in the past would not be permissible under the rules. 

The procedure would begin by publication of a contract notice in the Official Journal of the European 

Union ("OJEU"). A deadline for expressions of interest is set in the OJEU notice which will normally 

be a minimum of 37 days from the date of despatch (as opposed to publication) of the notice. It 

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may be possible to reduce this minimum period by up to 7 days if the notice is submitted on-line, on 

the Commission's website. It may also, however, be necessary to provide a longer period, 

depending on the circumstances of a particular procurement including, inter alia, its complexity and 

the volume of documentation involved. 

Interested parties will then undergo a qualification and selection stage – usually on the basis of 

information submitted in response to a Pre-qualification Questionnaire. At this stage, candidates 

will be assessed in respect of: 

 

 

 

Certain eligibility requirements – which may lead to either mandatory or discretionary 

exclusion; 

Their economic and financial standing; and 

Their technical or professional ability. 

Selected candidates (being a minimum of three) will then be invited to participate in a dialogue with 

the Authority during which all aspects of a proposed contract may be discussed. The Invitation to 

Participate in a Dialogue will, inter alia, set out the contract award criteria which will be taken into 

account in determining which offer is most economically advantageous. The relative weightings of 

the award criteria should be given. 

The purpose of the dialogue is to identify one or more solutions which are capable of meeting the 

Authority's requirements. The dialogue stage may be conducted in iterations during which the 

number of participants/solutions to be discussed is reduced. 

Once one or more solutions capable of satisfying the Authority's requirements has been identified, 

the Authority will declare the dialogue at an end and invite the submission of final bids. Following, 

perhaps, some very limited fine-tuning and confirmation of commitments, the Authority will reach its 

contract award decision. Before actually awarding the contract, it must send an Alcatel notification 

and relevant debrief information to all participants in the process and then provide for a minimum 

ten day mandatory standstill period. Within 48 days of contract award, a Contract Award Notice in 

prescribed form must be sent to the Office for Official Publications of the European Union. 

4. National Proton Therapy Service Programme Considerations 

The National Proton Therapy Service Programme procurement has a number of features that justify 

the use of the Competitive Dialogue procedure: 

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Contracting authorities could be UCLH, The Christie or a new company formed as a special 

purpose vehicle. Additionally, there is a possibility that University Hospitals Birmingham NHS 

Foundation Trust may become a party to the procurement. 

Each of the potential contracting authorities wishes to retain the independence to contract 

with its own choice of supplier should it wish to do so, or to join forces with any of the other 

contracting authorities to place a joint contract with a supplier. This has necessitated dividing 

the procurement into Lots. 

The procurement seeks to secure complex equipment and services whose cost will run into 

the tens of millions of pounds, if not more. 

The scale of spend necessitates that numerous financial options need to be explored as a 

means of contracting, including renting, PFI, project financing and self financing. 

Both scanning and passive scattering based technology solutions could be used to satisfy 

the contracting authorities’ requirements, and the selection of the most appropriate method 

is a decision that requires analysis and discussion with suppliers before arriving at a 

conclusion. 

The procurement is therefore not straightforward, but complex. The contracting authorities are not 

objectively able to define the technical means capable of satisfying their needs and objectives at the 

outset and additionally they are not able to specify both the legal and financial make-up of the 

project. There are several possible solutions that could satisfy their joint needs. The procurement 

requires greater flexibility than that afforded by the open and restricted processes. The contracting 

authorities believe that it would simply not be possible to award a contract under the open or 

restricted procedures. For these reasons the competitive dialogue procedure will be followed. 

 

 

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Annex H 

Joint Proton Therapy Equipment Procurement Group 

Terms of Reference 

1. Name Of Group: Joint Proton Therapy Equipment Procurement Group 

2. Accountable To: 

Technical and operational workstream, The Christie 

Phase 4 Programme Board, UCLH 

3. Aims And Purpose: To develop and manage the equipment procurement process, coordinating 

activities between The Christie and UCLH, making 

recommendations for approval within both trusts. 

4. Objectives And 

Responsibilities: 

Joint group 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Develop robust equipment procurement strategy, documented 

and approved by: 

o Manchester Proton Therapy Programme Board 

o UCLH Phase 4 Programme Board 

Identify resources required for procurement 

Identify external advice required and potential costs 

Procure technical advisors, legal advisors, procurement 

advisors and other external advice where necessary 

Seek and co-ordinate advice from all advisors including 

procurement, legal and external technical advisors 

Agree procurement process, budget and timescales with 

Programme Manager(s) for UCLH and Christie 

Establish clearly defined rules of engagement with potential 

suppliers communicated and managed across all team 

members 

Make recommendations on strategy, documentation and 

equipment procurement outcome to Manchester Proton 

Therapy Programme Board and UCLH Phase 4 Programme 

Board 

Ensure effective and proactive lines of accountability 

To co-ordinate input as required from key stakeholders and 

ensure effective communications as required 

Ensure timescales of process are coordinated with the wider 

programme 

Manage procurement of equipment to deliver on time and to 

budget 

Regularly report to Technical and Operational Workstream 

lead and UCLH Senior Responsible Officer 

Contribute to the development of UCLH and Christie FBCs as 

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equired 

Develop and maintain a risk register throughout the duration of 

the programme 

Follow document management policy and instigate document 

management software as required to co-ordinate procurement 

5. Membership: Core Team Members 

 

 

 

 

Physics 

 

 

 

 

 

 

 

 

 

 

 

 

Secretariat 

 

 

 

 

Wider team members 

Representatives from both trusts as required: 

Clinical 

Radiographer 

Engineer 

Capital planning 

Financial 

Advisors 

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Joint procurement advisors 

Joint legal advisors 

The core team will be responsible for agreeing the procurement 

documentation including technical specification and evaluation, 

making recommendations to both Trusts’ steering groups on how the 

proceed. 

During the procurement of equipment phase the core team together 

with the wider team and advisors will undertake the procurement and 

make recommendations to both trusts boards on the outcome of the 

equipment procurement. 

6. Members’ 

responsibilities 

1. Confidentiality 

All meeting material and supporting information, whether verbal or 

written, electronic or hard copy is deemed to be commercially 

sensitive and is shared on the basis of commercial in confidence. 

It is the responsibility of each member to ensure that information 

remains confidential. All non-Trust employee members will be 

required to sign a Non-Disclosure Agreement? 

2. Communicating within organisation 

It is the responsibility of each member to ensure that they 

communicate appropriate information within their organisation and 

represent views from within their organisation to the programme 

board. 

3. Decision taking 

It is expected that members will be authorised by their organisation 

to take decisions on behalf of their organisations within the 

boundaries of each organisation’s approval processes. 

4. Attendance 

Members are expected to attend meetings on a regular basis. 

Where this is not possible the programme board reserves the right 

to review the membership and seek alternative representation. 

Deputies may be sent with the agreement of the Joint Chair. 

7. Quorum To be quorate each meeting should have equal numbers of people 

represented from both trusts including at least one of the joint chairs. 

8. Frequency Of 

Meetings 

This will be determined by the schedule of work to develop the 

procurement strategy and documentation and then the requirements 

of the equipment procurement. To be not less than monthly in 

frequency. 

9. Governance and 

accountability 

The Joint Group will be accountable to the Technical and Operational 

Workstream (Christie) and Phase 4 Programme Board (UCLH). It will 

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produce a monthly report covering progress, highlighting risks and 

issues. 

10. Escalation In the event of any material failure to agree escalation would first be to 

the SROs for UCLH and The Christie to reach mutual agreement. In 

the event that this was not possible it would be escalated to the Board 

of Directors of both trusts. 

11. Review Date 

The terms of reference for the Joint Group will be reviewed by each 

Trust’s Programme Board at OBC, FBC and at annual intervals in 

between. 

 

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Appendix4C:ConstructionProcurementStrategy 

PBTConstructionProcurementStrategy 

Overviewandimplementationtimeline: 

ThePBTconstruction procurementstrategysetsoutthemain procurementroutesavailabletoUCLHand 

highlightstheprincipalconsiderationsassociatedwitheachofthesealternativesprocurementroutes.The 

strategypresentedherewassummarisedintheOutlineBusinessCase. 

The need to review the procurement route for the project has been driven mainly around the following 

considerations; 

• Theprojectdeliverytimelinetodeliveranoperationalbuilding(Q1–2018) 

• Levelofriskwhichcanbeacceptedortransferredadequately 

• Outturncostcertainty 

• Flexibility in terms of control of design interface by client & contractor design approvals 

necessary 

• Changewhichcanbeaccommodatedwithintheprojectorresultingcontract 

• Leveloftechnicalcompetencewithinthemarkettodelivertheproject 

• MeetingOJEUthresholdsandregulatoryrequirements 

 

All of the above have been considered in context of what can also be bought or transferred within the 

marketwithoutpayingsignificantpremium. 

UCLHasanorganisationhaveanextensivetrackrecord,experienceandresourcedteamofexpertswhoare 

capableofassessingandimplementingprocurementstrategies,mostrecentlyhavingsuccessfullycompleted 

thePhase3CancerCentreatanoutturncostapproaching£100m. 

Incontextofthisproject,thePBTteamhaveextensivelyexploredarangeofprocurementoptionsavailable 

alreadypriortowritingthistext. 

UCLH’sprocurementapproachhasbeendevelopedoverthepasttwoyearsinconjunctionwiththeChristie 

from bid submission. This has been done with the assistance of UCLH’s in house procurement team and 

appointedexternallegaladvisors, . 

 

. 

Inparticular,theconsiderationsoftheintendedprocurementstrategyhastakenintoconsideration: 

 

 

• Jointequipmentandbuildcontractsorasseparateprocurementworkstreams 

• Equipmentprocurementinisolation 

• Buildprocurementinisolation 

 

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Design&Build 

formofcontract 

Thisprocurementroutewilldelivertheprojectby(Q1–2018)–Thisroute 

offersDesign&CostcertaintyandallowstheDesignProcesstoproceedin 

tandemwithboththeProcurementandConstructionProcess.It 

necessitatesanagreementupfrontofafixedpriceandaprogrammeand 

mayalsoinvolvethenovationornonnovationofsomeorallofthe 

presentdesignconsultantstotheMainContractor(fortheconstruction 

delivery). 

 

ToenablethefacilitytobeopenontimetheteamareproposingaDesign 

&Buildformofcontractwhereacontractorisselectedfromalistof3or4 

toproceedtopriceanddevelopthedesignfromthatpointtoapoint 

whereafixedpriceisagreedwhilstalsoseparateequipmentvendoris 

beingsought.Thefinalorderplacementismadewhenanequipment 

providersdetailsarefinalisedandcoordinatedwiththecontractor’s 

proposals. 

ManagedFormof 

contract 

Thisprocurementroutewilldelivertheprojectby(Q1–2018)–The 

managedformsofcontractinvolvesacontractorwhowillmanageand 

procureeachoftheindividualelementsofwork(workpackages),then 

placecontractswiththesesuppliersandtheemployertoexecutethe 

works,thecontractoralsothencoordinatestheirdeliveryonsite. 

 

 

Procure21+ 

ProCure21isaframeworkwhichhasbeenorganisedbytheDHfor 

constructioncontractsthroughouttheNHS.Theframework,nowinits 

secondgeneration,isbasedoncollaborativeworkingthroughtheuseof 

theECCContract,OptionC.TheframeworkwasletinOctober2010andis 

duetorunfor6years. 

 

AstheframeworkhasalreadypassedthroughtheEUprocurement 

process,acontractorcanbeappointedwithoutnotificationintheOJEU. 

Becausetheframeworkisbasedonapreagreedpricingmechanism,no 

actualtenderprocessisrequired.Selectionismadefromtheframework 

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Single Point responsibility for 

the above and below ground 

(Constructionworks) 

Programme Certainty to 

deliver the building for 

requiredopening. 

Cost certainty to deliver the 

building once contract has 

beenawarded 

Retains a degree of control 

with client team through 

remaining design evaluation 

reviews with contractor(with 

or without novation of design 

team) 

 

MoretimefortheDesignTeam 

to refine the detail/coordinate 

andcompletethedesign. 


toobtainEnduserinput,ifthe 

briefisemergingorunclear 

 

Easy and quick timescale to 

appointcontractor 






briefisemergingorunclear

contractors,referredtoasPrincipalSupplyChainPartners(PSCPs),solely 

onthebasisofquality. 

Todothis,aschemeinformationpackisemailedtothePSCPs,inresponse 

towhichPSCPswhowishtobeconsideredsubmitanexpressionof 

interest.TheNHSclientselectsashortlistofPSCPsandinvitesthemtoan 

openday,followingwhichtheyattendaninterviewandaselectionis 

made.Thisprocesstakesthreetofourweeksalthough,insome 

circumstances,aPSCPcanbeappointedquickerthanthis. 

Theearlyappointmentofthecontractorhasbothprogrammebenefitsand 

enablesconstructioninputtothedesignprocess,thusinfluencing“build 

ability”. 

UnderProCure21+,theTrustandPSCPagreeaTargetPrice.Shouldthe 

projectcostlessthanthisfigure,thefirst5%ofthedifferenceissplit50/50 

betweentheTrustandPSCP.Anysavingbelowthislevelgoes100%tothe 

Trust.Shouldtheprojectcostmore,theclientTrustonlypaystheTarget 

Price.ForthisreasontheTargetPriceunderProcCure21+isnormally 

referredtoastheGuaranteedMaximumPrice(GMP). 

TheGMPisestablishedbasedonframeworkratesandaprocessofopen 

bookmarkettestingofworkspackages. 

ThisreportconsidersthatProCure21+isnotthemostappropriate 

frameworkforprocurementoftheworksduetothelimitednumberof 

Procure21members,lackofcompetitioncomparedtoopenmarket 

tenderingandhighoverheadandprofitcostswhichexistunderthis 

arrangement. 

IESEFramework 

TheImprovementandEfficiencySouthEast(IESE)frameworksupports 

councilsandpublicsectororganisationsinthesoutheastincludingLondon 

Authorities.Assuch,UCLHareeligibletoutilisetheframework.The 

frameworkwasoriginallyplacedinJuly2007. 

TheIESEframeworkisbasedontheprincipleofatwostagetender 

process.Otherthanareductionintimescales,amajoradvantageofthis 

approachistheearlyinvolvementofthecontractorwhocancontributehis 

constructionexpertisetothedesignprocess,thusinfluencing‘buildability’ 

costandtimescales.AnadditionalbenefitofIESEisthatitisnotbasedona 

specificformofcontractenablingtheTrusttoselectasappropriate. 

 


Easy and quick timescale to 

appointcontractor 






briefisemergingorunclear 

Nosetordefinedcontractand

Competitive 

Dialogue 

Equipment 

Toappointacontractor,aprojectoutlinewouldbedevelopedbythe 

designteamandissuedtothetencontractorsbytheframeworkmanagers. 

Thecontractorsrespond,demonstratingtheirintentviaanexpressionof 

interest.Fromthesubmissions,theframeworkmanagersdrawupa 

shortlistofcontractors. 

Thenextstageoftheprocessinvolvesaminitenderwherebythe 

shortlistedcontractorsareinvitedtosubmittheirbidsonthebasisof 

informationdevelopedbythedesignteam.Ratesforprelims,overhead 

andprofitwereconfirmedwhenthecontractorswereappointedtothe 

frameworkwhichthecontractorsutilisewhenbuildingthepreliminaries 

costsforevaluationinminicompetition. 

Withintheminitendersubmissions,contractorsarerequired 

todemonstratetheirprojectspecificapproach,competenciesandkey 

initialcommercialinformation.Predominantlyevaluationandselectionofa 

contractorisonthebasisofqualityandvalueratherthanlowestprice,on 

70%quality30%commercialbasis. 

Followingtheminitenderthechosencontractorwouldbeappointedona 

preconstruction agreement to develop the design, depended on the 

procurementrouteandformofcontractandthenenterintoaprocessof 

open book market testing of works packages to arrive at a Target Price. 

Thisisthenfirmedupaftertheopenbooktenderstoafixedcontractoffer. 

On arrival at the target price, the Trust would appoint the contractor to 

deliver the project. If the project were aborted at this stage the Trust 

wouldbeliableforanycontractorcostsincurred 

Inarapidlyadvancingtechnologywebelieveitisextremelyimportantto 

understand what the equipment manufacturers can offer in terms of 

delivery against or exceeding our requirements and as such we have 

concluded the most appropriate procurement approach is to use 

competitivedialoguefortheequipmentonly. 

 

The following longlist of options for the procurement of PBT equipment 

hasbeenconsideredinarrivingatthisdecision: 

A single procurement with one lot procurement for purchase of 

equipmentfromonelotsuppliertoUCLHandtheChristie. 

Asingleprocurementwithtwoseparatelotstosupplyequipment 

forUCLHandtheChristie 

Asingleprocurementwiththreelotsasfollows: 


 

thereforepotentiallyflexibleto 

contractterms 

Relatively easy and quick 

timescale to engage with 

market 

GivesmoretimefortheDesign 

Team to refine the detail / 

Coordinate and complete the 

design as a result of feedback 

on options and offers from 

market. 



brief is emerging or unclear, 

which the PBT element is as 

opposed to the infrastructure

SupplyofPBTtobothsites; 

SupplyofequipmenttoUCLHand 

SupplyofequipmenttoTheChristie. 

Completelyseparateprocurements. 

Thispaperconcludesthatonesupplierispreferabletotwosuppliersdueto 

thepotentialbenefitsofaconsistentsystemintwositesandthepotential 

discountsavingsofjointprocurement,althoughitshouldbenotedthatthe 

financialbenefitsarenotyetavailabletobeevidenced.TheTrustsandDH 

willundertakefurtherinvestigationstoascertainwhether: 

Anjointevaluationcriteriacanbedevelopedtomeettheneedsof 

bothsites; 

Equipment suppliers can deliver solutions that meet the 

restrictionsofeachsite; 

Themarketcandeliversuchasolutioninsimilartimescales;and 

It can be shown that this represents the optimum solution in 

termsof,forexample,valueformoney. 

Scopeofequipmentprocurement 

Theassumptionisthattheprocurementwillbefortheequipmentplusa 

maintenance service (currently expected to be for a minimum of five 

years). 

A managed service has been discounted as the service needs to be 

integratedintoeachFoundationTrustservicedeliverystrategy. 


 

works which are fairly well 

defined. 

Nosetordefinedcontractand 

thereforepotentiallyflexibleto 

contract terms which the 

suppliers understand and can 

reduceriskpremiums

Thediagramillustratedbelowhighlightsthemajorityofdifferingtypesofprocurementroutesandresulting 

contractopportunitieswhichexisteachwithcompetingcharacteristicswithregardtodesignflexibility, 

programmecertainty,costandchange: 

 

 

 

 

 

 

 

 

 

 

 

 

NOVATIONCONSIDERATIONS 

The Design & Build route does require that there are considerations and further discussions and 

agreementsheldwithregardtothepossiblenovationofthedesignteamtothemaincontractorandhow 

thisstrategybestfitstheclientaspirationsandrequirements. 

Ifthewholedesignteamisnovated(toworkfor)thecontractor,theclientusuallyhasconcernsthatany 

controlhehadoverthedesignteaminensuringthatqualitystandardsweremetduringtheconstruction 

phasewilldisappearwhenthecontractorbecomesthedesignteam’snewemployer. 

Thisconcerncanbeeasilyovercomebyintroducingintoanynovationagreementtherequirementofthe 

designertocompleteonaregularbasisareportfortheoriginalemployerthatconfirmsorotherwisethat 

in the opinion of the consultant the works are being designed or constructed in accordance with the 

specificationrequirements.Thishasbecomeknownasa“whistleblower”clause. 

There can also be concerns both from the design team and the main contractor that there may be an 

incompatibilitybetweentheirseparatestyles,whichmeansthatneitherpartyrelishestheopportunityto 

work with each other. The main contractor may have practices with which he has a preference to use 

aheadofthedesignteambeingproposed.Inthesecircumstancestherearenosetrulesbutwhathastobe 

consideredandproposedisascenariowhereallpartiestothecontractfeelcomfortable. 

Itisnormalpractiseitiscommonthatifaconsultantisnovatedthenthereisapreferencethattheybe 

novated as a team and that their novation agreements should contain the “whistle blower” clause as 

described above and if proposed would be a reasonable and workable solution. The contractual 

relationshipsarenormallyalteredbetweenthedesignteam/contractorandEmployeronceNovationhas 

occurred. 

CHANGECONTROL 

AsystemofChangeControlmustbemaintainedifcontractsareeffectivelymanagedsothatanydeviations 

tothebrieforcontractisunderstoodandsignedoffpriortoimplementation.ThePBTisnodifferentandit 

is envisaged that this protocol will continue throughout the duration of the project. The system will 

Version4 Page123

Construction works will not be included in the lot as it is considered important to reduce complexity to 

better manage the project specific cost and timescales risks under a Design & Build arrangement with 

advancedemployers’requirementsreflectingtheirdetailedrequirements,whichwilleffectivelyresultina 

highdegreeofprogramme,costandqualitybeingestablishedattheoutset. 

 

 

Version4 Page126

Appendix4D:CabinetOfficeICTSpendControlForm(v2.18) 

Cabinet Office ICT Spend Control Form (v2.18) 

 

ThepurposeofthisformistoprovideanoverviewofproposedICTexpendituretoaidapprovalthroughtheCabinet 

OfficeITControlProcess.Thisformshouldmakereferencestoandbesupplementedbyrelevantdepartmental 

documents(e.g.latestbusinesscases). 

 

ThisformshouldbereadinconjunctionwiththeCabinetOfficeControlGuidanceavailablehere 

 

Forallqueriesorfeedbackrelatingtothiscontrolpleasecontactyourdepartmentalleadforthecontrols,alternatively 

contacttheCabinetOfficeat: 

Unclassified:ictfutures@digital.cabinetoffice.gov.uk 

Restricted:ictspendapproval@cabinetoffice.gsi.gov.uk 

 

Earlyengagementbeforeanapprovalisrequiredwillalwaysimprovethechancesofasuccessfuloutcome.This 

formisintendedtobedevelopediterativelyfromearlyengagementwiththeCabinetOfficeuntilthefinalspend 

requestissubmitted.ItincludesquestionstosupportapprovalofothercontrolssuchasStrategicSuppliers. 

 

FormVersionNumber: 

V 0.0 

Organisational information 

Organisationname: UCLHNHSFoundationTrust 

Parentdepartment: N/A 

 

Organisationapprovals 

TrustBoardapprovaloftheOutlineBusinessCaseandFullBusinessCase 

DepartmentofHealthapprovaltheOutlineBusinessCaseandFullBusinessCase 

HMTreasuryapprovaloftheOutlineBusinessCaseandFullBusinessCase 

MonitortheOutlineBusinessCaseandFullBusinessCase 

Department information 

Businessactivity/Projectname: 

Referencenumber(ifknown): enterreference. 

SRO: entername. 

Mainpointofcontact: entername. 

Mobile/phone: enternumber. 

Email: enteremail. 

Version4 Page127

PBTwilldelivertheseobjectives: 

TheNationalRadiotherapyAdvisoryGroupReport,2007 

TheCancerReformStrategy,2007 

AframeworkforthedevelopmentofPBTserviceinEngland,2009 

ImprovingOutcomes:Astrategyforcancer,2011 

TheDHandNHSEnglandhaveworkedwithTheChristieandUCLHtodevelopaServiceandInvestmentFramework 

(SIF).ThisisacooperationagreementbetweentheTrusts,theSecretaryofStateforHealth,andNHSEnglandthat 

providesthegovernance,clinical,technical,commercial,procurementandfinancialstructureswithinwhichthe 

servicewillbedevelopeduptoapprovaloftheFBC. 

 

Isthisspendassociatedtoaproject/programmeincludedontheGovernmentMajorProjectPortfolio?Yes 

 

Whatstageistheproject/programmerelatedtothisrequestatinitslifecyclee.g.StartingGate,SOC,OBC,FBC 

TheNHSEnationalprogrammehasdevelopedaSOC,approvedbyDHCIB/HMT. 

ThisisanOBCforthedevelopmentofaservicebasedatUCLH. 

 

Highlevelspendbreakdownbystage(ifknown):Notknown 

 

Start 

date 

End 

date 

Stage 

Spendalready 

committed(£k) 

Spendsoughtfor 

approval(£k) 

Spendyettobe 

confirmed(£k) 

Predesign 

Design 

Build 

Test 

Implement 

Run 

Total 


Totalspend 

forecast(£k) 

Requirements & Options: 

 

Pleaseexplainoptionsconsidered(includingdonothing).Thiswillinclude: 

Whataretheuseroutcomesthatthisinvestmentissupporting? 

Howdoesthistransfertheburdenfromthestatebyempoweringtheuser? 

Howdoesthisfitinwiththedepartment’soverallinformationandtechnicalarchitectureobjectivesanddesign? 

Ifreplacinglikeforlike,pleaseprovidecostpertransactioncomparisons 

 

ThealternativeoptionstodevelopingaPBTserviceare: 

Providesuboptimaltreatments(e.g.radiotherapy)topatients 

Treatalimitednumberofpatientsoverseas 

TheDHproducedaSOCwhichwasapprovedbyHMTreasuryon12Feb2012.Thisshowsthedevelopmentofa 

nationalPBTservicewillrepresentgoodvalueformoney. 

Procurement & commercial strategy: 

Itisunderstoodthatsomeofthisinformationmaynotbeknowatthecurrentactivitylifecycle,pleasecompletewhat 

isknown. 

 

Whatprocurementvehicleislikelytobeused(e.g.OJEU,Framework,existingsupplier)? 

TheprocurementvehiclefortheICTelementoftheprojecthasyettobedecided,thisisinlinewiththeprojectplan. 

TheICTequipmentsupplierscannotbeprocureduntiltheprotonbeamtherapyequipmentisselected;ourlatest 

programmeplanidentifiesthatthisisduetobecompletedinOctober2014.Thereforetoensurethatthemost

commerciallyappropriatevehicleisselectedprocurementshouldbedoneonatimelybasis.Detailedspecifications 

ofICTrequirementswillbeworkeduppostOBCapproval,whichisplannedforJune2013. 

Thereareonlyalimitednumberofsuppliersforthetreatmentspecificsoftware,andthereforeOJEUislikelytobe 

theprocurementroute.However,ifthereareexistingframeworksinplaceitispossiblethatthesewillbeutilized 

wheretheyofferadvantagesoveranopenprocurementroute.ItislikelythatforgeneralICTaframeworkwillbe 

utilized 

 

PleaselistbelowtherelevantFrameworkspursuanttowhichrelevantsolutions/servicesarelikelytobeprocured. 

ForgeneralICTitislikelythattheGPSframeworkwillbeused 

 

LikelyprimaryITsupplier(s)(ifknown): 

Notknownatthisstage 

 

Whoistheexistingsupplier(ifapplicable): 

N/A.Thisisanewservice 

 

SOCOBC:howdoyouintendtoensurecompetitivetensionisbuiltintotheprocurementtoassistindetermining 

ValueforMoney? 

 

FBC:howwasrealcompetitivetensionbuiltintotheprocurementtoassistindeterminingvalueformoney?If 

competitivetensionwasnot,whynot? 

Allopportunitieswillbeexploredtodelivervalueformoney 

 

Howisthespendsplitbetweensuppliers?(Filltablebelowifknown):Notknown 

Supplier Spend(£m) Duration(months Activity 

 

 

Total 

 

Isthecontractopenbook,ifnotwhynot? 

 

Contractstructurenotknownatthisstage 

Whatisthepricingbasis?(fixedprice/fixedpriceincentive/costplusfixedfee/costplusincentivefee/T&Metc.)? 

 

Pricingstructurenotknownatthisstage 

Howhaveyoumanaged/doyouintendtomanagetheriskof,orexposureto,nondelivery,slippage,oroverspendby 

thesupplier? 

ProgrammeBoardestablishedtomanagecontractandprojectrisks 

Legaladvisorsappointedtoensurerisksappropriatelyapportionedincontactandanyongoingcontractualissues 

 

Pleaseprovideusthatratecardbeingused,andtheaveragedayrate(onshore/offshore): 

 


HowdotheratescomparewithrateselsewhereintheDepartment?Pleaseprovideabreakdown. 

Version4 Page131


WhatchecksandbenchmarkinghastheDepartmentdonetoconfirmthepriceiscompetitive?Pleaseprovidedetailed 

evidence. 

 


Whatdiscounthasbeenappliedacrosslabour,software,andhardware? 

 


Pleaseprovideuswithabreakdowninanylicensingcostsassociatedwiththisproject: 

 


Pleaseprovideuswithabreakdowninanytransitioncostsassociatedwiththisproject: 

 

Notknownatthisstage. 

Canyoupleasefilloutthetablebelow:Notknownatthisstage 

 

Supplier 

Total 

spend 

(£m) 

Average 

Dayrate 

(£) 

Gross 

margin 

(%) 

Net 

margin 

(%) 

Discount 

applied 

Onshore/offshore 

Start 

date 

Labour 

Hardware 

Software 

Total 

Policyrelevance&ITStrategicandSIPAlignment 

ThissectionisakeycomponentofthisSpendControlFormasitwillenablethedepartmentandCabinetOffice 

determinethelevelofpolicyandSIPcompliance. 

Duration 

PleasecompletethissectionalongsidetheExcelSIPCompliancespreadsheet.Pleaseusethissectiontoaddcomments 

inrelationtothecompletedSIPcompliancespreadsheet. 

HowdoesthisspenddelivertheGovernmentICTPolicyobjectivesinaccordancewiththeStrategicImplementation 

Plan,specificallyobjectivesof: 

AlignmentofITwiththeBusiness 

EconomicGrowth 

CreatingaCommonICTInfrastructure 

UsingICTtoDeliverChange 

 

N/A 

 

LinktoSIP:http://www.cabinetoffice.gov.uk/content/governmentictstrategystrategicimplementationplan 

Version4 Page132

StrategicImplementationPlanDepartmentalProjectCompliance 

EachsectionlistedbelowispartoftheCabinetOfficeITStrategicImplementationPlan. 

Pleaserateyourcompliancewiththesestrategicgoalsusingthedropdownboxes 

1. Alignment of IT with the Business 

Business Case 

Delivers Cashable 

Savings 

Delivers better public 

services 

Transparency Policy 

Not Relevant Not Relevant Compliant Not Relevant 

2. Economic Growth 

ASK ICT – Asset and 

Services 

Knowledgebase 

Demonstrates Open 

Source level playing 

field 

Procurement 

Open procurement 

process 

Complies with £100m 

ceiling 

Avoids commercial 

lock-in and retains 

competitive, open 

market 

Validation via 

independent 

benchmarking and 

market testing 

Contributes to 

growing the role of 

SMEs 

Focuses on 

capabilities rather 

than infrastructure 

acquisition 

Agile Capability 

Not Relevant Not Relevant Not Relevant Not Relevant Compliant Not Relevant Not Relevant Not Relevant Not Relevant Not Relevant Not Relevant 

3. Creating a Common ICT Infrastructure 

Open Standards 

Reference 

Architecture 

Open technical 

standards 

Cloud computing and 

applications store 

Public services 

network 

Data centre 

consolidation 

End-user device 

strategy 

Green ICT Information strategy 

Privacy, security and 

identity policy 

Risk management 

regime 

Not Relevant Not Relevant Not Relevant Not Relevant Not Relevant Not Relevant Not Relevant Not Relevant Not Relevant Not Relevant Not Relevant 

4. Using ICT to Deliver Change 

Channel Shift 

Open Application 

Programme 

Interfaces (APIs) 

Contributes to big 

society with open 

APIs and open data 

Online government 

consultation 

Social media 

Not Relevant Not Relevant Not Relevant Not Relevant Not Relevant 

End of Sheet 

Data Validation Below - Please leave 

Compliant 

SomeEvidence 

LittleEvidence 

NoEvidence 

NotRelevant 

AwatingInformation 

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Appendix4E:PBTMilestoneTracker 

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Communications,HR,Finance,etc.) 

UCLHStaff 

StaffUnionsandassociations 

Serviceuserspatients 

TheChristieNHSFoundationTrust 

EDH&RNTNEStaff 

LocalAuthority–CamdenCouncil 

Local Authority – Town Planning and 

BuildingControl 

EnvironmentAgency 

MetropolitanPolice 

TransportforLondon 

LocalResidents’Association 

LocalBusinesses 

CharitiesandtheVoluntarySector 

Publicgeneral 

Commissioners 

GP’s 

UniversityCollegeLondon 

Other Universities and Academic 

Institutions 

Media–nationalandlocal 

LocalMP’s/Politicians 

PBTContractor/Operator 

DesignTeam 

Projectcontractors 

C 

C 

C 

A 

C 

C 

B 

B 

B 

B 

C 

C 

C 

C 

A 

D 

B 

B 

C 

B 

 

A 

A 

A 

 

Stakeholder analysis of the above individuals/groups will be undertaken to ascertain the 

following: 

• Whatinterestdotheyhaveintheproject?Isitpositiveornegative? 

Version4 Page137

UCLH 


STAKEHOLDERACTIONPLANWORKSHEET 

STAKEHOLDER 

NAME 

COMMUNICATIONS 

APPROACH 1 

KEY INTERESTS & 

ISSUES 

CURRENT 

STATUS 2 

DESIRED 

SUPPORT 3 

DESIRED PROJECT 

ROLE(ifany) 

ACTIONS 

DESIRED (if 

any) 

MESSAGES 

NEEDED 

ACTIONS & 

COMMUNICATIONS 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Manageclosely/Keepsatisfied/Keepinformed/Monitor 

2 Advocate/Supporter/Neutral/Critic/Blocker 

3 High / Medium / Low 

Version4 Page139

Itisrecognisedthatwithinoverallstakeholdergroupsthereare‘subgroups’,andthesesubgroupsmaywellhavedifferingprioritiesandinterests.Itisanticipated 

thattheactionplanscanbenuancedtoaccommodatethesedifferences. 

 

(A)KeyPlayers 

These are the most important Stakeholders – they have high power and high interest in UCLH and its activities. Such stakeholders need to be involved in all 

relevantdevelopmentsandcouldhaveaconsiderableinfluenceoverthefuture. 

 

(B)KeepSatisfied 

TherelationshipwithstakeholdersingroupBcanbedifficult.Inthisgrouparefoundnationalrepresentativeorlegislativebodies.Theybehavepassivelymostof 

thetime,butcanexertanenormous impactontheTrust. Itis thereforenecessarytoanalyzepotentialintentions andreactionsofthesegroupsinallmajor 

developmentsandtoinvolvethemaccordingtotheirinterests. 

 

(C)KeepInformed 

StakeholdersingroupChaveahighinterestintheorganisationanditsactions.However,theyhavelimitedmeanstoinfluence.Despitetheirlowerinfluence,such 

stakeholderscanbevaluablealliesinimportantdecisions.Therefore,itisadvisabletokeeptheminformedabouttheissuestheyareinterestedin. 

 

(D)MinimalEffort 

StakeholdersingroupDhavelittleinterestinUCLH,orthepowertoexertmuchimpact.Itis,therefore,appropriatetokeepthesegroupsinformed,butnotinvest 

toomucheffortintothem. 

 

StakeholderManagement 

 

The overall approach to Stakeholder Management needs to be structured and supported, This will include the identification of clear leads responsible for 

maintainingrelationships–andpersonalandteamobjectivestoreflectthis. 

 

Differentialstrategiesneedtobedeployedtotargetspecificrelationshipswithstakeholders,reflectingtheneedtopositivelymaintainsomerelationships,develop 

newrelationshipsand/orreorientorextendexistingones 

 

Aregularprogrammeofcommunications,ledbytheHeadofCommunications,whichwillraiseawareness,enhancethereputation,andimprovetheperceptionof 

UCLHanditsPhase4DevelopmentProgrammewillbeimplemented. 

 

 

 

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Appendix6D:ContingencyintheeventofAccelerator/PBTCentreFailure 

 

Contingency in the event of Accelerator/PBT centre failure 

The purpose of this paper is to set out the contingency arrangements for patients under going PBT 

in the UK in the event that one of the national service’s two centres is unavailable. 

The paper considers the impact of whether site availability is planned (servicing) or unplanned 

(accelerator failure, power outage, gantry issues, planning system failures or other serious 

untoward incidents) and where in the treatment pathway the patient is. The paper also looks at the 

impact of compatibility of referral systems and technology solutions and their affect on contingency 

planning. 

1. Reduction in available capacity 

Scenarios 

Planned 

Downtime 

(Servicing) 

Contingency 

Modelling of this scenario can be done well in advance with a prioritised indication list 

for centre that will continue functioning, with liaison between centres well in advance of 

the proposed servicing schedule. 

No new patients accepted at facility to be serviced. This process needs to commence 

over a month prior to servicing, with the centre not being serviced also required to 

reduce the number of new starters – prioritising clinically those patients referred to their 

centre. 

Planned completion of treatments at the affected centre prior to servicing. 

Waiting list of patients to be sent to facility continuing treatment and new referrals added 

to that waiting list. Patients to be treated at continuing facility to be prioritised until 

capacity is reached (Clinical criteria to be established). 

Patients not prioritised for treatment at continuing facility to be triaged for 

commencement after servicing complete, some patients (given timescales) may require 

transfer to photon plans or referral abroad (clinical criteria to be established). 

Unplanned 

Downtime 

(New 

Patients) 

Mitigation plan as for planned downtime. 

Daily review of waiting lists required until confirmed date for reopening and 

patients/referrers kept informed. 

Unplanned 

Downtime 

(Patients 

on 

treatment) 

Patients on treatment at downed facility nearing completion of treatment to be changed 

to emergency photon plans until completion. 

Patients mid treatment converted to photon plans in the interim and prioritised for 

continuing Proton Beam treatment at functioning facility. 

Patients at start of treatment at downed facility starting treatment, clinical decision to be 

made to stop completely and restart as a new patient (criteria to be established), or 

Version4 Page154


conversion to a photon plan with the expectation of continuing treatment with protons at 

functioning facility (clinical criteria to be established). 

 

Issues of note when considering contingency for particular groups of patients are: 

The patients that would benefit the most from protons (i.e. the current indication list who we are 

currently sending abroad) would take priority in being transferred. However, even a small transfer 

time might mean some patients will require conversion to photons at the downed site as some 

tumours require treating in exceptionally short timescales (e.g. Medulloblastoma etc.). 

The duration of the repair of the beam would also affect how new referrals to the proton centre 

were dealt with. If the repairs were to be lengthy (?weeks) then we would have to prioritise referrals 

to the single working centre. For prolonged periods of downtime there is the potential for some 

clinical staff temporarily supporting the other centre in planning prioritised patients. 

2. Compatibility of referral systems and technology solutions 

The existence of two UK proton beam therapy facilities, regardless of technology solution, allows 

high priority patients (current indication list) to be prioritised within a national service and to access 

timely treatment in the UK. 

Any contingency will be limited by the capacity of the remaining centre and the logistics of 

transferring patients. To reduce the risk of untimely delays in transferring patients, the data 

systems must allow easy transfer of patient information (joint referral storage and waiting list 

systems), including patient records, imaging and proton plan (if available) for reference. Both 

centres using the same referral system will mitigate much of this. 

The timely transfer of patients is less sensitive to the type of technology, planning and 

immobilisation systems at each site. In the case of patients who do not have PBT plans at the 

downed facility or when servicing is scheduled, there would be no difference in timeliness to 

treatment whether there were different technologies or the same technology at both centres. For 

those patients with PBT plans or have started treatment, or where there is unexpected failure of 

service, the limiting factor to transfer will be the capacity at the functioning centre (which will need 

to wind down low priority new starters in any event). This will give sufficient time for those 

prioritised transferred patients to be planned at the functioning centre. 

 

 

Version4 Page155

Outline 

Case 

Business 

Guidance for Completion of the RPA 

 

What is the RPA for? 

This version of the Risk Potential Assessment (RPA) is designed to provide a standard set 

of high-level criteria for assessing the strategic risk potential of programmes and projects, 

and of emerging policies and initiatives that are expected to be delivered through a 

programme or project in the future. 

The RPA is used to initiate a Starting Gate, a Project Assessment Review (PAR) or 

an OGC Gateway review, by helping to determine who should arrange and manage a 

review and decide on the make-up of the review team. This RPA replaces the earlier 

2009 RPA previously used only for OGC Gateway reviews. 

Once agreed the completed form should be sent to the Departmental Assurance 

Coordinator (DAC)910 for onward transmission to the Cabinet Office Major Projects 

Authority (MPA), where appropriate. 

This assessment is an indicator of risk potential and is not an exhaustive risk analysis 

model. However, it can be the starting point for a more exhaustive risk assessment. The 

RPA enables a conversation to be had about the risks and responsibilities for delivery of 

a programme or project, and its visibility, reporting and assurance in a wider portfolio 

management context. The RPA can also help to identify areas where specific skills sets, 

commensurate with the level of programme or project complexity, may be required. 

How to complete this RPA 

Assurance reviews are applicable to a wide range of change programmes and projects, 

including policy driven, business, property/construction, ICT enabled or 

procurement/acquisition-based change initiatives. 

The RPA should be completed as early in the life of a change initiative as possible, e.g. 

when policy is being formulated or to support the development of the Integrated 

Assurance and Approval Plan (IAAP). The RPA should subsequently be reviewed before 

its use to initiate all MPA assurance reviews. 

The RPA requires the Senior Policy Owner (SPO) or Senior Responsible Owner (SRO) or 

Project Executive, to consider the initiative from two perspectives: firstly through a 

strategic assessment of the Consequential Impact, should the programme or project fail 

to deliver its objectives or outcomes (see Table A); followed secondly, if appropriate, by 

an assessment of Complexity (see Table B). 

Each table is made up of a series of assessments, with the result indicated by 

marking X in the appropriate box between VERY LOW (VL) and VERY HIGH (VH). 

These assessments are made using the knowledge and judgement of the SPO/SRO and 

policy/programme/project team, and should be considered in the light of the strategic 

context for the initiative. Examples have been provided as a guide to what might be 

considered as VL or VH assessments. For each assessment a short explanatory note of 

the reasoning for each mark should be given (where appropriate) in the text box to 

provide an audit trail of the considerations. 

Table A – Consequential Impact Assessment 

Having considered each Strategic Impact Area an overall assessment is required to 

determine the Consequential Impact Assessment. This is based on the holistic 

assessment of all five areas in total; there is no formula or calculation involved. The 

overall assessment should be shown by an X in the final (pink) section of Table A. 

An explanatory note must be given in the text box provided to give the reasoning for the 

overall assessment. 

 

10 

This role was previously called the Departmental Gateway Coordinator (DGC) but with expansion in the range of assurance reviews 

available, the original role name is no longer accurate. In some organisations Departmental Gateway/Assurance Coordinator will be 

somebody’s job title; in others someone with a different job title will fulfil the DAC function. 

Version4 Page159




During policy development, when assurance may be provided through a Starting Gate or 

equivalent review, completion of only Table A is required. Only the Overall Consequential 

Impact Assessment mark should be entered in Box 14 on the cover sheet. If this 

assessment indicates that the impact is MEDIUM or above, the RPA should, after 

agreement of the SPO, be submitted to the DAC. 

For existing programmes/projects if, after completing Table A, the Overall 

Consequential Impact Assessment is considered to be VERY LOW, completion of Table 

B is optional and the completed RPA can be sent to the DAC, who will discuss with the 

programme/project what assurance activity might be most appropriate. 

 

Table B – Complexity Assessment 

If the Consequential Impact Assessment (Table A) is assessed as greater than VERY 

LOW, completion of the Complexity Assessment (Table B) is required. The approach for 

Table B largely follows the same format as for Table A, but for convenience is broken 

down into four Complexity Areas. 

Having assessed each factor in each of the four complexity areas, an assessment is then 

required to determine a summary assessment for each area. Again an X should be 

marked in the appropriate (yellow) score box for each complexity area and an explanation 

given in the notes box. 

At the end of Table B there is a (yellow) table headed Complexity Assessment Summary 

where the area summary assessment results should be recorded. 

Consideration should now be given to reaching an Overall Complexity Assessment for 

the initiative, based on the four area assessments. Again, there is no scoring or formula 

for determining this; it is the policy/programme/project team’s holistic assessment. 

The Overall Complexity Assessment is recorded in the final (green) section of the 

Complexity Assessment Summary with an X marked in the appropriate box. An 

explanatory note must be provided to support the overall complexity assessment for 

audit trail purposes. 

Finalising the Risk Potential Assessment 

As the environments in which programmes or projects operate will vary, there may be other 

aspects that might not be covered by the RPA which affect the impact and/or complexity 

assessments in this form. These additional aspects, if considered material to the overall 

impact and/or complexity assessments, should be reflected with explanatory notes in the 

overall assessments in Tables A and B respectively. 

Having completed the Consequential Impact Assessment (Table A) and the Complexity 

Assessment (Table B), the overall Risk Potential Assessment for the programme or 

project is determined by plotting the respective assessments on Table C. 

Using the overall results from the Consequential Impact and Complexity Assessments and 

the respective axis of Table C, mark an X in the appropriate cell where the two 

assessments intersect. This will then indicate what level of review may be required, as 

suitable for the Low, Medium or High Risk level of the initiative. The overall level of 

review (L/M/H) should then be noted in Box 14 on the cover sheet of the RPA. 

The SPO or SRO (as relevant) must agree the completed RPA, after which the completed 

RPA should then be sent to the DAC, who in turn will copy it on to the organisation’s 

Portfolio Manager (or an equivalent e.g. Head of Centre of Excellence), for validation. 

For all submissions the Portfolio Manager (or equivalent) should independently validate the 

RPA and be satisfied that it fairly reflects the initiative’s strategic profile within the 

organisation’s overall change portfolio. If the RPA is deemed by them to be inaccurate, a 

discussion with the SPO/SRO should be held to reach a consensus. 

Using the RPA for assurance purposes 

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Once an RPA is agreed the DAC will instigate the assurance review process by arranging 

an Assessment Meeting. There are lead times between the Assessment Meeting and 

the review itself (see below Table C) which depend on a number of factors; your DAC can 

offer advice on those lead times. 

PLEASE NOTE: It may not be possible for the MPA to organise a review at shorter 

notice, based on limited availability of reviewers. 

The initial RPA assessment will normally be used throughout the life of the integrated 

assurance and approval process, even though the risk potential might decline as the 

programme/project progresses through the change lifecycle. Should the RPA marking 

increase, the higher assessment may take precedent. Departments, Agencies and 

NDPBs, in discussion with the MPA, should undertake periodic reviews of their portfolios 

to ensure a consistent and appropriate use of the RPA in setting risk levels, and hence 

the appropriate assurance regimes. 

The RPA will also be reviewed at each Assessment Meeting to ensure there have been no 

material changes since it was completed. Following the Assessment Meeting the 

constitution of the review team and duration of the review will be determined. 

 

For further information see contact details on last page. 

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Proton Beam Therapy - Outline Business Case (OBC) - Volume 2

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