Agenda item - 3Ts Redevelopment of the Royal Sussex County Hospital

Report of the Executive Director, Governance, People & Resources (copy attached).

18.1    This item was presented by Karen Geoghegan, UHSx Chief Financial Officer, and by Peter Larsen-Disney, Clinical Director for the 3Ts Programme.

18.2    Ms Geoghegan told the committee that the full business case for 3Ts had been agreed in 2015. 3Ts has been a programme to develop the Royal Sussex County Hospital (RSCH) as a regional tertiary, trauma and teaching hospital. The programme has three phases: phase 1 involves the redevelopment of the Barry building to provide a trauma centre and improved wards (due to open in 2023); phase 2, a new cancer centre (opening in 2025); phase 3, a new logistics centre (opening in 2026). In all 3Ts will involve the creation of 100+ new beds and new specialist facilities at an overall cost of around £750 million. 3Ts is part of the Government’s 40 Hospitals Programme. Phase 1 buildings will become available in November 2022, with a pre-occupation stage from November to January 2023, followed by services moving across in February/March 2023, and then preparation for phase 2.

18.3    Mr Larsen-Disney told members that he is proud of the new facilities: moving from having the oldest clinical estate in the NHS to the newest is a fantastic thing and will have a massive positive impact on patients,  especially in terms of the privacy and dignity that can be accorded to them, with lots more room around beds and around 60% of beds to be in single ensuite rooms, many with sea views. Outpatient facilities have also been significantly improved, with street level access, better waiting rooms, shops, a bus stop directly outside the unit, better car parking (with 150 new spaces for patients and visitors) etc. Lots of thought has been given to the patient journey across the site, with lifts positioned at the front of the building so people can go directly to the floor they require. The new buildings will be very energy efficient.

18.4    3Ts will benefit staff also, creating a much improved work environment as well as offering lots of new job opportunities. There will be a focus on developing smarter job roles with greater opportunities for career progression: e.g. finding innovative uses for pharmacists, physician assistants etc.

18.5    3Ts presents an opportunity to rethink the delivery of acute care and there is an ongoing regional review of critical care capacity, involving a shift-change in thinking about clinical pathways and patient journeys. This will involve more focus on ambulatory care and short-term admissions; the development of a frailty unit; development of better sub-critical care acute respiratory support; and rapid stroke assessment and access to thrombolysis. There has also been a focus on the physical lay-out of services within the hospital: e.g. a new CT scanner has been located in ITU, which will eliminate the need to move critically ill patients around the hospital to access scanning.

18.6    Ms Geoghegan added that there has been extensive engagement with local people, with a liaison group in operation since 2009. HOSC members will be invited to visit the phase 1 site.

18.7    Cllr West commended the achievement to deliver 3Ts and noted the positive impact it would have. However, he had concerns about pressures caused by additional car journeys to and from the site and about the provision of public transport. It was particularly unfortunate that there was no covered interchange for bus travellers. Mr Larsen-Disney responded that the Trust encourages sustainable travel, but it is inevitable that many sick people will want or need to drive to the RSCH, and it is very difficult for people to do so currently given the limited parking availability. UHSx has made a conscious effort to improve traffic flow around the hospital site, but has limited influence on what is essentially an issue for the city council. Ms Geoghegan added that there was a limit to the facilities for bus travellers that could be provided on the RSCH site, but that there were screens in the foyer providing regularly updated bus information, so people can wait for buses in the warm.

18.8    Cllr West asked a question about the sustainability of the 3Ts build. Ms Geoghegan replied that sustainability has been a core element of the development, with lots of recycling and use of recycled materials. Much of the development has involved modular buildings constructed off site. This significantly reduces traffic in and out of the site.

18.9    Geoffrey Bowden noted that he had been a member of the BHCC Planning Committee that had approved the original 3Ts application. He asked what the building would look like in 10 years’ time. Ms Geoghegan responded that really high specification materials have been used in the build which means it will continue to look good for many years. However, it will require maintenance, including a substantial amount of window cleaning.

18.10  Mr Bowden asked a question about use of the helipad. Mr Larsen-Disney responded that there would be around 50-100 flights per year. There are no restrictions on when helicopters can land, although wind factors may restrict landings.

18.11  Cllr Grimshaw asked how a development only providing around 100 new beds could cost £750 million. Mr Larsen-Disney responded that Phase 1 of 3Ts would take patients out of other parts of the hospital, freeing up space in other departments which could be used to expand or otherwise improve services. In addition, the Trust is focused on reducing the length of bed stays: e.g. people typically spent 10 days in hospital recovering from major surgery, but this has now been reduced to an average of 4-5 days. This is of great benefit to patients, particularly to elderly and frail patients where there are real risks associated with being bed-bound for long periods of time. This focus, which will be supported by the new RSCH environment, means that there is not necessarily a need to significantly increase the number of beds at the hospital. It should also be recognised that 3Ts is only one part of the improvement picture. For example, investment in A&E will be needed to deal with overcrowding. Ms Geoghegan added that the improved layout of beds in the Phase 1 rebuild will increase the clinical effectiveness of care and play a part in reducing length of stay. It should be noted that there will not be an short-term increase of 100 beds, as not all will be opened immediately and there will be issues with staffing etc. However, the completion of Phase 1 will allow the decant of patients from other parts of the hospital which will allow the Trust to move at pace with its plans to redevelop the emergency department.

18.12  The Chair asked how many new beds would be available when Phase 1 comes into operation in Spring 2023, and how many of these would be for city residents? Mr Larsen-Disney responded that on day one of Phase 1 opening to patients there will be around 50 extra unallocated beds. 24 of these will be critical care beds, so could in theory be filled by patients from anywhere in the region. However, most of the decant of patients into the Phase 1 build is from the Barry and Courtyard buildings, which mostly provide local services.

18.13  In response to a question from Cllr O’Quinn on private beds, Ms Geoghegan assured members that there will be no private beds in RSCH.

18.14  In answer to a query from Cllr Rainey on local food sourcing and sustainability, Ms Geoghegan told the committee that there has been lots of focus in 3Ts on ensuring that cafes offer healthy eating options and minimise the use of plastics etc. In terms of patient food, the ambition is to use the kitchen facilities at St Richards Hospital, Chichester, to provide for all UHSx sites. This would mean all hospital food being made in Sussex, a major advance in terms of carbon footprint and localism.

18.15  In response to a question from Cllr Grimshaw on whether there is always enough food for patients, Ms Geoghegan confirmed that there is always enough reserve food and that robust contingency plans are in place for emergencies.

18.16  Geoffrey Bowden asked what the per meal budget was for hospital food. Ms Geoghegan did not have the figure to hand but promised to provide a written response.

18.17  Cllr West noted that he understood the argument that a focus on lessening length of stay would reduce the demand for beds. However, when would the system know that 3Ts is working in this way? Mr Larsen-Disney responded that it was difficult to give a timeline for this, but the principle is widely accepted with lots of evidence of it working from other places.

18.18  In response to a question from Cllr West on fresh air in the hospital, Mr Larsen-Disney confirmed that the new facilities will have much better access to ventilation than the buildings they replace.

18.19  The Chair asked a question about flow through the hospital and problems with discharge delays. Mr Larsen-Disney responded that the Trust works hard with the city council, Sussex Community NHS Foundation Trust and other partners on discharge. 3Ts will assist in this work by reducing length of stay, meaning that patients will be at less risk of becoming deconditioned through lengthy bed stays, and less likely to need extensive care packages on discharge.

18.20  The Chair thanked the presenters for their contributions and noted that, although the local health and care system faces considerable challenges, the 3Ts development offers exciting opportunities for the city.

18.21  RESOLVED – that the report be noted.