Agenda item

To receive a presentation on Building Berkshire Together - hospital building programme.

Nicky Lloyd, Acting Chief Executive, Royal Berkshire NHS Foundation Trust and Victoria Parker, Director of Communications, Royal Berkshire NHS Foundation Trust provided a presentation on Building Berkshire Together – hospital building programme.

During the discussion of this item, the following points were made:

·         Nicky Lloyd thanked those who had supported the RBH during the pandemic.  She referred to people bringing in hot food so that staff could have hot food breaks, volunteers sewing scrubs, the use of a bus service provided by a local school, and the delivery of prescriptions when RBH had moved to virtual clinics, amongst other initiatives.

·         The Building Berkshire Together development programme was a once in a generation opportunity. 

·         Victoria Parker stated that the Foundation Trust hoped to receive funding to develop a Strategic Outline Case (SOC) to develop its estate, and if that went successfully through the Treasury and Department of Health and Social Care, an outline business case would be developed and further engagement would take place with key stakeholders and communities.  A further business case would then be developed.  This process, if successful, would take a number of years.

·         Under the Government Health Infrastructure Plan, (HIP), funding would be provided for 40 new hospital projects over the next ten years.  The Trust was one of 21 NHS Trusts to receive seed funding of £2million to develop ideas.  All possibilities would be considered.  It was a major opportunity for the Trust and for the local communities and staff to improve services, patient experience and the environment.

·         Victoria Parker set out the case for change:

Ø  Condition – much of the buildings and building fabric was in poor condition, the estate having been built over a long period.  The CQC, after a recent visit, whilst it had applauded the level of care provided, had had some concerns regarding the condition of some of the buildings.

Ø  Capacity – the demographic was growing and the population ageing.  It was important that the buildings were fit to meet future needs.

Ø  Capability – the Trust was a good place to work but could be better.  Redevelopment would create an opportunity for first class training and development and attract more staff.  The existing buildings were designed to support an 18^th and 19^th century model of clinical care and limited the capability of staff to provide high quality modern healthcare for the local communities.

Ø  Climate – the Trust was committed to the green agenda but the current estate was not environmentally friendly and was expensive to run.  Buildings needed to have green spaces to improve the quality of environment and to reduce the Trust’s carbon emissions.

Ø  Catalyst – the Trust as an anchor institution had a desire to develop its strategic partnerships and to play its part in the economic development of communities.

·         Supporting the care closer to home agenda and ensuring that patients had to travel less, was important.

·         The Trust was currently at the development of the SOC stage.  Input had been received from the ONS population, internal feedback from staff and engagement with stakeholders.

·         Possible scenarios included:

Ø  Refurbishment and some rebuilding on the existing site – parts of the buildings were not fit for purpose.

Ø  Some refurbishment and substantial rebuilding on the current site.

Ø  Completely new hospital on the current site.

Ø  Completely new hospital on a new greenfield or brownfield site.  The Trust would want to retain adjacencies with partners such as the University of Reading and also travel plans would need consideration.

Ø  Other partial or additional scenarios.

·         Each scenario had pros and cons covering a range of areas;

Ø  Adjacencies

Ø  Environment

Ø  Economy

Ø  Speed

Ø  Compliance

Ø  Cost

Ø  Convenience

·         Next steps in the process were outlined.  Further engagement would take place with key stakeholders and unique features such as the relationship with the Life Sciences Park, identified.  The SOC would be developed and delivered in Autumn and whatever option was preferred would need to fully align with the Trust’s Vision 2025 and beyond.

·         Members were informed that the Trust had an engagement microsite.  There had been around 3000 visits to the site so far and approximately 10% of those visits had translated into the completion of surveys outlining what people did and did not want for the future.  The Committee was encouraged to provide their views via the microsite.

·         Councillor Jones questioned whether the Trust wished to become a teaching hospital as this was a good way of training and retaining good quality staff.  Nicky Lloyd commented that it did.  Strong alliances with the University of Reading were already in place.  In addition, two specialities had achieved excellence in terms of teaching and research and the standards set for them by the university.  The hospital already hosted students from the Deanery, on their placements and rotations.  Creating a medical school would take time but was a proven model of successful delivery.  Research and the ability to be involved in teaching to broaden their professional scope, was attractive to many staff.

·         Councillor Jones asked how much the different scenarios would cost and also where a new hospital would be located should the option of building a new hospital on either a greenfield or brownfield site, be progressed.  Nicky Lloyd stated that the funding process was lengthy, although Alok Sharma was working with the Trust to try to reduce this.  The Trust was currently working on the SOC and all different options from a minor refurbishment to a full rebuild in a different location, had to be set out as part of that.  The different possible scenarios all had hugely different indicative costs and the SOC would help to establish what funding would be available and the Treasury’s views on what would be financially achievable.  It was important that the built environment supported the clinical strategy.  Nicky Lloyd went to on to say that in terms of alternative sites, there were no fixed views of where might be suitable.  However, planning requirements would be key to any considerations.

·         Councillor Frewin asked that his thanks be passed on to staff for the hard work that they had undertaken in the pandemic.

·         Councillor Frewin commented that the hospital’s current location was good for those travelling to the hospital by public transport but less so for those travelling by car.  Parking was already an issue and he felt that this would worsen as the local population grew and if the site was extended.  Nicky Lloyd stated that the area was one where significant growth was projected in terms of population, patient and traffic size. 

·         Active engagement was taking place with users of all six of the Trust’s sites about reducing the impact on the environment and providing alternatives.  During the pandemic, many appointments were virtual and a lot of activity was moved away from the main Reading site to other sites in order to dilute the volume of visitors.  Work was also being undertaken with staff on reducing car usage where possible.  Staff could purchase a bicycle through the payroll deduction scheme.  Shower block and changing facilities on site were being refreshed to help encourage more green travel.  Many patients would still need to use private vehicles and one of the requirements of whatever change was made to the estate, was that sufficient site flow was in place.

·         Members were informed of the new app which helped to triage people before they came to A&E.

·         Deliveries were coordinated so that they did not take place during rush hours.

·         During the pandemic the University of Reading and Reading Borough Council had made a number of parking spaces available to staff on the streets of Reading, in the Queen’s Road car park and on the Whiteknights campus.  It was hoped that some of this could be continued.

·         Victoria Parker stated that travel and transport were always controversial issues when looking to make changes.  An informal consultation was being carried out with staff to establish those who absolutely needed to bring their cars, for example if they were travelling between sites for clinics.  This work was ongoing.

·         Councillor Frewin emphasised that the hospital ran 24 hours a day so park and ride was not appropriate for those working out of hours.

·         Councillor Bishop Firth commented that the current site was not overly accessible.  She asked how much the Trust could make a case that a site that was accessible by green transport and public transport, was important.  With regards to accessibility, Nicky Lloyd indicated that Access Able had been engaged to review accessibility of the signage, steps and ramps and wayfinding on arrival at the building.  Covid had meant that arrival times and appointment times had been more spread out than usual. 

·         Members were asked to feed back any particular routes around the hospital which were problematic for traffic.

·         Councillor Mather referred to his own personal experience of the Reading site.  He agreed that the fabric was not fit for purpose in parts and referred to nurses not being able to fit into a corridor at one time due to the narrowness of the corridor.

·         Councillor Mather emphasised that he felt that the Trust should be ambitious.  He questioned whether consideration had been given to becoming a major incident hospital.  Nicky Lloyd confirmed that currently major trauma cases were either sent to London, Oxford or Southampton.  The Trust was trying to be ambitious and to secure the maximum amount of funding available to it.  She outlined the likely timescale for the process.  Depending on the scale, plans could take up to 8 to 10 years to come to fruition, although work was being carried out to try to expedite this.

·         On the microsite, questions were being asked as to what people did and did not want to see from their future hospital, such as whether there should a be a hot and a cold site; one site able to do elective work and planned orderly work, and another site that dealt with emergencies and urgent care provision. 

·         The Trust had been actively looking for additional funding and had recently secured £4.5million to help enlarge the existing emergency department, creating additional cubicles for majors and paediatrics and increasing the size of the waiting area.

·         Members were informed that the Committee had also applied for an early draw down of funding from the HIP2 scheme.  Funding had been secured to help de-steam the site and move over to a green boiler by March 2021.

·         Input was being sought from the commissioners both local, regional and national about what services would be required going forwards. 

·         In response to a Member question regarding engagement with the Clinical Commissioning Groups, Nicky Lloyd stated that they had recently spoken with James Kent, Executive Lead of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (ICS) and Accountable Officer of the three Clinical Commissioning Groups, who was undertaking a review of the structure and commissioning arrangements required. 

·         The Trust was working closely with the Primary Care Network and during the pandemic, the TICC-19 Pathway Triage had been developed which brought together the early diagnosis of Covid and created virtual wards of patients suspected of having Covid.  Relationships between different branches of the health service had been greatly strengthened.

·         Councillor Grandison stated that he would prefer a new hospital on a greenfield site as the current site had some challenges. 

·         Nicky Lloyd commented that one of the greatest challenges of a substantial rebuild would be the phasing of the project and the minimising of the disruption to staff and patients.

·         Councillor Grandison asked whether PFI funding had been included.  Nicky Lloyd indicated that the Trust would not look to go down an expensive loan finance route.  Other routes might be considered such as joint ventures.

·         Councillor Grandison questioned what councillors could do to support the project.  Victoria Parker stated that support from them as key stakeholders was welcomed.  She encouraged the Committee to provide their feedback via the microsite or via a letter.  The Committee agreed that a letter of support would be produced.

·         In response to a question from Councillor Loyes, regarding population growth, Nicky Lloyd indicated that population health management data was used to help model projections.  Data was also provided by the local authorities.

·         Councillor Frewin commented that he hoped that the process took less than 8-10 years as the need for an improved hospital facility was urgent.

·         Councillor Jones questioned when the consultation would finish.  Victoria Parker reemphasised that the SOC would be submitted in early October but the Trust would be seeking further input as it sought to refine its plans.

RESOLVED: That

1)         Nicky Lloyd and Victoria Parker be thanked for their presentation

2)         the presentation be noted.

3)         the Committee produce a letter of support and that Members of the committee complete the survey on the Trust’s microsite.