Strategic Outline Case for Daisy Hill Hospital Site Redevelopment

Strategic Outline Case for DHH Site Redevelopment v0.4Strategic Outline Case for Daisy HillHospital Site RedevelopmentVersion 0.4Corporate Planning DivisionDirectorate of Performance & ReformDecember 2009Approved by Board of Directors on 25 th March 2010Page 1 of 8

Strategic Outline Case for DHH Site Redevelopment v0.4PROJECT TEAMDr Gillian Rankin – Interim Director of Acute Services;Mrs Paula Clarke – Acting Director of Performance & Reform;Mr Martin Kelly – Assistant Director of Corporate Planning;Mrs Claire Kelly – Head of Capital Planning;Mr Jim Austin – Head of Estates Development and Capital Works; andMr Dennis Quinn - Assistant Head of Estates Development and Capital Works.Approved by Board of Directors on 25 th March 2010Page 2 of 8

Strategic Outline Case for DHH Site Redevelopment v0.41.0 IntroductionThis Strategic Outline Case describes the need to redevelop the Daisy Hill Hospital (DHH)site. The Trust is committed to developing the DHH site in order to maximise it as part ofthe Trust’s network of hospital services (in particular to maximise DHH’s role in supportingCraigavon Area Hospital). The Trust is currently undertaking an extensive review of theexisting services on the DHH site and from this will develop and implement new models ofcare/service models. The Trust considers that redevelopment of the site is necessary toallow the new models of care/service models to be fully implemented. There are majorweaknesses with the existing accommodation at DHH, the weaknesses are not simplycosmetic or giving rise to minor inconvenience to patients and staff. Much of theaccommodation is unpleasant and cramped with inadequate environmental control andfalling short of safety and statutory standards.2.0 Strategic FitThis section outlines the drivers associated with the need to redevelop Daisy Hill Hospital.The Trust provides a wide range of hospital, community and primary care services. TheTrust provides its inpatient, day case and maternity hospital care across a network ofhospitals (Craigavon Area Hospital, Daisy Hill Hospital and South Tyrone Hospital) andprovides outpatient services in a range of local facilities. Acute in-patient hospital servicesare located at Craigavon Area Hospital and Daisy Hill Hospital.The Trust is committed to providing safe, quality hospital care in line with the regionalhospital strategy ‘Developing Better Services’. Under ‘Developing Better Services’ Daisy HillHospital was confirmed as one of the nine hospitals in Northern Ireland which will provideacute hospital services. The aim of the ‘Developing Better Services’ strategy is to create astable pattern of modern acute hospitals which will function in an integrated and mutuallysupportive network of acute and local hospitals.The Trust is committed to changing services for the better and has set out in its 5 YearStrategic Plan ‘Changing for the Better’ how it intends to develop and transform the healthand social care services it can provide over the next five year.The Trust wishes to consider how best Daisy Hill Hospital can meet its current and futureroles through the development of the site to facilitate modern clinical practice.5 Year Strategic Plan ‘Changing for the Better’ identifies the following strategic priorities foracute and maternity hospital care:Prompt Diagnosis and Treatment;More Responsive Care;More Integrated Care;Modernising Care; andPage 3 of 8Approved by Board of Directors on 25 th March 2010

Strategic Outline Case for DHH Site Redevelopment v0.4Improved Patient Safety.In support of these strategic priorities the Trust has plans for major redevelopment of eachof the acute hospital sites. The Trust is particularly keen to maximise Daisy Hill Hospital aspart of the Trust’s network of hospital services.3.0 Options AppraisalThe following options were considered for the redevelopment of Daisy Hill Hospital.Option 1 – Do Nothing – No capital works above planned maintenance work would beundertaken.Option 2 – Do Minimum – Refurbishment of main ward/theatre block withoutreconfiguration of existing accommodation This option proposes to refurbish theexisting ward/theatre block, however there would be no reconfiguration of the existingaccommodation to meet the needs of the new service models and no attempt to improvethe accommodation to current design standards as far as would be possible within theconfines of the existing footprint. In addition the Trust would deliver a number of smallercapital schemes from its General Capital Allocation.Option 3 – Redevelopment of main ward/theatre block, includingreconfiguration of existing accommodation This option proposes the reconfigurationand refurbishment of the existing ward/theatre block, A/E, OPD, and Radiology to meet theneeds of the new service modelsOption 4 – New Build on Daisy Hill Hospital site This option allows for a new hospitalto be developed on the DHH site while existing hospital services are maintained during itsconstruction. The new build option would address all statutory and building notestandards.Option 5 – New Build on Greenfield site This option allows for a new hospital to bedeveloped at a new Greenfield site while existing hospital services are maintained during itsconstruction. The new build option would address all statutory and building notestandards.Estimated capital costs for the identified options are provided in the table below.Capital CostsOption 1£Option 2£Option 3£Option 4£Option 5£Works, BuildInfrastructure.- 18,907,200 30,018,300 84,244,000 102,886,000On costs - 8,506,440 12,363,660 16,883,475 18,203,329Professional fees - 4,797,387 7,416,843 15,163,920 18,519,480Equipment - TBC TBC TBC TBCTotal - 32,211,027 49,798,803 116,291,395 139,608,809Approved by Board of Directors on 25 th March 2010Page 4 of 8

Strategic Outline Case for DHH Site Redevelopment v0.4Benefit Analysis The table below outlines a high level evaluation of the possible identified options against benefit criteria:Accommodation Aligned to Service Needs – It is desirable that the departments should be linked in an optimum manner to enable the delivery of the highest standard ofclinical care and to ensure that the accommodation provided reflects the needs of the service models and facilitates changes which result in better outcomes and improvedefficiency of use of resource.Quality of Accommodation - The Trust wishes to provide accommodation which is a high quality in terms of space, location and suitability for the function for which it isintended. It should be developed in accordance with the relevant building notes, and must be capable of meeting all legislative standards, particularly health and safety andfire regulations.Speed of Implementation – Differential timescales will be caused by varying lengths of design, procurement, construction and commissioning.Flexibility to respond to future changes – Any development would be expected to provide hospital accommodation suitable to ensure future sustainability. There shouldbe therefore be some flexibility provided within the redevelopment to respond to any unforeseen changes.AccommodationAligned to ServiceNeedsQuality ofAccommodationSpeed ofImplementationFlexibility torespond to futurechangesCommentsOption 1 X X ̌̌̌ X Option 1 does not propose any significant capital works to be undertaken,there would be no reconfiguration of the existing accommodation to meetthe needs of the new service models and to facilitate new ways ofworking. There would be no improvement to the quality of theaccommodation and no flexibility to respond to future changes.Option 2 X ̌ ̌̌̌ X Option 2 proposes some refurbishment of the existing accommodation,however as there would be no reconfiguration of the existingaccommodation there would be limited opportunity to provideaccommodation that is aligned to the service needs. Undertakingrefurbishment works would provide some improve to the quality of theaccommodation. Refurbishment works could be undertaken reasonablyquickly as there would be no requirement to plan for reconfiguration of theexisting areas. However as no reconfiguration of the existingaccommodation is proposed there would be limited flexibility to respond tofuture changes.Page 5 of 8

Strategic Outline Case for DHH Site Redevelopment v0.44.0 Preferred OptionThe preferred option proposes the reconfiguration and refurbishment of the existingward/theatre block, A/E, OPD, and Radiology to meet the needs of the new service models.The Trust recognises that it will be necessary to maintain clinical services during theredevelopment of the site and therefore has set out a number of phases that will ensurestability of services during the programme of works. It is estimated that the work could becarried out over a one to five year period dependent on the ability to take forward morethan one phase in any given year.The phases would be as follows:Phase 1 – Conversion of Floor 6 to accommodate a paediatric centre of excellenceincluding a paediatric theatre, ward accommodation and paediatric ambulatory care. Thiswould create a floor dedicated to paediatrics and support the Trusts strategic direction ofcentralising paediatric surgery on the Daisy Hill site. (£4,686,475).It is intended that Trust Board will make a decision on the associated consultation onservice changes for paediatric care at the January 2010 meeting.A decant facility will also be constructed in Phase 1. This will allow the different bedaccommodation refurbishment elements of the phasing to proceed while clinical servicescontinue. The decant will then be utilised as part of Phase 6 and provide the space for theextended A/E and outpatients.Phase 2 – This involves the creation of 2 endoscopy suites on the third floor which wouldbe used initially as main theatres to facilitate phase 3 which is the refurbishment of maintheatres, day surgery, recovery high dependency and the refurbishment of a 30 beddedarea. (£4,671,525)Phase 3 - Refurbishment of main theatres, day surgery, recovery and high dependencyon Floor 1 (£4,761,900)Phase 4 - Refurbishment of Floor 5 ward accommodation for 60 beds. (£3,145,650)Phase 5 - - Refurbishment of Floor 4 ward accommodation for 60 beds. (£3,145,650)Phase 6 – Refurbishment of the podium level to include A/E, Outpatients, Radiology andadministrative areas. The additional space required will be provided in the decant facilityconstructed during Phase 1. (£9,607,100)There are a range of other cost elements which also need to be considered including ‘oncosts at £12,363,660 and fees of £7.41m.5.0 AffordabilityThe high level capital costs associated with Option 3 are £49,798,803, revenue costs wouldbe determined at business case stage. Capital funding is sought from DHSSPS to providethis accommodation through a managed phased approach.Page 7 of 8

Strategic Outline Case for DHH Site Redevelopment v0.46.0 ProcurementThe Trust will seek advice from Health Estates Investment Group regarding the mostsuitable procurement route, at this point in time the Trust considers that this scheme wouldbe procured using traditional procurement.Traditional Procurement Design and construction are viewed as separate elements andcould include the separate tendering for both consultancy services and construction works.This involves open tendering based on a detailed specification. The production of a full setof documents is required before tenders are invited.7.0 AchievabilityIt is proposed to implement the organisation and management of this scheme inaccordance with the guidance contained in the Capital Investment Manual entitled ‘ProjectOrganisation and Capital Investment Manual: Management of Construction Projects’ issuedby the DHSSPS. Relevant expertise and experience will be required from Trust staff andfrom Health Estates Investment Group. The proposed project structure is summarised asfollows:Timescales for delivery of this scheme will be determined in developing the business case,when identification of the preferred option is confirmed.Page 8 of 8