Meeting the challenge The Gloucestershire Experience Sally Bye

BACKGROUND ( in 2009) • Gloucestershire merged two jurisdictions into one County Jurisdiction in 2006 • Appointed a part-time Coroner • Deaths Registered ~6000 • Referrals ~2000 • Post Mortem Examinations ~1200 • Inquests ~325 • Coroner revenue spend £ 1. 07 M

Context • • • NHS facilities not fit for purpose Clear that they would not be upgrading them Not their responsibility to provide mortuary Their usage decreasing and ours increasing Constructive discussions on options

DRIVERS legal : • NHS closing mortuary-gave us notice to leave • Statutory duty on second tier LA to provide mortuary facilities (S. 198 Public Health Act 1936) • S. 2 Local Government Act 2000 -power of well being • Coroners Act 1988 -Council to pay expenses

DRIVERS financial : • Lack of court accommodation-inappropriate and costly to use hotels • Rising mortuary charges from NHS • Potential for capital costs to be added in the future – long since indicated this may happen

NHS Mortuary Advantages • Don’t have to worry about managing staffing/procuring supplies/managing premises/HTA compliance etc – just get the bill!

NHS Mortuary Disadvantages • Little control over fee charged • Little influence over practices and procedures • Little control of pathology services

Public mortuary – LA run • Able to manage costs • Able to manage staffing resources • Presents opportunities – Bringing together other services – Use of building bereavement services/training – Different ways of working – Different ways of contracting – funeral directors/ NHS

OPTIONS APPRAISAL 1. 2. 3. 4. 5. Do nothing – not an option Put capital funding into NHS – not an option Lease an industrial unit – not an option Build a new mortuary with a court and office accommodation

BUILDING THE BUSINESS CASE • OPTION ONE – MORTUARY • £ 4. 2 M • OPTION TWO – CORONERS COURT COMPLEX • £ 4. 6 M

SEPTEMBER 29 TH 2009 GCC CABINET AGREE CAPITAL FUNDING FOR OPTION TWO CORONERS COURT COMPLEX

POTENTIAL SAVINGS • • • £ 315 K Mortuary charges from NHS (rising yr on yr) Officer travel costs £ 10 K Staff/systems efficiency savings £ 10 K Court hire costs ~£ 10 K Office and other premises costs £ 5 K Income from hiring facilities £ 25 K

VISION A Centre of Excellence to deliver Coroner’s services for the bereaved

PROJECT DESIGN • Appoint Project Managers – Sally Bye and Maria Boon • Develop fuller design brief with costs ØExperts – Coroner, Pathologists, APT and other users ØMortuary advisors ØProperty services

PROJECT TEAMS • User group • Design group • Technical group • HR group (TUPE) • Comms plan • Financial and risk management • ICT group

INITIAL DESIGN BRIEF – Mortuary • Storage for 60 bodies inc bariatric • 5 PM Tables • Body viewing • Staff facilities • Interview & training rooms • Court room to hold 50 + jury

DETAIL DESIGN BRIEF –MORTUARY • Fridges - 8 Obese and 45 semi-obese • Freezers - 5 Obese and 4 semi-obese • Tray transfer system • 4 tables in the main area and I table separate area with observation facilities and link to training room via camera

WHERE? Design dependant on site Issues to consider : • Public access • Public transport and parking • Sustainability GCC green agenda • Funeral directors • Pathologists

TIMELINE FOR BUILD • September 2009 funding agreed • December 2009 Kier Moss Build Contractor appointed • April 2010 Planning permission submitted • July 2010 Planning agreed and site secured • July to August 2010 Tendering and contracting • Value engineering – save £ 500 K • September 2010 work starts on site • November 2011 partial commissioning and coroners move in • April 2012 fully commissioned and mortuary opens • October 2012 Judge Thornton officially opened the building

OTHER WORK STREAMS • Ongoing research with colleagues around the country (Flax Bourton mortuary) • Restructure of the services – TUPE mortuary staff to GCC, bring all Coroners Officers and admin staff into one office • Consultation and communication with key staff and stakeholders – faith groups, local residents, councillors, funeral directors etc. • Prepare revenue budget • Develop Standard Operating Procedures and Policies • Compliance with HTA • Appoint Centre Manager –Scott Riddell

Pathologists Senior APT Team Coroner Centre Manager Admin team Head of Service Senior Coroners Officers

BODY REMOVAL OPEN ALL HOURS how to staff it? OPEN OFFICE HOURS – how do funeral directors access mortuary?

PAY BACK • Actual cost £ 4. 1 m • Annual savings £ 370 K – ~ 11 years Already saved more than anticipated Income not explored yet Improved quality of service to the public

LESSONS FROM THE PROJECT • Have a clear vision and get a mandate to proceed – comes from your business case • Research as many relevant projects as you can • Consult with users and experts • Listen but make decisions based on the long term – tray transfer • Team Work-trust and confidence in each other to challenge decisions

Benefits so far • Managing costs for the mortuary – Cost of mortuary supplies reduced – Reduced APT from 6 fte to 3 fte • Manage costs for coroners service – Coroner has reduced histology costs – New removal of bodies contract in place – Reviewing systems and processes • Managing staffing resources – Saving of 0. 5 fte Coroner officer post

Benefits so far • Improved service for the bereaved – One place with all services – More inquests dealt with • Opportunity to learn from other members of the team • SLA agreement with NHS to provide body storage and mortuary facilities • SLA with Flax Bourton to provide emergency back up