Agenda item

The Committee received a presentation to update Members on Shotley Bridge Hospital redevelopment (for copy of presentation see file of minutes).

Richard Morris, Associate Director of Operations, County Durham and Darlington NHS Foundation Trust was in attendance to deliver the presentation that provided members with details of the project principles; progress update; service efficiency measures; revised timelines; next steps and communication.

Paul Davies, Cohort 2 Project Lead, Jacqui MacDonald, End to End Specialist Advisor and Karina Dare, Primary Care Estates Strategy Lead and Jane Curry, Programme Manager were also in attendance at the meeting.

Mr Morris reminded the committee that a considerable amount of resource was being expended to retain services at the existing Shotley Bridge Hospital site which was unsustainable, hence the importance of the development of the new facility. He indicated that the proposed development would consist of a facility with 85% floor space utilisation albeit on a smaller scale to that currently provided at Shotley Bridge.

Members were advised that subsequent to previous updates given to the committee in respect of the project and following the submission of the outline business case in January 2023, it became apparent that the costs associated with the project fell considerably outside of the agreed funding allocation due to national hyperinflation pressures. Following consultation between the national hospitals programme and the foundation trusts executive, it was agreed to review the scheme of accommodation and engage healthcare planners to develop an affordable project scope. This involved maintaining current levels of activity across a reduced floor space.

Because of the redesign in the provision of the energy centre facility to service the proposed development, members were advised that it would not be possible to extend vertically but there may be scope at ground level. Mr Morris explained that a definitive timeline for the project could not be provided to members at this time because of ongoing discussions regarding the scheme but he assured members that the trust were fully committed to the new build as we're the representatives of the national hospitals programme.

Members were advised that it was the financial envelope allocated to the scheme and the ongoing inflationary pressures being experienced nationally that were causing the delays to the scheme as it had to be affordable, deliverable and sustainable. Mr Morris also confirmed that further reports would be brought back to the committee on the progress of the scheme including plans for on effective communication strategy. Furthermore he stressed that the delay to the project would not impact on future delivery of clinical services and importantly the new development retained plans for 16 inpatient beds.

Following the presentation, the Chair asked Members for their questions.

Councillor McKeon stated that she was relieved to hear that community services were not going to be cut back. She continued that she was concerned at moving the generator from the ground floor to the roof that would stop future development of the hospital. She wanted the hospital to stand the test of time and they already had a shortage of community hospital placements and care in the community was the way forward. She was concerned about not being able to expand on the site going forward and indicated that at some point the generator would need to be moved onto the ground floor from the roof to allow the hospital to build upwards and asked if this had been factored into the discussions.

The Cohort 2 Project Lead responded that the expansion issue was very real and they were looking to develop a plan going forward that allowed for expansion on the site. He indicated that he personally did not think that expanding upwards was the answer but going to the side or creating further expansion space was the direction that they were looking to go. They would be taking a paper to the board in the next couple of weeks with the intent of securing the full development area of the site, the money that was invested at this time would help future proof the hospital going forward. They were looking at expansion space horizontally on the building.

The Primary Care Estates Strategy Lead indicated that they were looking to make savings on the new development but not reducing the footprint of the land which would give potential for future development but also gave more flexibility for the siting of mobile facilities. By losing the energy centre to make savings it would create some potential for future expansion at ground floor level.

Councillor Haney indicated that he could only see three possible outcomes, the worst that the project did not go ahead, the second it was produced on the cheap even if services were still the same the way they were delivered was important and the third option would be for government to increase the money as construction costs were continuing to rise and asked the Committee to consider writing to government to express their concerns.

The Associate Director of Operations responded that there was no extra funding from the Trust, ICB or any other elements so the new hospitals programme was their funding source.

The Cohort 2 Project Lead stated that during COVID there was a national retail logistics company that carried out an expansion into the UK to meet the demand when everyone was ordering items from home. They had 10 regional hubs planned and they ran out of materials so they could not deliver that programme that was a 20th the size of the new hospital programme. They were attempting a £22 billion national project, they did not have enough contractors, materials or people, so there was a massive upskilling required on a national level. They had to do something different as there was only so much money and if costs overrun for one hospital this resulted in someone down the line not getting their service. They had to be rational and try to optimise as much as they could so they could deliver within budget. He continued that he did not think that the clinical outcomes were going to be comprised as much as they thought, there were some challenges around chemotherapy and the aim was to drive all the value out of the scheme they could with the opportunity of sitting back down and if they wanted chemotherapy, they could put a business case together and go back if necessary.

It was a national rollout programme and would fail with a number of schemes and commented that hospitals with RAAC needed to also be replaced. He was very positive and they were taking papers through to secure the land and start remediation as quickly as they can; he could not guarantee that it would be this financial year and commented that the comments on inflation were justified and that representations were being made to the treasury that delaying decisions was costing more money.

Councillor Jopling commented that they were going to continue the existing care but then stated that they were going to refresh the activity data and asked for more information on this. She then referred to non-clinical and asked what this referred to. She continued by referring to the business case and stated that when you keep redoing things it costs money and takes a long time and stated that whatever was decided it needed to be done at a pace so that it does not cost more money. She was worried that services may be taken away that were important to some residents and all the facilities were caring for people and it was important not to lose these facilities and put further strain on the bigger hospitals who were already under pressure.

The Associate Director of Operations responded that they could not function without Shotley Bridge Hospital and they did not have any capacity to absorb the services from Shotley Bridge into anywhere else in their setting, it was a fundamental delivery mechanism for care for their Trust. They had two big hospitals, Bishop Auckland as a mid-hospital and five community hospitals. They were conscious that Shotley Bridge Hospital had reached the end of its life, they could look to refurnish but they were not doing that and were continuing with the new build. He then referred to the element of care and stated that they had not finished the re-design yet but he was confident that they would deliver the same services. He stated that they had four other community hospitals and the way they were moving into community care was progressing and were already set up to deliver that model of care. Shotley Bridge was a plank of real estate that they valued and the public valued it and was valued as an organisation and could not function without it and the new hospital programme was well aware of this and had been discussed at a high level within the new hospital programme. This was not just a standalone community hospital as it had to fit with the overall Trust strategy about how they deliver care for people especially delivering care closer to home. Some of that was driven due to University Hospital North Durham being very small and whilst Darlington was a little bigger UHND was very small for the size of population and was a constrained site. He gave his assurance that they were aware of what they needed to do, which was to deliver acute care from being in hospital and in other facilities then home. He stated that the non-clinical space would be items such as the ventilation system and the third element was how they shared space such as physio and occupational therapy that would traditionally have different space.

In response to a further question from Councillor Jopling, the Associate Director of Operations indicated that the Managers in the new Hospital Programme were very much aware of the costs going up due to inflation and stated that he was convinced that the new Shotley Bridge Hospital would be built.

Councillor Quinn referred to community hospitals and not that long ago they were looking to close these hospitals and stated that it was good to hear that they were considered as a valued asset. She then referred to Bishop Auckland Hospital that could be better utilised and wished that the Trust would give it more thought. She continued that she was disappointed to hear about the reduction in the way the services were going to be developing especially given that hospitals were busier. She stated that this was tranche two and asked if future builds in the other tranches were at risk and asked should everything go the wrong way at Shotley Bridge as the building was decaying all the time, did they have a plan B.

The Associate Director of Operations responded that community hospitals were a difficult concept prior to COVID then came into their own during COVID and it would be silly to ignore what they delivered for the Trust. She continued that that they were beginning to expand Bishop Auckland hospital and was now a designated community diagnostics centre and had received significant involvement and investment. They were doing well as an organisation with diagnostic capability and Bishop Auckland was helping to deliver this and he could only see this expanding. The Trust had recently agreed to increase the amount of endoscopy that was to be delivered through Bishop Auckland with quite significant capital investment. They did recognise that all of the hospitals were part of the way that they delivered services and had taken a decision to offer support to surrounding hospitals for diagnostic testing.

The Primary Care Estates Strategy Lead responded in relation to Plan B and indicated that they were fully supporting Plan A which was their preferred option. She indicated that they were currently spending £0.5m a year to keep the hospital operational. Plan B would be to work with the Trust to consolidate within the building and reduce and close off some parts of the building to reduce maintenance costs on those parts, they would need to upgrade or replacement and those costs would fall to her organisation that would need to be planned over three or four years. Their view had always been that even if they made significant capital investment in the building short of a complete refurbishment the hospital only had 2 years of life left. If they spent four or five million over the next four years it would only extend the life of the hospital for a 10-year period.

The Cohort 2 Project Lead indicated that Cohort 2 was positive and that money was secured from the Treasury and that was why the scheme was safe going forward and the figures included inflation.

Councillor Earley stated that he was pleased to hear that there had been a logical breakthrough and commented if they kept to the same footprint, they could commit to groundworks that would be positive for the community to see. He referred to the expansion of the chemotherapy and asked if this was not happening and it would stay at the same level and if the MRI scanner was still going to happen. He continued and asked about the green rating of the building and indicated that there was a question mark over expansion. He asked if going ahead with clinical areas at 85%, were they going to have hospital management ability on site and if they went ahead with the desired plan with Karbon Homes to produce the step-down rehabilitation beds there could be some space within that unit that could be used by occupational health and physiotherapy.

The Associate Director of Operations responded that an MRI scanner as a fixed asset was never in the plan for Shotley Bridge. He did initially bid for an MRI scanner but was not successful but they do have a pad to enable a mobile unit on the proposed new development site which was still part of the design. He then referred to community appropriateness and indicated that they were in six care groups each one having its own management structure for delivery. They were very few care groups directly involved with Shotley Bridge and was highly unlikely that there would be a management structure that supports Shotley Bridge in itself but stated that he appeared to have inherited this role. They did have a clear governance route around management of hospitals so there were no cracks that would allow anything to fall between due to a lack of direct management.

The Programme Manager responded that part of the Trusts wider plan for chemotherapy was to move a lot of the elective chemotherapy to the community hospitals. The ambition was to expand in community provision and reduce Durham but the footprint was still within Durham and there was still a minor expansion planned for Shotley Bridge with ten chairs instead of the current eight. She continued that Health Care services were continually evolving and were moving chemotherapy out to things like home care and these were big moves that they were making within the organisation. Chemotherapy was up 30% and they have to do this across the board not just Shotley Bridge. Chemotherapy services needed to consider how they operate and intended to increase to weekend working which meant they would get value out of the estate and would allow flexibility for patients.

The Cohort 2 Project Lead referred to net zero that was mandated by the government and would go through according to policy.

Councillor Kay commented that he was yet to see a large public sector new build come in on time and within budget and asked if this was due to building to a price and not specification and asked if any buildings in this programme were on time and within budget.

The Cohort 2 Project Lead indicated that the challenge that they had delivering new projects was a scale issue. There was a lot of challenges around methods of construction and stated that there had been significant reduction in the overspend of schemes.

The Primary Care Estates Strategy Lead indicated that there were significant layers of governance and the difference between a private and public sector scheme was public sector schemes required eighteen months to two years for approval of the scheme.

Councillor Hovvels commented that she was disappointed they did not have timelines and how far they had come and were still standing still but understood the complexities of the issues.

The Associate Director of Operations responded that he was unable to give a timeframe as he did not have a design but he did have the commitment from the funding stream and everyone was committed to build a new Shotley Bridge Hospital.

The Chair commented that it was reassuring that clinical services were remaining.

The Principal Overview and Scrutiny Officer asked the committee to determine if they wished to write to the appropriate Secretaries of State reinforcing this Committee’s desire and support for the Shotley Bridge Hospital replacement scheme and to seek assurance from government around the funding envelope and suggesting this be reviewed to take into account the current inflationary financial pressures experienced with major capital projects.

Resolved: (i) That the information contained withing the presentation be noted.

(ii) That a letter be formulated on behalf of the Committee to the appropriate Secretaries of State reinforcing this Committee’s desire and support for the Shotley Bridge Hospital replacement scheme and to seek assurance from government on the funding envelope and suggesting this be reviewed to take into account the current inflationary financial pressures experienced with major capital projects.