NHS GRAMPIAN. ARI Reconfiguration Project/Backlog Maintenance Programme

Transcription

1 NHS GRAMPIAN Board Meeting 04/02/2016 Open Session Item 9.1 ARI Reconfiguration Project/Backlog Maintenance Programme 1. Actions Recommended The Grampian NHS Board is asked to approve the following key projects in line with the Board s five year capital plan:- Third stage of the Aberdeen Royal Infirmary - Phase 2 backlog maintenance project, not to exceed the identified budget of 10m including all risk and contingency allowances. First stage of the Aberdeen Royal Infirmary - Phase 1 ARI backlog maintenance project (including relocation of the Eye Outpatient Department and upgrading of the lifts) not to exceed the identified budget of 6m including all risk and contingency allowances. Replacement of the Aseptic Pharmacy Suite, not to exceed the identified budget of 2m including all risk and contingency allowances. The Board is asked to authorise the Chief Executive and Board Chairman to agree a final target price and to sign the contract agreement with the appointed Principal Supply Chain Partners for the above projects. The Board is also to formally note the signing of the contract for the Carbon Energy Fund (CEF) project for which approval and delegated authority was granted previously. NHS Grampian will benefit from circa 15.6m investment in energy efficiency infrastructure over the 25 year life of the CEF contract. 2. Strategic Context The investment in the reduction in backlog maintenance (Phase 1 and Phase 2) and aseptic pharmacy unit fits clearly with NHS Grampian s strategic theme of delivering high quality care in the right place. In addition the programme fits with national and local strategy as follows:- The Scottish Government s Policy for Property and Asset Management in NHS Scotland issued in September 2010(CEL 35(2010) requires all NHS Boards to target backlog maintenance reduction as an integral part of their Property and Asset Management Plans. NHS Grampian s backlog maintenance costs at 1 April 2015 were estimated at 168m, the second highest of all the Scottish Health Boards. A commitment by the Board to reducing high and significant backlog maintenance risks within the inpatient accommodation at Aberdeen Royal Infirmary (ARI). The planned work will also enable the reconfiguration of services consistent with the Health Campus Programme Initial Agreement and the Foresterhill Development Framework approved by the NHS Grampian Board in

2 The works within East End 2 block and the first stage of the Phase 2 block are now complete with work ongoing to fully refurbish all remaining clinical accommodation in Phase 2 over the next two years. Both buildings will remain as inpatient facilities for the next years. Beyond this period the Foresterhill Development Framework has identified an area to the east of the Matthew Hay Building for the construction of a new inpatient facility to replace both buildings. 3. Key matters relevant to recommendation Overall backlog maintenance risk and planned reduction 3.1 The total assessed backlog risk across all NHS Grampian properties at April 2012 was 193.4m 1 of which 76.2m was high or very high risk. 3.2 Our plans including a programme of targeted expenditure initiatives, asset disposals and site rationalisation will result in an overall reduction in backlog maintenance against this target of 61m (35%) by March Within this overall figure very high risk backlog will reduce by 16.7m (84%) and high risk by 37.9m (67%). 3.3 A summary of the overall backlog maintenance programme for the period to 31 March 2021 is provided in Appendix 1, together with details of the completed phases within East End Block and the Phase 2 building (stages 1 and 2). Aberdeen Royal Infirmary Phase 2 (third stage investment) 3.4 The scope of the works programme and detailed design planning for the next stage of Phase 2 is now complete and will be targeted at the following: Ward 212 and 213 Orthopaedics Ward 214 Plastic Surgery Wards 215, 216 & 217 Cardiothoracic and Surgical High Dependency Unit (HDU) 3.5 The scope of this programme was initially intended to cover 3 floors but the risks around our asset disposal programme are such that the target price is not affordable in 2016/17. Consequently we have asked the main contractor to produce a revised target price to cover the two floors that carry dependencies to other projects and critical service moves. The work on the third floor will be deferred and dealt with either through an addition to the next stage or to form an entirely separate stage. The revised target price for the two floor programme is estimated at 10m. 3.6 The backlog risk that will be eliminated by the investment programme in Phase 2 is quantified at 12.8m. 1 Please note that the above values used to quantify backlog maintenance risk are stated net of VAT, fees and other on costs which means that the actual project costs necessary to deliver the required works are often well in excess of these values 2

3 Phase 1 ARI Eye Outpatient Department (EOPD) and Lift Upgrade 3.7 Work planned within the Phase 1 block at ARI has been brought forward to 2017/18 to enable the relocation of the existing Eye Outpatient Department. This is the preferred location for the new ANCHOR Centre because of the various adjacencies to key cancer services. Keir Construction has been appointed through a competitive tendering process as the Principal Supply Chain Partner to lead the Phase 1 project. The initial stage of this project will focus on the programme of works necessary to enable the relocation, and subsequent demolition, of the existing EOPD. 3.8 The relocation of the EOPD also provides an opportunity to add valuable benefit to service provision from co-locating two ambulatory components of the ophthalmology services: the EOPD and the Cataracts Procedure Room (which will transfer from the Short-Stay Theatre Suite). This is possible due to the increased floor area and a more efficient design of the clinical areas that will improve patient flow. The new accommodation will also be designed to ensure future flexibility as the service changes to meet future demands. The project will also include upgrading of the lifts in Phase 1 which will be a critical part of the infrastructure for the foreseeable future and require significant refurbishment in order to extend their useful life. 3.9 The scope of the works programme and detailed design planning for this initial stage of the Phase 1 programme and the estimated cost is 6m. These works will eliminate 1.9m from the backlog maintenance risk register. Replacement of Aseptic Pharmacy Suite ARI 3.10 The Pharmacy Aseptic Suite in ARI is a facility with a sterile and controlled environment in which medicines can be prepared whilst reducing the risk of microbial or particulate contamination. This environment also minimises staff exposure to toxic medicines such as cytotoxic chemotherapy The Pharmacy Aseptic Suite supports the preparation of medicines for clinical trials, intravenous and intrathecal cytotoxic chemotherapy for cancer, total parenteral nutrition feeds for adults, children and neonates and the preparation of other specialised intravenous medicines. The unit also supports services across NHS Grampian, NHS Orkney and NHS Shetland Whilst the suite is functional at present there are risks associated with maintaining service resilience in the event of air handling plant issues, microbial or particulate contamination failures or the inability to get replacement parts due to the age of equipment 3.13 Whilst a further Aseptic Suite is planned for the ANCHOR Centre due to open in 2020, the current service requirements and operational continuity risks associated with the existing suite are such that a replacement is required within the next 12 months. 3

4 Service requirements 3.14 An outline of the current aseptic activity is outlined in Table 1. Table 1 Number of Aseptic Items Prepared in 2014 No of Items TPN Adult 3307 TPN Children 389 TPN Neonate 623 Chemotherapy Adult Chemotherapy Children Activity in some therapeutic areas is increasing, notably adult cancer services in Aberdeen Royal Infirmary (Figure 2) but also in Dr Gray s Hospital (Figure 3). Dependency on the aseptic facility is predicted to continue to increase. Figure 2 -Total adult chemotherapy doses given in Aberdeen Royal Infirmary (No of Doses Prepared in Aseptic Plus Ready to Use Dose Banded Items) Note the data does not include non-chemocare cytotoxic prescriptions Figure 3 - Total Adult Chemotherapy Doses Given in Dr Gray s Hospital, Orkney and Shetland (No of Doses Prepared in Aseptic Plus Ready to Use Dose Banded Items) 4

5 Continuity of supply 3.16 There is only one Pharmacy Aseptic Suite in NHS Grampian, NHS Orkney and NHS Shetland. In the past the contingency arrangements have been to call on the help of a neighbouring Board to assist The geographical position of Aberdeen Royal Infirmary makes the use of a neighbouring Board s facility very difficult, especially for cancer services which require good response times and flexibility to deal with variable patient care needs. In addition, aseptic suites across Scotland are now at capacity Whilst, there has been greater availability of compounded products being supplied by commercial units over the last few years, the continual introduction of new medicines has meant that any spare aseptic capacity in Grampian has been taken up. It is possible to outsource aseptic compounding to licensed units but response times and capacity would remain an issue In June 2015, the NHS Scotland National Chief Executives Group agreed that a shared service approach should be considered to support sustainable, consistent and effective services across NHS Scotland in the future. This work includes aseptic services and initial consultation with stakeholders is to take place in This work may address some of the contingency and capacity issues for some stable products. It will not replace the need for responsive local aseptic services especially for unstable products and will not provide a timeous solution for the current aseptic suite requirements in Grampian. Meeting professional standards 3.20 As a result of the Farwell Report and MEL(1997)12 (Aseptic Dispensing in NHS Hospitals), ASSIG (Scottish Aseptic Services Specialist Interest Group) in conjunction with SPQAG (Scottish Pharmacy Quality Assurance Group formerly Scottish Quality Assurance Specialist Interest Group) established a Scottish wide internal and external audit programme. ASSIG is due to carry out an external audit in The last external audit in 2013 and an internal audit in 2014 both reinforced the need for improvement in the work environment. Option appraisal Aseptic Pharmacy Suite 3.21 Following a detailed option appraisal the project team identified the option to develop a new Aseptic Suite in accommodation adjacent to the existing pharmacy department in Phase 2 at ARI as the most cost effective and deliverable option. The detailed scope and design planning is nearing completion and the estimated cost of the project is 2m. The project, if approved, will be delivered as a variation to the current stage of the Phase 2 backlog maintenance programme Alternative options considered included refurbishing the existing suite, which was discounted due to the requirement to vacate for several months while the work was completed. As explained earlier this would have significant impact to cancer service sustainability. A modular build was discounted on the grounds of cost. 5

6 Carbon Reduction Carbon Energy Fund Project 3.23 The contract with Vital Energi to deliver a series of infrastructure investments aimed at improving the carbon efficiency of three of our hospital sites, Foresterhill, Royal Cornhill and Dr Gray s was legally completed on 29 December An overall reduction in carbon emissions of 16% is anticipated. NHS Grampian will benefit from investment in infrastructure estimated at circa 15.6m over the 25 year life of the contract ( 10.4m of initial investment with 5.2m lifecycle replacement of lights and chiller units throughout the contract period) A significant component of the contract is the creation of an energy link between Foresterhill and Royal Cornhill Hospital which will also allow all areas of the Foresterhill Site to be serviced from the main CHP plant. This will make the East Boiler House redundant and the contract also includes provision to cover all demolition costs The overall Project is due to complete on 2 January The key project milestones are as follows :- Dr Gray s Boiler Replacement 3 rd August 2015 ARI Chiller replacements 29 th June 2016 Steam & Condensate to Laundry from ARI Energy Centre 15 th July 2016 Energy Link (ARI to Royal Cornhill) 2nd September 2016 Dental School & Institute integration 7 th October 2016 Mile End Boiler House Demolition 14 th October 2016 ARI High Voltage Ring 28 th October 2016 Lighting upgrade ARI and Royal Cornhill - 18 th November 16 Project handover 28 th November It is anticipated that this will eliminate 2.6m of backlog maintenance risk. 4. Risk Mitigation The proposed programme of works is affordable within our overall financial plans and will target the significant areas of risk within our estate. Failure to progress will result in existing infrastructure not able to support our objectives for future patient care. (Strategic Risk number 855). The dependency on asset disposals is a key risk to the affordability of the programme and to mitigate this the major programme of works planned at ARI Phase 2 and ARI Phase 1 will be delivered in distinct stages with Board approval requested prior to the commencement of each stage. 6

7 5. Responsible Executive Director and contact for further information If you require any further information in advance of the Board meeting please contact: Responsible Executive Director Alan Gray Director Of Finance Contact for further information Paul Allen General Manager, Facilities & Estates Graeme Smith Modernisation Director Date 4 February 2016 Additional supporting information Aseptic Pharmacy Business Case 7

8 Appendix 1; Backlog Maintenance Investment Plan to 2020/21 The following extract from our financial plan summarises the budgeted expenditure on backlog maintenance (inclusive of VAT fees and other on costs) and the sources of funding available to support the programme over the 9 years 2012/13 to 2020/21. NHS Grampian Backlog Maintenance Programme AVAILABLE FUNDING 12/13 13/14 14/15 15/16 16/17 17/18 18/19 19/20 20/21 Total investment 9 years to March s 000s 000s 000s 000s 000s 000s 000s 000s 000s Capital Allocation from SGHSCD 7,179 12,738 7,332 3,802 16,130 8,183 (1,143) (2,986) (390) 50,844 NHS Grampian Endowment Funds 858 1,000 1,594 3,452 Asset disposal proceeds 609 (1,625) 231 2,004 2,391 8,055 1,973 2,596 16,233 Revenue Estates Maintenance budget 1,450 1,390 1,390 1,390 1,390 1,390 1,390 1,390 1,390 12,570 TOTAL FUNDING AVAILABLE FOR INFRASTRUCTURE AND BACKLOG MAINT 9,238 12,503 9,811 8,196 21,504 17,627 2,220 1,000 1,000 83,099 EXPENDITURE East End 2/Phase 2 Blocks - ARI 1,429 6,479 7,217 4,746 13,300 7,427 1,220 41,818 ED Theatres ARI 1,850 1,850 Woolmanhill exit strategy ,760 Denburn Exit Strategy 1,800 3,200 5,000 Dr Gray's IP / fire regs Stage II 1, ,310 ENT/Audiology 100 1,600 1,700 Other Programme specific - Fire, legionella etc 4,738 4, ,555 Additional Estates Backlog Westburn Demolition Cornhill Exit Strategy 0 Woodend Masterplan Dr Grays A&E Mortuary Accreditation Woodend Boilers ,167 Aseptic Pharmacy 2,000 2,000 Chalmers Hospital/Health Centre 0 Phase 1 ARI - Anchor Centre enabling, Lifts and Relocation of Eye Infirmary 0 6,000 6,000 Peterhead CMU Contingency - Backlog Maintenance 0 1,000 1,000 1,000 1,000 1,000 5,000 Total Planned Expenditure on Backlog Maintenance 9,238 12,503 9,811 8,196 21,504 17,627 2,220 1,000 1,000 83,099 Surplus / (-)Deficit A major element of this programme is the planned package of works to be undertaken in the East End 2 and Phase 2 blocks at ARI and the relocation of the Eye Out Patient Department to Phase 1 at ARI. The overall programme at ARI is underpinned by a complex series of service moves, a decant plan, which is agreed on a stage by stage basis by both clinical leadership within the affected service areas and the Acute Sector Management Team. The decant plan is aimed at ensuring that services are required to move only once to allow the work to complete prior to occupying their permanent accommodation East End Block 2 ARI The programme of works associated with the East end 2 block was approved by the Board in September The final cost for this works package was 5.6m with all work complete and services operational in their new accommodation by December The backlog risk eliminated by the programmes in East End 2 is quantified at 1.3m. The accommodation addressed in this phase included: Ward 308 & 309 Breast & Gynaecology Ward 305 & 306 Acute Geriatric Medicine GI Physiology Laboratory Ward 303 & 304 Acute Geriatric Medicine Ward 301 & 302 Short Stay Surgical Unit & Pre-operative Assessment Clinic 2 8

9 Phase 2 ARI The scope of the works programme for ARI Phase 2 is complex. To manage the dependency on asset disposals to fund the programme the Board previously agreed that the works package will be delivered in separate stages. Detailed designs and a final target price for the first and second stages including a variation to recommission the Emergency Department theatres were previously approved by the Board. The final cost for Stage 1 was 10m and all work was completed and services operational by October The work to re-commission two operating theatres in the old Emergency Department was completed on schedule, at a cost of 1.85m, with the theatres fully operational in October Stage 2 is ongoing due for completion in June 2016 at an anticipated cost of 6.8m Stage 1 accommodation addressed Ward 203 Ophthalmology Anaesthetics Chaplains Wards 207 & 208 will become General Surgery wards from February 2017 Stage 2 accommodation addressed Ward 202 Urology Day Cases/Theatre Women s Day Clinic Ward 209 Urology UCAN Centre Ward 210 ENT, Maxillo-facial Ward 211 Short Stay Surgical Residual Backlog at March 2021 The current investment plan up to March 2021 will reduce but not address all the assessed backlog maintenance risks. The largest areas remaining to be addressed will be the Phase 1 block and Theatre Suite at ARI. The Foresterhill site rationalisation plan identifies Phase 1 as the future location for ambulatory care services in the medium term. The plans for this area cannot be agreed until the current service configuration is finalised. The works within the Theatre Suite relate to the ventilation plant which, although mechanically serviceable and meeting the standards to which it was designed, will require to be upgraded at a future date. The work necessary to install modern plant, is invasive requiring a programme of works over a 3 to 5 year timescale. 9