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LEEDS TEACHING HOSPITALS NHS TRUST

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Agenda Item 5.5

    TRUST BOARD

    7 OCTOBER 2009

Report of Mr Brian Steven

     Director of Business Development and Performance

    Delivery.

    Paper prepared by Mr Brian Godfrey Divisional General Manager, Diagnostic

     and Therapeutic Services.

    Mr Ronnie Hood Commissioning Manager, Radiology.

     Business case to support the procurement of a second fixed

    Subject/Title site Positron Emission Tomography - Computed

     Tomography (PET-CT) scanner at St James‟s University

    Hospital (SJUH).

     Cancer Research United Kingdom(CRUK ) Our Strategy Background papers 2009-2014

     Following informal approval by the Trust Board at the Board Purpose of Paper Discussion Group on the 27th August 2009, this paper

     seeks approval of the proposal to proceed with the

    procurement of a second PET CT scanner. The paper

    highlights the significant opportunity presented for a

    competitive world class research facility using PET-CT and

    demonstrates the revenue streams required to support this

    procurement. The Business Case also highlights

    opportunities for both National Health Service (NHS) and

    Private Patients (PP) to use this scanner, and highlights the

    potential benefits for patient care and income generation.

     To seek formal Trust Board approval for this project and Action/Decision required proceed with the procurement process following a

     successful bid through the National Institute for Health

    Research (NIHR) for the capital funding of a PET-CT

    Scanner.

    Link to:

     Cancer Research United Kingdom(CRUK ) Our Strategy ? NHS strategies and policy 2009-2014

     NHS Operating Framework

    Link to:

     Achieving excellent clinical outcomes ? Trust’s Strategic Direction Improving the way we manage our business ? Corporate objectives Becoming the hospital of choice for patients and staff.

     LTHT Research & Development Strategy (R & D)

    Resource impact Capital and Revenue implications are explained in the

     business case.

Consideration of legal issues Directorate will procure and comply with all relevant Trust

     legal and procurement policies.

Acronyms and abbreviations Explained at first use.

Trust Board final version 29th Sept 2009 1

    Agenda Item 5.5

    THE LEEDS TEACHING HOSPITALS NHS TRUST

    TRUST BOARD - 7th OCTOBER 2009 - SUMMARY PAPER

    BUSINESS CASE FOR THE PROCUREMENT OF A SECOND FIXED SITE

    PET-CT SCANNER IN BEXLEY WING, ST JAMES’S UNIVERSITY HOSPITAL

    1. PURPOSE OF THE PAPER

This paper seeks formal Trust Board approval to progress with the procurement process

    of a Positron Emission Tomography Computed Tomography (PET-CT) scanner

    following a successful bid for capital monies through the National Institute for Health

    Research (NIHR). The purpose of the bid was to fund, through the National Health

    Service (NHS), high-quality patient-focussed research with the purchase and installation

    of a second PET-CT scanner, in Bexley Wing, adjacent to the Independent Sector (IS)

    scanner.

    2. BACKGROUND

In January 2008 St. James‟s Institute of Oncology (SJIO) opened on the St James's

    University Hospital (SJUH) campus bringing together expertise in cancer research and

    physical sciences with imaging capabilities. The SJIO incorporates the Leeds

    Experimental Cancer Medicine Centre (ECMC) with a dedicated Oncology Clinical

    Research Facility (OCRF) which opens in October 2009, comprising protected research

    beds and day-case unit, and the Cancer Research UK Clinical Centre that has an

    extensive programme of laboratory and clinical research, and is part of the Leeds

    Institute of Molecular Medicine (LIMM) on the same campus. Fitted out (i.e. radiation

    shielded) space for two PET-CT scanners within a dedicated PET-CT centre in this

    building is under contract to be completed by March 2010. An Independent Sector

    Provider (ISP) owned PET-CT scanner will be installed in early 2010, as part of the DH-

    procured national contract for PET-CT. However, routine clinical service demand is

    already near contractual expectation and only a small proportion of capacity on this

    scanner will be available to support R&D.

    3. BENEFITS TO LTHT

    ? Uniquely position LTHT to place itself as a world class research centre and market

    leader in the north of England.

    ? Improve the competitive advantage of LTHT

    ? Enhanced recruitment/retention of high calibre individuals

    ? Increased opportunities for income generation

    ? Infrastructure for 2nd scanner already exists in Bexley Wing

    ? Facilitates repatriation of Paediatric patients who current travel to London for this

    imaging

    ? The ability to flex staff according to need, based on income guaranteed from sign

    up to research trials and associated funding streams.

    ? Improved diagnostic accuracy, better staging of oncology patients and the

    potential to reduce futile surgery.

    ? There will be an option for us to compete for the current National Contract in 2013

    (worth approximately ?2M per year).

    Trust Board final version 29th Sept 2009 2

    Agenda Item 5.5

    The Leeds service is already the largest provider centre in the Northern PET-CT contract

    and there has been a steady increase in referrals since its inception. The Trust will be in

    a very good position to take on this already „established‟ service with all its associated

    income in 2013.

    The research scanner gives us the opportunity to ensure that we will be able to train our

    workforce accordingly, placing the Trust in pole position to take on this contract.

4. KEY ISSUES

    Key issues for consideration by the Board are as follows:

    ? The NIHR has approved the LTHT bid for ?2.132m to facilitate the establishment

    of this key research facility

    ? The Department of Health has recognised the under resourcing of PET-CT

    imaging within the NHS

    ? The ISTC contract expires in 2013 presenting LTHT with further opportunities for

    income generation

    ? LTHT currently employs the leading Consultant Radiologists in this field within the

    north of England.

    ? Surrounding Trusts are aware of the business opportunities presented by a PET-

    CT service and are keen to invest in such areas to grow their market share, and

    reduce our monopoly.

    5 SUMMARY

    This represents a unique opportunity for LTHT to position itself as one of the leading

    imaging research centres in the country. This facility will enhance our reputation in

    oncological research and contribute greatly to the achievement of the Trust‟s objectives.

    Research leaders and clinicians within Radiology and across the Trust view this as a real

    positive step and an endorsement of their current research portfolio which enhances the

    Trusts reputation.

    Since the announcement from the NIHR we have already been approached to provide

    PET-CT to two areas in support of their research initiatives which total 125 scans per

    year this already represents the anticipated first year research scans illustrated later in

    this document.

    We have been conservative in our predictions of anticipated use but we are confident

    that the research income and the use of PET-CT across a wider range of specialties

    represents a relatively low risk to the Trust which is further reduced if we were to be

    successful in winning the contract in 2013 for the work currently undertaken within the

    IST contract.

6 RECOMMENDATION nd PET-CT scanner The Trust Board is asked to approve this Business Case for a 2

    funded from the NIHR 09/10 capital monies and authorise the procurement and

    installation of the scanner.

    Brian Godfrey

    Divisional General Manager

    Division of Diagnostic and Therapeutic Services

    29th September 2009

    Trust Board final version 29th Sept 2009 3

    Agenda Item 5.5

    LEEDS TEACHING HOSPITALS NHS TRUST

    BUSINESS CASE FOR THE PROCUREMENT OF A SECOND FIXED SITE

    PET-CT SCANNER IN BEXLEY WING, ST JAMES’S UNIVERSITY HOSPITAL

    1. Introduction

This paper seeks formal Trust Board approval to progress the procurement and installation

    of a Positron Emission Tomography Computed Tomography (PET-CT) scanner following a

    successful bid for capital monies through the National Institute for Health Research (NIHR).

This business case was discussed at a Board Discussion Group on the 27th August 2009

    when informal approval was given to proceed with the procurement process and

    confirmation sent to the NIHR of the Trust‟s support for this initiative.

This is an opportunity for LTHT to confirm the intention to create a leading UK and European

    cancer and molecular imaging research centre at St James‟s University Hospital. This

    development will open up unique opportunities for research and attract potentially lucrative

    new income streams. A second PET-CT scanner will help LTHT achieve the excellent

    clinical outcomes which characterise a hospital of choice in addition to improving the way we

    manage our business. Although it is acknowledged that there is a degree of risk, we believe

    that this risk is manageable. Our financial assessments at this stage are robust, and, this is an opportunity to demonstrate that LTHT is an organisation that not only delivers its

    business objectives but also values research, innovation and development.

    2. Background and Strategic Fit

2.1 Background

PET is a powerful imaging tool which can demonstrate changes in the function of cells

    before there is any detectable change in the size and shape of organs and tissues. By

    combining PET with CT, it is possible to overlay this functional information on a detailed

    anatomical map of internal structure. This has revolutionised the imaging of cancer and

    promises to do the same for heart disease and brain disorders.

Realising that the United Kingdom(UK) was falling behind other developed countries in

    implementing the new technology, the Department of Health (DH) initiated an IS PET-CT

    procurement and awarded the northern contract to Alliance Medical (AML). The timeframe

    for implementation of an IS fixed site PET-CT scanner within Bexley Wing has been delayed

    and LTHT currently have interim mobile provision from AML. It is evident from projected

    demand analysis that the IS will have difficulty meeting the required increase in oncology

    activity. Despite the mobile scanner increasing operational frequency, there remains a lack

    of capacity to undertake research and non-oncology activity. There is also insufficient

    capacity to meet private sector and paediatric demand. It is primarily towards the areas

    stated that this business case is targeted.

2.2 Strategic Fit and Opportunities

There are major opportunities for the use of PET-CT within research projects as recognised

    by the NIHR in funding the Trust‟s bid for ?2.1m to provide a PET-CT scanner to support

    Research and Development in Leeds. Because this research is subject to external bids, it is

    anticipated that there will be an incremental growth of research activity and, initially, this will be supplemented by the previously identified unmet demand in oncology. There is also

    robust evidence for the use of PET-CT in improving patient management by improved

    Trust Board final version 29th Sept 2009 4

    Agenda Item 5.5

    diagnostic accuracy, better staging (thus avoiding futile surgery), monitoring the response to

    treatment and radiotherapy treatment planning. All of these are outside the scope of the IS

    contract. In addition, no other major private facility in the North of England caters for private

    PET-CT referrals and this unmet demand represents significant opportunity for the Trust.

    The Trust has attracted a team of researchers with a proven track record in molecular

    medicine and clinical oncology research. Provision of additional PET-CT capacity would

    enable research support and further develop a facility unique in the UK and, probably

    Europe.

The Directorate has engaged with research leaders and clinicians in both oncology and non-

    oncology areas and letters of support are appended to this business case. In addition, there

    is interest from charitable sources to contribute to the revenue costs of this second scanner.

    A further example of the potential to increase our PET-CT scanning ability is the partnership

    between the Trust and Nova Healthcare which has recently launched a neurosurgical

    service using a gamma knife. When fully operational, this service will require approximately

    50 PET - CT scans per year.

The Radiology Directorate believe that the research use of the scanner and the ability to

    undertake both NHS and private scans makes this a viable proposition, with the use of PET -

    CT increasing in non-oncology areas such as cardiac and neurosciences the viability and

    potential profit increases. National evidence and guidance quotes the advantages of using

    PET-CT. Should this become the approved recommended imaging technique, the

    Directorate will enlist appropriate commissioner support. Trust Board approval to submit this

    bid and be successful with the capital allocation will enable us to exploit current and future

    research projects and open negotiation with commissioners.

2.3 Letters of Intent and Support

A number of letters have been received by the Directorate expressing strong clinical support

    for this proposal with some including estimates of activity. The letters also outline how this

    facility will not only cement the Trust‟s position as an internationally competitive centre for

    research in oncology, but will also place the Trust in a position to exploit the emerging

    potential for research using PET-CT within other clinical specialties.

    Appendix 1, Dr. A. Crellin, Director of Clinical Oncology, LTHT.

    Appendix 2, Dr. D. Jackson, Clinical Lead, Yorkshire Cancer Research Network and Co- director, West Yorkshire Comprehensive Local Research Network.

    Appendix 3. Professor P. Rabbitts, Professor of Experimental Respiratory Research, Leeds Institute of Molecular Medicine.

    Appendix 4, Professor S.G. Ball, British Heart Foundation, Professor of Cardiology.

    Appendix 5, Mr. N. Phillips, Consultant Neurosurgeon, LTHT

    Appendix 6, Professor C. Twelves, Professor of Clinical Phamacology and Deputy Director Leeds Cancer Research UK Clinical Centre

    Appendix 7, Dr. A. Glaser, Consultant, Yorkshire Regional Centre for Paediatric Oncology and Haematology.

    Trust Board final version 29th Sept 2009 5

    Agenda Item 5.5

2.4 Summary of benefits

    ? Facilitate the establishment of the St. James‟s Institute of Oncology as an internationally

    competitive centre for oncology research an aim which has wide support. LTHT will

    be in a strong position to compete for research funding along with the „golden triangle‟ of

    London, Oxford and Cambridge, and with competing local providers from whom there is

    interest. ? Guarantee capacity for work that has not been prioritised within the national contract and

    also allow LTHT to sub-contract sessions to the IS when, as evidence predicts, their fixed

    scanner is unable to meet increasing demand (see 3.2). ? Allow LTHT to establish a staff base trained in PET-CT which will place us in an

    advantageous position when the current IS contract ends in 2013 as it will facilitate

    competitive tendering for the national contract.

    ? Place LTHT in the best possible position to take advantage of further income potential,

    via the growing range of evolving applications in other specialties. ? Improved diagnostic accuracy, better staging of oncology patients, thereby reducing futile

    surgery.

    3. Impact on Activity and Case for Demand

3.1 Research and Development

    There are already strong collaborative links between the University of Leeds, Cancer Research UK, the Medical Physics Department at LTHT and internationally renowned

    clinicians with proven track records in academic research. The St James‟s Institute of Oncology brings this team together under one roof in the largest oncology centre in Europe, incorporating the Leeds Experimental Cancer Medicine Centre (ECMC) with dedicated clinical research facilities and beds reserved for research, and the CR-UK Clinical Centre which is part of the Leeds Institute of Molecular Medicine. They will perform important work in (inter alia) phase I, II and III cancer clinical trials using PET-CT as a new tool in evaluating tumour response to novel drugs and demonstrating proof-of-principle, and will also develop the role of PET-CT in radiotherapy planning. A number of oncology research trials involving PET-CT have already begun recruiting in the Yorkshire Cancer Research Network and these include funding streams for imaging costs through the Comprehensive Local Research Network (CLRN). Other cancer trials already within the NIHR portfolio require additional PET-CT, either as the subject of the study or used to evaluate other interventions, in clinically relevant areas such as lung cancer (Lung ART), mesothelioma (MARS), lymphoma (IELSG 26, RATHL), gastrointestinal cancers (SCOPE-1, PACER, FOXTROT), melanoma,

    paediatric oncology, myeloma and head & neck cancers (PET-NECK). The incorporation and evaluation of PET in drug development is an explicit priority for the ECMC network and our recruitment to early phase oncology trials will increase due to the additional capacity created by the new Oncology Clinical Research Facility (OCRF)

    .

    There are a number of developmental areas in Neurology which includes differentiating between recurrence and radio necrosis in brain tumours in children. This would not only attract referrals from across the Yorkshire and Humberside region, but nationally. The National Institute of Health Research is investing heavily in clinical trials and LTHT will be in a position to attract this investment; in part through the National Cancer Research Network.

    LTHT has also established an international reputation in cardiac imaging research and there is interest in extending this work to include the cardiac applications of PET-CT. The British Heart Foundation (BHF) has a MRI scanner on the LGI site and funds the Leeds based CE-MARC trial with associated income of ?1.3 million. The trial compares techniques for the investigation of ischemic heart disease (IHD). Given the political priority accorded to the

    Trust Board final version 29th Sept 2009 6

    Agenda Item 5.5

    diagnosis and treatment of IHD and the proven commitment of the BHF to Leeds, there is likely to be a significant funding stream for research programmes involving cardiac PET-CT.

3.1.1 Research activity for NIHR portfolio trial patients (PET CT)

     2010/11 2011/12 2012/13 2013/2014

    Research patients 150 200 250 300

    These numbers are based on current NIHR portfolio trials which are already recruiting. There is every likelihood that there will be significantly more demand for research PET-CT scans as a surrogate end point measure of therapeutic response in Oncology. A range of trials are in development which will be supported by commercial funding by external pharma sponsors and the LTHT allocation from comprehensive local cancer networks (See 4.3.1). There is also increasing recognition that PET-CT is the optimal non-invasive modality for early assessment of regional and global metabolic changes in many tumours following therapeutic interventions. This is particularly important in early clinical trials and in the assessment of novel, expensive or potentially toxic therapies, and targeted therapies that may be cytostatic rather than cytotoxic. These trials form potentially an important element of our ECMC activities and recruitment into such trials mandates additional PET-CT capacity via a 2nd fixed-site scanner. As one of only four UK centres awarded additional Cancer Research UK/NIHR ECMC funding paediatric oncology/haematology we will collaborate with other UK centres performing phase I/II studies through the Therapeutic Steering Group of the Children‟s Cancer and Leukaemia Group (former UKCCSG) and European centres via the Innovative Therapies for Children with Cancer to develop functional imaging in this patient group. Agents studied in adults and children will include those evaluated through the Cancer Research UK New Agents Committee by the Drug Development Office. For example, the Chief Investigator (CI) for the first phase I study as part of the Cancer Research UK Clinical Development Programme is based in Leeds; the study will run from 2010 and incorporates PET-CT scanning. Likewise, the forthcoming international Ewing sarcoma clinical trial is about to be submitted to the relevant national authorities for approval. The primary objective is to improve survival, with a secondary objective being to determine the value of FDG-PET-CT in the diagnosis and response evaluation of these patients; the UK CI is based in LTHT and we propose to lead this part of the study including radiological review, data collection and analysis. In lymphoma, NCRI studies for early Hodgkins (already running), all other Hodgkins (RATHL - in setup) and the next main B cell study (in draft) will all require several PET-CT scans per patient; together they are expected to accrue from all haematological units in the Yorkshire & Humber region as there will be no other static PET-CT resource.

    3.2 Independent sector capacity issues

    The mobile IS PET-CT is operating at almost full capacity; currently only ambulatory patients can use this service. Once the static service is operational and includes service delivery to inpatients also, the facility will be operating to full capacity. There is provision in the northern contract for transfer of demand and associated funding between centres. There is increased demand from a growing and ageing population as is the pressure to develop the role of PET-CT in monitoring response to treatment in radiotherapy planning, and for non-oncology indications (cardiology and neurology).

    The installation of a second PET-CT scanner managed by LTHT will enable the Trust to deliver additional capacity and also provide resilience should the private sector service fail or be withdrawn. Advice from the Strategic Health Authority (SHA) is that, subject to their agreement, any activity over and above that required under the terms of the national procurement can be undertaken out-with that contract and that there is no requirement to operate a second scanner in partnership with AML.

    Trust Board final version 29th Sept 2009 7

    Agenda Item 5.5

    3.3 Non NHS Patients (Private and Overseas)

Public awareness of the role of PET-CT in improving cancer outcomes is resulting in

    increased demand for the service from self-funding patients, commercial institutions and

    medical insurers. Private patients from the Leeds area are currently travelling to PET

    centres in London for their scans. These patients could be repatriated to LTHT with a net

    profit of ?700-800 per patient. In the past year or so, the interim mobile PET-CT service at

    Seacroft Hospital has scanned a small but increasing number of private patients (95 scans)

    without marketing the service and because of limited availability. Growth in private activity

    will accelerate as the benefits of PET-CT in cardiology and neurology (particularly dementia

    screening) is brought to public attention. The IS provider does not have the capacity to

    capture this activity and, with appropriate marketing, it represents a significant commercial

    opportunity for LTHT. There will also be demand from private hospitals which lack the

    infrastructure and skilled staff to provide their own service.

3.3.1 Projected private patient activity (PET CT)

     2010/11 2011/12 2012/13 2013/14

    Private patients 100 140 140 140

3.4 PETCT for Radiotherapy Planning

PET CT has provided a new approach to the management of cancer patients by allowing

    the incorporation of biological information about tumour behaviour into the radiotherapy

    treatment planning process. The combination of information from PET and CT in a single

    imaging system used to obtain fused anatomical and functional image data is rapidly

    becoming an accepted method of tumour volume delineation for radiation planning. Should

    additional scanning capacity become available via a second fixed site scanner, the potential

    for using PET-CT for radiotherapy planning would be of considerable benefit for the patients

    of Leeds and beyond, both for clinical service and future research projects.

This facility will also be used with MRI to plan treatment of brain tumours using the recently

    installed Gamma Knife. This will create a unique combined facility and would, therefore,

    attract supra-regional referrals.

3.4.1 Projected annual radiotherapy planning activity (PET-CT)

    Tumour Type PET-CT scans per year

    Lung 50 Rectal/Anal 45 Lymphoma 50 Head and Neck 250 (inc 50 cases from Neurosciences related to the Gamma Knife.

    CNS 90 Breast Clinical trial number to be determined

    Gynaecology 40 Sarcoma Clinical trial number to be determined

    Oesophagus 30 Total (minimum) 555

3.5 PET-CT for Cardiovascular Disease

There has been a considerable increase in the use of PET-CT in modern management of

    cardiovascular disease and there is substantial support from the British Heart Foundation

    (BHF) via the Cardiac Imaging Group for further extensive research. In particular, newer

    developments which will enable plaque composition in the vessel wall to be assessed using

    Trust Board final version 29th Sept 2009 8

    Agenda Item 5.5

    PET-CT rather than the simple degree of anatomical obstruction available by using CT. Most myocardial infarcts take place on non obstructing coronary lesions and the composition of the offending underlying plaque is thought to determine the likelihood to rupture and is highly relevant to the outcome of carotid artery disease. This would equate to 20 clinical patients in year 1 with many more than this in the longer term via appropriately funded research programmes. Access to PET-CT for research will become a prerequisite if the Trust is to stay at the forefront as a leading regional cardiac clinical service and research centre. The development of PET-CT to support this cardiac work is essential and likely to be so for other areas of cardiovascular surgery; for example surgery of carotid artery disease.

3.6 Additional activity - NHS patients

    As highlighted earlier in this paper, it is anticipated that demand for PET-CT scans within the LTHT catchment area for oncology related diagnosis will quickly exceed the capacity of the AML scanner. There is potential for LTHT to undertake this excess as a subcontractor to AML or, as a potential independent provider directly funded by commissioners. It is difficult to estimate the level of demand as this will be determined by a number of drivers; commissioning guidelines, commissioning arrangements under the national IS contract (including spare capacity at other sites) and commissioner intentions. An assessment has been made based on the fact that the AML service will commence fully in 2010.

3.6.1 Projected additional NHS activity (PET CT)

     2010/11 2011/12 2012/13

    Additional NHS patients 100 300 1000

    In addition, paediatric NHS patients under the age of 12 and any children requiring sedation or general anaesthetic currently have to travel to London for provision of PET-CT. The supporting infrastructure exists within the Bexley Wing to provide this service locally.

    4. Financials

4.1 Capital

    The cost of a new PET-CT scanner has been based on estimates from the NHS Supply Chain at approximately ?2 million which includes the equipment, installation and modification required to the existing Radiopharmacy department. The financial table refers to a scanner purchased from the NIHR research bid and the revenue costs met by LTHT.

    The Directorate recognise and are committed to ensuring the Trust receives a return on the investment, however, the capital funding has already been agreed via NIHR and as such this project is not competing with other Trust projects for the use of its scarce capital allocation.

4.2 Revenue

    The overall revenue position is summarised below. The table assumes a phased increase of activity to utilise 4 sessions largely in respect of research and private activity. The balance of sessions will be utilised to support the expansion in PCT demand for scans identified earlier in this paper. The viability of this service is dependant upon attracting research and

    increasing private patient use of PET-CT. Additional NHS activity and associated income will reduce the financial risk to the Trust. The basis of the increase within each category of activity is detailed below. The table identifies the capital cost based on the outright purchase of the scanner. This may change and probably reduce dependant on the procurement process followed or the potential contributions from charitable sources or the private sector.

    Trust Board final version 29th Sept 2009 9

    Agenda Item 5.5

    1.ACTIVITYPrivate Patients2010/112011/122012/13ResearchRT Planning via clinical trial funding100140140NHS Patients150200250TOTAL2502502502.STAFFINGWTECostWTECostWTECost1003001,000Consultant?104,0000.3?31,2000.45?46,8000.6?62,4006008901,640RadiographersB7?40,8510.4?16,3400.6?24,5111?40,851RadiographersB6?34,1510.4?13,6600.6?20,4911?34,151(all at mid-point)Admin supportB4?22,8920.4?9,1570.6?13,7351?22,892Admin supportB2?17,1000.4?6,8400.6?10,2601?17,100Medical PhysicsB8A?49,6760.3?14,9030.45?22,3540.7?34,773PharmacistB8A?49,6760.05?2,4840.075?3,7260.1?4,968Pharmacy tech.B3?19,5740.2?3,9150.3?5,8720.4?7,830Total staffing?98,499?147,749?224,964

    3.OTHER COSTSMaintenance

    12 mth warranty Yr1?185,000?185,000Radiopharmaceuticals?105,000?155,750?287,000Facilities costs?10,000?10,000?10,000Total other costs?115,000?350,750?482,000

    4.CAPITAL CHARGES?240,000?234,000?227,000

    TOTAL COSTS?453,499?732,499?933,964

    5) INCOME

    Income Per Private Patient?150,000?210,000?210,000Income Per Research Patient?150,000?200,000?250,000Income Per RT Planning funded via clinical trial?250,000?250,000?250,000Income per NHS Patient?100,000?300,000?1,000,000Total Income ?650,000?960,000?1,710,000

    6.POSITIVE CONTRIBUTION ?196,501?227,502?776,036

The above table demonstrates the viability of this investment, as the income in the first year

    is expected to cover all costs including capital charges and make a positive contribution to

    the Radiology Directorate income. As mentioned earlier there may also be opportunities for

    some of the staff costs to be funded from charitable sources.

     4.3 Funding

4.3.1 Research funding

    The revenue costs associated with research will be covered by the price quoted for scanning

    in the many initiatives, examples of which are contained in the letters of support in the

    appendices. These include the following examples:-

    ? Cancer Research UK (and other non-commercial funding) for particular research

    programmes. The facility would form part of the CRUK centre which would

    significantly increase the likelihood of securing additional research funding. It may

    be possible to also secure funding from Yorkshire Cancer Research as there is no

    other comparable facility in Yorkshire.

    ? Commercial funding to support clinical trials participation and agent development

    including a partnering agreement with an equipment manufacturer and a large

    pharmaceutical company.

    ? Appeal Fund and Charitable donations.

Negotiations are ongoing with the West Yorkshire Comprehensive Local Research Network

    and NHS Specialist Commissioning Group regarding support costs for Research and

    Development being met by the NHS.

A demand for 150 research scans per annum has been identified by the clinical lead for

    research from YCRN based upon demand from current or pending studies. It is anticipated

    that this level of demand would continue on an ongoing basis as cancer is the Trust‟s largest

    and strongest area of clinical research. However, this is a conservative estimate of the total

    Trust Board final version 29th Sept 2009 10

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