New Urgent and Emergency Care Centre Full Business Case

Transcription

1 New Urgent and Emergency Care Centre Full Business Case Agenda Item No: 3

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3 The Royal Wolverhampton NHS Trust Trust Board Report Meeting Date: 14 th April 2014 Title: Executive Summary: Action Requested: Report of: Author: Contact Details: Resource Implications: Public or Private: (with reasons if private) References: (eg from/to other committees) Appendices/ References/ Background Reading NHS Constitution: (How it impacts on any decision-making) New Urgent and Emergency Care Centre This report contains the Full Business Case for the New Urgent and Emergency Care Centre. Approval. Medical Director Dr Jonathan Odum Tel This project has both capital and revenue funding implications for the Trust. Details are provided within the business case and appendices. Public Session Emergency Centre Project Group Attachment 1 Full Business Case and Appendices In determining this matter, the Board should have regard to the Core principles contained in the Constitution of: Equality of treatment and access to services High standards of excellence and professionalism Service user preferences Cross community working Best Value Accountability through local influence and scrutiny Background Details 1 The Full Business Case (FBC) for the development of a New Urgent Care and Emergency Centre is attached for approval. The Trust has appointed a Procure 21+ PSCP contractor (Kier Construction) with the intention of beginning work on the main project in June 2014, with the target of seeing the first patients in the New Emergency Centre by the end of November Full planning application for the building was granted on 1st April It should be noted that the FBC contains an assumption that additional external funding (PDC) of 10m will be provided by the TDA in order to meet the above programme.

4 The FBC has been submitted to the Trust Development Authority with the intention of it being approved at the TDA Board meeting on 15th May See Attachment 1 Full Business Case and Appendices. Page 2 of 2

5 A Full Business Case for the Urgent and Emergency Care Centre (Phase 1) at New Cross Hospital Version 16.0 (Final) Date: 7 th April 2014

6 VERSION HISTORY Version No. Issue Date Issued to Purpose 1.0 Not issued Author only Drafting th February 2014 Project Team/Project Review Group 3.0 Not issued Author only Drafting 4.0 Not issued Author only Drafting th February 2014 Workstream Leads Amendment rd March 2014 Project Team Review th March 2014 Project Group Review th March Divisional Review Groups/Contracting and Commissioning/ Capital Review Group th March 2014 Division 2 Core Group Review/amendment JMcK/EW th March 2014 KS/JO/MG/TP/JMcK/EW Review/amendment th March 2014 TP/EW Review/ amendment th March 2014 KS/JO/MG/TP/JMcK/EW Review/ amendment st March 2014 Author only Review/amendment st March 2014 Project Group Approval th April 2014 WCCG Governing Approval Body/NHS TDA 16.0 See note 7 th April 2014 RWT Trust Board, TMC, NHS TDA Approval Note: Change to Table 5f (Page 99) Scenario 3: Capital cost increase by 10% added to table and figures are after capital charges are taken into account 2

7 Contents 1. EXECUTIVE SUMMARY Introduction Strategic Case The Strategic Context The Case for Change Emergency Services Activity Activity Scenarios Future Capacity Requirements Workforce Assumptions Economic Case Changes for OBC The Procurement Key Findings Commercial Case Agreed Products and Services Key Contractual Arrangements Agreed Implementation Timescales Accountancy Treatment Financial Case Impact on I&E Overall Affordability Sensitivities Capital Affordability Management Case Project Management Arrangements Benefits Realisation and Risk Management Post Project Evaluation Arrangements Recommendation THE STRATEGIC CASE Introduction Part A: The Strategic Context Organisational Overview Clinical Services Activity

8 2.2 Business Strategies Other Organisational Strategies Part B: The Case for Change Investment objectives Existing Arrangements Activity and Performance Trends Workforce Profile Income and Expenditure Business Needs Unprecedented Demand on the Emergency Care System Inefficiencies in Care Pathways and Service Model Physical Capacity and Environment Workforce Equipment & ICT Governance, Operational and Financial Inefficiencies Estates Strategy Potential Business Scope and Key Service Requirements The Intended Service Signposting Emergency Department Clinical Decisions Unit Urgent Care The Urgent and Emergency Care Strategy and Activity Modelling Emergency Services Activity Urgent and Emergency Care Departments Clinical Decisions Unit Emergency Department Review Outpatients Diagnostics Activity Scenarios Future Capacity Requirements Workforce and Key Planning Assumptions Project Scope Functional Content Main Benefits Criteria Main Risks Constraints

9 2.11 Dependencies Consultation and Engagement Stakeholders Patient and Public Involvement Health Scrutiny Panel & Health & Wellbeing Board THE ECONOMIC CASE Introduction The Procurement Process Changes from OBC Capital Costs Optimism Bias Upper Bound Assessment Mitigation of Optimism Bias Revenue Costs Changes since OBC Impact of changes from the OBC Qualitative Benefits Methodology Risk Appraisal THE COMMERCIAL CASE Introduction Required Services Functional Content and Adjacencies Design Principles Equipment ICT Future Flexibility Design Review Panel Planning Status Equality Impact Assessment Agreed Risk Transfer Agreed Contract Length Key Contractual Clauses Personnel Implications (including TUPE)

10 4.7 Procurement Route and Implementation Timescales FRS 5 Accountancy Treatment THE FINANCIAL CASE Introduction Impact on the Organisation s Income and Expenditure Account Revenue Affordability Sensitivities Capital Affordability THE MANAGEMENT CASE Introduction Programme Management Arrangements Project Management Arrangements Project Reporting Structure Project Roles and Responsibilities Use of Special Advisers Arrangements for Change Management Arrangements for Benefits Realisation Arrangements for Risk Management Key Risk areas Management of Risk Arrangements for Contract Management Arrangements for Post Project Evaluation Post Implementation Review Project Evaluation Review OGC Gateway Review Arrangements

11 TABLES Table 1a: Acute Hospital Activity Profile 2010/11 to 2013/14 Table 1b: Emergency Services Activity 2007/8 to 2012/13 Table 1c: Emergency Department Attendance Shift Table 1d: Workforce 2014/15 to 2025/26 Table 1e: Impact of National and Local Policy Drivers impacting Emergency Services Table 1f: Principles of the New Service Table 1g: Future Emergency Services Activity 2013/ /26 Table 1h: Cost and Income Changes OBC v FBC Table 1i: Key Milestones Table 1j: Impact on I&E OBC v FBC Table 1k: Affordability Statement for Preferred Option (Base Model) /15 income and costs Table 1l: 5 year Capital Programme Table 1m: Capital Spend Profile OBC v FBC Table 2a: Clinical Services Table 2b: Acute Hospital Activity Profile (Spells) 2010/11 to 2013/14 Table 2c: Community Activity Profile 2011/12 to 2013/14 Table 2d: Table 2e: National and Local Drivers impacting Emergency Services Trust Organisational Strategies underpinning the Urgent and Emergency Care Centre development Table 2f: Emergency Services Activity 2007/8 to 2012/13 Table 2g: Emergency Department Attendance Shift Table 2h: Emergency Department Activity 2013/14 by Commissioner Table 2i: Radiology Activity related to the Emergency Department 2007/08 to 2012/13 Table 2j: Radiology Activity split between Emergency Department & Main Radiology Department for 2012/13 Table 2k: Emergency Department Activity Change and Performance against the 4 hour wait target for Type 1 and Type 1 and 3 combined Table 2l (i): Workforce Establishment (WTE) for Clinical Staff in Emergency Department Table 2l (ii) Workforce Establishment (WTE) for Nursing Staff in Emergency Department Table 2l (iii) Workforce Establishment (WTE) for Clinical & Non-Clinical Support Staff Table 2m: Current Estates Performance Indicators Table 2n: Principles of the New Service Table 2o: Future Emergency Services Activity 2013/ /26 Table 2p: Anticipated changes to Workforce 2013/14 to 2025/26 Table 2q: Key Benefits Table 2r: Key Risks and Mitigations Table 3a: Changes in Capital Costs OBC v FBC Table 3b: Optimism Bias for Preferred Option (Option 5) OBC v FBC Table 3c: Revenue Costs OBC v FBC Table 3d: Option Scores Not Weighted Table 3e: Option Scores - Weighted Table 4a: Summary AEDET Scores Table 4b: Key Milestones Table 5a: Impact of additional Annual costs in 2017/18 compared to 2014/15 Table 5b: Summary of Income and Expenditure Impact in 2017/18 Table 5c: Breakdown of Capital Charges OBC v FBC Table 5d: Affordability Statement for Preferred Option (Base Model) /15 income and costs Table 5e: Affordability Statement for Preferred Option (including inflation and staff deflator) 7

12 Table 5f: Table 5g: Table 5h: Income less direct expenditure for each sensitivity compared to base case for Preferred Option (Option 5) 5 year Capital Programme Capital Spend Profile OBC v FBC FIGURES Figure 1a: Emergency Department Attendances Figure 1b: RWT Emergency Department Performance against 95% achievement of 4 hour turnaround target since 2004 Figure 1c: Future Clinical Service Model Figure 1d: Site Context for the Preferred Option Figure 1e: Project Reporting Structure Figure 2a: Emergency Department Attendances Figure 2b: Emergency Department Performance against 95% achievement of 4 hour turnaround target since 2004 Figure 2c: Number of Ambulances Monthly 2011/12 and 2012/13 Figure 2d: Future Clinical Service Model Figure 4a: Site Context for the Preferred Option Figure 4b: ICT Framework Figure 4c: Conceptual Model of Electronic Patient Record Figure 6a: Project Reporting Structure Figure 6b: Management Structure PMO 8

13 GLOSSARY OF TERMS Abbreviation AEDET AMU BREEAM CDM CDU CQUIN CSU CT CTKUB CTPA CWP DH ED EPR FBC GMP HBN HTM I&E IBP ICT KPI JCT LOS LTFM MES MRI MSS NHS TDA OBC OJEU PAU PCT PFI PSCP PUBSEC.BIS FP QIPP RWT SAU SES & SPCCG Full Title Achieving Excellence Design Evaluation Tool Acute Medical Unit Building Research Establishment Environmental Assessment Construction, Design Management Clinical Decisions Unit Commissioning for Quality and Innovation Commissioning Support Unit Computed Tomography Computed Tomography - Kidney, Ureter, Bladder Scan Computed Tomography Pulmonary Angiogram Clinical Web Portal Department of Health Emergency Department Electronic Patient Record Full Business Case Guaranteed Maximum Price Health Building Note Health Technical Memorandum Income and Expenditure Integrated Business Plan Information and Communications Technology Key Performance Indicator Joint Contracts Tribunal Length of Stay Long Term Financial Model Managed Equipment Service Magnetic Resonance Imaging Management Systems Services NHS Trust Development Authority Outline Business Case Official Journal of the European Union Paediatric Assessment Unit Primary Care Trust Private Finance Initiative Principal Supply Chain Partner Public Sector, Dept. for Business Innovation & Skills Firm Price (Tender Price Index of Public Sector Buildings (Non-housing) Quality, Innovation, Productivity and Prevention The Royal Wolverhampton NHS Trust Surgical Assessment Unit South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group 9

14 SLA s SLAM SI SOC UECC WCCG Emergency Care Urgent Care Service Level Agreements Service Level Agreement Monitoring Site Investigation Strategic Outline Case Urgent and Emergency Care Centre Wolverhampton Clinical Commissioning Group Life-threatening illnesses or injuries (ref: Wolverhampton Urgent and Emergency Care Strategy) Minor illnesses or injuries which cannot wait for a routine GP appointment (ref: Wolverhampton Urgent and Emergency Care Strategy) 10

15 1. EXECUTIVE SUMMARY 1.1 Introduction This Full Business Case seeks approval to invest 29,886,143 to build Phase One of a new Urgent and Emergency Care Centre on the New Cross Hospital site at Wolverhampton. This development will provide a new Emergency Department, with supporting Ambulatory, Diagnostic and Urgent Care facilities. This project is an integral part of the Wolverhampton Urgent and Emergency Care Strategy developed jointly by The Royal Wolverhampton NHS Trust, Wolverhampton Clinical Commissioning Group and other stakeholders. The proposals outlined in this Business Case focus on the provision of redesigned services within a new facility which will support significant operational benefits for Emergency Services within the Trust and across Wolverhampton and surrounding areas. 1.2 Strategic Case New Cross Hospital is operated by The Royal Wolverhampton NHS Trust and is located in the Heath Town area of the city of Wolverhampton. The Trust operates a full range of clinical services at community, secondary and tertiary levels. The New Cross Hospital site comprises a range of clinical and support facilities which vary significantly in terms of age and functional suitability. The Trust s key objective is to be an organisation which continually strives to improve patient experience and outcomes. In order to achieve this, the Trust has established a strategic vision for the reconfiguration of a number of core clinical services plus the redevelopment of the New Cross Hospital site to provide modern facilities which are fit for purpose. To this end a Planning Application for the redevelopment of the New Cross site was submitted to Wolverhampton City Council and received approval in This included outline planning approval for a new Emergency Centre. The Royal Wolverhampton NHS Trust was established in 1994 and is a major acute Trust providing a comprehensive range of services for the people of Wolverhampton, the wider Black Country, South Staffordshire, North Worcestershire and Shropshire. It gained Cancer Centre status in 1997, was designated as the 4 th Regional Heart & Lung Centre during 2004/05 and became one of the first wave Bowel Screening Centres in The Trust is the largest teaching hospital in the Black Country providing teaching and training to around 130 medical students on rotation from the University of Birmingham Medical School. It also provides training for nurses, midwives and allied health professionals through wellestablished links with the University of Wolverhampton. With an operating budget of circa 385 million the Trust is one of the largest acute/community providers in the West Midlands having more than 800 beds on the New Cross site including intensive care beds and neonatal intensive care cots and 82 rehabilitation beds at West Park Hospital. As the second largest employer in Wolverhampton, the Trust employs more than 6,500 staff. In April 2011 the Trust completed a successful transaction to integrate with the community services from Wolverhampton City PCT. The Trust adopted a model of full integration within the existing clinical and corporate structures to ensure that models of service delivery drive 11

16 quality of service, patient experience and efficient use of resources. The integration also ensures the long term sustainability of a wide range of services for local people. The Trust serves a core catchment population of around 335,000 for its secondary care services and around 1,000,000 for its tertiary services. The Trust provides a comprehensive range of community, acute and specialist/tertiary services from the following locations: New Cross Hospital secondary and tertiary services, Maternity, Accident & Emergency, Critical Care, Outpatients; West Park Hospital rehabilitation inpatient and day care services, Therapy services, Outpatients; More than 20 Community sites community services for children and adults, Walk In Centre, Therapy and Rehabilitation services. Wolverhampton Clinical Commissioning Group (WCCG) are the Trust s main commissioner of services and are the coordinating commissioner for acute and community services on behalf of other local associate commissioners. Table 1a: Acute Hospital Activity Profile 2010/11 to 2013/14 Activity Type 2010/ / / /14 Plan 2013/14 Month 9 Forecast Outturn Electives 9,916 10,128 9,143 9,342 8,037 Non Electives 45,925 44,245 44,883 44,518 47,540 Day cases (including chemotherapy day cases) 42,033 44,074 45,552 46,037 49,929 New Outpatients 119, , , , ,444 Follow up Outpatients 323, , , , ,759 Outpatient Procedures 33,222 36,583 37,324 37,441 40,835 ED Attendances 98, , , , ,811 Notes: - AMUAMB patients included as New outpatients from 11/12 - Regular day attenders and Births excluded - Outpatient activity included only where plan exists for New and Follow ups - Source of data is SLAM - Month 9 13/14 forecast - ED 2013/14 Plan changed from OBC due to initiative to reduce frequent attenders The current Urgent and Emergency Care system in Wolverhampton includes the following services: One hospital provider (The Royal Wolverhampton NHS Trust) providing emergency care at New Cross Hospital; Two walk in centre providers across the city: Phoenix Walk In Centre, provider The Royal Wolverhampton NHS Trust; Showell Park, provider Docs on Call; One out of hours provider Primecare; Forty eight (48) GP practices. Currently there are several ways of accessing emergency services provided by RWT depending on the mode of referral. 12

17 These are: The Royal Wolverhampton NHS Trust Emergency Department: (self-referrals; 999 ambulance referrals; some GP referred patients; Trauma and Orthopaedic referrals; Ophthalmology referrals and self-presenters); Acute Medical Unit (AMU): (GP referred medical patients; referrals for urgent Haematology/Oncology admissions from other specialty outpatients e.g. Renal; A/E referred medical patients for admission); A9 (formerly Surgical Assessment Unit - (SAU) (GP referred patients and A&E referred surgical patients for admission); Paediatric Assessment Unit: (GP referred children; A/E referred children; some selfreferrals); In addition to the above, emergency Obstetrics and Gynaecology (GP referred) is provided for in the Women s Hospital; Urgent ENT/Maxillo-facial assessment is available in the Outpatient Department during normal working hours ; Hot clinics e.g. Respiratory, Cardiac, Ambulatory Assessment Area; Heart & Lung Centre; Phoenix Walk In Centre. These different emergency services are generally staffed by their own dedicated nursing and medical teams and have their own 24 hour emergency clinical rotas. For the purposes of this project the re-provision of emergency care relates to the following specialties: Emergency Department (ED) Acute Medical Unit (AMU) General Medicine (all specialties including Oncology/Haematology) Ophthalmology The Emergency Department is the first step in the pathway of emergency care often for patients who have complex needs and are at their most vulnerable. It is the shop window of the Trust for the emergency patients and their carers. The current clinical service model can be defined as: Traditional; Slow with time wasted between steps; Leading to duplication; Multiple handovers between clinical teams with resultant increase in risk to safety; Limited collaborative working due to poor adjacencies; Care plans and investigations developed following transfer from ED. Table 1b shows the historical change in emergency services activity across the health economy since 2007/8. 13

18 Jan-04 Apr-04 Jul-04 Oct-04 Jan-05 Apr-05 Jul-05 Oct-05 Jan-06 Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11 Jan-12 Apr-12 Jul-12 Oct-12 Jan-13 Apr-13 Jul-13 Oct-13 Jan-14 Table 1b: Emergency Services Activity 2007/8 to 2012/13 Year New Cross ED Attendances Walk-in Centre Attendances New Cross Assessment Unit Activity impacting the Urgent & Emergency Care Centre Phoenix Centre Showell Park Acute Medical Unit Acute Medical Unit Ambulatory 2007/8 98,510 14,224 6, /9 99,944 24,223 7, /10 98,898 32,441 9,720 7, /11 98,288 29,137 21,395 4,059 2, /12 101,303 28,551 25,479 3,987 2, /13 106,836 36,186 29,009 3,192 2,417 Notes : Phoenix centre opened in 2007 Showell Park opened in 2009 (shown for completeness but not RWT activity) Surgical Assessment Unit (SAU) previously within AMU prior to 10/11 and known as EAU (Emergency Assessment Unit) Acute Medical Unit, SAU and AMUAMB (ambulatory) are discharges from these wards Figure 1a and Table 1c show the increase in attendances to the New Cross Emergency Department from 2004 to Since 2004 monthly attendance has increased from 5,816 in January 2004 to 9,109 in January Figure 1a: Emergency Department Attendances 2004 to Table 1c: Emergency Department Attendance Shift January 2004 January 2014 Increase Monthly attendances (patients) 5,816 9,109 3,293 Average daily attendances (patients)

19 Until two years ago ED performance at The Royal Wolverhampton NHS Trust against the 4 hour turnaround target was consistently amongst the best in the country. However, since this time, RWT performance, in common with other Trusts, has fallen. Figure 1b shows the RWT performance against the 95% target for 4 hour turnarounds since Figure 1b: RWT Emergency Department Performance against 95% achievement of 4 hour turnaround target since % 100% 98% 96% 94% 92% 90% 88% 86% 84% Table 1d (column 1) shows the workforce numbers (Whole Time Equivalents) by band and discipline as at April

20 Table 1d: Anticipated yearly changes to Workforce from baseline in 2014/15 to 2025/26 Post 2014/ / / / / / / / / / / /26 Total ED - Consultants ED - Other Medical Staff ED - ACP's (8b, 8a & 7) ED - ENP's ED - Nursing ED - Nursing (Ophthalmology) ED - Ancilliary ED - Admin AAA - Nursing 5.28 (5.28) AAA - Admin 1.13 (1.13) Therapies Radiology - Consultants Radiology - Other Medical Staff Radiology - Nursing Radiology - Radiographers Radiology - Sonographer Radiology - Technician Radiology - Admin Porters (0.80) Domestics IT Staff (1.00) Medical Physics Total

21 The Trust s income and expenditure associated with the provision of emergency services as at April 2014 is as follows: Income 15,131,282 Pay 11,029,813 Non Pay 1,358, /15 Efficiency Savings at 4%2230 (495,514) This equates to a contribution (before capital charges) in 2014/15 of 3,238, The Strategic Context This Full Business Case has been prepared in the context of a complex national and local policy agenda considered by the Trust and health economy to be critical to the planning process. These are summarised in Table 1e. Table 1e: National and Local Policy Drivers Impacting Emergency Services Policy Everyone Counts: planning for patients 2014/15 to 2018/19, NHS England National Review of A&E Services in England Wolverhampton Urgent and Emergency Care Strategy Scheme strategic fit Sets out the vision of high quality care for all, now and for future generations. Sets out the requirement for transformational change and transformational service models across the health care system. In relation to emergency care the requirements are access to the highest quality urgent and emergency care. The aim of the Urgent and Emergency Care Strategy for Wolverhampton and the redesign of Emergency Services within the Trust outlined in this FBC underpins this vision by setting out to ensure that the patient receives the right care, in the right place at the right time. The national review of Accident & Emergency Services launched by the NHS Commissioning Board in January 2013 and led by Sir Bruce Keogh, Medical Director has been tasked with developing a national framework of the best way of organising A&E Services to meet the needs of patients and to ensure high quality, consistent standards are offered across the Country. Whilst the final report is awaited, the Trust has been working with member organisations within the health economy to develop the A&E Sustainability Plan for 2013/14 to put initiatives in place at all stages of the emergency care system to meet rising demand and improve performance against quality indicators. The national agenda for Urgent and Emergency Care Services highlights the need to ensure services are more responsive to people, use resources more efficiently and use developments in medical and technological advances to deliver better care to support people. This strategy has been developed jointly between RWT, WCCG other Commissioners and Stakeholders with the following aims: Ensure improved and simplified arrangements for urgent and emergency care Ensure strong patient-centred clinical leadership in all access points of the urgent and emergency care system Provide better value for money and sustainability improving appropriate use of urgent care facilities and services. Provide greater consistency and openness, transparency and candour Ensure improved quality, safety and standards 17

22 Ensure improved patient experience Provide greater integration & information - No blame culture A&E Clinical Quality Indicators The building of the new Urgent and Emergency Care Centre is closely linked to the Urgent & Emergency Care strategy. As part of the strategy work, WCCG and RWT have been working collaboratively on the development of an urgent care facility within/alongside the new ED. It is the intention that the urgent care facility will see and treat those patients whose condition is not an emergency but for a variety of reasons, have not been able to access their primary care physician in a timely fashion. It also affords the opportunity to merge the out of hours and daytime services together at the front door of the Emergency Department to provide a 24/7 service. The strategy describes the direction of travel for urgent and emergency care within Wolverhampton. The new Urgent and Emergency Care Centre will provide the local health economy with the opportunity to improve and simplify urgent care by providing both a primary and secondary care resource in one place. The Strategy has been subject to Public Consultation which completed on 3 rd March /12 saw the introduction of a set of clinically led indicators to allow a rounded view to be taken of the performance of Accident and Emergency Services. Whilst the full set of indicators are no longer used to benchmark nationally, WCCG monitors performance against a number of these criteria. In judging performance nationally the operational standard of 95 per cent of patients being seen within four hours continues to be used. Future Hospital, Caring for Medical patients: A report from the Future Hospital Commission to the Royal College of Physicians Sept 2013 The College of Emergency Medicine Emergency Medicine Consultants Workforce Recommendations 2010 Achievement of these targets has of late been a challenge to the Trust. In tandem with Wolverhampton s Urgent and Emergency care strategy an improvement in performance is a key success criterion of this project. This key document sets out a vision for hospital services structured around the needs of patients. It focuses on the acutely ill medical patient, the organisation of medical services and the role of physicians. Key components include the need to bring services to the patient and to organise care such that patients receive a single initial assessment and on-going care by a single team care will be organised so that patients are reviewed by a senior doctor as soon as possible after arriving at hospital. Specialist teams will work together with emergency and acute medicine consultant to diagnose patients swiftly, allow them to leave hospital if they do not need to be admitted and plan the most appropriate care pathway if they do. By co locating the Urgent and Emergency Care Centre alongside the Acute Medical Unit, bringing physicians into the unit for early handover of appropriate patients, further developing ambulatory care and supporting partnership working across acute and community care, the Urgent and Emergency Care Centre goes a long way to achieving this vision and provides a catalyst for future development across all areas of care in Wolverhampton. This document recommends an agenda of consultant expansion in response to the failure of demand management to limit Emergency Department attendances. It recommends Consultant presence in the ED for 16 hours per day, 7 days per week as a minimum, and suggests there is a strong argument for 24/7 Emergency Medicine consultant presence in hospitals even when they are not operating as major trauma centres. The benefits from this investment are outlined as: 18

23 Improving the quality of patient care; Enhancing patient safety; Developing Emergency Care; Reducing admissions Public Inquiry into Standards of Care at Mid Staffordshire NHS Foundation Trust and subsequent Public Consultation on the recommendations of the TSA. NHS 111 The Trust aspires to achieving this level of cover and has been successful in doubling its consultant compliment over the last 18 months so that 15 hours/day presence is currently provided. A full 24/7 consultant presence in ED will be the subject of further business cases. The Trust is a key player in delivering the recommendations outlined in the report of the Trust Special Administrators recently supported by Monitor. The Trust has been receiving additional emergency patients from Staffordshire since December 2011 following the overnight closure of Stafford ED. The proposals suggest that further emergency activity will transfer to outlying Trusts including RWT and capacity will be provided within this project. This service has been rolled out from April 2013 as part of the wider revision to the Urgent Care System with the aim of:- Improving public access to urgent healthcare services; Increasing public satisfaction and confidence in the NHS; Increasing efficiency of the NHS; Enabling the commissioning of more effective and productive healthcare services; Reducing the non-emergency calls received by the 999 Emergency Ambulance Service. NHS Patient Experience Framework NHS 111 was introduced in Wolverhampton in line with the national roll out to make it easier for patients to access local health services and to direct patients to the most appropriate service when they are unsure where to go. NHS 111 is a key component of the Urgent and Emergency Care Strategy. Improving patient experience is a key aim for the NHS. The NHS Patient Experience Framework developed in conjunction with The King s Fund is significant for healthcare organisations because it provides a common evidence-based list of what matters to patients, and can be used to direct efforts to improve services. Other policy drivers include the NHS Constitution and NICE Quality Standards for Patient Experience in Adult NHS Services. Since the Darzi review of 2008 to the present day, NHS organisations have been driven to afford the same level of importance to patient experience as they do clinical effectiveness and safety. In terms of patient experience specifically, focus needs to be placed on the human interactional and environmental aspects of a patient s care and treatment as well as the functional aspects. Research about what matters to patients, which has shaped policy and thinking in today s NHS, highlights quality consistent information and involvement about decision making in care as key themes in enhancing experience. Providing assurance and treating people as individuals with courtesy and respect are also important. Other critical elements can be categorised as: 1. Respect of patient-centred values 2. Co-ordination and integration of care 3. Information, communication and education 4. Physical comfort 5. Emotional support 6. Welcoming the involvement of family and friends 7. Transition and continuity 8. Access to care 19

24 Ambulance Service Quality Indicators RWT Priorities for Improvement 2013/14 Regional Review of Stroke Services The NHS has tended to concentrate on improving functional aspects of care yet the research clearly reveals that the relational aspects, such as feeling listened to or informed, matter much more to patients than the functional aspects. Applying these principles directly to an Emergency Department requires the relational or human aspects to be factored in, taking the patient journey into consideration. For example, the process of arrival at hospital can in a patient s or relative s mind, induce heightened senses of anxiety around traveling to the hospital, parking, and booking in at reception. The patient s expectation is that they will receive safe and effective treatment (functional). The things that take place on the other side of the line, before any care or treatment has been administered, have a profound effect on how they view their experience. This development will make a significant improvement to the environment in which patients receive first line emergency care in the Trust, providing the right level of capacity of the right size and quality. Ambulance Quality Indicators were introduced in April The Quality Indicator which has particular relevance for Emergency Departments is the requirement for a 30 minute turnaround for ambulance crews. Fines have been introduced from April 2013 for exceeding these turnaround times and have cost implications for both Acute and Ambulance Trusts. This development will provide the necessary capacity to support the achievement of these targets. The Trust s priorities for improvement were initially chosen after consulting with staff and clinical teams and looking at what patients and members of the public say about our services in national and local surveys, complaints and compliments Urgent Care is one of the Trusts 2013/14 Priorities for Improvement and builds on initiatives implemented during 2012/13. The Trust plans for 2013/14 included the development of a Joint Urgent and Emergency Care Strategy which includes proposals for the new Urgent and Emergency Centre at New Cross Hospital. These proposals were finalised in November 2013 with WCCG launching a 3 month public consultation in December The vision is to provide an improved, simplified and sustainable 24/7 urgent and emergency care system which supports the right care in the right place at the right time for all of our population. The aim is that patients will receive high quality and seamless care from easily accessible, appropriate, integrated and responsive services In May 2012, it was announced that the NHS Midlands and East will be undertaking a review of stroke services, including the provision of Hyper Acute Stroke Services. The purpose of the review is to achieve a step change improvement in the quality of stroke services and stroke outcomes. The Trust is engaging in this review process to develop a proposal to deliver stroke services across the whole pathway including Hyper Acute Services. The success of achieving Hyper Acute Status is extremely important for local patients and the Trust s extended border areas; it will bring untold benefits to patients, e.g. faster treatment, better outcomes and improved standards of care but will increase the input through the Emergency Department as patients will be required to follow a pathway for suspected stroke through the paramedic alert system to the Emergency Department. The Stroke Service working with the ED have already a strongly established service which is recognised by Commissioners. The opportunity of a new Emergency Department will further enhance the stroke care that is provided to patients and our ability to offer this to more patients who require this care. 20

25 1.2.2 The Case for Change As previously stated there are several emergency access points at New Cross Hospital which have their own dedicated staff and have their own 24 hour emergency medical rotas. The model of care varies from department to department. This results in duplication of skill base and work including duplication of diagnostic tests, multiple handovers as patients move through the system and different experience of waiting times i.e. time to see a senior decision maker as well as time to access facilities including diagnostic services. There is a high level of complaints regarding excessive waiting times in some of the departments. Patient safety is also compromised with patients sometimes having to wait in corridors before they access a cubicle or bed. At a time of growing emergency activity (8% increase in ED attendances over 5 years excluding walk in centres and 5% increase between 2011/12 and 2012/13), capacity is limited and will cannot continue to cope with ncreasing demand. The existing ED is no longer fit for purpose with the key issue for the department being the lack of space for reorganising services and physical size of cubicles and diagnostic space. This results in compromised patient safety, lack of privacy, sub-optimal/poor patient and staff environment and consequently poor experience. The Urgent and Emergency Centre Project Group has identified a number of key priorities for the delivery of a modern service within the context of the wider Urgent and Emergency Care Strategy for Wolverhampton which meet the changing needs of patients and commissioners of the service. These are: To provide high quality clinical care for emergency patients that is timely, accessible and consistently available and enables delivery of quality targets; To deliver closer integration of Emergency Services improving communication between clinical teams and reducing movement and travel distances between departments; To deliver closer integration with Primary Care ensuring patients see the right clinician at the right time, 24/7; To modernise Emergency Services and facilities which will ensure the most appropriate use of resources and improve the overall patient, visitor and staff experience; To ensure that the project and service are financially sustainable; To establish services/facilities which can respond flexibly to internal and external changes; To maximise the use and availability of technology to support the internal service model and interface with internal and external stakeholders/users; To develop good quality, energy efficient and low carbon buildings. The principles underpinning the new service model for Emergency Services are as described in Table 1f. 21

26 Table 1f: Principles of the New Service Emergency Services Directorate Focus on patient need Right care, right time, right location Service Smoother pathways of care and streaming patients effectively Avoid duplication Improved diagnostics Admission avoidance 24/7 service Integration of primary and secondary care Staff Appropriately trained personnel, grade and number to support 24/7 A flexible multidisciplinary workforce Maintain teaching and training focus Consistent and appropriate staffing structure for all services provided Best and appropriate technology Flexibility for expansion and development Facility for in-house training and teaching Building & Equipment Providing a safe, secure and healthy environment for patients and staff Appropriate clinical and non-clinical support space Use of sustainable technologies which are low carbon, energy efficient. Meet patient expectations with regard to privacy and dignity and equality Paper light Best use of IT Improved IT interface with external stakeholders e.g. GPs IT Figure 1c shows the revised and future intended patient flows through the Emergency and Urgent Care System. 22

27 Figure 1c: Future Clinical Service Model C Clin Clinical Decisions Unit Paediatrics/ Elderly Care & Ambulatory Emergency Pathways The new service model will bring together Urgent and Emergency Care into one department. Patients who come to the hospital, whether as self-referral, via their GP or by the ambulance services will all be received through the same access point Emergency Services Activity Table 1g provides a summary of the anticipated projected activity levels for Emergency Services delivered by The Royal Wolverhampton NHS Trust. In line with the capital planning guidance the projections have been taken to the planning horizon of 2015/16 and then plus 5 years and 10 years. 23

28 A detailed year by year analysis is included in Appendix 2c. Table 1g: Future Emergency Services Activity 2013/ /26 Year Emergency Department Urgent Care currently attending ED (20% of total) Potential additional Urgent Care Activity (relocation of WIC) ED Review Outpatients Clinical Decisions Unit 2013/14 108,811 4,795 2, /16 107,983 8,510 5,464 4, /21 112,452 25,765 22,483 5,596 6, /26 126,857 29,066 25,363 6,313 6,975 These figures have been based on activity and assumptions which have been agreed with Commissioners. The main change to activity assumptions since OBC is the inclusion of emergency activity from Stafford in the base model (previously modelled as a scenario/sensitivity) Appendix 2d provides details on the change in assumptions from OBC to FBC and the reasons for these changes Activity Scenarios Following the conclusion of the Consultation on the Urgent and Emergency Care Strategy the WCCG intends to competitively tender the provision of the urgent care service to commence in November 2014 with new services being provided from April The Trust has therefore undertaken scenario modelling relating to the urgent care activity and the consequential financial implications as follows: Scenario Change from Base Model Impact in 2016/17 (1 st full operational year) 1 Base Model less urgent care activity (Walk In Centre) identified to relocate to Emergency Centre - assumes activity does not relocate to Emergency Centre 2 Base Model less 20% RWT urgent care and urgent care activity (Walk In Centre) identified to relocate to Emergency Centre assumes activity delivered in Emergency Centre but is provided by others at a future date to be agreed with commissioners -21,987 EC attendances -45,383 EC attendances The worst case is Scenario 2 which will result in a reduction in activity of 45,383 attendances by 2019/20. The financial impact is that the loss in the base case contribution increases from 2.1m to 8.2m. The Trust has agreed with the WCCG some mitigation measures which are discussed more fully in Section

29 1.2.4 Future Capacity Requirements The activity projections as at 2025/26 have been used to derive the capacity requirements of the departments included within the scope of this OBC. Reference has been made to Health Building Notes and the Schedules of Accommodation have been benchmarked with a number of other Trusts with similar activity levels and who have recently built new emergency departments. A further capacity exercise has been undertaken by external consultants to support the Trust s capacity projections. These were reviewed again at FBC to reflect changes to the activity modelling. These capacity requirements assume transfer of the urgent care activity to the new emergency centre and provide sufficient capacity to provide out of hours services should this need arise. The main capacity requirements at 2025/26 are: 7 Resuscitation spaces 16 Majors cubicles 12 Minors/Ambulatory Care cubicles 12 CDU spaces 6 Paediatric cubicles 2 Crisis rooms 3 spaces for multi-disciplinary team e.g. social worker, police, alcohol liaison team etc. 6 Clinic cubicles (Urgent Care and ED review/hot clinics) 1 CT Scanning room 3 Plain Film rooms (including dental) 1 Ultrasound Scanning room Integrated/alongside urgent care facility The main changes since OBC are: an increase in Resuscitation spaces to a total of 7 to include the impact of additional patients from Staffordshire; and a reduction in Minors/Ambulatory spaces to 12 following refinement of the Urgent Care model Workforce Assumptions The introduction of the new service model for Emergency Services will affect all staff disciplines. The details of the future workforce requirements for all disciplines to 2025/26 to support the new service model and changes in activity and capacity are provided in Table 1d. These workforce numbers assume a phasing of capacity from 2015/16 to 2025/ Communication and Consultation The Trust has developed a Communication Strategy for this project and engagement with stakeholders including commissioners, patients and public, Health Scrutiny Panel and Health and Wellbeing Board has been on-going since the initiation of the project. The Urgent and Emergency Care Strategy for Wolverhampton which includes plans for the new Centre at 25

30 New Cross Hospital has been the subject of Public Consultation between December 2013 and March 2014 and has concluded that 94% of stakeholders support the plans. 1.3 Economic Case Changes for OBC The changes in costs and income for the preferred option from OBC to FBC are summarised in Table 1h. Table 1h: Cost and Income Changes OBC v FBC Element OBC 000 FBC 000 Capital Costs (at Approval Level) 26,910 27,693 Additional Annual Revenue Costs (2017/18) 3,122 3,691 Additional Annual Income (2017/18) 968 1,715 The major change in income and costs is driven by the inclusion of emergency activity transferred from Stafford Hospital. This would have similarly affected the refurbishment option (Option 4) considered in the OBC and would have also reflected that a Do Nothing option was not viable. Therefore the preferred option at OBC remains the preferred option The Procurement The following goods are being contracted: 1) Enabling works to prepare the construction site. These were procured during 2013 as a Procure 21+ contract which was awarded to Balfour Beatty. These works commenced on site in October 2013 and are due to complete in May ) Main construction contract. This contract is again being procured as a Procure 21+ contract and has been awarded (to the end of Stage 3) to Kier Construction. As the Trust s original intention was to procure this contract through a single tender JCT traditional contract, much of the detailed design work had been concluded prior to the contract being awarded. The Design Team appointed by the Trust transferred to Kier in January It is anticipated that the main contract will commence in June Key Findings There are no personnel implications associated with this contract and TUPE does not apply. 26

31 1.4 Commercial Case Agreed Products and Services The Trust only intends to procure the design and construction of the new Urgent and Emergency Care Centre. The provision of hard and soft facilities management services will be managed through the Trust s existing arrangements. The proposed development will provide Phase One of a fully integrated Urgent and Emergency Care Centre within a single building situated towards the North/East of the New Cross Hospital site. The functional content of the new building and schedule of accommodation are detailed in Section 2 and Appendix 4b. The new building will consist of three storeys of 9923m 2 including plant space as follows: Ground floor collocated with reconfigured East Entrance of the hospital and linked to main hospital street (access to AMU and medical beds) includes: New Emergency Department; Satellite Radiology. First floor linked to 1 st floor (access medical beds) and Heart and Lung Centre (access to critical care) includes: Clinical Decisions Unit; Emergency Review Clinic; Urgent Care Facilities; Staff Accommodation; Shell space (1301 m 2 ) for fit out in in Phase 2 to provide additional clinical support space and additional capacity for CDU. Second floor includes: Shell space (2275 m 2 ) for fit out in Phase 2 for in-patient beds; Enabling works are in progress to clear the main construction site. These are scheduled to be completed in May These include: Re-provision of electrical substation and generator; Removal of a concrete slab left from the former catering department; Relocation of departments and demolition of small sections of old Victorian accommodation to the north side of the existing main corridor. Figure 1d provides a graphical representation of the proposed solution within the context of the hospital site. 27

32 Figure 1d: Site Context for the Preferred Option AMU and Medical Beds New Urgent and Emergency Care Centre Centre Heart and Lung Centre Key Contractual Arrangements The Construction Contract will be procured under the Procure 21+ Framework Agreed Implementation Timescales The Construction Programme has been confirmed as 72 weeks. A summary of the key milestones for approval of the FBC, planning and the main components of the construction is outlined in Table 1i. 28

33 Table 1i: Key Milestones Milestone Target Date Selection and Appointment of P21+ PSCP for Main Contract (Stage 3) December 2013 to February 2014 SOC Approval (NHS TDA) September 2013 OBC Approval (NHS TDA) January 2014 FBC Approval (Trust and Commissioners) April 2014 Planning Approval April 2014 FBC Approval (NHS TDA) May 2014 Instruction to Proceed, Mobilisation and Site Set Up May 2014 Start on Site June 2014 Substructure June 2014 August 2014 Frame and Envelope August 2014 April 2015 First and Second Floor December 2014 September 2015 Third Floor Plant Room December 2014 May 2015 External Works and Ambulance Drop Off December 2014 September 2015 Ground Floor February 2014 October 2015 Building weather tight January 2015 Atrium March 2015 October 2015 Power and heat on June 2015 Commence Commissioning June 2015 Familiarisation and training September 2015 Completion and Handover and installation of Radiology Equipment October 2015 Trust Commissioning October November 2015 Workforce redesign, management of change, recruitment and selection and training September 2014 November 2015 Equipment selection, procurement, and installation September November 2015 Service Redesign new patient pathways, operational policies, implementation and training January 2014 November 2014 Operational Building - Transfer of Emergency Department, Radiology and CDU November 2015 Transfer of AMU activity (Direct referrals) February 2016 Transfer of Urgent Care Activity April 2016 Post Project Evaluation January 2016 to February

34 1.4.4 Accountancy Treatment The assets underpinning the delivery of service will be on the balance sheet of the organisation. 1.5 Financial Case Impact on I&E The additional income and expenditure as a result of the development are highlighted in Table 1j and are also compared with the figures at OBC. Table 1j: Impact on I&E OBC v FBC at 2017/18 OBC Preferred Option FBC Position 000 (2017/18) 000 (2017/18) Income 969 1,715 Pay 758 1,308 Non Pay Capital Charges 1,459 1,596 Total Expenditure 3,122 3,691 Net Additional Expenditure 2,153 1, Overall Affordability Table 1k shows the Income and Expenditure position over the investment period and beyond at current prices. 30

35 Table 1k: Affordability Statement for Preferred Option (Base Model) /15 income and costs 31

36 1.5.3 Sensitivities As referred to in Section following the conclusion of the Consultation on the Urgent and Emergency Care Strategy the WCCG intends to competitively tender the provision of the urgent care service to commence in November 2014 with new services subsequently being provided from April The Trust has therefore undertaken scenario modelling relating to the potential loss of urgent care activity and the consequential financial implications. In relation to Scenario 1, the Trust anticipates a non-recurrent contribution in line with the base model and to negotiate with the WCCG on the urgent care tariff. The worst case (Scenario 2) would result in the loss of circa 45,000 attendances resulting in an increase in the loss in the base case contribution from 2.1m (over 4 years) to 8.2m (over 9 years). In discussions with WCCG, the CCG have agreed to mitigate this impact by funding up to 5.6m non-recurrently. The Trust would also have two chances in 2015/16 and 2018/19 to tender for this service. Should the Trust be unsuccessful in it s bid to provide the service the Trust will mitigate any further financial impact (over and above the support from the CCG) by reallocating any spare capacity to other use to support estates rationalisation elsewhere and review its cost base and efficiency measures to reduce the financial deficit. The affordability statements for the scenarios modelled are included in Appendix 5a Capital Affordability The Trust has allowed funding for this project in its Capital Programme to deliver an operational building by November 2015; this is six months earlier than was assumed in the OBC (May 2016). See Table 1l for detail. The capital costs included in this FBC is 29,886,143. Capital Cost Forms are included in Appendix 3a. This delivery programme assumes additional Public Dividend Capital (PDC) funding of 10m over 2 years ( 7m in 2014/15 and 3m in 2015/16). The capital costs for the Project are included in the Trust s Long Term Financial Model (LTFM). 32

37 Table 1l: RWT 5 Year Capital Programme 2014/ / / / /19 m m m m m CRL Additional DH PDC funding ,000 Total CRL 26,776 21,820 15,720 15,700 15,700 Medical & General Equipment IM&T Statutory Standards Improvement of Retained Estate ,500 New Schemes - Pharmacy Adult Cystic Fibrosis facility Linacs Replacement Theatre refurbishment Other miscellaneous Urgent and Emergency Care Centre New Build (Phase 1)* Urgent and Emergency Care Centre (Phases 2 & 3) Demolition of WH/Relocation of therapies Welcome Centre/OPD Reconfiguration Carbon Reduction Other Schemes GRAND TOTAL VARIANCE (2.058) (2.459) Note: * These figures exclude prior years spend in 2012/13 and 2013/14 of 2.86m. See Table 1m. Should additional PDC funding not be available in the timescales required, this will result in delay to the delivery of this project and will impact the delivery of other projects within the programme. The funding profile at OBC to deliver an operational building by May 2016 assumed additional PDC funding of 3m in 2014/15. The capital spend profile for the project at FBC compared to that at OBC is shown in Table 1m. 33

38 Table 1m: Capital Spend Profile OBC v FBC 2012/ / / / /17 Total OBC FBC Management Case Project organisation within the Trust reflects ownership of projects such as this at the highest level and draws not only upon the traditional roles associated with capital project management but also upon representatives from across the Trust to ensure that the wider business objectives of the organisation are met Project Management Arrangements The Trust has a successful history in the management and implementation of key projects and will ensure appropriate project methodologies continue to underpin the management of the project. The project reporting structure is outlined in Figure 1e and was revised post OBC to reflect the changing activities and outputs required for the next stages of the project. This also reflects recommendations made at the Department of Health Gateway Review 2 undertaken in December

39 Figure 1e: Project Reporting Structure The Trust s Medical Director is the Project Sponsor/Senior Responsible Officer. The Project Director role is a shared role with the Head of Estates Development having responsibility for design and construction and Project Management Office, and the Deputy Chief Operating Officer for Emergency Medicine and Community Services having responsibility for service redesign. Clinical teams have been actively involved throughout the project and design development process and will lead on service implementation. Details of internal and external teams supporting the project are included in Appendix 6a. Transition/change management plans have been developed to take the project from approval of this FBC to an operational facility. These are included in Appendix 4f. It is anticipated that the new facility will be opened on a phased basis between November 2015 and April 2016 with the majority of the Trust s emergency services transferring to the new Centre in November Benefits Realisation and Risk Management A draft Benefits Realisation Plan was developed for the OBC. This has been further developed and updated to reflect any changes in the operating environment which have 35

40 occurred since submission of the OBC in October The plan identifies against each benefit: Baseline; Who will have lead responsibility for ensuring delivery of the benefit; The projected timescale for realisation of the benefit; How the realisation of the benefit will be monitored and measured. A Project Risk Register has been developed for the preferred option which includes all risks identified to date. This Risk Register is included in Appendix 6c. The methodology used is in accordance with the Trust s governance structure for managing risk. This Risk Register identifies the following: Risk reference, description and category; Mitigation measures; Risk rating in accordance with the Trust s Risk Categorisation Matrix (Probability and Impact leading to a red, amber, yellow and green rating); Risk lead/owner who has responsibility for monitoring, actively managing and mitigating the risk. The Risk Register has been, and will continue to be, reviewed on a regular basis throughout the life of the project by the Project Group and Project Team. Where risks potentially have an impact on the capital costs or delivery programme (time) for the Project these have informed the contingency value included within the capital costs Post Project Evaluation Arrangements The Trust is committed to the full evaluation of all major schemes and projects through the formal evaluation methodology, with involvement as necessary from local commissioners. In order to facilitate this process a Project Evaluation Team will be put in place by the Capital Review Group post project delivery. 1.7 Recommendation The Royal Wolverhampton NHS Trust is committed to a vision for the redevelopment of the clinical services provided on the New Cross Hospital site to ensure that it can appropriately address the demand on its services from its local population. A key milestone in the delivery of that vision is the modernisation of Emergency Services and the provision of a new Emergency Department co-located with assessment, diagnostic and urgent care facilities. The service will operate within a purpose built, state of the art environment with the aim of improving the patient and staff experience, improving quality and efficiency of care and patient safety, and future proofing capacity to meet demand. This development supports and facilitates the delivery of the Joint Urgent and Emergency Care Strategy for the city of Wolverhampton and patients using our services. Approval of this case will be a significant step in the development of the New Cross Hospital site and will form a key enabler for the future development of Emergency Services and other key services on the site. 36

41 The proposal is fully supported by the clinical and operational teams within the Trust, external stakeholders including patients and public and by local Commissioners. This case has demonstrated the drivers for change and the key objectives and benefits which can be realised by this project. The case has also demonstrated that the proposed development is in line with the Trust and local health economy overall clinical and strategic vision and is affordable. On this basis we recommend this case for approval. 37

42 2. THE STRATEGIC CASE 2.0 Introduction This Full Business Case (FBC) is for the provision of the first phase of a New Urgent and Emergency Care Centre at New Cross Hospital. This is part of a wider development of the New Cross site which will provide modern facilities which are fit for purpose. The proposals outlined in this case focus on the provision of redesigned services within a new facility which will support significant operational benefits for Emergency Services within the Trust and across Wolverhampton. This FBC has been prepared using the agreed standard and format for business cases using the Five Case Model, (Office of Government Commerce s recommended standard for preparation of business cases) and comprises the following key components: the strategic case section. This sets out the strategic context and the case for change, together with the supporting investment objectives for the scheme; the economic case section. This demonstrates that the organisation has selected the most economically advantageous offer which best meets the existing and future needs of the service and optimises value for money (VFM); the commercial case section. This outlines the content of the proposed project; the financial case section. This confirms funding arrangements and affordability and the effect on the balance sheet of the organisation; the management case section. This details the plans for successful delivery of the scheme to cost, time and quality. The Trust believes that the development of this FBC and contents therein comply with Monitor s governance proposals for major investments outlined in the document Risk Evaluation for Investment Decisions by Foundation Trusts (REID). A review of national, regional and local business strategies affecting this project was undertaken at Strategic Outline Case (SOC) and Outline Business Case (OBC) stages which showed an alignment of the proposals with national and health economy strategies. Since the submission of the Outline Business Case the following movements in the strategic landscape have taken place which further support the need for redesigned emergency services within a new facility in Wolverhampton: The Urgent and Emergency Care Strategy for Wolverhampton has been finalised and public Consultation was launched 3 rd December 2013 with a completion date of 3 rd March 2014; Monitor and the Secretary of State have supported the Trust Special Administrators recommendations for Mid Staffordshire NHS Foundation Trust and the consequential changes to service provision; Publication of Everyone Counts 2014/15 to 2018/19 38

43 Part A: The Strategic Context 2.1 Organisational Overview The Royal Wolverhampton NHS Trust was established in 1994 and is a major acute Trust providing a comprehensive range of services for the people of Wolverhampton, the wider Black Country, South Staffordshire, North Worcestershire and Shropshire. It gained Cancer Centre status in 1997, was designated as the 4 th Regional Heart & Lung Centre during 2004/05 and became one of the first wave Bowel Screening Centres in The Trust is the largest teaching hospital in the Black Country providing teaching and training to around 130 medical students on rotation from the University of Birmingham Medical School. It also provides training for nurses, midwives and allied health professionals through wellestablished links with the University of Wolverhampton. With an operating budget of circa 385 million the Trust is one of the largest acute/community providers in the West Midlands having more than 800 beds on the New Cross site including intensive care beds and neonatal intensive care cots and 82 rehabilitation beds at West Park Hospital. As the second largest employer in Wolverhampton the Trust employs more than 6,500 staff. In April 2011 the Trust completed a successful transaction to integrate with the community services from Wolverhampton City PCT. The Trust adopted a model of full integration within the existing clinical and corporate structures to ensure that models of service delivery drive quality of service, patient experience and efficient use of resources. The integration also ensures the long term sustainability of a wide range of services for local people. Serving a catchment population of around 330,000 for secondary care services and up to 1,000,000 for tertiary services the Trust has an extensive natural boundary within which it delivers healthcare. The Trust has grown its specialist service portfolio and its income significantly over the last few years as part of a business strategy to increase tertiary services both directly and as a driver to secure secondary service referrals from PCTs on our geographical boundaries. The year on year growth now forms part of our base contracts for activity moving forward. The Trust has an excellent reputation for its clinical services and for whole system transformation in the delivery of clinical care, service reform and partnership working. Delivering its services from hospital and community sites across Wolverhampton in addition to a number of outreach clinics in other provider organisations, it fulfils two main roles: The provision of high quality emergency, community and secondary care services for our local population; Tertiary and specialist services both independently and through clinical networks to the wider population of West Midlands and beyond. The Trust s excellent transport links with close access to the M6, M6 Toll, M5, M42, and M54, national and local rail networks, national and local bus networks and international airports mean that it is ideally positioned to fulfil its two main roles in the future. The Trust s Vision and Values play an important role in describing the principles and beliefs that underpin the way in which it does business. They provide the checks and balances to make sure that all plans improve the experience for patients. 39

44 Our Vision An NHS organisation that continually strives to improve patients experiences and outcomes. Our Values Patients are at the centre of all we do: We maintain a professional approach in all we do. We are open and honest at all times. We involve patients and their families and carers in decisions about their treatment and care. Working together we deliver top quality services: We work in partnership with others. Working in teams we will recognise and respect our differences. We support each other as members of the Trust. We will be innovative in how we work: We make it easy to do the right thing. We continue to improve the experiences of those who use our services. We encourage and support people who lead change. We create an environment in which people thrive: We empower people to explore new ideas. We act as positive role models. We work hard for our patients. We recognise achievements Clinical Services The Trust provides a comprehensive range of Community, Acute and Specialist/Tertiary services from the following locations: New Cross Hospital Secondary and Tertiary Services, Maternity, Accident & Emergency, Critical Care, Outpatients West Park Hospital Rehabilitation Inpatient and Day Care Services, Therapy Services, Outpatients More than 20 Community sites Community Services for children and adults, Walk in Centre, Therapy and Rehabilitation Services The clinical services are currently managed through two divisions led by Divisional Medical Directors. The mix of specialities within the divisions has been chosen to facilitate the integration across hospital and community services and to forge complementary clinical relationships ensuring investment and development is addressed in every area. Table 2a shows the split of services across the two clinical divisions: 40

45 Table 2a: Clinical Services Division 1: Division 2: Radiology Pathology ITU/Anaesthetics/Theatres Cardiothoracic General Surgery Urology Trauma & Orthopaedics Obstetrics and Gynaecology Ophthalmology Head and Neck Paediatrics Adult Community Services Rehabilitation Care of the Elderly Stroke Neurology Rheumatology Sexual Health Dermatology Respiratory Diabetes Gastroenterology Renal Emergency Services Therapy Services Pharmacy Oncology/Haematology Activity The Trust s activity profile for the last 3 years and projected outturn for 2013/14 are outlined in Tables 2b and 2c. This table shows a small change in the 2013/14 planned position for ED attendances since OBC (107,178 attendances) due to an initiative to reduce frequent flyers. The detailed specialty breakdown is provided in Appendix 2a. Table 2b: Acute Hospital Activity Profile 2010/11 to 2013/14 Activity Type 2010/ / / /14 Plan 2013/14 Month 9 Forecast Outturn Electives 9,916 10,128 9,143 9,342 8,037 Non Electives 45,925 44,245 44,883 44,518 47,540 Day cases (including chemotherapy day cases) 42,033 44,074 45,552 46,037 49,929 New Outpatients 119, , , , ,444 Follow up Outpatients 323, , , , ,759 Outpatient Procedures 33,222 36,583 37,324 37,441 40,835 ED Attendances 98, , , , ,811 Notes: - AMUAMB patients included as New outpatients from 11/12 - Regular day attenders and Births excluded - Outpatient activity included only where plan exists for New and Follow ups - Source of data is SLAM - Month 9 13/14 forecast based upon pro-rota - ED 2013/14 Plan changed from OBC due to initiative to reduce frequent attenders 41

46 Table 2c: Community Activity Profile 2011/12 to 2013/14 Community Currency 2011/ / /14 Plan 2013/14 Month 9 Forecast Outturn Contacts e.g. District Nursing 534, , , ,461 Units (wheelchairs) 2,117 1,910 2,158 2,065 Group Contacts e.g. phlebotomy 98,632 95,997 97, ,015 Inpatients OBD's 32,159 31,043 30,796 29,963 Outpatients Attendances 6,377 6,089 6,918 5,900 Walk In Centre Attendances 28,551 36,186 28,286 33,173 Notes: - Community figures from SLAM community report - Month 9 13/14 forecast based upon pro-rota Key Commissioners The Local Area Team covering Wolverhampton is Birmingham and the Black Country. Shropshire and Staffordshire Area Team will also cover part of the Trust s activity. Wolverhampton Clinical Commissioning Group (WCCG) is the Trust s main commissioner of services and is the co-ordinating commissioner for acute and community services on behalf of local associate commissioners. The Trust also works closely with South East Staffordshire and Seisdon Peninsular CCG (SES&SPCCG). The Trust has worked hard to establish new and mutually beneficial relationships with these partners. Progress to date includes: Trust attendance at CCG forum for Wolverhampton and South East Staffordshire & Seisdon Peninsular; CCG board member has a place at the Trust Board; CCG members for Wolverhampton and South East Staffordshire and Seisdon Peninsular attend the contract clinical quality review meetings; CCG members undertake a programme of planned and short notice visits to wards and departments; A modernisation Board has been established to oversee implementation of QUIPP/CIP schemes; CCG members for Wolverhampton and South East Staffordshire & Seisdon Peninsular sit with the Trust on the Urgent Care Working Group and will join other groups linked to the delivery of the Trust s priorities. The Trust is a key player in the context of NHS West Midlands, having a unique market place as the only acute provider with a catchment population larger than its host population between Birmingham and North Staffordshire. 2.2 Business Strategies This Full Business Case has been prepared in the context of the national and local policy agenda considered by the Trust as being critical to the planning process for this project. These are detailed in Table 2d. 42

47 Table 2d: National and Local Policy Drivers Impacting Emergency Services Policy Everyone Counts: planning for patients 2014/15 to 2018/19, NHS England National Review of A&E Services in England Wolverhampton Urgent and Emergency Care Strategy Scheme strategic fit Sets out the vision of high quality care for all, now and for future generations. Sets out the requirement for transformational change and transformational service models across the health care system. In relation to emergency care the requirements are access to the highest quality urgent and emergency care. The aim of the Urgent and Emergency Care Strategy for Wolverhampton and the redesign of Emergency Services within the Trust outlined in this FBC underpins this vision by setting out to ensure that the patient receives the right care, in the right place at the right time. The national review of A&E Services launched by the NHS Commissioning Board in January 2013 and led by Sir Bruce Keogh, Medical Director has been tasked with developing a national framework of the best way of organising A&E Services to meet the needs of patients and to ensure high quality, consistent standards are offered across the Country. Whilst the final report is awaited, the Trust has been working with member organisations within the health economy to develop the A&E Sustainability Plan for 2013/14 to put initiatives in place at all stages of the emergency care system to meet rising demand and improve performance against quality indicators. The national agenda for Urgent and Emergency Care Services highlights the need to ensure services are more responsive to people, use resources more efficiently and use developments in medical and technological advances to deliver better care to support people. This strategy has been developed jointly between RWT, WCCG other Commissioners and Stakeholders with the following aims: Ensure improved and simplified arrangements for urgent and emergency care Ensure strong patient-centred clinical leadership in all access points of the urgent and emergency care system Provide better value for money and sustainability improving appropriate use of urgent care facilities and services. Provide greater consistency and openness, transparency and candour Ensure improved quality, safety and standards Ensure improved patient experience Provide greater integration & information - No blame culture The building of the new Urgent and Emergency Centre is closely linked to the Urgent & Emergency Care strategy. As part of the strategy work, WCCG and RWT have been working collaboratively on the development of an urgent care facility within/alongside the new ED. It is the intention that the urgent care facility will see and treat those patients whose condition is not an emergency but for a variety of reasons, have not been able to access their primary care physician in a timely fashion. It also affords the opportunity to merge the out of hours and daytime services together at the front door of the Emergency Department to provide a 24/7 service. The strategy describes the direction of travel for urgent and emergency care within Wolverhampton. The new Urgent and Emergency Centre will provide the local health economy with the opportunity to improve and simplify urgent care by providing both a primary and secondary care resource in one place. The Strategy has been subject to Public Consultation which completed on 3 rd March

48 Policy A&E Clinical Quality Indicators Scheme strategic fit 2011/12 saw the introduction of a set of clinically led indicators to allow a rounded view to be taken of the performance of Accident and Emergency Services. Whilst the full set of indicators are no longer used to benchmark nationally, WCCG monitors performance against a number of these criteria. In judging performance nationally the operational standard of 95 per cent of patients being seen within four hours continues to be used. Future Hospital, Caring for Medical patients: A report from the Future Hospital Commission to the Royal College of Physicians Sept 2013 The College of Emergency Medicine Emergency Medicine Consultants Workforce Recommendations 2010 Achievement of these targets has of late been a challenge to the Trust. In tandem with Wolverhampton s Urgent and Emergency care strategy an improvement in performance is a key success criterion of this project. This key document sets out a vision for hospital services structured around the needs of patients. It focuses on the acutely ill medical patient, the organisation of medical services and the role of physicians. Key components include the need to bring services to the patient and to organise care such that patients receive a single initial assessment and on-going care by a single team care will be organised so that patients are reviewed by a senior doctor as soon as possible after arriving at hospital. Specialist teams will work together with emergency and acute medicine consultants to diagnose patients swiftly, allow them to leave hospital if they do not need to be admitted and plan the most appropriate care pathway if they do. By co locating the Emergency Department alongside the Acute Medical Unit, bringing physicians into the unit for early handover of appropriate patients, further developing ambulatory care and supporting partnership working across acute and community care, the Urgent and Emergency Care Centre goes some way to achieving this vision and provides a catalyst for future development across all areas of care in Wolverhampton. This document recommends an agenda of consultant expansion in response to the failure of demand management to limit Emergency Department attendances. It recommends Consultant presence in the ED for 16 hours per day, 7 days per week as a minimum, and suggests there is a strong argument for 24/7 Emergency Medicine consultant presence in hospitals even when they are not operating as major trauma centres. The benefits from this investment are outlined as: Improving the quality of patient care; Enhancing patient safety; Developing Emergency Care; Reducing admissions Public Inquiry into Standards of Care at Mid Staffordshire NHS Foundation Trust and subsequent Public Consultation on the recommendations of the TSA. The Trust aspires to achieving this level of cover and has been successful in doubling its consultant compliment over the last 18 months so that 15 hours/day presence is currently provided. A full 24/7 consultant presence in ED will be the subject of further business cases. The Trust is a key player in delivering the recommendations outlined in the report of the Trust Special Administrators recently supported by Monitor. The Trust has been receiving additional emergency patients from Staffordshire since December 2011 following the overnight closure of Stafford ED. The proposals suggest that further emergency activity will transfer to outlying Trusts including RWT and capacity will be provided within this project. 44

49 Policy NHS 111 Scheme strategic fit This service has been rolled out from April 2013 as part of the wider revision to the Urgent Care System with the aim of:- Improving public access to urgent healthcare services; Increasing public satisfaction and confidence in the NHS; Increasing efficiency of the NHS; Enabling the commissioning of more effective and productive healthcare services; Reducing the non-emergency calls received by the 999 Emergency Ambulance Service. NHS Patient Experience Framework NHS 111 was introduced in Wolverhampton in line with the national roll out to make it easier for patients to access local health services and to direct patients to the most appropriate service when they are unsure where to go. NHS 111 is a key component of the Urgent and Emergency Care Strategy. Improving patient experience is a key aim for the NHS. The NHS Patient Experience Framework developed in conjunction with The King s Fund is significant for healthcare organisations because it provides a common evidence-based list of what matters to patients, and can be used to direct efforts to improve services. Other policy drivers include the NHS Constitution and NICE Quality Standards for Patient Experience in Adult NHS Services. Since the Darzi review of 2008 to the present day, NHS organisations have been driven to afford the same level of importance to patient experience as they do clinical effectiveness and safety. In terms of patient experience specifically, focus needs to be placed on the human interactional and environmental aspects of a patient s care and treatment as well as the functional aspects. Research about what matters to patients, which has shaped policy and thinking in today s NHS, highlights quality consistent information and involvement about decision making in care as key themes in enhancing experience. Providing assurance and treating people as individuals with courtesy and respect are also important. Other critical elements can be categorised as: Respect of patient-centred values Co-ordination and integration of care Information, communication and education Physical comfort Emotional support Welcoming the involvement of family and friends Transition and continuity Access to care The NHS has tended to concentrate on improving functional aspects of care yet the research clearly reveals that the relational aspects, such as feeling listened to or informed, matter much more to patients than the functional aspects. Applying these principles directly to an Emergency Department requires the relational or human aspects to be factored in, taking the patient journey into consideration. For example, the process of arrival at hospital can in a patient s or relative s mind, induce heightened senses of anxiety around traveling to the hospital, parking, and booking in at reception. The patient s expectation is that they will receive safe and effective treatment (functional). The things that take place on the other side of the line, before any care or treatment has been administered, have a profound effect on how they view their experience. This development will make a significant improvement to the environment in which patients receive first line emergency care in the Trust, providing the right level of capacity of the right size and quality. 45

50 Policy Ambulance Service Quality Indicators RWT Priorities for Improvement 2013/14 Regional Review of Stroke Services Scheme strategic fit Ambulance Quality Indicators were introduced in April The Quality Indicator which has particular relevance for Emergency Departments is the requirement for a 30 minute turnaround for ambulance crews. Fines have been introduced from April 2013 for exceeding these turnaround times and have cost implications for both Acute and Ambulance Trusts. This development will provide the necessary capacity to support the achievement of these targets. The Trust s priorities for improvement were initially chosen after consulting with staff and clinical teams and looking at what patients and members of the public say about our services in national and local surveys, complaints and compliments Urgent Care is one of the Trusts 2013/14 Priorities for Improvement and builds on initiatives implemented during 2012/13. The Trust plans for 2013/14 included the development of a Joint Urgent and Emergency Care Strategy which includes proposals for the new Urgent and Emergency Centre at New Cross Hospital. These proposals were finalised in November 2013 with WCCG launching a 3 month public consultation in December The vision is to provide an improved, simplified and sustainable 24/7 urgent and emergency care system which supports the right care in the right place at the right time for all of our population. The aim is that patients will receive high quality and seamless care from easily accessible, appropriate, integrated and responsive services In May 2012, it was announced that the NHS Midlands and East will be undertaking a review of stroke services, including the provision of Hyper Acute Stroke Services. The purpose of the review is to achieve a step change improvement in the quality of stroke services and stroke outcomes. The Trust is engaging in this review process to develop a proposal to deliver stroke services across the whole pathway including Hyper Acute Services. The success of achieving Hyper Acute Status is extremely important for local patients and the Trust s extended border areas; it will bring untold benefits to patients, e.g. faster treatment, better outcomes and improved standards of care but will increase the input through the Emergency Department as patients will be required to follow a pathway for suspected stroke through the paramedic alert system to the Emergency Department. The Stroke Service working with the ED have already a strongly established service which is recognised by Commissioners. The opportunity of a new Emergency Department will further enhance the stroke care that is provided to patients and our ability to offer this to more patients who require this care. 46

51 2.3 Other Organisational Strategies Other organisational strategies underpinning this development are detailed in Table 2e. Table 2e: Trust Organisational Strategies underpinning the Urgent and Emergency Care Centre development Strategy Scheme strategic fit RWT Patient Experience Strategy This strategy sets out 9 objectives to improve feedback and data quality which will drive reliability and consistency in patient experience RWT Human Resources Strategy It is acknowledged that over the next 5 10 years the Trust will continue to undergo radical changes in the way it delivers services and these drivers for change will impact on the shaping of the workforce. The Trust has the following overall aims in terms of its Human Resources strategy: Alignment of community staff into an integrated organisational form. To ensure the provision of clear strategies which enable effective workforce planning which is aligned to our patients needs and increases the flexibility and productivity of our workforce. To ensure that we recruit and retain staff with values, attitudes and beliefs that are appropriately aligned to those of the Trust and that therefore enable the further development of the commitment based culture. To ensure that we have a high quality workforce in terms of; numbers, appropriate skill set, in the right place at the right time, that is flexible enough to maximise delivery of service objectives in a climate of competition and where income is determined by results. To ensure that our workforce encounter a positive experience whilst employed by the Trust that enables us to be recognised as an employer of choice and, more importantly, leads to our employees acting as advocates of the Trust as both an employer and a service provider. To develop the culture of the organisation so that our employees are committed to maximising productivity, efficiency and the quality of patient service. To further develop ways of working in full partnership with all staff and their representative organisations, via engagement strategies described, that ensures their contribution and commitment to decision making. To develop and implement effective and efficient HRM processes and policies which support the development of a high performing foundation trust and minimise risk. This Strategy underpins the service redesign and implications for staffing in Emergency Services. 47

52 Strategy RWT ICT Strategy Scheme strategic fit The importance of technology has increased as has its strategic value to the organisation with a growing dependence on ICT by all Trust services both clinical and non-clinical. Information handling and business transformation form the key objectives that the ICT strategy looks to address. The ICT strategy for the Trust is therefore based on the development of a single corporate processing environment with a single physical shared technical infrastructure. This will result in a move away from the frontline services logging on to different application systems to process different stages of the patient journey. Specific activities and events for ICT for the Trust in general include: Development of a clinical Electronic Document and Records Management system; Integration of all Trust Patient Systems through the use of Middleware software (BizTalk); Development of workflow transactions for all patient processes, enabling the patient journey through the Trust to be as smooth as possible; Development of a Fibre Wide Area Network (WAN); Implementation of mobile technology infrastructure within the network; Enablement of links to domestic residences to support home working and telemedicine where possible; and Improved links with primary care. Hospital Site Rationalisation and Redevelopment The Trust commenced the building of the first stage of the new hospital development in This first stage is part of a journey culminating in the delivery of a Masterplan approved by Wolverhampton City Council in Within this Masterplan, the Trust proposes that the site is zoned according to the proposed clinical models for: Women and children s services; Cancer; Cardiothoracic services; Emergency services; Elective services; Clinical support accommodation including diagnostics; and, Business support functions. A major challenge for the Trust is the establishment of a single integrated hospital, reducing the quantity of peripheral buildings on the site, and concentrating clinical services at the core. This involves maximising the use of the better quality existing buildings on the site, refurbishing where appropriate and cost effective, and providing new buildings linked to the existing facilities to achieve the required clinical adjacencies and design to be fit for purpose into the future. The key objectives can be summarised as: To provide an integrated Urgent and Emergency Centre that maximises linkages with the existing Heart and Lung Centre and inpatient beds; and, Provide new Inpatient and Outpatient accommodation that addresses Privacy, Dignity and Choice agenda. The projected works are extensive and are increased in complexity by the need to plan and deliver on a live hospital site. This development is a key component of the Masterplan. 48

53 Part B: The Case for Change 2.4 Investment objectives The investment objectives for this project are: To provide high quality clinical services for patients requiring urgent and emergency care that is timely, accessible and consistently available and enables delivery of quality targets; To deliver closer integration of Emergency Services improving communication between clinical teams and reducing movement and travel distances between departments; To deliver closer integration of urgent and emergency care ensuring patients see the right clinician at the right time, 24/7; To modernise Emergency Services and facilities which will ensure the most appropriate use of resources and improve the overall patient, visitor and staff experience; To ensure that the project and service are financially sustainable; To establish services/facilities which can respond flexibly to internal and external changes; To maximise the use and availability of technology to support the internal service model and interface with internal and external stakeholders/users; To develop good quality, energy efficient and low carbon buildings. 2.5 Existing Arrangements The current Urgent and Emergency Care system in Wolverhampton includes the following services: One hospital provider (The Royal Wolverhampton NHS Trust) providing emergency care at New Cross Hospital; Two walk in centre providers across the city: Phoenix Walk In Centre, provider The Royal Wolverhampton NHS Trust; Showell Park, provider Docs on Call; One out of hours provider (Primecare); Forty eight (48) GP practices. Currently there are several ways of accessing emergency services provided by The Royal Wolverhampton NHS Trust depending on the mode of referral. These are: The Royal Wolverhampton NHS Trust Emergency Department: (self-referrals; 999 ambulance referrals; some GP referred patients; Trauma and Orthopaedic referrals; Ophthalmology referrals and self-presenters); Acute Medical Unit (AMU): (GP referred medical patients; referrals for urgent Haematology/Oncology admissions and from other specialty outpatients e.g. Renal referrals; ED referred medical patients for admission); A9 (formerly Surgical Assessment Unit - (SAU) (GP referred and ED referred surgical patients); Paediatric Assessment Unit: (GP referred children; ED referred children; some selfreferrals); 49

54 In addition to the above, emergency obstetrics and gynaecology (GP referred) is provided for in the Women s Hospital; Urgent ENT/Maxillo-facial assessment is available in the Outpatient Department during normal working hours ; Hot clinics e.g. Respiratory, Cardiac, Ambulatory Assessment Area as part of AMU; Heart & Lung Centre; Phoenix Walk In Centre. These different emergency services are generally staffed by their own dedicated nursing and medical teams and have their own 24 hour emergency medical rotas. For the purposes of this project, the re-provision of emergency care relates to the following specialties: Emergency Department; Acute Medical Unit; General Medicine (all specialties including Oncology/Haematology); Ophthalmology. The Emergency Department is the first step in the pathway of emergency care often for patients who have complex needs and are at their most vulnerable. It is the shop window of the Trust for the emergency patients and their carers. The current model can be defined as: Traditional; Slow with time wasted between steps; Leading to duplication; Multiple handovers between clinical teams with resultant increase in risk to safety; Limited collaborative working due to poor adjacencies; Care plan and investigations developed following transfer from ED Activity and Performance Trends Table 2f includes the historical Emergency Services activity since 2007/08. 50

55 Jan-04 Apr-04 Jul-04 Oct-04 Jan-05 Apr-05 Jul-05 Oct-05 Jan-06 Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11 Jan-12 Apr-12 Jul-12 Oct-12 Jan-13 Apr-13 Jul-13 Oct-13 Jan-14 Table 2f: Emergency Services Activity 2007/8 to 2012/13 Year New Cross ED Attendances Walk-in Centre Attendances New Cross Assessment Unit Activity impacting the Urgent & Emergency Care Centre Phoenix Centre Showell Park Acute Medical Unit Acute Medical Unit Ambulatory 2007/8 98,510 14,224 6, /9 99,944 24,223 7, /10 98,898 32,441 9,720 7, /11 98,288 29,137 21,395 4,059 2, /12 101,303 28,551 25,479 3,987 2, /13 106,836 36,186 29,009 3,192 2,417 Notes : Phoenix centre opened in 2007 Showell Park opened in 2009 (shown for completeness but not RWT activity) Surgical Assessment Unit (SAU) previously within AMU prior to 10/11 and known as EAU (Emergency Assessment Unit) Acute Medical Unit, SAU and AMUAMB (ambulatory) are discharges from these wards Since 2004 monthly attendance has increased at the New Cross Emergency Department from 5,816 in January 2004 to 9,109 in January This increase is demonstrated in Figure 2a and Table 2g. Figure 2a: Emergency Department Attendances

56 Table 2g: Emergency Department Attendance Shift January 2004 January 2014 Increase Monthly attendances (patients) 5,816 9,109 3,293 Average daily attendances (patients) The increase in ED attendees between financial year 2011/12 and 2012/13 was over 5%. Table 2h shows the Emergency Department Activity Plan for 2013/14 split by Commissioner volume and value. Table 2h: Emergency Department Activity (2013/14) by Commissioner Emergency Department PbR Attendances Activity Finance NHS Wolverhampton CCG 75,398 7,427,053 NHS Cannock Chase CCG 4, ,315 NHS East Staffordshire CCG 51 5,403 NHS South East Staffordshire & Seisdon CCG 6, ,109 NHS Stafford and Surrounds CCG 2, ,923 NHS Birmingham South & Central CCG ,125 NHS Birmingham Crosscity CCG 27 2,298 NHS Shropshire CCG ,545 NHS Walsall CCG 10,907 1,077,438 NHS Telford & Wrekin CCG ,773 NHS Sandwell & West Birmingham CCG 1, ,569 NHS Dudley CCG 3, ,300 NHS North Staffs CCG 45 4,148 NHS Stoke on Trent CCG 85 8,371 NHS Redditch and Bromsgrove CCG 40 3,974 NHS South Worcestershire CCG 39 4,006 NHS Wyre Forest CCG 60 5,791 Total 107,061 10,662,142 Note: excludes small amount of non-contract activity and is based on 2013/14 plan A 24/7 Radiology service is provided in the Emergency Department for Plain Film Examinations and CT Heads. A small number of examinations are also performed in the main Radiology Department for CT, MR and Ultrasound. Tables 2i and 2j show the activity growth 2007/08 to 2012/13 and how this activity is apportioned between the two areas at 2012/13. 52

57 Table 2i: Radiology Activity related to the Emergency Department 2007/08 to 2012/13 Emergency Department 2007/ / / / / /13 Plain Film Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Ultrasound Total Table 2j: Emergency Radiology Activity split between Emergency Department & Main Radiology Department for 2012/13 Radiology Activity 2012/13 ED Main Total Plain Film Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Ultrasound Total Until two years ago ED performance against the 4 hour turnaround target was consistently amongst the best in the country. Since this time, ED performance, in common with many other Trusts, has fallen. See Figure 2b. Figure 2b:- Emergency Department Performance against 95% achievement of 4 hour turnaround target since % 100% 98% 96% 94% 92% 90% 88% 86% 84% The Royal Wolverhampton NHS Trust has previously had a good record of achieving the access targets for A&E waits. However, whilst the Trust achieved the contractual target for 2012/13, it did not achieve the target for Quarter 4 attendances and this pattern of 53

58 performance has continued throughout 2013/14. Table 2k shows the performance for Type 1, and Type 1 and 3 combined for 2012/13 and 2013/14 to date. Table 2k: Emergency Department Activity Change and Performance against the 4 hour wait target for Type 1 and Type 1 & 3 combined ED Activity ED Performance 2013/14 Quarter 2012/ /14 % activity Change All Type ,242 26, % 95.12% 93.56% 2 27,524 27, % 96.63% 95.63% 3 26,834 27, % 94.65% 92.91% 4 26,238 Total 106,838 81, % 95.47% 94.05% Workforce Profile The current workforce profile for Emergency Services is summarised in Tables 2l(i), (ii) and (iii). Table 2l(i): Workforce Establishment (WTE) for Clinical Staff in Emergency Department (ED) April 2014 Consultants Middle Grades: Associate Specialist Registrar Staff Grade ACP's Junior Doctors ENP's GP's Radiology - Consultant Radiology - Registrar Total Band 6 Band 8a Band 8b Other Total Table 2l(ii): Workforce Establishment (WTE) for Nursing Staff in Emergency Department April 2014 Department Band 2 Band 3 Band 5 Band 6 Band 7 Band 8a Total ED(including Ophthalmology ) Ambulatory Assessment Area Radiology Total

59 Table 2l(iii): Workforce Establishment (WTE) for Clinical &Non-Clinical Support Staff April 2014 Department ED Health Recs/Ward Clerks/Receptionists ED Medical Secretaries Band 1 Band Band Band Band Band Band Band Band Band Total a 8b 8c ED A&C ED Ancilliary AMU Health Records Porters (all depts) Domestics Radiology - Radiographers Radiology - Sonographers Radiology - Technicians Radiology- Clerical/Helpers Therapies Therapists Therapies - Admin IT Staff Medical Physics Technician Total Income and Expenditure The Trust s income and expenditure associated with the provision of emergency services at April 2014 is as follows: Income 15,131,282 Pay 11,029,813 Non Pay 1,358, /15 Efficiency Savings at 4%2230 (495,514) This equates to a contribution (before capital charges) in 2014/15 of 3,238,

60 2.6 Business Needs The issues relating to Emergency Services were described at OBC and these continue to be relevant at FBC: Unprecedented demand on the Emergency Care System; Inefficiencies in Care Pathways and Service Model; Sub-optimal physical capacity and environment; Workforce issues; Equipment and ICT requirements; Governance, Operational and Financial inefficiencies Unprecedented Demand on the Emergency Care System Wolverhampton Health Economy has experienced unprecedented demand on its Urgent and Emergency Care Services which is reflective of trends across the country. The demand has steadily grown over recent years resulting in winter pressure wards remaining open during summer 2012/13. The number of attendances at ED has continued to increase and, of note, this did not decrease following the introduction of two Walk In Centres in the city. Care pathways have been developed with community teams in an attempt to provide alternative services. However, the numbers presenting to ED are still expected to increase in response to an increase in demand at all stages of the patient interaction with the NHS. Fifty per cent (50%) of ED attendances are classed as major/resuscitation; the other 50% are cases which can be treated in the Minors area. Usually, demand rises each morning from 9.00am with a constant flow of attendances arriving each hour until 9.00pm. Attendances per hour then reduce overnight although the ratio of Majors patients to Minors tends to rise during this time period. Children under the age of 16 years account for 18% of ED activity. The impact of the increases in demand described in Section 2.5 on patient care has been significant, with patients at times experiencing long waits to see a doctor for initial assessment, for treatment and, where necessary, admission to an inpatient bed. As the number of patients requiring admission increases, the pressure on inpatient beds intensifies. There has been subsequent impact on bed pressures, increased cancellations and loss of elective income and overall poor patient experience. Increased activity and the arrival times of patients and ambulances, has caused further capacity pressures and resulted in the need to open an Ambulance Off-load Area during This area did not provide a suitable environment for the initial assessment or treatment of patients and afforded little privacy and dignity. The Trust responded to this influx by the provision in November 2013 of additional Majors facilities in a modular extension. Figure 2c shows that in excess of 2,051 more ambulances were conveyed to the ED in 2012/13 when compared to the previous year, an increase of over 5.4%. The % increase into RWT Type 1 A&E is consistently higher than the WMAS average. Since October 2012 ambulance conveyances have increased by 5.8% into RWT against a 1.1% WMAS average. This equates to an extra 43 ambulances per week. 56

61 The increase in ambulance conveyances has a disproportionate impact on emergency services given that the admission rates for patients arriving by ambulance in Q1 2013/14 was 45.7% compared to a standard admission rate of 18.6%. Figure 2c: Number of Ambulances Monthly 2011/12 and 2012/13 Number of Ambulances monthly (11/12 v 12/13) May June July August September October November December January February March April Ambulances (Actual) 12/13 Ambulances (Actual) 11/12 To summarise, the key issues are: Increases in ambulance conveyances; Increases in ED attendances; Increases in admission rates from ED; Some evidence of a higher rate of increase in attendances/admissions in out of hours periods (after 6pm and weekends) Inefficiencies in Care Pathways and Service Model The current model of Emergency Care at RWT varies from department to department. This results in duplication of work including duplication of diagnostic tests, multiple handovers as patients move through the system and different experience of waiting times e.g. time to see a senior decision maker as well as time to access facilities including diagnostic services. Multiple access points results in duplication of skill base. In the past there has been: Tendency by the management team and ED staff to focus on the 4 hour wait target with little buy in to on-going care; An inward focus and lack of engagement with other services who could support including community teams and primary care; A culture that all patients who attend are assessed and treated rather than referred on/deflected to other supportive services; Provision of care in ED and AMU has predominantly been from medical clinicians against a background of reducing availability of doctors (static junior docs through the training system and desire for expansion across the majority of Trusts); 57

62 A reliance on individually acquired knowledge of clinical and management ways of doing things rather than a culture of consistent and available pathways. The result is inconsistency, repetition, gaps and un-auditable practice. This also means that individuals and teams, and therefore the service, do not have a basis on which to develop and progress. The ED has recognised these shortfalls and has taken steps to address them with the aim of improving patient care. However, lack of co-location and cramped conditions of work mean that there is a ceiling on the change that is possible. In particular, the medical teams are keen to implement the service model described by the Future Hospital Commission in the document Future Hospital: Caring for Medical Patients (Sept. 2013). These recommendations include bring together clinical areas focusing on initial assessment and stabilisation of acutely ill medical patients in a single Acute Care Hub. The current model whereby medical clinicians are located at the other end of a hospital from the majority of emergency patient admissions, and where the diagnostic facilities provided are limited, does not lend itself to a centralised system. Friends and Family tests overall show a high satisfaction rate with the clinical and compassionate care shown in ED. However, when patients make comments they invariably mention the restrictive environmental conditions, lack of privacy, long waiting times at various stages of their journey and the pressures under which staff work Physical Capacity and Environment The Emergency Services are currently provided from a number of disparate buildings on site. The Emergency Department (ED) has been located in the same accommodation footprint for over 15 years and is no longer fit for purpose. The Emergency Department is located towards the North West of the site and is at the opposite end of the site to the Acute Medical Unit and the medical wards which are accessed by long public corridors and steep ramps. This results in long and difficult travel distances including the requirement for portering staff to take patients up to the first floor in a lift and back down to the ground floor in order to avoid steep ramps at ground level for admitted medical patients. The disparate geographic location of portals results in logistical difficulties with patient management. The physical capacity of the Emergency Department is limited to the building footprint with little room for expansion either to the North or West of the site, and without relocating other adjacent departments. A key issue for the department is lack of space for re-organising services and physical size of cubicles and diagnostic space resulting in compromised patient safety, privacy and dignity issues and sub-optimal patient and staff environment. Reference to DH Building capacity guidance: Health Building Note 22, indicates that the current ED has insufficient capacity to cope with the future levels of activity. The current capacity shortage in ED also leaves no room for service provision should Trusts in the surrounding areas change their patient emergency pathways. For example, should Stafford ED stop taking Type 1 ED patients (usually ambulance transported patients), the ED 58

63 at The Royal Wolverhampton NHS Trust would have no room to take on the added demand which would undoubtedly flow to Wolverhampton without the planned expansion. Table 2m identifies the estates performance of the existing ED. Table 2m: Current Estates Performance Indicators Area Year of Construction Functional Suitability Space Utilisation Quality Emergency Department Building constructed in 1974: Ground floor accommodation refurbished in 1996 for ED CX Overcrowded CX Notes: CX this category indicates that nothing but a total rebuild or relocation will suffice (i.e. improvements to existing are either impracticable or too expensive (Ref: HBN 00-08) The department underwent a facelift during 2011/12 in an effort to maintain the environment; however, this had little effect on physical capacity. Consequently, the Trust further enhanced the current department during 2013/14 by adding a modular extension to create additional Majors cubicle space to cope with increasing demand and to convert an adjacent clinic area to a small Clinical Decisions Unit. These enhancements were supported by commissioners and included in local A&E Sustainability Plans. These developments however are considered only sufficient to plug the capacity gap between now and 2015/16 when a new department can be provided. These additional facilities, whilst helping in reducing numbers of patients waiting in corridors, have done little to improve the environment for the majority of patients, increase the capacity for paediatric or resus patients, improve the lack of space in existing patient areas or improve diagnostic capability. Neither have they improved adjacencies, both internally within the department or with other key departments such as assessment and inpatient medical beds. Concern about the sustained rise in activity and resultant pressure on performance, together with safety issues particularly where patients are waiting in corridors due to lack of space, has focussed the need for a new facility Workforce A review of the workforce in the Emergency Department has already taken place. The aim is to move towards 24 hour consultant cover and to this end the team have been successful in increasing the consultant complement from 5 WTE to 10 WTE over an 18 month period. Mindful of the scarcity of middle grade doctors, the Trust has actively sought to recruit from India by establishing links with hospitals and universities in the country. The department has also successfully established an Advanced Clinical Practitioner role and has three staff in these posts. The intention is to further increase this complement including by providing training opportunities for those currently at lower grades. Whilst the service has been successful in recruiting to existing posts, the Trust believes there are opportunities for cross specialty working e.g. Acute Medicine with Emergency clinicians. The current geographical gap between these areas makes it difficult to introduce or sustain this model of working efficiently and therefore opportunities for staff training and improved patient care are lost. 59

64 2.6.5 Equipment & ICT Some equipment replacement within the Emergency Department has taken place in the last 18 months particularly in relation to patient monitoring equipment in individual cubicles. Radiology equipment currently consists of: two plain film machines; one OPG (dental) machine; one CT scanner which is currently used for head scans. This equipment is located in dedicated Radiology rooms within the ED. Other equipment consists of: one plain film machine mounted on overhead gantry which serves the four resuscitation cubicles in the ED; one mobile ultrasound machine. The radiology equipment is either owned by the Trust or is supplied through a managed equipment service (MES) linked to the Radiology Private Finance Initiative (PFI). Links with Pathology until April 2013 involved samples being transported by pneumatic tube system through three zones to four separate Pathology departments. Although this was improved when the new Integrated Pathology Building became operational, there is still no direct link from the Emergency Departments to Pathology. The current IT system and data capture relies heavily on paper and there is little use of mobile devices. The Emergency Department is working with the existing manufacturers of the clinical and demographic software in an effort to upgrade the current model to one that will support paper free clinical and demographic data capture. Once upgraded within the Emergency Department it is planned to implement the application within AMU ahead of the new build and integration of the 2 services. This will help to inform the decision on final ICT requirements, particularly the mix between mobile and worktop devices. The Trust s Patient Administration System (PAS) is the source of all master patient data and is interfaced with the existing ED application utilising the PAS HL7 messaging interface to ensure a single and consistent view of patient data. The existing ED system supports the use of the National NHS Number. Significant progress has been achieved over recent years on delivering a clinical web portal which provides a consolidated single view of patient data within the Trust. Whilst this is available to GP s via their desktop, more work on integration with GP systems needs to be undertaken and this will be a key driver in delivering the new integrated department. Work is already underway to access summary care information by patient via the Trust s clinical portal to support this going forward Governance, Operational and Financial Inefficiencies Governance issues arise due to patients receiving different management for the same condition depending on which portal they present to. For example, patients with suspected DVT can present to 3 different departments depending upon who has referred. The number of access points leads to financial inefficiencies. 60

65 Separation of clinical teams by geography, management and governance means that there is a lack of opportunity for learning and development between the various workforces and whilst some roles are shared, there is a repetition of information collected or processes across the emergency and then the on-going urgent care journey (e.g. history/bloods in Emergency Department, history/bloods in AMU, history/bloods on the ward). There is also a risk of assuming that the other team will follow through on a clinical action Estates Strategy The Trust s Estates Strategy has been developed to create the quality of environment and facilities required to support the Clinical Services Strategy. The Strategy identifies how the Trust will use and support its existing buildings, which buildings will become obsolete and be demolished and where new buildings are required to underpin the Models of Care and Service Delivery. This objective is therefore reflected in this business case. The provision of new facilities for Emergency Services is a key pillar of the Trust s Estates Strategy. See Appendix 2b and Section 5 for the site Masterplan and 5 year Capital Programme. 2.7 Potential Business Scope and Key Service Requirements The Trust has developed a long-term vision for Emergency Services which is outlined below: An Emergency Service which puts patients needs at the core of its provision; An Emergency Service which achieves high quality and safe care provision, which is measured, both by external and internal KPI s; An Emergency Service where staff ask to work; An Emergency Department which is perceived as the best in the West Midlands, one which staff from other organisations visit as a source of ideas and leadership; An Emergency Service which has education, research and innovation at the heart of its provision; An Emergency Service which is affordable to the local health economy. This vision underpins the cohesive vision of the local health economy in relation to Urgent and Emergency Care: Our vision is for an improved, simplified and sustainable 24/7 Urgent and Emergency care system that supports the right care in the right place at the right time for all of our population. Our patients will receive high quality and seamless care from easily accessible, appropriate, integrated and responsive services. Self-care will be promoted at all access points across the local health economies and patients will be guided to the right place for their care and their views will be integral to the culture of continuous improvement. The principles underpinning the new service model for Emergency Services are therefore as described in Table 2n. 61

66 Table 2n: Principles of the New Service Emergency Services Directorate Focus on patient need Right care, right time, right location Service Smoother pathways of care and streaming patients effectively Avoid duplication Improved diagnostics Admission avoidance 24/7 service Integration of primary and secondary care Staff Appropriately trained personnel, grade and number to support 24/7 A flexible multidisciplinary workforce Maintain teaching and training focus Consistent and appropriate staffing structure for all services provided Best and appropriate technology Flexibility for expansion and development Facility for in-house training and teaching Building & Equipment Providing a safe, secure and healthy environment for patients and staff Appropriate clinical and non-clinical support space Use of sustainable technologies which are low carbon, energy efficient. Meet patient expectations with regard to privacy and dignity and equality Paper light Best use of IT Improved IT interface with external stakeholders e.g. GPs IT 62

67 Figure 2d shows the revised and future intended patient flows through the Emergency and Urgent Care System. Figure 2d: Future Clinical Service Model C Clin Clinical Decisions Unit Paediatrics/ Elderly Care & Ambulatory Emergency Pathways The Intended Service The new service model will bring together Urgent and Emergency Care into one department. Patients who come to the hospital, whether as self-referral, via their GP or by the ambulance services will all be received through the same access point Signposting Patients will enter the department through one door and will be signposted to the most appropriate service for their care, either the urgent care or the emergency care pathway. The aim of the urgent care facility is to enable patients who attend with minor illness and injury, to be seen, treated and discharged or signposted to alternative services dependent on their need. A patients GP will still remain the first point of contact for patients, but the facility will provide urgent access to the right service at times when the patients own GP is not open or unable to see patients quickly. 63

68 Emergency Department Those patients who attend the emergency care pathway (either via ambulance or walk-in) will be triaged to the ambulatory (Minors) area, Majors or Resus. The aim will be for all patients to be seen initially by a senior decision maker. To this end a rapid assessment and triage area will be staffed 24/7 at the ambulance entrance and within the waiting area for walk-ins. Both areas will have senior nurse presence and either consultant or senior middle grade doctor. Children will be seen in a dedicated area with its own triage facility. Where adult patients have an acute medical problem, after initial assessment by the ED senior decision maker they will be handed over quickly to the Acute Medical Team within the ED. This team will also include senior (consultant or registrar) and junior clinicians. Assessment, diagnostics and treatment will be started early and those that require admission will be clerked within ED before admission to an inpatient facility thereby reducing duplication and omitting at least one hand over Clinical Decisions Unit The new service model will also extend the current limited provision of a Clinical Decisions Unit (CDU). Clinical Decisions Units are nationally/internationally recognised clinical models for treating patients. A Clinical Decisions Unit is a designated area where patient conditions can be managed in circumstances where more than 4 hours is required for further investigation and/or treatment. Patients remain under the care of the ED team while in the CDU and will benefit from access to the multidisciplinary workforce within the department. Use of an ambulatory care service such as a CDU is in line with the recent directive published by NHS England aimed at advising Trusts on how to manage the surge in demand experienced by all Trusts across the country (NHS England: Improving A&E Performance Gateway ref 00062, May 2013) The CDU will provide a suitable environment for patients who require observation, investigation and treatment that will take longer than the 4 hour standard, but do not require an admission. Historically these patients have either breached the 4 hour standard or been admitted to an assessment and/or an inpatient bed thus impacting on patient flow. The advantage of increasing the bed stock in CDU is that it will be accessed by all patients fitting the clinical criteria including those that are presently admitted to beds within AMU or attend the ambulatory assessment area in AMU. All patients will have access to the same rapid assessment and diagnostic facilities. The benefits of a CDU include: Reducing admissions to an inpatient bed from ED; Freeing room on inpatient wards for those patients requiring longer lengths of stay; Freeing room in ED thereby providing room for other patients to be assessed and treated within the 4 hour turnaround; Reducing the number of 4 hour breaches. The following groups of patients, if clinically appropriate, will be moved to the CDU: 64

69 Diagnostic Evaluation o Low risk chest pain on the Troponin I pathway; o Pulmonary embolism awaiting further test like CTPA; o Renal colic awaiting CT KUB - to rule out aneurysm; o Awaiting blood results. Short Term Treatment o Allergic reaction; o Asthma - mild to moderate requiring nebuliser; o Dehydration/vomiting for first line IV; o Cellulitis; o Head injury, with normal CT Scan Head, requiring less than 24 hours admission, (for example: alcoholic, elderly living alone); o Post Sedation monitoring; o Elderly patients awaiting Occupational Therapy/Physiotherapy/Social Services assessment (Admission Avoidance). The following exclusions will be applied: Patients likely to require admission; Patients requiring social admissions or placement in long-term care; Palliative patients; 16 years of age or under; Not listed in the Inclusion Criteria Urgent Care The Urgent & Emergency Care Strategy has been developed for the residents of Wolverhampton and for those using services within the city and neighbouring CCG s. A major development within the strategy is an urgent care stream that will provide a high quality, efficient, urgent primary care service for patients both in and out of hours. Local residents have told us that the current system is complex and difficult to navigate, they are confused on how and where to go and often resort to ED as a default. Urgent care in Wolverhampton will include a multi-faceted approach: Clinical Signposting - by clinicians who will direct patients to the appropriate stream within the Urgent and Emergency Care Centre; See and Treat - patients will be seen in a timely manner by an appropriately trained clinician according to clinical need; Minor illnesses seen quickly by clinicians with an expertise in primary care; Telephone based clinical triage - for those patients who require a clinical discussion with a GP/Health Care Professional as a result of calling NHS111; Outreach service aimed at keeping patients out of the urgent care system where possible by providing a rapid response service to care/residential home, working closely with the patients registered GP and Emergency Ambulance Services (WMAS) 65

70 2.7.2 The Urgent and Emergency Care Strategy and Activity Modelling The Royal Wolverhampton NHS Trust and WCCG (also representing South East Staffordshire & Seisdon Peninsula CCG (SES&SPCCG)) commissioned the Birmingham, Black Country & Solihull Commissioning Support Unit in January 2013 to facilitate and conduct a joint activity modelling exercise to determine future activity levels and associated costs for differing ways forward for Urgent Care within the City. In advance of the finalisation of the Joint Urgent and Emergency Care Strategy and to reflect the activity work underpinning this strategy, the Trust agreed its future activity projections for the Outline Business Case with Commissioners. Further refinements of the activity model have taken place since OBC and the activity assumptions outlined in Section were agreed with WCCG and the Staffordshire CCG s prior to submission of this FBC Emergency Services Activity Table 2o provides a summary of the anticipated projected activity levels for Emergency Services to be delivered in the new Urgent and Emergency Care Centre. In line with the capital planning guidance the projections have been taken to the planning horizon of 2015/16 and then plus 5 years and 10 years. A detailed year by year analysis is included in Appendix 2c. Table 2o: Future Emergency Services Activity 2013/ /26 Year Emergency Department Urgent Care currently attending ED (20% of total) Potential additional Urgent Care Activity (relocation of WIC) ED Review Outpatients Clinical Decisions Unit 2013/14 108,811 4,795 2, /16 107,983 8,510 5,464 4, /21 112,452 25,765 22,483 5,596 6, /26 126,857 29,066 25,363 6,313 6,975 The activity figures included in Table 2o have been based on the following assumptions which have been agreed with Commissioners: Urgent and Emergency Care Departments Activity baseline is 2013/14 Month 1-9 projected outturn; Demographic growth actual in 2013/14, 2.45% in 2014/15 and 2.44% thereafter; 3.8% transfer of New Cross Emergency Department activity to an alternative urgent care setting from November 2015; 20% reassignment of New Cross Emergency Department activity to urgent care activity but to be delivered in/alongside the New Cross ED. This is to take effect from November 2015; 22,000 potential urgent care attendances relocated to New Cross ED from April 2016; RWT gains Hyper Acute Stroke Unit status from April 2016; Additional Stafford Activity of 5,540 attendances from April

71 Changes since OBC relate mainly to implementation dates as the operational date (subject to funding availability) has been brought forward from May 2016 to November 2015, introduction of phasing to the operational opening of the facility and the inclusion of Stafford activity in the base model (previously modelled as a scenario and at a higher level of activity). ED activity in all years except the base year has increased due to inclusion of Stafford Clinical Decisions Unit Baseline is Month /14 projected outturn and includes activity which currently goes to Medical and Surgical Assessment Units and other areas with a Length of Stay of less than 24 hours for a number of identified conditions and patients waiting longer than 4 hours for breach reason of investigations, transport, mental health assessment and admission avoidance; Demographic growth is factored in at the same rate as ED. CDU activity has reduced compared to that included in the OBC as this is now based on actual activity through the interim CDU rather than the estimated activity used for OBC Emergency Department Review Outpatients Activity baseline is as ED; Demographic growth is factored in at the same rate as ED. Appendix 2d provides details on the change in assumptions from OBC to FBC and the reasons for these changes Diagnostics It is proposed to provide an enhanced diagnostic service in the new Emergency Department. Radiology Xray facilities have been increased from 2 to 3 rooms and workforce has been increased so that reports can be produced more quickly. The majority of diagnostic tests will be requested from ED, performed and reported before a decision is made to admit the patient. This will reduce the number of admissions and in some instances negate the diagnostic wait for those admitted Activity Scenarios Following the conclusion of the Consultation on the Urgent and Emergency Care Strategy the WCCG intends to competitively tender the provision of the urgent care service to commence in November 2014 with new services being provided from April The Trust has therefore undertaken scenario modelling relating to the urgent care activity and the consequential financial implications as follows: 67

72 Scenario Change from Base Model Impact in 2016/17 (1 st full operational year) 1 Base Model less urgent care activity (Walk In Centre) identified to relocate to Emergency Centre - assumes activity does not relocate to Emergency Centre 2 Base Model less 20% RWT urgent care and urgent care activity (Walk In Centre) identified to relocate to Emergency Centre assumes activity delivered in Emergency Centre but is provided by others at a future date to be agreed with commissioners -21,987 EC attendances -45,383 EC attendances The worst case is Scenario 2 which will result in a reduction in activity of 45,383 attendances by 2019/20. The financial impact is that the loss in the base case contribution increases from 2.1m (over 4 years) to 8.2m (over 9 years). The Trust has agreed with the WCCG some mitigation measures which are discussed more fully in Section Future Capacity Requirements The activity projections as at 2025/26 have been used to derive the capacity requirements of the departments included within the scope of this OBC. Reference has been made to Health Building Notes and the Schedules of Accommodation have been benchmarked with a number of other Trusts with similar activity levels and who have recently built new emergency departments. A further capacity exercise has been undertaken by external consultants to support the Trust s capacity projections. These were reviewed again at FBC to reflect changes to the activity modelling. The main capacity requirements at 2025/26 are: 7 Resuscitation spaces 16 Majors cubicles 12 Minors/Ambulatory Care cubicles 12 CDU spaces 6 Paediatric cubicles 2 Crisis rooms 3 spaces for multi-disciplinary team e.g. social worker, police, alcohol liaison team etc 6 Clinic cubicles (Urgent Care and ED review/hot clinics) 1 CT Scanning room 3 Plain Film rooms (including dental) 1 Ultrasound Scanning room Integrated/alongside urgent care facility The main changes since OBC are: an increase in Resuscitation spaces to a total of 7 to include the impact of additional patients from Staffordshire; and a reduction in Minors/Ambulatory spaces to 12 following refinement of the Urgent Care model. 68

73 2.7.5 Workforce and Key Planning Assumptions The introduction of the new service model for Emergency Services will affect all staff disciplines. The current Workforce profile is summarised in Tables 2l (i), (ii) and (iii). Prior to the opening of the new department in 2015, it is anticipated that there will be a number of workforce changes within the Emergency & Urgent Care Services. Some business cases supporting service developments have already been approved and implemented. A business case to provide nine additional cubicles and a small CDU (six beds) was approved by the Trust Board in May 2013 to plug the short term capacity gap and deal with current performance issues. The new services were implemented in the autumn of 2013 and the staffing figures are included in the 2014/15 baseline. Other initiatives are currently being scoped for which business cases are under development. The Trust has identified that it needs additional consultants to provide 24/7 cover in the Emergency Department. One additional consultant has been approved as part of the Business Case for interim Majors and CDU capacity but a number of additional consultants are required to support a full 24/7 rota. The current consultant workforce allows for 8.00 to shop floor presence. Any further increases in posts will be the subject of a separate business case at the appropriate time. The Acute Physician and General Physician on call rota will also be refined and subject to a business case in order to provide 7 day working at extended hours. The details of the future workforce requirements for all disciplines to 2025/26 to support the new service model and changes in activity and capacity are provided in Table 2p. 69

74 Table 2p: Anticipated yearly changes to Workforce from baseline in 2014/15 to 2025/26 Post 2014/ / / / / / / / / / / /26 Total ED - Consultants ED - Other Medical Staff ED - ACP's (8b, 8a & 7) ED - ENP's ED - Nursing ED - Nursing (Ophthalmology) ED - Ancilliary ED - Admin AAA - Nursing 5.28 (5.28) AAA - Admin 1.13 (1.13) Therapies Radiology - Consultants Radiology - Other Medical Staff Radiology - Nursing Radiology - Radiographers Radiology - Sonographer Radiology - Technician Radiology - Admin Porters (0.80) Domestics IT Staff (1.00) Medical Physics Total

75 2.7.6 Project Scope In taking forward the vision for remodelled Emergency Services the Trust s aspirations for an Emergency Centre are outlined below: Phase 1 Re-provision and expansion of Emergency Department facilities; The Emergency Department should have two access points for urgent care serving adults and children but with both areas being linked operationally and geographically; Development of a Clinical Decisions Unit (CDU) as a care component of the Emergency Department providing protocol driven periods of investigation, observation and review for patients up to 24 hours who would otherwise be admitted to hospital beds or discharged potentially unsafely; Co-location with the Heart and Lung Centre to provide access to Critical Care; Co-location with medical assessment facilities/acute Medical Unit (AMU) and medical beds to support greater co-operation and rapid deployment of appropriate expertise to improve patient care and throughput; Alongside or integrated urgent care provision; Facilities for medical ambulatory illness (currently seen in ED and AMU); Provision of a multi-purpose outpatient clinic for patients currently seen in ED and AMU to facilitate discharge and review of patients. Unrestricted access to imaging (CT, Ultrasound and Plain Film) to allow immediate diagnosis of life threatening conditions; Phase 2 Expansion of CDU and clinical support space; Provision of inpatient beds to accommodate either paediatric or medical beds creating even better clinical adjacencies. Phase 3 Provision of new in-patient beds. Whilst, the project scope for this Business Case is only those works described in Phase 1, the Trust has taken steps to ensure that its plans for Phase 2 and 3 fit with the strategic direction of the Trust and the site Masterplan Functional Content The functional content required for Phase 1 accommodation is as follows: Main Entrance Ambulance Entrance Reception and waiting areas adults Reception and waiting areas children Urgent Care facilities Triage Majors cubicles Minors/ambulatory cubicles including specialist requirements for Ophthalmology and ENT Resuscitation Children s triage and cubicles Body viewing rooms and relatives waiting area Trolley waiting area for Radiology facilities 71

76 Radiology (CT, MRI, Ultrasound, Plain Film) Major Incident facilities De-contamination facilities Clean and dirty utility Storage Staff facilities including education area and staff change Space for multidisciplinary team e.g. social worker, domestic abuse worker etc Clinical Decisions Unit Outpatient Clinic Administrative accommodation Externally the facility will need to be supported by ambulance parking, public drop-off and accessible parking. 2.8 Main Benefits Criteria The key benefits to be derived from the new service model and re-provided Emergency Department facilities are described in Table 2q. Table 2q: Key Benefits Objective Provision of high quality Clinical Care Key Benefits Improved Patient satisfaction Achievement of quality targets Improved outcomes for patients right treatment, right time, right service Closer Integration of Emergency Services Increased clinical efficiency Improved access to services primary and secondary care Reduced travel distances for patients and staff Less duplication Improved teaching and shared learning Co-location physically and mentally Modernisation of Services & Facilities Improved environment Reduction in violence & aggression Improved privacy & dignity Improved staff satisfaction and recruitment and retention Improved patient satisfaction Capacity of right type and scale to cope with demand Improved Service Models & Patient Pathways Improved Patient Experience Less duplication 72

77 Objective Key Benefits Achievement of quality targets Single access/one stop shop Earlier intervention Definitive care plan before patient leaves ED Workforce Re-profiling Flexibility of workforce Improved skill mix Improved outcomes for patients Availability of senior decision makers earlier in the process 24/7 cover provided by appropriate clinicians Flexibility to respond to change Increased capacity Flexibility of capacity Improved adjacencies with dependent/related services Financial sustainability of service and project Value for money Affordable to Trust and Commissioners Maximisation of Technology to support Service Model Improved diagnostics and reporting Improved monitoring Reduced admissions Energy efficient/low carbon buildings Improved quality, condition and functional suitability of estate Energy & carbon reduction targets achieved Lower energy costs/m Main Risks The main business and service risks associated with this project are shown in Table 2r, together with their counter measures. 73

78 Table 2r: Key Risks and mitigations Risk Mitigation Business Case Approval Business Case Delays/Rejection Financial Additional PDC funding is not available Scheme is unaffordable from Trust revenue perspective Scheme is unaffordable from Commissioners expenditure perspective Capital costs increase Increases or decreases in activity due to service reviews (locally or regionally) Design and Planning Planning issues Increases or decreases in activity due to service reviews (locally or regionally) Change in clinical scope to that briefed Ensure that both OBC and FBC are robust and that joint financial modelling is undertaken to ensure both commissioner & provider are satisfied with the Business Case and that the proposals are financially affordable for the Local Health Economy. Minimise cost commitment until FBC approved. Ensure that proposed sign off dates are communicated with WCCG. Investigation of alternate sources of funding and procurement model. Reprofile spend on other projects within capital programme. Delay delivery of project. Ensure that affordability is fully understood, that efficiencies are maximised and that joint financial modelling is undertaken to ensure both commissioner & provider are satisfied with the FBC. Ensure that affordability is fully understood, that efficiencies are maximised and that joint financial modelling is undertaken to ensure both commissioner & provider are satisfied with the FBC. Contingencies included in capital costs. Model capital cost increase as a sensitivity. Re-profile spend on other projects within capital programme. Dialogue with Users to ensure maximum flexibility of design. Close working with Administrators and Commissioners. Scenario planning undertaken. Outline Planning achieved. Close working with Wolverhampton City Council on detailed planning to close down issues in a timely manner. Planning application submitted with a confirmed planning committee date of 1 st April Dialogue with Users to ensure maximum flexibility of design and close working with commissioners. Scenario planning undertaken. Ensure all requirements including primary care elements are picked up at Design Workshops and refer any potential issues to Project Board for agreement Failure to involve all stakeholders Risk of disruption/harm to patients, staff and visitors in the live hospital environment from construction works including tugway interface Human Resources Trust does not resource project sufficiently Programme Failure to manage activities to programme approval, start on site and handover dates Trust to co-ordinate stakeholders and develop engagement strategy to ensure all areas are covered. Strategies developed to separation of construction works and patient, staff and visitor routes and continued access to directly adjacent buildings and facilities. Good stakeholder engagement and communication throughout the development. On-going review of staffing requirement through Trust Project Group Monitor progress against programme for all workstreams throughout the life of the project. Report delay to Project Group and higher level as appropriate. 74

79 2.10 Constraints The main constraints associated with this scheme are as follows: The Trust has a limited amount of capital available to deliver the scheme; The Trust has to deliver the scheme in an environment of increasing pressure on Emergency Services from both a demand and performance perspective and also in the context of reducing income to deliver this; The Trust will need to deliver the scheme whilst delivering a comprehensive Emergency service; Interface with the infrastructure on the New Cross site, including the Tug Way, the links into the Heart and Lung Centre and the main hospital corridor; Maintaining patient staff and visitors access to the hospital site during construction Dependencies The main dependencies associated with this scheme are as follows: Availability of capital from the Trust s internal capital programme and external funding; Delivery of Urgent & Emergency Care Strategy for Wolverhampton; Recruitment and availability of key operational and project staff; Competitiveness of suppliers to enable the scheme to be delivered within budget; Transfer of urgent and emergency care activity to New Cross; Trust s continued strong financial position Consultation and Engagement Stakeholders The key external stakeholders in relation to this scheme are patients and their representatives, Wolverhampton Clinical Commissioning Group (WCCG), South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group (SES&SPCCG) and other local commissioners, the GPs within Wolverhampton and Wolverhampton City Council. The Clinical Commissioning Groups have been involved in the development of the proposals outlined in this Business Case through the Joint Urgent and Emergency Care Board and the Emergency Centre Project Group. A number of meetings and presentations have been held with commissioners during the development and finalisation of the SOC, OBC and FBC. The potential impact on the Emergency Services staff is significant. In order to ensure that the nature of the changes is understood the Project Group has included senior clinicians and managers from the Emergency Services Directorate and key clinical and support staff have been involved throughout the design development process Patient and Public Involvement The Trust has reported regularly to patients and public and other stakeholders (including commissioners, partner organisations and the voluntary sector) and Trust staff on the major 75

80 site development plans and specifically concerning Stage 1 projects which includes the Emergency Centre. A number of stakeholder events have been held by the Trust and Commissioners to discuss patient and public expectations in relation to Emergency Services during 2012 and A number of events have also been held for Trust and CCG staff. The Urgent and Emergency Care Strategy for Wolverhampton was finalised and approved in November This strategy promotes system wide changes to urgent and emergency care services to make these more sustainable and cohesive and aims to simplify and improve access. The strategy was subject to Public Consultation between December 2013 and March The provision of a new Urgent and Emergency Centre at New Cross Hospital and integration of some urgent and emergency care services at New Cross Hospital is an integral part of this strategy. The outcome of the Consultation concluded that 94% of stakeholders supported the plans. A Communication Strategy has been developed by the Trust for the Urgent and Emergency Care Centre project which details all activities undertaken to date and plans for future activities. Communication with all Stakeholders will be on going throughout the introduction of new service models and opening of the new facilities Health Scrutiny Panel & Health & Wellbeing Board The Trust is extremely conscious of its obligations in terms of public consultation and the involvement of the Health Scrutiny Panels and Health & Wellbeing Boards. In line with the national requirements, the Trust site redevelopment Masterplan was subject to public consultation undertaken by Wolverhampton City PCT as far back as 2006 and specific presentations have been made by the Chief Executive and senior staff on the key proposals on a continuous basis since that date to the Health Scrutiny Panel and more recently to the Wolverhampton Health and Wellbeing Board. The Urgent and Emergency Care Strategy was approved to go forward to public consultation by both bodies in November The outcome of the Consultation was presented to and received approval from the Wolverhampton Health Scrutiny Panel on 27 th March

81 3. THE ECONOMIC CASE 3.1 Introduction This section focuses on the economic position of the proposed development. It looks to confirm the preferred option highlighted in the OBC and explains the reasons for changes since the OBC 3.2 The Procurement Process Since the finalisation of the OBC in September 2013 there have been a number of issues which have resulted in the Trust to reflect on its decision to use a Single Stage traditional route and to consider an alternative route, namely NHS Procure 21+. The key reasons for this were: a) requirement for the delivery of an accelerated programme b) market response to the OJEU Pre Qualification Questionnaires (PQQ) c) feedback from visits to other Trusts using the NHS Procure 21+ route The NHS Procure 21+ National Framework is an agreement with six Principal Supply Chain Partners (PSCP s) which have been already selected via an OJEU tender process for capital investment construction schemes within the NHS. The delivery programme indicated in the Outline Business Case (OBC) was for completion by May 2016, this being driven by the availability of funding. Notwithstanding the programme outlined in the OBC, the Trust has a desire to deliver the project by November 2015 and prior to winter to minimise the impact on the existing service from increasing activity and mitigate the impact of emergency activity from Stafford. One of the benefits articulated for the use of Procure21+ is the earlier engagement of a main contractor and, whilst the delivery programme is still challenging, it is argued that using Procure 21+ could provide greater certainty in relation to a November 2015 delivery date. The Trust has also undertaken consultation with other Trusts who have recently used Procure 21+ on similar types of projects and these Trusts were generally satisfied with both the Procure 21+ process and project outcomes. The Trust had also made the decision to use Procure 21+ for the Enabling Works for the project. As a result of the above, the Trust Project Team re-evaluated the procurement strategy and considered that the appointment of a PSCP under the Procure 21+ Framework would be the most appropriate route to develop the new Urgent and Emergency Care Centre. In accordance with the requirements of the Procure 21+ process a High Level Information Pack was issued to the six PSCP s in late November 2013 and the Trust received four responses, these being from Miller HPS, Kier Construction, Balfour Beatty Group and Integrated Health Projects. The expressions of interest were reviewed and scored in conjunction with support from the National Procure 21+ Team. It was agreed that the two highest scoring PSCP s would be invited to interview. Following the conclusion of the interviews, it was agreed that Kier Construction be appointed as the PSCP for the new Emergency Centre. Kier indicated that they would continue to use the design team that had already been appointed by the Trust, namely Keppie in association with Arup and Ramboll. The Trust Board approved the appointment of Kier Construction in February

82 3.3 Changes from OBC Capital Costs The capital costs for Option 5 (The preferred option) were identified in the OBC as million outturn and an approval total of million. The FBC capital costs are identified as million outturn and approval total of million. This represents a 2.9% increase in capital costs and is within the 10% margin allowed for cost movements between an OBC and FBC. The reason for the change in costs is shown in Table 3a. Table 3a: Changes in Capital Costs OBC v FBC OBC Option FBC Costs 000 Reasons for changes in costs Works cost 16,372 19,923 Shift between optimism bias, contingency and non- works cost together with design and capacity changes driven by activity Location adjustment -1,063-1,109 Change in works costs Non Works cost Changes to decant and ICT costs Fees 1,460 1,333 Actual costs at FBC Equipment 1,271 1,127 Costed equipment schedule at FBC Contingency 1, Costed risk schedule at FBC compared with 10% assumption at OBC Optimism bias 2,345 1,192 Reduction in upper bound and mitigation factor VAT 4,241 4,393 Change in costs Total cost (PUBSEC BIS 26,910 27,693 FP 173) Inflation 1,787 2,193 Indices change from 185 at OBC to 188 for FBC for outturn calculation Outturn Cost (PUBSEC BIS FP 185/188) 28,697 29,886 The detailed capital costs are included in Appendix 3a Optimism Bias In line with HM Treasury guidance, the Green Book and DH template, the Trust has re-assessed the level of optimism bias for the preferred option associated with each of the short-listed options. This has been done through consultation with the Project Group and the Design Team and then reviewed and confirmed following the risk workshop. In assessing optimism bias, the Trust has sought to base the assessment on evidence from other NHS schemes. The optimism bias tool tailored by the DH in England to reflect the key contributions to optimism bias in health build projects has been used. The spread sheets used to identify the upper bound and the levels of mitigation are included in Appendix 3a. 78

83 Table 3b summarises the upper bound assessment, degree of mitigation and residual optimism bias for Option 5 at OBC and FBC stages. Table 3b: Optimism Bias for Preferred Option (Option 5) Preferred Option (Option 5) Upper Bound Assessment Degree of Mitigation Residual Optimism Bias OBC 27% 53% 12.69% FBC 22% 75% 5.5% Upper Bound Assessment The upper bound assessment identified an upper bound of 27% for Option 5 at OBC. This has reduced to 22% at FBC due to more certainty regarding service changes Mitigation of Optimism Bias The Trust has assessed the mitigation of optimism bias that can be applied at this stage in the design development and expected at FBC. Significant mitigation factors have been allowed for, particularly in respect of output specifications, planning and policy environment. increased contractor involvement and increased communication with and involvement of stakeholders particularly patients and public Revenue Costs The OBC preferred option 5 identified a net increase in costs of 2.15 million (after allowing for additional income). Table 3c identifies the changes at FBC. 79

84 Table 3c: Revenue Costs OBC v FBC OBC Annual Recurrent Revenue FBC Annual Recurrent Revenue Reason for Change 2014/15 Direct Pay 10,097,717 10,403,765 Includes staffing increases for increased activity for Stafford patients and 2014/15 pay changes. Direct Non Pay 853, ,148 As above Indirect Pay and Non Pay 14/15 Efficiency Savings at 4% 1,047,714 1,122,947 (495,514) Includes increased costs for ICT 2014/15 efficiency requirement Capital Charges 242, ,006 Increase in capital costs Income 15,454,273 15,131,282 Includes activity changes to forecast outturn and 2014/15 tariffs. Also includes 5k attendances for Staffordshire patients Sub Total 3,213,571 2,942, /18 Direct Pay 10,855,381 11,591,891 Includes staffing increases for increased activity for Stafford patients and 2014/15 pay changes. Direct Non Pay 941, ,290 As above Indirect 1,864,733 1,926,404 Includes increased costs for ICT 14/15 Efficiency Savings at 4% (495,514) 2014/15 efficiency requirement Capital Charges 1,700,929 1,892,152 Increase in capital costs Income 16,422,657 16,846,060 Includes activity changes to forecast outturn and 2014/15 tariffs. Also includes 5k attendances for Staffordshire patients Sub Total 1,060, ,837 Increase/(Decrease) in Net Revenue Position (2,153,353) (1,976,093) Changes since OBC The changes at FBC show a 8% reduction in the net revenue cost increase. The reason for the improvement in the position is the revised assumption on Stafford activity, which attracts more income than the additional cost. It needs to be borne in mind that the scheme already had the flexibility to accommodate the additional Stafford activity and therefore some of the non-direct costs had already been accounted for in the OBC. The Capital Investment Manual states that there should only be a maximum change in revenue costs by 5% (increase or decrease). The net revenue change from the baseline position has improved by 9% as a result of the additional income the Trust will receive for Stafford patients (this was only included as a sensitivity in the OBC as the position with mid Staffordshire Hospitals had not been finalised when the OBC was completed). However the total revenue costs for the Emergency Department have only increased by 3.4% (

85 million to million) therefore staying within the 5% threshold. It should be noted that 2017/18 has been used for comparison purposes as 2017/18 was the first full year of operation at OBC) although at FBC the first full year of operation is 2016/ Impact of changes from the OBC The changes in the capital and revenue consequences of the development are within DH tolerance limits. Most have been caused by the transfer of activity from Mid Staffordshire. This activity transfer was anticipated in the OBC and reviewed as a sensitivity at the time as this transfer was not confirmed. There is therefore no requirement to revisit the option appraisal. The impact on the capital programme and on the Trust revenue position in the context of its LTFM is discussed more fully in Section Qualitative Benefits Methodology The OBC identified Option 5 as the preferred option. Although there have been some changes in the scope and activity assumptions since the OBC, these have had no impact on the benefit scoring. As a result the Qualitative benefits scored in the OBC remain valid. These were as detailed in Tables 3d and 3e. Table 3d: Option Scores Not Weighted Option 1 Do Nothing Option 4 Extend & Reconfigure Existing Option 5 New Build Strategic Fit Clinical Effectiveness Access to Services Staff Experience Patient Experience Environmental Quality Disruption Timescales Flexibility Total Rank

86 Table 3e: Option Scores- Weighted Option 1 Do Nothing Option 4 Extend & Reconfigure Existing Option 5 New Build Strategic Fit Clinical Effectiveness Access to Services Staff Experience Patient Experience Environmental Quality Disruption Timescales Flexibility Total Rank Risk Appraisal The Capital and economic costs of the preferred option allowed for a number of construction, design and operational risks. These risks have been updated to reflect the current position in the FBC. These are fully supported by a costed risk register The major revenue risks centre around changes in activity as a result of commissioning intentions and the position with Mid Staffordshire patients. These were treated as sensitivities in the OBC. The Trust has now included Mid Staffordshire activity into its baseline but allowed for urgent care activity as a number of sensitivities. See Section 5. 82

87 4. THE COMMERCIAL CASE 4.1 Introduction This FBC supports the construction of a new Urgent and Emergency Care Centre under a Procure 21+ Framework with Kier Construction. 4.2 Required Services The proposed development will provide Phase One of a fully integrated Urgent and Emergency Care Centre within a single building situated towards the North/East of the New Cross Hospital site. The functional content of the new building and schedule of accommodation are detailed in Section 2 and Appendix 4b. The new building will consist of three storeys of 9923m 2 including plant space as follows: Ground floor collocated with reconfigured East Entrance of the hospital and linked to main hospital street (access to AMU and medical beds) includes: New Emergency Department; Satellite Radiology. First floor linked to main hospital street (access to medical beds) and Heart and Lung Centre (access to critical care) includes: Clinical Decisions Unit; Emergency Review Clinic; Urgent Care Facilities; Staff Accommodation; Shell space (1301 m 2 ) for future expansion of CDU and clinical support space in Phase 2. Second floor includes: Shell space (2275 m 2 ) for in-patient beds in Phase 2. In order to ensure that the Trust s proposals for fit out of shell space in Phase 2 are feasible and robust in design terms, an outline design has been produced for this space at 1 st and 2 nd floor level; See Appendix 4a. These proposals allow expansion of the CDU and provision of additional assessment beds to a maximum of 29 beds if required on the 1 st floor and for two 24 bedded wards on the 2 nd floor. The Trust has clear plans for the programming of Phase 2 and has allocated capital estimates for this purpose in its 5 year capital programme. Enabling works are in progress to clear the main construction site. These are scheduled to be completed in May These include: Re-provision of electrical substation and generator; Removal of a concrete slab left from the former catering department; Relocation of departments and demolition of small sections of old Victorian accommodation to the north side of the existing main corridor. Figure 4a provides a graphical representation of the proposed solution within the context of the hospital site. 83

88 Figure 4a: Site Context for the Preferred Option AMU and Medical Beds New Urgent and Emergency Care Centre Centre Heart and Lung Centre The Trust is committed to the development of sustainable facilities which contribute positively to improvements in the overall carbon footprint and specific targets for energy and environmental efficiency. Achievement of the national agenda for sustainable development has been incorporated into the design solution. Detailed proposals are included in drawings and specification documents which have been produced for this project. See Appendix 4g for detailed list Functional Content and Adjacencies The proposed distribution of the key functions and adjacencies within the building including proposed floor layouts are provided in the detailed drawings which supports this business case. See Appendix 4g for Drawings and Document Register. The functional content provided by the proposed development is as specified in Section 2. The detailed Schedule of Accommodation is included in Appendix 4b. The net impact on the Trust s Estates portfolio is an increase of 9423m² after the demolition of buildings on the North side of the existing main corridor. However, in order to clear the site footprint, the Trust demolished the former Catering Building which occupied this site, in 2011/12. This building was 3617m 2 in size and had a backlog maintenance liability of 2.5million. 84

89 The relocation of the existing Emergency Department to new facilities will free up circa 2,000m 2 of space which will be used for the relocation of other clinical services e.g. outpatients and clinical support services. This relocation in turn will facilitate further site rationalisation and potential demolition of 8385m 2 of a partly occupied building which has a backlog maintenance liability of circa 10 million. This Urgent and Emergency Care Centre development will also result in the removal of 500m 2 of Victorian buildings adjacent to the main corridor. This development will consequently result in an overall improvement in the condition, quality and functional suitability of the Estate Design Principles As part of the design evaluation, an initial BREEAM assessment was completed at OBC stage and the credits supported achievement of an Excellent rating. A further preassessment was undertaken in February 2014 which again supported this rating with a score of 75.9%. These pre-assessment have been carried out using BREEAM Healthcare Units. The Trust has submitted its proposals to BRE with the intention of achieving an interim certificate by early May The latest pre-assessment summary is attached at Appendix 4c. An initial multi-disciplinary AEDET Workshop was held in April A further workshop is scheduled for April The AEDET scores for workshop 1 are summarised in Table 4a Table 4a: Summary AEDET Scores Criteria 1 st Assessment (April 2013) Character & Innovation 4.7 Form & Materials* 2.4 Staff & Patient Environment* 3.6 Urban & Social Integration 5.0 Performance* 2.0 Engineering* 2.8 Construction* 3.3 Use 5.1 Access 4.3 Space 4.3 A detailed analysis of the scores is included in Appendix 4d. The building will be designed and built to meet the relevant D.H. Estates standards including Hospital Building Notes, (HBNs) and Hospital Technical Memorandum (HTMs) where appropriate. In moving forward with the detailed design, the Trust has paid particular attention to the following design guidance:- Health Building Note 15-01: Accident and Emergency Departments Planning and Design Guidance; Design Council Toolkit for Reducing Violence and Aggression in A&E; Kings Fund Enhancing the Healing Environment Programmes including the recent programme relating to Dementia Care. 85

90 4.2.3 Equipment In developing the design solution the team have taken full account of the range of equipment needed to support the new service model and new facilities. A detailed schedule of equipment has been developed which identifies existing equipment to transfer and new equipment to be purchased. Existing equipment which is considered to be fit for purpose and has in excess of two years remaining life at the operational date of the new Urgent and Emergency Care Centre will transfer to the new facility. All other equipment will be purchased new using normal NHS procurement processes with the exception of radiology equipment. The majority of radiology equipment currently in situ in the existing ED was procured and installed as part of the Trust s Radiology PFI/Managed Equipment Service some years ago. The Trust subsequently purchased a second-hand CT Scanner and will need some additional equipment to support the additional radiology capacity in the new facility. As all existing equipment is now reaching the end of its useful life, it was agreed, following a value for money test carried out at OBC, that this will all be refreshed or procured through the Radiology PFI/Managed Equipment Service route. Consequently there will be no major radiology equipment to transfer from the existing building to the new facilities as all will be installed as new equipment during the commissioning phase. This equipment includes: 3 x Plain film machines 1 x Portable Plain film machine 1 x OPG dental machine 1 x Plain film machine for the 4-bedded Resuscitation Area. 1 x CT Scanner 1 x Ultrasound Scanner Costs for this equipment have been included as revenue costs. Whilst capacity within the building has been provided for either MRI or a second CT Scanner, this will not be installed in Phase 1 and this equipment has therefore been excluded from this business case All other new equipment identified is that required to support the new service model or additional capacity within the new facilities. This new equipment has been categorised as follows: Group 1 purchased and installed by the Contractor. Nominated suppliers have been identified by the Trust where appropriate: Group 2 purchased by the Trust and installed by the Contractor; Group 3 purchased and installed by the Trust. All costs for this equipment have been included in the capital costs. Detailed specifications for all new equipment will be developed during the construction phase of the project and equipment will be delivered and commissioned where necessary prior to hand over of the building. Where additional equipment e.g. patient monitors, is required to support the service during transfer to the new facilities to support double running, short term loan agreements will be 86

91 set up with equipment suppliers. Costs to support this have been included in this business case as non-recurrent revenue ICT The basic principles of the Trust s ICT strategy , approved July 2013, are: 1. Continue to move in the direction established over the last 2-3 years; 2. Deliver the electronic patient record: A desire to move from where we are today to an environment where all patient data is available to those who need it in a timely manner wherever they need it to ensure a safe and effective patient experience that our staff would view as an indispensable asset; 3. Deliver applications that support decision-making using timely and consistent information; 4. ICT systems that are seamless to the user, fit for purpose and efficient to run As few systems as possible; Robust and secure infrastructure; An ICT department that is appropriately skilled, structured and focused to deliver the appropriate support and SLA s. The ICT Framework in Figure 4b has been produced to summarise the component parts of the ICT Strategy. It is made up of the key outcomes, enablers and foundation stones required, all of which are essential to ensure success. Detail for each outcome, enabler and foundation can be found within the ICT Strategy , which provides the direction of travel for ICT for the next 5 years if required. Figure 4b: ICT Framework The key priority for RWT, as it is for all healthcare organisations in England & Wales, is to deliver an integrated electronic patient record (EPR). The conceptual model of an EPR is shown in Figure 4c. The key ambitions being to provide secure information that can be shared both internally and externally to ensure both improved and integrated care for all patients. 87

92 Figure 4c Conceptual Model of Electronic Patent Record EPR Clinical Web Portal Projects feeding into EPR solution [ i.e. E-Discharge, e- Prescribe, Server platforms] Source Data Systems [PAS / Theatres / Pathology / Radiology / Prescribing / Cardiology / Diabetes Infrastructure Platform Web Servers, Database Cluster, Network Capability, Scanners, Desktop PC s Record Keeping Standards, Retention Policy, Security Policies, Health Records Policies, Data Protection, Governance Standards This priority will be applied to the new integrated service and will see a move to paperless electronic patient records by improved integration with the RWT trust wide clinical web portal. Integration of electronic patient information between the Trust and urgent care service is assumed and costs allocated for this within the CWP integration and implementation of patient first, the current RWT ED application. ICT infrastructure is a critical foundation stone for any ICT provision at service level and as a result, the new building will include a wireless network allowing for the use of any appropriate device to access patient information in a timely and secure manner. There will also be the provision of a voice and data network; including a smaller secondary network which will be utilised should the network go down. This will help to ensure limited impact to patient care within the new integrated service as we move more and more towards a fully electronic patient record. Other elements that have been built into the case include additional PC s, larger higher specification screens and mobile options at the patient bedside and the rollout of our trust wide asset and hand hygiene tracker to help reduce time lost in searching for equipment and improve both patient and staff safety. In summary, the ICT provision in this business case is based largely on moving current service levels to the new building and future proofing where-ever practical. Any further service improvements enabled directly by ICT will be submitted as separate business cases in accordance with RWT processes for approval and allocation. This will potentially include the roll out of Management Systems Services (MSS) software (clinical and demographic data base) into other emergency portals eg: Paediatric and Surgical Assessment Units; Patient Self-Check-in and use of the standard trustwide electronic observation tracking system Future Flexibility Phase 1 of the Urgent and Emergency Care Centre has been designed to create maximum flexibility in relation to future capacity and to acknowledge the position of the building within a key part of the New Cross site. 88

93 The location of the new urgent and emergency care centre is surrounded on three sides by existing buildings, with the fourth elevation facing the Perimeter Ring Road. As such it presented a unique opportunity to maximise the height of the building for future clinical use, particularly as the footprint of the building was governed by the clinical requirements and adjacencies required by the Emergency Department. The Trust therefore elected to explore the potential of creating a three storey building to ensure maximum future flexibility and at the same time not losing the potential for future development in a critical part of the site. As such future shell space of 1,031m² has been provided at first floor level, to allow for future expansion of clinical support space and Clinical Decisions Unit, together with the Second Floor (2,275m 2 ) which is intended to provide in-patient bed accommodation. It is intended that all shell space will be fitted out in Phase 2 of the development. Space has also been provided at ground floor to accommodate an additional CT Scanner or MRI Scanner at a later date. Similarly, this space if not needed for radiology investigations, will be used as additional Resuscitation space, Majors cubicles or clinical support space. Cubicles have been sized and will be equipped to allow flexing of capacity between Minors and Majors Design Review Panel Department of Health guidance published 2007 confirms that the threshold for panel reviews is 35million total outturn. Therefore the value of this project falls below the formal threshold and a submission for Design Review Panel review is not required. However, in recognition of the significance of the investment a full information pack has been developed and is included in Annex 1 Design Proposals to this Business Case Planning Status The Trust submitted a Hybrid Planning Application in June 2008 for the overall Masterplan and was granted conditional outline planning permission for redevelopment of the hospital site in This included planning permission for the erection of a three storey Emergency Centre building on the proposed site and associated ancillary works. The conditions relating to the detailed planning permission include the customary need to submit and have approved the materials of the façade, the soft landscaping proposals, drainage details, plant noise attenuation measures, parking and access arrangements. Other conditions, such as the requirement to investigate the site for contamination has now been addressed by completion of full geotechnical Site Investigations (SI). From the findings of the intrusive SI contamination levels were found to be low, thus anticipating no requirement for remediation, and the summary of the SI Report states that no significant constraints to the construction of the proposed Urgent and Emergency Care Centre have been identified. The detailed (full) planning application for the development was approved on 1 st April

94 4.2.8 Equality Impact Assessment In line with the Trust s Single Equality Scheme an Equality Impact Assessment has been completed and this has identified that there is no adverse impact on any group anticipated. The assessment outcome is attached at Appendix 4e. This has been reviewed at FBC with no change to the status of the EIA. 4.3 Agreed Risk Transfer Under Procure 21+ guidance, the Trust and Kier have developed and reviewed a risk register, allocating the responsibility for risks in the most appropriate manner. As a result Kier have allowed for a number of these risks within its Guaranteed Maximum Price (GMP). The risks allocated to the Trust have been quantified and allowed for in the Trust s capital affordability calculations along with the GMP. Some of the Trust s risks, where they crystalise may be managed through a compensation event changing the Guaranteed Maximum Price. The risks allocated to Kier will be managed within the GMP and if the cost is greater than anticipated then Kier will bear that increase in cost. 4.4 Agreed Contract Length It is anticipated that the Kier Construction, the selected PSCP, will commence on site on 2 nd June 2014 with a 72 week construction programme with delivery of the building to the Trust on 18 th October The new Emergency Centre will be operational by the end of November Key Contractual Clauses The project is to be delivered using the Procure 21+ Framework, NEC Option C. 4.6 Personnel Implications (including TUPE) There are no known personnel implications including TUPE associated with this project. 4.7 Procurement Route and Implementation Timescales As noted above the project is being procured under the National Procure 21+ Framework process. The implementation timescales are outlined in Table 4b. 90

95 Table 4b: Key Milestones Milestone Target Date Selection and Appointment of P21+ PSCP for Main Contract (Stage 3) December 2013 to February 2014 SOC Approval (NHS TDA) September 2013 OBC Approval (NHS TDA) January 2014 FBC Approval (Trust and Commissioners) April 2014 Planning Approval April 2014 FBC Approval (NHS TDA) May 2014 Instruction to Proceed, Mobilisation and Site Set Up May 2014 Start on Site June 2014 Substructure June 2014 August 2014 Frame and Envelope August 2014 April 2015 First and Second Floor December 2014 September 2015 Third Floor Plant Room December 2014 May 2015 External Works and Ambulance Drop Off December 2014 September 2015 Ground Floor February 2014 October 2015 Building weather tight January 2015 Atrium March 2015 October 2015 Power and heat on June 2015 Commence Commissioning June 2015 Familiarisation and training September 2015 Completion and Handover and installation of Radiology Equipment October 2015 Trust Commissioning October November 2015 Workforce redesign, management of change, recruitment and selection and training September 2014 November 2015 Equipment selection, procurement, and installation September November 2015 Service Redesign new patient pathways, operational policies, implementation and training January 2014 November 2014 Operational Building - Transfer of Emergency Department, Radiology and CDU November 2015 Transfer of AMU activity (Direct referrals) February 2016 Transfer of Urgent Care Activity April 2016 Post Project Evaluation January 2016 to February

96 A detailed project programme is included in Appendix 4f. 4.8 FRS 5 Accountancy Treatment The assets underpinning delivery of service will be on the balance sheet of the organisation. 92

97 5. THE FINANCIAL CASE 5.1 Introduction This section assesses the overall affordability of the scheme. The analysis assumes that the scheme is financed through the Trust s operational capital programme, surpluses and with a contribution of 10 million PDC. Capital Charges for the development have been calculated and the analysis accounts for them in the context of the scheme s overall affordability. The Trust has reviewed direct and indirect budgets related to the Emergency Services Group. It has identified costs as a result of the development relating to the following: ED in relation to nursing and reception staff; Radiology in relation to an enhanced service need in the new building and to support the new Emergency Services Model; Estates and Facilities in relation to energy costs and cleaning associated with the increased area. Costs relating to the anticipated activity growth in emergency services have also been included in the case as they are a driver for the Emergency Centre in terms of size, costs and overall affordability. 5.2 Impact on the Organisation s Income and Expenditure Account Table 5a provides a summary of the full impact of the costs identified for the proposed development. 93

98 Table 5a: Full Impact of Additional Annual Costs in 2017/18 compared to 2014/15 Direct Staff Costs Area of Savings Amount of Recurrent (Annual Savings)/ Additional Costs 's Commentary Emergency Department 1,226,215 Due to requirements of new build and activity Ambulatory Assessment Area (193,221) Transferred into EC Radiology 155,133 Requirements of enhanced service Sub Total 1,188,126 Direct Non Pay Costs Emergency Department 49,959 Activity driven Radiology 53,183 Requirements of enhanced service Radiology PFI Maintenance 196,446 Increased facilities, plain film Sub Total 299,588 Indirect Costs Estates & Facilities Pay 113,123 Increase to domestics due to increased area & facilities, partly offset by porters savings Estates & Facilities Non Pay 460,153 Energy increase, maintenance and rates IT Pay 6,942 IT Non Pay 26,438 Sub Total 607,011 Capital Charges 1,596,146 Total 3,690,872 The Trust showed in the OBC that the development is affordable within its latest Long Term Financial Model (LTFM) and the financial ratios within the LTFM surpassed the minimum requirements. Since the OBC the position in respect of Stafford has become more clear and as a result, Stafford activity has been included in the baseline as opposed to a sensitivity. The result of this is shown in Table 5b. 94

99 Table 5b: Summary of I&E Impact in 2017/18 OBC Position s FBC Position s Reason for Change 2014/15 Direct Pay 10,097,717 10,403,765 Includes staffing increases for Stafford patients and 2014/15 pay changes Direct Non Pay 853, ,148 Driven by increase in activity Indirect Pay and Non Pay 1,047,714 1,122,947 Increased costs for ICT 14/15 Efficiency Savings at 4% (495,514) Not included in OBC Capital Charges 242, ,006 Increase in capital costs Income 15,454,273 15,131,282 Includes activity changes to forecast outturn, Stafford activity and 2014/15 tariffs Sub Total 3,213,570 2,942, /18 Direct Pay 10,855,381 11,591,891 Includes staffing increases for Stafford patients and 2014/15 pay changes Direct Non Pay 941, ,290 Driven by increase in activity Indirect Pay and Non Pay 1,864,733 1,926,404 Increased costs for ICT 14/15 Efficiency Savings at 4% 0 (495,514) Not included in OBC Capital Charges 1,700,929 1,892,152 Increase in capital costs Income 16,422,657 16,846,060 Includes activity changes to forecast outturn, Stafford activity and 2014/15 tariffs Sub Total 1,060, ,837 Increase/(Decrease) in net Revenue Position (2,153,353) (1,976,093) Note: Due to change to delivery programme of new facility at FBC stage, the first full year of operation is 2016/17. However, 2017/18 costs and income have been used for FBC in Table 5b to give direct comparison with OBC. Capital Charges at OBC and FBC in 2017/18 are broken down and detailed in Table 5c. Table 5c: Breakdown of Capital Charges OBC v FBC Category OBC FBC s s Buildings Depreciation 407, ,736 Equipment Depreciation 367, ,041 Sub total 775, ,777 Rate of Return 925, ,375 Total 1,700,929 1,892,152 95

100 5.3 Revenue Affordability The revenue impact of the preferred option is shown in the affordability statement in Table 5d. The baseline revenue position at 2014/15 shows a contribution of 3,238,397 before capital charges. Additional costs in 2016/17 and future years associated with the operational costs of the new building, which are only partly offset by increased income, means that the current level of contribution is not recovered until 2019/20. However, during affordability discussions with WCCG, the Commissioners have agreed to underwrite this shortfall on a non-recurrent basis until this position is recovered. The capital charge implications of the build are funded within the Trust s LTFM which has previously been agreed by the Trust Board. Table 5e shows the proposed development including the impact of inflation and staff deflator. The percentages used are as included in the LTFM. Income is deflated by 1.3% per annum; pay costs have been inflated by 1% per annum; energy costs inflated by 5.5% and PFI costs by 2.5%. As in the LTFM annual efficiency savings have been included at the required 4% and also, a level of inflation for Trust support departments, methodologies are as per the LTFM. 96

101 Table 5d: Affordability Statement for Preferred Option Base Model (2014/15 income and costs) 97

102 Table 5e: Affordability Statement for Preferred Option Base Model (including inflation and deflation) 98

103 5.4 Sensitivities As referred to in Section following the conclusion of the Consultation on the Urgent and Emergency Care Strategy the WCCG intends to competitively tender the provision of the urgent care service to commence in November 2014 with new services being provided from April The Trust has therefore run sensitivities around the loss of urgent care activity. Table 5f shows the financial impact of the sensitivities compared to the base case. Table 5f: Income less direct expenditure (including capital charges) for each sensitivity compared to base case for Preferred Option (Option 5) 2014/ / / /26 Base Case 2,942, ,853 1,625,595 3,101,009 Scenario 1: Base Case less Walk In Centre Activity (assumes Walk in Centre does not relocate) Scenario 2: Base Case less all urgent care activity provided by a different provider from New Cross Hospital Scenario 3: Base Case plus 10% increase in Capital Costs 2,942,931 (122,267) 705,564 2,229,642 2,942,931 (386,750) 433,726 1,837,646 2,942, ,874 1,463,911 2,948,297 The year by year detail relating to these sensitivities is provided in Appendix 5a. In relation to Scenario 1, the Trust anticipates a non-recurrent contribution in line with the base model and to negotiate with the WCCG on the urgent care tariff. The worst case (Scenario 2) would result in the loss of circa 45,383 attendances resulting in an increase in the loss in the base case contribution from 2.1m (over 4 years) to 8.2m (over 9 years). In discussions with WCCG, the CCG have agreed to mitigate this impact by funding up to 5.6m non-recurrently. The Trust would also have two chances in 2015/16 and 2018/19 to tender for this service. Should the Trust be unsuccessful in it s bid to provide the service the Trust will mitigate any further financial impact (over and above the support from the CCG) by reallocating any spare capacity to other use to support estates rationalisation elsewhere and review its cost base and efficiency measures to reduce the financial deficit. 99

104 5.5 Impact on the Balance Sheet The proposed development will be funded by the Trust through operational capital, surpluses and PDC. The asset will therefore be in the ownership of the Trust and will be accounted for accordingly. The anticipated capital charges are highlighted in Table 5c. 5.6 Capital Affordability The Trust has allowed funding for this project in its Capital Programme to deliver an operational building by November 2015, this is six months earlier than was assumed in the OBC (May 2016). See Table 5g for detail. This delivery programme assumes additional PDC funding of 10m over 2 years ( 7m in 2014/15 and 3m in 2015/16). The capital costs for the Project are included in the Trusts LTFM. Table 5g: RWT 5 Year Capital Programme 2014/ / / / /19 m m m m m CRL Additional DH PDC funding ,000 Total CRL 26,776 21,820 15,720 15,700 15,700 Medical & General Equipment IM&T Statutory Standards Improvement of Retained Estate ,500 New Schemes - Pharmacy Adult Cystic Fibrosis facility Linacs Replacement Theatre refurbishment Other miscellaneous Urgent and Emergency Care Centre (Phase 1)* Urgent and Emergency Care Centre (Phases 2 & 3) Demolition of WH/Relocation of therapies Welcome Centre/OPD Reconfiguration Carbon Reduction Other Schemes GRAND TOTAL VARIANCE (2.058) (2.459) Note:* These figures exclude prior years expenditure in 2012/13 and 2013/14 of 2.86m. See Table 5l. 100

105 The funding profile at OBC to deliver an operational building by May 2016 assumed additional PDC funding of 3m in 2014/15. The capital spend profile for the project at FBC compared to that at OBC is shown in Table 5h. Table 5h Capital Spend Profile OBC v FBC 2012/ / / / /17 Total m m m m m m OBC FBC As part of the planning for the Capital funding of the new Urgent and Emergency Care Centre, the Trust had previously assumed that the funding for Phase 1 would be phased over three years. The Trust had also identified funding within its Long Term Capital Programme to enable the development of the new Urgent and Emergency Care Centre, however these assumptions have now been overtaken by events relating to the administration of the Mid Staffordshire NHS Foundation Trust. As a consequence of issues at Mid Staffordshire the Trust has, of necessity, been forced to divert capital funding that had previously been identified for the new Urgent and Emergency Care Centre. As a result of the transfer of activity from Mid Staffordshire to New Cross, the Trust believed it had no option but to develop additional facilities at New Cross, these being the extension to its existing A&E Department at a cost of 3 million together with construction of a Multi Storey Car Park at a cost of over 4 million. In addition to these two projects, the Trust has also been proactive in considering the implications of the changes that are now taking place at Mid Staffordshire in relation to Emergency Services. As such the Trust has assumed that additional activity will arrive at the new Emergency Centre as a result of the changes and has therefore incorporated this into the design for the new Urgent and Emergency Care Centre. The impact of the activity on the project is estimated at approximately 3 million. The overall impact to the Trust of the issues relating to Mid Staffordshire is therefore 10 million. The Trust has already identified as part of its submission to the Trust Special Administrator for Mid Staffordshire that these costs should be met in full. The Trust has also identified that the timing of this additional support is important if the new facility is to be operational by November 2015 and has therefore assumed additional PDC funding of 7 million in 2014/15 and a further 3million in 2015/16 which will negate the impact on the Trust s Long Term Capital funding. Should the additional PDC funding not be available in the timescales outlined then this will result in a delay to the delivery of the project and will severely impact on the delivery of other Capital projects within the Trust s Long Term Capital programme. 101

106 6. THE MANAGEMENT CASE 6.1 Introduction The Trust recognises the challenges of bringing this project to a successful completion with the commissioning of the new building and equipment and transfer of integrated Urgent and Emergency Care services into state of the art facilities. Project organisation within the Trust reflects ownership of projects such as this at the highest level and draws not only upon the expertise within the Trust to ensure that the wider business objectives of the organisation are met. 6.2 Programme Management Arrangements The Trust is delivering this development as a single project but within the context of the Wolverhampton Urgent and Emergency Care Strategy. 6.3 Project Management Arrangements The Trust has a successful history in the management and implementation of key projects and will ensure that appropriate project methodologies continue to underpin the management of the project. The primary objectives of the project organisation are to ensure:- Delivery of the new patient centred service model and associated patient pathways; Effective clinical engagement; Input from an extensive range of stakeholders; Smooth implementation of the workforce changes; Construction of the building on time to budget and in accordance with the design brief; Effective operational commissioning of the building Project Reporting Structure The project structure has been reviewed post OBC to ensure that adequate resources were allocated to the project. Cognisance in doing so has also been paid to the recommendations made following the DH Gateway Review 2 held in December

107 This revised structure is outlined in Figure 6a. Figure 6a: Project Reporting Structure Project Roles and Responsibilities Emergency Centre Project Group The Emergency Centre Project Group (formerly known as Emergency Centre Project Board) meets monthly or more frequently as required. This includes the following membership and is chaired by the Project Sponsor/Senior Responsible Officer. Jonathan Odum, Medical Director (Project Sponsor/SRO & Chair) Mike Goodwin, Head of Estates Development Kevin Stringer, Chief Financial Officer Gwen Nuttall, Chief Operating Officer Tim Powell, Deputy Chief Operating Officer, Emergency, Medicine and Community Services Division Charlotte Hall, Deputy Chief Nurse Lee Dowson, Divisional Medical Director, Emergency, Medicine and Community Services Division 103

108 Andy Morgan, Clinical Director, Emergency Services Caroline Marshall, Deputy Human Resources Director Healthwatch Representative Diane Preston, Head of Emergency Preparedness Jin Kalkat, Trust Governor Andrea Smith, WCCG Urgent Care Management Lead Dr Julian Morgans, WCCG Urgent Care Clinical Lead Dr Kam Ahmed, WCCG, Clinical Representative Louise Landucci, Service Development Redesign Manager Jane McKiernan, Group Manager Emergency Services and Project Manager Service Redesign/Equipment Workstream Carolyn Robinson, Team Manager, Estates Development The Emergency Centre Project Group reports to the Trust Management Committee (TMC) and Trust Board through the Capital Review Group A close working relationship between the Urgent Care Working Group (formerly the Urgent and Emergency Care Strategy Board) has been maintained throughout this project to ensure that any work undertaken in the latter informs and supports the development of the business cases for this project. Key Responsibilities: The Project Group are responsible for delivering this project from procurement of the design team to delivery of an operational Emergency Department. Consultation/Communication on the proposals with all stakeholders; Development of the Project Delivery Programme; Development of the business case and submission for approval at the appropriate levels and stages; To advise the Capital Review Group of major issues/concerns arising from the project Approve the Risk Register, Assumptions Log and Benefits Realisation Plan for the Project; Identify key investment decisions for onward referral to the Capital Review Group and TMC and Trust Board as necessary; Post Project Evaluation. Emergency Centre Project Team The Emergency Centre Project Team meets fortnightly or more frequently if required. This includes the following membership and is chaired by the Project Director Service Redesign/Delivery who is also the Deputy Chief Operating Officer responsible for Emergency Medicine and Community Services. Tim Powell, Deputy Chief Operating Officer Emergency, Medicine and Community Services Division (Chair/Project Director for Service Redesign); Rose Baker, Head Nurse, Emergency, Medicine and Community Services Division; Lee Dowson, Medical Director, Emergency, Medicine and Community Services Division/Activity/,Service Redesign/ Workforce Lead; Hannah Reade, Human Resources Manager; Louise Landucci, Service Development Redesign Manager; 104

109 Jane McKiernan, Group Manager Emergency Services and Project Manager Service Redesign/Equipment Workstream Lead; Ed Callaghan, Design and Construction Workstream Lead and Project Manager; Elaine Williams, Finance and Risk Workstream Lead; Andy Morgan, Clinical Director Emergency Services; Kay Cantrill, ICT Workstream Lead; Carolyn Robinson, Business Case Development/PMO; Anthony Leese, Head of Radiology; Mike Goodwin, Head of Estates Development/Project Director for Design and Construction. The Emergency Centre Project Team reports directly to the Emergency Centre Project Group. Key Responsibilities: The Project Team are responsible for delivering the key deliverables for the Project through the Workstreams and any further task and finish sub groups set up as appropriate. Workstreams Monitoring and ensuring delivery of workstream key deliverables to required quality and programme; Maintenance of Risk Register - reviewing, grading and monitoring of risks and escalating any red/high amber risks to Project Group; Maintenance of Issues Log - reviewing and resolving issues and escalating any issues requiring intervention by Project Group or others as appropriate; Development of Assumptions Log and assumptions underpinning proposals reviewing and confirming and escalating for decision to Project Group as appropriate; Development of Benefits Realisation Plan agreeing workstream benefits and development of plan which will form the basis of Post Project Evaluation Change Control identification of any requests for change and consequent impact on the project. Escalating any which need higher approval to Project Group; Progress Reporting to Project Group (monthly) status against budget and programme, issues requiring resolution, assumptions requiring approval, requests for change, red/high amber risks In order to deliver the key activities associated with the development of the business cases and the design and then construction of the physical solution a number of workstream groups were established to OBC stage to focus upon the following areas: Service Model and Activity/Capacity Assessment Design (Including equipment and ICT) Workforce Planning Finance & Risk These workstreams were also reviewed post OBC and were amended in accordance with the revised project structure shown in Figure 6a. The main changes include the amalgamation of the Activity and Service Model workstream with the Workforce workstream due to the fact that these were intrinsically linked and with the intention of making the best use of clinical members time. Separate workstreams for Equipment and ICT have also 105

110 been established due to the amount of detailed work needed around these workstreams to inform the plans and costs for FBC and work required to facilitate the opening of the new facility. A further two workstreams were added to ensure the further involvement of other stakeholders affected by the plans. These are: Operational Infrastructure Workstream to ensure that other service providers affected by the proposals are kept up to date with plans particularly during enabling works and main construction; and the Patient Involvement Group to ensure that patients and their representatives have input to the design proposals particularly in relation to access, dementia, and interior design/environment. Project Management Office The Project Management Office (PMO) is run by the Estates Development Department. The management structure for the PMO is shown in Figure 6b. Figure 6b: Management Structure PMO The Project Directors report directly to the Senior Responsible Officer for the purposes of this Project. The Project Directors responsibilities are as follows: Design and Construction Design and construction of the new facility including procurement and appointment of advisory team and construction contractor/s; Planning Approval; Provision of the necessary resources (internal and external) to ensure delivery to stakeholder requirements, quality standards, programme and budget; 106

111 Overall management of the Project Management Office; Business Case development; Monitoring and management of capital costs/budget and construction delivery programme. Service Redesign Overseeing the delivery of key products including: Activity and Capacity Model, Service Specification, Equipment and ICT Schedules and Specifications, Income and Expenditure Model, Benefits Realisation Plan; Delivery of the Transition Plan in terms of service redesign, workforce re-profiling including any associated change management, benefits realisation; Monitoring and management of revenue costs/budget. Resourcing Internal Project Support The Project Director (Design and Construction) is supported by an internal team with a history of delivering successful projects and who have the requisite skills and experience to support this project. The Project Management Lead for the design and construction elements of the project is the Capital Developments Team Manager. The Project Management Lead for the Business Case Development and control of the Project Management Office functions is the Team Manager Project and Estates. Both Project Managers have the support of resources within their own teams and will use these as appropriate to deliver the project. The team includes staff who have qualifications in PRINCE2 (Practitioner level) and Managing Successful Programmes (MSP). It is acknowledged that completion of this work will require significant input from key members of the Trust. Workstream leads specifically will need to secure the involvement of key members of staff from all clinical and support areas of the Trust, and other stakeholders as appropriate, throughout the project in order to ensure full involvement and ownership of the proposals. The Group Manager for Emergency Services has been seconded on a full time basis as the Project Manager for Service Redesign to the project to FBC submission to ensure that the key clinical deliverables are met. Additional internal support and input to the design and other project workstreams has been provided from the following Trust teams: Emergency Services Clinical & Management Teams; Clinical support Teams e.g. Radiology, Therapies, Pharmacy, Pathology; Non-clinical support Teams e.g. Estates & Facilities; Health & Safety Advisor; Infection Prevention Team; Radiation Protection Advisor; Fire Safety Advisors; Communication Lead; WCCG clinical and management representatives. A further review of resources required to take the project through the construction, commissioning and operational stage will be undertaken post FBC submission. 107

112 6.4 Use of Special Advisers The Trust has commissioned a number of advisors to support the delivery of the project and provide external assurance. These include the Design Team led by the Architects: Keppie Architects; Arup Mechanical and Electrical Design Consultants; Ramboll Structural Design Consultants. The appointment of the Design Team was approved by the Trust Board on 23 rd July 2012 following an OJEU procurement process in response to a detailed Project Brief and on the basis that the main construction contract would be procured using a Traditional JCT Contract. Since then the Trust has agreed to appoint the Enabling Works Contractor and more recently the Main Contractor through the P21+ procurement process. Consequently, the Design Team have been novated to the P21+ Contractor to complete their commission and to support the production of a Guaranteed Maximum Price (GMP). The Trust has also independently appointed a number of additional consultants to provide advice and assurance in the following areas: Capital costs; Building Regulations; Health and Safety/CDM; BREEAM; Capacity planning. Details of these advisors are provided in Appendix 6a. 6.5 Arrangements for Change Management The Trust has developed detailed transition plans to take the project from approval of this FBC through to an operational facility in These are included in the detailed project programme in Appendix 4f. A period of 6 weeks has been included in the programme for Trust commissioning. It is anticipated that receipt of all new equipment, training in the use of all equipment and specifically radiology equipment, familiarisation with the new facilities and revised operational procedures will take place during this time. The actual transfer of services has been planned to take place on a phased based as follows: Emergency Department, Radiology, Review Clinic and CDU November 2015 It is anticipated that this transfer will take place on one day with both the existing department and the new department running for a number of hours until the transfer of activity is complete. AMU direct referrals transferred to the new Emergency Department February

113 Walk In Centre transfer April 2016 The project management and reporting structures will be reviewed again post FBC but it is anticipated that the relevant workstreams will continue to function and report to the Project Team and Project Group to ensure all operational transition plans are delivered to schedule including: Implementation of new service models and patient pathways; Recruitment, selection and training of workforce; Specification and procurement of equipment; Specification, procurement and where applicable early implementation of ICT systems; Operational commissioning of the new facilities; Phased implementation of services where applicable; Communication and engagement with patients, staff and general public. 109

114 6.6 Arrangements for Benefits Realisation A Benefits Realisation Plan was developed for the OBC and this has been reviewed and updated to reflect any changes in the operating environment since submission of the OBC in October A copy of the Benefits Realisation Plan is included in Appendix 6b. The plan identifies against each benefit Baseline; Who will have lead responsibility for ensuring delivery of the benefit; The projected timescale for realisation of the benefit; How the realisation of the benefit will be monitored and measured. Overall responsibility for ensuring that the Benefits of the Project are achieved lies with the Project Group. Where relevant, the performance measures identified within the Benefits Realisation Plan will be incorporated within the relevant stage of the Post Project Evaluation Plan (PPE) 6.7 Arrangements for Risk Management The key risks of the preferred option have been assessed and strategies for managing them outlined. The process of risk analysis has therefore the following four steps: Risk identification - developing a Risk Register covering key risk areas and individual risks within these areas; Risk assessment - estimating the probability and timing of each risk occurring and the impact if it should occur; Risk quantification - putting a value to each of the risks, using the estimates of probability, impact and timing; and, Risk management - developing a plan to manage all the risks identified in the risk register for the preferred option, including responsible persons and monitoring mechanism Key Risk areas Project risks have been categorised as follows: Business Case Approval; Financial; Design and Planning; Human Resources; Construction; Equipment and ICT; Programme. 110

115 6.7.2 Management of Risk The Risk Register included at Appendix 6c has been developed for the preferred option which includes all risks identified to date. The methodology used is in accordance with the Trust s governance structure for managing risk. This risk register identifies the following: Risk reference, description and category; Mitigation measures; Risk rating in accordance with the Trust s Risk Categorisation Matrix (Probability and Impact leading to a red, amber, yellow and green rating); Risk lead/owner who has responsibility for monitoring, actively managing and mitigating the risk. The Risk Register has been, and will continue to be, reviewed on a monthly basis throughout the life of the project by the Project Team and red/high amber risks escalated to the Project Group. Where risks potentially have an impact on the capital costs or delivery programme (time) for the Project these have been costed and formed the basis of the contingencies included within the capital costs. Risks associated with the Project deemed to have an impact on the Trust s business will be escalated by the Project Sponsor and/or Project Director as Corporate risks to the Trust s Assurance Framework in Datix which is reported through the Board Assurance Committee to the Trust Board. 6.8 Arrangements for Contract Management The contract will be managed directly by the Trust using its internal project management resources supplemented where needed by external consultancy support. The Trust has also appointed a Cost Advisor (Fathful & Gould), a Health & Safety/CDM (Construction, Design Management) Co-ordinator and a BREEAM Advisor. The management of the construction contract from the Trust s perspective is the responsibility of the Project Director Design and Construction and designated Project Manager. Regular technical project team meetings will be held with the PSCP and nominated key sub-contractors which will involve representatives from the clinical user group as appropriate. Regular reporting on progress and status against key milestones, overall programme and budget will be key components of these meetings as will risk status, change control, quality control and achievement of other targets including BREEAM. Regular reporting on project status to the Project Team and Project Group will be through the design workstream and highlight reports. 6.9 Arrangements for Post Project Evaluation Post Implementation Review A Closedown Report will be compiled for this development which will review the construction delivery and functional suitability of the facility. It will address: Completion against schedule; Achievement of forecast budget; Rationale for any variations, and mitigating action taken; 111

116 Recommendations for future projects; Functional suitability of the facility; and, Review of working relations between Trust, Main Building Contractor and any other contractors. The Closedown Report will be signed off by the Capital Review Group and submitted to the Trust Management Team and Trust Board Project Evaluation Review The Trust is committed to the full evaluation of all major schemes and projects through the formal evaluation methodology, with involvement as necessary from local commissioners. In order to facilitate this process the Capital Review Group will designate a Project Evaluation Team consisting of: Project Team members including Evaluation Manager; Representatives of the Clinical Users; Independent Technical Consultants (if required); and, Stakeholder interests. The role of the Evaluation Manager will be to: Define in detail the Evaluation Processes for sign off by the Capital Review Group; Chair the Evaluation Team; Identify members of the Evaluation Team, ensuring that all interest are represented; and, Manage the Evaluation Programme and ensure that the results are communicated within specified timescales. Detailed records will be maintained on Project Files in formats approved by the Capital Review Group OGC Gateway Review Arrangements The Trust completed an initial risk potential assessment at SOC stage which identified the project as medium risk (RPA score of 37), included in Appendix 6d. The Trust commissioned its first Gateway Review on completion of the OBC and this Gateway Review (2) was held in December At this stage the project was rated as Amber and seven recommendations were made to move the project forward to the next stage. These recommendations have since been actioned and a further Gateway Review (3) at FBC stage is scheduled to take place in May

117 A Full Business Case for the Urgent and Emergency Care Centre (Phase 1) at New Cross Hospital APPENDICES Version 15.0 (Final) Date: 4 th April 2014

118 Index of Appendices Appendix Title 2a RWT Activity Profile 2010/11 to 2013/14 by Specialty 2b Master Plan 2c Future Emergency Services Activity and Scenario Modelling 2d Changes in Activity Assumptions 3a Capital Cost Forms 4a Outline Drawings and Schedule of Accommodation for fit out of shell space (Phase 2) 4b Schedule of Accommodation for Phase 1 4c BREEAM Pre-assessment 2 Results 4d AEDET Results 4e Equality Impact Assessment 4f Project Programme 5a Affordability statements for Scenarios 6a Project Responsibilities 6b Benefits Realisation Plan 6c Risk Register 6d Risk Potential Assessment

119 2a RWT Activity Profile 2010/11 to 2012/13 by Specialty

120 Trust Activity 2010/2011 Year 1011 Sum of Total Activity Category Specialty A&E Attendances Daycases (inc chemo daycases) Electives Follow up Outpatients New Outpatients Non Electives Outpatient Procedures Grand Total Accident & Emergency 98, ,565 3, ,991 Breast Surgery 2,147 1, ,397 Cardiac Catheters ,128 Cardiac Surgery , ,885 Cardiac Surgery Pre Op Cardiac Surgery War Attender 2, ,029 Cardiology ,260 5, ,781 18,114 Clinical Neuro-Physiology 0 0 Clinical Oncology 5, ,398 2, ,448 25,934 Colorectal Surgery 2,429 1, ,118 Cystic Fibrosis - Child Cystic Fibrosis Adult - Band Cystic Fibrosis Adult - Band Cystic Fibrosis Adult - Band Other 2 2 Cystic Fibrosis Child - Band Cystic Fibrosis Child - Band Cystic Fibrosis Child - Band Cystic Fibrosis Child - Band Dermatology 3 10,726 4, ,167 18,164 Dermatology Treatments 9, ,277 Diabetic Medicine 4, ,328 Dietetics 1,789 1, ,990 Electrophysiology Endocrinology 3, ,093 ENT ,848 5, ,387 19,708 Fetal Med 2, ,042 Gastroenterology 5,551 2, ,463 General Medicine 1, , , ,942 General Medicine INR 0 0 General Surgery 2,272 1,979 13,747 4,772 3, ,714 Genito-urinary Medicine 1 4,136 7,023 11,160 Geriatric Medicine 2, ,587 Gynaecological Oncology ,983 Gynaecology 1,555 1,361 7,809 3,370 1,625 3,151 18,871 Haematology (Clinical) 5, , ,328 Head and Neck Surgery Interventional Radiology Medical Endoscopy 4, ,989 Medical Oncology 3, , ,175 Medical Ophthalmology 5,784 2, ,873 Nephrology ,974 1, ,465 Neurology ,497 2, ,909 Obstetrics using Bed or Delivery 0 16,747 5,609 9,261 1,396 33,013 Occupational Therapy 3, ,006 Ophthalmology 3, ,199 21, ,348 70,095 Oral Surgery 1, ,262 3, ,814 13,833 Orthodontics ,652 2,485 Orthoptics 13, ,696 Paediatric Dentistry Paediatrics ,395 3,744 6, ,159 Pain Management , ,393 Palliative Medicine PCI ,582 Physiotherapy 27,366 7, ,907 Plastic Surgery , ,475 Respiratory Medicine 6,022 2, ,340 Rheumatology 1, ,826 2, ,267 Sleep Studies Surgical Endoscopy Thoracic Surgery Thoracic Surgery Ward Attender TIA TOE's Trauma & Orthopaedics 3,542 1,678 20,699 8,040 1, ,824 Trauma & Orthopaedics - Fracture 13,221 4, ,287 Upper Gastrointestinal Surgery Urology 3,231 1,241 10,313 2, ,272 19,649 Vascular Surgery 2,108 1, ,422 Vascular Surgery INR 0 0 Grand Total 98,281 42,033 9, , ,915 45,925 33, ,243 Notes: - Regular day attenders and Births excluded - Outpatient activity included only where plan exists for New and Follow ups - Source of data is SLAM

121 Trust Activity 2011/2012 Year 11/12 Sum of Total Activity Category Daycases (inc Follow up New Outpatient Specialty A&E Attendances chemo daycases) Electives Outpatients Outpatients Non Electives Procedures Grand Total Accident & Emergency 101,297 1,787 3, ,428 Anaesthetics Breast Surgery 1,602 1, ,917 Cardiac Catheters ,055 Cardiac Surgery ,290 1, ,860 Cardiac Surgery Pre Op Cardiac Surgery War Attender Cardiology ,681 5, ,433 18,911 Cardiology Coding Block 0 0 Clinical Haematology 5, ,558 1, ,711 Clinical Haematology Coding Block 0 0 Clinical Oncology 6, ,283 2, ,986 27,971 Colorectal Surgery 1, ,847 Critical Care Medicine 5 5 Dermatology 11 11,521 5, ,845 20,848 Dermatology Treatments 9, ,276 Diabetic Medicine 1 5, ,659 Dietetics 1,808 1, ,882 Endocrinology 3, ,128 ENT ,792 5, ,483 19,405 EPS Fetal Med 3, ,735 Gastroenterology 5,735 2, ,871 General Medicine ,648 2,519 14, ,096 General Surgery 2,289 2,030 17,846 5,839 4, ,089 General Surgery Coding Block Genitourinary Medicine 4,011 7,343 11,354 Geriatric Medicine 1 1, ,736 Gynaecological Oncology ,697 Gynaecology 1,566 1,414 7,923 3,805 1,447 2,838 18,993 Gynaecology Coding Block ICD Interventional Radiology Medical Endoscopy 5,354 5,354 Medical Oncology 3, , ,378 Medical Ophthalmology 5,104 1, ,882 Nephrology ,620 1, ,030 Neurology ,701 2, ,232 Obstetrics 1 17,408 6,203 9,198 1,980 34,790 Occupational Therapy 3, ,022 Ophthalmology 3, ,321 19, ,904 63,235 Oral & Maxillo Facial Surgery Oral Surgery 1, ,840 3, ,684 13,075 Oral Surgery Coding Block Orthodontics ,703 2,408 Orthoptics 22,133 1,652 23,785 Paediatrics ,795 3,541 6, ,821 Pain Management ,694 1, ,481 Pain Management Coding Block 0 0 Palliative Medicine PCI ,418 Physiotherapy 27,772 8, ,622 Plastic Surgery , ,955 Podiatry 2, ,993 Respiratory Medicine 1 6,199 2, ,661 Respiratory Physiology Rheumatology 1, ,307 2, ,829 Surgical Endoscopy T&O Coding Block Thoracic Surgery TIA TOE's Trauma & Orthopaedics 3,538 1,880 20,961 8,543 1, ,760 Trauma & Orthopaedics - Fracture 12,618 4, ,987 Upper Gastrointestinal Surgery Urology 4,161 1,101 8,752 2, ,468 19,270 Urology Coding Block Vascular Surgery 1, ,815 Grand Total 101,297 44,074 10, , ,876 44,245 36, ,149 Notes: - EAUAMB patients included as New outpatients from 11/12 - Regular day attenders and Births excluded - Outpatient activity included only where plan exists for New and Follow ups - Source of data is SLAM

122 Trust Activity 2012/2013 Year 12/13 Sum of Total Activity Category Specialty A&E Attendances Daycases (inc chemo daycases) Electives Follow up Outpatients Non Electives Outpatient Procedures Grand Total Accident & Emergency 106,836 5, ,583 Breast Surgery 2, ,625 Cardiac Catheters Cardiac Surgery , ,035 Cardiology , ,257 19,537 Clinical Haematology 6, , ,416 Clinical Oncology 6, , ,916 27,405 Colorectal Surgery 1, ,695 Critical Care Medicine Dermatology 19 27, ,214 31,590 Dermatology Treatments Diabetic Medicine 6, ,533 Dietetics 2,538 2,538 Endocrinology 4, ,223 ENT , ,943 18,910 EPS Gastroenterology 9, ,357 General Medicine 1, ,418 15, ,976 General Surgery 2,015 1,709 23,164 3,942 1,221 32,051 Genitourinary Medicine 11,222 11,222 Geriatric Medicine 1 0 2, ,230 Gynaecological Oncology ,685 Gynaecology 1,430 1,313 12,635 1,257 2,613 19,248 ICD Interventional Radiology Medical Endoscopy 5,597 5,597 Medical Oncology 3, , ,077 Medical Ophthalmology 6, ,212 Midwife Episode Nephrology , ,550 Neurology , ,618 Obstetrics ,577 8,972 1,485 37,037 Occupational Therapy 3,846 3,846 Ophthalmology 4, , ,266 74,105 Oral & Maxillo Facial Surgery Oral Surgery 1, , ,627 13,587 Orthodontics ,644 2,467 Orthoptics 27, ,970 Paediatric Trauma And Orthopaedics Paediatrics ,233 7, ,385 Pain Management , ,312 Palliative Medicine PCI ,418 Physiotherapy 37, ,665 Plastic Surgery , ,793 Podiatry 2, ,503 Respiratory Medicine 0 10, ,410 Respiratory Physiology Rheumatology 1, , ,389 Surgical Endoscopy Thoracic Surgery ,006 TIA TOE's Trauma & Orthopaedics 3,066 1,652 44,611 1, ,117 Upper Gastrointestinal Surgery 0 0 Urology 3,817 1,012 10, ,605 18,268 Vascular Surgery 1, ,286 Grand Total 106,836 45,552 9, ,583 44,883 37, ,321 Notes: - EAUAMB patients included as New outpatients from 11/12 - Regular day attenders and Births excluded - Outpatient activity included only where plan exists for New and Follow ups - Source of data is SLAM

123 Trust Activity 2013/ up to Month 9 Year 13/14 Sum of Total Activity Category Specialty A&E Attendances Daycases (inc chemo daycases) Electives Follow up Outpatients New Outpatients Non Electives Outpatient Procedures Accident & Emergency 81,979 1,091 2, Anaesthetics 1 Breast Surgery 1,239 1, Cardiac Catheters Cardiac Surgery ,549 1, Cardiac Surgery Pre Op Cardiology ,219 4, ,529 Clinical Haematology 5, , Clinical Oncology 4, ,449 2, ,149 Colorectal Surgery Critical Care Medicine 11 Dermatology 12 16,305 3, ,178 Diabetic Medicine 0 4, Dietetics 1,195 1,013 0 Endocrinology 2, ENT ,816 3, ,494 EPS Gastroenterology 4,441 2, General Medicine ,270 2,074 12,873 2 General Surgery 1, ,939 4,452 3,099 1,314 Genitourinary Medicine 3,485 5,499 Geriatric Medicine 2 1, Gynaecological Oncology ,034 Gynaecology ,072 4, ,819 ICD Interventional Radiology Medical Endoscopy 4, Medical Oncology 2, , Medical Ophthalmology 3, Midwife Episode Nephrology , Neurology ,334 1, Obstetrics 0 13,824 2,125 6, Occupational Therapy 2, Ophthalmology 3, ,326 15, ,249 Oral & Maxillo Facial Surgery 24 3 Oral Surgery 1, ,740 3, ,483 Orthodontics ,096 Orthoptics 21,872 1,471 2 Paediatric Trauma And Orthopaedics Paediatrics ,217 2,931 5, Pain Management ,006 1, Palliative Medicine PCI Physiotherapy 20,232 5,439 1 Plastic Surgery , Podiatry 1, Respiratory Medicine 5,534 2,453 1 Respiratory Physiology Rheumatology 1, ,715 1, Surgical Endoscopy 763 Thoracic Surgery TIA 524 TOE's Trauma & Orthopaedics 2,494 1,212 24,020 10,574 1, Trauma & Orthopaedics - Fracture 0 Urology 2, ,097 2, ,451 Vascular Surgery Grand Total 81,979 37,447 6, ,069 99,333 35,655 30,626 Notes: - Regular day attenders and Births excluded - Outpatient activity included only where plan exists for New and Follow ups - Source of data is SLAM

124 2b Master Plan

125 WIMBORNE ROAD 00 Hir stle Royal Wolverhampton Hospitals NHS Trust New Hospital Project 28 7a m T Pre stw he oo ( PH d A rm ) 380 Gar age s 8 PO ENS GARD m 1 23 Car parking at grade, service areas 1 22 CEN T RES HIGH FIEL DC er' s Yar d AD IA RO Residential Zone North 16 E Sub l Sta 121 Buil d ldre n Ho 's me 7 23 E ENU AV SE Chi 3 24 Hospital roads U KHO PAR OR VICT S m 57.6 BM 1 40 CLOSE Buildings to be demolished 0 EN ARD MG KHA IC W RTON BRAME Existing buildings refurbished and/or converted VE RO EG TH AD RO 137 ON LT MI 10 New buildings Wo rks 1 Existing buildings retained HAM WICK Gar ag e Elm Ho use LANE THORNEYCR OFT m 145 2a Ward Bdy CR OAD OD R TWO PRES 156a 156b a m m ROAD WOOD PREST 3.67m BM 15 TC B CR ROAD WEST PRESTWOOD 3 1a 1 7 Bd y Ward 6.21m BM m Key 93 igh m VIE Pedestrian / controlled areas; see landscape strategy Te nnis 7 20 Tug Only Zone Tugway Access s lla Vi Planted amenity areas; see landscape strategy w Ne Water Treatment OO LW ZE HA Surrounding residential areas indicating aspect D RDC E IV DR Energy Centre FM Compound Catering b Su El 2 a St 85 Surrounding non-residential areas indicating aspect 9 13 Workforce Development 7 Da iry 00 O TW ES PR m D O Existing trees retained AD RO No rth Future Expansion Zone Far m 73 New trees; see landscape strategy Cardiac Centre Trees to be felled He a Hig th P a hs r ch k oo l Non-Clinical Support stu m a s 83 8 Co urt m 72 Emergency Centre BM 154.2m 48 m Inpatients Cancer Service Link e ial Zon eya r MEM ORY Works Works LAN E to 77 The Fi rs The Cedar s 136 to ATION CORON 76 ROAD Oaks SM SM storey 3 level deck parking 395 spaces 78 to 95 The ELEY LAN E to 113 Elms The GRA IS m BM 14 Cancer Centre West Ambulatory Centre 1 50 ENUE CE AV LAWREN 30 South Entrance TH C LOSE stu m 36 to 41 Beec hes The Ce ntr e SM Ch ild Ca re 30 to Limes 6 The 18 to 29 The m Willo ws OKEM ENT DR Th e Ha ll m El S TC B Ne wc ro Vil ss la Wo rks Strategic Option: FDF v Ne wb Bri entle dge y m CC BM m g Path Towin 93 and anal ton C Essing 6 100m Masterplan Cin em a 93 1 erm an ta PTON ROAD ge Wo rks Rev D: Red line area reinstated. Residential zone re-planned from south to west location. HL Rev C: Red line area reduced. HL 21:12:07 Rev B: South residential layout revised. West car park revised. Drop off road amended. HL 31:11:07 Rev A: Residential layouts indicated. HL 31:08:07 Wharf 30 Towing Path m FB Be nt ley Ca na l Nic k Planning Statement Fig m e (PHlode on ) NEW CROSS AVENUE y Wyrle Scale Ne wc Bri ross dge Ward Bdy m Ga ra ub S m m WOL VERH AM BM m Works 319 Fis h (PH ) IVE m NE W JUN CRO CT SS IO N ROAD CORONA TION 98 Wk s 36 d Pathology m VICTORIA ROAD Gra v NEW HEA storey 5 level MSCP 540 spaces The Pine s 42 to Future Expansion Zone The Map les 114 to storey part 2 level deck parking 334 spaces 2 nt Reside m Future Expansion Zone 23 ROAD ATION E TC B Event 152.4m 13 N CORO 24 CL O S Arcade East RY TO N Travelators Cycles Arcade West Nu rsin gh om e 49 Women & Children's Centre 12 Sta ub El S North East Entrance STRATEGIC HEALTHCARE PLANNING LTD TTC HOUSE HADLEY PARK TELFORD SHROPSHIRE TF1 6QJ Tel: Fax: Project 7 Drawing Title New Hospital Project New Cross Site Client 99 9 Royal Wolverhampton Hospitals NHS Trust El S 93 8 ub S ta Amended Planning Submission April 2008 Drawn HL Date Feb 08 Chkd Scale @A1 Job No Number Rev D

126 2c Future Emergency Services Activity and Scenario Modelling

127 Projected Emergency Services Activity 2013/ /26 Base Model (Includes Stafford activity) A B C D E F G H I J K L M N O P Q R S T Patients Going Through ED Classed as Attendances Primary Care/Showell Park Year ED Attendances Demographic Growth ED Attendances PLUS Growth (B+C) Stafford patients Less Primary Care Transfer (3.8%) HASU Total Adjusted ED Attendances Less 20% Primary Care AMU AMB Patients to ED Previous Direct AMU Admissions Not from ED Total Revised ED Attendances (Ground floor) Primary Care (20%) Walk in Centre Total Primary Care Ground Floor ED plus Primary Care Activity ED Review Outpatients CDU AMUAMB prior to ED transfer Direct AMU Admissions Not from ED prior to ED transfer 2013/14 108, , , , ,811 4,795 2,911 3,232 1, /15 108,811 2, ,477 5, , , ,017 5,938 3,704 3,311 1, /16 117,017 2, ,872 (4,236) 115,636 8, ,983 8,510 8, ,493 5,464 4,067 2,844 1, /17 115,636 2, ,457 1, ,075 23,397 3,475 1, ,115 23,397 21,987 45, ,498 5,082 5, /18 120,075 2, , ,005 23,968 3,560 2, ,606 23,968 21,974 45, ,547 5,206 5, /19 123,005 3, , ,007 24,552 3,646 2, ,159 24,552 21,960 46, ,671 5,333 5, /20 126,007 3, , ,081 25,151 3,735 2, ,773 25,151 21,947 47, ,872 5,463 6, /21 129,081 3, , ,231 25,765 3,826 2, ,452 25,765 22,483 48, ,700 5,596 6, /22 132,231 3, , ,457 26,394 3,920 2, ,195 26,394 23,031 49, ,621 5,733 6, /23 135,457 3, , ,762 27,038 4,016 2, ,006 27,038 23,593 50, ,637 5,873 6, /24 138,762 3, , ,148 27,698 4,113 2, ,886 27,698 24,169 51, ,752 6,016 6, /25 142,148 3, , ,617 28,373 4,214 2, ,835 28,373 24,759 53, ,967 6,163 6, /26 145,617 3, , ,170 29,066 4,317 2, ,857 29,066 25,363 54, ,285 6,313 6,975 13/14 figures based upon Month 9 finance forecast E.D Wolverhampton demographic growth increase taken from Stafford CPT modelling is 2.45% for 2014/15 and then 2.44% going forward. This has been applied to: ED attendances AMUAMB admissions (changed to ED in 15/16) AMUAMB and AMU direct admissions primary care Stafford patients added from 1st April 2014 TSA model suggests 923 to come to Wolverhampton, 50% share of 9, % of E.D attendances reduced in 2015/16 for transfer of activity to GP practices Increase of E.D attendances from April 2016 of 1,618 attendances if HASU status is achieved (from CSU modelling) E.D Attendances to include AMUAMB from 1st Feb (Excludes ED referred patients and patients who go to AMU from AMUAMB). 13/14 forecast figure based upon month 9. AMU admissions not admitted from ED (AMUAMB Referrals + Direct GP referrals) using 13/14 month 9 forecast + growth each year. Figures pro rot'd for start of 1st Feb 2016 Notes: 13/14 A&E forecast based on M9 forecast (from finance) HASU to commence from April 2015 Primary Care 20% shift from Operational date 16/11/2015 Stafford patients added from 1st April 2014 figure of 5,540 AAA transfer to ED from = 01/02/ days within 15/16 31/03/2016 Current assumption of new ED Build t open = 16/11/ days within 15/16 31/03/ % of E.D attendances to change tariff due to primary care front from operational date. 20% is taken from Column K (which excludes AMUAMB) transfers Potential additional primary care activity of 21,987 taken from CSU modelling. Between 2016/17 and 2019/20 there is an assumed reduction of 2.5% ED outpatient activity growth each year linked to 12/13 % proportion of ED attendances (column A) 4,061 15/16 CDU Activity comprised of: *Forecast CDU Activity based upon previous year CDU % proportion of ED attendances = 3,794 * Referrals from AMUAMB into AMU (not via ED) less than 24 Hrs los with conditions identified by clinicians pro rota from 1st Feb 16= 19 * Patients who attend AMUAMB (not via ED and less than 24 Hrs) and then discharged home with clincian identified conditions pro rota from 1st Feb 16 = 231 * Patients admitted directly to AMU (not via ED or AMUAMB and less than 24 Hrs) with conditions pro rota from 1st Feb 16 = 17 * Basline CDU attendances taken for period Sept Dec 13/14 AMUAMB activity and direct Amu Activity shown prior to ED transfer & operational date

128 Projected Emergency Services Activity 2013/ /26 Base Model excluding Walk In Centre Activity A B C D E F G H I J K L M N O P Q R S T Patients Going Through ED Classed as Attendances Primary Care Year ED Attendances Demographic Growth ED Attendances PLUS Growth (B+C) Stafford patients Less Primary Care Transfer (3.8%) HASU Total Adjusted ED Attendances Less 20% Primary Care AMU AMB Patients to ED Previous Direct AMU Admissions Not from ED Total Revised ED Attendances (Ground floor) Primary Care (20%) Walk in Centre Total Primary Care Ground Floor ED plus Primary Care Activity ED Review Outpatients CDU AMUAMB prior to ED transfer Direct AMU Admissions Not from ED prior to ED transfer 2013/14 108, , , , ,811 4,795 2,911 3,232 1, /15 108,811 2, ,477 5, , , ,017 5,938 3,704 3,311 1, /16 117,017 2, ,872 (4,236) 115,636 8, ,983 8,510 8, ,493 5,464 4,067 2,844 1, /17 115,636 2, ,457 1, ,075 23,397 3,475 1, ,115 23,397 23, ,511 5,082 5, /18 120,075 2, , ,005 23,968 3,560 2, ,606 23,968 23, ,574 5,206 5, /19 123,005 3, , ,007 24,552 3,646 2, ,159 24,552 24, ,711 5,333 5, /20 126,007 3, , ,081 25,151 3,735 2, ,773 25,151 25, ,925 5,463 6, /21 129,081 3, , ,231 25,765 3,826 2, ,452 25,765 25, ,217 5,596 6, /22 132,231 3, , ,457 26,394 3,920 2, ,195 26,394 26, ,589 5,733 6, /23 135,457 3, , ,762 27,038 4,016 2, ,006 27,038 27, ,044 5,873 6, /24 138,762 3, , ,148 27,698 4,113 2, ,886 27,698 27, ,583 6,016 6, /25 142,148 3, , ,617 28,373 4,214 2, ,835 28,373 28, ,209 6,163 6, /26 145,617 3, , ,170 29,066 4,317 2, ,857 29,066 29, ,922 6,313 6,975 13/14 figures based upon Month 9 finance forecast E.D Wolverhampton demographic growth increase taken from Stafford CPT modelling is 2.45% for 2014/15 and then 2.44% going forward. This has been applied to: ED attendances AMUAMB admissions (changed to ED in 15/16) AMUAMB and AMU direct admissions primary care Stafford patients added from 1st April 2014 TSA model suggests 923 to come to Wolverhampton, 50% share of 9, % of E.D attendances reduced in 2015/16 for transfer of activity to GP practices Increase of E.D attendances from April 2016 of 1,618 attendances if HASU status is achieved (from CSU modelling) E.D Attendances to include AMUAMB from 1st Feb (Excludes ED referred patients and patients who go to AMU from AMUAMB). 13/14 forecast figure based upon month 9. AMU admissions not admitted from ED (AMUAMB Referrals + Direct GP referrals) using 13/14 month 9 forecast + growth each year. Figures pro rot'd for start of 1st Feb 2016 Notes: 13/14 A&E forecast based on M9 forecast (from finance) HASU to commence from April 2015 Primary Care 20% shift from Operational date 16/11/2015 Stafford patients added from 1st April 2014 figure of 5,540 AAA transfer to ED from = 01/02/ days within 15/16 31/03/2016 Current assumption of new ED Build t open = 16/11/ days within 15/16 31/03/ % of E.D attendances to change tariff due to primary care front from operational date. 20% is taken from Column K (which excludes AMUAMB) transfers ED outpatient activity growth each year linked to 12/13 % proportion of ED attendances (column A) 4,061 15/16 CDU Activity comprised of: *Forecast CDU Activity based upon previous year CDU % proportion of ED attendances = 3,794 * Referrals from AMUAMB into AMU (not via ED) less than 24 Hrs los with conditions identified by clinicians pro rota from 1st Feb 16= 19 * Patients who attend AMUAMB (not via ED and less than 24 Hrs) and then discharged home with clincian identified conditions pro rota from 1st Feb 16 = 231 * Patients admitted directly to AMU (not via ED or AMUAMB and less than 24 Hrs) with conditions pro rota from 1st Feb 16 = 17 * Basline CDU attendances taken for period Sept Dec 13/14 AMUAMB activity and direct Amu Activity shown prior to ED transfer & operational date

129 Projected Emergency Services Activity 2013/ /26 Base Model excluding Walk In Centre Activity and 20% Primary Care from Apr 16 A B C D E F G H I J K L M N O P Q R S T Patients Going Through ED Classed as Attendances Primary Care Year ED Attendances Demographic Growth ED Attendances PLUS Growth (B+C) Stafford patients Less Primary Care Transfer (3.8%) HASU Total Adjusted ED Attendances Less 20% Primary Care AMU AMB Patients to ED Previous Direct AMU Admissions Not from ED Total Revised ED Attendances (Ground floor) Primary Care (20%) Walk in Centre Total Primary Care Ground Floor ED plus Primary Care Activity ED Review Outpatients CDU AMUAMB prior to ED transfer Direct AMU Admissions Not from ED prior to ED transfer 2013/14 108, , , , ,811 4,795 2,911 3,232 1, /15 108,811 2, ,477 5, , , ,017 5,938 3,704 3,311 1, /16 117,017 2, ,872 (4,236) 115, , ,493 5,464 4,067 2,844 1, /17 115,636 2, ,457 1, ,075 23,397 3,475 1, , ,115 5,082 5, /18 120,075 2, , ,005 23,968 3,560 2, , ,606 5,206 5, /19 123,005 3, , ,007 24,552 3,646 2, , ,159 5,333 5, /20 126,007 3, , ,081 25,151 3,735 2, , ,773 5,463 6, /21 129,081 3, , ,231 25,765 3,826 2, , ,452 5,596 6, /22 132,231 3, , ,457 26,394 3,920 2, , ,195 5,733 6, /23 135,457 3, , ,762 27,038 4,016 2, , ,006 5,873 6, /24 138,762 3, , ,148 27,698 4,113 2, , ,886 6,016 6, /25 142,148 3, , ,617 28,373 4,214 2, , ,835 6,163 6, /26 145,617 3, , ,170 29,066 4,317 2, , ,857 6,313 6,975 13/14 figures based upon Month 9 finance forecast E.D Wolverhampton demographic growth increase taken from Stafford CPT modelling is 2.45% for 2014/15 and then 2.44% going forward. This has been applied to: ED attendances AMUAMB admissions (changed to ED in 15/16) AMUAMB and AMU direct admissions primary care Stafford patients added from 1st April 2014 TSA model suggests 923 to come to Wolverhampton, 50% share of 9, % of E.D attendances reduced in 2015/16 for transfer of activity to GP practices E.D Attendances to include AMUAMB from 1st Feb (Excludes ED referred patients and patients who go to AMU from AMUAMB). 13/14 forecast figure based upon month 9. Increase of E.D attendances from April 2016 of 1,618 attendances if HASU status is achieved (from CSU modelling) AMU admissions not admitted from ED (AMUAMB Referrals + Direct GP referrals) using 13/14 month 9 forecast + growth each year. Figures pro rot'd for start of 1st Feb % of E.D attendances to move tp external primary care. 20% is taken from Column K (which excludes AMUAMB) transfers Notes: 13/14 A&E forecast based on M9 forecast (from finance) HASU to commence from April 2015 Primary Care 20% shift from Operational date 16/11/2015 Stafford patients added from 1st April 2014 figure of 5,540 AAA transfer to ED from = 01/02/ days within 15/16 31/03/2016 Current assumption of new ED Build t open = 16/11/ days within 15/16 31/03/2016 ED outpatient activity growth each year linked to 12/13 % proportion of ED attendances (column A) 4,061 15/16 CDU Activity comprised of: *Forecast CDU Activity based upon previous year CDU % proportion of ED attendances = 3,794 * Referrals from AMUAMB into AMU (not via ED) less than 24 Hrs los with conditions identified by clinicians pro rota from 1st Feb 16= 19 * Patients who attend AMUAMB (not via ED and less than 24 Hrs) and then discharged home with clincian identified conditions pro rota from 1st Feb 16 = 231 * Patients admitted directly to AMU (not via ED or AMUAMB and less than 24 Hrs) with conditions pro rota from 1st Feb 16 = 17 * Basline CDU attendances taken for period Sept Dec 13/14 AMUAMB activity and direct Amu Activity shown prior to ED transfer & operational date

130 2d Changes in Activity Assumptions

131 Changes to Activity Assumptions OBC v FBC Factor Outline Business Case Full Business Case Reason for Change Baseline 2013/14 Plan (109,804 ED attendances) 2013/14 Month 9 Forecast outturn Latest available actual activity which will be agreed with WCCG. HASU RWT gains HASU status from April 2014 at 1618 attendances Activity transfer out to primary care 3.8% of Category 1 ED attendances from 2015/16 onwards - equates to 4,248 attendances RWT gains HASU status from April 2016 at 1618 attendances 3.8% of Category 1 ED attendances from 1st April 2015 Change of implementation date due to delay and most recent communication from network No change Out of Hours Service Demographic Growth Demographic Growth No activity transfer to RWT assumed No activity transfer to RWT assumed No change 2.45% in 13/14 and 14/ % in 14/15 (13/14 actual - circa 13/14 now based on actuals and 1.6%) projections. 2014/15 as OBC 2.44% 2015/16 onwards 2.44% 2015/16 onwards No change

132 Factor Outline Business Case Full Business Case Reason for Change Activity tariff change to primary care 20% from May 2016 = attendances 20% from November 2015 Change of operational date Transfer in to ED from Showell Park attendances from May attendances from 1 April 2016 Change to ED operational date but also to allow for operational phasing AMU referrals transfer in to ED CDU ED Review Outpatients Activity groups included in Base Model from 2015/ attendances (NB this was underestimated as exc direct admissions into AMU) 2013/14 activity is part year impact and includes activity which previously went to SAU and AMU and other areas with a LOS of less than 24 hours for a number of identified conditions; patients waiting longer than 4 hours for breach reason of investigation, transport, mental health assessment and admission avoidance. From 16/17 will also include patients discharged from AMU/AMB 2013/14 figures are based on current activity in ED and AMU review clinics. Growth factored in at same rate as ED ED, AAA Activity, CDU, Review Clinics Activity, HASU, Showell Park 1st February /14 actual activity Sept to Dec 13 forecast outturn plus AMU and AMU/AMB attendances specific conditions and <24 hrs LOS 2013/14 Month 9 Forecast outturn for ED and AMU review clinics + paeds activity when known ED, AMU & AMU/AMB, Review Clinic Activity, CDU, HASU, Showell Park, Stafford (5540 attendances from April 14 = % of 9234) Change to ED operational date but also to allow for operational phasing Based on actual activity rather than estimates Latest available actual activity which will be agreed with WCCG. To include all RWT appropriate emergency activity to transfer, plus Stafford activity transfer to RWT based on TSA recommendation made to Secretary of State

133 3a Capital Cost Forms

134 NEW EMERGENCY CENTRE COST FORM FB1 TRUST/ORGANISATION: The Royal Wolverhampton NHS Trust ORGANISATIONAL CODE: SCHEME: New Emergency Centre STRATEGIC HA: PROJECT DIRECTOR: CAPITAL COSTS SUMMARY PHASE: One - Three Storey - Option 5 New Build Cost Excl. VAT Cost Incl. VAT VAT 1 Departmental Costs (from Form FB2) 14,855,373 2,971,075 17,826,448 2 On Costs (from Form FB3) (24.46% of Departmental Cost) 3,633, ,742 4,360,445 3 Works Cost Total (1+2) at 173 PUBSEC Calculations Based upon FBC Submission 3Q ,489,077 4 Provisional location adjustment (if applicable) planning contingency -(6.00 % of Works Cost) (b) 1,109, ,869 1,331,213 (where detail allows this should be based upon quantified risk analysis) 5 Sub Total (3+4) 17,379,732 3,475,946 20,855,680 17,379,732 location adjusted works cost 6 Fees (from Form FB4) (c) (d) 1,332,803 fees (7.67% of sub-total 5) 1,332,803 1,332,803 1,833,984 non-works costs 7 Enabling works (from FB4) 1,433, ,738 1,720,429 8 Non-Works Costs (from Form FB4) (e) 1,127,401 equipment cost LAND 21,673,920 SUM SUBJECT TO PLANNING CONTINGENCY OTHER 400,293 80, ,352 9 Equipment Costs (from Form FB2) 433,478 CONTINGENCY SUM 2.00% (7.59% of Departmental Cost) 1,127, ,480 1,352, Contingencies 433,478 86, ,173 inflation adjustment 11 TOTAL (for approval purposes) ( ) 22,107,399 4,154,919 26,262,318 23,299,464 sub total (line 30) at PUBSEC Optimism Bias 1,192, ,413 1,430,479 (1,127,401) less equipment cost (purchased toward end of construction - inflation accounted for below) 13 Sub Total (11+12) 23,299,464 4,393,332 27,692,797 (22,548) less planning contingency for equipment costs 14 Inflation adjustments (f) 1,904, ,925 2,285,549 (62,007) less optimism bias for equipment costs 15 Less (1,332,803) less Fees - Client cost at completion level Estimated VAT Recovery on Construction Costs -92,201-92,201 20,754,705 SUM SUBJECT TO CONSTRUCTION CONTRACT INFLATION ADJUSTMENT 16 FORECAST OUTTURN BUSINESS CASE TOTAL ( ) 25,204,088 4,682,056 29,886,144 Proposed start on site (g) 2nd Quarter 2014 Proposed completion date (g) 3rd Quarter BUSINESS CASE SUBMISSION BIS 173 PUBSEC BIS FP (Base) Cash Flow:- Year SOURCE BUSINESS CASE SUBMISSION EPI 173 PUBSEC BIS FP (Base) yy/yy EFL OTHER GOVERNMENT PRIVATE TOTAL 1,799,541 construction contract Inflation - start on site 188 PUBSEC BIS FP (2Q14).. - construction contract Inflation - mid point of construction N/A 188 PUBSEC BIS FP (2Q14) 105,083 equipment cost inflation 188 PUBSEC BIS FP (1Q15) 1,904,624 TOTAL INFLATION ON FP CONTRACT INCLUDING EQUI 188 Optimism Bias Total Cost (as 10 above) 22% Upper Bound 25% Mitigating Factor Total (for approval purposes) match against Cashflow ERROR EQUIPMENT COST ONLY CALC 1,127,401 equipment cost 22,548 ADD: planning contingency for equipment costs 62,008 ADD: optimism bias for equipment costs 1,211,956 TOTAL EQUIPMENT COST

135 NEW EMERGENCY CENTRE COST FORM FB2 TRUST/ORGANISATION: The Royal Wolverhampton NHS Trust SCHEME: New Emergency Centre PHASE: One - Three Storey - Option 5 New Build PROJECT DIRECTOR: CAPITAL COSTS: DEPARTMENTAL COSTS AND EQUIPMENT COSTS Functional Content.. Functional Units/Space Requirements (1) N/A/C (2) Cost Allowance Version Equipment Cost Version. HCI 2.1 HCI 2.1 Nett Building Cost N 14,855,373 Equipment Costs N Direct Cost from Trust 1,127,401 Departmental Costs and Equipment Costs Carried Forward 14,855,373 1,127,401

136 OUTLINE BUSINESS CASE FOR PREFERRED OPTION COST FORM FB2 (CONT) CAPITAL COSTS : DEPARTMENTAL COSTS AND EQUIPMENT COSTS Functional Content Functional Units/Space N/A/C (2) Cost Allowance Equipment Cost Requirements (1) Brought Forward 14,855,373 1,127,401 Less abatement for transferred 1,127,401 equipment if applicable % ( 4 ) Departmental Costs and Equipment Costs To Summary 14,855,373 1,127,401

137 COST FORM FB2 (CONT) Cost allowances should be based on Departmental Cost Allowances where appropriate and include allowances for essential complementary accommodation and optional accommodation and services where details not available. Identify separately any proposed adjustment (over or under cost allowances) justifiable in value for money terms (details to be provided). * Delete as appropriate 1. State area and rate if departmental cost allowance not available. 2. Insert: N for new build. A for adaptions for alternative use or C for upgrading existing building retaining current use. 3. Insert relevant version number of HCI listing of Departmental Cost Allowances and Equipment Cost allowances. 4. Provide details where appropriate. Completed by Name (capitals) KEITH WOOLDRIDGE Authorised for issue Position MANAGING SURVEYOR Project Director Address FAITHFUL+GOULD THE AXIS 10 HOLLIDAY STREET BIRMINGHAM B1 1TF Date Telephone

138 NEW EMERGENCY CENTRE COST FORM FB3 TRUST/ORGANISATION: The Royal Wolverhampton NHS Trust SCHEME: New Emergency Centre PHASE: One - Three Storey - Option 5 New Build CAPITAL COSTS: ON COSTS Estimated Cost (exc. VAT) Percentage of Departmental Cost 1 Communications % a. Space (Covered within Floor Costings) - b. Atria at First and Second Floor (Building cost only) 181,730 c. Allowance for plant rooms etc associated with services - (Covered within Floor Costings) d. Lifts and staircases (stairs Covered within Floor Costings) 408, , ''External'' Building Works (1) a. Drainage 176,341 b. Attenuation 155,916 c. Roads, paths, parking, including enhanced landscaping 402,668 d. Site layout, walls, fencing, gates 38,382 e. Builders work for engineering 332,353 f. Allowance for minor alterations to East/West corridor access and associated works 28,034 g. Major Incidents Decontamination Areas (not in building footprint) 24,648 h. Canopies to Main Entrance and Ambulances 154,379 1,312, ''External'' Engineering Works (1) a. Steam, condensate, heating, hot 877,175 water and gas supply mains b. Cold water mains and storage 170,931 c. Electricity mains, sub-stations, 275,663 stand-by generating plant d. Calorifiers and associated plant 79,664 e. Local Chiller to MRI/CT Scanners 58,904 f. Diversion of steam main within Tugway 48,733 g. Additional services to Atrium 15,428 h. Moving of substation and generator; work to relocate 11kVA mains (see FB4) - 1,526, Auxiliary Buildings a. New external Substation & Generator (see FB4) - 5 Other on-costs and abnormals (2) a. Building allowance for abnormals including building demolition and - demolition of existing slabs etc ( see FB4) b. Abnormal foundations due to ground conditions 155,158 c. Engineering 49,575 e. Decant Costs (See FB4) - 204, Total On-Costs to Summary OB1 Notes: 3,633, Must be based on scheme specific assessments/measurements; attach details to define scope of works as appropriate. Identify separately any proposed additional capital expenditure justifiable in value for money terms (details to be provided). * (1) (2) Delete as appropriate. ''External'' to Departments Identify any enabling or preliminary works to prepare the site in advance e.g. demolitions; service diversions; decanting costs; site investigation and other exploratory works. Completed by Name (capitals) KEITH WOOLDRIDGE Authorised for issue Position MANAGING SURVEYOR Project Director Address FAITHFUL+GOULD THE AXIS 10 HOLLIDAY STREET BIRMINGHAM B1 1TF Date Telephone

139 NEW EMERGENCY CENTRE COST FORM FB4 TRUST/ORGANISATION: The Royal Wolverhampton NHS Trust SCHEME: New Emergency Centre PHASE: One - Three Storey - Option 5 New Build CAPITAL COSTS: FEES AND NON-WORKS COSTS Percentage of Works Cost % 1 Fees (including "in-house" resource costs) As Trust Information 1,332,803 a. Architects b. Structural Engineers c. Mechanical Engineers d. Electrical Engineers e. Quantity Surveyors f. Project Management g. Project Sponsorship h. Legal fees i. Site Supervision j. Building Regulations and Planning Fees k. Other Total Fees to Summary (FB1) 1,332, Fee allowance as discussed with Trust - includes external professional fees and internal Trust costs 2 Enabling works - comprising 1,433,691 a. Substation construction b. Substation and generator installation c. Demolitions d. Site clearance e. Enabling works preliminaries Total enabling works to Summary (FB1) 1,433, Non-Works Costs a. Land purchase costs and associated legal fees b. Statutory and Local Authority charges c. Other (Decant Costs) 216,250 d. Other (IT Works Costs) 138,032 e. Other (Asbestos Removal Costs) 46,011 Non-Works Costs to Summary (FB1) 400, Notes: * Delete as appropriate. Completed by Name (capitals) KEITH WOOLDRIDGE Authorised for issue Position MANAGING SURVEYOR Project Director Address FAITHFUL+GOULD THE AXIS 10 HOLLIDAY STREET BIRMINGHAM B1 1TF Date Telephone

140 The Royal Wolverhampton NHS Trust New Emergency Centre Phase One - Three Storey - Option 5 New Build Appendix 1: - DCAG and ECAG Calculations ELEMENT Functional Content Total ( ) at BIS FP reporting Level 173 Notes Substructure Substructure 768,147 Superstructure Frame 1,142,808 Upper floors 506,697 Roof 608,169 Stairs and ramps 117,208 External walls 1,060,704 Windows and external doors 305,906 Internal walls and partitions 932,856 Internal doors 277,173 Internal finishes Wall finishes 491,778 Floor finishes 454,238 Ceiling finishes 237,476 Fittings, furnishings and equipment Fittings, furnishings and equipment 554,548 Services Sanitary installations 148,071 Disposal installations 180,544 Water installations 388,648 Heat source See FB3 costs Space heating and air conditioning 845,405 Ventilation 277,766 Electrical installations 1,062,064 Fuel installations 27,090 Lift and conveyor installations See FB3 costs Fire and lightning protection 77,261 Communication, security and control systems 736,611 Specialist installations 403,588 Sub contractor preliminaries 460,003 Builder's work in connection with services See FB3 costs Works to existing buildings Mechanical and electrical installations 89,085 External works Site preparation works See FB3 costs Roads, paths, pavings and surfacings See FB3 costs Soft landscaping, planting and irrigation systems See FB3 costs Fencing, railings and walls See FB3 costs External fixtures 15,368 External drainage See FB3 costs External services 117,006 Minor building works and ancillary buildings See FB3 costs Preliminaries 1,854,885 Overheads & Profit 714,270 14,855,373

141 The Royal Wolverhampton NHS Trust New Emergency Centre Phase One - Three Storey - Option 5 New Build Accommodation Business Case Optimism Bias - Upper Bound Calculation for Build Lowest % Upper Bound 13% Mid % 40% Upper % 80% Actual % Upper Bound for this project 22% Build complexity Scope of scheme Choose 1 category X Choose 1 category X Length of Build < 2 years x 0.50% 0.50% Facilities Management Hard FM only or no FM x 0.00% 0.00% 2 to 4 years 2.00% 0 Hard and soft FM 2.00% Over 4 years 5.00% 0 0 Choose 1 category Choose 1 category Equipment Group 1 & 2 only 0.50% 0 Number of phases 1 or 2 Phases x 0.50% 0.50% major Medical equipment x 1.50% 1.50% 3 or 4 Phases 2.00% 0 All equipment included 5.00% 0 More than 4 Phases 5.00% 0 Choose 1 category Choose 1 Category IT No IT implications 0.00% 0 Number of sites involved (i.e. before and after Single site* x 2.00% 2.00% Infrastructure x 1.50% 1.50% 2 Site 2.00% 0 Infrastructure & systems 5.00% 0 More than 2 site 5.00% 0 change) * Single site means new build is on same site as existing facilities Choose more than 1 category if applicable External Stakeholders 1 or 2 local NHS organisations 1.00% 0 Location 3 or more NHS organisations x 4.00% 4.00% Universities/Private/Voluntary sector/local government 8.00% 0 Choose 1 Category New site - Green field New build 3% 0 Service changes - relates to service delivery e.g. NSF's New site - Brown Field New Build 8% 0 Existing site New Build x 5% 5.00% Choose 1 category or Stable environment, i.e. no change to service x 5% 5.00% Existing site Less than 15% Refurb 6% 0 Identified changes not quantified 10% 0 Existing site 15% - 50% Refurb 10% 0 Longer time frame service changes 20% 0 Existing site Over 50% Refurb 16% % Gateway Choose 1 category RPA Score Low 0% 0 Medium x 2% 2.00% High 5% %

142 The Royal Wolverhampton Hospitals NHS Trust New Emergency Centre Phase One - Three Storey - Option 5 New Build Accommodation Business Case Contributory Factor to Upper Bound Progress with Planning Approval % Factor Contributes 4 % Factor Contributes after mitigation 1 Explanation for rate of mitigation Planning approval received 1st April 2014 Other Regulatory 4 1 All costs accounted for in capital costs Depth of surveying of site/ground information 3 1 All necessary surveys undertaken Detail of design 4 1 1:50's developed with some minor areas for finalisation Innovative project/design (i.e. 3 has this type of project/design been undertaken before) Design complexity All issues resolved Likely variations from Standard Contract 2 1 P21+ Design Team capabilities 3 1 Design Team have experience of delivering similar projects. Now novated to P21+ PSCP Contractors capabilities (excluding design team covered above) Contractor Involvement Experience of delivering similar projects Heavily involved Client capability and capacity (NB do not double count with design team capabilities) Robustness of Output Specification 6 1 Internal capital project team have experience of delivering large projects. Clinical users have been heavily involved in design development and will continue to be involved through construction and commissioning 25 3 Most issues resolved Involvement of Stakeholders, including Public and Patient Involvement Agreement to output specification by stakeholders Robust communications plan in place and a number of stakeholder workshops held including a design workshop with more scheduled Mainly agreed New service or traditional 3 1 Mainly traditional service with some new elements Local community consent 3 Stable policy environment Support for new development and its interface with Urgent and Emergency Care Strategy for Wolverhampton. Public Consultation now concluded and strategy supported Most issues known Likely competition in the market for the project 2 1 Contractor selected and award to be made subject to approval TOTAL % Note: Across all contributory factors, mitigation would be expected to be greater the greater the extent of risk quantification and risk management.

143 35,000,000 Accumulated monthly spend 30,000,000 25,000,000 20,000,000 15,000,000 10,000,000 5,000,000 0

144 Annual spend ,000, ,000,000 4,000,000 6,000,000 8,000,000 10,000,000 12,000,000 14,000,000 16,000,000 18,000,000

145 New Cross Hospital - New Emergency Centre New Build - Cashflow ########### 17 Retention (%) :None allowed Retention (%) : None allowed Fees 1,437,497 Construction works 24,104,450 Non-works costs 522,000 Enabling works 1,869,600 Equipment cost 1,470,184 Stage 3 fee 483,582 TOTAL COST 29,887,313 Non works costs Enabling and Main Works Item Date Proportion of Contract Elapsed Predicted Gross Cumulative Predicted In the Month Proportion of Contract Elapsed Predicted Gross Cumulative Predicted In the Month Cumulative Total Of All Works Year End Totals Apr-12 0 May-12 0 Jun-12 0 Jul-12 0 Aug-12 0 Sep-12 0 Oct-12 0 Nov-12 0 Dec-12 0 Jan-13 0 Feb-13 0 Fees Mar , , ,000 Apr ,000 May ,000 Jun ,000 Jul ,000 Aug ,000 Sep ,000 Oct ,000 Nov ,000 Dec ,000 stage 3 Jan-14 71, ,524 stage 3 Feb , ,560 Fees 75, ,389 enabling 1,869,600 2,748,989 stage 3 Mar ,011 2,857,000 2,321,000 Asbestos Apr-14 59,233 2,916,233 stage 3 108,011 3,024,244 May-14 3,024,244 Fees Jun ,000 3,324,244 Jul , ,089 3,806,333 Aug , ,044 4,047,377 Sep ,687, ,178 5,011,555 Oct ,169, ,089 5,493,644 Nov ,856,712 1,687,311 7,180,956 Dec ,026,112 2,169,400 9,350,356 Jan ,231,335 1,205,222 10,555,579 Feb ,713, ,089 11,037,668 Mar ,733,712 3,020,288 14,057,956 11,200,956 Fees 525,668 14,583,624 Apr ,595,579 4,861,868 19,445,491 May ,548,040 1,952,460 21,397,952 Jun ,404,082 1,856,043 23,253,994 Jul ,970,871 1,566,789 24,820,783 IT+Equip Aug , , ,320,721 1,349,849 26,566,633 IT+Equip Sep , , ,309, ,282 27,974,915 IT+Equip Oct , , ,911, ,611 28,997,526 IT+Equip Nov , , ,104, ,836 29,604,546 Decant Dec-15 60,000 60,000 29,664,546 Decant Jan-16 84,000 84,000 29,748,546

146 Decant Feb-16 84,000 84,000 29,832,546 Decant Mar-16 54,000 54,000 29,886,546 15,828,590 Apr-16 29,886,546 May-16 29,886,546 Jun-16 29,886,546 Jul-16 29,886,546 Aug-16 29,886,546 Sep-16 29,886,546 Oct-16 29,886,546 Nov-16 29,886,546 Dec-16 29,886,546 Jan-17 29,886,546 Feb-17 29,886,546 Mar-17 29,886,546 0

147 4a Outline Drawings and Schedule of Accommodation for fit out of shell space (Phase 2)

148 shell area A 8 additional beds (incl 4 singles) 365sqm (excl link corridor from lifts) shell area B 11 additional beds (incl 3 singles) 469sqm ensuite wc 2.0sqm ensuite wc 2.0sqm unallocated space 50sqm clean supplies/ equipment store 12sqm single bedroom 19.0sqm single bedroom 20.1sqm single bedroom 20.1sqm MBB (4) 58.2sqm CDU area 10 beds (incl 2 singles) 360sqm fire escape stair and lobby single en-suite 5.1sqm single en-suite 4.5sqm single en-suite 4.5sqm MBB (4) 63.9sqm single bedroom 21.9sqm riser ensuite sh/wc 6.5sqm ensuite wc 2.0sqm ensuite wc 2.0sqm sw rm 2sqm single en-suite 4.5sqm ensuite sh/wc 6.5sqm general store 8sqm bed lift bed lift cleaner's room 8sqm dirty utility 12sqm staff base 6sqm hoist bay 2sqm assisted bathroom 15sqm dirty utility 12sqm MBB (4) 60.5sqm MBB (4) 60.5sqm riser staff base 6sqm ensuite sh/wc 6.5sqm lift lobby office/ meeting room 16sqm medicine prep' 8sqm st wc 2sqm sw rm 2sqm cleaner's room 8sqm store 8sqm ensuite sh/wc 6.5sqm ensuite sh/wc 6.5sqm MBB (4) 58.2sqm hoist bay 2sqm assisted bathroom 15sqm medicine prep' 8sqm ensuite wc 2.0sqm food trolley 2sqm resus trolley 2sqm sw rm 2sqm single en-suite 4.5sqm single en-suite 4.5sqm single en-suite 4.5sqm staff base 6sqm interview crisis room 16sqm riser riser clean supplies 11sqm (soa 8sqm) single bedroom 20.1sqm single bedroom 20.1sqm single bedroom 20.1sqm linen store 4sqm disposal hold 7.5sqm resus 2sqm ward pantry 12sqm office/ meeting room 16sqm dirty utility 12sqm equipment store 8sqm single bedroom 19.0sqm single en-suite 5.1sqm single en-suite 5.1sqm void to below staff base 6sqm food trolley 2sqm sw rm 2sqm single bedroom 24.8sqm (soa 19.0sqm) fire escape stair bed lift stair and lift lobby bed lift fire escape stair and lobby unallocated space 96.5sqm New Emergency Centre, New Cross Hospital first floor shell space, room relationship layout as proposed includes alternative arrangement for the existing CDU (50sqm area saving) Royal Wolverhampton Hospitals NHS Trust and Kier Health scale A2 27:02:14 drg ref 13019/SK/010 option 01 j e n s s e n architecture limited

149 ensuite wc 2.0sqm ensuite wc 2.0sqm ensuite wc 2.0sqm single bedroom 19.0sqm single en-suite 5.1sqm single bedroom 19.0sqm single bedroom 20.1sqm single bedroom 20.1sqm fire escape stair and lobby MBB (4) 58.2sqm MBB (4) 58.2sqm single en-suite 5.1sqm single en-suite 4.5sqm single en-suite 4.5sqm MBB (4) 63.9sqm single bedroom 21.9sqm ensuite sh/wc 6.5sqm riser ensuite sh/wc 6.5sqm ensuite wc 2.0sqm ensuite wc 2.0sqm sw rm 2sqm single en-suite 4.5sqm ensuite sh/wc 6.5sqm general store 8sqm ensuite sh/wc 6.5sqm bed lift bed lift cleaner's room 8sqm dirty utility 12sqm staff base 6sqm hoist bay 2sqm treatment room 16sqm dirty utility 12sqm MBB (4) 60.5sqm MBB (4) 60.5sqm riser staff base 6sqm ensuite sh/wc 6.5sqm MBB (4) 58.2sqm lift lobby office/ meeting room 16sqm medicine prep' 8sqm st wc 2sqm sw rm 2sqm assisted bathroom 15sqm ensuite sh/wc 6.5sqm ensuite sh/wc 6.5sqm MBB (4) 58.2sqm MBB (4) 58.2sqm ensuite wc 2.0sqm ensuite wc 2.0sqm resus 2sqm staff base 6sqm therapy room 25sqm dirty utility 12sqm linen store 4sqm general store 8sqm clean supplies 8sqm equipment store 8sqm food trolley 2sqm sw rm 4sqm ward pantry 12sqm riser clean supplies 11sqm (soa 8sqm) single en-suite 4.5sqm single bedroom 20.1sqm single en-suite 4.5sqm single bedroom 20.1sqm single en-suite 4.5sqm single bedroom 20.1sqm staff base 6sqm linen store 4sqm single en-suite 5.1sqm resus 2sqm treatment room 16sqm ward pantry 12sqm assisted bathroom 15sqm office/ meeting room 16sqm hoist bay 2sqm medicine prep' 8sqm dirty utility 12sqm ensuite wc 2.0sqm equipment store 8sqm riser single bedroom 19.0sqm single single en-suite en-suite 5.1sqm 5.1sqm ensuite sh/wc 6.5sqm single bedroom 22.3sqm single en-suite 4.5sqm single bedroom 19.0sqm single en-suite 5.1sqm single bedroom 19.0sqm patient day space 12sqm interview room 8sqm void to below single bedroom 19.0sqm cleaner's room 8sqm patient day space 12sqm disposal hold 12sqm food trolley 2sqm st wc 2sqm sw rm 2sqm single bedroom 19.0sqm single en-suite 5.1sqm single bedroom 19.0sqm single en-suite 4.5sqm fire escape stair single bedroom 22.3sqm staff lockers 6sqm dis wc 4.5sqm vis wc 2.5sqm vis wc 2.5sqm reception 22sqm st wc 2.0sqm single en-suite 5.1sqm st wc 2.0sqm interview room 8sqm bed lift communal staff changing allowance 44.7sqm staff rest /kitchen 12sqm seminar room 24sqm waiting 20.4sqm stair and lift lobby bed lift therapy room 25sqm fire escape stair and lobby New Emergency Centre, New Cross Hospital second floor shell space, room relationship layout as proposed Royal Wolverhampton Hospitals NHS Trust and Kier Health scale A2 27:02:14 drg ref 13019/SK/020 j e n s s e n architecture limited

150 Royal Wolverhampton NHS Trust Schedule of accommodation New Cross Hospital, shell space j e n s s e n architecture limited DEPT 2 - second floor shell space in-patient ward (initial assumption based on 2 x 24 bed wards, 30% single rooms) Room No Room name HBN04-01 unit no. total comments area area area multi-bed ward (4) mbb en-suite wc semi-ambulant mbb en-suite shower: assisted single bedroom en-suite wc semi-ambulant bathroom: assisted office/meeting room touchdown base 12@2sqm allowed for 6sqm each treatment room interview room patients 'break out' space 12 sqm ward pantry parking bay: resus equipment parking bay: food trolley parking bay: mobile hoist ward storage allowance 18.0 equipment store general store linen store Medicine store/preparation room dirty utility room, 12sqm cleaner's room staff locker bay: 12 small lockers staff wc switch room essential reception 4@5.5sqm waiting area 12@1.7sqm wc dis wc (shared between two wards) clean supply room allowance sqm per bed disposal hold allowance sqm per bed staff rest and mini kitchen 6@1.8sqm seminar room (24 place) per 64 beds communal changing allowance incl sh check Trust policy and proximity of central chang staff wc optional nappy changing room 5.0 optional addition to waiting space vending machine 3.0 optional addition to waiting space lobby to isolation room 5.0 Trust to advise if isolation rooms required clean utility room 16.0 Trust to advise if preferred to separate rooms shower room:assisted 8.0 can be in lieu of assisted bathrooms regeneration kitchen 12.0 Trust to advise on policy and size for two wards suggested therapy room Net Area Circ (HBN 35%) TOTAL note: HBN04-01 based on a 24 bed ward, 50% singles shell space 2,275sqm-250sqm comms = 2,025sqm draft no Revisions 1 first issue for comment 27th February :02:14 Page /C2

151 4b Schedule of Accommodation for Phase 1

152 New Emergency Centre Phase 1 Schedule of Accommodation Revision 01 - Issued Revision 02 - Issued Stage D issue. Revision 03 - Revised Stage D Issue Revision 04 - Updated to suited status of design at date of issue Level Department Name Area 00 Ground Floor Childrens Triage Resus 2.2 m² 00 Ground Floor Childrens Triage WC 2.4 m² 00 Ground Floor Childrens Triage Acc WC 4.2 m² 00 Ground Floor Childrens Triage Acc WC/Nappy 5.5 m² 00 Ground Floor Childrens Triage Ambulance Entrance 9.8 m² 00 Ground Floor Childrens Triage Staff Base 10.9 m² 00 Ground Floor Childrens Triage Clean Utility / Supply Store 11.3 m² 00 Ground Floor Childrens Triage Treat m² 00 Ground Floor Childrens Triage Treat m² 00 Ground Floor Childrens Triage Dirty Utility 11.6 m² 00 Ground Floor Childrens Triage Relatives 12.2 m² 00 Ground Floor Childrens Triage Treat m² 00 Ground Floor Childrens Triage Treat m² 00 Ground Floor Childrens Triage Treat m² 00 Ground Floor Childrens Triage Treat m² 00 Ground Floor Childrens Triage Child TI 12.8 m² 00 Ground Floor Childrens Triage Store 13.1 m² 00 Ground Floor Childrens Triage Peadiatric Major Bay 41.8 m² 00 Ground Floor Childrens Triage Waiting 43.2 m² 00 Ground Floor Childrens Triage Corridor m² Total net department room area m² 00 Ground Floor Circulation Stair 1 Lobby 8.2 m² 00 Ground Floor Circulation Lift m² 00 Ground Floor Circulation Lift m² 00 Ground Floor Circulation Lift m² 00 Ground Floor Circulation Lift m² 00 Ground Floor Circulation Stair 2 Lobby 10.5 m² 00 Ground Floor Circulation Lift Lobby 19.4 m² 00 Ground Floor Circulation Stair m² 00 Ground Floor Circulation Stair 3 Lobby 25.9 m² 00 Ground Floor Circulation Stair m² 00 Ground Floor Circulation Corridor m² 00 Ground Floor Circulation Stair m² 00 Ground Floor Circulation Corridor 51.4 m² 00 Ground Floor Circulation Corridor m² Total net department room area m² 00 Ground Floor Main Entrance Acc WC/Nappy 4.2 m² 00 Ground Floor Main Entrance Assisted WC 8.8 m² 00 Ground Floor Main Entrance Retail Storage 10.8 m² 00 Ground Floor Main Entrance Male WC 22.8 m² 00 Ground Floor Main Entrance Female WC 25.5 m² 00 Ground Floor Main Entrance Lobby m² 00 Ground Floor Main Entrance Waiting m² Total net department room area m² 00 Ground Floor Major Injuries WC 2.7 m² 00 Ground Floor Major Injuries Acc WC 4.2 m² 00 Ground Floor Major Injuries Acc WC 4.2 m² 00 Ground Floor Major Injuries Acc WC 4.2 m² 00 Ground Floor Major Injuries Pantry / Bev Bay 6.0 m² 00 Ground Floor Major Injuries Disp Hold 10.5 m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Interview / Crisis 11.2 m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Exam m² 00 Ground Floor Major Injuries Corridor 12.7 m² 00 Ground Floor Major Injuries Dirty Utility 14.3 m² 00 Ground Floor Major Injuries Store 18.9 m²

153 00 Ground Floor Major Injuries Staff Base with Linen Store 19.1 m² 00 Ground Floor Major Injuries Clean Utility 20.1 m² 00 Ground Floor Major Injuries Rapid Assessment Treatment 50.9 m² 00 Ground Floor Major Injuries Corridor m² Total net department room area m² 00 Ground Floor Minor Injuries / Triage / Acc WC 3.5 m² 00 Ground Floor Minor Injuries / Triage / Acc Staff WC 3.5 m² 00 Ground Floor Minor Injuries / Triage / Acc Sluice 4.7 m² 00 Ground Floor Minor Injuries / Triage / Acc Acc WC 5.0 m² 00 Ground Floor Minor Injuries / Triage / Acc Store: Plaster Equip. 6.8 m² 00 Ground Floor Minor Injuries / Triage / Acc Cleaners 6.8 m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Pantry 8.2 m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Disp Hold 8.8 m² 00 Ground Floor Minor Injuries / Triage / Acc Exam Eyes m² 00 Ground Floor Minor Injuries / Triage / Acc Exam Eyes m² 00 Ground Floor Minor Injuries / Triage / Acc See & Treat m² 00 Ground Floor Minor Injuries / Triage / Acc See & Treat m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Corridor 12.6 m² 00 Ground Floor Minor Injuries / Triage / Acc See & Treat m² 00 Ground Floor Minor Injuries / Triage / Acc Store 13.5 m² 00 Ground Floor Minor Injuries / Triage / Acc Exam Eyes m² 00 Ground Floor Minor Injuries / Triage / Acc Dirty Utility 14.5 m² 00 Ground Floor Minor Injuries / Triage / Acc Exam m² 00 Ground Floor Minor Injuries / Triage / Acc Triage Base 18.0 m² 00 Ground Floor Minor Injuries / Triage / Acc Staff Base with Linen Store 18.1 m² 00 Ground Floor Minor Injuries / Triage / Acc Procedure Room m² 00 Ground Floor Minor Injuries / Triage / Acc Procedure Room m² 00 Ground Floor Minor Injuries / Triage / Acc Treatment Room: Plaster 29.9 m² 00 Ground Floor Minor Injuries / Triage / Acc Corridor m² Total net department room area m² 00 Ground Floor Radiology Water Point 1.5 m² 00 Ground Floor Radiology WC 2.0 m² 00 Ground Floor Radiology Ch m² 00 Ground Floor Radiology Ch m² 00 Ground Floor Radiology Ch m² 00 Ground Floor Radiology TR 2.7 m² 00 Ground Floor Radiology Acc WC 4.2 m² 00 Ground Floor Radiology Acc Ch. 4.4 m² 00 Ground Floor Radiology Interview / Prep 5.1 m² 00 Ground Floor Radiology Linen 5.5 m² 00 Ground Floor Radiology Disp Hold 5.6 m² 00 Ground Floor Radiology UPS/IPS 6.1 m² 00 Ground Floor Radiology Cleaners 6.3 m² 00 Ground Floor Radiology Radiology Store 6.8 m² 00 Ground Floor Radiology Clean Utility 8.8 m² 00 Ground Floor Radiology Dirty Utility 8.9 m² 00 Ground Floor Radiology Crutch Store 9.3 m² 00 Ground Floor Radiology Reception 9.9 m² 00 Ground Floor Radiology Interview / Prep 10.0 m² 00 Ground Floor Radiology Trolley Wait 10.4 m² 00 Ground Floor Radiology Reporting m² 00 Ground Floor Radiology Patient Test 11.0 m² 00 Ground Floor Radiology Reporting m² 00 Ground Floor Radiology Ultrasound 16.5 m² 00 Ground Floor Radiology Proc & View 16.6 m² 00 Ground Floor Radiology Control Room 18.1 m² 00 Ground Floor Radiology MRI Equip. (Shell) 18.9 m² 00 Ground Floor Radiology Waiting 27.4 m² 00 Ground Floor Radiology X-Ray m² 00 Ground Floor Radiology X-Ray m² 00 Ground Floor Radiology X-Ray m² 00 Ground Floor Radiology Scanner Room MRI (Shell) 42.1 m² 00 Ground Floor Radiology Scanner Room CT 44.0 m² 00 Ground Floor Radiology Corridor m² 00 Ground Floor Radiology Corridor m²

154 00 Ground Floor Radiology Corridor m² Total net department room area m² 00 Ground Floor Relatives Acc WC 4.2 m² 00 Ground Floor Relatives Body Viewing Room m² 00 Ground Floor Relatives Body Viewing Room m² 00 Ground Floor Relatives Relatives Room m² 00 Ground Floor Relatives Corr m² 00 Ground Floor Relatives Relatives Room m² Total net department room area 71.4 m² 00 Ground Floor Resus Trolley bay 1.7 m² 00 Ground Floor Resus Staff WC 2.9 m² 00 Ground Floor Resus Nair Store 7.4 m² 00 Ground Floor Resus UPS/IPS 9.1 m² 00 Ground Floor Resus Resus/Waiting 9.5 m² 00 Ground Floor Resus Dirty Utility 10.6 m² 00 Ground Floor Resus Clean Utility 14.3 m² 00 Ground Floor Resus Corridor m² 00 Ground Floor Resus Resus m² 00 Ground Floor Resus Corr m² 00 Ground Floor Resus Resuscitation room : 2 Bay 53.6 m² 00 Ground Floor Resus Resuscitation room: 4 Bay m² Total net department room area m² 00 Ground Floor Services DB Cup 1.0 m² 00 Ground Floor Services DB Cup 1.6 m² 00 Ground Floor Services DB Cup 2.5 m² 00 Ground Floor Services DB Cup 2.7 m² 00 Ground Floor Services DB Cup 2.9 m² 00 Ground Floor Services Riser 4.1 m² 00 Ground Floor Services Riser 7.4 m² 00 Ground Floor Services Riser 10.4 m² 00 Ground Floor Services Riser 11.7 m² 00 Ground Floor Services Riser 11.7 m² Total net department room area 70.8 m² Total nett floor area m² Total Gross Internal floor area m² 01 First Floor Administration Store 8.1 m² 01 First Floor Administration Single Office m² 01 First Floor Administration Single Office m² 01 First Floor Administration Single Office m² 01 First Floor Administration Single Office m² 01 First Floor Administration 2 Person Office m² 01 First Floor Administration 2 Person Office m² 01 First Floor Administration 2 Person Office 16.8 m² 01 First Floor Administration Office x4 Touch 27.3 m² 01 First Floor Administration Major Incident / Meeting Room 36.4 m² 01 First Floor Administration Office x8 Place 38.7 m² 01 First Floor Administration Staff Rest Room 41.9 m² 01 First Floor Administration Office x8 Touch 42.8 m² 01 First Floor Administration Corridor m² 01 First Floor Administration Seminar Room 44.2 m² 01 First Floor Administration Office x8 Touch 45.9 m² 01 First Floor Administration Corridor m² Total net department room area m² 01 First Floor Circulation Lift m² 01 First Floor Circulation Lift m² 01 First Floor Circulation Lift m² 01 First Floor Circulation Lift m² 01 First Floor Circulation Stair 2 lobby 10.5 m² 01 First Floor Circulation Stair 1 Lobby 10.8 m² 01 First Floor Circulation Lift Lobby 20.8 m² 01 First Floor Circulation Stair 3 Lobby 25.8 m² 01 First Floor Circulation Stair m² 01 First Floor Circulation Stair m² 01 First Floor Circulation Stair m² 01 First Floor Circulation Link Corr m² 01 First Floor Circulation Corridor 60.6 m² Total net department room area m² 01 First Floor Clinical Decisions Unit Resus 2.3 m² 01 First Floor Clinical Decisions Unit Equip. 2.3 m² 01 First Floor Clinical Decisions Unit WC 2.4 m²

155 01 First Floor Clinical Decisions Unit WC 2.4 m² 01 First Floor Clinical Decisions Unit Disposal Hold 7.5 m² 01 First Floor Clinical Decisions Unit En-Suite 7.6 m² 01 First Floor Clinical Decisions Unit En-Suite 7.6 m² 01 First Floor Clinical Decisions Unit Linen 7.6 m² 01 First Floor Clinical Decisions Unit En-Suite 8.1 m² 01 First Floor Clinical Decisions Unit En-Suite 8.1 m² 01 First Floor Clinical Decisions Unit Cleaners 8.1 m² 01 First Floor Clinical Decisions Unit Dirty Utility 11.4 m² 01 First Floor Clinical Decisions Unit Store 11.6 m² 01 First Floor Clinical Decisions Unit Clean Utility 14.0 m² 01 First Floor Clinical Decisions Unit Interview/ Crisis 15.8 m² 01 First Floor Clinical Decisions Unit Team Base 17.8 m² 01 First Floor Clinical Decisions Unit Pantry 19.2 m² 01 First Floor Clinical Decisions Unit Single Bed m² 01 First Floor Clinical Decisions Unit Single Bed m² 01 First Floor Clinical Decisions Unit 4 Bay Ward m² 01 First Floor Clinical Decisions Unit 4 Bay Ward m² 01 First Floor Clinical Decisions Unit Corridor m² Total net department room area m² 01 First Floor Outpatient Clinic WC 2.9 m² 01 First Floor Outpatient Clinic Equipment Bay 3.1 m² 01 First Floor Outpatient Clinic Acc WC 4.2 m² 01 First Floor Outpatient Clinic Cleaners 7.7 m² 01 First Floor Outpatient Clinic Patient Test 8.9 m² 01 First Floor Outpatient Clinic Clean Utility 9.1 m² 01 First Floor Outpatient Clinic Dirty Utility 10.7 m² 01 First Floor Outpatient Clinic Disposal Hold 11.2 m² 01 First Floor Outpatient Clinic Cons. Ex m² 01 First Floor Outpatient Clinic Cons. Ex m² 01 First Floor Outpatient Clinic Cons. Ex m² 01 First Floor Outpatient Clinic Cons. Ex m² 01 First Floor Outpatient Clinic Cons. Ex m² 01 First Floor Outpatient Clinic Cons. Ex m² 01 First Floor Outpatient Clinic Treatment 18.8 m² 01 First Floor Outpatient Clinic Reception 19.6 m² 01 First Floor Outpatient Clinic Corridor m² 01 First Floor Outpatient Clinic Combined Waiting (Outpatient) 96.1 m² Total net department room area m² 01 First Floor Services DB Cup 1.4 m² 01 First Floor Services DB Cup 2.5 m² 01 First Floor Services DB Cup 2.7 m² 01 First Floor Services DB Cup 2.7 m² 01 First Floor Services Riser 4.1 m² 01 First Floor Services IT Hub 7.4 m² 01 First Floor Services Riser 7.4 m² 01 First Floor Services IT Hub 9.3 m² 01 First Floor Services Riser 10.9 m² 01 First Floor Services Riser 12.4 m² Total net department room area 60.9 m² 01 First Floor Shell Space Shell Space 49.8 m² 01 First Floor Shell Space Shell Space 60.2 m² 01 First Floor Shell Space Corridor 71.7 m² 01 First Floor Shell Space Shell Space 97.0 m² 01 First Floor Shell Space Shell Space m² 01 First Floor Shell Space Shell Space m² Total net department room area m² 01 First Floor Staff Change WC 2.6 m² 01 First Floor Staff Change Shower 2.7 m² 01 First Floor Staff Change Shower 2.7 m² 01 First Floor Staff Change WC 3.0 m² 01 First Floor Staff Change Acc WC 4.2 m² 01 First Floor Staff Change Acc WC 4.2 m² 01 First Floor Staff Change Acc WC 4.2 m² 01 First Floor Staff Change Lobby 4.9 m² 01 First Floor Staff Change Lobby 5.1 m² 01 First Floor Staff Change Acc. Shower 5.5 m² 01 First Floor Staff Change Acc. Shower 5.5 m² 01 First Floor Staff Change Female Staff Room 49.4 m² 01 First Floor Staff Change Male Staff 52.7 m² Total net department room area m² 01 First Floor Therapies Assessment Ice Machine Room 2.1 m² 01 First Floor Therapies Assessment Therapies St 8.1 m² 01 First Floor Therapies Assessment Admin 8.7 m²

156 01 First Floor Therapies Assessment Therapies Treatment 16.9 m² 01 First Floor Therapies Assessment Therapies Treatment 17.0 m² 01 First Floor Therapies Assessment Corridor 19.8 m² Total net department room area 72.6 m² Total nett floor area m² Total Gross Internal floor area m² 02 Second Floor Circulation Lift m² 02 Second Floor Circulation Lift m² 02 Second Floor Circulation Lift m² 02 Second Floor Circulation Lift m² 02 Second Floor Circulation Stair 2 Lobby 10.5 m² 02 Second Floor Circulation Stair 1 Lobby 10.8 m² 02 Second Floor Circulation Lift 1/2 Lobby 21.2 m² 02 Second Floor Circulation Stair 3 Lobby 25.8 m² 02 Second Floor Circulation Stair m² 02 Second Floor Circulation Stair m² 02 Second Floor Circulation Stair m² Total net department room area m² 02 Second Floor Services DB Cup 1.4 m² 02 Second Floor Services DB Cup 2.5 m² 02 Second Floor Services DB Cup 2.7 m² 02 Second Floor Services DB Cup 2.8 m² 02 Second Floor Services Riser 4.1 m² 02 Second Floor Services Riser 7.4 m² 02 Second Floor Services Riser 11.0 m² 02 Second Floor Services Riser 11.7 m² Total net department room area 43.7 m² 02 Second Floor Shell Space Shell Space m² Total net department room area m² Total nett floor area m² Total Gross Internal floor area m² 03 Third Floor Circulation Lift m² 03 Third Floor Circulation Stair 1 Lobby 10.8 m² 03 Third Floor Circulation Lobby 17.9 m² 03 Third Floor Circulation Stair m² Total net department room area 70.5 m² 03 Third Floor Services Vacuum 28.3 m² 03 Third Floor Services Compressor 28.8 m² 03 Third Floor Services Gas Manifold Room 51.5 m² 03 Third Floor Services Plant Room m² Total net department room area m² Total nett floor area m² Total Gross Internal floor area m² Total Gross Internal floor area of main building m² 00 Ground Floor * Note. Refurbishment of existing facilities Main Entrance Feeding Room 4.6 m² Total Gross Internal floor area of main building inc. * m² 01 First Floor Roof Roof 59.9 m² 01 First Floor Roof Roof 99.5 m² Total Gross External floor area m² 02 Second Floor Roof Roof 53.9 m² 02 Second Floor Roof Roof m² 02 Second Floor Roof Roof m² Total Gross External floor area m² 03 Third Floor Roof AREA FOR PV PANELS m² 03 Third Floor Roof Roof m² Total Gross External floor area m² 04 Roof Roof Stair 1 Roof 43.9 m² 04 Roof Roof Roof m² Total Gross External floor area m² Sub-station Ground Services HV Switchgear 15.3 m²

157 Sub-station Ground Services Transformer 15.6 m² Sub-station Ground Services Transformer 15.6 m² Sub-station Ground Services Ex Tugway Access 20.3 m² Sub-station Ground Services LV Switchgear 40.9 m² Sub-station Ground Services Generator 41.0 m² Sub-station Ground Services Oil Tank 51.3 m² Total nett floor area Total Gross Internal floor area m² 00 Ground Floor Services LV Switchboard 26.4 m² Total Gross Internal floor area 26.4 m² Total Gross Internal floor area of substation and LV Switch (Construction part of enabling works package) m²

158 4c BREEAM Pre-assessment 2 Results

159 New urgent and Emergency Care Centre New Cross Hospital, Wolverhampton BREEAM New Construction 2011 Pre assessment Mark Pendry Gleeds Advisory Town Centre House Merrion Centre Leeds LS2 8ND Tel: Mob: Version: 10_01 Date: 26/02/2014

160 BREEAM New Construction 2011 Pre-assessment Report Client: Project: Gleeds Project Number: The Royal Wolverhampton NHS Trust New Urgent and Emergency Care Centre GASA0066 Date of Report: 26th February 2014 Prepared by: Mark Pendry - Associate Reviewed by: Richard Tucker - Senior Revision History Issue Date Reason for Change 1_0 10/10/2012 n/a - First issue 2_0 21/02/2012 Updated Assessment 3_0 05/03/2012 Updated Assessment to Support OBC 4_0 07/04/2013 Updated Assessment 5_0 14/06/2013 Updated Assessment 6_0 11/07/2013 Updated Assessment 7_0 24/08/2013 Updated Assessment 8_0 20/10/2013 Updated Assessment (Riba D) 8_1 23/10/2013 Updated (post DTM) 9_0 17/01/2014 Updated Assessment 9_1 06/02/2014 Updated Assessment (Kier in place) 10_0 24/02/2014 Updated Assessment - post review

161 BREEAM New Construction 2011 Pre-assessment Report Project Name: Client: New Urgent and Emergency Care Centre The Royal Wolverhampton NHS Trust OVERVIEW Performance Summary: % Required Rating: EXCELLENT 70% Predicted Rating EXCELLENT 75.9 Commentary: The following document provides an overview of the progress of the new emergency centre against BREEAM. The building will be a three storey building hosting a range of medical functions. BREEAM is a method of benchmarking the environmental performance of a building, and involves assessing a building against a range of environmental criteria ranging from Biodiversity through to Energy Performance. At present the Royal Wolverhampton Hospitals NHS Trust is proposing to achieve a BREEAM EXCELLENT rating for the Emergency Portal building. This requires more than 70% of BREEAM credits to be achieved. It also requires a number of mandatory requirements to be met for certain credits (e.g. 6 credits or more must be achieved under Credit Ene 01). The building has been reviewed during a number of design development meetings and through BREEAM specific workshops. These meetings have involved input from representatives of the Trust, from Kier (the Contractor), Keppie (the Architects and Landscape Architects), Arup (the M&E Consultant), Ramboll (the Structural, Civils, Ecology and Acoustic Consultants), Faithful and Gould (the Cost Managers) and Rona Harper Associates (the CDM co-ordinator). Mark Pendry of Gleeds has been the represented BREEAM Assessor. Mark is also a BREEAM Accredited Professional Threshold for Excellent Not Sought, 30.8 Difficult, 3.3 During these various meetings, the scheme has been reviewed against the BREEAM New Construction Criteria, and each credit has been reviewed for its feasibilty. As a result of this each credit has been categorised as either Awarded, Targetted, Difficult or Not Sought. The results of this categorisation are detailed in the BREEAM Pre-assessment Scoring Tool contained in this report Targeted 68.5 It should be noted that the scheme is still in the design phase - and there are still a number of issues to resolve. This will mean that some credits may end up being recategorised. Kier have also now been appointed as P21+ prefered contractors - and this has changed the status of a number of credits The results of the pre-assessment are summarised in the table overleaf and the graph opposite. These show that the scheme is above the EXCELLENT threshold - by approximately 6%. 0.0 Awarded, 7.4 1

162 Scoring Breakdown Awarded Targeted Difficult Not Sought Section Total Credits Weighting Credit Value Credits % score Credits % score Credits % score Credits % score Management Health and Wellbeing Energy Transport Water Materials Waste Landuse and Ecology Pollution Innovation Total Assumptions The following assumptions have been made about the scheme so far: - Building is a Healthcare Building and forms part of a General Acute Hospital - Building will be fully fitted out - Building will not have a cold storage or laboratory facilities - Building will have soft landscaping and a lift

163 4d AEDET Results

164 Achieving Excellence Design Evaluation Toolkit (AEDET Evolution) Project details: Title Emergency Portal Phase 1 Workshop details: Location Date New Cross Hospital, Wolverhampton Results summary: A: Character and innovation of 5 scored B: Form and materials of 5 scored C: Staff and patient environment of 8 scored D: Urban and social integration of 4 scored E: Performance of 4 scored F: Engineering of 5 scored G: Construction of 7 scored H: Use of 7 scored I: Access of 7 scored J: Space of 6 scored NOTE: A filled traffic light dot [ ] in the table above indicates a valid average score, a hollow dot [ ] indicates that one or more statements have been marked as 'unable to score'.

165 IMPACT: Character and innovation Average score: 4.7 The four IMPACT sections deal with the extent to which the building creates a sense of place and contributes positively to the lives of those who use it and are its neighbours. Section A deals with the overall feeling of the building. It asks whether the building has clarity of design intention, and whether this is appropriate to its purpose. A building that scores well under this heading is likely to lift the spirits and to be seen as an exemplar of good architecture of its kind. ID Description Weighting Score Notes A.01 There are clear ideas behind the design of the building High (2) Strong agreement (5) Clear, strong ideas functionaly, good presense on site. Interested to see developing ideas A.02 The building is interesting to look at and move around in Normal (1) Fair agreement (4) Clear wayfinding internally to suit function. Entrance legible from main car park public realm in a suitable location A.03 The building projects a caring and reassuring atmosphere High (2) Fair agreement (4) Natural daylighting being maximised. Ideas to be developed further A.04 The building appropriately expresses the values of the NHS Normal (1) Virtually total agreement (6) Healing environment, clincial effectiveness A.05 The building is likely to influence future designs Normal (1) Strong agreement (5) phase 1 of the emergency dept, fits into trust masterplan Project workshop setup Results summary Form and materials

166 IMPACT: Form and materials Average score: 2.4 Section B deals with the nature of the building in terms of its overall form and materials. It is primarily concerned with how the building presents itself to the outside world in terms of its appearance and organisation. Although it deals with the materials from which the building is constructed it is not concerned with these in a technical sense but rather the way they will appear and feel throughout the life of the building. ID Description Weighting Score Notes B.01 The building has a human scale and feels welcoming Normal (1) Fair agreement (4) Materials to be developed further B.02 The design takes advantage of available sunlight and provides shelter from prevailing winds Normal (1) Fair agreement (4) Development zone on existing site. Site constraints largely dictate design. Soutehrly aspect - partially blocked by buildings - atriums included B.03 Entrances are obvious and logically positioned in relation to likely points of arrival on site Normal (1) Fair agreement (4) Patient routes good. Ambulance routes largely dictated by site constraints. B.04 The external materials and detailing appear to be of high quality Normal (1) Unable to score Currently going the options B.05 The external colours and textures seem appropriate and attractive Normal (1) Unable to score options Character and innovation Results summary Staff and patient environment

167 IMPACT: Staff and patient environment Average score: 3.6 Section C deals with how well an environment complies with best practice as indicated by the research evidence. ID Description Weighting Score Notes C.01 The building respects the dignity of patients and allows for appropriate levels of privacy and dignity Normal (1) Strong agreement (5) Large majority of private rooms within majors. Separate childrens dept - segregated from adult as soon as possible. Possibility for male female split. Separate resus bays C.02 There are good views inside and out of the building Normal (1) Fair agreement (4) Maximised views considering site constraints, atria included as part of design C.03 Patients and staff have good access to outdoors Normal (1) Fair agreement (4) Public realm. Separate staff routes from east / west corridor C.04 There are high levels of both comfort and control of comfort Normal (1) Unable to score C.05 The building is clearly understandable Normal (1) Strong agreement (5) logical functional internal layout. Wayfinding to be developed C.06 The interior of the building is attractive in appearance Normal (1) Unable to score C.07 There are good bath/toilet and other facilities for patients Normal (1) Virtually total agreement (6) C.08 There are good facilities for staff, including convenient places to work and relax without being on demand Normal (1) Strong agreement (5) Staff facilities at first floor level Form and materials Results summary Urban and social integration

168 IMPACT: Urban and social integration Average score: 5.0 Section D deals with the way the building relates to its surroundings. It asks whether the building plays a positive role in the neighbourhood whether that is urban, suburban or rural. A building that scores well is likely to improve its neighbourhood rather than detract from it. ID Description Weighting Score Notes D.01 The height, volume and skyline of the building relate well to the surrounding environment Normal (1) Virtually total agreement (6) Within acute hosptial site, inkeeping with surroundings D.02 The building contributes positively to its locality Normal (1) Fair agreement (4) D.03 The hard and soft landscape around the building contribute positively to the locality Normal (1) Strong agreement (5) D.04 The building is sensitive to neighbours and passersby Normal (1) Strong agreement (5) Inkeeping with aesthetics on site Staff and patient environment Results summary Performance

169 BUILD QUALITY: Performance Average score: 2.0 The three BUILD QUALITY sections deal with the physical components of the building rather than the spaces. This is therefore what might be thought of as the more technical and engineering aspects of the building. It asks whether the building is soundly built, will be reliable and easy to operate, last well and is sustainable. It is also concerned with the actual process of construction and the extent to which any disruption caused is minimised. Section E is concerned with the technical performance of the building during its lifetime. It asks whether the components of the building are of high quality and fit for their purpose. However we are not concerned here with how well the building functions in relation to the human use of it which belongs in another section. ID Description Weighting Score Notes E.01 The building is easy to operate Normal (1) Unable to score E.02 The building is easy to clean Normal (1) Fair agreement (4) Detail required E.03 The building has appropriately durable finishes Normal (1) Fair agreement (4) to be developed E.04 The building will weather and age well Normal (1) Unable to score Urban and social integration Results summary Engineering

170 BUILD QUALITY: Engineering Average score: 2.8 Section F is concerned with those parts of the building that are engineering systems as opposed to the main architectural features. It asks whether the engineering systems are of high quality and fit for their purpose, will be easy to operate and if they are efficient and sustainable. ID Description Weighting Score Notes F.01 The engineering systems are well designed, flexible and efficient in use Normal (1) Unable to score F.02 The engineering systems exploit any benefits from standardisation and prefabrication where relevant Normal (1) Unable to score F.03 The engineering systems are energy efficient Normal (1) Strong agreement (5) F.04 There are emergency backup systems that are designed to minimise disruption Normal (1) Strong agreement (5) HBN compliant F.05 During construction disruption to essential services is minimised Normal (1) Fair agreement (4) Stage C report minimises disruption. To be developed Performance Results summary Construction

171 BUILD QUALITY: Construction Average score: 3.3 Section G is concerned with the technical issues of actually constructing the building and with the performance of the main components. A building that scores well is likely to be constructed as quickly and easily as possible under the circumstances of the site and to offer a robust and easily maintained solution. ID Description Weighting Score Notes G.01 If phased planning and construction are necessary the various stages are well organised Normal (1) Strong agreement (5) enabling works and phases. G.02 Temporary construction work is minimised Normal (1) Strong agreement (5) G.03 The impact of the building process on continuing healthcare provision is minimised Normal (1) Strong agreement (5) specific detail to be developed G.04 The building can be readily maintained Normal (1) Fair agreement (4) to be developed G.05 The construction is robust Normal (1) Unable to score G.06 The construction allows easy access to engineering systems for maintenance, replacement and expansion Normal (1) Fair agreement (4) G.07 The construction exploits any benefits from standardisation and prefabrication where relevant Normal (1) Unable to score Engineering Results summary Use

172 FUNCTIONALITY: Use Average score: 5.1 The three FUNCTIONALITY sections deal with all those issues to do with the primary purpose or function of the building. It deals with how well the building serves these primary purposes and the extent to which it facilitates or inhibits the activities of the people who carry out the functions inside and around the building. Section H is concerned with the way the building enables the users to perform their duties and operate the healthcare systems and facilities housed in the building. To get a good score the building will be highly functional and efficient, enabling people to have enough space for their activities and to move around economically and easily in a way that relates well to the policies and objective of the Trust. A high scoring building is also likely to have some flexibility in use. ID Description Weighting Score Notes H.01 The prime functional requirements of the brief are satisfied Normal (1) Virtually total agreement (6) H.02 The design facilitates the care model of the Trust Normal (1) Strong agreement (5) capability for future phasing H.03 Overall the building is capable of handling the projected throughput Normal (1) Strong agreement (5) future workload difficult to predict - future proofed for expansion H.04 Work flows and logistics are arranged optimally Normal (1) Strong agreement (5) thorough 1:500 development at early stage H.05 The building is sufficiently adaptable to respond to change and to enable expansion Normal (1) Strong agreement (5) phase 3 expansion to west. MRI shell space at GF, shell space at first first and second floor H.06 Where possible spaces are standardised and flexible in use patterns Normal (1) Strong agreement (5) Good standardisation between minors and majors H.07 The layout facilitates both security and supervision Normal (1) Strong agreement (5) good observation from team base Construction Results summary Access

173 FUNCTIONALITY: Access Average score: 4.3 Section I focuses on the way the users of the building can come and go. It asks whether people can easily and efficiently get onto and off the site using a variety of means of transport and whether they can logically, easily and safely get into and out of the building. ID Description Weighting Score Notes I.01 There is good access from available public transport including any on-site roads Normal (1) Strong agreement (5) good existing infrastructure to site. Bus stops, cycle routes and car parking directly adjacent I.02 There is adequate parking for visitors and staff cars with appropriate provision for disabled people Normal (1) Select additional proximity spaces part of project I.03 The approach and access for ambulances is appropriately provided Normal (1) Fair agreement (4) site constraints I.04 Goods and waste disposal vehicle circulation is good and segregated from public and staff access where appropriate Normal (1) Fair agreement (4) existing routes to be utilised I.05 Pedestrian access routes are obvious, pleasant and suitable for wheelchair users and people with other disabilities / impaired sight Normal (1) Fair agreement (4) I.06 Outdoor spaces are provided with appropriate and safe lighting indicating paths, ramps and steps Normal (1) Strong agreement (5) development required I.07 The fire planning strategy allows for ready access and egress Normal (1) Fair agreement (4) to be developed Use Results summary Space

174 FUNCTIONALITY: Space Average score: 4.8 Section J concentrates on the amount of space in the building in relation to its purpose. It asks if this space is well located and efficient and whether people can move around in it efficiently and with dignity. ID Description Weighting Score Notes J.01 The design achieves appropriate space standards Normal (1) Strong agreement (5) J.02 The ratio of usable space to the total area is good Normal (1) Strong agreement (5) J.03 The circulation distances travelled by staff, patients and Normal (1) Strong agreement (5) efficient as possible due to site constraints visitors are minimised by the layout J.04 Any necessary isolation and segregation of spaces is achieved Normal (1) Strong agreement (5) J.05 The design makes appropriate provision for gender segregation Normal (1) Strong agreement (5) J.06 There is adequate storage space Normal (1) Fair agreement (4) Additonal storage at first floor Access Results summary

175 4e Equality Impact Assessment

176 RWHT Equality Impact Assessment Initial General Screening of Policy/Strategy Pro Forma Completion Guidance: Please ensure that all the questions on the pro-forma are completed and that written evidence is provided. Should you have any problems when filling out this pro-forma then please contact the Equality and Diversity Department. Policy* Number (if applicable) Name of policy * State type of *policy e.g., policy, business case, leaflet etc Aim of policy * Not applicable Emergency Department new build / services Business Case To provide phase 1 of a new Emergency Centre which includes Emergency Department, Satellite Radiology, Clinical Decisions Unit, Paediatric Assessment Unit and other clinical support accommodation Name of Accountable Director Dr Jonathan Odum Name of Responsible person/people Medical Director Project Sponsor, Head of Estates Development Technical Lead Assessment Carried out by:- Name Jane McKiernan, Louise Landucci, Carolyn Robinson Department Emergency Centre Project, Project Board Members Tele Date of Synopsis of * project / procedure or attach policy Equality Impact Assessment 1. Does the policy* target or exclude any Personal Protected Characteristics (PPCs)? Age NO Please provide an Disability NO explanation for your Gender / Sex NO answer below and * Policy includes; strategies, procedures, processes, projects, functions, services, leaflets, posters, guidance, guidelines and most business cases U:\OBC\Emergency Centre Project Board\OBC 2012\Appendices\Appendix 8b Equality Impact Assessment.doc - 1 -

177 Gender Reassignment NO evidence as appropriate Please delete YES / NO as appropriate Marriage and Civil Partnership NO Pregnancy and Maternity NO Race (incl Ethnicity) NO Religion, Belief or Spirituality NO Sexual Orientation NO Any Other e.g. Socio Economic Status NO The emergency department is aimed to be accessible to anyone who needs to use the service/premises. 2. Does the policy* affect any of the Personal Protected Characteristics (PPCs) disproportionately? Age NO Please provide evidence Disability Yes for your answer below Gender / Sex NO Gender Reassignment NO As an Emergency Marriage and Civil Partnership NO Portal, likely to have Pregnancy and Maternity NO increased proportion of Race (incl Ethnicity) No vulnerable groups attending including Religion, Belief or Spirituality NO those with a disability Sexual Orientation NO Any Other e.g. Socio Economic Status NO * Policy includes; strategies, procedures, processes, projects, functions, services, leaflets, posters, guidance, guidelines and most business cases U:\OBC\Emergency Centre Project Board\OBC 2012\Appendices\Appendix 8b Equality Impact Assessment.doc - 2 -

178 As no.1, however, there are some areas that may have a potential disproportionate affect e.g, DISABLITY : The new build will be built to accommodate people with disabilities. Lift access is available throughout the building. All areas will be accessible to wheelchairs. The building will be built to latest building regulations, Health Technical Memoranda and Health Building Notes. Accessible WC s will be available throughout the building. Audio and visual alarms and notifications will be provided for people with hearing and visual impairment although the exact nature of these is yet to be determined in the detailed design of the building. Use of colour and design will be used as a wayfinding aid for all users of the department. Accessible parking and drop off will be provided adjacent to the new Emergency Department. Reasonable adjustments will be put into place for all disabilities where possible. Mental Health and Learning Disabilities : there are a specific team/staff to support patients with mental health disabilities/assessments and learning disabilities. RACE : Interpreting and translation will be provided on request. Religion and belief : where patients request a specific gender of clinician this will be facilitated. 3. Are there barriers which could inhibit access to the benefits of the policy*? e.g. Communication/information, physical access, location, sensitivity etc. Yes, there could be communication problems e.g., language barriers for people with little or no English, people with a hearing impairment, people with a visual impairment, people with Dyslexia. Staff should be undertaking mandatory training to ensure they are aware of services available e.g., interpretation and translation services, customer care training. Please provide evidence for your answer 4. Does the policy* give people with Personal Protected Characteristics (PPC s) the same choices as everybody else? Yes. The emergency department is aimed to be accessible to anyone who needs to use the service/premises. Please provide evidence for your answer 5. What evidence has Demographic data and other statistics, including census findings Recent research findings including studies of deprivation * Policy includes; strategies, procedures, processes, projects, functions, services, leaflets, posters, guidance, guidelines and most business cases Please provide any evidence U:\OBC\Emergency Centre Project Board\OBC 2012\Appendices\Appendix 8b Equality Impact Assessment.doc - 3 -

179 been used to make these judgements? Please tick 1 or more in column 3 Results of recent consultations and surveys Results of ethnic monitoring data and any equalities data from the local authority / PCT Information from groups and agencies within Wolverhampton Comparisons between similar functions / policies Analysis of PALS, complaints and public enquires information Analysis of audit reports and reviews that you feel may be appropriate This new build is to improve current services, car parking may be an issue. The Trust has held 2 public engagement sessions, in the Wolverhampton Medical Institute, to outline and inform a number of parties on the proposals for the new Emergency Portal. The sessions were held on 18 th February and 11 th March, and took place during the evening to encourage attendance (i.e. out of core working hours ). The sessions offered the Trust Management Team an opportunity to share with attendee s, via a PowerPoint presentation, proposals on portal location, department zones and discuss patient journeys through the portal. They also gave attendee s the opportunity to express their thoughts and raise questions on the development and its impact on the site/ patients, and also offer areas for consideration as the design progresses. Attendees at the sessions included; Local Neighbourhood Partnership (LNP) meetings, New Cross Patients Association, LINk (now known as Healthwatch ), Wolverhampton City CCG, Express & Star, Local Residents, West Midlands Ambulance Service, PPG, DAGLA, League of Friends (WEI) and Age UK. Details were taken of all participants to enable engagement in future workshops, as applicable. 6. How is the effect of the policy* on people with Personal Protected Age Collected Please provide Disability Gender / Sex Gender Reassignment evidence for your answer * Policy includes; strategies, procedures, processes, projects, functions, services, leaflets, posters, guidance, guidelines and most business cases U:\OBC\Emergency Centre Project Board\OBC 2012\Appendices\Appendix 8b Equality Impact Assessment.doc - 4 -

180 Characteristics (PPCs) going to be monitored? Please specify for each PPC Marriage and Civil Partnership Pregnancy and Maternity Race (including Ethnicity) Religion, Belief or Spirituality Sexual Orientation Any Other e.g. Socio Economic Status Collected Collected Collected PPC data is collected where indicated. PALS and Complaints data is captured and recorded against PPC s. No monitoring undertaken as yet to see if there is a higher proportion of a PPC not able to gain access to the service. Information is sent to various committees as part of reporting. Counters are used as a mechanism for feeding back. Impact Group Level of Impact Evidence 7. What level of Age Low level Impact can be rectified by small actions being taken Please provide evidence for your impact will this answer policy* have? Please tick one or more in column 4 High level / Adverse Impact Impact cannot be rectified without significant changes to the *policy or strategy Disability Low level - Impact can be rectified by small actions being taken High level / Adverse Impact Impact cannot be rectified without significant changes to the *policy or strategy Gender / Sex Gender Low level - Impact can be rectified by small actions being taken High level / Adverse Impact Impact cannot be rectified without significant changes to the *policy or strategy Low level - Impact can be rectified by small actions being taken * Policy includes; strategies, procedures, processes, projects, functions, services, leaflets, posters, guidance, guidelines and most business cases U:\OBC\Emergency Centre Project Board\OBC 2012\Appendices\Appendix 8b Equality Impact Assessment.doc - 5 -

181 Reassignment Marriage and Civil Partnership Pregnancy and Maternity High level / Adverse Impact Impact cannot be rectified without significant changes to the *policy or strategy Low level - Impact can be rectified by small actions being taken High level / Adverse Impact Impact cannot be rectified without significant changes to the *policy or strategy Low level Impact can be rectified by small actions being taken High level / Adverse Impact Impact cannot be rectified without significant changes to the *policy or strategy Race (incl Ethnicity) Low level Impact can be rectified by small actions being taken High level / Adverse Impact Impact cannot be rectified without significant changes to the *policy or strategy Religion or Belief or Spirituality Sexual Orientation Any Other e.g. Socio Economic Status Low level Impact can be rectified by small actions being taken High level / Adverse Impact Impact cannot be rectified without significant changes to the *policy or strategy Low level Impact can be rectified by small actions being taken High level / Adverse Impact Impact cannot be rectified without significant changes to the *policy or strategy Low level Impact can be rectified by small actions being taken High level / Adverse Impact Impact cannot be rectified without significant changes to the *policy or strategy High level / Adverse Impact Impact cannot be rectified without significant changes to the policy or strategy Full Impact Assessment required No impact on any of the PPC s as the department is aimed to be accessible for all. See point 3 above possible communication problems e.g., language barriers for people with little or no English, people with a hearing impairment, people with a visual impairment, people with Dyslexia. This should be addressed with mandatory staff training. * Policy includes; strategies, procedures, processes, projects, functions, services, leaflets, posters, guidance, guidelines and most business cases U:\OBC\Emergency Centre Project Board\OBC 2012\Appendices\Appendix 8b Equality Impact Assessment.doc - 6 -

182 Actions Please give details of the actions you will take to address the issues highlighted in this assessment and when you will complete them by Personal Protected Characteristics (PPCs) All Disability RACE : Interpreting and translation Religion and belief : specific gender of clinician Action Lead Person Timescale Ensure staff are up to date with mandatory training ensuring staff know where to access interpreting, translation, mental health and learning disability services / support To provide reasonable adjustments where possible To provide interpreter services (verbal) and translation (written) on request To provide a specific gender of clinician where requested TBA TBA TBA TBA Ongoing Ongoing Onoing Ongoing Date of completion : Additional Information Please put in an additional information that you think may be relevant to the Equality Impact Assessment Send Completed EIA pro-forma (remove first page) to : Equality and Diversity Officer Rwh-tr.EqualityandDiversity@nhs.net (Patient Experience Team) and Governance Secretary, New Cross Hospital with corresponding documents for publication on the Website. * Policy includes; strategies, procedures, processes, projects, functions, services, leaflets, posters, guidance, guidelines and most business cases U:\OBC\Emergency Centre Project Board\OBC 2012\Appendices\Appendix 8b Equality Impact Assessment.doc - 7 -

183 4f Project Programme

184 URGENT AND EMERGENCY CARE CENTRE PROJECT UECCP/CR/ ID Task Name Duration Start Finish Predecessors Sep '13 Oct '13 Nov '13 Dec '13 Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14 Sep '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15 Sep '15 Oct '15 Nov '15 Dec '15 Jan '16 Feb '16 Mar '16 Apr '16 May '16 Jun '16 Jul ' PROGRAMME FROM FBC APPROVAL TO OPERATIONAL FACILITY 1075 days Mon 07/01/13 Fri 17/02/17 2 BUSINESS CASE APPROVALS 171 days Thu 19/09/13 Thu 15/05/14 3 SOC Approval (NHS TDA) 0 days Thu 19/09/13 Thu 19/09/13 19/09 4 OBC Approval (NHS TDA) 0 days Thu 23/01/14 Thu 23/01/ /01 5 FBC Approval (RWT WCCG) 5 days Tue 08/04/14 Mon 14/04/ FBC Review & Approval (NHS TDA) 32 days Wed 02/04/14 Thu 15/05/ DH GATEWAY REVIEW 223 days Wed 04/12/13 Fri 10/10/14 8 Gateway Review (2) 3 days Wed 04/12/13 Fri 06/12/13 9 Gateway Review (3) 3 days Wed 07/05/14 Fri 09/05/14 8,4 10 Gateway Review (4) 5 days Mon 06/10/14 Fri 10/10/14 9,6 11 WORKFORCE 300 days Mon 01/09/14 Fri 23/10/15 12 Review workforce models against new service pathways 60 days Mon 01/09/14 Fri 21/11/ Confirm new rotas/roles as appropriate for all identified staff groups 38 days Wed 01/10/14 Fri 21/11/14 14 Develop detailed programme for recruitment of additional staff at milestones identified 30 days Mon 24/11/14 Fri 02/01/15 4,13 15 Agree with WCCG contractural arrangements for primary care service and consequent staffing implications/employment issues 30 days Mon 13/10/14 Fri 21/11/ Identify need and develop Propsals for management of change process and associated timelines 40 days Mon 05/01/15 Fri 27/02/15 6,14,15 17 Develop new Job Descriptions and seek Deanery approval where appropriate 90 days Mon 24/11/14 Fri 27/03/ Implement management of change where/if applicable 90 days Mon 30/03/15 Fri 31/07/15 17,16 19 Implement new rotas 20 days Mon 03/08/15 Fri 28/08/ Recruit to new posts 20 wks Mon 30/03/15 Fri 14/08/ Develop programme for staff transfer to new departments 40 days Mon 31/08/15 Fri 23/10/ SERVICE RE-DESIGN 477 days Thu 23/01/14 Fri 20/11/15 23 Agree and confirm new patient and service pathways 100 days Thu 23/01/14 Wed 11/06/ Detail new patient pathways as part of operational policy 100 days Thu 12/06/14 Wed 29/10/14 4,23 25 Agree dates for implementation of new pathways 20 days Thu 30/10/14 Wed 26/11/ Detail departmental policies and protocols (clinical and non clinical) including business continuity 9 wks Mon 06/04/15 Fri 05/06/ Identify training needs and any supporting resource 40 days Thu 27/11/14 Wed 21/01/ Implement training 25 wks Mon 01/06/15 Fri 20/11/15 27,20FF 29 Implement new service models 25 wks Mon 01/06/15 Fri 20/11/15 28SS 30 COMMUNICATION AND CONSULTATION 845 days Mon 07/01/13 Fri 01/04/16 Programme from FBC Approval to Operational Facility

185 URGENT AND EMERGENCY CARE CENTRE PROJECT UECCP/CR/ ID Task Name Duration Start Finish Predecessors Sep '13 Oct '13 Nov '13 Dec '13 Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14 Sep '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15 Sep '15 Oct '15 Nov '15 Dec '15 Jan '16 Feb '16 Mar '16 Apr '16 May '16 Jun '16 Jul ' Public Consultation on Urgent and Emergency Care Strategy 65 days Tue 03/12/13 Mon 03/03/14 32 Report to Health Scrutiny Panel on outcomes of Public Consultation 1 day Thu 27/03/14 Thu 27/03/ On going stakeholder events and communication activities 133 wks Mon 07/01/13 Fri 24/07/15 34 Develop detailed programme for move of departments to new building 12 wks Mon 05/01/15 Fri 27/03/15 35 Agree communication activities for informing all stakeholders of moves/transfers 20 days Mon 06/04/15 Fri 01/05/15 36 Agree communication activities for informing GP's, WMAS etc 20 days Mon 04/05/15 Fri 29/05/ Agree communication activities for informing patients with WCCG 20 days Mon 04/05/15 Fri 29/05/ Implement Communication Plans - Notification to All Stakeholders 30 wks Mon 07/09/15 Fri 01/04/16 39 Communication with Helicopter Service 10 days Mon 04/05/15 Fri 15/05/ Ambulance Trial Runs 20 days Mon 14/09/15 Fri 09/10/15 65FS+5 days 41 Final Notification to All Trust Staff and Outside Clients and Suppliers of New Facility 26 wks Mon 05/10/15 Fri 01/04/16 42 DESIGN AND CONSTRUCTION 615 days Mon 02/09/13 Fri 08/01/16 43 Arrange and hold first patient design workshop and schedule future workshops 100 days Fri 17/01/14 Thu 05/06/14 44 Confirm detailed design for all elements including primary care, WUCTAS etc 140 days Mon 02/09/13 Fri 14/03/14 45 Planning Approval 40 days Wed 05/02/14 Tue 01/04/14 46 BREEAM interim Certificate 60 days Mon 10/02/14 Fri 02/05/14 47 Set up and schedule technical project team meetings with main contractor and involve users as appropriate 140 days Mon 02/09/13 Fri 14/03/14 48 Develop detailed construction programme and cashflow 15 days Thu 24/04/14 Wed 14/05/ Develop detailed commissioning and handover programme and interface with Equipment and IT workstreams to coordinate delivery, installation and commissioning of equipment 40 days Mon 19/01/15 Fri 13/03/15 88SS, Manage and monitor main contract delivery 72 wks Mon 02/06/14 Fri 16/10/ Project Team Meetings 84 wks Mon 02/06/14 Fri 08/01/ Manage and monitor programme and budget and report any material changes to Project Team (monthly) 84 wks Mon 02/06/14 Fri 08/01/ Agree handover procedures and training requirements for Trust Staff 30 days Mon 20/04/15 Fri 29/05/15 62,49 54 Building Works 550 days Mon 21/10/13 Fri 27/11/15 55 Manage and Monitor Enabling Works Programme 150 days Mon 21/10/13 Fri 16/05/14 56 Approval of Construction Contract 0 days Fri 16/05/14 Fri 16/05/14 5,55 16/05 57 Construction Contract Award and Agree Start on Site Date 1 day Mon 19/05/14 Mon 19/05/ Instruction to Proceed & Mobilisation 10 days Mon 19/05/14 Fri 30/05/14 6,56 59 Pre-Start Meetings 10 days Mon 19/05/14 Fri 30/05/ Start on Site 0 days Mon 02/06/14 Mon 02/06/14 59,58 02/06 Programme from FBC Approval to Operational Facility

186 URGENT AND EMERGENCY CARE CENTRE PROJECT UECCP/CR/ ID Task Name Duration Start Finish Predecessors Sep '13 Oct '13 Nov '13 Dec '13 Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14 Sep '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15 Sep '15 Oct '15 Nov '15 Dec '15 Jan '16 Feb '16 Mar '16 Apr '16 May '16 Jun '16 Jul ' Substructure 10 wks Mon 02/06/14 Fri 08/08/ Frame and Envelope 40 wks Mon 14/07/14 Fri 17/04/15 61FS-4 wks 63 Building Weather Tight 0 days Fri 23/01/15 Fri 23/01/15 62SS+28 wks 23/01 64 Power and Heat On 0 days Fri 12/06/15 Fri 12/06/15 62FS+8 wks,63 12/06 65 External Works and Ambulance Drop Off 40 wks Mon 01/12/14 Fri 04/09/15 62SS+20 wks 66 PSCP Commissioning 18 wks Mon 15/06/15 Fri 16/10/ Trust Familiarisation and Training 18 wks Mon 15/06/15 Fri 16/10/15 66SS,53 68 Trust Commissioning 30 days Mon 19/10/15 Fri 27/11/15 67,66 69 Handover of building 113 days Mon 15/06/15 Wed 18/11/15 70 Completion of Fitout including all Group 1 and Group 2 Equipment 12 wks Mon 15/06/15 Fri 04/09/ Building Services Commissioning 18 wks Mon 15/06/15 Fri 16/10/ Final Snagging and Practical Completion 6 wks Mon 07/09/15 Fri 16/10/ Final Building Verifications by Trust; Flood Testing of Services 15 days Mon 28/09/15 Fri 16/10/15 71FS-15 days 74 Building completion and handover 0 days Fri 16/10/15 Fri 16/10/ /10 75 Installation of hospital internal and external Wayfinding & Signage 23 days Mon 19/10/15 Wed 18/11/ Deep Clean 5 days Mon 19/10/15 Fri 23/10/ Installation of Group 3 Equipment 15 days Mon 26/10/15 Fri 13/11/ Final Clean 3 days Mon 16/11/15 Wed 18/11/ EQUIPMENT 586 days Mon 02/09/13 Mon 30/11/15 80 Purchased Equipment (Excluding Radiology) 578 days Mon 02/09/13 Wed 18/11/15 81 Review Equipment Schedule & Confirm Requirements 195 days Mon 02/09/13 Fri 30/05/14 82 Confirm any preferred/nominated suppliers for main contract items 30 days Mon 02/06/14 Fri 11/07/ Finalise Equipment Purchase List and Develop Specifications 40 days Mon 14/07/14 Fri 05/09/ Agree Procurement Routes for all items of Equipment and Identify Lead Times 20 days Mon 08/09/14 Fri 03/10/ Develop detailed programme for procurement of all non PFI items 20 days Mon 06/10/14 Fri 31/10/ Arrange any trials/visits to view equipment etc prior to purchase 40 days Mon 03/11/14 Fri 26/12/ Agree Delivery, Installation and Commissioning Programme with Medical Physics and Design Lead 15 days Mon 29/12/14 Fri 16/01/15 86,84 88 Agree Delivery and Installation Plan with PSCP and Vendors 15 days Mon 19/01/15 Fri 06/02/ Place Orders for Purchase of Equipment 95 days Mon 03/11/14 Fri 13/03/15 88FF,85 90 Monitor spend against budget and report any material changes to project team(monthly) 42 wks Mon 03/11/14 Fri 21/08/15 89SS Programme from FBC Approval to Operational Facility

187 URGENT AND EMERGENCY CARE CENTRE PROJECT UECCP/CR/ ID Task Name Duration Start Finish Predecessors Sep '13 Oct '13 Nov '13 Dec '13 Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14 Sep '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15 Sep '15 Oct '15 Nov '15 Dec '15 Jan '16 Feb '16 Mar '16 Apr '16 May '16 Jun '16 Jul ' Site Surveys and Verification of Building Services for Equipment Installation 5 days Mon 02/09/13 Fri 06/09/13 92 Arrange Storage Facilities for Delivery of New Items of Equipment 40 days Mon 16/03/15 Fri 08/05/ Install, Commission and Validate Purchased Equipment on Ground and First Floor 20 days Mon 19/10/15 Fri 13/11/15 92,90,74 94 Formulate Standard Operating Procedures 95 days Mon 08/06/15 Fri 16/10/ Carry Out Staff Operator Training 23 days Mon 19/10/15 Wed 18/11/15 93SS,94 96 Radiology 383 days Mon 02/06/14 Wed 18/11/15 97 Confirm items, with outline specifications, to be procured through radiology PFI 50 days Mon 02/06/14 Fri 08/08/14 98 Agree Specification for Radiology Equipment 60 days Mon 11/08/14 Fri 31/10/ Develop detailed programme for procurement of PFI equipment (radiology) 25 days Mon 03/11/14 Fri 05/12/ Confirm Building Services Requirement with PSCP 10 days Mon 03/11/14 Fri 14/11/14 99SS 101 Internal Trust Approval for Procurement of Radiology Equipment 25 days Mon 08/12/14 Fri 09/01/ Agree Programme for Installation with PSCP 10 days Mon 12/01/15 Fri 23/01/ Place Order for Radiology 5 days Mon 26/01/15 Fri 30/01/ Site Surveys and Verification of Building Services 5 days Mon 31/08/15 Fri 04/09/ Install, Commission and Validate Radiology Equipment on Ground Floor 30 days Mon 07/09/15 Fri 16/10/ Formulate Standard Operating Procedures 90 days Mon 08/06/15 Fri 09/10/15 103, Carry Out Staff Operator Training 23 days Mon 19/10/15 Wed 18/11/15 106, Transferred Equipment 446 days Mon 17/03/14 Mon 30/11/ Agree Decant Management Team 20 days Fri 16/05/14 Thu 12/06/ Confirm items of existing ED equipment for transfer 60 days Mon 17/03/14 Fri 06/06/ Identify Equipment with Particular Decant Requirements 60 days Mon 17/03/14 Fri 06/06/ Identify programme for moving any transferred equipment 60 days Mon 17/03/14 Fri 06/06/ Identify, Locate and Bar Code all Medical Equipment for Transfer 30 days Fri 13/06/14 Thu 24/07/14 110, Indentify Equipment to be Decommissioned for Disposal 30 days Fri 25/07/14 Thu 04/09/ Appoint a Move Manager to Detail-Plan the Decant 30 days Mon 06/07/15 Fri 14/08/ Agree and Write Detailed Procedures for Moving Critical Activities 15 days Mon 17/08/15 Fri 04/09/15 115, Agree and Write Detailed Move Plans for Each Significant Item of Equipment 20 days Mon 07/09/15 Fri 02/10/ Arrange for Any Hire of Temporary Equipment 10 days Mon 07/09/15 Fri 18/09/15 117SS 119 Place Any Orders with Specialist Suppliers to Move Their Own Equipment 15 days Mon 21/09/15 Fri 09/10/ Appoint Removals Contractor for the Decant 30 days Mon 06/07/15 Fri 14/08/15 115SS Programme from FBC Approval to Operational Facility

188 URGENT AND EMERGENCY CARE CENTRE PROJECT UECCP/CR/ ID Task Name Duration Start Finish Predecessors Sep '13 Oct '13 Nov '13 Dec '13 Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14 Sep '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15 Sep '15 Oct '15 Nov '15 Dec '15 Jan '16 Feb '16 Mar '16 Apr '16 May '16 Jun '16 Jul ' Agree Emergency Arrangements 12 days Mon 12/10/15 Tue 27/10/15 120,117, Final Briefings Prior to Each Move 5 days Wed 28/10/15 Tue 03/11/ Install, Commission and Validate Transferred Equipment on Ground and First Floor 19 days Wed 04/11/15 Mon 30/11/ ICT 580 days Mon 02/09/13 Fri 20/11/ Confirm IT stategy and specification for new emergency centre (all departments) 40 days Mon 14/04/14 Fri 06/06/ Confirm interface requirements for primary care with WCCG 40 days Mon 14/04/14 Fri 06/06/ Confirm and identify all hardware for transfer as appropriate 20 days Mon 09/06/14 Fri 04/07/ Develop detailed specifications for IT requirements 60 days Mon 07/07/14 Fri 26/09/ Agree procurement routes for all IT items and identify lead times 40 days Mon 29/09/14 Fri 21/11/ Develop detailed programme for procurement 20 days Mon 24/11/14 Fri 19/12/ Place orders 100 days Mon 05/01/15 Fri 22/05/ Identify implementation programme for any new software 30 days Mon 29/09/14 Fri 07/11/ Identify any training requirements and develop detailed programme for delivery 20 days Mon 10/11/14 Fri 05/12/14 128, Agree delivery, installation and commissioning programme with suppliers, design lead and main contractor 5 days Mon 02/09/13 Fri 06/09/ Monitor spend against budget and report any material changes to project team (monthly) 230 days Mon 05/01/15 Fri 20/11/15 131SS 136 MAJOR INCIDENTS ARRANGEMENTS 390 days Mon 02/06/14 Fri 27/11/ Discuss Procedures with Emergency Planning Team 13 wks Mon 02/06/14 Fri 29/08/ Confirm new Location for Decontainer 5 days Mon 01/09/14 Fri 05/09/ Develop & Agree new Major Incident Plan 13 wks Mon 08/09/14 Fri 05/12/ Share Plan with Stakeholders including WMAS 13 wks Mon 08/12/14 Fri 06/03/ Train Staff on New Major Incident Plan 13 wks Mon 09/03/15 Fri 05/06/ Agree Arrangements for Decontainer Move with Business Continuity Manager and PSCP 10 days Mon 08/12/14 Fri 19/12/ Move and Commission Decontainer 5 days Mon 23/11/15 Fri 27/11/15 142, DECANT and GO-LIVE in NEW BUILDING 435 days Mon 22/06/15 Fri 17/02/ Brief Staff on Decant Procedures 10 days Mon 05/10/15 Fri 16/10/15 115, Provide Shredding Equipment and Skips for Obsolete Equipment 90 days Mon 22/06/15 Fri 23/10/ Deliver Crates & Packing Materials 10 days Mon 05/10/15 Fri 16/10/15 115, Arrange Back Up from Alternative A&E Providers for Support If Required 10 days Mon 06/07/15 Fri 17/07/15 115SS 149 Contact Equipment Manufacturers to Confirm Assistance with Relocation 5 days Mon 07/09/15 Fri 11/09/ Agree Support from IM&T During Move 5 days Mon 07/09/15 Fri 11/09/ Programme from FBC Approval to Operational Facility

189 URGENT AND EMERGENCY CARE CENTRE PROJECT UECCP/CR/ ID Task Name Duration Start Finish Predecessors Sep '13 Oct '13 Nov '13 Dec '13 Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14 Sep '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15 Sep '15 Oct '15 Nov '15 Dec '15 Jan '16 Feb '16 Mar '16 Apr '16 May '16 Jun '16 Jul ' Agree Suppport from Facilities Staff during Move 5 days Mon 07/09/15 Fri 11/09/ Agree E&FM Disaster Recovery Plans 5 days Mon 07/09/15 Fri 11/09/ Agree Support from Medical Physics during Move 5 days Mon 07/09/15 Fri 11/09/ Agree Support from Pathology during Move 5 days Mon 07/09/15 Fri 11/09/ Agree Standby Support from PSCP and Services Subcontractor during Move 10 days Mon 07/09/15 Fri 18/09/ Agree Standby Support from Lift Suppliers during Move 10 days Mon 07/09/15 Fri 18/09/ Agree Support from M&E Design Engineer during Move 5 days Mon 07/09/15 Fri 11/09/ Arrange for Re-Routing of Pneumatic Tube System 5 days Mon 07/09/15 Fri 11/09/ Arrange for, and Hire, Temporary Equipment 10 days Mon 04/01/16 Fri 15/01/16 166SS, Decant Non-Critical Staff and FF&E 5 days Mon 13/02/17 Fri 17/02/17 178FS+10 days 161 Verify that All Preparations are Complete - Commit to Full Service Decant for ED, CDU, Radiology and support areas 3 days Wed 20/01/16 Fri 22/01/16 170FS+2 days 162 Transfer ED, CDU, Review Clinic & Staff Areas 5 days Mon 30/11/15 Fri 04/12/ Transfer direct referrals from GP's to AMU to new U&ECC 5 days Mon 01/02/16 Fri 05/02/ Transfer Walk In Patients to new U&ECC 1 day Fri 01/04/16 Fri 01/04/ POST-DECANT 40 days Mon 07/12/15 Fri 29/01/ Crate Collection 20 days Mon 04/01/16 Fri 29/01/ Back-Check Vacated Building to Ensure Left in Safe Condition 5 days Mon 07/12/15 Fri 11/12/ Clinical Clean All Vacated Areas 5 days Mon 14/12/15 Fri 18/12/ Suppliers Decommission and remove Radiology Equipment 10 days Mon 04/01/16 Fri 15/01/ Specialist Contractors Decommission and Remove all Equipment for Disposal 10 days Mon 04/01/16 Fri 15/01/16 169SS 171 Validate that Areas are Safe for General Contractors to Enter 5 days Mon 18/01/16 Fri 22/01/ General Contractor Removes Furniture, Fittings and Non-Medical Equipment 10 days Mon 04/01/16 Fri 15/01/16 169SS 173 Vacated departments mothballed for refurbishment 10 days Mon 18/01/16 Fri 29/01/ POST PROJECT EVALUATION 280 days Mon 04/01/16 Fri 27/01/ Project Closedown initial 20 days Mon 04/01/16 Fri 29/01/ Project Closedown final 10 days Mon 04/04/16 Fri 15/04/ Post Project Evaluation 1 20 days Mon 06/06/16 Fri 01/07/ Post Project Evaluation 2 20 days Mon 02/01/17 Fri 27/01/ Programme from FBC Approval to Operational Facility

190 4g Document and Drawings Registers

191 drawing issue New Cross Hospital DAY Emergency Department DATE OF ISSUE MONTH Wolverhampton YEAR Job No PRELIMINARY / / / / / / / / / / / / / PURPOSE OF ISSUE FOR INFORMATION PLANNING BUILDING CONTROL GMP CONSTRUCTION FINAL ISSUE DRAWING TITLE SCALE DRAWING NO. / / Layouts Ground Floor Plan 1:200 A1 KD-G(00) First Floor Plan 1:200 A1 KD-G(00) Second Floor Plan 1:200 A1 KD-G(00) Third Floor Plan 1:200 A1 KD-G(00) Roof Plan 1:200 A1 KD-G(00) Existing Building Works Ground Floor AS A0 KD-G(00)EX Existing Building Works First Floor AS A0 KD-G(00)EX Proposed Elevations 1:200 A1 KD-G(21)EV Sub-Station Recladding Elevations AS A1 KD-G(21)EX-SUB Partition Type Layout - Ground Floor 1:200 A1 KD-G(22) Ground Floor Setting-Out 1:100 A0 KD-G(22) Partition Type Layout - First Floor 1:200 A1 KD-G(22) First Floor Setting-Out 1:100 A0 KD-G(22) Partition Type Layout - Second Floor 1:200 A1 KD-G(22) Second Floor Setting-Out 1:100 A0 KD-G(22) Partition Type Layout - Third Floor 1:200 A1 KD-G(22) Third Floor Setting-Out 1:100 A0 KD-G(22) Window Types Layout - 00 Ground Floor 1:100 A0 KD-G(31) Window Types Layout - 01 First Floor 1:100 A0 KD-G(31) Window Types Layout - 02 Second Floor 1:100 A0 KD-G(31) Louvre Types Layout - 03 Third Floor 1:100 A0 KD-G(31) Door Types Layout - GF 1:100 A0 KD-G(32) Internal Screen Types Layout - 00 Ground Floor 1:100 A0 KD-G(32) Door Types Layout - FF 1:100 A0 KD-G(32) Door Types Layout - SF 1:100 A0 KD-G(32) Door Types Layout - TF 1:100 A0 KD-G(32) Reflected Ceiling Plan Setting-Out - GF 1:100 A0 KD-G(35) Reflected Ceiling Plan Setting-Out - FF 1:100 A0 KD-G(35) Reflected Ceiling Plan Setting-Out - SF 1:100 A0 KD-G(35) Reflected Ceiling Plan Setting-Out - TF 1:100 A0 KD-G(35) Wall Finishes Layout - GF 1:200 A2 KD-G(42) Wall Finishes Layout - FF 1:200 A2 KD-G(42) Wall Finishes Layout - SF 1:200 A2 KD-G(42) Wall Finishes Layout - TF 1:200 A2 KD-G(42) Floor Finishes Layout - GF 1:200 A2 KD-G(43) Floor Finishes Layout - FF 1:200 A2 KD-G(43) Floor Finishes Layout - SF 1:200 A2 KD-G(43) Floor Finishes Layout - TF 1:200 A2 KD-G(43) Reflected RainWaterPipe Route Plan - GF 1:200 A1 KD-G(52) Reflected RainWaterPipe Route Plan - FF 1:200 A2 KD-G(52) Reflected RainWaterPipe Route Plan - SF 1:200 A2 KD-G(52) Reflected RainWaterPipe Route Plan - TF 1:200 A2 KD-G(52) Fire Strategy - Ground Floor 1:200 A1 KD-G(68) Fire Strategy - First Floor 1:200 A1 KD-G(68) Fire Strategy - Second Floor 1:200 A1 KD-G(68) Fire Strategy - Third Floor 1:200 A1 KD-G(68) Fire Strategy - Roof Plan 1:200 A1 KD-G(68) Wall Protection - Ground Floor 1:200 A1 KD-G(71) Wall Protection - First Floor 1:200 A1 KD-G(71) Signage Plan - GF AS A1 KD-G(76) Signage Plan - FF AS A1 KD-G(76) Signage Plan - SF AS A1 KD-G(76) Signage Plan - TF AS A1 KD-G(76) Access & Maintenance - 00 Ground Floor 1:100 A0 KD-G(85) Access & Maintenance - 01 First Floor 1:100 A0 KD-G(85) Access & Maintenance - 02 Second Floor 1:100 A0 KD-G(85) Access & Maintenance - 03 Third Floor 1:100 A0 KD-G(85) Access & Maintenance - Roof Level 1:100 A0 KD-G(85) Proposed Site Plan 1:500 A1 KD-G(90) Site Plan 1 of 2 (Public Realm) 1:200 A1 KD-G(90) Site Plan 2 of 2 (Ambulance Zone) 1:200 A1 KD-G(90) Existing Hospital Site Plan 1:1250 A1P KD-G(90) Site Plan 1:500 A1 KD-G(90) Sections Typical External Wall Sectional Detail - Section WS - A 1:20 A1P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - B 1:20 A0P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - C 1:20 A1P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - D 1:20 A1P KD-G(21)SE

192 Typical External Wall Sectional Detail - Section WS - E 1:20 A1P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - F 1:20 A1P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - G 1:20 A1P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - H 1:20 A1P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - J 1:20 A0P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - K 1:20 A1P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - L 1:20 A1P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - M 1:20 A0 KD-G(21)SE Typical External Wall Sectional Detail - Section WS - N 1:20 A0P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - P 1:20 A0P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - Q 1:20 A1P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - R 1:20 A1P KD-G(21)SE Typical External Wall Sectional Detail - Section WS - S 1:20 A1P KD-G(21)SE Proposed Sections 1:200 A1P KD-G(22)SE Typical Internal Wall Sectional Detail - Section WS - AA 1:20 A0P KD-G(22)SE Typical Internal Wall Sectional Detail - Section WS - BB1 1:20 A0P KD-G(22)SE Typical Internal Wall Sectional Detail - Section WS - BB2 1:20 A0P KD-G(22)SE Typical Liftshaft 1-2 Sections 1:50 A1 KD-G(66)SE Typical Liftshaft 3-4 Sections 1:50 A1 KD-G(66)SE Details Typical Ground Bearing Slab Edge Detail 1:5 A3 KD-D(16)XX Typical Suspended Slab Edge Detail 1:5 A3 KD-D(16)XX Typical Threshold DPM,DPC Arrangement 1:5 A3 KD-D(16)XX Typical Liftpit Damp-proofing Details 1:5 A3P KD-D(16)XX Typical Arrangement At Slab Abutment 1:5 A3 KD-D(16)XX Typical Retaining Wall Tanking Detail 1:5 A3P KD-D(16)XX Partition Base & Head Details 1:2 A1 KD-D(22)XX Typical Partition Penetration Details 1:2 A2 KD-D(22)XX Typical Partition Patressing Details 1:2 A3 KD-D(22)XX Typical Partition Lead Lining Details 1:2 A1 KD-D(22)XX Typical Column Encasement Details 1:2 A3 KD-D(22)XX Staff Base Glazed Partitions 1:50 A1 KD-D(22)XX Staircase 1 Details 1:50 A1 KD-D(24) Staircase 2 Details 1:50 A1 KD-D(24) Staircase 3 Details 1:50 A1 KD-D(24) Stair 2 Roof Access Ladder 1:20 A2 KD-D(24) Roof Plan Coordination AS A1 KD-D(27)XX Roof Sections 1:20 A1 KD-D(27)XX Roof Sections 1:20 A1 KD-D(27)XX Plant Room Wall Head Detail 1:5 A3 KD-D(27)XX Plant Room Louvre Base Detail 1:5 A3 KD-D(27)XX Plant Room Wall Base Detail 1:5 A3 KD-D(27)XX Typical Zinc Cladded Parapet 1:10 A3 KD-D(27)XX Typical Roof Gully Detail 1:5 A3 KD-D(27)XX Fully Metal Cladded Parapet 1:10 A3 KD-D(27)XX Link Bridge Parapet 1:5 A3 KD-D(27)XX Link Corridor Parapet 1:5 A3 KD-D(27)XX Link Corridor Parapet 1:5 A3 KD-D(27)XX Stair 1 Parapet 1:5 A3 KD-D(27)XX Accessible Roof (1st Floor Level) Parapet 1:10 A3 KD-D(27)XX Typical Metal Cladded Parapet 1:10 A3 KD-D(27)XX Typical External Window Details AS A1 KD-D(31)XX Typical External Window Details AS A1 KD-D(31)XX Curtain Wall Setting-Out 1:50 A1 KD-D(31)XX Window Type Elevation 1:20 A1 KD-D(31)XX Typical Internal Door Types 1:25 A2 KD-D(32)XX Typical Internal Door Head & Jamb Details 1:2 A3 KD-D(32)XX Internal Screens Types AS A1 KD-D(32)XX Internal Screens - Atrium 1:100 A1 KD-D(32)XX Staircase Handrail Details 1:20 A1 KD-D(34) IPS/Cubicle Setting-Out - MAE005 1:20 A1P KD-D(74)00-MAE IPS/Cubicle Setting-Out - MAE006 1:20 A1P KD-D(74)00-MAE Typical PAN902 IPS Panel Details 1:20 A0 KD-D(74)XX Typical PAN903 IPS Panel Details 1:20 A1 KD-D(74)XX Typical PAN906 IPS Panel Details 1:20 A2 KD-D(74)XX Ambulance canopy details AS A0 KD-D(92)XX Ambulance canopy details AS A1 KD-D(92)XX Assembly Fixing Type 1 Typical Lightweight Plasterboard Fixing Details 1:2 A3 KD-A(22)XX Fixing Type 2 Typical Mediumweight Plasterboard Fixing Details 1:2 A3 KD-A(22)XX Fixing Type 3 Typical Heavyweight Plasterboard Fixing Details 1:2 A3 KD-A(22)XX Typical FF&E Fixing Heights AS A1 KD-A(70)XX-001 Laboratory Shelving Typical Construction Details 1:5 A3 KD-A(70)XX Typical Worktop and Cabinetry Fixing Details (non-laboratory) AS A3 KD-A(70)XX Staff Base Desk MAJ026 1:20 A1 KD-A(72)00-COU Staff Base Desk CHI008 1:20 A2 KD-A(72)00-COU Staff Base Desk MIN029 1:20 A1 KD-A(72)00-COU Reception Desk RAD024 1:20 A1 KD-A(72)00-COU Main Reception Desk MAE002 1:20 A0 KD-A(72)00-COU Reception Desk OPD102 1:20 A1 KD-A(72)01-COU Staff Base Desk CDU117 1:20 A1 KD-A(72)01-COU Typical Reception Desk Details 1:5 A1 KD-A(72)XX Schedule Master Equipment Schedule / / Internal Door Schedule 1:20 A0P KD-S(32)XX External Door Schedule 1:20 A1 KD-S(32)XX Floor Finishes Schedule N/A A0P KD-S(43)XX Typical IPS Panel Schedule NTS A0 KD-S(74)XX Sanitaryware Schedule Sheet 1 N/A A1 KD-S(74)XX Sanitaryware Schedule Sheet 2 N/A A1 KD-S(74)XX Specification NBS Specification N/A A4 N/A / 04 REVIT MODEL N/A N/A N/A 19 DISTRIBUTION Electronic copy NUMBER OF COPIES - ('e' - denotes issued electronically) / / / / /

193 Ed Callaghan Royal Wolverhampton Hospital NHS Trust / / / / / Carolyn Robinson Royal Wolverhampton Hospital NHS Trust / Phil Horne Kier Construction / Matt Pugh Kier Construction / Andy Webb Kier Construction / Chay Kilpatrick Ramboll / / / / / / Peter Brown Ramboll / / / / / / Adam Fair Ramboll / / / / / Alex Clayton Ramboll / / / / / Gareth Ormes Ramboll / / / / / Adrian Popplewell Ramboll / / / / / Sarah Gill Ramboll / / / / / Allan Wilson Ramboll / / / / / / Mark Walker Arup / / / / / / Ian Hurst Arup / / / / / Neil Campbell Arup / / / / / Nicole Evans Arup / / / / / Richard Jeffs Arup / / / / / Rachel Chaloner Arup / / / / / Keith Wooldridge Faithful+Gould / / / / / Mike Hook Faithful+Gould / / / / / Ryan O`connor Faithful+Gould / / / / / Martin Watton Approved Design Mark Elliot Planning file

194 1:50`s drawing issue New Cross Hospital DAY Emergency Department DATE OF ISSUE MONTH Wolverhampton YEAR Job No PRELIMINARY / / / / / PURPOSE OF ISSUE FOR INFORMATION PLANNING BUILDING CONTROL GMP CONSTRUCTION FINAL ISSUE DRAWING TITLE SCALE DRAWING NO. / / Room Layouts GROUND FLOOR Child TI 1:50 A2 KD-R(70)00-CHI Waiting 1:50 A1 KD-R(70)00-CHI Treatment 1 1:50 A2 KD-R(70)00-CHI Treatment 2 1:50 A2 KD-R(70)00-CHI Treatment 3 1:50 A2 KD-R(70)00-CHI Treatment 4 1:50 A2 KD-R(70)00-CHI Treatment 5 1:50 A2 KD-R(70)00-CHI Staff Base 1:50 A3 KD-R(70)00-CHI Dirty Utility 1:50 A2 KD-R(70)00-CHI Treatment 6 1:50 A2 KD-R(70)00-CHI Acc WC 1:50 A3 KD-R(70)00-CHI Relatives Room 1:50 A3 KD-R(70)00-CHI WC 1:50 A3 KD-R(70)00-CHI Store 1:50 A3 KD-R(70)00-CHI Clean Utility / Supplies Store 1:50 A2 KD-R(70)00-CHI Peadiatric Major Bay 1:50 A1 KD-R(70)00-CHI Acc WC / Nappy 1:50 A3 KD-R(70)00-CHI Main Entrance 1:50 A0 KD-R(70)00-MAE Acc WC / Nappy 1:50 A3 KD-R(70)00-MAE Assisted WC 1:50 A3 KD-R(70)00-MAE Male WC 1:50 A2 KD-R(70)00-MAE Female WC 1:50 A2 KD-R(70)00-MAE Feeding Room 1:50 A3 KD-R(70)00-MAE Retail Storage 1:50 A3 KD-R(70)00-MAE Store 1:50 A2 KD-R(70)00-MAJ Exam 15 1:50 A2 KD-R(70)00-MAJ Exam 14 1:50 A2 KD-R(70)00-MAJ Exam 13 1:50 A2 KD-R(70)00-MAJ Clean Utility 1:50 A2 KD-R(70)00-MAJ Interview - Crisis 1:50 A3 KD-R(70)00-MAJ Exam 11 1:50 A2 KD-R(70)00-MAJ Exam 10 1:50 A2 KD-R(70)00-MAJ Exam 9 1:50 A2 KD-R(70)00-MAJ Exam 8 1:50 A2 KD-R(70)00-MAJ Exam 7 1:50 A2 KD-R(70)00-MAJ Rapid Assessment Treatment 1:50 A1 KD-R(70)00-MAJ Exam 5 1:50 A2 KD-R(70)00-MAJ Exam 4 1:50 A2 KD-R(70)00-MAJ Exam 3 1:50 A2 KD-R(70)00-MAJ Exam 2 1:50 A2 KD-R(70)00-MAJ Exam 1 1:50 A2 KD-R(70)00-MAJ WC 1:50 A3 KD-R(70)00-MAJ Acc WC 1:50 A3 KD-R(70)00-MAJ Disposal Hold 1:50 A3 KD-R(70)00-MAJ Dirty Utility 1:50 A2 KD-R(70)00-MAJ Acc WC 1:50 A3 KD-R(70)00-MAJ Exam 16 1:50 A2 KD-R(70)00-MAJ Exam 17 1:50 A2 KD-R(70)00-MAJ Team Base With Linen Store 1:50 A2 KD-R(70)00-MAJ Pantry / Bev Bay 1:50 A3 KD-R(70)00-MAJ Exam 18 1:50 A2 KD-R(70)00-MAJ Acc WC 1:50 A3 KD-R(70)00-MAJ Triage Base 1:50 A2 KD-R(70)00-MIN Cleaners Room 1:50 A3 KD-R(70)00-MIN See & Treat 2 1:50 A2 KD-R(70)00-MIN Exam Eyes 3 1:50 A2 KD-R(70)00-MIN See & Treat 3 1:50 A2 KD-R(70)00-MIN See & Treat 1 1:50 A2 KD-R(70)00-MIN

195 1:50`s drawing issue New Cross Hospital DAY Emergency Department DATE OF ISSUE MONTH Wolverhampton YEAR Job No PRELIMINARY / / / / / PURPOSE OF ISSUE FOR INFORMATION PLANNING BUILDING CONTROL CONSTRUCTION FINAL ISSUE DRAWING TITLE SCALE DRAWING NO. Acc WC 1:50 A3 KD-R(70)00-MIN WC 1:50 A3 KD-R(70)00-MIN Staff WC 1:50 A3 KD-R(70)00-MIN Disposal Hold 1:50 A3 KD-R(70)00-MIN Store 1:50 A3 KD-R(70)00-MIN Exam 9 1:50 A3 KD-R(70)00-MIN Exam 8 1:50 A3 KD-R(70)00-MIN Pantry 1:50 A3 KD-R(70)00-MIN Exam 16 1:50 A2 KD-R(70)00-MIN Exam 7 1:50 A2 KD-R(70)00-MIN Exam 6 1:50 A2 KD-R(70)00-MIN Exam 5 1:50 A2 KD-R(70)00-MIN Exam 4 1:50 A3 KD-R(70)00-MIN Exam 3 1:50 A3 KD-R(70)00-MIN Exam 2 1:50 A3 KD-R(70)00-MIN Exam 1 1:50 A3 KD-R(70)00-MIN Exam Eyes 1 1:50 A2 KD-R(70)00-MIN Exam Eyes 2 1:50 A2 KD-R(70)00-MIN Dirty Utility 1:50 A2 KD-R(70)00-MIN Exam 10 1:50 A3 KD-R(70)00-MIN Exam 11 1:50 A3 KD-R(70)00-MIN Exam 12 1:50 A3 KD-R(70)00-MIN Staff Base with Linen Storage 1:50 A2 KD-R(70)00-MIN Exam 13 1:50 A3 KD-R(70)00-MIN Exam 14 1:50 A3 KD-R(70)00-MIN Exam 15 1:50 A3 KD-R(70)00-MIN Store Plaster Equipment 1:50 A3 KD-R(70)00-MIN Treatment Room Plaster 1:50 A1 KD-R(70)00-MIN Procedure Room 2 1:50 A2 KD-R(70)00-MIN Procedure Room 1 1:50 A2 KD-R(70)00-MIN Sluice 1:50 A3 KD-R(70)00-MIN X-Ray 3 1:50 A2 KD-R(70)00-RAD Ultrasound 1:50 A2 KD-R(70)00-RAD X-Ray 2 1:50 A2 KD-R(70)00-RAD Processing & Viewing 1:50 A2 KD-R(70)00-RAD X-Ray 1 1:50 A2 KD-R(70)00-RAD Reporting 1 1:50 A3 KD-R(70)00-RAD Reporting 2 1:50 A3 KD-R(70)00-RAD Linen 1:50 A3 KD-R(70)00-RAD Acc WC 1:50 A3 KD-R(70)00-RAD WC 1:50 A3 KD-R(70)00-RAD CH1 1:50 A3 KD-R(70)00-RAD CH2 1:50 A3 KD-R(70)00-RAD CH3 1:50 A3 KD-R(70)00-RAD Clean Utility 1:50 A3 KD-R(70)00-RAD Dirty Utility 1:50 A3 KD-R(70)00-RAD Acc Ch 1:50 A3 KD-R(70)00-RAD Disposal hold 1:50 A3 KD-R(70)00-RAD Crutch Store 1:50 A3 KD-R(70)00-RAD Waiting 1:50 A2 KD-R(70)00-RAD Reception 1:50 A3 KD-R(70)00-RAD Trolley Wait 1:50 A3 KD-R(70)00-RAD Scanner Room CT 1:50 A1 KD-R(70)00-RAD Control Room 1:50 A2 KD-R(70)00-RAD Scanner Room MRI 1:50 A1 KD-R(70)00-RAD Store Equipment 1:50 A2 KD-R(70)00-RAD Interview / Prep 1:50 A3 KD-R(70)00-RAD Cleaners Room 1:50 A3 KD-R(70)00-RAD Radiology Store 1:50 A3 KD-R(70)00-RAD Patient Test 1:50 A2 KD-R(70)00-RAD GMP / /

196 1:50`s drawing issue New Cross Hospital DAY Emergency Department DATE OF ISSUE MONTH Wolverhampton YEAR Job No PRELIMINARY / / / / / PURPOSE OF ISSUE FOR INFORMATION PLANNING BUILDING CONTROL CONSTRUCTION FINAL ISSUE DRAWING TITLE SCALE DRAWING NO. Interview Prep 1:50 A3 KD-R(70)00-RAD Water Point 1:50 A3 KD-R(70)00-RAD Acc WC 1:50 A3 KD-R(70)00-REL Relatives 1 1:50 A2 KD-R(70)00-REL Body Viewing Room 1 1:50 A3 KD-R(70)00-REL Body Viewing Room 2 1:50 A3 KD-R(70)00-REL Relatives 2 1:50 A3 KD-R(70)00-REL Resuscitation room 4 Bay 1:50 A0 KD-R(70)00-RES WC 1:50 A3 KD-R(70)00-RES Nair Store 1:50 A3 KD-R(70)00-RES Resus 1 1:50 A1 KD-R(70)00-RES Resusitation 2 Bay 1:50 A1 KD-R(70)00-RES Resus Waiting 1:50 A3 KD-R(70)00-RES Clean Utility 1:50 A2 KD-R(70)00-RES Dirty Utility 1:50 A2 KD-R(70)00-RES GMP / / FIRST FLOOR Major Incident/Meeting Room 1:50 A2 KD-R(70)01-ADM Office 8 staff 1:50 A2 KD-R(70)01-ADM Office x8 Touch 1:50 A1 KD-R(70)01-ADM Office x8 Touch 1:50 A1 KD-R(70)01-ADM Seminar Room 1:50 A1 KD-R(70)01-ADM Office 4 Person 1:50 A2 KD-R(70)01-ADM Staff Rest Room 1:50 A1 KD-R(70)01-ADM Single Office 1 1:50 A2 KD-R(70)01-ADM Single Office 2 1:50 A2 KD-R(70)01-ADM Single Office 3 1:50 A2 KD-R(70)01-ADM Single Office 4 1:50 A2 KD-R(70)01-ADM Person Office 1 1:50 A2 KD-R(70)01-ADM Person Office 2 1:50 A2 KD-R(70)01-ADM Store 1:50 A3 KD-R(70)01-ADM Person Office 1:50 A2 KD-R(70)01-ADM Disposal Hold 1:50 A3 KD-R(70)01-CDU Linen 1:50 A3 KD-R(70)01-CDU WC 1:50 A3 KD-R(70)01-CDU Bed Ward 1:50 A1 KD-R(70)01-CDU Ensuite 1:50 A3 KD-R(70)01-CDU Ensuite 1:50 A3 KD-R(70)01-CDU Bed Ward 1:50 A1 KD-R(70)01-CDU WC 1:50 A3 KD-R(70)01-CDU Dirty Utility 1:50 A2 KD-R(70)01-CDU Cleaners 1:50 A3 KD-R(70)01-CDU Store 1:50 A3 KD-R(70)01-CDU Ensuite 1:50 A3 KD-R(70)01-CDU Single Bed 1 1:50 A2 KD-R(70)01-CDU Single Bed 2 1:50 A2 KD-R(70)01-CDU Ensuite 1:50 A3 KD-R(70)01-CDU Clean Utility 1:50 A2 KD-R(70)01-CDU Team Base 1:50 A2 KD-R(70)01-CDU Pantry 1:50 A2 KD-R(70)01-CDU Crisis Room 1:50 A2 KD-R(70)01-CDU Reception 1:50 A2 KD-R(70)01-OPD Disposal Hold 1:50 A2 KD-R(70)01-OPD Cleaners 1:50 A3 KD-R(70)01-OPD Dirty Utility 1:50 A2 KD-R(70)01-OPD Cons. Ex. 6 1:50 A2 KD-R(70)01-OPD Cons. Ex. 5 1:50 A2 KD-R(70)01-OPD Cons. Ex. 4 1:50 A2 KD-R(70)01-OPD Treatment 1:50 A2 KD-R(70)01-OPD Cons. Ex. 1 1:50 A2 KD-R(70)01-OPD

197 1:50`s drawing issue New Cross Hospital DAY Emergency Department DATE OF ISSUE MONTH Wolverhampton YEAR Job No PRELIMINARY / / / / / PURPOSE OF ISSUE FOR INFORMATION PLANNING BUILDING CONTROL GMP CONSTRUCTION FINAL ISSUE DRAWING TITLE SCALE DRAWING NO. Cons. Ex. 2 1:50 A2 KD-R(70)01-OPD Cons. Ex. 3 1:50 A2 KD-R(70)01-OPD Clean Utility 1:50 A2 KD-R(70)01-OPD Combined Waiting 1:50 A0 KD-R(70)01-OPD Patient Test 1:50 A2 KD-R(70)01-OPD WC 1:50 A3 KD-R(70)01-OPD Acc WC 1:50 A3 KD-R(70)01-OPD IT Hub 1:50 A3 KD-R(70)01-SER IT Hub 1:50 A3 KD-R(70)01-SER Male Staff 1:50 A1 KD-R(70)01-STA Shower 1:50 A3 KD-R(70)01-STA Acc Shower 1:50 A3 KD-R(70)01-STA Acc WC 1:50 A3 KD-R(70)01-STA WC 1:50 A3 KD-R(70)01-STA Male Staff Lobby 1:50 A3 KD-R(70)01-STA Female Staff Lobby 1:50 A3 KD-R(70)01-STA WC 1:50 A3 KD-R(70)01-STA Acc WC 1:50 A3 KD-R(70)01-STA Acc Shower 1:50 A3 KD-R(70)01-STA Shower 1:50 A3 KD-R(70)01-STA Female Staff 1:50 A1 KD-R(70)01-STA Acc WC 1:50 A3 KD-R(70)01-STA Therapies Treatment 1:50 A2 KD-R(70)01-THE Therapies Store 1:50 A3 KD-R(70)01-THE Treatment Room 1:50 A2 KD-R(70)01-THE Admin 1:50 A3 KD-R(70)01-THE Ice Machine Room 1:50 A3 KD-R(70)01-THE / / DISTRIBUTION NUMBER OF COPIES - ('e' - denotes issued elec Ed Callaghan Royal Wolverhampton Hospital NHS Trust / / / Chay Kilpatrick Ramboll / Peter Brown Ramboll / Adam Fair Ramboll Alex Clayton Ramboll Gareth Ormes Ramboll Adrian Popplewell Ramboll Sarah Gill Ramboll Allan Wilson Ramboll / Mark Walker Arup / / Ian Hurst Arup Neil Campbell Arup / / Nicole Evans Arup / / Richard Jeffs Arup Rachel Chaloner Arup / Keith Wooldridge Faithful+Gould / Mike Hook Faithful+Gould / Ryan O`connor Faithful+Gould Martin Watton Approved Design Mark Elliot Planning file e

198 DRAWING/DOCUMENT ISSUE SHEET (PP12.7) job name: New Cross Hospital Kings Court 2-4 Exchange St St Mary's Gate Manchester M2 7HA job no tel +44(0) fax +44(0) date of issue day month year purpose purpose code I I C C C C T T T Design Team Architect Chris Oates - Keppie E E E E E E E E E QS Keith Wooldridge - Faithful & Gould E E E E E E E E E M&E Mark Walker - Arup E E E E E E E E E Kier Phil Horne E E Woobius Woobius E E office copy ramboll 1P 1P 1P 1P 1P 1P 1P 1P 1P drg/doc no. drawing/document title size scale last rev issue/revision Specifications & Reports DR-SP001 Below Ground Drainage Specification T01 - T01 S-SP001 New Cross Structural Spec T01 T01 tes: Purpose: P - Preliminary, A - Approval, I - Information, T - Tender, C - Contract Copies: P - Paper, F - Fax, E - , CD - CD/DVD, A3 - Ar Reduction, DGN, DWG, PDF Sheet 1 of Issues 01-10

199 DRAWING/DOCUMENT ISSUE SHEET (PP12.7) job name: New Cross Hospital Kings Court 2-4 Exchange St St Mary's Gate Manchester M2 7HA job no tel +44(0) fax +44(0) date of issue day month year purpose purpose code I I C C C C T T T Design Team Architect Chris Oates - Keppie E E E E E E E E E QS Keith Wooldridge - Faithful & Gould E E E E E E E E E M&E Mark Walker - Arup E E E E E E E E E Kier Phil Horne E E Woobius Woobius E E office copy ramboll 1P 1P 1P 1P 1P 1P 1P 1P 1P drg/doc no. drawing/document title size scale last rev issue/revision Main Works Structural Drawings S-002 General Notes Drawing A1 NTS T01 T01 S-005 3D Isometric Views A1 NTS T01 T01 S-010 Ground Floor - Dead Load GA A1 1:200 T01 T01 S-011 Ground Floor - Live Load GA A1 1:200 T01 T01 S-020 First Floor - Dead Load GA A1 1:200 T01 T01 S-021 First Floor - Live Load GA A1 1:200 T01 T01 S-030 Second Floor - Dead Load GA A1 1:200 T01 T01 S-030 Second Floor - Live Load GA A1 1:200 T01 T01 S-040 Roof Level - Dead Load GA A1 1:200 T01 T01 S-041 Roof Level - LiveLoad GA A1 1:200 T01 T01 S-050 Upper Roof Level - Dead Load GA A1 1:200 T01 T01 S-051 Upper Roof Level - Live Load GA A1 1:200 T01 T01 S-080 Pile Setting Out GA A1 1:150 T01 - T01 S-090 Foundation Level GA A1 1:150 T01 I01 I02 - T01 S-091 Ambulance Canopy Details A1 1:150 - T01 S-092 Entrance Canopy Details A1 1:100 - T01 S-093 Interface Plan - Foundation Level A1 1:50 - S-094 Interface Plan - Ground Level A1 1:100 - S-100 Ground Floor GA A1 1:150 T01 I01 I02 - T01 S-105 Liftcore/Stairwell Capping Off A1 1:100 T01 T01 S-106 External Works & Details GA A1 1:250 T01 I01 T01 S-108 LV Switch Room A1 1:75 - T01 S-109 Ground Floor Saw Cut Locations A1 1:150 - T01 S-110 First Floor GA A1 1:150 T01 I01 I02 - T01 S-111 Link Corridor GA A1 1:150 T01 I01 I02 - T01 S-112 East/West Corridor Ground Floor A1 1: S-113 East/West Corridor First Floor A1 1: S-114 East/West Corridor Second Floor A1 1:100 T01 - T01 S-115 First Floor Slab GA A1 1:150 T01 - T01 S-120 Second Floor GA A1 1:150 T01 I01 I02 - T01 S-125 Second Floor Slab GA A1 1:150 T01 - T01 S-130 Roof Level GA A1 1:150 T01 I01 I02 - T01 S-131 Lightwell GA A1 1:50 T01 - T01 tes: Purpose: P - Preliminary, A - Approval, I - Information, T - Tender, C - Contract Copies: P - Paper, F - Fax, E - , CD - CD/DVD, A3 - Ar Reduction, DGN, DWG, PDF Sheet 2 of Issues 01-10

200 DRAWING/DOCUMENT ISSUE SHEET (PP12.7) job name: New Cross Hospital Kings Court 2-4 Exchange St St Mary's Gate Manchester M2 7HA job no tel +44(0) fax +44(0) date of issue day month year purpose purpose code I I C C C C T T T Design Team Architect Chris Oates - Keppie E E E E E E E E E QS Keith Wooldridge - Faithful & Gould E E E E E E E E E M&E Mark Walker - Arup E E E E E E E E E Kier Phil Horne E E Woobius Woobius E E office copy ramboll 1P 1P 1P 1P 1P 1P 1P 1P 1P drg/doc no. drawing/document title size scale last rev issue/revision S-135 Roof Slab Level GA A1 1:150 T01 - T01 S-140 Upper Roof GA A1 1:150 T01 I01 I02 - T01 S-145 Upper Roof Slab GA A1 1:150 T01 - T01 S-150 Parapet GA - First Floor A1 1:150 T01 I01 I02 - T01 S-151 Parapet GA - Second Floor A1 1:150 T01 I01 I01 - T01 S-152 Parapet GA - Roof A1 1:150 T01 I01 - T01 S-153 Parapet GA - Upper Roof A1 1:150 T01 I01 - T01 S-200 Sub-Structure Details - Sheet 1 A1 1:20 T01 T01 S-201 Sub-Structure Details - Sheet 2 A1 1:20 T01 T01 S-202 Sub-Structure Details - Sheet 3 A1 1:20 T01 T01 S-210 External Works Details A1 1:20 T01 T01 S-300 Building Sections - Sheet 1 A1 1:150 T01 I01 I02 - T01 S-301 Building Sections - Sheet 2 A1 1:150 T01 I01 I02 - T01 S-305 Building Elevations - Sheet 1 A1 1:150 T01 I01 I02 - T01 S-306 Building Elevations - Sheet 2 A1 1:150 T01 I01 I02 - T01 S-307 Building Elevations - Sheet 3 A1 1:100 I01 I02 - T01 S-310 Braced Bay Elevations - Sheet 1 A1 1:150 - I01 I02 - T01 S-311 Braced Bay Elevations - Sheet 2 A1 1:150 - I01 I02 - T01 S-320 Super-Structure Details - Sheet 1 A1 1:20 T01 S-321 Super-Structure Details - Sheet 2 A1 1:20 T01 S-322 Super-Structure Details - Sheet 3 A1 1:20 S-710 1st Floor Loose Bar Re-Inforcement A1 1:150 S-720 2nd Floor Loose Bar Re-Inforcement A1 1:150 S-730 Roof Loose Bar Re-Inforcement A1 1:150 tes: Purpose: P - Preliminary, A - Approval, I - Information, T - Tender, C - Contract Copies: P - Paper, F - Fax, E - , CD - CD/DVD, A3 - Ar Reduction, DGN, DWG, PDF Sheet 3 of Issues 01-10

201 DRAWING/DOCUMENT ISSUE SHEET (PP12.7) job name: New Cross Hospital Kings Court 2-4 Exchange St St Mary's Gate Manchester M2 7HA job no tel +44(0) fax +44(0) date of issue day month year purpose purpose code I I C C C C T T T Design Team Architect Chris Oates - Keppie E E E E E E E E E QS Keith Wooldridge - Faithful & Gould E E E E E E E E E M&E Mark Walker - Arup E E E E E E E E E Kier Phil Horne E E Woobius Woobius E E office copy ramboll 1P 1P 1P 1P 1P 1P 1P 1P 1P drg/doc no. drawing/document title size scale last rev issue/revision Main Works Drainage Drawings DR-001 Existing Drainage Layout - Sheet 1 A1 1:200 T01 T01 DR-002 Existing Drainage Layout - Sheet 2 A1 1:200 T01 T01 DR-006 Extg Drain to be Removed - Sheet 1 A1 1:200 T01 T01 DR-007 Extg Drain to be Removed - Sheet 2 A1 1:200 T01 T01 DR-100 Proposed Drainage Layout - Sheet 1 A1 1:200 T01 T01 DR-101 Proposed Drainage Layout - Sheet 2 A1 1:200 T01 T01 DR-110 Drainage Schedules A1 NTS T01 DR-400 Drainage Details - Sheet 1 A1 Varies T01 T01 DR-401 Drainage Details - Sheet 2 A1 Varies T01 T01 DR-402 Drainage Details - Sheet 3 A1 Varies T01 T01 DR-403 Drainage Details - Sheet 4 A1 Varies T01 T01 DR-404 Drainage Details - Sheet 5 A1 Varies T01 T01 tes: Purpose: P - Preliminary, A - Approval, I - Information, T - Tender, C - Contract Copies: P - Paper, F - Fax, E - , CD - CD/DVD, A3 - Ar Reduction, DGN, DWG, PDF Sheet 4 of Issues 01-10

202 St James's Building, Oxford St Manchester, M1 6EL T:+ 44 (0) F:+44(0) DATE OF ISSUE New Cross Hospital Day Emergency Centre Month Year Document Title: Scale Size Doc. Ref. No. OUTGOING DOCUMENT REGISTER Public Health Services Above Ground Drainage Ground Floor Layout Sheet 1 of 4 1:50 A0 ARP-G-52-A T1 T2 T2 Above Ground Drainage Ground Floor Layout Sheet 2 of 4 1:50 A0 ARP-G-52-B T1 T2 T2 Above Ground Drainage Ground Floor Layout Sheet 3 of 4 1:50 A0 ARP-G-52-C T1 T2 T2 Above Ground Drainage Ground Floor Layout Sheet 4 of 4 1:50 A0 ARP-G-52-D T1 T2 T2 Above Ground Drainage First Floor Layout Sheet 1 of 4 1:50 A0 ARP-G-52-A T1 T2 T2 Above Ground Drainage First Floor Layout Sheet 2 of 4 1:50 A0 ARP-G-52-B T1 T2 T2 Above Ground Drainage First Floor Layout Sheet 3 of 4 1:50 A0 ARP-G-52-C T1 T2 T2 Above Ground Drainage First Floor Layout Sheet 4 of 4 1:50 A0 ARP-G-52-D T1 T2 T2 Above Ground Drainage Second Floor Layout Sheet 1 of 4 1:50 A0 ARP-G-52-A T1 T2 T2 Above Ground Drainage Second Floor Layout Sheet 2 of 4 1:50 A0 ARP-G-52-B T1 T2 T2 Above Ground Drainage Second Floor Layout Sheet 3 of 4 1:50 A0 ARP-G-52-C T1 T2 T2 Above Ground Drainage Second Floor Layout Sheet 4 of 5 1:50 A0 ARP-G-52-D T1 T2 T2 Above Ground Drainage Plantroom Layout Sheet 1 of 4 1:50 A0 ARP-G-52-A T1 T2 T2 Above Ground Drainage Plantroom Layout Sheet 2 of 4 1:50 A0 ARP-G-52-B T1 T2 T2 Above Ground Drainage Plantroom Layout Sheet 3 of 4 1:50 A0 ARP-G-52-C T1 T2 T2 Above Ground Drainage Plantroom Layout Sheet 4 of 5 1:50 A0 ARP-G-52-D T1 T2 T2 Above Ground Drainage Roof Layout 1:50 A0 ARP-G-52-X T1 T1 Domestic Water Services Ground Floor Layout Sheet 1 of 4 Domestic Water Services Ground Floor Layout Sheet 2 of 4 Domestic Water Services Ground Floor Layout Sheet 3 of 4 Domestic Water Services Ground Floor Layout Sheet 4 of 4 1:50 A0 ARP-G-53-A T1 T2 T2 1:50 A0 ARP-G-53-B T1 T2 T2 1:50 A0 ARP-G-53-C T1 T2 T2 1:50 A0 ARP-G-53-D T1 T2 T2 Domestic Water Services First Floor Layout Sheet 1 of 4 1:50 A0 ARP-G-53-A T1 T2 T2 Domestic Water Services First Floor Layout Sheet 2 of 4 1:50 A0 ARP-G-53-B T1 T2 T2 Domestic Water Services First Floor Layout Sheet 3 of 4 1:50 A0 ARP-G-53-C T1 T2 T2 Domestic Water Services First Floor Layout Sheet 4 of 4 1:50 A0 ARP-G-53-D T1 T2 T2 Charged Dry Riser Second Floor Layout 1:50 A0 ARP-G-53-X T1 Charged Dry Riser Plantroom Layout 1:50 A0 ARP-G-53-X T1 Medical Gas Tugway Layout Sheet 1:100 A0 ARP-G-54-X-TG-001 T1 T2 Medical Gas Ground Floor Layout Sheet 1 of 4 1:50 A0 ARP-G-54-A T1 T2 T2 Medical Gas Ground Floor Layout Sheet 2 of 4 1:50 A0 ARP-G-54-B T1 T2 T2 Medical Gas Ground Floor Layout Sheet 3 of 4 1:50 A0 ARP-G-54-C T1 T2 T2 Medical Gas Ground Floor Layout Sheet 4 of 4 1:50 A0 ARP-G-54-D T1 T2 T2 Medical Gas First Floor Layout Sheet 1 of 4 1:50 A0 ARP-G-54-A T1 T2 T2 Medical Gas First Floor Layout Sheet 2 of 4 1:50 A0 ARP-G-54-B T1 T2 T2 Medical Gas First Floor Layout Sheet 3 of 4 1:50 A0 ARP-G-54-C T1 T2 T2 Medical Gas First Floor Layout Sheet 4 of 4 1:50 A0 ARP-G-54-D T1 T2 T2 Medical Gas Second Floor Layout Sheet 1 of 2 1:50 A0 ARP-G-54-A T1 T2 T2 Medical Gas Second Floor Layout Sheet 1 of 2 1:50 A0 ARP-G-54-B T1 T2 T2 Medical Gas Plantroom Layout Sheet 1:50 A0 ARP-G-54-X T1 T2 T2 Domestic Water Schematic NTS A0 ARP-S-53-X-XX-001 T1 T2 Kemper Hygiene System End of Line Flushing NTS A3 ARP-S-53-X-XX-002 T1 Charged Dry Riser Schematic NTS A1 ARP-S-53-X-XX-003 T1 Oxygen Schematic 1 of 2 NTS A1 ARP-S-54-X-XX-001 T1 T2 Oxygen Schematic 2 of 2 NTS A1 ARP-S-54-X-XX-002 T1 T2 Nitrous Oxide Schematic NTS A1 ARP-S-54-X-XX-003 T1 T2 Medical and Surgical Air Schematic NTS A1 ARP-S-54-X-XX-005 T1 T2 Medical Vacuum Schematic 1 of 2 NTS A1 ARP-S-54-X-XX-006 T1 T2 Medical Vacuum Schematic 2 of 2 NTS A1 ARP-S-54-X-XX-007 T1 T2 Nitrous Oxide / Oxygen Mixture Schematic NTS A1 ARP-S-54-X-XX-004 T1 T2 AGSS Schematic NTS A1 ARP-S-54-X-XX-008 T1 T2 Above Ground Drainage Details NTS A0 ARP-D-52-X-XX-001 T1 T2 Above Ground Drainage Details NTS A0 ARP-D-52-X-XX-002 T1 T2 Domestic Water Services Details NTS A0 ARP-D-53-X-XX-001 T1 T2 Medical Gas AVSU Details 1 of 2 NTS A1 ARP-D-54-X-XX-001 T1 T2 Medical Gas AVSU Details 2 of 2 NTS A1 ARP-D-54-X-XX-002 T1 T2 Medical Gas Plant Alarms NTS A1 ARP-D-54-X-XX-003 T1 T2 Mechanical Steam and Condensate Existing Connection Various A1 Steam and Condensate New Connection Various A1 Heating and Cooling Ground Floor Layout Sheet 1 of 4 1:50 A0 Heating and Cooling Ground Floor Layout Sheet 2 of 4 1:50 A0 Heating and Cooling Ground Floor Layout Sheet 3 of 4 1:50 A0 Heating and Cooling Ground Floor Layout Sheet 4 of 4 1:50 A0 Heating and Cooling First Floor Layout Sheet 1 of 4 1:50 A0 Heating and Cooling First Floor Layout Sheet 2 of 4 1:50 A0 Heating and Cooling First Floor Layout Sheet 3 of 4 1:50 A0 Heating and Cooling First Floor Layout Sheet 4 of 4 1:50 A0 Heating and Cooling Second Floor Layout Sheet 1 of 4 1:50 A0 Heating and Cooling Second Floor Layout Sheet 2 of 4 1:50 A0 Heating and Cooling Second Floor Layout Sheet 3 of 4 1:50 A0 Heating and Cooling Second Floor Layout Sheet 4 of 4 1:50 A0 Plantroom Heating and Cooling Layout 1:50 A0 Ventilation Ground Floor Layout Sheet 1 of 4 1:50 A0 Ventilation Ground Floor Layout Sheet 2 of 4 1:50 A0 Ventilation Ground Floor Layout Sheet 3 of 4 1:50 A0 Ventilation Ground Floor Layout Sheet 4 of 4 1:50 A0 Ventilation First Floor Layout Sheet 1 of 4 1:50 A0 Ventilation First Floor Layout Sheet 2 of 4 1:50 A0 Ventilation First Floor Layout Sheet 3 of 4 1:50 A0 Ventilation First Floor Layout Sheet 4 of 4 1:50 A0 Ventilation Second Floor Layout Sheet 1 of 2 1:50 A0 Ventilation Second Floor Layout Sheet 2 of 2 1:50 A0 Ventilation Plantroom Layout Sheet 1:50 A0 Pneumatic Tube Tugway Layout Sheet 1:200 A0 Pneumatic Tube Ground Floor Layout Sheet 1:100 A0 Pneumatic Tube First Floor Layout Sheet 1:100 A0 External Mechanical Services Layout Sheet 1:100 A0 ARP-G-54-X-TG-002 T1 T2 ARP-G-54-X-TG-003 T1 T2 ARP-G-56-A T1 T2 ARP-G-56-B T1 T2 ARP-G-56-C T1 T2 ARP-G-56-D T1 T2 ARP-G-56-A T1 T2 ARP-G-56-B T1 T2 ARP-G-56-C T1 T2 ARP-G-56-D T1 T2 ARP-G-56-A T1 T2 ARP-G-56-B T1 T2 ARP-G-56-C T1 T2 ARP-G-56-D T1 T2 ARP-G-56-X T1 T2 ARP-G-57-A T1 T2 ARP-G-57-B T1 T2 ARP-G-57-C T1 T2 ARP-G-57-D T1 T2 ARP-G-57-A T1 T2 ARP-G-57-B T1 T2 ARP-G-57-C T1 T2 ARP-G-57-D T1 T2 ARP-G-57-A T1 T2 ARP-G-57-B T1 T2 ARP-G-57-X T1 T2 ARP-M-59-X-TG-001 T1 ARP-G-59-X T1 ARP-G-59-X T1 ARP-G-96-X T1 Steam System Schematic Heating and Cooling Schematic NTS A1 ARP-S-54-X-XX-010 T1 NTS A1 ARP-S-56-X-XX-001 T1 T2 Heating and Cooling Schematic Heating and Cooling Schematic Heating and Cooling Schematic Heating and Cooling Schematic Mechanical Services Schematic Valve Arrangements NTS NTS NTS NTS NTS A1 ARP-S-56-X-XX-002 T1 T2 A1 ARP-S-56-X-XX-003 T1 T2 A1 ARP-S-56-X-XX-004 T1 T2 A1 ARP-S-56-X-XX-005 T1 T2 A1 ARP-D-56-X-XX-001 T1