Agenda item

To receive a presentation from Betsi Cadwaladr University Health Board representatives regarding progress with capital projects in Denbighshire relating to North Denbighshire Community Hospital Project, Corwen Health Centre, Ruthin Clinic and the development of the Community Resources Teams.

10.45 a.m. – 11.30 a.m.

Betsi Cadwaladr University Health Board officials had been invited to the meeting to update the Committee regarding progress with capital projects in Denbighshire.

 

The Health Board’s Director Clinical Services – Therapies gave the Committee a presentation on the progress made with respect of the work to develop a Health and Well-being Campus for the north Denbighshire area on and around the site of the former Royal Alexandra Hospital in Rhyl.  He advised that the WG had approved the Health Board’s Outline Business Case (OBC) for the campus in January 2019 and consequently the Board was now in the final stages of developing the Full Business Case (FBC) for the project.  This entailed checking its robustness and the building and service models’ design and tendering arrangements, with a view to submitting the FBC to WG by March 2020.  During the presentation he described the proposed service model and its benefits for the area and its residents which would include –

 

·         integrated working between primary and community care to support urgent/same day care, which would reduce the impact on the Emergency Department (ED) at Ysbyty Glan Clwyd;

·         providing capacity for cluster practices to manage demand in primary care;

·         increasing the provision of services open after 5pm in the area;

·         enhancing collaboration between health partners, the local authority, third sector and the community by optimising the use of resources through the integration and co-location of multi-agency or multi professional teams and improving the recruitment and retention of staff;

·         a 21^st Century health and well-being campus that provided a range of care pathways through from self-management to in-patient care beds;

·         education, information and preventative services;

·         a range of ambulatory outpatient services with an emphasis on care closer to the home that should deliver a better experience for the patient and reduce the number of conveyances to the district general hospital;

·         an integrated approach to meeting the physical and mental health needs of older people with a view to reducing the impact on wards at Ysbyty Glan Clwyd and maximising recovery and reablement to aid independence and the reduce the need for institutional type care; and

·         the retention and refurbishment of the original Royal Alexandra Hospital building.  Whilst this had increased the cost of the project and had complexities attached to it, its inclusion in the project plans was in itself an acknowledgement of the building’s historic and cultural importance to the town.  Of the £40m awarded by WG for the development of the entire campus, approximately £7m to £8m would be invested in the original building to completely overhaul its electrical and heating systems, restore its exterior and to undertake some light internal refurbishment to accommodate support staff and multi-agency teams, such as the Single Point of Access (SPoA) Service and the Child and Adolescent Mental Health (CAMHS) Service.  The building’s listed status restricted the options for any major refurbishment work to be undertaken to enable modern healthcare services to be delivered from the building.

 

The Committee was advised that the focus of the new campus would be to provide –

 

·         a same day care centre;

·         outpatient clinics;

·         inpatient beds;

·         intravenous therapy suite (IV suite);

·         diagnostics;

·         therapy services;

·         Community Dental Services;

·         Sexual Health Services;

·         Older Persons Mental Health Outpatient Service; and

·         a community hub to include a café, third sector provision and meeting rooms to support the local community

 

It was proposed that the Project Board would re-form in the near future to progress and refine the final business case for submission to WG by March 2020, with a view to it being approved during June 2020 to enable the new building to be opened in April 2022 and the refurbishment of the former hospital building to be completed by the end of 2022.

 

Responding to members’ questions Health Board representatives –

 

·         advised that workforce planning and staffing requirements would be addressed as part of the final business case for the hospital.  As the facility would not open until 2022 it gave the Health Board an opportunity to effectively plan its workforce requirements and ensure it had staff with the appropriate qualifications on the campus when it opened.  The Health Board’s workforce planning was in line with and complemented the national workforce planning in place for health service staff.  Of the 60 full-time posts that would be required to operate the new campus, 25% of them would be non-medical posts;

·         informed members that it was anticipated that a number of the posts at the campus would be filled from within the local community, others would be taken by staff who had relocated to Holywell Community Hospital following the withdrawal of in-patient services at the Royal Alexandra Hospital.  The challenge would lie with filling the professionally qualified posts.  However, effective workforce planning and recruitment campaigns should ensure that these posts were filled in time for the facility’s opening.  The existence of the project to deliver the facility would influence the number of training places that would available for the various disciplines required;

·         advised that shortage of appropriately qualified staff in a number of health related professions was a national and international problem, not one that was unique to North Wales.  The situation was continually being reviewed with a view to effective marketing of the local environment and education offer in order to attract qualified people to work in the area.  Work was also underway with partners, including Registered Social Landlords (RSLs) with a view to securing local housing for health workers within a reasonable walking/cycling distance to their work base.  In the Rhyl area it was envisaged that this approach would support the regeneration work in the area;

·         advised that work was also underway with Schools of Medicine in the North West of England to try and attract students from those establishments to consider practicing in North Wales once qualified;

·         confirmed that contingencies to cover potential cost increases, including inflation costs, would be built into the FBC;

·         advised that major capital projects of this type were subject to a protracted business planning process before they could be delivered.  They had to follow the process set out by the WG, which was a three stage process.  In addition, similar to all building projects they had to comply with the local planning authority process to obtain planning permission for new buildings etc.  A further complexity in this particular case was the existence of the original listed building and the requirement to preserve it. This, along with the time lapse since the wards’ closure, had resulted in the cost for the project rising from original estimate of £22m to the current £40m figure;

·         confirmed that a substantial amount of money had been invested in recent years in educational and placement opportunities for medical students in North Wales, however the population of the area was not large enough to sustain the development of a medical school for the area;

·         recognised that car parking facilities was a perennial problem at the majority of health care facilities.  In a bid to ease such pressures on the North Denbighshire campus the Health Board was developing a ‘green transport’ plan for the facility, the site was also well served by public transport, had a number of public car parks nearby and there was on-street parking in the vicinity.  In addition, as part of the planning application process, the Board would be seeking to de-adopt Alexandra Road which effectively split the site into two.  If this was permitted the road area would increase the number of parking spaces available on-site; and

·         confirmed that the new facility would be a nice, welcoming, fit for purpose building but would not include any unnecessary adornments or features.  The existing Chapel facility in the original building would remain, as this was also a listed building.

 

The Committee was then given a presentation on the progress achieved to date in relation to the proposed capital project to re-provide services currently being delivered from The Clinic in Mount Street, Ruthin.

 

A Health Board primary Estates Review in 2016 had identified this facility as not fit for purpose due its poor state of repair.  Whilst initial consideration had been given to undertaking some essential refurbishment work on the building, because of its poor state of repair and its time-limited fabric it was decided that a medium to long-term solution was required for delivering the services housed there.  In early 2017 the WG confirmed the availability of £1.7m to support the transfer of services currently delivered from the Clinic to another location in the town, subject to the development of a business case for the project.  The proposal for delivering these services in the Ruthin area fitted in with the Health Board’s strategic direction and vision for delivering services in the community, closer to the patient’s home. 

 

As this project was on a much smaller scale than those for both the north Denbighshire and the Denbigh area it would entail a single stage business case process for the Health Board to access the capital funding on offer.  The option favoured by the Health Board and its partners for delivering the services, currently delivered from the Clinic facility, would be to relocate the majority of the services to Ruthin Community Hospital.  The services under consideration included the GPs surgery, Health Visitors, School Nurses and the Community Mental Health Team.  The Community Dental Service was currently considering two options – to relocate to the Community Hospital site or to utilise current facilities available to them in both Corwen and Denbigh in addition to providing a mobile service to the Ruthin area.  The Welsh Ambulance Service Trust (WAST) was pursuing options to share a facility in the town with North Wales Fire and Rescue Service, a practice already adopted in other areas of North Wales.  WAST favoured this option as access from the Community Hospital site was not of a sufficient standard when reacting to emergencies.  The business case for this project would also include provision for using the facility as a base to deliver more secondary and community care activities, well-being activities and for using it as a facility to support rural GP training. 

 

A number of stakeholder engagement events and workshops had been held as part of the project’s development.  In addition a Health Impact Assessment had been undertaken and representatives from the Health Board had met with Community Health Council (CHC) representatives to discuss whether the proposals required to be formally consulted upon.  Health Estates design teams had completed their accommodation and service designs, these were currently being costed in readiness to be sent out for tendering during April 2019.  Early cost indications should be available by May 2019 to enable the business case to be written and finalised for submission to the Health Board in July 2019, prior to being submitted to WG for approval in September 2019.  If all business case timescales were met and approval given it was anticipated that the building work on the hospital site would commence during the winter of 2019/20, with the final transfer of services from The Clinic site being achieved during the winter of 2020.   

 

Responding to members’ questions Health Board representatives –

 

·         advised that the aim of the Health Board’s proposed Estate Strategy, ‘Living Healthier, Staying Well’, was to ensure that the Health Board’s buildings were fit for purpose and provided a safe and effective environment to meet the clinical and business needs.  In the longer term the Strategy would provide the Board with an opportunity to eliminate high, significant and moderate backlog maintenance work;

·         confirmed that The Clinic site once vacated and demolished would form part of an asset transfer agreement with the Council, which would also see the Council transfer part of the former schools site adjacent to the Community Hospital to the Health Board for the purpose of extending the car parking facilities at the hospital; and

·         advised that the business case which was in the process of being compiled would be robust.  It would include costs for preparing the land which formed part of the former school sites for car parking facilities as well as the costs for developing primary care services on the hospital site.

 

At the conclusion of the discussion the Committee welcomed the proposed developments in Ruthin and –

 

RESOLVED to receive the presentations and to request that the Committee be updated on developments in relation to both the North Denbighshire and Ruthin capital projects before the end of the calendar year.

 

At this juncture (11.45 a.m.) the meeting adjourned for a refreshment break.