Site Development Control Plan
1st November 2003
In September 2002 the Trust formulated a five-year site development plan, which has recently been updated to reflect the longer term strategic aspirations of the Trust. This new ten-year site development plan details both the short term (2 years) and longer-term (10 years) refurbishment, upgrades and new builds envisaged for the main hospital site. There are two copies of the plan displayed within the hospital; one located in the main entrance and the other on the notice board in Time Out. The plans are very detailed and clearly indicate the exact location of each proposed development. The full specification of the plan is given below.'
Contents:
Executive Summary
Introduction
Current Site Development Control Plan
Part 1a - In Progress
Part 1b - Short Term (within 2 years):
Part 2 – Long term (within 10 years)
Part 3 – Rolling Programme
Part 4 – Facilities Initiatives
The West Suffolk Hospital was constructed in 1974 on the current Hardwick Lane site. The population numbers and public expectations of health service delivery have changed considerably since the date of opening, with the result that the hospital is now in danger of outgrowing the site. This being the case, great care must be exercised when planning any future developments on the site taking full regard of any future needs as far as is reasonably practical. The hospital has undergone a number of alterations over the years to meet these challenges, both in it’s physical build and operational policies. The demands on the hospital today are still changing, as would be expected, and will continue to do so for the foreseeable future. We are however, currently in a phase of significant change with the result that special measures need to be taken.
Both short term, 2 year, and long term, 10 year, operational plans have been formulated by the Trust, and a five year site development strategy was produced in the autumn of 2002. This document was produced as a direct result of a meeting between the hospital’s Director of Facilities and the local planners in August 2002, which identified the need for such a plan. Such a document would enable the Borough planning office to take a holistic view of all future developments planned for the site. It was also noted that the planning process would benefit greatly by such proposals taking into account all aspects of possible impact on the local environment during the design phase.
This document was subsequently produced, and has recently, October 2003, been updated to become a ten year Site Development Control Plan. All known future developments are included, both funded and envisaged, linked together wherever possible, thus producing an overall development strategy document.
The document has also been communicated within the wider health economy and consideration given to the strategic context. Ensuring inclusion into the LHDP and ownership of elements within the clinical community.
In 1948, the date for the introduction of the NHS, the East Anglian Regional Hospital Board became responsible for the running of hospitals for a population of 1,250,000 million in an area which included Norfolk, East & West Suffolk, Cambridgeshire, Ely, Hungtindonshire and Peterborough. The population during the mid 1960’s was 1,735,000 and was expected to increase to 2,100,000 by 1981; it now stands at some 7,375,000 for the Eastern Region!
In 1962 the then Ministry of Health published “A Hospital plan for England and Wales” this document put forward firm proposals for a major development at Bury St Edmunds.
The West Suffolk Hospital (WSH) was constructed during 1974 at a cost of £5,000,000, during 1975 an additional wing, the Joyce Cochram Day Hospital (JCDH) and geriatric extension was constructed at a cost of £1,160,000.
The present hospital site covers approximately 19 hectares, the original covering only 14.
The term “best buy” was first used in 1967, when a mandate was given to the DoHSS. The planning principles were:
1. That as many patients as possible should be investigated and treated in the community by family doctors, helped by local authority nurses and health visitors.
2. That when admission was essential, the stay should be made as short as possible by good management and planned early discharge.
There were six objectives:
3. Function – to provide a basic hospital service, which compliments integrated community health services in an area.
4. Economy – to build hospitals as economically as possible without creating increased maintenance and revenue costs.
5. Efficiency – to design hospital as complete units, placing individual departments in good functional relationship with one another. This ensured that when patients had to receive hospital attention, it should be possible by the maximum use of out-patient, diagnostic and treatment facilities, including day beds, to treat more of them as out-patients.
6. Quality – to build hospitals to a standard no higher than that required by clinical and amenity needs.
7. Environment – to create hospitals, which engender a sense of well being for patients and staff.
8. Speed – to design and build hospitals as rapidly as possible, making optimum use of planners and designers.
The Trust formulated this ten year site development control plan as a direct result of the five-year development plan formulated late 2002 which detailed both the funded, short term (2 years) and longer term (5 years) issues that had been identified at that time. The Plan was, and still is, by it’s very nature, subject to constant change in order to ensure it fulfils the demands of the NHS today with its many different priorities in an ever-changing environment.
Due to the outstanding natural beauty and parkland setting of the site, it is recognised that great care must be exercised when planning any future developments. To this end landscape architect, Lizlake Associates, were commissioned to carry out a full survey of all on site trees and topography, and to make necessary recommendations with respect to landscape management. The capital programme therefore proposes expenditure on a year by year basis both to manage the existing woodland areas and carry out mitigating planting to provide screening where necessary prior to building works taking place.
This details all capital schemes in progress on site within the WSH at the time of writing this document
Car Park E
Most of the work on Car Park E was completed in the summer of 2003 with circa 150 spaces being opened to the public on 1st September. A small amount of work is still required in the area nearest to the Education Centre which is currently being used by a contractor as their site compound. This area will be vacated in January 2004 when the extension to the Day Surgery Unit is complete, see 2a below. Once the area has been vacated it will be reworked to provide an additional circa 50 parking spaces.
A press release in the summer of 2002 announced the successful conclusion to a £5.6 million bid by the Trust to carry out significant alterations to it’s service delivery both in terms of quality and capacity. The bid was submitted to the DoH during mid July, with approval being given during late August. The bid covered a group of schemes which collectively are known as the Diagnostic and Treatment Centre. Once completed this facility will be used not only by West Suffolk Hospitals NHS Trust, but also by neighbouring trusts in the delivery of their services. The building will also enhance patient choice. The main objective of the Diagnostic and Treatment Centre is to reduce patient waiting times and lists. This will be achieved by:-
a) Carrying out an additional 2,000 cataract procedures every year.
These operations will be day surgery type activity with patients being admitted, operated on and discharged normally within 4 hours. The existing Day Surgery Unit will be extended at the rear, in a southerly direction, with the addition of a two storey block. This block will consist of two additional operating theatres at ground level and full ophthalmic outpatient clinic at first floor level. Variations in ground level within the proposed footprint enable the design to be planned such that future extension of the first floor outpatient area could be accommodated if required. The design also includes circa 50 additional parking spaces already completed during the summer of 2003. This new facility is planned for construction completion in December 2003, becoming operational in January 2004.
b) Carrying out an additional 800 hip and knee replacements every year. This will be achieved by the commissioning of the hospital’s third ultraclean operating theatre. This theatre was completed and opened in September 2003. Prior to this opening, the hospital operated 8 theatres within the main hospital, 2 of which are Ultraclean units. The addition of this third Ultraclean theatre is within the existing theatre complex adjacent to theatre 8 in the remaining courtyard space. The construction is very similar to theatre 8, which was completed and handed over early in 2002. The design of the theatre meant that it was constructed on stilts at first floor level. The void created underneath the theatre will be utilised for storage if funding allows such a future development.
c) A new orthopaedic outpatients department will be required in order to facilitate some of the above. The Trust has not yet identified a suitable location for this facility, but it will almost certainly be within the main hospital building and could well be the development of a previously vacated area or internal courtyard.
d) Minimising the number of blocked beds by the addition of 40 beds within the vacated ward G8. These beds are utilised to free up surgical and medical beds thus negating the need to send delayed transfer of care patients to Walnutree Hospital in Sudbury. This project involved the complete refurbishment of the ward area and was completed in December 2002.
This element is all work intended to start construction within the next two years.
1. Ward F10/G6 Refurbishment
Ward F10 is the next ward to be refurbished under the current refurbishment programme, followed by G6. F10 will then be used as a decant ward to facilitate all future ward maintenance and refurbishments works.
2. Oncology Services (MacMillan Cancer Relief) (see project definition)
The current cancer service is over subscribed and spilling out of its present accommodation within ward G1. Through a partnership with MacMillan cancer care a design has been agreed for an extension to the existing oncology unit in a westerly direction, providing both in and outpatient facilities, whilst maintaining patient flow from the existing unit, which will be retained. A re-design of the existing car park arrangements in the area will be required incorporating a new dedicated patient drop off and pick up road as most of the treatments carried out within the building will be of a day case nature. Tree loss will be minor with exterior planting included for screening and patient enjoyment whilst undergoing treatment. Construction will commence in November 2003 with a 10 month build programme.
3. Car Park C Extension
A further extension to car park C is planned. This will be in an easterly direction and will accommodate circa 100 additional parking spaces.
4. Education Centre – Lecture Theatre (see project definition)
The Education Centre opened it’s doors to the public in February 2003. The original design for this facility included a 180 seat lecture theatre. Unfortunately, funds did not permit the building of the lecture theatre which is still an outstanding feature of the design. Fund raising initiatives are currently ongoing in order to secure the necessary funding to enable the construction to take place and it is anticipated that this should be completed within the next 2 years. Consideration is also being given to additional office and training space.
5. Endoscopy/Urology Services
A new purpose built Urology and Endoscopy clinic is currently being proposed in the area of the existing Endoscopy/F14 suite with an extension over the ground floor roof in a southerly direction.
The re-development combines the Urology and Endoscopy Units into one project. The aim is to provide and co-ordinate packages of modern specialised services to cover a spectrum of activities these will include clinical care, treatment and education from a centralised location with specialist facilities.
The development will enable the Trust to:
a) provide appropriate high quality accommodation and environment in which care is delivered
b) ensure there is sufficient capacity to improve access and NHS Plan targets (of thirteen weeks maximum wait), combined with an annual predicted increase in endoscopic activity
c) allow sufficient capacity for other PCT’s and aid the ‘Patient Choice’ agenda
d) centralise the Urology Team improving the patient experience in facilitating a ‘one stop’ treatment philosophy
e) provide flexible accommodation that changes with the needs of the service
f) bring scoping decontamination facilities in line with best practice and national and Department of Health guidance
g) improve patient flows by matching demand and capacity and removing constraints
6. Diabetes
On completion of the Day Surgery Extension and the move of ophthalmology into the new unit, the existing ophthalmology unit will undergo minor internal modifications into a diabetes screening and treatment clinic. This in turn will free up current diabetes office space and ease the pressure on the outpatients department where the diabetes clinics are currently held.
7. Estates Works Department
An extension to the Estates workshop is required due to increased workload around the site. This workshop extension will initially be single storey, with the option of an additional second storey at a later date. The estate carpenters are currently located in a temporary building external to the hospital which is less than ideal, both in terms of Health & Safety and finance.
8. Breast Screening Department Phase II
Part of the Breast Imaging and Screening Department moved to it’s current location in the old Joyce Cochram Day Hospital in September 2002. When the remainder of the day hospital has been vacated by ophthalmology in January 2004, a second phase of this project will be undertaken. This will involve a degree of internal remodelling of the accommodation, in order to provide a purpose built support services area, including all necessary offices.
9. Creche
This is an externally funded initiative, which has previously been refused planning permission on the grounds that the design did not blend in with the surrounding area. The location and design of the unit is, therefore still under review, taking account of current traffic movements around the site and neighbouring buildings. It is hoped to locate this facility within an area behind and adjacent to the new Diagnostic and Treatment Area.
10. Old G8 Area
Following the move of adult mental health services and the resultant establishment of the integrated care unit within part of the old ward area, as in Part 1a para 2d, an area of the old G8 ward still remains vacant. It is absolutely essential that the most efficient use be made of this prime area within the main hospital building. It is therefore envisaged to house either all or some of the following clinics/services within this space.
a) Pre-operative assessment clinic – This is required in order to fast track pre-operative assessment and administration of patients prior to surgical procedures being carried out. Such a facility would greatly accelerate the current pre-operative processes thus leading to a greater throughput of patients, with a resultant reduction in waiting lists and times. This will clearly be a pre-requisite if the target of an additional 800 hip and knee joints per year is to be achieved.
b) Chronic pain clinic – currently being conducted in part of the old PGME area which is totally unsuitable for the purpose, and must be relocated prior to the Emergency Assessment Unit being built, see para. 14.
c) Discharge liaison team – currently accommodated in a temporary building at the rear of the hospital.
d) Social services – the team is dispersed around the main hospital building and also occupy a temporary building at the rear of the hospital.
e) Booking office - Telephone Appointments Centre, to support the governments Booked Admissions initiative. Will enable patients to agree a convenient out-patients.
11. On-site Residential Accommodation
It is envisaged as part of the long-term plan to provide additional on-site residential accommodation. It is intended that any new on-site accommodation will be in the vicinity of the existing units at the northern boundary. It is recognised by the hospital that the area of land on the western boundary is a particularly sensitive area in respect of the local environment. It is the intention of the Trust to develop an overall plan for this area such that it becomes an amenity for all users of the hospital and may well include for the provision of on- site residential accommodation and the crèche.
12. Re-location of Medical Records
In order to facilitate the provision of the new Emergency Assessment Unit, see 13 below, it is first necessary to relocate medical records from their current accommodation at the hospital’s north-east corner. It is therefore intended that medical records be moved to the old Post Graduate Medical Education area (PGME), which was vacated when the new education centre opened.
13. Emergency Assessment Unit
A temporary Emergency Assessment Unit was constructed in early 2003, being opened in May of that year. This is a 30 bed unit which has been positioned adjacent to the Joyce Cockram Day Hospital entrance. During construction, the foundations of the unit were strengthened such that a second storey may be added at some future date, again providing much needed office accommodation. A Strategic Outline Business Case is currently being drawn up with a view to the construction of a purpose built unit, to be located on the North East corner of the hospital adjacent to Accident and Emergency. This development could also include for first floor accommodation, possibly to house the IT department, thus moving them out of their grossly overcrowded existing accommodation, including a temporary building at the rear of the hospital.
14. X-Ray Reception Refurbishment
The existing X-Ray reception area is less than ideal for modern healthcare provision. Plans have been drawn up to re-model the area and make it more suitable for current patient needs. All existing services will be decanted into part of the old vacant PGME area whilst the building works take place. This work will clearly need to be completed prior to the move of medical records, which will occupy the same area.
15. New CT Scanner
Lottery funding has been secured to purchase an additional CT scanner for the hospital. This will greatly enhance the health service provision capability. A suitable location together with associated building plans are currently being drawn up to incorporate the new scanner into the existing x-ray area/old breast screening.
16. Air Ambulance Landing Area
The sports pitches located on Hardwick heath are currently used as the air ambulance landing pad. This arrangement presents no problems for the helicopter. The problems occur when the patient leaves the aircraft and has to be ferried by trolley across the grass, through a small wooded area, over the main hospital circulation road and up the footpath to the accident and emergency entrance to the hospital. Plans are being drawn up for a dedicated trolley path from landing pad to A&E, covered where ever possible in order to afford some weather protection to both the patient and medical staff.
17. Obstetrics Theatre (Central Delivery Suite)
The need for a dedicated obstetrics theatre within the central delivery suite has been identified and a strategic outline business case is currently being drawn up. Under present arrangements any requirement for emergency surgical procedures necessitate the patient being transferred into the main theatre suite. Whilst the distances involved are not great, the situation is less than ideal.
18. Audiology
An additional soundproof room and associated office space is required within the audiology department to facilitate the fitting of the new digital hearing aids in accordance with the NHS plan. This additional accommodation is likely to be situated in the courtyard adjacent to the existing audiology department
19. Sterile Services Department (Decontamination)
Significant investment is being made for theatre instrumentation. This will not only cover the extra activity in the Day Surgery, Main Theatres and outpatients, but will enable a longer turn around time between the hospital and Sterile Services Department (SSD). New washer disinfectors have been procured, and will be installed in November/December 2003. This will greatly enhance the de-contamination processes. A new tracking system has been introduced which aids the monitoring of surgical instruments full circle, SSD to theatre to SSD. All that remains is the procurement and installation of a new clean steam raising boiler plant to ensure that all future foreseeable decontamination and sterilization targets will be met.
20. Office Accommodation
There is an immediate need for additional office accommodation. Overcrowded offices are a common feature throughout the Trust as accommodation within the main core of the hospital generally tends to be utilised for clinical purposes. In addition to this already unacceptable overcrowding situation, space and support facilities will need to be provided for the staff required to carry out the extra activities already identified. It is therefore proposed to install a 2 storey portable type of building in one of internal courtyards. The courtyard being considered for this purpose already houses a single storey portable building. The intention is that the unit would contain offices together with an open plan area, and would accommodate 12 to 14 personnel on each level. In the longer term, this unit could be used as a decant facility to enable maintenance work to be carried out.
21. 23Hr Short Stay Ward
A short stay ward facility is required at the hospital to cater for those “day case patients” who maybe require a little more recovery time. This facility could be co-located with the discharge lounge, which is also a shortfall in the current service provision. Both these facilities could be located, in the short term, within ward F12, with the short stay ward moving to DSU at some time in the future, whilst the discharge lounge could be a feature of the Emergency Assessment Unit.
22. Dermatology
The existing dermatology service is disperate and serviced by many existing areas across the site. The trust has received £500k to develop the service within a new area on the WSH site. An exact location is as yet to be identified from a completed option appraisal.
The second part of the development plan identifies the longer-term requirements of the hospital and proposes new builds and alterations, that have not yet been funded or finalised.
1a. Car Parking – 100 additional spaces
An additional 100 parking spaces are planned along the existing western boundary, opposite the care of the elderly wards. These parking spaces will be provided in conjunction with the road realignment project as detailed in 1b below,
1b. Road Realignment
It is planned to reroute and realign the existing site perimeter road in order to achieve two way traffic flow throughout the site. This will provide much greater flexibility with respect to emergency vehicle access both to the Accident and Emergency department and around the site. It will also provide much greater flexibility in respect of access to car parks.
2. Multi Storey Car Park
Consideration is being given to the possibility of installing a second deck on the main car park at the front of the hospital, Car Park A. Whilst providing much needed additional parking, as already identified, this would also greatly improve disabled access to the main hospital entrance. In order to maximise the potential of this scheme it would be necessary to secure two way traffic flow throughout the site, see 1b above.
3. Sterile Services Department (SSD)
This service is currently located off site at Hospital Rd. The land on which the department is situated is owned by the Local Health Partnership and is in the process of being re-developed. A suitable site within the West Suffolk Hospital boundary must be identified for this service at some time in the future. A suitable area has not yet been identified and will depend very much on other more pressing site developments.
4. MRI Covered Link
In the spring of 2003, a new MRI scanner was installed and commissioned. This unit is located at the most southerly end of the hospital underneath the main kitchen. In-patients being transferred from the main hospital wards to the MRI scanner are taken outside via the rear hospital entrance in order to access the unit. A covered link is required to ensure that patients undergoing such a transfer are not exposed to adverse weather conditions.
5. Cellular Pathology, Histology and Mortuary
The location of the existing mortuary is less than ideal, in that it provides very little dignity when deceased patients are collected by funeral directors, the whole operation being on view from a number of the main circulation corridors within the hospital. The body store needs to be investigated in terms of it’s capacity, which is inadequate during the winter months, resulting in the need to hire a portable body store from late October to March. This unit affording even less patient dignity. The long term aim therefore, is to have a mortuary and body store large enough to cater for year round demand, located away from the main hospital building such that transfer of deceased patients will not be witnessed by other patients, visitors or staff. Completion of such a facility would have the added benefits of freeing up core space in the main hospital for development, whilst at the same time reducing revenue costs by obviating the need to hire a portable unit every winter. The exact location and operation of such a facility has not yet been finalised or funded.
6. Office Accommodation (Facilities/Estates/Works)
The short-term need for additional office accommodation has already been identified, see Part 1.8. An administration block, built as a second storey extension to the existing estates workshops and main stores complex is envisaged, thus providing much needed office space, without impinging on any of the clinical areas within the main hospital building, see para 1.7.
7. Pharmacy Production Relocation
Pharmacy production is rapidly outgrowing it’s current accommodation and should ideally be in a more central location to the main hospital. Work is currently being undertaken to try and identify a more suitable location such that plans can then be drawn up for a purpose built facility. In the event the Emergency Assessment Unit goes ahead, with the addition of a first floor to house the IT department, the accommodation vacated by IT could be utilised for pharmacy production. This wouldn’t address the location issue, but would enable the expansion and re-modelling of the existing facilities.
8. Nuclear Medicine
Nuclear medicine is currently located on the second floor of the main hospital building. New equipment and machinery planned for this department is heavier than the existing equipment and as such it is felt that a ground floor location would be more appropriate. Again, a suitable location needs to be identified and plans drawn up. Currently this scheme is being worked into the viability/feasibility within the current x-ray/breast screening area.
9. Main Entrance Refurbishment
The hospital main entrance is, by definition, the first view that patients and visitors see on their arrival at the hospital. Whilst the area is functional and serves the patients needs, it is not what one would expect to see on entering a modern 21st century facility. Plans are therefore being drawn up to refurbish the area to generate a more welcoming environment for both patients and visitors.
10. X-Ray (A&E)
A dedicated X-Ray capability within the Accident and Emergency unit would not only accelerate the patient journey through the A&E department, but would dramatically reduce the number of patient movements between the 2 departments. This would have very clear benefits from the point of view of the patient journey.
A rolling programme is required for the following in order to constantly develop, maintain and improve our facilities.
· Windows
· Roof Repairs
· Sub Main electrical distribution upgrade
· Nurse Station replacement
· Internal/External Painting
· Building Management System upgrading
· Clinical Equipment and Non-Clinical Equipment
· Ward Refurbishment x 2 per year
· Water main replacement
· Boiler replacement
· Main theatres upgrading
· Site utility upgrade
· Combined heat and power plant
· Fire alarm upgrade
· Strategic boundary planting
· Health & Safety programme
· Fire Safety upgrading
· Patient Power, this will provide TV and telephone to every bed head by end of 2003. Current refurbishment areas are wired and ready for installation. All costs will be born by the Trust chosen supplier “Wandsworth”, who in turn recoup expenditure through rentals and call costs.
· Brighter Living : committee set up to improve the overall site appearance for staff and patients alike. Funded £20k per year and spent on items such as plants, pictures, art work, upgrading staff rooms, water coolers etc.
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Introduction