Implementing “Designed for Life” in

The Clinical Futures Programme

Welsh Health Estates Conference 30 & 31 March 2006 Health Care Facilities in Gwent

• 3 hospitals providing acute services

• comprehensive mental health services

• 14 other hospitals

 41 health centres and clinics

• serving 600,000 local residents Can’t stay as we are because……

Demography Our Needs Advances in technology

Waiting times, congestion, Access no alternative to DGH, DTOCs

Specialisation and critical mass Quality Pathways and integration

EWTD, Modernising Medical Careers Workforce Recruitment & retention

Backlog maintenance Estate Poor design / location / access

We all agree

• Clinical Futures Public Engagement Programme Spring 2005 • Unreasonable waits to access services • Limited local access to routine services • Standards of cleanliness (MRSA) • Poor quality of many healthcare facilities • Need for investment in staff and facilities Aims

• Improving access • Improving the to services quality of care – By providing as – By strengthening and many services as consolidating major can safely be emergency, complex provided at local and specialist level services

• Improving the links between all parts of the patient pathway System Change for Clinical Services in Gwent Current range Future range

District General Hospitals

Community hospitals

P& CHS Out of Hospital Care (Level 1) Remodelling Out of Hospital Care

Primary Care Estates Strategies eg Resource Centres New roles eg Physician Extended roles eg, Optometrists Expanded services eg Clinical Nurse Specialists day care and re-ablement and GPSIs Assistive technologies Integrated services eg eg SMART House OOH with emergency care

Being delivered through Local Health, Social Care and Well Being Strategies (£11m Wanless investment) System Change for Clinical Services in Gwent Current range Future range

District General Hospitals

Local General Hospitals Community hospitals (Level 2)

P& CHS Out of Hospital Care (Level 1) Local General Hospital

Mental Health Services

Women and Children’s Services

Integrated Care Services

Diagnostic and Treatment Services

Local Emergency Services System Change for Clinical Services in Gwent Current range Future range

Specialist and Critical Care District General Service (Level 3) Hospitals

Local General Hospitals Community hospitals (Level 2)

P& CHS Out of Hospital Care (Level 1) Specialist and Critical Care Centre

• Complex operations that need intensive care • Critical Care • Major emergencies • Specialist inpatient care • Acutely ill children • High tech diagnostics • Higher risk births • Outreach tertiary services (Level 4)

Minimising outpatients, minor injuries, routine diagnostics day case and short stay patients FM and support services zone

adult wards emergency assessment

specialist ambulatory DTC emergencies diagnostics theatres critical care

maternity and paediatrics Designed for Life

4. Tertiary and highly specialised

3. Specialised and Critical Care Centre

2. Local Acute Services

1. Services provided at home, in the local community or in supported housing.

Determinants of Health Policy Development

Effectiveness Needs Analysis Best Practice Moving from this…

• 3 hospitals providing acute services

• comprehensive mental health services

• 14 other hospitals

 41 health centres and clinics

• serving 600,000 local residents ….to this

Local General Hospitals

Critical Care Centre

Supported by locally based resource centres Benefits

• Meeting demand – Factoring in growth in demand over next 10 years – Achieving better waiting times – Project 2009 compliant • Improving efficiency – ALOS & DC rate – minimum upper quartile UK – Occupancy levels – average 82.5% • Facilitating redesign – Admission avoidance - 50% < 2 days avoided – Workforce – EWTD compliant – Long stays – zero > 42 days – DTOCs – all “out of hospital” • Improving quality – Delivering Healthcare Standards for – Improving compliance with NSFs and NICE guidance Costs

• Capital Costs • Revenue Costs – £600M – £43M – £43M is a 1% year on year real terms growth for Gwent – Do Minimum costs £36M Clinical Futures Delivery Programme

Service Capital Workforce Interim Communication Redesign Investment Redesign Service & and Estates Engagement Plans

Primary Care Estates Strategies – role & location of resource centres Hospital Network - OBCs to be completed early 2007 in order to complete work by 2012/13. Public consultation in autumn. Pathfinders - Blaenau Gwent and Local General Hospitals at Full Business Case stage (complete in 2009 and 2010). Caerphilly Local General Hospital

Outline Business Case Current health service locations in Caerphilly Borough Population 170,000

PCH 28,000 hectares

Redwood Memorial 33 wards incl 50 distinct & District towns and villages

Oakdale 34 GP practices

Ty Sirhowy 23 dentists 42 pharmacists Caerphilly Miners 18 ophthalmic premises RGH 5 hospitals and 1 mental UHW health unit Why Change?

Poor Local Clinical Access Standards

Disjointed Poor Health Care

Poor Facilities Staffing Public Engagement Programme

• Top three priorities – Better location for future hospital – Improvement in waiting times – Better emergency care • Modern facilities – privacy and dignity – cleanliness – child friendly environments • More local access to services – tests and investigations – clinics – operations • Improvements in GP care and community services • More emphasis on health promotion Proposed Configuration for Caerphilly

Resource centres PCH New Local General Hospital At Ystrad Fawr

Resource Centres for North, Mid and South of County Borough

Closure of Oakdale, Aberbargoed, Ystrad Mynach, Caerphilly District Miners, Caerphilly Ty Sirhowy LGH Future of Redwood Hospital part of planning process for resource centre

UHW HospitalHospitalCaerphilly servicesservices toto bebe providedprovidedLocal inin CaerphillyCaerphilly General County CountyHospital BoroughBorough Mental Health Services Day care, outpatient & inpatient care for adults and older adults (60 beds) Women and Children’s Services Antenatal & postnatal care, low risk birthing centre (6 beds) and birthing pool, dedicated children’s clinic Integrated Care Centre Rehabilitation, step up / down care, palliative care (130 beds), therapies, hydrotherapy pool, health maintenance centre Diagnostic and Treatment Centre Tests, investigations, CT scanner, clinics, 4 theatres, 40 beds and day places Local Emergency Centre Emergency admissions (30 beds), rapid assessment (10 beds), minor injuries, GP out of hours Benefits

• Quality of care • Better input from specialist services eg cardiology • Building on successful service redesign - midwifery led unit • Local Access • More than doubling number of outpatient clinics and operations at local level • Doubling the number of emergency patients seen locally • Range of services • Enhancing diagnostics with CT scanner • Improving rehabilitation through hydrotherapy • Environment • Potential for 100% single rooms and a therapeutic environment • Integration • Streamlining urgent and unscheduled care • Co-location of mental health services • Consolidation of therapy, rehabilitation and sub acute services • Efficiency • Reducing number of small hospitals and pooling resources Costs

• Capital • Revenue – £108M –£6.6M Programme

OBC approved Dec 2006

Appoint Supply Chain Partner July 2006

Complete Full Business Case Early 2007

Start on site 2007

Complete/commission 2010 Challenges for the Capital Project

• Translating new service models into new types of health care buildings • All Wales Construction Procurement Framework • Policy issues – eg single rooms • Complex site issues • Impact on highways • Revenue impact from optimism bias and capital charges • Closing much loved institutions - sensitively The Ystrad Fawr Site Existing hospital

Caerphilly road

Rhymney river

A469 Caerphilly road

f. expansion

Rhymney river

A469 Conclusion What have we learned so far?

• Importance of excellent project management • Service redesign has to lead • Radical change requires proper “partnerships” - for better or worse.. • Effective public engagement pays dividends • Invest heavily in stakeholder involvement • Short term objectives need to be balanced with long term goals - it will be worth it in the end! Thank you for listening