East Kent Hospitals University NHS Foundation Trust: Estates Strategy Introduction | Section 1 Estates Strategy | SEPTEMBER 2016 |

SECTION 1

Contents

Reference Issue Number Date Initial GB1010072 Issue 1 - Draft 05.09.2016 LT / KBP GB1010072 Issue 2 - Draft 09.09.2016 VM / KBP GB1010072 Issue 3 - Draft 16.09.2016 VM/ KBT GB1010072 Issue 4 - Draft 22.09.2016 VM/ KBT GB1010072 Issue 5 - Draft 23.09.2016 VM/ KBT GB1010072 Issue 6 - Draft 26.09.2016 VM/ KBT

CONFIDENTIAL-DRAFT

SECTION 1

1.0 Executive Summary

1.01 Overview of the Trust

Our Priorities

History

1.02 What we do as a Foundation Trust

1.03 Hospital Locations

1.04 Our Hospitals

Kent & Canterbury Hospital

Queen Elizabeth The Queen Mother Hospital

William Harvey Hospital

Buckland Hospital

Royal Victoria Hospital

1.05 Where we are now

The National Challenges

The Growing Demand

The Financial Picture

CQC and Special measures

1.06 The Clinical Strategy - Delivering Our Future

The Clinical Strategy

The Estate working to support the Clinical Strategy

1.07 The Estate Strategy Principles

1.08 The Estate Picture

Estate Physical Condition

Evaluation of the Estate

Summary of Physical Conditions

Asset Disposal and Rationalisation

Current 5 Year Capital Plan to 2019

Recurrent Allocations

1.09 Operationalising the Estate

Management information systems

Formal Estate Returns

Energy and Carbon

1.10 Capital Schemes - 2009 to 2016 Summary

SECTION 2 Kent & Canterbury Hospital, Canterbury SECTION 3 Queen Elizabeth The Queen Mother Hospital, Margate SECTION 4 William Harvey Hospital, Ashford SECTION 5 Buckland Hospital, Dover SECTION 6 Current and Future Strategic Initiatives

Executive Summary This Interim Estates Strategy has been prepared by the East Kent Hospitals University NHS Foundation Trust. The Trust like many Foundations Trusts faces considerable challenges both nationally and regionally in dealing with financial and demographic demand issues. This interim strategy updates the 2009 Estate Strategy with current and medium term estate plans and begins to outline the post consultation clinical reconfiguration plans. A new five year Estates strategy covering 2017 to 2022 will be published in the summer of 2017. This strategy is set out as follows- Section 1 reviews the Trust and its relationship with the wider NHS, it also introduces the hospital management processes and the estate as it is today. Sections 2 to 5 details the capital investment carried out at each of the hospital sites since the 2009 Estates Strategy Section 6 Outlines the current and medium term initiatives Section 7 Outlines future strategic estate planning prior to public consultation on clinical options in 2017.

1.00 Executive Summary Introduction The regular updating of the Estates Strategy enables the Trust to detail work undertaken during intervening periods. In addition, the Trust is able to reflect on the latest strategic objectives of the Department of health and respond appropriately in relation to the planning of its estate. The objective of this document is to facilitate improved communication and understanding regarding the future of:

Kent & Canterbury Hospital

Queen Elizabeth The Queen Mother Hospital

William Harvey Hospital

Buckland Hospital

Royal Victoria Hospital

CONFIDENTIAL-DRAFT

1.01 Overview of the Trust Overview of the Trust Our Priorities Patients We want to enable all our patients (and clients who are not ill) to take control of all aspects of their healthcare by 2021. People We want to identify, recruit, educate and develop a talent pipeline of clinicians, healthcare professionals and broader teams of leaders, skilled at delivering integrated care and designing and implementing innovative solutions for performance improvement. Provision We want to clearly identify ‘what business we are in’, ‘what we want to be known for’ and ‘what our core services are’. We need to provide the right services and do them well. Partnerships We want to define and deliver sustainable services and patient pathways together with our health and social care partners, by 2021.

CONFIDENTIAL-DRAFT

History East Kent Hospitals Trust was formed in 1999 when three hospital trusts covering Thanet, Canterbury, Ashford, Swale, Shepway and Dover merged. A major reconfiguration of hospital services followed which saw the William Harvey Hospital in Ashford and Queen Elizabeth The Queen Mother in Margate opening as East Kent’s district general hospitals while Kent & Canterbury Hospital, in Canterbury, became a specialist services hub, alongside the provision of medical care for adults. The Trust received its formal certificate of registration in June 2010 by the Care Quality Commission (CQC) under the Health and Social Care Act 2008. The registration currently includes conditions which the Trust is addressing through its improvement, turnaround and transformation work. Since becoming a foundation trust in 2009, East Kent Hospitals has been regulated by Monitor – the organisation responsible for authorising, monitoring and regulating NHS foundation trusts.

Our vision, mission and values

What we do as a Foundation Trust East Kent Hospitals University NHS Foundation Trust (EKHUFT) manages five hospitals (210,000sqm) including the William Harvey in Ashford, the Queen Elizabeth The Queen Mother in Margate, Buckland in Dover, Royal Victoria in Folkestone and Kent and Canterbury in Canterbury. The Trust also provides health services from other NHS facilities including renal services in Medway and Maidstone. The Trust has over 1000 beds including 27 critical care beds and 67 children’s beds. Its 8,000 plus staff provide a range of core and specialist healthcare services to a population of over 750,000 across east Kent.

1.02 What we do as a Foundation Trust

The Trust receives over 200,000 emergency attendances, 94,000 inpatient spells and 727,000 outpatient attendances per year. There are 138,000 day case attendances. As a teaching Trust the organisation plays a vital role in the education and training of doctors, nurses and other healthcare professionals, working closely with local universities and King’s College University in London. The Trust is proud of its national and international reputation for delivering high quality specialist care, particularly in cancer, kidney disease, stroke and vascular services.

1.03 Hospital Locatio

Kent and Canterbury Hospital Kent and Canterbury Hospital is an acute hospital providing a range of elective and emergency services including an Emergency Care Centre.

The hospital is located in the City of Canterbury. The original part of the main hospital building was constructed in 1937, with later developments undertaken on site in the 1960s and 2000.

This hospital provides a central base for many specialist services in east Kent such as renal, vascular, interventional radiology, urology, dermatology, neurology and haemophilia services.

The hospital also hosts cancer services with Maidstone and Tunbridge Wells NHS Trust.

Kent & Canterbury Hospital has a postgraduate teaching centre and staff accommodation. Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent,

CT1 3NG.

Queen Elizabeth The Queen Mother Hospital (Margate)

The Queen Elizabeth The Queen Mother (QEQM) Hospital, Margate is an acute hospital providing a range of emergency and elective services and comprehensive trauma, orthopaedic, obstetrics, general surgery and paediatric services. The hospital dates back to the 1930s when the original building was constructed. Between 1996 and 1998 most services were relocated and expanded into a new main hospital building linked to the original facilities.

The hospital has a specialist centre for gynaecological cancer and modern operating theatres, Intensive Therapy Unit (ITU) facilities, children’s inpatient and outpatient facilities, a Cardiac Catheter Laboratory and Cancer Unit.

QEQM has a postgraduate teaching centre and staff accommodation. On site there are also co-located adult and elderly mental health facilities run by the Kent & Medway NHS and Social Care Partnership Trust. Queen Elizabeth The Queen Mother Hospital St Peters Road Margate Kent CT9 4AN

William Harvey Hospital (Ashford) The William Harvey Hospital (WHH), Ashford is an acute hospital providing a range of emergency and elective services as well as comprehensive maternity, trauma, orthopaedic and paediatric and neonatal intensive care services. The hospital was commissioned in 1977, and since then the site has been developed, substantially upgraded and, more recently, reorganised into medical and surgical floors. The hospital has a specialist cardiology unit undertaking angiography, angioplasty, a state of the art pathology analytical robotics laboratory that reports all east Kent’s General Practitioner (GP) activity and a robotic pharmacy facility. A single Head and Neck Unit for east Kent includes centralised maxillofacial services with all specialist head and neck cancer surgery co-located on the site. WHH has a postgraduate teaching centre and staff accommodation. William Harvey Hospital Kennington Road Willesborough Ashford Kent TN24 0LZ

Buckland Hospital (Dover) The Buckland Hospital is a community hospital that provides a range of local services. East Kent Hospitals has invested £24m to rebuild the Dover hospital to provide modern facilities for the south Kent coast population. The new hospital opened to patients in June 2015. The new facilities include a minor injuries unit walk in centre, outpatient facilities, renal satellite services, day hospital services, child health ambulatory and child development services and diagnostic facilities. This was an important development for the Trust, securing local access to services. Buckland Hospital, Coombe Valley Road, Dover, Kent, CT17 0HD

1.04 The Hospitals

Royal Victoria Hospital (Folkestone) The Royal Victoria Hospital, Folkestone is a community hospital that provides a range of local services. The hospital building is essentially Victorian, but has been upgraded over the years to provide a minor injuries unit with a walk-in centre (both operated by the local Clinical Commissioning Group), a thriving outpatients department, the Derry Unit and diagnostic services. Royal Victoria Hospital (Folkestone) Radnor Park Avenue, Folkestone, Kent, CT19 5BN

1.05 Where we are now The National Challenges In terms of the national context, there is now a major focus on the future shape and function of hospitals, triggered by the Royal College of Physicians’ Future Hospital Commission, NHS England’s Urgent and Emergency Care Review, Monitor’s report ‘Smaller Acute Providers’ and most recently NHS England’s landmark Five Year Forward View and the Dalton Review. Like many other acute hospital trusts up and down the country, the Trust must now work in partnership with its commissioners, other healthcare providers and the public to consider the most appropriate configuration of hospital services. We need to ensure that clinical services are fit for purpose, sustainable, accessible, adequately supported by other specialties and able to deliver the highest possible quality of care. The NHS Five Year Forward View identified that the NHS needs better ways of delivering care at a greater scale. It rightly ascertains that: a) care should be personal, whilst

based on population health needs; b) there should be a new focus on co-

ordinated care systems and networks;

c) a greater emphasis should be given to redesigning out-of-hospital care;

d) centralisation should be supported where it demonstrably delivers improvements in quality and safety; and

e) to achieve greater productivity, new approaches should adopt greater

standardisation of processes, use of technology and shared information.

In addition, as part of the national picture, EKHUFT is faced with a number of political and economic pressures which are beyond its control, but could impact on the future delivery of health care across east Kent. Examples include the current service tariff review; the reduction in training posts for new doctors and nurses; and the need for the NHS to reduce costs by £22 billion over the next five years. There is also a continued national drive to improve the quality of care provided by: a) improving outcomes for patients

based on best practice and clinical evidence;

b) achieving national standards for care; c) meeting the growing demands of

patients for more convenient care closer to home;

d) taking advantage of the latest developments in treatments and technologies (including medical technology and data solutions), telehealth; and

e) ensuring that specialist care is available to treat the most seriously ill patients 24 hours a day, seven days a week, as well as achieving more generally the national drivers towards seven day working.

The Trust faces national workforce pressures across a wide range of specialties, including factors such as the availability of specific groups of staff, skills gaps where staff are available and the provision of appropriate levels of education and training. There are particular issues with Doctors. Due to Junior Doctor and Consultant vacancies it is becoming impossible to sustain a general internal medicine rota on all 3 sites. Due to retirements and resignations some specialist services e.g. Diabetes are being managed by locum doctors. The pressures of managing elective and emergency demands are creating a risk of increased consultant sickness and resignations. The Trust is also required to meet the guidelines from professional bodies such as the Association of Surgeons for Great Britain and Ireland (ASGBI) “Emergency General Surgery: The Future” and the from the Royal College of Surgeons (RCS) on “Standards for Emergency Surgical Care”, in terms of the provision of emergency care at night and at weekends, together with ensuring any issues around increased sub- specialisation and medical on-call arrangements are adequately addressed. Other national guidance supports new, improved models of care, ranging from Royal College Guidance to national reviews such as Sir Bruce Keogh’s review of seven day working. There are increasing pressures from the Royal Colleges to deliver services as part of a

1.05 Where we are now wider clinical network, increase Consultant presence and senior decision-making early in the patients’ pathway and to continue to separate elective and non-elective pathways. The current General Internal Medicine rotas are 1:8 and in some cases require the consultant to also cover a specialist rota such as stroke or gastro-intestinal bleeding. The intensity of the rota is unsustainable due to increasing numbers of patients presenting 24/7 and additional requirements for junior doctors e.g. study leave, ward based working etc. There have been many other documents published which call for new ways of working. One such document is the “NHS Call to Action” which notes, “… We know there is too much unwarranted variation in the quality of care across the country. We must place far greater emphasis on keeping people healthy and well, in order to lead longer, more illness free lives, preventing rather than treating illness. There are a number of future pressures that threaten to overwhelm the NHS. The population is ageing and we are seeing a significant increase in the number of people with long term conditions. The resulting increase in demand, combined with rising costs, threatens the financial sustainability of the NHS. These issues will need fundamental changes to how we deliver and use health and care services…” East Kent’s CCGs agree with these views and that is why it is taking a proactive, responsible approach to discuss and address these challenges.

1.05 Where we are now The growing demand The ageing population and increasing numbers of people with long-term conditions will result in increased demand for healthcare services. With old age comes the increased likelihood of having a long-term condition or becoming frail. East Kent’s current disease prevalence profile reflects its older population with a higher prevalence of hypertension and coronary heart disease (CHD). Rates of diabetes, stroke and heart disease are expected to grow faster than the England average. By 2020 around 1 in 10 of the population could have diabetes and around 1 in 8 could have CHD. Without the development of effective new approaches, the increasing demand driven by the elderly population is likely to overwhelm the Trust’s capacity over the next 5 year period. Developing and implementing operational changes that meet these demands within the Trust’s current service configuration and financial envelope will not be possible. The current mismatch between demand and capacity (in terms of staff and estate) will be further compounded by overall population growth in east Kent. This shows that by 2023, if the Trust continues to deliver its services as it is currently doing, demand would increase significantly:

inpatient activity would increase by 16%. This would mean trying to accommodate an additional 15,000 patients each year

day case activity would increase by 17% or by 12,000 patients each year

out-patient attendances would increase by 15% which equates to an additional 92,000 patients each year.

Furthermore, it is important to highlight that east Kent has an increasing younger population showing a 1.3% growth per year (an increase of 18,000 population over the next ten year period). Alongside demographic change there are also lifestyle factors which impact on the level of health care needs communities require. Similar to population growth these are uncontrollable factors and include deprivation; increased obesity; smoking and alcohol consumption. Certain localities in east Kent have higher the average rates for these factors and therefore have a higher demand for health care services.

Changes to in year surplus / deficit FY15/16 to FY20/21

The financial picture The National picture within the NHS remains stark, with a number of Trust reporting a deficit in 2016/17. EKHUFT has modeled its own business as usual five year financial forecast which estimates that the Trust will have a deficit of £43m at the end of 20/2021. This analysis takes the normalised 2015/16 outturn as its start point applying a £20m CIP in 2016/17 and £12m pa (2.1%) from 2017/18 onwards. This equates to an average CIP of 2.4% p.a. over 5 years. Capital expenditure spend of £15.5m is included along with Tariff and contract changes of £19.9m from 2016/17 built in as is £0.8m p.a. of assumed growth from 2017/18. Inflation on pay, non pay, drugs and CNST is applied using latest national guidance.

1.05 Where we are now CCQC and Special Measures Monitor placed the Trust into special measures on 29 August 2014 following a CQC inspection in March 2014 which identified two of the three main hospital sites as ‘inadequate’ and the Trust rated overall as ‘inadequate’. A second follow up inspection was undertaken in July 2015. The inspection report, published on 18 November 2015, rated two of our five hospitals as ‘good’ and three as ‘requires improvement’. The Trust awaits the outcome of a third inspection conducted in September 2016.

1.06 The Clinical Strategy – Delivering or future The Clinical Strategy The Trust is facing some significant challenges, most notably increasing demand, reduced income and continuing workforce pressures, meaning that we need to re-consider how we deliver care in the future. We absolutely recognise that we need to continue to deliver services locally wherever possible. However, in order to maintain safe and sustainable services for the long-term we also know that we cannot continue to deliver services in the same way as we do at the moment. Work is now underway led by our commissioners and with healthcare partners, to explore ways to transform how care is delivered. This is being overseen for east Kent by the East Kent Strategy Board. In addition to the original ambition of the Board in taking a ‘whole system approach’ to designing health and care services, planning guidance from NHS England, published 22 December 2015, means that this work has an additional dimension as it will form part of a ‘sustainability and transformation plan’ for Kent and Medway.

Plans and timescales will be developed in 2016/17 with the intention is to go to public consultation on proposed options for service delivery in early 2017.

The Board will work with other health and care partners in Kent and Medway to deliver the plan whilst maintaining the pace and ambition of the programme for the population of East Kent. Part of this engagement incudes consultation with numerous local groups and organisations including the Kent Health Overview and Scrutiny Committee (HOSCs).

The Estate working to support the Clinical Strategy East Kent Hospitals University Foundation Trust is well placed to unlock value from its own estate, which covers some 101 buildings, and through maximising these assets it can reinvest and redevelop its accommodation landscape to better support its strategic aims, Delivering Our Future and to provide better, more fit for purpose flexible health care environments. The Trust’s future estates planning needs to directly link with the Delivering Our Future strategy, acting as an enabler, contributor and catalyst. The Board has demonstrated the potential opportunities which exist for the Trust through utilisation of its estate, which highlighted that the Trust’s large estate, some 210,000 sqm, was: a) being underused in terms of staff and

patient accommodation and; b) has significant challenges keeping up

to date in terms of compliance, patient and staff expectations: and

c) inflexible, with continuing changes in care pathways, technology and health initiatives.

Currently and as part of our strategic aims, the estate faces a number of complex related and emerging priorities including the need to develop a master plan capable of creating the built environment for;

Reconfigured Hospital services on one or more sites

Integrated Health through Health and Social Care work – community and acute

Primary Care co-habitation – hosting and partnering onsite GP practices

Corporate Land-lording – supporting Divisions to focus on care

Whilst the Trust has successfully called on its own capital funds to deliver key estate capital projects, technology and service developments, it is clear that such significant service reconfiguration coupled with the resulting estate reconfiguration will require access to funds which are beyond the Trust’s own ability to generate.

Estate Tenants

Estate Strategy Principles This interim estate strategy bridges our current approach in estate and asset management, to the final estates strategy that will be completed post clinical strategy consultation in 2017. It is written to support, control and dovetail into the emerging needs arising from the Trust’s Clinical Strategy and Quality agendas. In the context of a very challenging financial landscape for the NHS, the strategy is one of maximising the use of our existing assets in the short to medium term to move towards an efficient, generic and flexible asset base laying the foundation for strategic services development in the longer term. In developing the strategy key estate challenges that need to be met include;

Delivering more with less with no medium term growth in funding

Making our assets work better to meet strategic aims

Ensuring the right capacity in the right place

Protecting future flexibility and agility

Exploiting opportunities for non-traditional funding routes

Embracing technology to facilitate new ways of working including providing our services in off-site locations.

1.07 Estate Strategy Principles In adopting these principles a key challenge is to improve productivity of the assets. This may be achieved by a combination of:

Consolidating the estate where appropriate, with better utilisation of underused facilities and new ways of working; and/or

Rationalising the use of space within buildings by using existing capability more effectively to release space for future growth and quality improvements for the patients in the medium and longer terms.

In parallel with the medium and long tern clinical priorities from an estates perspective are 3 core development priorities: Quality: Providing the best patient accommodation possible within financial and other constraints to improve the healing environments, patient experience, and respond better to patient choice. Flexibility: moving towards a generic flexible model for capability and space across all sites with more shared multi-use and less dedicated capacity for individual services and departments. This will provide more agility to rebalance across services and accommodate growth and service reconfiguration in the future. Efficiency: making the most efficient use of the Trust’s property base including off-site properties and non-clinical support space. This will be facilitated by embracing IT potential and new technologies.

1.08 The Estate picture Estate Physical Condition The physical condition of the Estate is a product of the age, use, design, construction and maintenance of the assets that make up the estate. Assets have an economic life varying from 5 years for equipment, up to 60 years for the structure of a building. Engineering services and replaceable elements like roofs, windows, and floors generally have economic lives of 10-20 years. Many parts of the Estate have gone beyond their economic life e.g. lifts, boilers, switchgear, flooring. Some elements are obsolete and spare parts to repair them have to be specially made. Assets can be often worked beyond their economic life but will incur an increased frequency of maintenance and emergency breakdown repairs at additional costs Whilst the estate comprises modern fit for purpose buildings such as the new hospital in Dover and Endoscopy building in the William Harvey, c80% of our current estate comprises buildings largely built between 1930 and the 1980’s making the estate complex and varied in terms of compliance to modern standards and effectiveness. Evaluation of the Existing Estate: The 6-Facet Survey A considerable amount of detailed information has been developed to support the operational and strategic roles of our Estate management. The information is used to help assess risk

levels, set investment priorities and opportunities for disposal and to inform a five year programme of maintenance and minor capital projects. The Trust has used two facets from a six facet surveying methodology, Facet 1 – Physical condition and facet 5 – statutory compliance and completed a Trust-wide survey in 2013. Additionally components of two more Facets, three – space utilization and 6 – energy efficiency have also played a part in our estate decision making. Facet 1 Estate Physical Condition Categories The physical condition assessment includes the building structure and fabric together with mechanical and electrical engineering installations. It shows what proportion of the building area is in each Estatecode condition category, and identifies the cost to upgrade these areas to the acceptable standard – Condition ‘B’. The categories of physical condition are as follows: Condition ‘A’ - new building that fully complies with national standards and has a full life expectancy of 60 years. No immediate expenditure is required except for routine operational maintenance. Condition ‘B’ - a building that is in an acceptable condition for its use. No immediate major expenditure required except that for minor repairs and upgrading and routine operational maintenance. The building will have a life expectancy of at least 10 years for its

existing use without major repairs and upgrading. Condition ‘C’ - a building that is not in an acceptable condition for its use and requires capital expenditure to bring to Condition ‘B’. This expenditure will not exceed 50% of the replacement cost and would provide the building with an expected remaining life comparable with that of a new building. Condition ‘D’ - a building that is not in an acceptable condition for its existing use and requires capital expenditure to achieve condition ‘B’ of between 50% and 100% of replacement costs. Facet 5 Statutory Compliance Classification The Trust is required to comply with a wide range of Statutory Regulations, the most important of which include the ‘Health and Safety at Work Act’ and ‘Electricity at Work Regulations’ and the Building Regulations. The range of categories is as follows: Level ‘A’ Complies fully with current mandatory fire safety requirements and statutory safety legislation. Level ‘B’ – Upgrading to a new standard which is suggested, but not mandatory. Assumes the item is legal and functioning safely. Level ‘C’ – Contravention of one or more mandatory fire safety requirements and statutory safety legislation which falls short of ‘B;’

Level ‘D’ – Dangerously below condition A and B Summary Physical Condition Our large estate of over 101 buildings is made up of a mixture of old and new buildings, with the older estate deteriorating over time. There are extensive areas requiring refurbishment in order to improve the patient environment. New challenging standards for privacy and dignity, infection control and mixed sex accommodation increases the pressure on our older buildings to be compliant. Our backlog maintenance liabilities are in the region of £30m, with £18m required for replacing critical infrastructure plant. Additionally the estate suffers from a deteriorating physical appearance due to wear and tear with much of the estate looking tired. Refurbishing, redecorating and introducing better visible working environments is not included in the £30m figure above as this often tends to be deprioritised over higher risks. Having said this the Trust allocates funds each year on maintaining and replacing the estate assets with £18m earmarked for 2016/17, £2.8m spent in 2015/16 and £3.7m in 2014/15. The Trust has also invested its own capital in new builds with £10.1m allocated in 2015/16 and £12.2m in 2014/15, excluding the IT and medical

device replacement.

Asset disposals and rationalisation In 2015/16 the Trust undertook a review of its non-core and surplus estate. This resulted in reducing our foot print through the disposal of c£4.5m worth of land and building stock. Going forward over the next three years further rationalisation opportunities may emerge following the conclusion of the Clinical Strategy. This will allow us to focus available resources on core assets, removing unnecessary operational costs such as business rate, utilities and maintenance whilst also reducing risk. Current 5 Year Capital Plan to 2019 The Trust has a clear capital expenditure plan for the next 2-3 years to 2018/19. It is probable that, in the context of the Trust having a financially prudent strategic plan, to deliver the strategic initiatives laid out in the plan, capital investment will potentially be required beyond the level of internally generated resources and cash reserves. The Trust’s Board has commenced exploring the options for external financing in preparation for this. Scheme level detail can be seen in the table attached. This table includes £0.5m of donated assets that the Trust broadly expects to receive in each financial year primarily supporting the purchase of medical equipment to enhance patient experience. This expenditure is fully supported by income streams from charitable organisations.

Recurrent Allocations Annually the Trust has held some expenditure under Recurrent Allocations to address issues such as backlog maintenance and equipment replacement. A key element of challenge from Monitor as part of the FT assessment was the likely timescales for the eradication of a major backlog maintenance programme. It is also a requirement of the Trust’s Terms of Authorisation to have a detailed annual maintenance and equipment replacement programme and this is reflected in the on-going allocations.

Purchase of new/ replacement major items of medical equipment;

Replacement of current medical devices and equipment;

Backlog maintenance;

Replacement and purchase of new IT equipment;

Divisional capital requirements.

1.08 The Estate picture

1.09 Operationalising the Estate Management information systems Effective operational estate management is vital to the safety and efficient use of our estate. Day to day estate support remains directly delivered by NHS estates staff whilst soft FM is delivered in partnership with Serco. The Trust has reviewed the estates service and implemented a number of initiatives to support enhanced service performance and customer satisfaction. This has included the extension of the working day to be more aligned to operational needs, multiskilling staff and investing in new service management tools. The Estate teams are integral to the smooth running of the sites with excellent relationships between “frontline staff” and estate personnel on the ground. Having said this the service did need to review its performance in terms of the time taken to resolve jobs raised by our customers and the ratio of reactive to proactive work. The Trust (unsurprisingly, given the estate condition) is c30% proactive but is committed to improving this in the coming years. Additionally there was a gap in management information in relation to day to day prioritisation of maintenance budgets. High risk items are identified via the risk adjusted condition survey however prioritising day to day repairs needed further refinement.

To support these aims the Trust implemented a new computer aided facilities management (CAFM) information system called Planet. This system allows the estates teams to focus on problematic areas, for example focusing on highlighting replacement programs given that localised lighting issues remains one of our top ten most common service requests. Additionally and as move more towards clinical service reconfiguration the estates service will need to become flexible, focusing available staffing resource on sites with the highest user requests. Our future planning will need to reflect that more activity simply means more wear and tear. Supporting the CAFM system the Trust is investing in upgrading its Building Management Systems (BMS), which support the operational management of utilities, safety and plant on the sites. These systems are helping the Trust achieve its carbon reduction targets in addition to better and more effective use of the sites.

1.09 Operationalising the Estate Formal Estate returns The Trust’s annual submissions to both the Estates Return Information Collection (ERIC) and Patient Lead Assessment of Clinical Environments (PLACE) also contribute to the management information available to prioritise and run our sites effectively. The Lord Carter review into NHS efficiency and savings has escalated the value in these information returns and now, both require formal Board awareness and in the case of ERIC, CEO sign off. As a national benchmarking tool, both returns provide value data upon which to support decision making and highlight areas of innovation. The Trust’s 2016/17 PLACE results excellent work being done by a wide group of teams within the organisation across clinicians, catering, cleaning and estates.

1.09 Operationalising the Estate The Trust has also made good progress against national ERIC benchmarking with particular focus in total estates and facilities running costs, which has the Trust in the lowest Quartile for costs. The Trust’s Board recognises the importance of ERIC and has agreed five key metrics that it wishes to be reported on a quarterly basis. These include -

Total Estates and facilities costs,

Energy consumption,

Clinical to non- clinical space,

Waste

Critical infrastructure risk.

Energy and Carbon In 2012 East Kent Hospitals University NHS Foundation Trust partnered with the Carbon Trust on its Sustainable Development Management Plan in order to realise substantial carbon savings. This Plan committed the Trust to a target of reducing CO2 by 10% by 2015. In setting emission reduction targets the NHS has chosen to focus on energy use (scope 1 and 2) and business travel (scope 3) emissions, and uses a baseline year of 2007/08 against which to set its reduction targets. EKHUFT emissions from these sources in 2007/08 were 23,103 tonnes CO2e. EKHUFT set itself two targets, the first to meet the NHS 2015 target and the second a stretch target, they are as follows:

Trust target: EKHUFT will achieve a 10% reduction in its carbon emissions from its scope 1, 2 and 3 (business travel) activities by 2015 (using a 2007/08 baseline); and

Stretch target: EKHUFT will achieve a 20% reduction in its carbon emissions from its scope 1, 2 and 3 (business travel) activities by 2020 (using a 2007/08 baseline).

The Trust achieved its 2015 target by delivering its phase 1 energy schemes and its new hospital facilities incorporating high levels of energy reduction designs.

Whilst Government policy on Carbon targets is under review the Trust remains committed to reducing its energy use and in doing so reduce its carbon emissions in line with the 2020 stretch target. We have begun working with the NHS Sustainable Development Unit (DSU) for support and guidance and are undertaking a review of our Sustainable Development Management Plan so that it can reflect best practice and emerging guidance. The Trust’s greatest “sustainability” success has been the completion of the new hospital in Dover, which achieved BREEAM* excellence certification in July 2015. The Trust was committed to making the building’s design and operation as green as it could possibly be. *Building Research Establishment Environmental Assessment Method Achievement of BREEAM Excellent means:

The Health and wellbeing of the occupants has been taken prioritised and therefore throughout the building the use of natural day light has been maximised.

Indoor air quality has been enhanced by minimising the sources of air pollution.

The design of the building has ensured it is low risk, safe and that it has secure access for patients and staff.

1.09 Operationalising the estate

The building has exceeded the nation CO2 emissions rate by over 25%.

Cyclist facilities are been provided to encourage staff and patients to cycle to the site.

All the building materials used in construction had the lowest possible carbon footprint rating. Because of this, the project has achieved a superior “innovation credit” score.

54.84% of the sub-contractors were sourced locally.

90% of the waste on the site, during construction was recycled and therefore did not gone to landfill.

The project ensured the supply of heat to the building is from a system that reduces pollution of the local

environment.

1.10 Capital Schemes - 2009 to 2016 Capital projects carried out from 2009 to 2016 In addition to the developments introduced in operational estates since the 2009 strategy was written, the Trust has invested c£80m of its own capital into replacing and refurbishing its physical estate assets in addition to improving the quality of care that can be provided. The following sections, two to five detail the wide range of developments by hospital site. Time Line

2010- 11 1. QEQMH staff accommodation

2. KCH urology interim expansion

3. WHH Centralisation of maxillo-facial services

4. KCH oncology upgrade

5. QEQM Endoscopy – JAG accreditation

6. QEQMH refurbish central admissions lounge

7. WHH new access road

8. WHH replace nursery

2011 -12 1. WHH New Theatres

2. WWH Replacement & Additional Cardiac

Catheter Lab

3. WHH Replacement & Additional MRI

4. WHH Replacement Generators

5. WHH Cellpath Accreditation

2012 – 13 1. WHH Endoscopy Unit

2. New Dover Hospital

3. Car Parks Staff and patients

4. QEQM CT Scanner

5. Trustwide Energy Project various small

schemes

6. KCH Outpatients Strategy, Polyclinic

7. KCH CDU Mixed Sex compliance

8. WHH Out Patient Strategy – Procedure Suite

2014 – 15 1. WHH CT Scanner

2. WHH A&E Refurbishment 2015 – 16 1. WHH Orthopaedic OPD

East Kent Hospitals University NHS Foundation Trust: Kent & Canterbury Hospital | Section 2 Estates Strategy | SEPTEMBER 2016 |

SECTION 2

2.1 General Overview K&CH Kent and Canterbury Hospital is an acute hospital providing a range of elective and emergency services including an Urgent Care Centre. The hospital is located in the City of Canterbury. The original part of the main hospital building was constructed in 1937, with later developments undertaken on site in the 1960s and 2000. This hospital provides a central base for many specialist services in east Kent such as renal, vascular, interventional radiology, urology, dermatology, neurology and haemophilia services. Kent and Canterbury Hospital has a postgraduate teaching centre and staff accommodation.

2.1 General Overview K&CH PROJECTS LIST 02_Urology Interim Expansion 05_Oncology Upgrade 21_Oupattients 22_CDU

2.2 Urology Interim Expansion K&CH

COST: £442k PROGRAMME: 2010 The brief for the interim work to the Urology Suite required an additional 6 bedded trolley bay. This area required similar facilities and services to the adjacent bed areas. Within the trolley bay a nurse base for one member of staff was required. The proximity of the waiting area to the existing changing, treatment and W/C facilities was unsatisfactory in terms of privacy and patient dignity. There was an increase in size of the waiting area to accommodate up to 20 patients or visitors as required.

2.2 Urology Interim Expansion K&CH

2.3 Oncology Upgrade K&CH COST: £2.5m PROGRAMME: 2010 Clinical Oncology services in Kent were commissioned through Maidstone and Tunbridge Wells NHS Trust (MTW) which was the host Trust. They provide services to patients from Oncology centres at Maidstone hospital and also at the Kent and Canterbury hospital. An OBC was approved for two new Tomotherapy machines one of which is housed in the Oncology centre at the Kent and Canterbury hospital. The result of this new machine would increase activity through the centre by 50%. The current facilities were inadequate to support this increased activity and in addition the fabric of the department was now very old and shabby, there were also Health and Safety and Infection Control issues including clinical incidents that had occurred. It was important to note that the majority of the work included within this business case was already built into the Trust’s Capital programme as the poor fabric of the estate had already been requested as a priority for investment. The MTW Business case gave the Trust a unique opportunity to recharge the majority of this cost, in rent, to MTW. It was vital therefore that this department was made ‘Fit for Purpose’ to support this growing service and the Trust’s Strategic objectives.

2.3 Oncology Upgrade K&CH

2.5 CDU K&CH COST: £1155m PROGRAMME: 2012 CDU part of the new model of care and Primary Care led Urgent Care Centre was introduced on 6th July 2016 and building works are due to complete by October 2017. Reconfiguration of the waiting area, consulting rooms, as well as modification to the staff base and sanitary provision. The capital costs of the project were £115k.

2.5 CDU K&CH

2.4 Outpatients K&CH COST: £1.16m PROGRAMME: 2012 Outpatients Strategy, Polyclinic. An area of estate was identified within the main outpatients department, which was large enough to accommodate two Procedure Rooms, three Consulting Examination Rooms, a clean utility room, dirty utility room, disabled WC and sub-waiting area. This move was in line with the Trust’s wider Outpatient Clinical Strategy, which aimed to create a Procedures Suite on each of the Trust’s sites to support the provision of one-stop clinics within the outpatient departments.

2.4 Outpatients K&CH

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East Kent Hospitals University NHS Foundation Trust: Queen Elizabeth The Queen Mother Hospital | Section 3 Estates Strategy | SEPTEMBER 2016 |

SECTION 3

3.1 General Overview QEQMH The Queen Elizabeth The Queen Mother (QEQM) Hospital, Margate is an acute hospital providing a range of emergency and elective services and comprehensive trauma, orthopaedic, obstetrics, general surgery and paediatric services. The hospital dates back to the 1930s when the original building was constructed. Between 1996 and 1998 most services were relocated and expanded into a new main hospital building linked to the original facilities. The hospital has a specialist centre for gynaecological cancer and modern operating theatres, Intensive Therapy Unit (ITU) facilities, children’s inpatient and outpatient facilities, a Cardiac Catheter Laboratory and Cancer Unit. QEQM has a postgraduate teaching centre and staff accommodation. On site there are also co-located adult and elderly mental health facilities run by the Kent & Medway NHS and Social Care Partnership Trust.

3.1 General Overview QEQMH PROJECTS LIST 01_Staff Accommodation 06_Endoscopy 07_Admissions Lounge 19_ CT Scanner

3.2 Staff Accommodation QEQMH COST: £4.548m PROGRAMME: 2010-2011 Provision of new build Staff Accommodation, 280 rooms arranged in single and multiple accommodation. There is a mix of four - bedroom and single person accommodation provided in one and two bedroom flats. The residences were designed to the highest affordable standard.

3.2 Staff Accommodation QEQMH Planning Application Drawings .

3.3 Endoscopy QEQMH COST: £2.67m PROGRAMME: 2010 One additional endoscopy theatre was required at QEQMH to deliver the endoscopy growth (including displaced patients from K&CH) and an increase of bowel cancer screening service from K&CH. The Endoscopy Department at QEQM Hospital was greatly undersized and lacked a number of facilities required for JAG accreditation and endoscopy growth. The unit would be redesigned with an additional third room; this would entail redeployment of cancer services and North Foreland outpatients. To facilitate the work the unit would decant to an alternative area which also included the relocation of the Doctors Mess. Relocation of the central booking office from temporary accommodation at K&CH, which was required to achieve waiting times and JAG accreditation was incorporated within the estates solution and building costs at QEQM.

3.3 Endoscopy QEQMH

3.4 Admissions Lounge QEQMH COST: £700k PROGRAMME: 2010-2011 Project was to convert a redundant Sterile Services Department at QEQM Hospital into a new Centralised Admissions Lounge. The refurbishment work comprised the decommissioning and strip out of existing services, alterations including structural and general building works, the upgrade and alteration to mechanical/electrical/medical Gas services and installation of new fixtures, fittings, finishes and decorations.

3.4 Admissions Lounge QEQMH

3.5 CT Scanner QEQMH COST: £2.5m PROGRAMME: 2012-2013 Provision of a new CT scanner adjacent to the existing CT scanner. The former store to be reduced and modified to accommodate the expansion and refurbishment to create a new scanner room and patient change and sub wait area.

3.5 CT Scanner QEQMH

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East Kent Hospitals University NHS Foundation Trust: William Harvey Hospital | Section 4 Estates Strategy | SEPTEMBER 2016 |

SECTION 4

4.1 General Overview WHH The William Harvey Hospital (WHH), Ashford is an acute hospital providing a range of emergency and elective services as well as comprehensive maternity, trauma, orthopaedic and paediatric and neonatal intensive care services. The hospital is located on the outskirts of Ashford, adjacent to the M20 and was commissioned in 1977. Since then the site has been developed, substantially upgraded and, more recently, reorganised into medical and surgical floors. The hospital has a specialist cardiology unit undertaking angiography, a state of the art pathology analytical robotics laboratory that reports all east Kent’s General Practitioner (GP) activity and a robotic pharmacy facility. A single Head and Neck Unit for east Kent includes centralised maxillofacial services with all specialist head and neck cancer surgery co-located on the site WHH has a postgraduate teaching centre and staff accommodation. There are also adult and elderly mental health services onsite provided by Kent and Medway NHS & Social Care Partnership Trust.

The William Harvey Hospital (WHH),

4.1 General Overview WHH POJECTS LIST PROJECTS LIST 03_Maxilo-Facial Services 08_New Access Road 10_Replacement Nursery 11_New Theatres 12_Cardiac Catheter Lab 13_MRI 14_Generators 15_Cellpath 16_Endoscopy Unit 23_Outpatients 24_CT Scanner 25_A&E 26_Orthopaedic OPD

4.2 Maxillo-facial services WHH COST: £3.8m COST: £3.8m PROGRAMME: 2010-2011 PROGRAMME: 2010-2011 Centralisation of maxillo-facial services. Purpose built facility over two floors incorporates orthodontic, workshop, laboratory and clinical staff facilities. The project includes the refurbishment of spaces within the adjoining day surgery unit for ophthalmology. Year Range Hospital Project Title

Start Date Completed

4.2 Maxillo-facial services

4.3 New Access Road WHH COST: £3.8m COST: £850k PROGRAMME: 2010-2011 PROGRAMME 50k PGRAMME: 2010-2011 The new perimeter access road to the Hospital Campus provides a better directing of the staff and visitors and frees up the main drive. This new road was done in two different phases:

Phase 1: January 2011 - June 2011

Phase 2: April 2013 - March 2014

This project also includes the provision of additional staff parking at £1,65m.

4.3 New Access Road WHH .

4.4 Replace Nursery WHH COST: £3.8m COST: £1.5m PROGRAMME: 2010-2011 PROGRAMME 50k To replace the outdated existing modular building with a new single storey modular Day Nursery building including external works and drainage. The building is approximately

488m2ME: 2010-2011

Year Range Hospital Project Title Construction

Value £

4.4 Replace Nursery WHH

4.5 New Theatres WHH COST: £3.8m COST: £2.99m PROGRAMME: 2011-2012 PROGRAMME This involved building a new Medical records dept. in a courtyard and refurbishing the former Sterile Services Department Area to provide one laminar flow main Theatre and one C-Section Theatre.

Year Range Hospital Project Title Construction

Value £ Construction Start

4.5 New Theatres WHH

4.6 Cardiac Catheter Lab WHH COST: £3.8m COST: £3.2m PROGRAMME: 2011-2012 The Trust provided a second Cardiac Catheter Lab at the WHH to support the Cardiology department. The existing, 7 year-old Cardiac Catheter Lab was refurbished. The project included the capital cost of putting both Cardiac Labs onto the hospital site’s maintained power supply and for the part re-provision of the Post Grad Centre.

Year Range Hospital Project Title Construction

Value £ Construction Start Date

4.7 MRI WHH COST: £3.8m COST: £1m PROGRAMME: 2011-2012 To extend the existing MRI building to provide the replacement of existing MRI scanner and the provision of additional 4th Static MRI scanner for the WHH site. The flows and waiting of the facility also to be improved.

Year Range Hospital Project T

4.8 Generators WHH COST: £3.8m COST: £2.9m PROGRAMME: 2011-2012 To replace the obsolete generator installation at the WHH site. Also upgrade the capacity to give N+1 compliance.

Year Range Hospital Project Title Construction Value £

4.9 Cellpath WHH COST: £3.8m COST: £275k PROGRAMME: 2011-2012 New build to provide additional space to the rear of the existing facility – Microbiology corridor where 5 offices were erected as a permanent facility. These changes will cumulatively provide additional laboratory space to satisfy the space needs for Histopathology for the next 2-5 years Implementation of lower GI Lean project recommendations achievable.

Year Range Hospital Project

Title Construction

Value

4.10 Endoscopy Unit WHH COST: £3.8m

COST: £7.7m PROGRAMME: 2012-2013 One additional endoscopy theatre would be required at WHH to deal with the endoscopy growth and the spread of bowel cancer screening service from K&CH. To meet JAG requirements and endoscopy growth the physical design of the current unit requires significant expansion and alteration requiring relocation of services currently provided in the Celia Blakey outpatient unit. A new two storey building would be located in the car park of the Elizabeth Brown Unit at WHH. Dermatology and Gynaecology would relocate to the ground floor and Cancer Services to the first floor.

Year Range Hospital Project

Title Construction Value £ Construction Start Date

Completed 4.10 Endoscopy Unit WHH Planning Application Drawings

4.11 Outpatients WHH COST: £3.8m COST: £1.13m PROGRAMME: 2014-2015 Procedure Suite Project The project to refurbish the vacated Endoscopy Suite at the William Harvey Hospital to accommodate the move of the Fracture Clinic department required some enabling works. This enabling work included the Procedure Suite, located within the Celia Blakey Centre, to be relocated together with two consulting exam rooms. An area of estate was identified within the main outpatients department (the former Max Fax area), which was large enough to accommodate two Procedure Rooms, three Consulting Examination Rooms, a clean utility room, dirty utility room, disabled WC and sub-waiting area. This move was in line with the Trust’s wider Outpatient Clinical Strategy, which aimed to create a Procedures Suite on each of the Trust’s sites to support the provision of one-stop clinics within the outpatient departments. The creation of these procedures suites was therefore a priority and was jointly-funded by the Outpatients Clinical Strategy Programme and the Fracture Clinic development project. Work to create this new Procedures Suite commenced at the end of October and was completed in April 2015.

Year Range Hospital Project Title Construction Value £

4.11 Outpatients WHH

4.12 CT Scanner WHH COST: £3.8m COST: £2.6m PROGRAMME: 2014-2015 Provision of a new CT Scanner in a former XRay room, to include a scanner room and control room.

4.12 CT Scanner WHH

4.13 A&E WHH COST: £3.8m COST: £1m PROGRAMME: 2014-2015 A&E Refurbishment achieved:

Separate Paediatric area with secure door access

Relocate Minor Injuries Unit with treatment bays and chair bays and a plaster room.

Large central store with access from all areas

Assessment area beside ambulance area

Treatment room adjacent to existing assessment room off waiting area

Additional relatives room and psychiatry room.

Additional 2 bed bays in Major Injuries and new staff workstation with views to bed bays.

Retain drug dispensing area and provide equipment bay to Majors.

Addresses privacy and dignity issues with rear exit to Majors.

4.13 A&E WHH

4.14 Orthopaedic OPD WHH COST: £3.8m COST: £1.9m (not started) PROGRAMME: 2015-2016 Fracture Clinic. An area of the WHH site has been identified and designated as the future location of the Fracture Clinic and Orthopaedic Outpatient department. This area has the necessary clinical links with A&E and Radiology. This proposed future site is the current Endoscopy Suite area, which is due to be vacated by Endoscopy early in the spring of 2014. The accommodation required for the Fracture Clinic and Orthopaedic Outpatient department is:

8 Consulting Rooms large enough for access to both sides of couch, 16.5m2 each

Plaster room with space for 3No curtained bays, plaster sink and hand-wash station.

Clean treatment room/bay with couch for dressing wounds, 12m2

Plaster store, 3m2

Store for walking aids, 3m2

Waiting area for up to 40 patients, 66m2

Accessible toilet, 4.5m2

Unisex toilet, 2.5m2

Housekeeper/cleaners store 7m2

Reception/office for 2 persons, 10.5m2

Clinical preparation area, 12m2

Records trolley storage, 4m2

Small beverage bay, 6m2

Managers office 2 persons, 10.5m2 The plaster room will need to be accessed by patients directly from the waiting area and also from the hospital street moving from wards, Emergency Department and X-ray Department.

Year Range Hospital Project Title

Construction Value £ Construction Start (predicted)

Date Completed

4.14 Orthopaedic OPD WHH

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East Kent Hospitals University NHS Foundation Trust: Buckland Hospital Dover | Section 5 Estates Strategy | SEPTEMBER 2016 |

SECTION 5

5.1 New Buckland Hospital - Dover COST: £24.3m PROGRAMME: 2012-2013 New facility incorporating:

Minor injuries unit

Physiotherapies department (all adult therapy services

Activities of Daily Living (ADL)

Renal Dialysis unit

Children’s ambulatory care

Day hospital

Adult Ambulatory care provided by multi-disciplinary services to include medical treatment and procedure rooms:

Pharmacy pod/retail outlet

Maternity ante-natal and day care services

Radiology to support a 1 stop OPD model (plain xray and ultrasound)

Hard standing for a Mobile MRI

Pathology point of care testing to support the 1 stop model

Health Records The new Hospital moved services from a non fit for purpose Victorian workhouse and Hospital, to a modern state of the art facility for the community of Dover.

5.1 New Buckland Hospital - Dover

East Kent Hospitals University NHS Foundation Trust: Current and Future Strategic Initiatives | Section 6 Estates Strategy | SEPTEMBER 2016 |

SECTION 6

6.1 Current and Future Strategic Initiatives

Current and Future Strategic Initiatives. The Trust has started to develop estate opportunities to support future clinical needs. Over the next two years, this will potentially see a primary care facility built on our Canterbury site and a Dementia Village built on our New Buckland Hospital site. We are also exploring the opportunity through our innovative Public Estate Partnership (PEP) with Kent County Council, the prospect to grow the number of non-acute beds via community nursing homes, within the local health economy, helping to support the underline direction of travel of our clinical strategy. These innovative approaches to partnership working supported by estate solutions will see strategic enhancements to our estate that complement our needs for the next five years. This also directly supports the strategic work being undertaken by Sir Robert Naylor, centre for estates efficiency and the One Public Estate initiative.

Dementia Village A number of recent reports have highlighted the shortcomings in the current provision of dementia services in the UK. Dementia presents a huge challenge to society, both now and increasingly in the future. In 2015 there were 850,000 people living with dementia in the UK, by 2025 this will have grown to 1,142,677. Dementia now costs the UK economy £26.3 billion a year, with this figure set to rise. The high number of people living with dementia is also placing a burden on the Trust in terms of capacity, decreasing efficiency and increasing costs. In 2015 there were 6,667 beddays lost to dementia patients who were on the caseload of the integrated discharge team (IDT) team, this equates to a total of 18 beds. New financially sustainable methods of providing nursing care for patients living with dementia will be vital if the challenges presented by the rapidly increasing elderly population are to be addressed. The Trust’s has identified an opportunity to build a bespoke dementia village on its land adjacent to the Trusts new Buckland Hospital in Dover.

The Trust is working with a range of partners both in the UK and overseas to bid for EU capital so as to facilitate the construction and operation of the facility at Dover in addition to a range of supportive facilities in other locations such as “Guest house with care” facilities in Maidstone, Kent, New Zealand, Holland and a mobile support unit in Northern France. The Trust’s application is at an advanced stage with expected funding outcome to resolved by December 2016. Following this date an application for planning consent will be submitted with work beginning in 2017.

Primary Care Co-Location In order to support care integration across primary and acute sectors the Trust has been working with primary care providers to collocate GP practices on our hospital sites. These talks are in advanced stages with local primary care providers in and around the Canterbury area and agreement has been reached to locate a new practice on the Kent and Canterbury Hospital site. The practice and Trust are being supported by NHS England and NHS property services and hope to be able to submit a planning application in late 2016 or early 2017. As a result the Trust benefits from having primary care services provided on its site and therefore may receive support on referrals being made to the hospital. The practice will in turn have access to diagnostic and pharmacy facilities in addition to replace older GP buildings with a newly built facility capable of providing care to the current community and future needs.

6.1 Current and Future Strategic Initiatives Rehabilitation Facilities The clinically led models of care that the Trust needs to provide in the future are highlighting that significant numbers of patients remain in hospital that could be discharged and or cared for in more suitable environments, this is also true of the national picture. We know that some patients would receive better care and enhanced speed of recovery if there was access to dedicated rehabilitation facilities. The Trust has begun exploring the opportunity to co-locate and partner with sector specialists in rehabilitation and is assessing which patient groups would benefit from this approach to care. Although this is early strategic work, the Trust sees this type of innovative approach to care as an important development in Health and is supportive of exploring this fully in 2016/17.

6.1 Current and Future Strategic Initiatives Private Patient Services The Trust currently supports the private patient market through its ownership of the Spencer Private Hospitals. The Spencer Private Hospital in Margate is a purpose built hospital located close to the Accident & Emergency units at the Queen Elizabeth The Queen Mother Hospital in Margate (QEQM). The unit has its own High Dependency Unit and access to Intensive Care facilities. The Spencer Private Hospital in Ashford is located within the Arundel Unit building of the William Harvey Hospital in Ashford (WHH) and includes Consulting Rooms, a treatment room, audiology services and outpatient Physiotherapy. The hospitals offer consultant appointments in all of the major specialities including Ear Nose and Throat, Maxillo Facial, Dermatologu, Ophthalmology, Gynaecology, Paediatrics, Allergy, General Surgery, Urology, Pain and Orthopaedics. The Spencer Private Hospitals see over three and a half thousand in-patients and ten and a half thousand outpatients each year. More than half the procedures undertaken for patients are of an orthopaedic nature which is directly meeting the needs of the service users in our demographic area. The Trust sees the expansion of private health services as a key opportunity and is looking to expand its offering at the William Harvey site in addition to opening services at the Kent and Canterbury Hospital, Canterbury.

Clinical reconfiguration This interim estate strategy is not intended to articulate in detail the potential estate options arising from the intended 2017 public consultation. Having said this, the Trust continues to work with its clinicians, Clinical Commissioning Groups (CCGs) and other health and social care providers to focus possible options into clearer choices for consultation next year. The leaflet Better Health Care in East Kent – time to change, provides more information into this work As outlined in section 1.05 of this strategy, there are complex national and regional pressures which are indicating that the Trust will need to consider what services are provided from which locations in the future and how these can be sustainably safe and affordable. One option for example is suggesting that we can centralise some services where they can provide the best care and outcomes and crucially where they can be staffed and managed safely.

Some emerging thinking being led by the East Kent Strategy Board suggests that the Trust should reconfigure services into a model that includes more care in the community and reconfigured hospitals sites to include:

One Emergency Hospital Centre with

Specialist Services

One Emergency Hospital

One Planned Hospital This thinking is based on a set of assumptions including:

Reduction of c300 beds (based on patient acuity modelling)

Co-locating specialist services

Consolidating high volume planned care

Funding Opportunities to support future needs As part of our work to develop future reconfiguration options the Trust has begun to explore capital funding opportunities. The Trust has submitted a capital bid for £100m to central funding as part of the STP (Sustainable Transformation Plan) submission process. This sum would allow the Trust to deliver on its immediate 3 year horizon estates needs and move our hospitals towards the three reconfiguration options outlined above. The £100m is very unlikely to be sufficient to allow other best practice aspirations for our sites including more single en-suite rooms and backlog eradication. In addition to the STP submission and to help in the event of a lack of available capital across the whole health economy the Trust is also working on options to access capital through the use of its own assets. Whilst the Trust has disposed of surplus assets to date as part of its rationalisation program we do need to look at how we own our assets and whether these could be better financed to unlock working capital.

6.1 Current and Future Strategic Initiatives The Trust has undertaken a review of potential Strategic Estates Partners (SEP) who could support the Trust in the long term, these would support our existing Public Estate Partnership with Kent County Council by helping to deliver individual (or larger) projects through Joint Ventures. Trust has also commissioned Deliottes to support the Trust on capital releasing opportunities arising from the Trusts 500 residential units, based on all three main sites. Additionally the Trust as part of the East Kent Strategy Group is working with partners and KCC to understand what opportunities might be available, Kent and Medway wide, from the use of Bonds, particularly given the whole system capital needs required for infrastructure across Kent as a whole.

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