Witnesses:
Caroline Hutton,
Interim Chief Executive (Frimley Health NHS Foundation
Trust)
Carol Deans, Director
of Communications and Engagement (Frimley Health NHS Foundation
Trust)
Sam Burrows, Chief
Transformation, Delivery and Digital Officer (Frimley Health NHS
Foundation Trust, Integrated Care Board)
Ellie Davies,
Associate Director, Communications and Engagement (Frimley Health
NHS Foundation Trust)
Nigel Foster, Senior
Responsible Officer (SRO), New Hospital Programme (Frimley Health
NHS Foundation Trust)
Cain Thomas, Interim
Programme Director, New Hospital Programme (Frimley Health NHS
Foundation Trust)
Key
points raised in the discussion:
Background
- The Chief Executive
provided a presentation on the background of Frimley Park Hospital.
It was outlined that Frimley Health NHS Foundation Trust
(“The Trust”) had over 13,000 staff that worked across
10 sites and within patients’ homes. The Trust served a
population of around 900,000 people with an annual turnover of
£1 billion and was classed as a large NHS Trust. Modelling
showed that the current capacity of the hospital’s facilities
would not meet future demand. Emergency Department (ED) capacity
was 20% greater than in 2019/20 during three peak points in summer
2023. Frimley Park Hospital currently had 640 beds, which did not
meet the current or future demand. The current building was old and
not suited for the delivery of the needed clinical model. 64% of
Frimley Park Hospital was constructed of RAAC, which was first
discovered in 2012 and was widespread throughout the hospital. Two
areas of the hospital, an accommodation and admin block, had
already been demolished. The Trust was constantly monitoring and
proactively undertaking safety works. By 2024/25 Frimley Health NHS
Foundation Trust would have spent nearly £30 million on
surveys, safety inspections and remedial works to keep the current
hospital site safe and staff were educated and trained on what to
look out for. Several emergency preparedness sessions had also been
run. Frimley Health NHS Foundation Trust had the deadline of 2030,
as set by the Department for Health and Social Care to stop using
the affected parts of the current hospital site.
Integrated Care System (ICS) Understanding Our
Communities-
Integrated Clinical Transformation
- The Chief
Transformation, Delivery and Digital Officer provided some
background information on Frimley Health NHS Foundation Trust and
Care Integrated Care System (ICS). The focus of the ICS was working
together to best meet the needs of the people in the different
areas and reduce the variation that existed. There was significant
variation in people’s life expectancy depending on where
people lived. The average life expectancy for a male in Frimley was
81 years, and for a female it was 84 years. The healthy life
expectancy (years of life lived in good health) for a male in
Frimley was just under 67 years, and for a female was just under 68
years. The focus within the ICS was on decreasing the gap between
life expectancy and healthy life expectancy, and the existing
variation depending on where people lived. A new hospital would be
a key enabler to help achieve this.
- The Chief
Transformation, Delivery and Digital Officer provided background
information on the communities covered by Frimley Health NHS
Foundation Trust and Care ICS, which included Surrey heath, North-East
Hampshire, and Bracknell Forest.
- The Chief
Transformation, Delivery and Digital Officer added there was a need
to have an integrated approach to transformation and planning
services that benefitted the population regardless of what area
people lived in or what people’s social circumstances were.
This meant a need to focus on partnership working to ensure the
wider determinants of health were addressed. Somewhere between
80-90% of what influenced someone’s health outcomes were
things that happened away from healthcare services. Therefore,
partner working was needed to ensure the approach was integrated to
meet people’s needs. Frimley Health NHS Foundation Trust
would ensure there was a whole system clinical strategy that
focused on what happened inside the hospital and what needed to
happen inside the community and primary care services, and taking
full advantage of new technology and digital enabled care that
could best meet people’s needs. This was all underpinned by a
partnership-based approach.
New
Hospital Programme and Hospital 2.0
- The Senior
Responsible Officer (SRO) for the new hospital programme outlined
that modelling for the new hospital, towards 2041, had been done
locally and nationally on what the likely demands would be on
hospital services, the impact of the increasing population and
housing growth. More beds would be needed in the acute hospital and
a community setting, and more services would be needed to care for
people outside of the acute hospital. The expectation for the new
hospital was that it would be roughly twice the size of the current
hospital, partly due to the need for more beds and partly a desire
to have 100% single rooms in the new hospital, which was the new
national design standard for new hospitals. This was to improve
privacy and dignity for patients and would help manage the
day-to-day running of the hospital. Hospital 2.0 was the national
programme for new hospitals and was the national design criteria
being developed. Hospital 2.0 included the following objectives:
modern methods of construction drawn on best practice, built to net
zero standards, and the best digital infrastructure. The primary
focus had currently been on finding a new site.
- The Chairman asked
about what would be done to ensure the hospital staff were
retained. The Chief Executive explained that staff were sighted
about the new hospital programme and were looking forward to
getting involved to help inform some of the design work and
clinical strategy that would contribute to the new hospital. Staff
were waiting to learn where the new hospital would be. Staff were
constantly kept informed and had been involved in engagement
sessions to get their ideas. In terms of the wider strategy, there
was a ‘People Promise’, which had a variety of plans to
help provide the right culture and opportunities for staff and to
help retain staff.
- A Member asked how
Officers viewed the model of urgent care centres in the future, and
questioned if urgent care centres would be built as a bigger entity
to relieve the pressure from hospitals. The Chief Executive
explained that in terms of clinical models the vision for urgent
care centres would need to be developed as part of the clinical
strategy, and it was hoped it would look better than it currently
did. Working with partners in an integrated way was a strategy that
needed to be developed for the clinical models, with consideration
of what could also be done outside of the hospital.
- The Member asked how
many beds were expected to be in the new hospital. A Member also
raised that accommodation was crucial for staff. The SRO explained
that across the system, including community and acute beds, there
were around 700 beds. By 2041/42, this was expected to go up to
1150. Not all these beds needed to be in an acute hospital setting,
with more community-based beds going forward. There had been an
increase in virtual care, where patients did not always need to be
in a bed. The new hospital site was expected to have around 100
more beds. In terms of staff accommodation, the current primary
objective was to focus on what needed to be built and the running
of the hospital. It was not yet known, but the chosen site could
have more space available which could provide opportunities for key
worker housing. Work was already done with housing associations to
provide some key worker housing, which would need to be
investigated further as the new hospital programme
progressed.
- A Member raised
several areas that the new hospital programme would need to
consider such as, the infrastructure to support acute and blue
light services, public transport, staff accommodation, training
facilities, dentistry services, reablement, the use of technology,
and coordination of systems across the NHS. The Member raised the
importance of the site location to ensure it was a bigger building
in terms of width, not height, to prevent restrictions. The Member
also referred to public concerns regarding travel to the new
hospital site, with consideration for people with disabilities and
accessibility needs. The Chief Executive noted that all the points
raised by the Member would need to be thought through and addressed
as the new hospital programme progressed.
- A Member asked if The
Trust felt confident that enough funding and resource was available
for the new hospital programme to be completed in the required
timeframe. The SRO replied to confirm that there was confidence in
terms of funding that was coming through to support a rapid step-up
of the programme team across all technical functions needed to work
on the project, and in how clinicians and support staff were
involved. There was a detailed resource plan, which recognised the
need for skills now, and of the need for different skills as the
programme moved forward. The programme was about having a blend of
external support. The best architects and planners needed to be
drawn on and blended with the local understanding of Frimley Health
NHS Foundation Trust’s population, their needs, and the
clinical services. One example of this was that the Deputy Medical
Director was working part time in the new hospital team programme,
providing clinical leadership on the programme alongside people who
were good at designing buildings. The funding flow had currently
been working well.
- The Chairman noted
that one of the concerns of the national audit office report was
that of the national programme and shortage of appropriate
skills.
- A Member asked about
the plans in place to ensure people would not feel isolated in the
planning of single rooms, and whether Hospital 2.0 expected to
involve more support workers. The Chief Executive explained that
technology would need to be utilised to ensure patients could be
cared for in a way that would not require one-to-ones with nurses
in every room. Staff models would need to be considered. Single
rooms were excellent in terms of infection control, but there were
some patients who did not want to be in a single room. The Director
of Communications and Engagement added that the prospect of single
rooms did raise concerns with staff. An engagement opportunity
would be looked at to run sessions in Summer 2024 to talk to staff
and the local population to see how single rooms would work once
more information was received nationally.
- The Member asked if
the single rooms would have windows. The SRO explained that the
plans and design criteria were considering where the windows would
be and whether everyone had access to daylight. Space
considerations for family members was also being considered.
Putting patients, carers, and family members first was the theme
throughout the hospital’s design criteria. If there was more
space available in the hospital this would offer more opportunity
to achieve this for patients, carers, and family members, as well
as for staff.
- A Member asked what
part of the consultation Frimley Health NHS Foundation Trust
considered the most contentious. The Chief Transformation, Delivery
and Digital Officer felt the consultation was not necessarily
around contention. The opportunity to have a once in a generation
multi-billion pound investment in new health care facilities for
local people could only be positive. Everyone would have
preferences around where things may be sighted or where the exact
models of care that might be delivered. However, people could not
lose sight that the new hospital should be better than what was
currently available. The Officer responded that rather than viewing
anything as a contentious issue, engaging with local people is an
exercise to listen to what people wanted.
The
Overall Plan and Timeline
A
Challenging Timeline
- The Interim Programme
Director provided a presentation on Frimley Health NHS Foundation
Trust’s overall programme delivery. There was a detailed
programme with over 400 activities. The programme had a challenging
timeline but remained on track for the critical deadline of 2030.
Getting the design right was important. The programme team were
currently looking at the master plan and the site as part of the
design journey. Designing the hospital would start in late 2024
with the benefit of the design template developed by the national
programme: Hospital 2.0.
- The Interim Programme
Director outlined the key activities in the New Hospital Programme.
One key activity was planning. A pre-application process would
shortly start, to get confidence in the programme team’s
ability to achieve outline planning consent for the whole master
plan. Other key areas would then be developed such as enabling
works, to get the site ready as the programme team moved towards
the main delivery of the site. The new hospital was a 4-year build
process, but there was tolerances and flex within this. It was
hoped the building of the new hospital would start in 2026. The
programme team had to work through the criteria and governance of
the national programme. Many of the activities on the programme had
to be optimised, for example the programme team was running
activities concurrently where possible. There was hope that the
issuing of design templates and Hospital 2.0 information would help
the programme team see further opportunities to optimise. The
programme team hoped the national team would work with the
programme team on some of the governance criteria that could be
optimised. There was confidence the 2030 deadline for the new
hospital could be achieved.
- A Member asked about
the mitigation plans. The Chief Executive explained it was
important to understand the mitigation of the risks. Work was being
done closely with the national programme team, and It would be a
phased plan, where each phase would need to be managed, with close
scrutiny and input from the national team. Mitigation would need to
be put in place for risks associated with each phase. Mitigations
for issues at the current site would need to be managed in
parallel, as the current hospital’s infrastructure would
become more fragile.
- A Member asked about
engagement with utility companies and utilities’ ability to
deliver what was needed. The Interim Programme Director explained
that discussions were already taking place with utility companies,
both as a programme team and a national team. Utility companies
would need to work with the programme team, as the new hospital
would be all-electric which was a significant demand on power which
may not be readily available in the area. Achievable timelines
would need to be ensured. There had been engagement with new
utilities and existing utilities which may need to be
diverted.
- A Member asked about
planning and the potential height restrictions of the new building.
The Member also raised the programme’s tight schedule and the
possibility of the plan being refused by the authority. The SRO
explained that the challenges presented with the planning process
such as with the local planning authority, highways agencies and
Natural England was factored into the new hospital programme and
was also an area of risk and potential delay if things did not go
smoothly. Regarding height, various plans and designs had been
looked at for a range of potential sites, some of which would need
to be 14/15 stories high to fit the size of the hospital with the
needed facilities. This would be difficult to get planning
permission for. The Building Safety Act would also need to be
considered regarding height. Operating a hospital site that was 4
or 5 stories was very different to operating a building that was 14
or 15 stories high. There was hope that the new hospital programme
was in a place where some choices could be made around the
height.
- A Member asked what
the stages of the programme were, where the team was worried about
slippage, and what the mitigations were. Regarding the
pre-construction elements, the Interim Programme Director explained
that a current risk was the approvals that would be needed from a
Trust and ICB level up to the treasury level. The programme team
was working with partners and stakeholders on the governance
procedures, so the correct procedures could be maintained. If there
was an opportunity to optimise the governance procedures and
timeframes, the programme team would do so. A risk around the
construction of the new hospital was around the fact construction
programmes were well documented to take longer than planned. Modern
methods of construction would be used for the new hospital
programme to help mitigate against this. All the risks of delivery
would be reviewed along with the mitigations.
A break was called at
3.48pm
Meeting resumed at
3.55pm
Identifying Our Preferred Way Forward- The Preferred Way
Forward- Key Outcome
- The SRO explained
that in 2022 a Strategic Outline Case had to be produced, to answer
whether a new hospital could be rebuilt on the current site, or if
a new site was needed. The level of disruption of re-building on
the current site for staff and patients would be significant. There
was also no further room for expansion on the current hospital
site. Rebuilding on the current site would result in a hospital
that was not a Hospital 2.0 or fit for the rest of the century. For
example, there would not be enough beds, or the opportunities for
improvement in patient facilities or experience. Re-building on the
current site would take 7 years of construction, compared to 4
years on a new site. The SRO referred to the Queen Elizabeth
Hospital in Birmingham which, in terms of square meters, was a
similar size to what the New Hospital Programme was looking for.
The programme team was looking for a site of around 50 acres for
the new hospital.
Site
Selection Process
- The Interim Programme
Director provided an overview of the site selection process. In
Summer 2023 the programme team developed a site briefing with land
agents, following which a public and staff engagement brief was
developed. A high-level evaluation of hurdle criteria, evaluating
the sites on their key merits, was reviewed. The programme team
ensured the feedback received in the public engagement was worked
into the development brief and that the technical site evaluation,
which involved the architects and specialist designers were
included within the master plan. The programme team took the
priority sites to the Trust boards ensuring the correct governance
and continual due diligence had been applied, reassuring the
committee that due diligence would continue throughout the Summer.
Work was continuing in the development of the master planning
design, further the due diligence and learning about the preferred
sites and their viability to be the new hospital site. The
programme team anticipated that it would expect to secure an option
to buy the preferred site towards the end of Summer
2024.
- The Interim Programme
Director explained that the initial search criteria involved
finding a site no less than 20 acres, which was within 5 miles of
the existing hospital. The site characteristics included being on a
brownfield site that was capable of delivering a new hospital by
2030. If the site was not greater than 20 developable acres then
the site was not taken any further, which was part of the hurdle
criteria. If the site was in a Special Protected Area (SPA), the
site was not developable, and therefore failed the criteria.
Landowners also needed a willingness to sell the site for the site
to be taken further.
Engagement
- The Director of
Communications and Engagement explained that there was commitment
to engage with staff, stakeholders, patients and the public. An
engagement period was run from November 2023 to January 2024, to
get views on the criteria that would be used to evaluate the
potential priority sites. This feedback was reviewed and used to
develop the site criteria. Over half of staff and public
respondents viewed access by car as the most important. People felt
it was important that the site was purchasable within timeframe and
recognised the importance of the planning restriction. Parking was
also shown to be important and would be taken into consideration
concerning the size of the site, but the logistics concerning
parking would come into the design at a later stage.
- The Associate
Director for Communications and Engagement provided detail on the
demographic details of the engagement process. Of the 3,400
respondents, 40% were from North-East Hampshire and Farnham, 31%
were from Surrey Heath, 19% were from Bracknell Forest and 3% were
from the Royal Borough of Windsor and Maidenhead. This mirrored
with the flow into Frimley Park Hospital, where 41% of residents
were from North-East Hampshire and Farnham, 37% were from Surrey
Heath, 17% from Bracknell Forest, and 4% were from The Royal
Borough of Windsor and Maidenhead. Around half of respondents were
over 55 years and around half were under 55 years. 72% of
respondents were members of the public, and 25% were members of
staff. A piece of work was underway to provide feedback to people
on how their input had shaped the project. There was an independent
report which analysed people’s views and recent publication
of the ‘You Said, We Did’ on the dedicated Trust site
pages, which had been shared with Frimley Health NHS Foundation
Trust’s stakeholder groups. The Trust was creating a
stakeholder mapping exercise which looked at the different groups,
with a focus on equality and inclusion principles to target local
people, their views, and different needs.
Applying
Technical Criteria
- The Interim Programme
Director outlined the technical criteria which were being applied
to the priority sites to create the preferred sites. The technical
criteria included the overall programme, design and implementation,
transport, distance from the current hospital site, equality impact
assessment, relative cost, ecology, flooding, construction
logistics, planning, sustainability, approach, programme, Geotech,
air quality, and utilities.
- A Member asked if
Frimley Health NHS Foundation Trust was close to finding the
preferred site for the new hospital. The SRO explained that the
team were in the next stage of the detailed technical evaluation.
Commercial conversations on several sites were starting and the
team expected to reach a conclusion over the next few months. The
Interim Programme Director added that time was being taken to apply
the due diligence while being conscious of the critical 2030
deadline.
- A Member raised
concern that there did not seem to be the provision in the New
Hospital Programme for the hospital’s military connection.
The Chief Executive explained that she had recently met to
discusshow the military would factor into the
New Hospital Programme with the Commanding Officer to ensure that
the new hospital was designed with consideration of the
hospital’s military colleagues.
- The Member raised
that 100 extra beds in the new hospital did not seem a lot. The
Chief Transformation, Delivery and Digital Officer explained that
the 100 extra beds would be for the year 2040. The pace of change
in the way medicine was delivered, the availability of technology
to deliver services in a different way and the ability to work
together in partnerships to deliver services, provided
opportunities to plan for a different bed number, in the range of
100. There were significant demand and capacity assumptions and
work still remained to be done in this area. Assumptions around
what new models of care were available and what it converted to in
bed numbers to meet future capacity would be refined throughout the
planning process.
- The Member also
raised the importance of building staff accommodation on site
rather than leaving it to local authorities or housing
associations. The Chief Executive explained that the team would
need to think about this area further.
- The Member asked for
clarification around the acreage of land that was being looked at
for the new site. The Member also asked about the infrastructure in
the local community such as the road system into the hospital. The
SRO explained that the team started the programme looking for sites
with 20 acres and then realised a higher acreage would be needed.
The budget did include areas for highways improvement, but this
would not solve every highway issue in the local area. It was
important that there was a better transport infrastructure on the
new site, to make it easier for both patients and
staff.
- The Vice-Chairman
raised the separate adults and children Accident and Emergency
(A&E) aspects. The Chief Executive explained that A&E
provision for paediatrics and adults would be built to be
separated, which was now a requirement.
- The Chairman referred
to The Trust’s elective surgical hubs and Heatherwood’s
accredited surgical hub and suggested that lessons learned should
be taken. The Chairman also raised points around how the new
hospital could move people from one place to another and
implementing easy transport. The Chief Executive explained that
lessons were being learned from the success of Heatherwood, and by
working across the whole health system and understanding what and
where services would be placed, recognised that thought also needed
to be given to how people were transported.
The
Next Steps
- The SRO explained
that The Trust would continue to ensure the current hospital site
was safe until moving to the new hospital. Investment on the
current site had continued and the construction of a new block on
the current site was on the way which would provide some additional
needed beds and diagnostic facilities.
- For the new site, the
SRO explained there were business case processes that would need to
be completed, some of which would require HM Government/Treasury
approval. Three key things that currently needed to be focussed on
included continued due diligence, continued engagement with all
stakeholders, and clinical transformation.
- A Member asked what
would happen if the chosen site’s landowner decided to
increase the price. The Interim Programme Director explained this
was a reason why the programme was still in a confidential
environment, to allow the programme not to be put in that
position.
- The Chairman
suggested that the team at Frimley Health NHS Foundation Trust
should articulate clearly what the project plan wanted to achieve
within the next three months.