CWM TAF UNIVERSITY HEALTH BOARD ESTATES STRATEGY 2014/15 2017/18 1
CONTENTS 1. Introduction... 4 2. Executive Summary... 4 3. Strategic Context... 6 3.1 Cwm Taf Vision and Strategic Objectives... 6 3.2 Impact of the South Wales Programme... 6 3.3 Service Redesign and Site Rationalisation programme... 8 3.4 Primary Care Strategy... 9 3.5 Other Priorities within the 3 Year Integrated Plan... 11 4. The Existing Estate... 12 4.1 Estate Profile... 12 4.2 Condition of the Estate Backlog Maintenance... 13 4.3 Condition of the Estate Routine Maintenance... 14 4.4 Condition of the Estate Performance Measures... 15 4.5 Condition of the Estate Primary Care premises... 17 4.6 Condition of the Estate Summary... 17 5. Strategic Objectives and Vision for Estates... 17 6.1 Prince Charles Hospital... 18 6.2 Royal Glamorgan Hospital... 19 6.3 Medical Education Facility Merthyr Tydfil... 20 6.4 Community Hospitals... 21 6.5 Primary and Community Premises... 21 6.6 Administrative accommodation... 22 6.7 Energy Efficiency and Performance... 22 7. Land and Property Disposal and Acquisition programme 23 7.1 Disposal programme... 23 7.2 Acquisition programme... 23 8. Resources... 24 8.1 Major Capital Resource... 24 8.2 Resourcing of Primary care Estates Developments... 24 8.3 Discretionary Capital Allocation... 25 8.4 Revenue Resources... 25 9. Performance Monitoring... 26 2
10. Three Year Action Plan to Deliver the Estates Strategy 28 Appendix 1... 33 Work in Dewi Sant Hospital requirement to bring hospital up to physical condition category B Significant risk items... 33 Appendix 2... 34 Primary Care Premises and Condition... 34 Appendix 3... 40 Achievements in previous 18 months... 40 3
1. Introduction The Estate is one of the Health Board s largest assets, and consists of a range of facilities and services which support all the Health Board s activities in the delivery of healthcare for its catchment population. This Estates Strategy, updated from an interim strategy agreed in October 2012, describes the Health Board s existing estate and broadly outlines known and potential changes proposed to it over the next 5 years. It is written in the context of the Health Board s 3 year Integrated Plan 2. Executive Summary The objectives of this strategy will be to ensure that: The estate is developed to meet emerging service models, All statutory and safety obligations are achieved, Backlog maintenance levels are reduced year on year to a nominal amount by 2017/18 from 7.5m in 2013/14, Performance against the 6 national targets is improved, with the 90% target achieved by 2017/18, The cost per square metre is reviewed year on year, with a view to reducing this if possible, taking account of the safety of the service. The Health Board s 3 Year Integrated Plan sets out an ambitious programme of service change, quality and performance improvements and cost reductions. The estate will need to be developed and improved across acute, community and primary care sectors to ensure that it supports the service changes required. This is particularly relevant to the Royal Glamorgan Hospital which will see the greatest number of service changes over the coming years. In relation to the general condition of the estate, the data shows that: Major improvements have been made in the condition of the estate over the last few years, Work is still required to ensure that compliance against fire standards is improved at Prince Charles Hospital, The condition of the plant and estate is deteriorating at RGH with the biggest backlog maintenance cost associated with this site, 4
Dewi Sant Hospital also requires work to bring this up to standard if it is to continue to be a major site in the Health Board s portfolio, A significant increase in expenditure is required to reduce the overall backlog maintenance costs, There are a number of primary care practices in poor condition which will need to be addressed as part of the Primary Care Estates strategy. Priorities for the organisation will therefore include: Commencement of the refurbishment of ground and first floors at Prince Charles Hospital (PCH) to meet the requirements of a live Fire Enforcement notice, but also to redesign and relocate service departments to improve quality of services and meet modern accommodation standards, Significant changes to the Royal Glamorgan Hospital (RGH) site, - developing a programme for plant / equipment replacement to ensure that the hospital remains at physical condition and statutory compliance category B - creating a site development plan for the hospital to accommodate all of the changes outlined - developing a suite of business cases to secure capital to enable these changes to be implemented, Agreement of a Primary and Community Care Estates Development Plan, supporting the delivery of a Primary and Community Care Strategy, including urgent consideration and agreement with Welsh Government on a funding model, Development of the Dewi Sant site into a Health Park facility, with consideration being given to how Ysbyty Cwm Cynon (YCC) and Ysbyty Cwm Rhondda may also be able to contribute to this service model in their respective communities, Continued review of office accommodation, with the introduction of an agile working policy to improve space utilisation and to facilitate the transfer from YMH in 2016, Continuation of a disposal programme, with disposal of Pontypridd and District Cottage Hospital and Tonteg Hospital planned for next year, and a review of community premises to determine whether there are further opportunities for site rationalisation, Acquisition of one new site to facilitate the centralisation of medical records storage, Continuation of benchmarking of costs against English and Welsh providers, Negotiations with WG to secure the significant levels of capital to enable change. 5
3. Strategic Context In March 2014 the Health Board approved a 3 year Integrated Plan for the organisation which sets out its vision and strategic objectives as well as outlining priorities for quality and safety improvements, service redesign and achievement of cost reductions of 5.5% per year. Work is currently ongoing in relation to the development of the next iteration of the plan, due for submission to Welsh Government in January 2015. Summarised in this section of the strategy are some of the key elements of the current 3 year plan together with elements which will be added to the next iteration which drive the priorities for the estates strategy. 3.1 Cwm Taf Vision and Strategic Objectives The 3 year Integrated Plan sets out the Health Board s vision, which is to prevent ill health, protect good health and promote better health by providing services as locally as possible and reducing the need for hospital inpatient care wherever possible. The plan also sets out the following five strategic objectives, derived principally from the Institute for Healthcare Improvement (IHI) Triple Aim, which provides a clear framework for the plan. These objectives are: To improve quality, safety and patient experience. To protect and improve population health. To ensure that the services are accessible and sustainable into the future. To improve governance and assurance. To reduce the per capita cost of care in line with the resources made available to the University Health Board. 3.2 Impact of the South Wales Programme The South Wales Programme was established in January 2012 to review those services deemed fragile in terms of their ability to deliver safe and sustainable models of care. These services were specialist accident and emergency, inpatient paediatrics, neonatal services and consultant-led maternity services. 6
The outcome of the Programme was firstly the agreement to create three acute care alliances across South Wales and South Powys. These alliances will ensure that hospitals no longer work in isolation but instead work more closely together across health board boundaries as part of a network providing care to patients. Secondly, all health boards agreed to provide consultant led emergency medicine (A&E), maternity and neonatal care and inpatient children s services at five centres, one of which was the Prince Charles Hospital (PCH). In relation to the Royal Glamorgan Hospital (RGH), it has been agreed that local service models in emergency medicine, paediatric assessment and maternity services will be developed to replace the traditional services. Inpatient children s services will not be delivered from the RGH site in the future but implementation will require a new local assessment service being in place as the changes occur, to ensure that children continue to have their care delivered safely, as locally as possible. Consultant-led A&E services will not be delivered from the RGH site in the future but implementation will require the proposed new model for a local A&E service (non-consultant led) to be in place as the changes occur. Maternity and neonatal services at RGH will work closely with other units within the alliances to deliver as much safe care as locally as possible. There has also been full agreement that RGH will become a beacon site for developing innovative models of care in acute medicine and diagnostic services. Subsequently, the Minister has announced 2m of capital funding to commence the development of a diagnostic hub on the site. Whilst there are still detailed on-going discussions around the precise nature of the services to be provided from each site, the Health Board is clear that both hospitals will continue to be an integral part of the acute service provision for our populations. The Health Board is therefore committed to continuing to address any statutory and safety issues at these hospitals and to work to ensure that the accommodation is functionally suitable and can meet the meet the emerging service needs. The accommodation changes to facilitate these changes are likely to be significant. 7
3.3 Service Redesign and Site Rationalisation programme The current three year Integrated Plan for Cwm Taf University Health Board includes proposals to significantly remodel and transform services and continue with plans for improvements in efficiency, which will lead to improved quality of care for patients and reduced lengths of stay. These changes then provide an opportunity to review the number and location of beds and sites required to provide the remodelled and improved services. The main elements of the redesign programme are outlined below: 3.3.1 Redesigning the community hospitals Through a combination of increased investment and continued improvements in internal processes the length of time patients need to stay in community hospitals will reduce. The effect on the hospital system is that one ward at Dewi Sant Hospital has been vacated. The orthogeriatric rehabilitation services currently provided from Dewi Sant Hospital have been transferred to RGH to reduce the need for patients to be moved from hospital to hospital, to reduce unnecessary waits and delays in the patients journey and to make better use of scarce therapy staff on one site. This has therefore vacated a second ward on the Dewi Sant Hospital site. 3.3.2 Older Person s Mental Health Services Older People s Mental Health services have been redesigned, including investment in community services and transport, the centralisation of assessment services at RGH, the closure of Ward 1 at Dewi Sant Hospital, and a change in function of Ward 35 at PCH. 3.3.3 Stroke services redesign Stroke Services are being remodelled, with a centre of excellence for acute and early rehabilitation services provided on the PCH site and all longer stay rehabilitation services provided on the YCR site. 3.3.4 Palliative Care service redesign It is proposed that palliative care services currently provided from Y Bwthyn are transferred to RGH. This will improve patient safety, quality and access to care. In particular, this will avoid the need for 8
patients to be transferred to and from RGH for investigation and specialist treatment which is often difficult and distressing. The Older Person s Mental Health Day Unit and the Mental Health Outreach and Recovery Team base, also currently provided from the Pontypridd and District Cottage Hospital site, will be relocated into suitable accommodation so that the hospital site is vacated. This will then allow the Health Board to dispose of the site, which is now old and has a significant backlog maintenance requirement. 3.3.5 Health Park - Dewi Sant site As the Older Person s Mental Health service redesign, orthopaedic rehabilitation and length of stay changes have been taken forward and implemented, so inpatient care has ceased at Dewi Sant Hospital. This provides a fantastic opportunity to review the type and mix of services that can be provided from the site, and it is proposed that work commence on establishing the case for a health park type facility, similar to that recently opened in Merthyr Tydfil, with a mix of primary and community health care, social care and third sector partners using the site for ambulatory care. In order to develop specialist primary care services in each of the localities and avoid the need for secondary care services, the potential to create larger primary Cluster Hubs is being considered, and Dewi Sant will be considered as an ideal location for the Taff Ely area. 3.3.6 CAMHS services A range of outpatient CAMHS services are currently provided from the Tonteg Hospital site. The proposal is that these are relocated to be provided from RGH, as this will provide co-location with other mental health services, providing efficiencies of scale in some administrative functions. This will then allow the Health Board to dispose of the site, which is now old and has a significant backlog maintenance requirement. 3.4 Primary Care Strategy In relation to the development of this Estates Strategy, the most relevant element of the primary care provision is the General Practice provision. A full Primary and Community Care Strategy is currently in development, to be included in the next 3 Year Integrated Plan. This 9
will lead to the development of a supporting Primary and Community Care Estates Development Plan, which will form a key part of the Health Board s overall Estates Strategy. However, there are some known challenges and drivers which are likely to be a part of this plan: As an increased number and range of services move closer to people s homes, delivered through primary and community care teams, there will be a requirement to increase and improve the space available to provide these services. Many of the current practice premises do not have any expansion space Significant increases in population are planned over the coming years in some areas of the Cwm Taf catchment. This again will put pressure on existing premises and in one area, Llanharan, a new practice and associated accommodation will be required There remain a small number of single handed practices within Cwm Taf and the strategy is likely, as GPs retire, to encourage the creation of larger practices to provide a greater range of services to the local populations. This will in some cases require new, extended premises to accommodate the larger practice To enable the development of more specialist primary care services in each of the localities and avoid the need for secondary care services, the potential to create larger Cluster Hubs is being considered, potentially delivered from 4 health park type facilities (Keir Hardie, Dewi Sant, YCC and YCR) Primary Care estates developments will have an important role in the succession planning of the Primary Care GP and nursing workforce, giving healthcare professionals the opportunity to provide and develop services from modern, up to date premises. It is known that GPs will not make a commitment or invest in unpleasant substandard premises There are a number of premises, both owned by GPs and by the Health Board, which are not currently fit for purpose and which will require refurbishment or the delivery of a new build to ensure that services are provided from modern up-to-date accommodation In the light of the current GP recruitment problems, it may be necessary to consider the sustainability and viability of older sub standard branch surgeries. The focus on the main surgery sites is sometimes an enabler for the Primary Care GP team to maintain and / or improve access and the range and quality of services to patients. 10
3.5 Other Priorities within the 3 Year Integrated Plan The 3 Year Plan includes proposals for a number of other service changes and improvements which require improvements or changes to the estate to be undertaken. These include: Centralisation of medical records storage on one site to reduce health and safety concerns in the current libraries and streamline the efficiency of the service. This plan will require the organisation to purchase or lease a new building to store the records. In the longer term, strategies for the digitisation of records may reduce the requirement for storage space. There is a drive to improve the accommodation at Ysbyty George Thomas, moving from dormitory accommodation to single room accommodation with enhanced living/socialising space and rehabilitation facilities for older adults suffering with a functional illness or a cognitive impairment. Within Pathology, consideration is being given to creating a combined Blood Science department, which would require changes to the physical environment. In addition, the potential regionalisation of microbiology and histopathology is being considered by a national board. The Facilities Directorate are seeking opportunities for income generation which may have an impact on space and equipment requirements in the CPU and laundry. 11
4. The Existing Estate 4.1 Estate Profile At the end of March 2014 the Health Board estate covered a total land area of 72 Hectares with buildings having a total gross internal floor area of 179,000 m 2. The profile of the Health Board premises at the end of 2013/14 included the following: o General Acute Hospitals: 2 o Community inpatient facilities: 6 o Other Patient and support Facilities: 26 Within Primary Care, GPs own and manage a large number of premises, many of which the Health Board shares or utilises to some extent. Figure 1 compares the age profile of the Health Board s estate in 2013/14 with 2001/02. This shows that the Health Board s modernisation programme over the last 12 years has resulted in a reduction in Pre 1948 facilities from 26% to 3% and an increase in Post 1995 facilities from 30% to 60%. The major modernisation programme, which has been largely concentrated on improvements in the Merthyr and Cynon valleys, has included: The ward refurbishment programme at Prince Charles Hospital; The opening of a new Emergency Care Centre and Day Surgery Unit at Prince Charles Hospital; The opening of the new Ysbyty Cwm Cynon in Mountain Ash; The opening of the new Keir Hardie Health Park in Merthyr Tydfil; The disposal of Mountain Ash, St Tydfil s and Aberdare Hospitals and the Hollies and Seymour Berry Health Centres. 12
1% 1%3% 26% 30% 23% 0% 0% 11% 9% 10% 61% 24% 2001/02 2013/14 Figure 1: Age profile of the estate in 2001/02 and 2013/14 4.2 Condition of the Estate Backlog Maintenance Each year, data on all elements of the estate is submitted to the national Estates and Facilities Performance Management System (EFPMS), run by NWSSP Specialist Estates Services. A national Estate Condition and Performance report is produced each year on the basis of the submitted data. The data for 2013/14 has been submitted, but the national report and analysis of performance indicators has not yet been published. The data in this strategy therefore contains a mix of 2012/13 and 2013/14 data as appropriate. One of the elements measured in these returns is the Risk Adjusted Backlog (RAB) costs for each hospital and organisation. Figure 2 below identifies the 2013/14 Risk Adjusted Backlog (RAB) costs and compares them with the figures submitted for 2012/13. The backlog costs are broken down by risk category as these, together with an estimated remaining life of the building are used to calculate the RAB costs. It can be seen that, compared with the previous year, the RAB costs have decreased by 1.96m, largely as a result of the sale of St Tydfil s hospital. It should be noted however that the PCH figures 13
exclude all of the backlog maintenance issues that will be addressed by the ground and first floor refurbishment scheme. The largest and most significant RAB relates to RGH in recognition of the fact that it is now nearly 15 years old. However, given the size of the sites, there are also high backlog costs at Pontypridd and District Cottage Hospital and Dewi Sant Hospital. Site Name Ysbyty Cwm Cynon Pinewood House Pontypridd and District Cost to eradicate High Risk Backlog Cost to eradicate Significant Risk Backlog Cost to eradicate Moderate Risk Backlog Cost to eradicate Low Risk Backlog Risk adjusted Backlog 2013/14 Risk adjusted Backlog 2012/13 0 10,300 0 0 5,807 5,638 169 0 1,545 143,448 15,450 4,855 4,547 308 47,741 237,714 10,908 0 285,217 277,644 7,573 Variance in RAB Ysbyty George 0 265,890 520,860 10,609 284,217 296,728-12,511 Thomas Dewi Sant 0 480,798 520,150 0 498,734 559,810-61,076 Ysbyty Cwm 0 1,030 906,520 263,680 28,892 28,674 218 Rhondda Aggregated 26,560 810,012 878,352 320,018 866,531 837,683 28,848 Sites Prince Charles 0 120,253 2,783,743 17,974 202,656 251,263-48,607 Hospital Royal 0 5,251,799 3,071,748 582,026 5,353,293 5,641,952-288,659 Glamorgan Hospital St Tydfil s Hospital 1,586,746-1,586,746 Health Board 74,301 7,179,341 8,835,729 1,209,757 7,530,202 9,490,685-1,960,483 Figure 2: Risk Adjusted Backlog Costs by site Behind each of these figures sits a detailed spreadsheet outlining the specific areas within each hospital that require attention. This enables the capital and estates department to determine the priorities for investment with the capital made available each year. For illustration purposes, the elements making up the significant risk backlog at Dewi Sant Hospital are included in Appendix 1. 4.3 Condition of the Estate Routine Maintenance The Estates department operate a planned, preventative maintenance programme which is designed to ensure that all plant and buildings are maintained to the required standards. The standards are contained within a variety of guidelines, including the Welsh Health Technical Memoranda. In addition, defects can be notified to the Estates department via the Helpdesk. All planned, preventative tasks together with helpdesk tasks are recorded and monitored by the Estates department software 14
package TABs. There is an expectation that 100% of statutory and mandatory tasks are completed in a timely fashion. Performance is monitored monthly and is reported at the Estates Governance Board. A review of the methods for reporting performance is currently underway so that accurate data is not available at present. However, where performance dips, there is an expectation that an improvement action plan will be developed and implemented. 4.4 Condition of the Estate Performance Measures The EFPMS returns also measure each organisation s performance against the 5 national performance indicators for estates, which relate to the condition and usage of the estate. Figure 3 shows the Health Board s 2012/13 performance for the essential estate based on the five national performance indicators and compares it with the 2011/12 figures. Figures relate to the percentage of the estate in condition category B for Physical condition, Statutory and safety compliance (excluding Fire safety which is measured separately, also on the basis of the percentage of the estate in condition category B ), and Space utilisation. Figures for Functional suitability relate to the percentage of the estate in condition category F. Energy performance is based on consumption measured in terms of kwh/m 2. National Performance Indicator 2012/13 2011/12 Physical condition 83% 83% Statutory and safety compliance 79% 82% Fire safety* 86% 74% Functional suitability 97% 77% Space utilisation 97% 94% Energy performance 438 kwh/ m 2 426 kwh/ m 2 *Compliance with statutory Fire Safety legislation is not included under the Statutory and safety compliance National Performance Indicator 15
Key 90% or above (Energy performance: 410 kwh/m 2 or below) 75-89% (Energy performance: 411-479 kwh/m 2 ) 74% or below (Energy performance: 480 kwh/m 2 or above) Figure 3: Health Board performance matrix for national performance indicators The significant improvement in fire safety compliance is as a result of the major capital works undertaken at PCH over the last few years and the improvements in functional suitability are due to the removal of Aberdare, Mountain Ash and St Tydfil s hospitals from the data. These performance measures are also recorded at individual hospital and site level, and these reveal different challenges. Figure 4 below outlines the performance in 2012/13 for each site. Dewi Sant Hospital Pinewood House Pontypridd and District Cottage Hospital Prince Charles Hospital Royal Glamorgan Hospital Ysbyty Cwm Cynon Ysbyty Cwm Rhondda % in Physical Condition Category B % in Statutory Health and Safety Compliance % in Fire Safety compliance 84.1 91.3 95.3 86.3 97.3 92.3 72.1 89.3 76.5 83.4 64.2 72.5 81.3 87.5 97.8 100.0 97.7 100.0 67.7 88.9 100.0 Ysbyty George Thomas Aggregated sites TOTAL 67.7 88.9 100.0 83.1 67.8 69.0 82.6 79.2 86.3 Figure 4: Performance data for each site 2013/14 16
4.5 Condition of the Estate Primary Care premises There are 45 General Medical Practices within Cwm Taf and 1 University Board managed GP Practice. The majority of the practices operate out of buildings that they own, many of which have been constructed through Third Party Developer schemes. However, a number still operate from buildings owned by the Health Board, who retain responsibility for their maintenance and upkeep. A full list of premises used by General Medical practices is attached as Appendix 2, which also outlines the general condition of each building as established through the Annual Practice Development visits to each practice. Seven buildings are classed as being in poor general condition and the Primary Care estates priorities will take these into account. 4.6 Condition of the Estate Summary In summary, the data on the condition of the estate is telling us that: Major improvements have been made in the condition of the estate over the last few years, Work is still required to ensure that Prince Charles Hospital improves compliance against fire standards, The condition of the plant and estate is deteriorating at RGH with the biggest backlog maintenance cost associated with this site,, Dewi Sant Hospital also requires work to bring this up to standard if it is to continue to be a major service site, A significant increase in expenditure is required to reduce the overall backlog maintenance costs, There are a number of primary care practices in poor condition which will need to be addressed as part of the Primary Care Estates strategy, either requiring brand new premises or improvement work. 5. Strategic Objectives and Vision for Estates Specifically, the objectives of this strategy will be to ensure that: The estate is developed to meet emerging service models; All statutory and safety obligations are achieved; 17
Backlog maintenance levels are reduced year on year to a nominal amount by 2017/18; Performance against the 6 national targets is improved, with the 90% target achieved by 2017/18; The cost per square metre is reviewed year on year, with a reducing it if possible, taking account of the safety of the service. Achievements against the priorities within the Interim Estates Strategy, completed within the last 18 months, are highlighted in Appendix 3. 6. Proposed Priorities for the Estate This section of the strategy sets out the proposed priorities for change to the estate in the next 5 years. The aim of these priorities must be to ensure that the Estates Strategic objectives are achieved and that the estate is developed in such a way as to enable the Health Board to achieve its objectives as set out in its 3 year Integrated Plan. Whilst the overall direction of travel is clear in terms of developing service models, the specific details of where and how services will be provided is still in development in a number of service areas. This strategy will therefore need to be further developed and refined in conjunction with progress on service models being developed. 6.1 Prince Charles Hospital There remain significant fire safety and asbestos issues at Prince Charles Hospital. The ward refurbishment programme which has been completed has addressed these issues in the main ward block, but a Fire Enforcement Notice on the Ground and First Floor of the Merthyr block remains in force, which is evidenced by the poor performance on fire safety compliance for the site. The Health Board have committed to addressing this through a further major capital scheme. Work has been on-going within the Health Board on this issue, with approval of a 119m Outline Business Case for the refurbishment of the ground and first floor given in December 2013. The Full Business Case will be submitted in the autumn of 2015. However, in addition, an early release of funding is being sought to commence the enabling works, including car parking improvements and provision of decant accommodation, 18
with a mini FBC to be completed by December 2015. The work will take approximately 5 years to complete. This scheme will address the remaining fire safety and asbestos issues on the site, and will also address a significant proportion of the statutory compliance issues and backlog maintenance. However, the scheme also offers the opportunity to completely remodel the departments on the ground and first floor to meet current accommodation standards and deliver the Health Board s service plans. Extensive planning work has been undertaken with staff in developing these plans to ensure that fully functional and efficient accommodation is provided. The scheme also seeks to address the major car parking issues at the hospital, which have been evident for many years. The scheme will increase the number of car parking spaces by 263 and will increase the provision of disabled bays to correct levels. It will also completely renew a number of existing car parks which are in a poor state of repair. 6.2 Royal Glamorgan Hospital The Royal Glamorgan Hospital is now 15 years old, and the data in EFMPS suggests that a significant maintenance backlog has built up, and there are increasing pressures on the building and the accommodation in terms of overall space, functional suitability, and life span of major areas of plant / equipment. In addition, as outlined in previous sections, a number of major service changes are planned for the hospital as a result of both the South Wales Programme and the Health Board s internal service redesign programme and priorities within its 3 year Integrated Plan. The changes include: Development of new acute medical service models, which will affect the front door of the hospital Creation of a diagnostic hub, expanding radiology and other diagnostic services to support the hospitals in South Wales Development of a paediatric assessment model for the longer term, with contingency plans potentially required to support the transitional period Review of critical care facilities to meet the demands of the new service models Centralisation of decontamination facilities to meet HTM requirements 19
Transfer of Palliative Care services from Pontypridd and District Cottage Hospital Transfer of orthogeriatric rehabilitation service from Dewi Sant Hospital Creation of a centralised breast care service for the Health Board Movement of a range of clinical and non clinical services across and out of the site to accommodate these service changes. The 3 main strands of the strategy for this major hospital are therefore; to develop a programme for plant / equipment replacement to ensure that the hospital remains at physical condition and statutory compliance category B and to meet the infrastructure requirements of the South Wales programme; to create a site development plan for the hospital to accommodate all of the changes outlined; to develop either a suite of business cases to secure capital to enable these changes to be implemented. 6.3 Medical Education Facility Merthyr Tydfil A Business Justification Case, developed in partnership with Cardiff University School of Medicine, to provide an undergraduate Medical Education Facility on the Keir Hardie Health Park site, was approved by WG in April 2014. This is in response to Cardiff University School of Medicine s proposal to establish a teaching and research base for undergraduate medical trainees at the Merthyr Tydfil Health Park as part of a wider network of community-based teaching hubs. It is based on the new undergraduate medical teaching curriculum being planned by Cardiff University School of Medicine as part of its C21 programme. C21 involves the introduction of a completely new approach for the undergraduate medical teaching curriculum, the purpose of which is to improve the quality of medical education delivered by the university and a key part of the proposed solution is the provision of early and extensive exposure for students to healthcare in a community setting. It is anticipated that this scheme will be completed in December 2014, with students able to utilise the building from January 2015. 20
6.4 Community Hospitals The Health Board currently has 5 community hospitals: YCR, YGT, Dewi Sant, Pontypridd Cottage hospital and YCC. As part of the three year Integrated Planning process, decisions have been made about the level and location of services provided from these facilities. In particular: Inpatient provision has ceased at Dewi Sant Hospital and the site will be redeveloped to become a Health Park facility for ambulatory care. This will require significant capital investment and solutions will need to be provided in relation to the car parking provision on site. Consideration will be given as part of the Primary Care Strategy as to whether YCC and YCR will be further developed to enhance their local primary care provision, as part of a network of Health Park-type facilities in each locality Pontypridd and District Cottage Hospital will become surplus to requirements once services have been transferred to RGH and other alternative locations and will be sold Capital funding will be sought to continue to develop and update the accommodation at YGT to support the patients needs. 6.5 Primary and Community Premises The development of the Primary and Community Care Strategy and supporting Primary and Community Care Estates Development Plan will be key in this area as these will determine the priorities for development and improvement. However, the two predecessor organisations to the Health Board had detailed Primary Care Estates Strategies in place and significant work was undertaken in previous years to renew the estate in this area to positive effect. There are five remaining priorities for improvement at present: Llanharan: a number of residential developments in this area mean that the situation regarding the provision of GMS and other community health services in these areas is now reaching a critical point and the provision of a new surgery is seen as a priority. Mountain Ash: this scheme is required to relocate and accommodate the GP practices, some of whom are currently located in unsuitable accommodation. 21
Tonteg: this scheme is the replacement of a branch surgery currently accommodated in a converted residential property, with a new surgery which will not only provide up to date accommodation but also relieve pressure on the main surgery in Pontypridd and allow the practice to expand existing and provide new services. Tonypandy: this scheme is the replacement or refurbishment of Tonypandy Health Centre, which currently accommodates two GP practices, Community Dental Services and some Community Nursing teams. Aberdare Primary Care Centre: this scheme is required to replace or refurbish the existing Aberdare Health Centre and accommodate the local GP practices and community services. In addition to the priorities identified above there are a number of primary care premises which are in need of significant improvement programmes in order for them to respond to the growing needs of their patients or to maintain the good standard of premises. In relation to the supporting community premises, the Tonteg Hospital site has already been identified as surplus to requirements. A review will be undertaken to determine whether there is scope for further rationalisation and also to determine the priorities for investment in the infrastructure, given that the data suggest that there is a backlog maintenance requirement in these areas. 6.6 Administrative accommodation The Health Board continues to lease 2 buildings for office accommodation purposes Ynysmeurig House, Abercynon and the WHSCC offices in Caerphilly. The Health Board s strategy is to move away from leased accommodation, and will develop plans to accommodate these departments where possible within existing estate. In order to facilitate these changes, a plan will be developed to maximise the efficient use of this type of accommodation, including consideration of a much increased use of agile working / hot desking within the organisation. 6.7 Energy Efficiency and Performance The Health Board s Energy Management Plan sets out a range of priorities for the coming years. In particular, the plan sets out a target of a reduction in energy consumption of 7% each year for the coming 3 years. In addition, the organisation will be focused on improving performance against the national energy indicator. 22
Components of the plan include strengthening corporate commitment through introduction of a Lead Director for Energy Management, making energy everyone s business through launch and continuation of an energy awareness campaign, and investing in a suite of energy reduction schemes (e.g. CHP, LED lighting). The improvements sought however are dependent on major capital being made available to implement schemes that reduce consumption. Business cases will be submitted to Welsh Government in support of this objective. 7. Land and Property Disposal and Acquisition programme 7.1 Disposal programme The Health Board has been through an extensive disposal programme over the last few years, but may, through the future development of this estates strategy, identify further areas for rationalisation. All disposals are undertaken in close collaboration with NWSSP Facilities Services, who lead on property matters for the NHS in Wales. Tonteg Hospital: As part of the Health Board s 3 year Integrated Plan, it has been agreed that CAMHS services currently located at this site will transfer to RGH. Once this service move has been completed, the site will be disposed of. Pontypridd Cottage Hospital: As part of the 3 year Integrated Plan, agreement has been reached to locate specialist palliative care from Pontypridd Cottage Hospital to RGH, and alternative locations are being identified for the remaining services provided from that site. Once the site has been vacated, this facility will become surplus to requirements and will be sold. Aberdare Hospital: This site has recently been sold. 7.2 Acquisition programme The plan for the centralisation of medical records storage across the Health Board may require the purchase or lease of a facility for this purpose. The option appraisal for this development has considered whether there are any opportunities for utilising existing estate, but no feasible options are available. Various sites are therefore 23
currently being considered with a review of the options available due to be completed in the next few weeks. 8. Resources 8.1 Major Capital Resource Major capital investment will be required to implement elements of this strategy. The Health Board have submitted to the Welsh Government a set of investment priorities for coming years, which are currently being considered alongside all other Health Board priorities. The Minister will shortly announce the results of this prioritisation process. Elements of this investment plan are already acknowledged by the Welsh Government and are included in the future all Wales capital programme, including the refurbishment of the ground and first floor at PCH and the medical education facility on the Keir Hardie Health Park site. A series of business cases will be developed to support the requirement for each of the Health Board s priorities. 8.2 Resourcing of Primary care Estates Developments In the past, the development of new Primary Care premises has been achieved largely through the use of Third Party Developers (3PD) with funding support for any increased revenue costs met by Welsh Government. In June 2013, the Welsh Government notified Health Boards of the intention to establish a new policy framework to support the development of Primary Care estate. Health Boards were informed in October 2013 that decision making in the future would be undertaken by Local Health Boards, based on local need, service models and development priorities within their own areas. Health Boards were also notified that from 1 November 2013, schemes would need to be financed from within existing budget allocations. All of the priorities previously being taken forward by the Health Board have significant revenue implications and work has unfortunately been on hold in this area for some time. 24
Consideration has therefore being given to seeking capital funds from the All Wales Capital Programme to deliver the primary care estates priorities. It is planned that a Strategic Outline Programme (SOP) should be developed for Primary Care Estates Developments and submitted to the Welsh Government for consideration. It is likely that consideration would need to be given on a case by case basis on the merits of capital funding over third party developments, and this would be analysed in detail in the Business Justification Cases for each individual scheme. It is understood that the Welsh Government are keen to see significant primary care developments across Wales and are appraising a variety of financial models to support this strategy. 8.3 Discretionary Capital Allocation The Health Board has a limited discretionary capital allocation to utilise in support of its estate and IT / medical equipment requirements. Some small additional sums may be available following the disposal of remaining properties surplus to requirements. The Welsh Government have indicated that the allocation may be increased in future years based on the high levels of backlog maintenance across hospitals in Wales. A sum has been ring-fenced in the previous 2 years for the purposes of works to improve statutory and safety compliance and reduce backlog maintenance requirements ( 1m). Consideration will be given to whether this sum is sufficient in the coming few years or whether it should be increased to deliver the priorities within this strategy. However, consideration will also need to be given to funds to support other aspects of this estates strategy, including the energy management plan, and smaller service / estate improvement plans. 8.4 Revenue Resources A significant revenue sum is also spent on maintaining the estate each year, made up of staff costs, maintenance contracts and building supplies. In 2012/13, data submitted to EFPMS indicated that the total sum expended on building and engineering maintenance costs was approximately 4.248m, down from 4.8m in 2011/12. This gives a cost of 23.53 per square metre of occupied space. The equivalent costs for each of the other Health Boards are shown in the figure below: 25
/m2 Building and Engineering Maintenance Cost per Occupied Floor Area 35 30 25 20 15 10 5 0 25.97 18.59 18.77 14.77 23.53 26.57 27.17 22.58 30.58 20.99 20.78 This indicates that the cost per square metre may be higher in Cwm Taf than the Welsh average. However, it should be noted that there is no internal or external validation of the figures submitted to EFPMS and it is felt that there is some room for interpretation in the way in which the figures are compiled. Nevertheless, it will be important to explore with other Health Boards what actions they have taken to reduce the cost per square metre and to determine what levels of service they provide and the level of risk that they operate with. This will be achieved through the newly formed Assistant Director forum for Estates and Capital matters. In addition, the Health Board contributed to a corporate benchmarking exercise, comparing costs with NHS organisations in England. This demonstrated that the Health Board s costs were significantly below average, which may indicate that further cost reduction is unwise. 9. Performance Monitoring Successful implementation of this strategy will be measured through: Annual performance against National Performance Indicators (considering Health Board overall performance and performance for specific sites); Annual review of costs per square meter against English and Welsh organisations (both overall costs and costs for each site); Annual review of backlog maintenance costs; 26
Post contract evaluations of major capital schemes; Annual review of benefits and outcomes of the Discretionary Capital Programme. This will be captured in an Annual Estate Report and will be presented to Executive Board and to the Finance and Performance Committee. 27
10. Three Year Action Plan to Deliver the Estates Strategy Objective Priorities 2014/15 Priorities 2015/16 Priorities 2016/17 The estate is developed to meet emerging service models Primary care Agreement of Primary and Community Care Estates Strategy for the Health Board, including assessment of priority developments Strategic Outline Programme (SOP) for Primary Care Estate developed and submitted to WG, based on an agreed Primary and Community Care Strategy. This will need to include consideration of the various funding models. BJCs submitted on agreed priorities for Primary Care Estate. Current likely priorities include Mountain Ash, Aberdare, Tonteg, Llanharan and Tonypandy. Process and funding agreed for the continuation of the improvement grants scheme Work to continue on improvements to primary care estate priorities Community Hospitals / Health Parks Agreement of service model for Health Park at Dewi Sant Hospital Development of designs for refurbishment of Dewi Sant Hospital to facilitate the agreed service model Submission of business case (potentially as part of the SOP for Primary Care Estates Developments) for the refurbishment of Dewi Sant and the creation of a Health Park facility Major capital works commenced at Dewi Sant Hospital to enable conversion to Health Park model Transfer of services to Dewi Sant site, including services from Pontypridd and District Cottage Hospital and Tonteg Hospital Development of business cases as required to support the development of Health Park facilities at YCC and Works to start at YCC and YCR 28
YCR Community premises Review completed into usage and condition of community premises to determine scope for further site rationalisation Business case developed for the refurbishment of wards at YGT Any agreed site rationalisations implemented Royal Glamorgan Hospital SOP and BJC submitted for first phase Diagnostic Hub and Radiology Programme at RGH Agreement of service models for acute medicine, paediatrics and maternity services, and development of associated business cases for capital to enable change Submission of BJC for creation of Palliative Care service at RGH Finalisation of plans for the transfer of CAMHS to RGH, with associated capital works completed and accommodation changes made Completion of construction works for first phase diagnostic hub Construction work to enable service model changes, dependent on capital availability Completion of construction / refurbishment work to accommodate transfer of palliative care from P&D Hospital Site development plan created and agreed for RGH 29
Medical Education Facility Complete construction on the medical education facility at Kier Hardie University Health Park All statutory and safety obligations are achieved Prince Charles Hospital Submission and approval of the mini FBC for enabling works at PCH Commencement of enabling works (dependent on WG approval Develop and submit the Full Business Case for the refurbishment of the ground and first floor at Prince Charles Hospital Major capital scheme commences at PCH to address fire enforcement notice Medical Records Option appraisal completed on whether new centralised facility should be purchased or leased to address major health and safety concerns in current medical records libraries Commissioning of new facility, either purchased or leased Development of plans for digitisation of medical records, which may reduce space required Maintenance programme Performance data will be reviewed and accurately reported Action plan developed to remedy any performance problems Consideration of upgrading TABs software system to assist with improvements in performance levels 30
Backlog maintenance levels are reduced year on year to a nominal amount by 2017/18 Development of an plant and equipment asset replacement programme for RGH to ensure that it remains at physical condition and statutory compliance category B; Consideration of increased level of capital made available for backlog maintenance and statutory compliance at ECMG / Capital Programme Board Review of all high and significant risks identified through the EFPMS returns to determine priorities for investment across all sites Performance against the 6 national targets is improved, with the 90% target achieved by 2017/18 The cost per square metre is decreased year on year, with a target to be set Disposal Programme Disposal of Aberdare Hospital site Disposal of Tonteg and Pontypridd and District Cottage Hospital sites Move out of the leased accommodation at YMH 31