Agenda item

To receive a presentation from Betsi Cadwaladr University Health Board representatives regarding future plans for the provision of services at Denbigh Infirmary.

10.10 a.m. – 10.45 a.m.

The Chair welcomed Betsi Cadwaladr University Health Board’s (BCUHB) Director of Clinical Services – Therapies and Assistant Director of Community Services to the meeting to discuss the future provision of services at Denbigh Infirmary.  Apologies had been received from the Area Director: Centre BCUHB (Bethan Jones).

 

Introducing the presentation the Health Board’s Assistant Director of Community Services provided the Committee with a brief overview of the background to the closure of the ward at Denbigh Infirmary, including information on the detailed fire surveys and inspections undertaken and their findings which had resulted in work being commissioned to establish the costs and timescales for making the ward fit for purpose again.  This work had identified eight potential options for future re-provision of services at the Infirmary.  These were the –

 

·         refurbishment of the existing first and ground floor areas to re-provide 14 beds at an estimated cost of £10m to £11m, within an anticipated timescale of 3 years

·         demolition and rebuilding of the ground and first floor area to re-provide 16 beds at an estimated cost of £11m to £12m, within an anticipated timescale of 3 years

·         relocation of the Physiotherapy Department to another part of the hospital to enable the creation of a 4 bed bay at an estimated cost of between £1.2m to £1.4m, within an anticipated timescale of 2 years

·         construction of a new 5 bed ward between the current MacMillan Suite and the Clinic building at an estimated cost of between £1.2m and £1.3m, within an anticipated timescale of 2 years

·         construction of a new 6 bedroom ward at an estimated cost of between £4.5m and £5m, within an anticipated timescale of 3 years

·         demolition of the kitchen area and ward area above and the rebuilding of a 6 bed ward at an estimated cost of between £3.5m and £4m, within an anticipated timescale of 3 years

·         conversion of the conservatory adjacent to the MacMillan ward into a single bedroom unit without a bathroom at an estimated cost of £100k, within an anticipated 12 month timescale

·         relocation of the maternity room to a ground floor location at an estimated cost of between £350k and £400k within an anticipated 12 month timescale.

 

Further work was currently being undertaken in relation to the identified options.

 

If following detailed analysis a decision was taken to proceed to re-provide the whole ward this would necessitate the closure of the entire hospital site while the work was being undertaken.  To ensure that there was sufficient community beds available within the area whilst the re-provision work was underway the work could not be commenced until such time as the new North Denbighshire Hospital was open.  Nevertheless, some work on the site could be undertaken in the meantime.  Local county councillors and the Infirmary’s League of Friends were keen that the ward was not left empty in the meantime as they felt that it sent out the wrong message about the site’s future, therefore the Health Board and the County Council had recently agreed that members of the joint health and social care Community Resources Team (CRT) for the Denbigh area should be based at the former Lleweni Ward at the Infirmary until any refurbishment and re-provision work was ready to be commenced.  The CRT would relocate elsewhere when the refurbishment work was due to begin.

 

Members were advised by the Assistant Director of Community Services that Health Board officials had recently met with members of the Denbigh Member Area Group (MAG) to discuss the future of the Infirmary.  At that meeting MAG members had asked the Health Board to consider wider options for the site in conjunction with Denbighshire County Council and the other partner organisations.  Since that meeting the Health Board had been successful in securing some Integrated Care Fund (ICT) funding to facilitate exploratory work in relation to mapping out a joint vision for integrated health, well-being and social care services for the Denbigh area.

 

Responding to members’ questions Health Board officials –

 

·         confirmed that consideration had been given when Lleweni Ward closed to the potential of re-providing beds on a temporary basis in specialist mobile units.  Due to the limited space available on site and the need to continue with the delivery of other services at the hospital the re-provision of beds in mobile units had been deemed unsuitable.  If a decision was taken to demolish and rebuild the ground and first floor wards it would certainly be inappropriate to attempt to deliver hospital in-patient services from mobile units on a site which would also be a construction site.  In addition hospital wards/in-patient beds would require easy access to ancillary services, this would not be possible if they were located on a construction site;

·         advised that they were of the view that the Health Board would have more leverage to secure Welsh Government (WG) capital funding for the development of the Denbigh Infirmary site if any proposed project was a joint venture with the local authority for the purpose of delivering integrated health, social care and well-being services.  If the proposal was only to refurbish the current premises the Health Board would be less likely to be able to secure WG funding and would therefore need to fund the costs from within its own budget.  Discussions were currently underway with both Denbighshire County Council and Grŵp Cynefin with a view to developing a health and care vision for Denbigh as a basis for compiling a robust business case to apply for WG funding.  The ICF grant money would help facilitate this exploratory work as well as work with the wider community to determine a vision for the area and the facilities required to deliver the vision; 

·         informed the Committee that to date the Health Board had secured grant funding for healthcare developments in Rhyl, Corwen and Prestatyn, it was now focussing on the Denbigh area;

·         confirmed that following the Grenfell Tower fire the WG had instructed all Health Boards to inspect all in-patient facilities which were above single storey in height.  It was this detailed inspection, in accordance with WG instructions, which had rendered the upstairs ward at the Infirmary unsuitable for inpatients due to the method by which it could be evacuated in the case of an emergency.  In line with the requirements of the Fire and Rescue Services Act 2005 the hospital did have a fire evacuation plan in place which entailed a horizontal evacuation plan for the first floor ward.  Albeit that this plan, in recent years, had been endorsed by all fire safety inspectors, the Health Board’s own inspectors and those employed by the Fire and Rescue Service, it did not meet the requirements of the new guidelines published by WG post the Grenfell Tower disaster.  The Health Board was required to deliver its services in premises which were compliant with WG safety standards;

·         advised that the first survey undertaken of the building, during the summer of 2017, had discovered that the lack of fire compartmentation on the upstairs ward was a risk and consequently 10 beds (2 x 5 bed bays) had been withdrawn.  This survey had concluded that the 7 remaining beds on the ward could only be used by patients who were sufficiently mobile to walk in the event of an evacuation.  However, a further more detailed survey had rendered these beds not sufficiently safe in the event of a fire and consequently the entire ward had been closed for inpatient occupation;

·         confirmed that the take-up of maternity services at the Denbigh Infirmary, when it was open, was in the region of 10 to 12 per annum.  The services available there were similar to those available for home births.  Whilst consideration could be given to whether or not to continue with this service as part of the site’s future development it was important to bear in mind that an educational bursary was available for students who were born at the Infirmary;

·         advised that they were keen to work with the local authority, Grŵp Cynefin and the town’s four GP surgeries to develop a holistic health, social care and well-being vision for the town with services being provided in an easily accessible facility as well as delivered in residents’ own homes with a view to supporting independence and building resilience;

·         confirmed that, despite it being one of the oldest hospitals in Wales, the Infirmary was not at present a listed building:

·         advised that Health Service Estates personnel had explored a number of potential structural solutions that would enable the upstairs ward to re-open.  The only viable option would be for the ward’s wooden floor to be replaced with a concrete floor.  However due to the building’s age and fabric it was unlikely that the current building’s foundations would be sufficient to support an elevated concrete floor.  Consequently, current outline proposals for the building’s refurbishment included the erection of a steel frame as part of the capital investment plan;

·         advised that the community healthcare needs in the Denbigh area were different to those in the north of the county as the demography of the local area was different.  Residents in the central part of the county were far more likely to have family network support available to them, and

·         confirmed that whilst any future major project to redevelop the entire site would be required to follow the three stage WG capital projects procedure it was anticipated that in the Infirmary’s case this process would not be as protracted a process as the one for the North Denbighshire Community Hospital, as the vision for Denbigh was already a collaborative one and the lessons in business case planning which had been learnt from the North Denbighshire project should aid the development of the business case for Denbigh. 

 

The Council’s Head of Community Support Services advised that the local authority was acutely aware that there would be a growing need in the area in future for elements of nursing care as well as specialist dementia care – both at home and in a residential/nursing home setting.  The Council was therefore keen to work with the Health Board and partners in order to secure fit for purpose services for residents for the future.  At the conclusion of the discussion the Committee –

 

RESOLVED to  –

 

(a)       receive the information and presentation on the work undertaken to date in relation to the future provision of services at Denbigh Infirmary;

 

(b)       support the efforts underway to develop a health, social care and well-being vision for the Denbigh area, and

 

(c)        request that the Committee be updated on the progress made with developing the vision and business cases to realise it.