Estates Strategy2019-2024

An Associated University Hospital of Brighton and Sussex Medical School

Estates Vision• Our estate will be “smart”, accessible to all, in spaces that are easy to find, intuitive and fit

for purpose• We will make the working environment for our staff the best it can be.• We will develop our health campus with partners to enhance quality and access to care,

address gaps in current service provision and create an innovative hospital where people want to work

• We will work within our Integrated Care System to ensure that NHS estate is used to benefit the wider health economy

• All of our buildings will be utilised optimally, making use of flexible working and spaces, be environmentally friendly and meet all regulatory and compliance standards

• We will work to ensure that all areas of the hospital provide a temperature controlled environment that allows patients, visitors and colleagues to feel comfortable as they undertake their normal activities. We will be innovative in our approach recognising the greater temperatures that are being reached during summer months

• We will always listen to patients, visitors and colleagues as their experience will be invaluable in improving our hospital

• Everything we do will be done in a way that is a sustainable as it possibly can be, respecting the environment at all times

Our Estate

The trust owns East Surrey Hospital and the Earlswood Centre.

All other facilities where the Trust provides services estates are leased NHS Property Services.

East Surrey Hospital is a 697 bed hospital sitting within a 70 acre site. The site has expanded in recent years in part through collaboration with third parties such as Royal Surrey County Hospital and Guy's and St Thomas's.

The site provides significant potential for expansion and the Trust has applied for the hospital to be largely removed from the green Belt - it is expected that the result of this application will be available in Autumn 2019.

ContextModel Hospital MetricsThe model hospital provides comparative data for estates spend against a number of metrics and provides a comparison against other similar sized acute Trusts. Overall SASH performs well, demonstrating that it uses its resources and estate effectively.

Estates and facilities costs per weighted activity unit (a single unit of activity) are amongst the best in the country (8th best) and the best in our peer group. The metrics associated with square meterage tell a different story and we consider this to be due tohigh volumes of activity on a comparatively small estate. Key highlights from Model Hospital include:

StrengthsOverall costs per unit of activityGrounds and gardens maintenance spendFood costsLaundry and linenWater and sewerage costsLow levels of non clinical spaceLinen and laundry productivityCleanliness (patient led assessment)Dementia friendly environment – patient led

Opportunities for improvement EnergyFood – patient led assessmentDisability friendly environment – patient led scoreEnvironment at rented properties falls behind East Surrey HospitalPreventative Maintenance in some facilities/areas

We are taking a number of actions to address these – a key example of this is introducing a 24-hour shift system for the estates team which will reduce reliance on third-parties (and costs) as well as allowing maintenance to be undertaken out-of-hours more easily.

What do Patients and Carers want from our estate?The Trust population and demographic growth analysis detailed within the clinical strategy reinforces the need for our estate to be accessible/ sensitive to the following cohorts of patients:

• Patients with mental health difficulties (adults and children)• Frail individuals and those with neuro, physical and sensory disabilities • Patients with dementia and learning difficulties• Patients that are transgender• Facilities for families

• For any changes to our environment that we make and for any new developments we will consider how we make our areas accessible for all.

• We will engage our patients, local population and local experts within partner organisations to help us ensure we deliver against this objective.

• We know that our patients and visitors see accessing the hospital as a key part of their experience and we will ensure that parking and public transport access is as good as it can be. Of particular note is the need to increase disabled parking – the Trust is within recommended levels but demand exceeds supply.

• We will also work with our patients to develop and improve Trust signage both within and outside the hospital.

• We will work with Borough and County council colleagues to improve road access to the site

What do our People want from our estate?Feedback from colleagues raised some common themes:

• Access to quiet staff resting areas that are fit for purpose • Access to outdoor green spaces with facilities for keeping healthy e.g. outdoor gym, walking routes• Access to healthy refreshments both in and out of hours• Car parking, bicycle racks and a range of travel options

Our staff engagement exercise showed that half of the conversations about how to make SASH the best place to work focused on the environment being fit for purpose. Of this 18% of comments from staff related to the physical environment and 15% related to access.In responding to this the Trust will:• Review office space with a view to maximising the utilisation of existing space and creating a hot desking culture where

appropriate. This will be supported by flexible working practice supporting staff to work from home or in alternative locations.

• We will commit funds on an annual basis for the redevelopment of staff areas and staff initiatives that will improve the patient environment. This will be driven initially by the feedback gained through the best place to work exercise.

• Our ward based colleagues tell us that some of our staff facilities in clinical areas don’t provide an area conducive to a good working environment. As part of our Ward Improvement Programme we will ensure that we address staff as well as patient need.

• We will deliver a communications strategy that ensures staff are aware of the facilities for them and that they are accessible e.g. staff showers, bike racks, hot desk spaces

• Alongside our patients and visitors we know colleagues see accessing the hospital as a key part of their experience and we will ensure that parking and public transport access is as good as it can be. We need to look at innovative approaches to encouraging sustainable transport to work. We will also work with Borough and County council colleagues to improve road access to the site

The impact of growth in activity on our estateIn establishing the needs of our estate for the future we have developed a five year capacity and demand modelling tool.

It provides a “do nothing” approach to modelling and sets out ongoing needs for theatres, outpatient clinics, endoscopy suites, radiology equipment, staff car parking, patient car parking etc. The modelling provides us with a worst case scenario and is used to inform planning and strategic programmes which will mitigate delivery. Our clinical strategy describes this.

There will however, no doubt be additional needs for theatres, outpatient facilities, inpatient beds, office space. In planning for each year the impact of the strategic programmes aimed to reduce the growth in activity will need to be evaluated. Examples of these programmes include: the development of Primary Care Networks aimed at reducing non-elective activity, the outpatient programme aimed at reducing face to face outpatient appointments, the theatre productivity programme to increase utilisation in all our theatres. Other programmes that will need to be considered when undertaking ongoing planning will be external to SASH for example, potential new hospital being built in Sutton.

The Trust therefore acknowledges the worst case scenario but plans to work with the integrated care system to mitigate the need to expand further in the short term.

Estates Strategic ProgrammesIn considering benchmarking data, the needs of our patients and resident population, the STP areas of focus and the impact of our medium term strategic programmes the estates strategy has developed the following programmes:1. Continuous Improvement– Systematically assess and review new technology and equipment and invest in the estate to provide facilities to support the Trust in delivering high standards of clinical outcomes and patient experience. Standardise estate and accessibility of services for all patients and staff ensuring that all staff have access to clinical and office space as needed. Ensure existing services have sufficient space to deliver core services to deliver against the Trust’s plans.2. New developments– invest in and implement new developments in response to the Trust’s long term and annual clinical and corporate plans through an efficiently managed capital investment programme. Subject to planning permission and regulations and relevant partnerships the following services will be explored and new builds developed:• private patient unit• rehabilitation unit• mental health unit• unit for patients nearing the end of their lives and/or • innovations centre that would support innovation in healthcare and delivery of a far reaching education programme

including apprenticeships, new care models, and university programmes. Work with system partners to deliver integrated care exploiting the opportunities that co-location of teams the East Surrey Hospital site can provide.3. Backlog maintenance – to invest in specific schemes to address areas of the to ensure they are made fit for purpose and can be maintained routinely going forward. The next two slides show this in detail4. Managing tenanted property – to work with NHS Property Services to ensure that our tenanted properties are maintained and utilised to the same standards as East Surrey Hospital5. Sustainability – to ensure the Trust uses energy in a sustainable way and to use innovative approaches to provide a temperature-controlled environment for patients, visitors and staff.

Backlog Maintenance part1Location Item Cost £000

High RiskSite High-Voltage High-Voltage Network needs Upgrading £3,000,000Site CCTV Upgrade to CCTV £90,000Main Kitchen Fridges Kitchen Fridge Upgrades £120,000AngioLab Uninterrupted Power Supply Angio Lab UPS Upgrade £40,000Site Building Management System BMS Upgrade £700,000Site Fire Alarm Fire Alarm Upgrade £600,000Site Fuse Boards Fuse Board Replacements £250,000Site HSDU Upgrade of HSDU Equipment £1,500,000HQ Heating Trust HQ Boiler Replacement £80,000Site Chillers Main Hospital Chillers Replacement £1,200,000Site Autoclave New Autoclave £40,000Site Fire dampers Fire Damper Upgrades £100,000Site Emergency Light Emergency Lighting Upgrades £250,000

Total £7,970,000

Significant RiskSite Access Control Improved site lockdown £150,000Site Isolation Rooms Air Handling Unit Upgrades £100,000Site Bin Stores Upgrade Bin store Locks £400,000Mortuary Environment Mortuary Upgrade £50,000Grounds Waste Compound New Waste Compound £400,000Site Generator Second Main Generator £2,000,000Site Chaldon Ward Drainage re-routing £250,000Mortuary Fridges Upgrade to mortuary Fridges £20,000Pathology 1st Floor Air Handling Unit Ground floor Pathology AHU Needs Replacing £600,000Mortuary AHU Mortaury AHU Needs Replacing £400,000Pathology 2nd Floor AHU First floor Pathology AHU Needs Replacing £600,000Phase one AHU AHU for Hospital Phase One needs replacement £1,000,000Phase one Domestic Hot Water Domestic Hot water Pipe Need Upgrading £500,000

Total £6,470,000

Backlog Maintenance part2Medium RiskSite Medical Gases Create Oxygen pipework ring £100,000Wards Nurse Call System Upgrade some nurse call stations £150,000Site Fire Door Replace Fire doors £50,000Phase one Electrical Panel boards Phase 1 Replace electrical Panel Boards £1,000,000Phase two Electrical Panel boards Phase 2 Replace electrical Panel Boards £1,000,000Phase Three Electrical Panel boards Phase 3 Replace electrical Panel Boards £60,000Site Car Park Car park surface replacement £250,000Site Car Park Car park drainage upgrade £250,000Plantrooms A&E AHU Roof access A&E AHU Roof access upgrade £30,000

Site Variable Refrigerant Volume (gas powered) Chiller Replacement (17 remote) £1,700,000

Plantrooms Endoscopy Endoscopy AHU Roof access upgrade £30,000Phase one plantrooms All Plant rooms A&E AHU Roof access upgrade £50,000Phase two Ventilation Phase 2 AHU replacement £1,000,000Site Radiators Radiator Upgrades £20,000Site TMV's Thermostatic Mixing Valve Upgrades £20,000Site Water systems Removal of of remaining water dead legs £50,000

Total £5,760,000

Low RiskSite Public Toilets Public Toilet Upgrades £150,000Courtyards Trip hazards Courtyard Surface Upgrades £50,000Site Flooring Replace main hospital corridor £100,000Site Car Park Increase car park size £140,000Site Medical Gases Upgrade Medical Gas locks £3,000Site Medical Gases Medical Gas Upgrades £100,000Grounds Helipad Upgrade Helipad £500,000Site Lifts Lift Upgrades £500,000

Total £1,543,000

OtherSite Theatres Two new theatres £8,000,000

Total £8,000,000

Total £29,743,000

Carbon, Environment and Energy• It is essential that the Trust ensures it has sustainable energy.• From being part of East Surrey & Sussex STP the Trust is using the Countess of

Chester NHS-Carbon Energy Fund framework to provide a fully funded service solution that addresses the ‘carbon, environmental and energy’ performance of the Trust.

• This delivers performance and availability guarantees as well as guaranteed financial savings.

• Bids will include measures that reduce the cost and the consumption of energy, increase resilience and address critical risk backlog as well as delivering significant cash release over the term of the contract.

• One of the key elements of this is a new Combined Heat and Power (CHP) supported energy centre – it is anticipated that this can be implemented by summer 2021.

• The project will also address a number of critical infrastructure updates across the estate

Conclusion –“We found the overall standard of the built environment to be very high… “

• The Trust has moved a long way in the last ten years with significant investment across the hospital – this was recognised by the CQC who made the statement above

• Whilst reassuring, this helps to focus on how much needs to be done to ensure that everywhere in the hospital is of an equally high-standard and stays that way.

• The Ward Improvement Programme needs added momentum so that all wards provide the same high standards of accommodation

• We must focus on improving energy efficiency as well as addressing rising temperatures and their impact on our patients and colleagues

• We need to be innovative in our use of space and embrace new ways of working – SASH+ will be a key element in that approach

• We will develop a five-year implementation plan for this strategy• We will make East Surrey Hospital the most patient, visitor and colleague

friendly hospital it can be, and it will be recognised as such.