Agenda item

To receive a presentation from Betsi Cadwaladr University Health Board

representatives on the progress made to date with the development of the

new facility and the expected timescale for its delivery.

10.10 a.m. – 10.50 a.m.

BCUHB’s Director Clinical Services Therapies informed the Committee that the Health Board was currently working on the second stage of the Welsh Government’s (WG) 3 stage business case process for the developing the site of the former Royal Alexandra Hospital in Rhyl into a community hospital for North Denbighshire.  By means of a PowerPoint presentation he displayed an illustration of the proposed new building emphasising that the new community hospital would be far more than just a hospital:

•              the proposed service model to be developed on the site would include a multi-agency multi-disciplinary team which would design their services around the needs of the service user, supporting the ethos of reablement to empower service users to live independently by collaborating with social care and third sector partners to improve prevention and enhance well-being;

•              it would support more integrated working between primary and community based health care with a focus on older people with a view to ease the pressure on Ysbyty Glan Clwyd, deliver integrated physical and mental health service for older people, provide urgent same day health care services and a range of ambulatory and outpatient services closer to the patient’s home; and

•              the development would take the form of a Healthcare Campus which would make use of the Grade II listed former Royal Alexandra hospital building in conjunction with the proposed new hospital building.  The campus would include same day minor illness and minor injuries provision, outpatients clinics, integrated older persons’ mental health outpatient services, a 28 bed inpatient ward with a multi-disciplinary assessment unit, an intravenous (IV) therapy suite, diagnostic services, therapy services, extended community dental services, extended sexual health services, a community hub which would include a café and third sector meeting rooms.  It would also accommodate an integrated working base for the Single Point of Access (SPoA) Services, Child and Adolescent Mental Health Services (CAMHS) and offices for integrated support teams.

The Committee was informed that:

•           the Health Board had approved and submitted the Outline Business Case (OBC) for the North Denbighshire Community Hospital Project to WG in January 2017.  Included in the OBC was the case for capital investment in the new build and the provision of new services on the site, along with the rationale for additional investment in the Grade II listed building;

•           subsequent to the OBC’s submission to WG Board representatives had met with WG officials in July and September 2017 to discuss the proposals.  The Project Team had regrouped to respond to challenges identified as part of the OBC approval process and an independent Gateway Review of the business case and process had been commissioned.  The findings of the Gateway Review had proved extremely useful with a view to moving the project forward;

•           the WG wanted assurances in relation to how the OBC would support the delivery of the Health Board’s Living Healthier Staying Well strategic plan, a redefined workforce strategy and greater clarity on the benefits realisation of the plan.  The latter related to the use of the existing listed building, by utilising this mainly as office accommodation, the Health Board was confident that it could secure the building’s future and provide additional healthcare services within the new building.  Workforce related issues were not unique to this project they were

•           work was currently underway to re-draft the annex to the OBC which detailed the estates’ proposals, this would include a clear statement on the function of the Grade II listed building following a proposed investment of circa £200K.  More detail would be included in the OBC, prior to its re-submission to WG, on the revenue sources for the provision of new services on the site;

•           as part of the preparatory work for the redevelopment of the site the Outpatients Department had relocated to the former Glan Traeth building in December 2017, the demolition of the 1960’s extension should be completed by the end of April 2018.  Following this work the area occupied by the former Outpatients Department would be resurfaced to provide an additional 44 parking spaces, further resurfacing work would be undertaken on the main car park and pathways would be clearly defined with improved lighting installed for the protection of patients and staff;  and

•           once the project team were satisfied that all the challenges raised by WG had been sufficiently address the OBC would be presented to the Health Board for approval for re-submission to WG.  No definite timescale had been set for this as yet as the Project Team wanted to make sure that all queries had been addressed.

Responding to Committee members’ questions the Health Board’s Area Director:  Central Area:

•           confirmed that they felt the same frustrations as members in relation to the extensive length of time the project was taking to come to fruition.  The Business Case process was a WG process.  It was protracted as it was a three stage process.  However, significant discussions had taken place between the Health Board’s Chief Executive and the WG.  In addition, there was significant political support for the project;

•           the Health Board had experienced a similar delay previously when developing the Ysbyty Alltwen project, which was now open and operational;

•           the Health Board was fully committed to the project’s delivery despite continuing to be under special measures and facing severe financial pressures;

•           the WG had given assurances that it would provide £40m towards the capital cost of the project, with the Health Board to provide £2.3m revenue funding towards the project (whilst £2.3m may seem a considerable amount BCUHB was a £1.4bn organisation therefore the revenue funding it was required to provide was not excessive);

•           confirmed that the Health Board was firmly of the view that the scheme should include a Health and Well-being Hub considering Rhyl’s deprivation profile; and

•           advised that due to the poor condition of the Grade II listed building and fire safety concerns, on patient safety grounds in-patient beds could not be placed within the building;

In response to the Committee’s questions BCUHB officials advised that:

•           the current business case was a public document, however this business case was currently being reviewed.  Once the reviewed business case was submitted to the Health Board for approval that would also become a public document;

•           the Gateway Review had been commissioned by the WG from an independent organisation to provide a critical friend review of the business case with a view to strengthening it.  They undertook to make enquiries on whether or not the final report was available to the public;

•           they fully understood the importance to local residents of the Grade II listed building, hence the reasons they were attempting to incorporate it into the project for the new North Denbighshire Community Hospital.  Due to the constraints associated with its listed status it would not lend itself well to deliver 21st Century in-patient care.  Consequently, the Board were proposing to use it, following an extensive programme of refurbishment as office accommodation for the new facility, with some clinical services being delivered on the ground floor.  The Single Point of Access (SPoA) Service and other community based teams would be located on other floors; and

•           with the advances made in medical science and care in recent years, along with the proposed range of community based services built into the project and  the availability of suitable housing, that a 28 bed in-patient facility was sufficient to meet future NHS needs in the north Denbighshire area.

At the conclusion of the discussion Health Board representatives stated that they were confident that they now had a robust business case present to the WG.  They re-iterated that both they and the Health Board were fully committed to the project’s delivery.

Prior to briefing the Committee on the latest position with respect of the temporary closure of beds at Denbigh Infirmary Health Board officials gave members an overview of current and proposed developments to the Health Board’s Community Services in central and south Denbighshire.  Members were advised that with respect of:

Corwen:  work was about to start to redevelop the Health Centre.  This work, scheduled to be completed by the autumn, formed part of a £1.5m investment in the Centre. It would include the provision of two additional consulting rooms for the town’s GPs, two new dental surgeries and a multi-purpose treatment room.  Whilst the work was underway services would be provided from temporary accommodation, with dental services being provided from their current location.  Car parking facilities would be allocated to patients attending the surgery close to the temporary building, this would include an hour’s free parking.

Ruthin:  WG had recently announced that £1.7m had been earmarked for health services in the area, subject to the development of a business case.  The aim of this investment was to enable the relocation of services currently provided at The Clinic to Ruthin Community Hospital.  It would facilitate an extension to be built at the hospital and some refurbishment work to the hospital itself.  It would further develop the range of services available at the hospital to enable joint working between primary, community and secondary care to be maximised, as well as provide opportunities for better integration of services with statutory and third sector partners.  It was anticipated that a draft single Business Justification Case would be completed by the end of 2018.  If the project was approved it would facilitate  the relocation of GP services, Community Dental Service, Health Visitors, School Nurses, Community Mental Health Services and the Ambulance Service.  Looking forward the Health Board was considering wider opportunities within the south Denbighshire area to improve care closer to people’s home through joint working.  Initial discussions had taken place between the Board and the local authority to explore potential opportunities for integrated working which could form a future phase of the development in Ruthin.