The Hospital Modernisation Programme was unanimously approved by the States and the first phase is already underway.
Health and Social Care (HSC) has set out through the Partnership of Purpose (PoP) to tackle some of the deep seated challenges within the Bailiwick's health and care systems including those relating to the physical infrastructure of the Princess Elizabeth Hospital (PEH). Detailed below are answers to some of the most frequently asked questions. These will be updated as the modernisation programme progresses.
If you would like to contact us to ask a question about the Hospital Modernisation programme, please email: Hospital.ModernisationProgramme@gov.gg
Frequently Asked Questions
Below are some of the most frequently asked questions about the Hospital Modernisation Programme. Please click on a question to reveal further information.
Why do we need to modernise?
- The provision of a safe, sustainable and affordable health care system and hospital facilities is essential to Guernsey's ageing population and increasing demand. The current PEH has served the island well but some areas are no longer fit for purpose, we want to provide a modern standard of care in the coming years and deliver a planned change in health care which will support Islanders living longer.
- Other factors include:
- Flexibility - room for future expansion
- Changing standards - healthcare is changing fast and a 21st century hospital has different requirements to meet new challenges and a modern model for healthcare
- Ageing society - we need to be prepared for a larger number of older patients with more complex illnesses
- Attracting staff - a modern hospital is needed to attract and retain staff.
How was the preferred design selected?
- The preferred option selection process followed a UK government method known as HM Treasury Green Book Guidance. A number of design options were developed and then were evaluated against a list of requirements, including clinical safety and ability to meet capacity predictions, to arrive at a short list of options which all deliver the following:
- Best practice clinical model for each of the departments
- Sufficient capacity based on demand and capacity modelling
- Critical adjacencies of Maternity next to Theatre, and CCU next to Theatre PACU.
Who was involved in the design process?
- Nominated staff and clinicians from the departments reviewed the designs and discussed the layouts, the pros and cons and the timeline for delivery for each of the departments before scoring each option individually against qualitative criteria. The outcome of the evaluation resulted in some consistent themes: • Providing a new admission and discharge facility adjacent to theatres to improve patient pathways for surgery, reducing bed demand and resilience for future pandemic demands;
- All clinical groups gave highest scores to design options with Maternity and Paediatrics in the new extension outside the Porters Lodge and CCU and Post Theatre Recovery (PACU) in an extension adjacent to the current DPU entrance.
- Overall the two designs that were front runners both had the above arrangements. Both designs scored highly and were relatively close in the qualitative evaluation.
- Further feedback was then received from the clinicians:
- A new build including Paediatrics, Private ward, Maternity, Theatres, Surgical Admissions and Discharge unit within 3-storey building is favoured.
- Critical care, and PACU located to the south, with a new build extension was favoured and seen to be more flexible and the adjacency to ED was of great clinical benefit.
- Fracture clinic should be nearer ED than currently proposed.
- Improvements to ED are positive and are a priority.
Which design option was chosen and why?
- It was agreed to develop a 'hybrid design option' which could deliver the benefits of both front runners to include in the quantitative evaluation process. The combined evaluation resulted in the hybrid option being chosen as the best value for money. This preferred option has the full support of the senior clinical team supporting the programme, incorporating colleagues from HSC and the Medical Director as the Programme Governance Board, having been developed based upon the benefits of the two highest scoring options in that shortlist, and further improving on them by mitigating a number of previously identified risks. It does this by:
- Delivering what HSC and MSG clinicians consider to be the optimal solution for Maternity/Neonatal Intensive Care Unit including a vertical link to Paediatrics;
- Delivering the Post Anaesthesia Care Unit adjacent to the Critical Care Unit, giving immediately increased capacity for critically ill patients or future pandemic demands;
- Providing a new admission and discharge facility adjacent to theatres to improve patient pathways for surgery, reducing bed demand and resilience for future pandemic demands;
- Providing a new Breast Unit with internal connection to the main hospital while allowing the current Breast Unit to stay open, eliminating any break in service;
- Providing a private ward and also accommodating private outpatient facilities on Level 3 with a separate entrance and lift;
- Delivering a fracture clinic near to the Emergency Department for improved patient flow;
- Providing a new main entrance for wayfinding which meets UK Department of Health guidance and will lead to a better patient experience;
- Providing a more efficient communication and corridor layout;
- Delivering good solutions for the Emergency Department and Theatres, with the Critical Care Unit adjacent to ED and theatres although the Critical Care Unit will be refurbished with new extensions rather than a completely new build;
- Providing a flexible 3 storey solution;
- Minimising disruption to site; and
- Delivery within a relatively short timeframe (7 years in total with the Critical Care Unit in year 2 and Maternity in year 3 at the latest 4).
How will this support the progression of the Partnership of Purpose (PoP) and when?
- The programme to modernise the hospital site is a 10 year programme that will support the PoP by delivering a series of interrelated projects, to extend, refurbish and rebuild areas within the PEH campus.
- Work on some aspects of the transport and parking project and the staff facilities has already started.
- Ongoing work to support transport and parking continues with the female staff changing facilities already completed.
How will the programme address the policy issues raised in the PoP and achieve the intended outcomes, what is the relationship for example with user-centred care and bed capacity?
- These PoP outcomes cannot be achieved without this investment in the site which, when coupled with modernised pathways for patient care, will support a more service user friendly facility, such as enhanced one-stop clinics.
- Similarly, the programme will see improvements in the patient experience by making new services easier to use, tailoring the experience for patients, making better use of digital services and simplifying administration for staff and individuals.
- The Critical Care project will see the number of critical care beds increase from the current 7 to 12 by 2022, and provide further opportunity to increase bed numbers within the unit and adjacent areas to support future demand and pandemic situations.
How were the options appraised and how were the decisions made on which projects to include or not?
- During the early discussions around the PoP consideration was given as to whether a hospital, other than an emergency care service, was needed at all and if so, what alternative options were available to achieve the strategic aims of the PoP. This included considering a complete rebuild of the hospital, either on the existing site or by relocating to another. All of these options were discounted, as it was recognised that a hospital was needed for HSC to effectively and efficiently fulfil its mandate and that it was essential if Guernsey was to continue to be economically competitive.
- The projects were evaluated by stakeholders against different criteria relating to the impact they would have on the delivery and efficiency of services; the beneficial impact for service users; the contribution the projects would make to addressing identified clinical risks, and/or the potential impact of the projects in facilitating new ways of working. Then they were further reviewed based on the order in which they could be delivered. For example, the Orthopaedic Ward project cannot progress until the Women's and Children's (W & C's) project is complete, as it will occupy the space currently located by the Maternity Ward, an element of the W & C's project.
How do we know that the suggested approach is the best public value option?
- At a high level, the costs of a complete rebuild of the hospital on the existing or a new site would be unaffordable and given that there has been substantial investment in the site in recent years, the most cost effective way to deliver the intended outcomes was to refurbish and rebuild on the existing site.
- The indicative costs and benefits of the programme have been identified and quality assured by different stakeholders including health care specialists, to ensure that the best value can be derived based on the information available to date.
- It is intended that during the subsequent detailed design work to be carried out for each project and the whole development control plan that the value for money and the benefits to be realised by each project and the overall programme will be clearly demonstrated.
Why do we need to invest in care in the community at the same time as acute services, are both needed, is this good value?
- As above, the need for an acute hospital has been widely recognised as a requirement for HSC to deliver its mandate. Similarly, the PoP sets why we need to transform health and care services, whether hospital or community based, so that they are fit for the future and can best meet the community's needs effectively and efficiently. This is not an either or investment question, but rather how to best invest in the necessary and essential health and care services needed to support the Island.
What allowances are being made for future proofing the infrastructure to adapt to new technologies and service developments?
- The programme will allow for significant flexibility in how the new spaces created can be used in the future, should they need to be, including through enabling the possible use of robotics, for example.
- Another example would be the Theatres project that will merge the main and DPU theatre suites to allow more flexibility and efficiency in terms of staffing and equipment usage and potentially enable more surgical sessions to be carried out, if required. In particular, an increase in theatre capacity will enable more orthopaedic surgery to be conducted and help prevent future backlogs from building up. It is possible that by creating more theatre capacity that some procedures currently done off-island (for example, hip revisions) could be carried out on-island in the future.
Is the proposal practically deliverable in the suggested timeframes given and who will be involved?
- Phasing the programme and the construction activities spreads the impact on the local construction industry and enables the sector to ready itself. It will also enable the States to manage its' capital portfolio more easily when considering the other large scale construction projects planned in the short to medium term, such as the changes anticipated to the education estate.
- HSC intends to continue to involve and engage with all stakeholders including politicians, the public, service users, staff and service providers, contractors and other relevant service areas from across the States.
Are the benefits presented realistic and have these been sufficiently tested?
- The benefits presented are high level at this time given the stage that the programme is in and have been tested and validated by the various stakeholder groups. The details relating to the benefits will continue to be determined and will be scrutinised in line with the States approach for capital investments.
What will be the impact on ongoing service provision and how will this be communicated to the public?
- Given the scale of change that the programme is undertaking there is likely to be some disruption to services provided at the site. However, HSC will ensure that current service provision is not hampered and that disruption is kept to a minimum. This point will be an important consideration to factor into the next phase of the detailed design work.
Clinical Services Plan
- In this phase, health care planners assess what the health care needs of the community will be in the future and how these are best delivered. Our advisors took into account forecasts of the changing needs of the population, technological innovations and adopting practices for elsewhere around the world and in particular small islands. Our architects assess what types of building solutions may be applied to meet the future health care needs. We have projected 30 years into the future using current health data and data projections of future needs, such as population growth and a changing age profile.
Clinical Design Brief
- The Clinical Design Brief uses the predicted activity levels for each clinical service from the health care planning and applies the next level of detail to the project. This can be seen as the first definition of the new department and wards as it describes the full range of services to be provided, how they will operate and the functional and design requirements. Clinical User Groups have been established for each area (Maternity, Paediatrics, Critical Care, Operating Theatres and Emergency Care) as it is important to fully engage with clinicians and other staff, including nurses and hospital managers, during this stage. We also fully involved staff from supporting services, particular in respect of engineering services, to provide input into the infrastructure and services such as catering and linen.
Development Control Plan
- The first step in the design phase is the production of a development control plan. This considers the whole hospital and establishes areas of development that knit the site together to enable it to function for the healthcare needs of the future. The design is 'high level' and shows the relationships between the clinical functions, services, buildings and other facilities both horizontally and vertically. Throughout this phase the programme team has continued to consult extensively with user groups and key stakeholders. Consultation during this phase is vital in ensuring the design is heading in the right direction providing a means for adjustments to be made to ensure quality and value outcomes are delivered that meet stakeholders needs.
Business Case Development
- The development of a robust business case is States of Guernsey requirement for all large scale capital projects to ensure the projects drive value for money outcomes for the community. The Programme team will develop a preliminary business case in the first instance and once key elements of the final business case are endorsed by the various stakeholders, the final business case will be submitted for consideration.
Departmental and Developed Design
- This is the next step once the development control plan has been agreed and finalised. This stage is 'department focused' and includes plans for how rooms and services will relate to each other within a defined service, such as a critical care unit. Designers take into account the 'flow' of patients and staff through the hospital. They also incorporate the next level of detail including logistics around delivery of consumables, collection and disposal of waste, and interconnection with services such as electricity, water and telecommunications. The departmental design considers the building and services to the next level of detail, providing clinicians, staff and other stakeholders with a greater level of understanding of what the new departments will look like and how it will work. In parallel with the departmental design the overall design is developed in readiness for a planning application. This will require proposals that clearly demonstrate the exterior scale and materiality of the developments.
- After the departmental and developed design has been completed and signed off by key stakeholders, including senior clinicians at the hospital, the project moves into the detailed design phase. As an example of the level of detail taken into account in this phase, a data sheet will be made up for each and every room in the hospital, including specifications for the layout of the furniture, fittings and equipment. Packages of detailed information are also produced to enable a construction partner to price and construct the works.
- Procurement processes are designed to engage with the most capable range of local contractors to facilitate certainty of delivery. Tenders are evaluated on all their merits, taking into account the proven skills and capabilities of construction firms to ensure the right infrastructure is safely constructed, to meet the needs of the local community, within project timeframes and budget. As part of the procurement process, we are particularly interested in ensuring we support the local economy recovery phase for Guernsey post Covid-19.
- This phase often involves enabling works, early works as well as the main building works. Enabling works are often required to upgrade electricity, water or other utility networks to support the new scale of the infrastructure. Early works often involve demolishing, clearing and preparing a site for the start of main works.
Completion and Commissioning
- Throughout the construction process the project managers are responsible for the management of the overall project and making sure the buildings are being built to specifications and standards which are fit for purpose. After main works construction has been completed, and before patients are admitted, there is a commissioning and testing period, to ensure the facilities are ready to start delivering the highest quality of care. Commissioning is the process of assuring that all components are installed, tested, operated and maintained to the requirements.
Post occupancy evaluation
- This will ensure that any learning and improvement opportunities, and examples of best practice, are taken into account in planning, designing and implementing subsequent projects.
Further information can be found at the PEH Modernisation Programme homepage.