Agenda item

To receive an update from Betsi Cadwaladr University Health Board representatives on progress made in respect of capital projects relating to North Denbighshire Hospital (Business Case enclosed), Ruthin Clinic and Corwen Health Centre.

10.50 a.m. – 11.30 a.m.

The Health Board’s Director Clinical Services – Therapies gave the Committee a presentation outlining the progress achieved to date in relation to three major capital projects in Denbighshire.  He outlined the background to each project and advised that with respect of the current position –

 

Corwen Health Centre

 

·         a fit for purpose facility which provided a high quality environment for primary care services and enhanced dental services had opened on the site in Corwen on 12 October 2018, with an official opening scheduled for 29 November 2018.  The site also had potential to accommodate a broader range of health related services

·         the Health Board had awarded £1.48m towards the project from its Discretionary Capital Allocation

·         the Centre now housed a GP practice which had the added facility of consulting rooms for trainee doctors, specialist GP led cardiology services, two dental surgeries, district nursing services, health services, physiotherapists, podiatry services along with services for mental health and substance misuse, and

·         with a view to expanding the services further work was underway to recruit additional dental staff and to assess whether there was a potential to increase the Voluntary Sector’s (Third Sector) presence on the site to support the Health Service’s work in the area.

 

Mount Street Clinic, Ruthin

 

·         in 2016 a Primary Care Estates review had identified that this facility was not fit for purpose.  Due to its poor condition of repair the Health Board concluded that spending circa £750k to undertake maintenance and upgrading work on the building would not equate to an effective use of resources and would not deliver a long term solution to meet future needs in the Ruthin area

·         a strategic decision was taken to bid for £1.7m of WG capital funding for the purpose of delivering primary care services close to patients’ homes through the relocation of the services currently delivered at the clinic on the Ruthin Community Hospital site with a possibility of delivering other health services at the new site in due course

·         at present the proposals were to relocate the GP practice, Health Visitors, School Nurses and Community Mental Health (CMH) practitioners from the current Clinic site to the Ruthin Hospital site.  The Community Dental team were currently considering two options, whether to relocate to the Ruthin Hospital site or to utilise current facilities available at both Denbigh and Corwen and deliver a mobile service where appropriate, whilst the Welsh Ambulance Service Trust (WAST) was in discussions with North Wales Fire and Resource Services (NWFRS) to explore possibilities in relation to delivering their services from a shared facility.  Work was also underway to examine the potential of delivering additional services from the relocated facility at Ruthin Hospital, i.e. secondary/community care activity such as pulmonary rehabilitation services for the south of the county, well-being activity and services to support training for rural GPs

·         several stakeholder events had already been held to gauge community interest and support for the new service model and potential take-up of proposed ‘new’ services.  It was anticipated that all of these events would be concluded before Christmas 2018.  Designers were currently preparing to produce design briefs for the proposals along with costings and a business case was being written with a view to securing the WG capital funding for the project.  It was anticipated that the Health Board would consider the business case at its March 2019 meeting prior to it being submitted to WG for approval.  Subject to no timetable slippages and WG capital funding being approved it was envisaged that the building work could commence during the summer of 2019, with the final services being transferred from the current Mount Street clinic site to the facility at Ruthin hospital during the spring or summer of 2020

·         reassured members that there was no cause for concern with respect to the proposals to relocate community dental services from Mount Street Clinic, Ruthin to Denbigh and Corwen and provide a mobile service.  The same level of service would be available to patients in Ruthin and surrounding areas and they would be given the choice of where they would prefer to access those services, in Denbigh or Corwen, or if either was not accessible to them the could request a mobile service to their own home, and

·         confirmed that community hospitals such as Ruthin had in recent years taken on a number of extra services.  Denbigh’s new IV suite delivered a range of specialist IV services, i.e. Chemotherapy, services for the Walton Centre etc.  it was anticipated that other specialist services may be provided in the community/community hospital setting in future and staff were being trained to deliver theses specialist services.

 

North Denbighshire Community Hospital, Rhyl – a copy of the Outline Business Case (OBC) for this project, which had been considered and approved by the Health Board at its meeting on 1 November, and subsequently submitted to WG for approval had been circulated to members with the Committee meeting papers.

 

·         the revised OBC approved by the Board addressed the three main areas which the WG had asked to be included in the document, namely how the project proposal fitted-in and contributed to the Heath Board’s overall strategy and vision for delivering health care services in North Wales, details of the proposed new facility’s revenue affordability and how the Board proposed to safeguard and use the Grade II listed former Royal Alexandra Hospital building as part of its plans for the site

·         the OBC provided information on the proposed services that would be delivered at the new facility, including a 28 inpatient bed ward with a multi-disciplinary assessment unit, same day minor injuries and minor illnesses service, outpatients clinics, an IV Therapy Suite, diagnostics and therapy services, community dental services, sexual health services, integrated older persons mental health outpatient services, Single Point of Access (SPoA)/integrated working base, Child and Adolescent Mental Health Service (CAMHS), administration support for integrated teams and a community hub (to include a café, Third Sector facilities and meeting rooms)

·         the current projected timeline for the project was to receive the WG’s response and subsequent approval of the revised OBC by no later than the end of January 2019.  This would enable the Full Business Case (FBC) to be submitted to WG by March 2020, with a view to construction work starting on the site during September 2020 and the new build being delivered by the end of March 2022.  Following this it was expected that the refurbishment work on the former Royal Alexandra Hospital would be completed by December 2022.

 

Responding to members’ questions Health Board Representatives –

 

·         confirmed that costings for all above projects were done by qualified cost advisers who applied a specific formula when undertaking costing exercises.  The costings quoted in the OBC took into account potential inflationary cost increases

·         confirmed that the estimated costs for the proposed new North Denbighshire Community Hospital project had increased significantly between the time that the Strategic Business Case (SBC) had been compiled in 2013 and the present OBC, from £22.2m to £40.24m.  There were three main reasons for this, all of which were detailed in the OBC document circulated to the Committee

·         advised that the timeline given for progressing the North Denbighshire Community Hospital project and other projects through to their completion was dependent upon each stage within the projects being approved/delivered on time.  The milestone dates at present were based on these assumptions

·         advised that workforce planning was taking place with a view to staffing the new facility in Rhyl.  The workforce planning for the facility was multi-faceted, staff for a number of the services that would be delivered at the facility were already in post, and it would be a matter of relocating them to the facility.  Recruitment of new staff would mainly centre around staffing for the ward, and managing the day to day running of the facility and estate.  The Health Board regularly undertook local recruitment exercises and participated in national recruitment initiatives

·         confirmed that whilst a number of the services at the North Denbighshire Community Hospital would be nurse or nurse practitioner led, medical advice would be easily accessible to them if required

·         outlined the range of services provided at an Ambulatory Care Unit (ACU), which could potentially be developed on the North Denbighshire Community Hospital site if the ACU pilot project currently being trialled at Llandudno proved to be successful.  These were services, such as treatment for urinary tract infections (UTIs), Chronic Obstructive Pulmonary Disease (COPD) etc. which currently entailed the patient attending a District General Hospital (DGH).  If the pilot at Llandudno was successful ACUs could be operated on a number of sites across North Wales in order to alleviate pressures on the DGHs.  Patients would attend on a daily basis using either their own transport, public transport or where required transport would be provided.  The patients would be monitored and if their condition did not respond to the treatment given or worsened they could be ‘stepped-up’ to the most appropriate in-patient unit

·          advised that they did not at present envisage an ACU being available anywhere else but Rhyl in Denbighshire for the foreseeable future, as for the service to be effective it needed to be located in an area that was densely populated.  Nevertheless, its location should not be a barrier to residents from other areas of the county from accessing its services if it was the nearest ACU to their home, and

·         advised that the work to develop the FBC for the North Denbighshire Community Hospital project would include detailed analysis in relation to car parking provision and public transport links to the facility.  Exploratory work already undertaken had identified that the site was fairly well served by public transport.  The Health Board envisaged that the demolition of the temporary buildings on the current Royal Alexandra Hospital site would realise additional land which was earmarked for car parking for the hospital.  In addition there were chargeable public car parks nearby, chargeable car parking facilities on the promenade and free on-street parking on nearby side streets.  The Board was also developing and a Green Travel Plan and exploring the possibility of ‘buying’ Alexandra Road from the Council to facilitate its ‘de-adoption’ which would provide safe and easy access between the former Royal Alexandra Hospital site and the new health facility site and potentially realise additional space for vehicles to park.

 

During the discussion members registered their concerns that some of the facilities inherited by the current Health Board seemed not to have been subject to stringent business planning processes during their design to ensure that they would be fit for the future.  As a result the Board was now having to invest significantly in order to provide suitable accommodation from which services could be delivered.  Members requested Board officials to ensure that all proposed new facilities would be fit for the future and adaptable to meet changing needs and expectations in the future.

 

At the conclusion of the discussion the Committee thanked Health Board officials for attending to update members on the progress to date with the above capital projects and answering their questions in relation to them.

 

RESOLVED, subject to the above –

 

(a)       to receive the information on the current position in respect of the North Denbighshire Hospital, Ruthin Clinic and Corwen Health Centre capital projects, and

 

(b)       request that the Health Board further brief the Committee on all capital projects in Denbighshire, including the North Denbighshire Community Hospital project, Corwen Health Centre, Ruthin Clinic and the development of the Community Resource Teams (CRTs) during the Spring of 2019.

 

At this juncture (12.05 p.m.) the meeting adjourned for a refreshment break.