To receive a verbal update on delivery of the capital programme and re-design of the hospital.

(Note: presented by the Deputy Chief Executive and Chief Strategy and Transformation Officer, Senior Responsible Officer, New Hospital Programme, Torbay and South Devon NHS Trust).

The Director of Capital Developments, New Hospital Programme Director, Torbay and South Devon NHS Foundation Trust provided Members with an update and presentation on the delivery of the capital programme and re-design of Torbay Hospital.

It was recognised that Torbay Hospital was the third oldest hospital in the country and over 80% of the core hospital estate was in either bad or poor condition, including main inpatient wards, emergency department and outpatient department.  Therefore, the backlog maintenance remained significant and also impacted on delivery of patient care and affected staff morale, recruitment and retention.

The Board was informed that the programme was still at an early stage of development at the business planning and master planning concept design stage, but that the need for a new hospital was as great as ever.

Hospital 2.0 provided a ground-breaking standardised approach to designing and building hospitals and would make the process faster, more sustainable and more cost-effective, reducing the time from planning and design through to completion, commissioning and opening new buildings to patients.  The designs included digital solutions and optimised hospital layouts.  All schemes in the New Hospital Programme would proceed through the development phases up to full business case prior to 2030.  Torbay Hospital was in Cohort 4. 

Following feedback, some changes to the site enabling business case were being made to allow better alignment with the Hospital 2.0 programme.  Although the standardised approach had resulted in a slowing down of delivery of the programme, it was anticipated that site clearance would commence later in 2024.  This would cover three areas:

·         site clearance (two phases);

·         high voltage resilience and infrastructure; and

·         car parking.

In terms of current preparations, the Board was informed that the Masterplan had been reviewed and that the cost of the build, staffing and running the building would be analysed in the business case.  The outline business case and full business case would be required before the build could commence.

The Board asked a number of questions in relation to construction access to the site and engagement with local residents; whether a multi-storey car park was being considered to provide parking; when the build would commence and when the new hospital build would be completed; whether plans for the new diagnostic centre in Market Street were behind schedule; what work was being done to make improvements following the outcome of the Care Quality Commission (CQC) report; whether the current building was affected by Reinforced Autoclaved Aerated Concrete (RAAC); whether any of the current hospital building would remain; the cost of scaffolding around the tower and consultation around patient access and services.

In response, Members were reassured that there would be a wider public consultation once early development stages were completed.  Transport planners would work with Torbay and South Devon NHS Foundation Trust to develop egress and access strategies and construction site access would be addressed within that. Additional parking options were being explored in the interim together with longer term options for the Hospital, for example, a park and ride facility off site and multi-storey car park on site.  A site enabling communications strategy was being developed but would not be released until the changes to the site enabling case were approved. 

Given the existing timetable, it was anticipated that a significant start to the build would not commence before 2027.  In terms of improvements following the CQC recommendations, Members were informed that delivery was affected by the amount of funding available, with challenges around that and competing priorities – it was recognised that health and safety had to be a high priority.

It was confirmed that although RAAC did not affect the current buildings, there were other issues with regards to the concrete construction within the existing estate and in particular the 1967 Tower block and podium.  Over 80 structural defects had been identified and corrosion was accelerating due to airborne salt because of its location on the Coast.  Scaffolding and crash decks had been installed to reduce the risk of falling masonry.  Further investigation works were taking place before remedial works could be designed and delivered.  The money spent on the tower to date had been funded at a local level.  The case has been made that Torbay Hospital should be treated as a priority, alongside RAAC affected hospitals, given these issues. 

Members were informed that fifty percent of the current estate buildings would remain alongside the new build, but it was hoped that the remaining estate could be brought up to a better standard.  In terms of the new build delivery of a first phase would likely be parking solutions and the planned care centre, with a second phase of a new emergency department and ward blocks.  However a definite timeline was not yet available. 

Members acknowledged that since the opening of the new Endoscopy Unit, the waiting list had reduced by 87% and that the opening of the new Theatres had reduced the time people had to wait for surgery and the time that people were in hospital following surgery.

Other Members in attendance asked questions in respect of whether any of the existing hospital buildings were listed; how many hospitals were completed at Cohort 3; whether modular builds had a lesser life span than a regular build and that once the build was complete whether any of the existing facilities based at the hospital would be lost.  Other Members commented upon the positive support and engagement with new staff at the Hospital, which was complemented in the CQC report and asked what mitigations were in place to counterbalance the issues with the current hospital estate and the pace of delivery for the hospital programme and whether it was usual for hospitals to have to spend a significant amount of money on maintenance of buildings. It was also suggested that a positive approach would be to ask for confirmation as to when the next tranche of funding would be available.

In response, the Board was informed that the Chapel was currently the only building that was listed and that the standardised approach had not been built yet in terms of Cohort 3 and 4.  Modular units were not designed to have the same life span as more traditional buildings but were a bridge towards new facilities.  The Board was reassured that core clinical functions would remain based at the Hospital.  It was hoped that additional funding could be secured and that funding opportunities were constantly being explored, although more capital and revenue would be welcome.  In terms of comparison to other Trusts, the monies spent on current building maintenance meant that there was less money to spend on schemes that support improving patient services.  It was essential to ensure that every project could be delivered with best value for money, putting patient and staff needs at the forefront.  There was a lot of work that could be done around changing the way things were done, for example, reviewing management of pathways had a positive impact on reducing waiting lists.  Select committees had been investigating the pace of the programme and were aware of the condition and asset challenges across the estate.

Resolved (unanimously):

That the Adult Social Care and Health Overview and Scrutiny Sub-Board

notes the update provided by Torbay and South Devon NHS Foundation Trust

in relation to thedelivery of the capital programme and re-design of the

hospital andrecommends that:

1.         Torbay and South Devon NHS Foundation Trust be requested to provide further updates on progress of the delivery of the capital programme and re-design of the hospital to include regular provision of a dashboard document to enable interim progress to be tracked;

2.         Torbay and South Devon NHS Foundation Trust be requested to provide an update as to progress in delivery of the new diagnostic centre in Market Street, Torquay together with opening dates; and

3.         the Cabinet Member for Adult and Community Services, Public Health and Inequalities be requested to write to the Health and Social Care Minister for confirmation as to when the next tranche of funding will be released; making the case for increased revenue and capital funding for the Hospital in future; highlighting the structural issues with the current Hospital estate buildings and the subsequent maintenance cost and highlighting the results of the recent Care Quality Commission (CQC) report and the challenges identified.