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The Future of Hospital Services in West Hertfordshire Draft Strategic Outline Case

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The Future of Hospital Services in West Hertfordshire Draft Strategic Outline Case THE FUTURE OF HOSPITAL SERVICES IN WEST HERTFORDSHIRE DRAFT STRATEGIC OUTLINE CASE July 2019 DOCUMENT CONTROL Document information Document title West Hertfordshire Hospitals NHS Trust Future of Hospital Services SOC Owner Helen Brown, WHHT Deputy Chief Executive and Director of Strategy and SRO Status V0-10 Final version Revision history Version Date Description V0-1 09/05/19 Initial draft for project team review V0-2 13/05/19 Revised draft addressing review comments V0-3 29/05/19 Further updates V0-4 06/06/19 Numbers and supporting narrative added V0-5 13/06/17 Version for review with stakeholders V0-6 18/06/19 Revised draft incorporating stakeholder feedback for review V0-7 19/06/19 Version for final project team review V0-8 20/06/19 Further edits to address review comments V0-9 20/06/19 Final DRAFT version ready to publish V0-10 03/07/19 Minor amends to Final DRAFT ready to publish Document sign-off Name Date Helen Brown, WHHT Deputy Chief Executive and Director of Strategy and SRO Finance and Investment Committee WHHT Board HVCCG Board (to confirm commissioner support) DRAFT THE FUTURE OF HOSPITAL SERVICES IN WEST HERTFORDSHIRE July 2019 2 Executive Summary This is a summary of the Strategic Outline Case for the redevelopment of the hospital estate operated by West Hertfordshire Hospitals NHS Trust (WHHT). It describes WHHT’s plans to address the significant challenges the Trust faces in trying to deliver 21st century healthcare, with constrained finances and from buildings that are no longer fit for purpose. The Trust has a long-awaited opportunity to redevelop hospital services, a track record that demonstrates capability to deliver and a clear proposal which provides the basis for delivering safe, sustainable services. Case for change West Hertfordshire Hospitals NHS Trust (WHHT) provides a comprehensive range of acute hospital services, operating across three sites - Watford General Hospital (WGH), St Albans City Hospital (SACH) and Hemel Hempstead General Hospital (HHGH). WHHT has made significant improvements since 2016 – moving out of special measures and improving its financial baseline. However, WHHT faces some significant challenges - the age, dated design and poor condition of its buildings is having a detrimental impact on the delivery of safe, effective, responsive and efficient care. It is also limiting the Trust’s ability to implement new care models and digital technology aimed at transforming the service patients receive and improving WHHT’s operational performance and financial position. WHHT buildings are old and no longer ‘fit for purpose’ The age, layout and condition of WHHT’s current estate does not enable clinicians to deliver healthcare to the standards they want and that patients expect and deserve. The latest comprehensive estate survey report (called a Six Facet Survey) from September 2018, confirms what WHHT and patients have been experiencing for years now. This is summarised in Figure 1 below. It confirms that 57% of the Trust estate – and 80% of the WGH estate - is below Condition B, which is considered to be the minimum acceptable condition. £189m would be needed in construction costs alone to eliminate backlog maintenance and improve the functional suitability of WHHT’s existing buildings – with most of this needing to be invested at WGH. Almost double this would be needed overall once fees, VAT, business continuity and risk are included. Without significant capital investment there is a very high risk of failure of critical estate infrastructure and consequent impact on service delivery. Figure 1: Summary of WHHT’s estates challenges DRAFT THE FUTURE OF HOSPITAL SERVICES IN WEST HERTFORDSHIRE July 2019 3 The design of the buildings means infection control management is more challenging and beds are too close together to support good care and promote privacy and dignity. Poor design of clinical areas also drives inefficient practice. Difficulty co-locating services together when required, means that patients often have to be transferred long distances, sometimes outside, from one department to another. Figure 2 below summarises examples of poor functional suitability and its impact. Figure 2: Summary of functional suitability issues at WHHT and their impact The poor condition of the estate has resulted in a significant risk to business continuity. In one month alone, the Trust experienced several incidents as summarised in Figure 3 below. Figure 3: Summary of incidents at WHHT due to issues with the estates and infrastructure By investing in new and heavily refurbished buildings, this would significantly reduce backlog maintenance requirements and avoid the need to spend huge amounts of money on fixing buildings that are no longer fit for purpose. “WE ARE CURRENTLY SPENDING MONEY TO ENSURE STATUTORY COMPLIANCE AND TO MITIGATE AREAS OF HIGHEST RISK. BACKLOG MAINTENANCE LIABILITY HAS CONTINUED TO GROW. DRAFT THE FUTURE OF HOSPITAL SERVICES IN WEST HERTFORDSHIRE July 2019 4 THE VERY REAL ISSUES OF REDUCING THIS BACKLOG AND THE FUNCTIONAL SUITABILITY OF OUR BUILDINGS ARE NOT BEING ADDRESSED. IF NOTHING IS DONE, THE COST OF MAINTAINING THE ESTATE WILL CONTINUE TO GROW AT AN INCREASING RATE WITHOUT ANY REAL IMPROVEMENT IN CONDITION.” Patrick Hennessey, Director of Environment, WHHT WHHT clinical services and teams are fragmented and patient pathways disjointed The way that WHHT’s hospital services are organised across multiple sites means that some services are not able to achieve the required performance standards; clinical teams are fragmented, and staff spread too thinly; patients are being transferred unnecessarily to get the care they need; and operationally, additional costs of duplication are being incurred. West Hertfordshire has a large enough population to support a full range of acute general hospital services but splitting and duplicating these services over three sites in their current configuration is increasingly difficult to maintain without compromising the quality, efficiency and safety of services. “FASTER TREATMENT TARGETS FOR CANCER PATIENTS MEAN WE NEED TO SIMPLIFY PATHWAYS FOR PATIENTS AND THE CLINCIAL TEAMS LOOKING AFTER THEM.” Freddie Banks, Consultant Urologist and Associate Medical Director for Strategy WHHT financial overspend is growing every year The Trust is currently spending c.£50m more annually than it receives in funding; this is almost £1m each week. This position has been progressively deteriorating since 2014, with the annual deficit worsening from £11m to £50m in 2018. Underlying factors for this include: • Increasing investments in the clinical workforce • The cost of maintaining the estate • Reduced opportunities for efficiencies within existing operating and clinical models • Infrastructure limitations and degradations • Additional costs to accommodate high numbers of patients delayed in their transfer of care who are medically fit to leave hospital but require beds while arrangements are put in place WHHT’s estate must be redeveloped to enable maintenance costs to be reduced, operational efficiencies to be achieved and ensure the required capacity is in place to meet the demand. “WE SPEND SIGNIFICANTLY MORE MONEY ON KEEPING OUR BUILDINGS SAFE COMPARED TO A MODERN FACILITY. THIS IS MONEY WHICH WE WANT TO SPEND ON PATIENT CARE.” Don Richards, Chief Financial Officer WHHT’s journey so far The need to improve the hospital estate in west Hertfordshire is longstanding and has been acknowledged for many years, as illustrated in Figure 4. It has taken over a decade to get to this point, longer than anticipated; during this time the condition of the Trust’s buildings has further deteriorated, and services have also become more fragile as WHHT’s ability to deliver new models of care has been constrained. Without significant capital investment there is a very high risk of failure of critical estate infrastructure leading to an impact on services for patients. Figure 4: Summary of journey for WHHT hospital redevelopment DRAFT THE FUTURE OF HOSPITAL SERVICES IN WEST HERTFORDSHIRE July 2019 5 Objectives To address these challenges, a set of objectives have been agreed by the Trust Board: This Strategic Outline Case (SOC) explores options for redeveloping WHHT’s hospital estate to meet these objectives. However, the funding constraint set by regulators – that any request for capital investment is no greater than the WHHT’s annual turnover (c£350m) – means that affordability is the main criterion for evaluating the longlist of options for the future of WHHT’s hospitals. Within this funding constraint, it is simply not possible to explore full new build options that meet all of the Trust’s objectives and fully transform hospital services in west Hertfordshire. This document explores solutions that address the most pressing issues with WHHT’s estate and configuration of services, deliver significant benefits for patients and NHS staff in west Hertfordshire and provide flexibility to enable system wide transformation. Clinical model The proposed future model of hospital services will support and enable delivery of the vision and ambitions described in the NHS Long Term Plan that was published in January 2019, as well as plans set out by the DRAFT THE FUTURE OF HOSPITAL SERVICES IN WEST HERTFORDSHIRE July 2019 6 Hertfordshire and West Essex STP, A Healthier Future and Herts Valleys CCG, Your Care, Your Future programme which aim to deliver as much care as possible closer to home to meet the needs of the local population, deliver commissioners’ requirements and improve
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