Revision v 2.0 June Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 1

Transcription

1 Surrey and Sussex Healthcare NHS Trust Estates Strategy 2014 to 2020 Revision v 2.0 June 2014 Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 1

2 Contents Page 1. Foreword 3 2. Introduction 3 3. Organisational Tenets 4 4. Estates Vision, Strategy and Objectives 7 5. Where Are We Now? 9 6. Detailed Estates Plan Strategy Evaluation Estates Strategy Implementation 27 Version Control.docx Construction of new Theatres Block, East Surrey Hospital, October 2013 Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 2

3 1. Foreword This Estates Strategy has been developed by Surrey and Sussex Healthcare NHS Trust (the Trust / SaSH) in order to expedite a disciplined yet agile approach to the development and management of the Trust s estate over the next five years. The strategy references the Trust s clinical plans for service delivery, as set out in the Trust s Clinical Strategy which provides the context for the journey the Trust is taking to secure its future as a foundation trust. The Estates Strategy is aligned with the strategic plans for other divisions within the Trust, including Information Technology and Workforce and is based on the premise of ensuring clinical and financial sustainability. At the time of preparing this strategy, the healthcare economy and landscape are subject to the impact of continuing, major legislative, organisational and policy changes. There is consensus across the system that change is both necessary and inevitable; the way forward, however, is not prescribed. Financial pressures are juxtaposed with continuously increasing levels of clinical activity and whilst flexibility is inherent, a five-year strategy set out in this context must be taken and read as reflecting the Trust s current expectations of the period ahead. The strategy will be revisited, reviewed and revised as the variables and dynamics impacting the healthcare system evolve and are developed - and as the SaSH Clinical Strategy progresses. 2. Introduction Surrey and Sussex Healthcare NHS Trust provides a comprehensive range of emergency and non-emergency services, primarily for the residents of east Surrey, north-east West Sussex and south Croydon, including the major towns of Crawley, Horsham, Reigate and Redhill. The Trust owns East Surrey Hospital (ESH) which is located just south of Redhill and from this site delivers elective and non-elective services, including major and minor Accident and Emergency. East Surrey Hospital is a Trauma Unit and is the designated hospital for Gatwick Airport and sections of the M25 and M23 motorways. The Hospital is situated at the heart of a local community of over 500,000 people and the Trust employs around 3,500 staff. To enable the provision of appropriate services at locations which are closer to home for our patients, SaSH staff also deliver a range of day case, outpatient and diagnostic services at premises owned by other organisations. These include Crawley, Caterham Dene and Horsham Hospitals and Oxted Health Centre. This Estates Strategy has been developed by the SaSH Estates and Facilities Team, in collaboration with colleagues across the Trust including the Executive Team and Board. The Estates and Facilities Team has four functional work streams: Capital Projects Engineering Logistics Facilities Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 3

4 3. Organisational Tenets Over recent years, SaSH has worked to develop a culture that supports consistent improvement, resourcefulness and efficiency in clinical and non-clinical functions. Progress has been evidenced and recognised in many areas; recent examples include: CQC Hospital Intelligent Monitoring analysis which placed the Trust in the highest banding for offering safe, effective, high quality care Friends and Family Test combined scores which reported SaSH as having the best DGH score in its region. The following SaSH Vision Statement, Strategic Objectives and Values provide direction and stimulus for the Trust as well as offering a reflection of the character and aspirations of the Trust leadership and its staff. Aligned with its geographical and operational positioning, the Trust approach is summarised in its Vision Statement which is to deliver: Safe, High Quality Healthcare which puts our Community First This Vision is enshrined in five Trust Strategic Objectives. They are:- Safe To deliver excellent quality of services in the top 20% against our peers by ensuring that: o the safety of patients and staff comes first in all we do o we embed safety and quality into everyday systems and processes o we are open and transparent o we achieve harm free care o we maintain and exceed a Good CQC rating o we support safety by providing excellent learning environments and supporting our students as the workforce of tomorrow. Effective To deliver clinically and financially sustainable services and to control our own destiny by ensuring that we: o have appropriately qualified and competent staff providing care o achieve the best possible clinical outcomes for our patients o demonstrate full compliance with all NICE guidelines o use quality evidence at the point of care o live within our means to remain clinically and financially sustainable o embed a culture of lifelong learning, ensuring our education and training meets our needs to enable the best delivery of care. Caring To ensure patients are cared for and feel cared about by ensuring that we: o deliver high quality care around the individual needs of each patient o show compassion and go the extra mile at all levels o treat patients and their families with dignity and respect o always work to the highest standards of professionalism and ethics. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 4

5 Responsive to people s needs To become the secondary care provider and employer of choice for the populations of Surrey and Sussex by ensuring that we: o listen to patients and their families o involve patients and carers in their treatment and care o use feedback to shape and improve the experience of patients and the services they receive o ensure an effective patient journey with the right patient, in the right place, at the right time o maintain improving patient satisfaction and friends and family test results. Well led To develop the East Surrey Hospital site to provide a range of specialist and tertiary services closer to home and in response to local and national priorities in partnership with others, ensuring that: o we are an organisation that is clinically led and managerially enabled o we are a well governed organisation working in partnership with stakeholders o all staff consistently demonstrate the Trust s values and behaviours o we have visible leaders who are engaged and play a valuable part in the local health and social care system to ensure the development and delivery of safe and sustainable services. Underpinning achievement of these objectives are the Trust s Values: Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 5

6 These tenets are further developed to describe the basis of the Clinical Strategy (which in turn informs the Estates Strategy) as follows: Our patients deserve the best possible care and we intend to deliver good clinical and quality outcomes by further improving patient safety, patient experience and clinical effectiveness. We will provide a broad range of high quality, integrated district general hospital services that allow us to be a clinically and financially sustainable organisation and to especially work with other expert providers to bring tertiary services and expertise locally to our patients. We recognise that a good reputation is key to the delivery of our services, and we aim, therefore, to meet all local and national expectations which include meeting the needs of our patients and our commissioners. We are committed to academic training, research and innovation and aim to be both the provider and employer of choice. We understand that we cannot deliver our services in isolation and it is, therefore, imperative that we work in partnership with our NHS and commercial partners to deliver appropriate services and models of care, which include utilising clinical networks. Partnership means working with others across the whole health economy, both providers and commissioners, working to the same agenda of delivering high quality, safe and affordable care. So that we remain clinically and financially sustainable, we are working hard to improve our productivity by adopting better ways of working. We recognise the role that technology has to play in doing this. We also believe that it is vital to use intelligent information and benchmark our performance. By being sufficiently informed with the right information, we can make better decisions about improving and sustaining our performance. The Trust s Clinical Strategy drives and shapes the provision of services by SaSH and therefore sets the broad direction that each of the clinical divisions will follow. This in turn informs strategies for the clinical support services, including Estates, to ensure their clear alignment with the overall Trust vision and objectives. It should be noted that strategic planning is the starting point for the Trust s rolling five year business planning process which will develop and test the detailed plans of the individual clinical divisions and services. These, based on robust activity capacity and financial planning, will set the direction of travel for the Trust. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 6

7 4. Estates Vision, Strategy and Objectives Estates objectives are driven substantially by the Trust s Clinical Strategy and the outcomes of the 2012 Six Facet Survey, which is the standard mechanism for establishing and monitoring the status of NHS estate under Estatecode (DH 2007) see Section 5.0. The Estates Strategy informs the progression of the estate and site to enable delivery of optimum clinical outcomes and best possible patient experiences, ensuring that new facilities are built in line with service developments and that existing facilities are maintained and developed to support efficient pathways and processes. Aligned with the Organisational Tenets, including the Trust Vision described in Section 3.0 of this document, the strategy and objectives for the Estates function take as their foundation the following Estates Vision: Estates Vision To ensure that the estate contributes to the achievement of the Trust s objectives by maintaining and developing buildings and facilities which offer the necessary levels of safe and appropriate amenities, services and accommodation for patients, visitors and staff. Key Elements of Estates Strategy The Estates Strategy focuses on the following scheme and activity types: 1. Backlog maintenance to invest in specific schemes to address areas of the estate which require targeted activity to ensure they are made fit for purpose and can be maintained routinely going forward. 2. On-going maintenance to systematically invest in the estate to provide the required facilities to enable the Trust s services to achieve high standards of clinical outcomes and patient experience. 3. Modernisation to routinely assess the estate to identify and upgrade areas where facilities and the environment can be refurbished and developed to take advantage of new technology and equipment. 4. New development to invest in and implement new developments in response to the Trust s clinical and corporate plans for service and structure developments, through an efficiently managed capital investment programme. 5. Energy efficiency to invest in specific schemes designed to reduce energy costs and the Trust s carbon footprint including the replacement of time-expired plant and installation of a combined heat and power (CHP) unit. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 7

8 6. Space management to explore and implement creative solutions to space management, particularly to provide optimum clinical space occupation and efficient co-location, including SaSH utilisation of non-sash premises, where standards of accommodation and facilities are proactively managed through service level agreements. In practice, there is a great deal of overlap between these activities and during the evaluation of each capital scheme the opportunities for wider benefits are assessed and integrated where feasible. Capital projects which are driven by clinical service redesign incorporate maintenance and modernisation requirements identified in the six facet survey. Leading practice is taken into account in areas such as design of the environment for people with dementia. Energy efficiency is a consideration for all schemes. Estates Objectives The Estates objectives are driven by the Clinical Strategy and reflect the Key Elements of Estates Strategy as identified above. The Estates and Facilities Team aims to: maintain the fabric of the buildings at East Surrey Hospital through on-going investment in routine and backlog maintenance. explore and progress agreed solutions with clinical and non-clinical colleagues to optimise clinical space and afford the best possible environment for patients, visitors and staff. invest in energy efficiency, in particular through replacing old windows and time-expired plant, implementing the recommendations of the DEC audit and installing a combined heat and power unit to reduce energy generation costs and the Trust s carbon footprint. implement a systematic capital investment programme, supported by control mechanisms in line with Trust policies, to determine the allocation of internal and external funding. progress estates developments in line with all professional standards and good practice and always with reference to the Trust s Strategic Objectives. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 8

9 5. Where Are We Now? The first phase of East Surrey Hospital opened in Originally known as the New East Surrey Hospital, it initially replaced the previous (smaller) East Surrey Hospital and Smallfield Hospital. The second phase of building opened in 1991, allowing the final closure of the nearby Redhill General Hospital as the remaining services including maternity moved onto the new East Surrey Hospital site. Around 90% of the East Surrey Hospital estate was constructed between the early- 1980s and the mid-1990s, with the remainder built since A comparison of the position of SaSH estate with other trusts in the south-east coast area is shown below: 5.1 Ownership and Tenancies East Surrey Hospital occupies 27 hectares (67 acres) on a roughly shield shaped plot of land which is owned by the Trust. The main footprint of the buildings is on the western half of the shield, with the eastern half being largely taken up with the neighbouring golf course (including parking, which is used by hospital visitors and staff for a flat rate charge), and fringed with protected ancient woodland. The land currently leased by SaSH to the golf course operator will be returned to Trust management in October The Trust has well-established, good relationships with the planning authorities at Reigate and Banstead District Council and it is expected that the Trust and the Council will work together to progress a development strategy for the golf course area. 5.2 Estate Users SaSH works in partnership with other healthcare organisations which have staff located at East Surrey Hospital. These include: First Community Health and Care Surrey and Sussex Social Services Virgin Care. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 9

10 A key element of the Trust s overall strategy is partnership working. In addition to current schemes underway with BOC (Guy s and St Thomas ) and Royal Surrey County Hospital (described on page 13) there is also a plan under development with Macmillan for the opening of a Cancer Information and Support Centre on the East Surrey Hospital site. As noted in the SaSH Clinical Strategy, the Trust sets out to work with our NHS and commercial partners and engage with our community to deliver appropriate services. As well as providing clinical services at East Surrey Hospital, SaSH staff also carry out activity at a number of locations which are owned by other providers, in order to deliver care closer to patients homes. Examples are given below: Caterham Dene Hospital outpatient clinics, radiology, rehabilitation Crawley Hospital day surgery, outpatient clinics, care of the elderly, antenatal Horsham Hospital outpatient clinics, haematology, radiology Oxted Health Centre outpatient clinics, radiology, antenatal 5.3 Estate Development The eastern part of the site offers the Trust substantial opportunities for improvement of its own estate and also for strategic developments with partners. There are no restrictive covenants on the site, however, a strip along the eastern fringe of the site is designated as ancient woodland and is therefore protected from development. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 10

11 Recent Developments During the 3 years to March 2013 more than 20m was invested in estates developments and improvements including: Accident and Emergency Department a major rebuilding scheme has provided extended capacity to support improved privacy and dignity for patients, with upgraded facilities for adults and paediatrics: Maternity birthing unit providing fully equipped rooms with birthing pools, large beds and home-from-home facilities: Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 11

12 New Wards Copthorne and Charlwood surgical wards opened within 7 months of commencement of planning to provide additional bed capacity and improve patient flows. Endoscopy Unit following substantial investment the Trust has recently achieved JAG accreditation and the Digestive Diseases team is expanding and developing the inflammatory bowel disease (IBD) service in line with the published National IBD standards. Post Graduate Education Centre improved and extended facilities are supporting the Trust to advance its position as an Associated University Hospital in partnership with the Brighton and Sussex Medical School. Main (West) Entrance the new main entrance is enhancing patient experience through provision of enhanced reception and welcome services, improved signage and retail / catering outlets. New Developments In addition to the completed developments, the following construction projects are currently underway: SaSH Theatres the Trust has recently completed a scheme to build 4 new operating theatres and has now commenced a full refurbishment programme for the existing theatres, resulting in a total of 10 state of the art theatres. The full scheme is scheduled for completion in summer Radiotherapy Unit development of a radiotherapy centre in partnership with Royal Surrey County Hospital, to provide treatment for cancer patients closer to their homes. The facility is scheduled to be open in summer Respiratory Unit SaSH has leased land to BOC for provision of a step-down respiratory facility with capacity for 21 patients in partnership with Guy s & St Thomas NHSFT. The unit is scheduled to open in summer These developments are consistent with the organisational tenets which are the foundation of this strategic plan. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 12

13 5.4 Six Facet Survey As described above, the six facet survey is the standard mechanism for establishing and monitoring the status of NHS estate under Estatecode (DH 2007). It encompasses the elements of: 1. Physical condition 4. Functional suitability 2. Statutory compliance 5. Quality 3. Space utilisation 6. Environmental management During 2012, the Trust s built assets were fully re-surveyed and audited by The Oakleaf Group. The outcomes from this 2012 six facet survey have informed the Trust s Estates Programme from 2012 and continue to provide key benchmarks and a basis for this Estates Strategy. The results of the survey and audit process provided a general picture of estates facilities which, in terms of risks: a. whilst not aged, were seen to be ageing, with a significant and growing maintenance backlog. b. were tired in terms of look and feel, which affected the patient experience, overall quality and the organisation s reputation. c. were expensive to run and heat, scoring poorly on both NHS Estates and HM Government DEC measures of environmental performance. d. were cramped, especially in certain wards, and were increasingly unsuitable for modern healthcare delivery in terms of functional suitability and space allowances. e. had fallen behind the times in terms of published standards, and were increasingly ill-placed to respond to future developments. The assessment of the maintenance backlog for the Trust showed a 5m backlog for engineering, plus 3.3m for buildings, totalling 8.3m. The table below shows the 2012 position, analysed by risk category: Category Gross Risk Rated High - - Significant 5,097,245 5,097,245 Moderate 2,452,950 Low 724,100 54,885 Total 8,274,295 5,152,130 full cost Comment divided by remaining life of assets in years This is risk adjusted to reflect the urgency of the need to make good the backlog: high and significant risk items are counted at full cost, whereas moderate and low risk items are discounted by dividing the cost over the remaining life of the assets. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 13

14 The charts below show that, in 2012, the Trust had well over 8m of maintenance backlog, three-fifths of which was considered to be of significant risk. East Surrey Hospital 724 k High SE Coast Peers 1,160 k Significant 5,658 k 3,783 k 2,453 k 5,097 k Moderate Low 8,772 k When compared to the average backlog cost of similar Trusts in the south-east coast area, standardised by gross internal area, the Trust s maintenance backlog was, however, relatively low overall ( 8m versus 19m), although when risk adjusted the difference was less ( 5.1m versus 6.5m). All values above exclude VAT and professional fees. Space Occupancy The level of occupancy across the site is high, with almost three quarters of measured space being assessed as fully occupied in 2012, reflecting an improvement on the previous survey of 2008: Although the proportion of space categorised as overcrowded reduced by almost a third from 2008 to 2012, overcrowding remains as a particular problem in clinical areas, where 244 rooms (representing 37% of the total clinical floor area) were assessed as overcrowded in the 2012 survey. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 14

15 Category Empty 0% 0% Under used 3% 4% Fully used 62% 72% Overcrowded 35% 24% Quality Estate quality is measured in terms of general amenity, environmental factors and design, with the emphasis on patient experience and the functionality and appearance of the estate. Departments are assigned categories: A = Excellent B = Satisfactory C = Unsatisfactory D = Very Poor based on a number of contributory factors such as privacy and dignity, safety, user facilities and way finding. As shown in the chart above, the results of the 2012 survey classified 30 out of 72 departments (42%) as unsatisfactory. Accident & Emergency was the one department assessed as being of very poor quality, a position which was remedied by substantial investment in a construction programme completed in 2012 which provided 30% more space for A&E and improved facilities in both the adults and childrens departments see page 12. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 15

16 The full 2012 survey results are given below: Category No. Dept % Comment A - Excellent 3 4% Require no investment B - Satisfactory 37 52% Require general maintenance investment C - Unsatisfactory 30 42% Require significant investment D - Very Poor 1* 1% Require major investment Total % *A&E Department refurbishment now complete Environmental Audit In the last seven years the Trust has spent in the region of 1.5m - 2m per annum on utilities, the variance resulting from, amongst other things, increases in services provided, introduction of new equipment and fluctuating weather conditions. ( 000 s) Element 2006/7 2007/8 2008/9 2009/ / / /13 Energy 1,110 1,032 1,689 1,382 1,108 1,426 1,634 Water & Sewage Waste Total 1,399 1,397 2,120 1,802 1,564 1,745 2,081 Whilst energy costs have varied considerably (and in 2010/11 were at the same level as in 2006/7), the year to April 2013 saw prices rise again, meaning that last year energy cost the Trust almost 50% more than six years ago. Water and sewage costs have doubled over that time period and waste costs in 2012/13 were more than 30% higher than in 2006/7. According to the 2012 survey, the Trust performed reasonably well in terms of environmental management, scoring a B in four out of five categories, but a C in terms of energy efficiency: Category Procurement Energy Water consumption Waste management Transport management Score B C B B B Achieving a score of B for procurement, water, waste and transport is largely dependent on having the correct systems, policies and procedures in operation. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 16

17 Water, Sewage and Waste Water and waste costs are routinely assessed through the annual ERIC returns data. As part of the six facet survey a comparison with peer organisations in south east coast area showed that although SaSH water and sewage costs were around average for the peer group, waste costs per m 2 were over 50% greater. Energy Costs Energy efficiency is rated by the consumption for a given heated volume of accommodation, on a scale of A (best) to D (worst), with an X category where it is uneconomic to attempt improvement: Rating Between And Units Condition A GJ/100m 3 Condition B GJ/100m 3 Condition C GJ/100m 3 Condition D GJ/100m 3 Condition X 101? GJ/100m 3 The East Surrey Hospital site is deficient in terms of energy efficiency and was rated as D for This score is arrived at in the following way: Element Measure Units a Electricity 11,391,197 KilowattHour/Year b Gas 17,316,251 KilowattHour/Year c = a + b Total usage 28,707,448 KilowattHour/Year d KilowattHour;Gigajoule ratio KwH:GJ e = c x d Total 103,347 GJ f Heated Volume 123,642 m 3 g = f / 100 Heated Volume 1, m 3 h = e / g Energy Consumption 84 GJ/100m 3 Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 17

18 Heated KilowattHours Year GJ/100m 3 volume (m 3 Electricity Gas Total GigaJoules ) ,935 9,707,222 17,222,222 26,929,444 96, ,935 9,497,778 20,203,611 29,701, , ,935 9,909,444 16,585,556 26,495,000 95, ,935 10,257,136 16,516,045 26,773,181 96, ,362 10,535,738 15,047,126 25,582,864 92, ,642 11,391,197 17,316,251 28,707, , Source: ERIC returns The recent increase in usage per heated volume can be attributed to the adverse climatic conditions experienced in with a severe and extended winter period in the early part of 2013, as witnessed by a 13% increase in gas usage. This is slightly off-set by a small (1%) increase in heated volume at this time. All NHS Trusts should achieve at least rating C, with a target of rating B. This position is reflected in the HM Government Display Energy Certificate (DEC), issued in February 2011 which gave the site a rating of F on a scale of A-G, where A is more energy efficient. It suggests that the site consumed one-third more energy than average, representing an annual excess expenditure of ,000 above average. Sustainable Development Management Plan The Trust has been addressing the inefficient energy situation and a number of indicators of progress are noted below. It is, however, clear that the use of a combined heat and power (CHP) system is the key development which would bring major benefit to the Trust. Specific investigations have been carried out to assess the potential for combined heat and power (CHP) and plans are now in place to install a CHP plant in 2016/18. In the meantime, the Trust continues to limit energy consumption through a range of actions. The overall structure for this is the Sustainable Development Management Plan published in January The Plan takes as its foundation the NHS Carbon Reduction Strategy which dovetails with the concept of being a Good Corporate Citizen and focuses on corporate social responsibility within the wider sustainability remit. Objectives laid out in the Plan and achieved to date include use and adoption of: low energy equipment in capital schemes high efficiency lighting mains fed cooled water new cycle facilities increased recycling waste segregation TFL initiative regarding low emission vehicles. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 18

19 Travel and Parking The Trust s Travel Plan aims to reduce the number of vehicles coming on to the East Surrey Hospital site and sets out initiatives to encourage the use of alternative transport such as public transport, walking and bicycles. To assist with this, the Trust has developed a bus terminal that sits as a hub on a number of bus routes and is working with Surrey County Council to continue to promote the cycle routes and footpaths that converge on the site from different directions. The Trust has also invested in shower facilities for cyclists and additional secure bicycle storage. Despite the benefits derived from implementation of the Travel Plan it remains the case that the number of parking spaces available at East Surrey Hospital is inadequate; also that patient and visitor parking locations and facilities, especially for those with disabilities, require upgrading. Plans for improvements to access and parking are now under development, with provision in the estates plan for commencement of a formal review of access and parking configurations. Key objectives of the review are to identify the optimum layout to enable more convenient parking locations for patients and visitors and to confirm the appropriate increase in the overall number of spaces. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 19

20 6. Detailed Estates Plan 6.1 Estates Programme The Estates Programme detailed below has been developed from the strategic plans compiled by the clinical divisions, (where clinical plans are expected or known to necessitate estates activity) and Estates and Facilities own plans, including maintenance and modernisation, with reference to the outcomes of the 2012 six facet survey. ITEM CLINICAL STRATEGY REF to key elements of strategy ESTATES SCHEME PERIOD Angio Suite and Cardiac Private Beds Cancer Information and Support Centre Dental Simulation Suite in PGEC Diabetes and Endocrinology 2,3,4 Creation of second cath lab and a private cardiac unit. 4 Work with Macmillan, Olive Tree and Friends to develop and build a Cancer Information and Support Centre at East Surrey Hospital. 3,4,6 Develop and implement dental simulation suite. 3,4,6 Adapt underutilised GP facilities to provide community based locally accessible diabetes services. Emergency Medicine 1,2,3,4 Refurbishment of Resus department and CT scanner to be located in ED. Haematology offices and patient areas 2,3,6 Redesign and refurbish Haematology department to deliver improved patient experience and working efficiencies. Mammography 3,4 Redesign service to support the installation of a digital mammography machine for a unified breast service. Respiratory Unit 4 Unit being developed on ESH site by BOC for provision of a satellite service for Guy s and St Thomas Hospital. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 20

21 ITEM CLINICAL STRATEGY REF to key elements of strategy ESTATE SCHEME PERIOD Theatre Refurbishments 1,2,3,4,6 Refurbish and re-open six theatres by summer 2015, in addition to four new theatres due to be operational by end of Trauma and Orthopaedics Healthcare records storage Children s Assessment Unit 2,3 Redevelop and merge the existing emergency T&O wards to create a single purpose built T&O unit. 4,6 Develop additional capacity for health care records storage by replacement of Maple Annexe to reduce costs of commercial offsite storage solutions. 4,6 Redesign of service to collocate the children s assessment unit alongside paediatric ED. 2015/ / / /20 Maternity 2,3,4,6 Redesign for the step change that would be required to support 5000 births per annum. Medicine for the Elderly 3,4 Redesign services to create an acute elderly unit focusing on short stay patients and frailty assessment. Outpatient Facilities 1,2,3,4,6 Refurbish and redevelop outpatient facilities at ESH. Paediatric HDU 3 Redesign of service to support the upgrading of HDU rooms and equipment. Pharmacy 3,6 Redesign of service to centrally locate together the pharmacy store and the dispensary. 2016/ / / / /20 Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 21

22 ITEM CLINICAL STRATEGY REF to key elements of strategy ESTATES SCHEME PERIOD 2016/20 Private patient wing 4,6 Consider the development of a private patient wing on the ESH site. 2016/20 ESTATES STRATEGY Fire doors 1,3 Complete backlog maintenance and modernisation programme across site, commenced in 2013/14. Kitchen Ventilation and Modernisation (I) 1,3 Upgrade equipment under maintenance and modernisation scheme. Site Power 3,4 Progression of scheme commenced in 2013/14 to upgrade the electrical capacity of the site. 2015/16 East Entrance 1,2,3,4 Scheme to modernise East Entrance environment and facilities including additional retail outlets. 2015/16 Combined Heat and Power Plant 5* To enable the redevelopment of main plant room and the installation of state of the art heat and power generation technology, under the auspices of the government s Carbon Energy Fund programme. An external provider would be identified to fund and build a CHP unit. The operating arrangements would lead to reduced energy costs for the Trust, subsidised by income from the input tariff. It is therefore capital neutral and revenue positive. 2016/ /19 Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 22

23 ITEM ESTATES STRATEGY REF to key elements of strategy ESTATES SCHEME PERIOD 2017/19 Kitchen Ventilation and Modernisation (II) 1,3 Upgrade equipment under maintenance and modernisation scheme. 2017/19 Building Services Infrastructure and Ward Refurbishments 1,2,3 Focus for is to clear a proportion of maintenance backlog and ensure current maintenance is kept up to date. On-going On-going Car Parking 2,3,4,6 Existing car parking arrangements are not providing an appropriate level of experience for patients and visitors, particularly those with disabilities. There is opportunity to considerably improve the facilities commencing with the addition of extra parking spaces during 2013/14 and further significant developments in layout and facilities planned year on year. Space Management 2,3,6 On-going activity taking account of: Bed spacing standards Maximising space for clinical functions Office restructures Clinical adjacencies Reduced storage requirements. On-going On-going SaSH Services delivered from non-sash premises 3,4,6 Support clinical pathway initiatives to deliver services at the most appropriate locations, ensuring that landlords of non-sash premises maintain buildings and facilities to SaSH standards through proactive SLA management. On-going Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 23

24 ITEM ESTATES STRATEGY REF to key elements of strategy ESTATES SCHEME PERIOD On-going Ward Upgrades All Plan to remodel as required and fully refurbish two wards each year to achieve most effective use of clinical space and deliver leading quality facilities. Windows (across estate) 1,3,5* Clear backlog maintenance, introduce modernisation and energy efficiency. On-going On-going * Key Element 5 - Energy Efficiency - is a standard feature of each scheme. 6.2 Estates Schemes Finance Schedule The table below provides a summary of the planned capital expenditure for the period , showing estimated spend broadly allocated to the key elements of the Estates Strategy. Key Element 6, Space Management, is incorporated within each of the elements shown below, with a reference value of 5m across the life of the programme. '000's Key Elements of Estates Strategy Period 2015/ / / / /20 Total 1. Backlog Maintenance 3,300 1,000 1,000 1, , On-going Maintenance 4, , Modernisation 3, ,565 4,493 3,767 7,621 22, New Development 4,525 3,452 4, , Energy Efficiency , , Space Management 1 Other 2 3,951 6,699 2,550 4,300 3,800 2,800 24,100 19,595 12,576 12,540 11,418 9,692 12,046 77,867 Notes: 1. Value attributable to Space Management incorporated within other strategy elements. 2. Other includes IT, medical equipment, management costs. Further details of the Estates programme showing estimated capital expenditure for by year are provided below. Other planned capital investment, including IT, is also shown. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 24

25 Estimated expenditure for onwards '000's Item 2015/ / / / /20 Total Backlog Maintenance Leigh/Newdigate x Ward Upgrade - Ph2 - Ph ,500 Haematology Outpatients Resus & CT in ED Theatres Phase 2 1,500 1,500 Building services infrastructure - eg pipes, gases, electricity Fire Doors Windows replacement programme (Estates) ,000 Non-ward works - general maintenance Ward Improvements Group Total 3,300 1,000 1,000 1, ,800 On-going Maintenance Leigh/Newdigate x Ward Upgrade - Ph2 - Ph ,500 Haematology Outpatients Resus & CT in ED Theatres Phase 2 3,000 3,000 Building services infrastructure - eg pipes, gases, electricity Non-ward works - general maintenance Ward Improvements Group Total 4, ,675 Modernisation Resus & CT in ED Theatres Phase 2 2,000 2,000 Car park improvements ,050 East Entrance Childrens Assessment Unit Move to ED Outpatient Redesign and rebuild 1,500 3,500 5,000 Unallocated ,717 7,571 9,896 Kitchen Ventilation& Modernisation Improving Maternity Care Settings Pharmacy move and redesign 2,000 2,000 Total 3, ,565 4,493 3,767 7,621 22,115 New Development Angio/Cardio Private Patient Unit 3,900 3,900 BOC Respiratory 0 MacMillan Mammography Replacement of Maple Annex with Two-Storey incl Health Records 2,000 2,000 Paediatric High Dependency Unit Maternity Expansion for >5,000 Births Private Patient Wing 2,000 2,000 Pathology joint venture 1,128 2,050 3,178 Total 4,525 3,452 4, ,277 Energy Efficiency Site power Combined Heat and Power 1, ,500 Total , ,900 Information Technology 1,951 4, ,300 1, ,100 IT hardware ,800 Network Upgrade EPR Replacement 509 4,327 4,836 Document Management - i.e. Records replacement 2,000 1,000 3,000 EPMA replacement Windows upgrade (IT) Total 1,951 4, ,300 1, ,100 Medical Equipment 1,500 1,500 1,500 1,500 1,500 1,500 9,000 Fixed allocations (medical /theatres / endoscopes) ,000 Medical Equipment Replacement 1,000 1,000 1,000 1,000 1,000 1,000 6,000 Total 1,500 1,500 1,500 1,500 1,500 1,500 9,000 Capital Programme Management ,500 Capital Project Management ,500 Total ,000 Total 19,595 12,576 12,540 11,418 9,692 12,046 77,867 Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 25

26 7. Strategy Evaluation The SaSH Estates Strategy is routinely reviewed in regular meetings convened to assess progress at each level of estates activity and is formally considered alongside the Clinical Strategy at specific Management Board - Strategy meetings. Formal reports detailing progress of the capital programme are provided regularly to Finance and Operational management meetings. The following meetings ensure frequent oversight of various aspects of the strategy: Frequency Event Purpose Weekly Monthly Monthly Capital Projects Review Meeting Ward Improvements Group Capital Investment Group Scheme level review within Estates and Facilities Department to track progress of developments and maintenance. Forum established to enable operating divisions and support services to highlight ward improvements required and for allocation of funds for such works to be agreed. Formal meeting for applications for capital schemes valued from 5k to 250k to be evaluated for capital funding. Analysis of estates and facilities data covers items including: Scheme budgets Adherence to scheme programmes Energy consumption Water and waste Space utilisation Hard & soft FM costs. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 26

27 8. Estates Strategy Implementation The SaSH Estates and Facilities Team believe that this strategy clearly sets out the context and shape of the activities which are likely to be undertaken during the next five years. It is anticipated that there will be changes to some of the specific schemes but key objectives such as clearing backlog maintenance, progressing modernisation and improving energy efficiency will underpin all works carried out. The implementation of this strategy is intended to deliver high quality estate and facilities, whether through maintenance or new developments, in support of the Trust s Clinical Strategy to enable the best possible clinical outcomes and delivery of patient care. The Estates and Facilities Team commend this Estates Strategy to you. Surrey and Sussex Healthcare NHS Trust - Estates Strategy Page 27