2. The Purpose of the Estates Strategy

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1 Royal National Orthopaedic Hospital NHS Trust Trust Board - December 2012 Estates Strategy 2012 to Executive Summary 1. Purpose of the Report The purpose of this report is to advise the Trust Board of the work undertaken to refresh the Estates Strategy approved by the Trust Board in 2008 (subsequently update in 2009). This document provides a summary of the existing estate, the key changes proposed over the next 1-5 years and how the Trust s assets will change through investment, acquisition or disposal through land sales, to meet the Trust s clinical strategy and rationalise unsuitable accommodation. (Note: A full version of the Estates Strategy 2012) is available upon request) 2. The Purpose of the Estates Strategy The Estates Strategy provides the Trust with a strategy for ensuring that its Estate is properly developed and configured to meet service needs. In order to provide services that are genuinely centralised on patients it is essential that buildings and equipment are in the right location, condition and configuration. It should be noted that the Estates Strategy is a constantly developing document, and as such will be regularly updated to reflect changes to our organisational aspirations and goals, and developed to incorporate additional information as plans evolve. Whilst this Estate Strategy is an important document in itself, it should be recognised that it is one of a suite of strategies that support the Trust going forward to Foundation Trust status and beyond. 3. The Format of the Estates Strategy The Estates Strategy is structured in accordance with NHS ESTATECODE and as such describes:- Where we are now our current estate Where we want to be what our aspirations are for the coming years How we intend to get there what changes need to be made to the existing Estate to enable us to meet our aspirations 4. Where are we now? This initial stage is aimed at developing a comprehensive analysis of the current position and performance of the Trust in relation to the service it provides and how it uses the estate. This stage establishes a baseline against which the development of the strategy can be measured. 1

2 There should be recognition that this report will be required to be further modified in relation to the current changes being implemented and be updated each year to reflect service changes. The estate, has circa 100 buildings with a gross footprint area of 37,270m 2 (this figure excludes buildings with temporary planning permission) with predominately single storey buildings. Whilst the RNOH Stanmore is a centre of excellence, it is widely recognised that the existing site fails to meet the current and future operational demands of service provision and patient care. Despite the fact that since the 2009 Estate Strategy the Trust has invested in a number of refurbishment projects, including theatres and other temporary developments, such as an additional theatre and a new Children s High Dependency Unit. The condition of the site remains little unchanged, for example, 60% of the site s current buildings are over 60 years old and are deemed to be no longer suitable for the delivery of high quality health care. The site s engineering infrastructure is outdated and in need of replacement. The site layout falls far below acceptable standards for patient care or staff efficiency, since patients and staff still have to frequently travel between buildings, often outdoors and over difficult terrain. The hospital s car parks are located far from the buildings over uneven ground, which makes access to the hospital extremely difficult for patients and visitors. Many patient wards are of an antiquated design of asbestos clad construction, originally designated for temporary war-time use only and include poor facilities and steep slopes, which create difficulties for the transportation of patients and equipment. The main issues are: inappropriate corporate image; poor condition; energy inefficient; does not comply with health, safety, fire and other standards; space inefficient; and functionally unsuitable. Poor investment in backlog maintenance over the years has exacerbated this situation to a point where only a few buildings remain serviceable and suitable for modern healthcare. The current backlog stands out circa 49m. The estate is not providing an inclusive environment, i.e. one that can be used by everyone regardless of age, gender, ethnicity or disability as clearly demonstrated in the six facet Estatecode surveys. 5. Where do we want to be? In this section the long term service aims of the Trust are summarised and form the best current vision for future services to allow the development of a number of priority areas for investment. The 2009 Estates Strategy set out a sequence of phased developments. The delivery of new inpatient ward accommodation, with embedded therapies and clinical offices, retail facilities, an imaging department, landscaped gardens and facilities management space, including new site-wide catering facilities, was not dependent on land sales. 2

3 The Trust is currently in a competitive dialogue process with PFI Bidders for this phase of the new hospital development. A new outline planning application has been submitted in December 2012 as the extant planning permission no longer secured the best outcome to the Trust. Working within the recognised Green Belt, environmental and other planning constraints, this planning application seeks permission for a new hospital together with residential development. The receipt secured from the sale of the land benefiting from permission for residential development will contribute towards the delivery of the new inpatient ward. The plans for the site show effectively broken down into four distinct zones. 1. The Western Development Zone ( WDZ ) 2. The Central Development Zone ( CDZ ) 3. The Eastern Development Zone ( EDZ ) 4. The Northern Amenity Zone ( NAZ ) The 2012 planning application is seeking outline planning permission for the development of the site for the following hospital and residential purposes: Up to 16,400 sq m footprint (GEA)/ 56,895 sq m of floor space (GIA) of exemplar new hospital buildings. This footprint and floor space also includes an accommodation unit for the families of children being treated at the RNOH, a new rehabilitation centre and other ancillary clinical and service related development. Up to 311 residential dwellings, 13,938 sq m footprint (GEA)/ 37,158 sq m floor space (GIA), spread across the WDZ and EDZ as follows: WDZ: up to 92 residential units, including up to 54 houses and up to 38 apartments EDZ: up to 219 residential units, including up to 9 houses, up to 210 apartments Two new blocks for staff accommodation units providing 36 units, - 1,143 sq m footprint (GEA)/ 3,102 sq m (GIA); A 6 storey multi-storey car park providing 805 spaces (3,000 sq m footprint (GEA)/ 21,000 sq m floor space (GIA), and surface car parking to provide 215 car parking spaces for use by hospital staff and patrons; Provision of both private and publicly accessible open space. 6. How do we get there? The document concludes by developing options to enable the Trust to achieve these targets. There are significant benefits to be realised from rationalising the Estate, both in terms of quantifiable benefits and qualitative (for instance improvements in the patient experience and logistics). In conjunction with the clinical services strategy, with support from clinical services, a phased programme of challenging Estate rationalisation proposals has been identified. The primary intention is to vacate buildings which are in poor condition or have poor functionality and consolidate services into the better buildings. 3

4 Further supporting work for this programme is ongoing, in partnership with clinical services, addressing deliverability; impact on clinical services, cost implications and option analysis. The master plan represents an illustration of the main development proposals. The plan is designed to help everyone involved to understand the issues facing the hospital and to gain agreement and approval for the optimum solutions to meet the healthcare demands. The Trust has developed an indicative timetable for phasing of the site developments as illustrated in the table below: Phasing Timeframe Works to enable the PFI development Phase 1 Princess Eugenie House and Graham Hill house Phase 2: The PFI Hospital Development Phase 3: The EDZ 1 Replacement Staff Accommodation Phase 4: The WDZ Residential Development Phase 5: The Multi-Storey Car Park ( MSCP ) Phase 6: The Private Patients Unit The strategy for the redevelopment of the Stanmore site is based on a series of phased staged developments which consolidates the hospital functions into the central zone of the site. The phasing strategy allows for the continued operation of the Hospital during construction periods including decanting measures and temporary parking provision. The Trust has undertaken a footprint profiling exercise which has demonstrated that when the site development is completed the total over developable footprint is not exceeded. This includes the footprint allowances for the central zone hospital development and the footprints on the East and West Ends of the site being made available for housing, as illustrated in the following table: Current Development Proposals Footprint (GEA) Floorspace (GIFA) Clinical New Build 15,569 55,253 Clinical Buildings to be retained 2,432 4,505 Future Clinical Expansion 831 1,642 Staff Accommodation (existing & proposed) 1,500 4,150 Residential Development - WDZ 6,682 15,008 Residential Development - EDZ 7,256 22,150 Multi storey car park 3,000 21,000 Total 37, ,708 4

5 7. Conclusion In summary, the refreshed Estates Strategy focuses the hospital onto a reduced footprint, therefore enabling the release of existing operational areas for residential development. The residential element component is essential to ensure the future of the hospital: the receipts generated from the sale of this land, with residential permission, will directly cross-subsidise the new hospital development. The strategy articulates a plan for detailed delivery of the Trust s strategic objectives. The key conclusions from this Estates Strategy refresh are: The Trust is facing a challenging external agenda for change, from changes to the NHS and commissioning structures and the financial strictures on the NHS. The Trust needs to rapidly improve the efficiency and cost effectiveness of its Estate, to provide clinical facilities which are affordable and cost effective, and therefore make a positive contribution to the Trust s financial position. There are a number of clinical, estate and financial drivers for change and an overriding need to rationalise the estate and reconfigure services to improve the patient experience and make the Trust more efficient. The clinical services strategy process is the key driver for change and there will continue to be full engagement with this dynamic process. The Estates Strategy will continue to focus on making the most effective and efficient use of our hospital sites, to enable clinical staff to work in the right place, to provide the best, safest and most seamless care for our patients. However, it is important to realise that there are a number of factors that will serve to hinder the successful delivery of this strategy and achieving the delivery of all strategic objectives across all of the Trust s estate. The Trust faces a significant challenge to deliver this strategy, however, as long as there remains an appetite to make the inevitable difficult choices, operating within the flexible framework, as articulated within this strategy, then significant improvements to the management and delivery of the Trust estate will be realised. The proposed investments and phasing will be continually and individually assessed as part of the Capital Planning process, to ensure that they do not impact adversely on the Trust s Financial Risk Rating (FRR). 8. Recommendation The Board is asked to approve the refreshed Estates Strategy. Mark Masters Director of Projects, Estates & Facilities December

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