2.4 neurosurgery bjc 3 - cardiff and vale university ... 4... · • bjc 3 – reconfiguration of...

FOR DECISION

BJC3 - Neurosurgery of 23 Strategic Planning Committee 16 December 2010]

AGENDA ITEM 2.4

16 December 2010

Neurosurgery BJC 3 – Provision of Additional Related Works at UHW to Facilitate the Development of Safe and Sustainable

Neurosurgery Services for Mid and South Wales

Report of

Director of Planning

Paper prepared by Director of Planning

Executive Summary

This BJC is the third of three documents, which sets out the essential capital requirements to take forward the development of safe, high quality and sustainable neurosurgery services for Mid and South Wales at UHW, following the interim transfer of emergency and complex neurosurgery from Swansea in July 2009, and the subsequent Axford Report in October 2009. In essence the preferred option will:-

• Bring all neurosurgery and neurology

inpatient and day treatment services together in one location, in close proximity to theatre and critical care facilities

• Create additional critical care beds • Create new office accommodation to

support the transfer of Consultant Neurosurgeons from Morriston Hospital

• Provide teaching facilities in close proximity to the dedicated neurosurgery theatres, with IT links between the seminar room and theatres

FOR DECISION


WAG is requested to fund the capital element of the BJC. The activity and resource implications relating to the BJC are contained in a paper prepared by the Specialist Services Division. It takes into account the transfer of neurosurgery from Swansea, delivery of RTT and other clinical risk and quality issues relevant to the service and the Axford recommendations. This paper forms the basis for discussions with WHSSC regarding the necessary activity and resources to support the service.

Action/Decision required

To approve the BJC for Submission to WAG

Link to other Board Committee (s) and sub-committees

August 2009 – report to the former C+V Trust re: interim transfer of services from Swansea October 2009 – report to the Board re: taking forward Axford recommendations and position statement re: transfer of neurosurgery from Swansea March 2010 – Approval of Neurosurgery BJC 1 – Development of Theatre Facilities and BJC2 - Development of 2 wards at UHW

Link to Standards for Health Services in Wales

1 Governance and accountability framework 6 Participating in quality improvement activities 7 Safe and clinically effective care 8 Care planning and provision 12 Environment 13 Infection prevention and control and decontamination 16 Medical devices, equipment and diagnostic systems

Link to Public Health Agenda

None

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Link to UHB Strategic Direction and Corporate Objectives / Legislative and Regulatory Framework

Improving the quality, safety and outcomes of care Improving access to planned and emergency hospital treatment when required

Link to relevant evidence base

Axford Report (October 2009) James Steers Report (2008)

Neurosurgery BJC 3 – Provision of Additional Related Works at UHW to Facilitate the Development of Safe and Sustainable

Neurosurgery Services for Mid and South Wales

INTRODUCTION This BJC is the third of three documents, which sets out the essential capital requirements to take forward the development of safe, high quality and sustainable neurosurgery services for Mid and South Wales at UHW, following the interim transfer of emergency and complex neurosurgery from Morriston in July 2009, and the subsequent Axford Report in October 2009. • BJC 1 - additional 2 theatres in Tower Block 3 (approved in August

2010) • BJC 2 – additional 2 wards in Tower Block 3 (approved in August

2010) • BJC 3 – reconfiguration of inpatient facilities, provision of additional

critical care beds, teaching facilities and office accommodation (the subject of this BJC)

The activity and resource implications relating to the BJC are contained in a paper prepared by the Specialist Services Division. It takes into account the transfer of neurosurgery from Swansea, delivery of RTT and other clinical risk and quality issues relevant to the service and the Axford recommendations. This paper forms the basis for discussions with WHSSC regarding the necessary activity and resources to support the service.

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The Service Planning Committee is asked to approve the BJC prior to its submission to WAG for approval and funding of the capital elements of the BJC. BACKGROUND In July 2009, complex and emergency neurosurgery services were transferred on an interim basis from Morriston Hospital to UHW. In October 2009, the Minister for Health and Social Services issued an instruction requiring the implementation of the recommendations of the Mid and South Wales Neurosciences Implementation Planning Group (the Axford Report) as a matter of urgency. A report was submitted to the Board in October 2009, identifying proposals to drive forward the implementation of the Axford recommendations, and including a position statement on the transfer of the unscheduled neurosurgery service from Swansea. In advance of this, a report had been submitted to the former Cardiff and Vale NHS Trust in August 2009 on the interim transfer of services from Swansea. In order to develop the neurosurgical unit at UHW, it was acknowledged that there was an urgent need to increase both inpatient and theatre capacity at UHW as set out in the needs assessment section of BJCs 1 and 2. A suitable location for creating additional inpatient and theatre facilities was identified in Tower Block 3 which is in close proximity to existing theatre, critical care unit and inpatient facilities. BJCs 1 and 2 were approved by the UHB Board at their meeting on 23 March 2010 and subsequently formally approved by WAG in August 2010. At the time of their submission, the full implications of the transfer of neurosurgery services from Swansea, and its impact on the existing service at UHW, was still being worked through. The intention was that once this had been established, BJC 3 would set out the case for reconfiguring both the existing facilities, and also the new accommodation where necessary, to meet the identified requirements for the provision of a safe and sustainable neurosurgery service at UHW. As part of this process, and within the context of the development of the UHB’s Bed Capacity Plan, the current use and allocation of the ward areas and theatres has been reviewed with a view to ensuring the optimum utilisation of the facilities, both existing and new. The outcome of this review has identified the capital works required to reconfigure inpatient facilities to create an enhanced neurosurgery unit which will deliver the activity implications relating to the transfer of services from

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Swansea, the achievement of RTT targets and the implementation of Axford. PROPOSED DEVELOPMENT In essence the preferred option described in BJC 3 will:- • Bring all neurosurgery and neurology inpatient and day treatment

services together in one location, in close proximity to theatre and critical care facilities

• Create additional critical care beds • Create new office accommodation to support the transfer of

Consultant Neurosurgeons from Morriston Hospital • Provide teaching facilities in close proximity to the dedicated

neurosurgery theatres, with IT links between the seminar room and theatres

In order to achieve this, the preferred option is made up of a number of intricately related and dependent elements which will enable the current inpatient accommodation, to be reconfigured in a way that will efficiently utilise the facilities available to support the development of a cohesive and integrated neurosurgery unit within the neuroscience service at UHW. As indicated previously, the proposals in this BJC reflect the outcome of the internal service review and will support the development of the neurosurgery unit at UHW. COSTS The breakdown of funding sought from WAG is as follows:- Cost

(£’000) Capital costs (including VAT)

5,407

Depreciation 5 Impairment 5,137

Total 10,549 N.B. Impairment figure subject to valuation by the District Valuer when

asset is first brought into use

FOR DECISION


The revenue consequences of the consolidation of neurosurgical services at Cardiff and Vale UHB have been recognised by the newly established Welsh Health Specialised Services Committee. These costs were agreed for the year to date, i.e. 2009/10 between the Abertawe Bro Morgannwg University Health Board, Cardiff and Vale UHB and the former Health Commission Wales. An exercise has been undertaken within the UHB to identify the future service model to implement the Axford recommendations along with the consequent activity and resource implications to support a sustainable service. This paper forms the basis for discussions with WHSSC regarding the necessary activity and resources to support the service. Swansea

Transfer £’000

RTT £’000

Axford £’000

TOTAL £’000

Ward Costs 1,185 151 350 1,686 Critical Care 557 - - 557 Medical Costs 441 37 68 546

Theatres & ISAT 715 206 - 921

Support Services 234 57 360 651

Equipment 73 27 - 100 TOTAL 3,205 478 778 4,461

TIMESCALES The key phases and milestones for the overall project are summarised below:-

Milestone Activity Target/Start

Date Completion

Date Technical and Operational

Commissioning Completed

Completion of BJC 3 and informal submission to WAG

December 2010

- -

WAG Approval January 2011

- -

Helipad Store Early 2011 Autumn -

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CONCLUSION Subject to approval by the Service Planning Committee, the BJC 3 will be submitted to WAG for approval and funding of the capital elements of the BJC. The BJC will also be submitted to the UHB Board for ratification. The activity and resource implications will be subject to discussions with WHSSC. RECOMMENDATION The Committee is asked to:

• APPROVE the Business Justification Case prior to its submission to WAG for approval and funding of the capital elements of the BJC

2011 SAC4 Offices Early 2011 Autumn

2011 -

Surgical Assessment Unit (EU)

Early 2011 Autumn 2011

Autumn 2011

Additional Critical Care Beds (Ward A3 Link)

Autumn 2011

Spring 2012 Spring 2012

Ward C5 works Spring 2011 Spring 2011 Spring 2011

Ward B4/C4 Reconfiguration

Spring 2011 Winter 2011 Early 2012

Fit out of office suite and seminar room (Theatre Floor 3 TB3)

Early 2011

Spring 2011 -

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IMPACT ASSESSMENT Health Improvement

A number of benefits are anticipate, which will result in health improvements for service users as a result of improved environments and ward layouts. The scheme will facilitate the development of safe and sustainable neurosurgery in line with the Axford Report

Workforce

The development will enforce the UHB vision - skilled and committed staff will provide safe, high quality care, at the right time and in the right place. The workforce implications have been identified within the Activity and Resources Implications Paper, which forms the basis of discussions with WHSSC

Education and Training

The development of a single neurosurgery unit at UHW supports the continued education and training of medical staff

Financial

The UHB is seeking funding from WAG for the capital costs associated with the development. The activity and resource implications associated with the development have been identified and will form the basis of discussions with WHSSC

Legal

The capital planning process utilised in developing the scheme will be undertaken in accordance with the organisation’s governance requirements

Equality

The design process has been informed by equality considerations and relevant groups have been consulted throughout the design process

Environmental

As part of the capital planning process a full environmental impact assessment will be undertaken

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RISK ASSESSMENT Clinical/Service

The transfer of complex and emergency neurosurgery services from Swansea has placed the current service under extreme pressure. The proposals contained within the BJC will complete the capital solution to support a safe and sustainable service at UHW. The development of a service model which will deliver the Axford recommendations has been set out in the Activity and Resource Implications paper. This will form the basis of discussions with WHSSC

Financial

The revenue implications associated with this development have been identified and are the subject of discussions with WHSSC

Reputational

The Axford Report recommended a single neurosurgery unit for Mid and South Wales and the Minister for Health and Social Services has instructed the urgent implementation of the new model. Failure to progress and achieve this will have significant implications for both the organisation and NHS Wales as a whole

Acronyms and abbreviations

UHB – Cardiff and Vale University Health Board WAG - Welsh Assembly Government BJC – Business Justification Case UHW – University Hospital of Wales WHSSC – Welsh Health Specialist Services Committee RTT – Referral to Treatment EU – Emergency Unit TB3 – Tower Block 3

CONSULTATION AND ENGAGEMENT The development of a single neurosurgery unit at UHW has been subject to wide consultation and engagement as part of the development of the Steers and Axford Reports.

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A Local Implementation Group was set up to drive forward the recommendations of the Axford Report and in particular the provision of a safe and sustainable neurosurgery service at UHW. Membership of this group included representatives from neurosurgery, neurosciences, critical care, theatres, radiology, finance and planning. Consultant neurosurgeons from Abertawe Bro Morgannwg are also represented on this group. SOURCES OF INFORMATION Report of the Welsh Neuroscience External Review Group (Steers Report) – September 2008 Mid and South Wales Neurosciences Implementation Programme (Axford Report) – October 2009

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PROVISIONOF ADDITIONAL RELATED WORKS AT UHW TO FACILITATE THE DEVELOPMENT OF SAFE AND SUSTAINABLE

NEUROSURGERY SERVICES FOR MID AND SOUTH WALES

Business Justification Case (Introduction and Economic Case only)

1. INTRODUCTION/PURPOSE

This Business Justification Case seeks approval for the provision of additional related works at UHW to facilitate the development of safe and sustainable neurosurgery services for residents of Mid and South Wales, which are consistent with the recommendations of the Axford Report, published in October 2009. The breakdown of funding sought from WAG is as follows:- Cost

(£’000) Capital costs (including VAT)

5,407

Depreciation 5 Impairment 5,137

Total 10,549 N.B. Impairment figure subject to valuation by the District Valuer

when asset is first brought into use This BJC is the third of three documents, which sets out the essential capital requirements to take forward the development of safe, high quality and sustainable neurosurgery services for Mid and South Wales at UHW following the interim transfer of emergency and complex neurosurgery from Morriston in July 2009 and the subsequent Axford Report in October 2009. In brief, while an interim solution has been put in place to enable the safe continuation of neurosurgery services in Mid and South Wales, this arrangement needs to be formalised urgently, to support the development of sustainable neurosurgery services at UHW. The need to increase both inpatient and theatre capacity at UHW was acknowledged and proposals for delivering this was set out in BJCs 1 and 2, which were submitted to WAG in January 2010 and approved. The BJCs identified and costed the advance

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capital work required, based on available forecast data, to provide additional inpatient and theatre facilities in Tower Block 3 which is located in very close proximity to existing theatre, ICU and inpatient facilities. This work began in the summer of 2010. At the time of their submission, the full implications of the transfer of neurosurgery services from Morriston Hospital, and its impact on the existing service at UHW, was still being worked through. The intention was that once this had been established, BJC 3 would set out the case for reconfiguring the existing facilities and also the new accommodation where necessary, to meet the identified requirements for the provision of a safe and sustainable neurosurgery service at UHW. As part of this process, and within the context of the development of the UHB’s Bed Capacity Plan and 5 Year Strategic Framework, the current use and allocation of ward areas and theatres has been reviewed with a view to ensuring the optimum utilisation of facilities, both new and existing. The outcome of this review has identified the capital works required to reconfigure inpatient facilities in Wards B4/C4 to create an enhanced neurosurgery unit, the achievement of which will require a number of enabling schemes. These will include proposed works within the A3 Link Ward, Emergency Unit, SAC4 and the Helipad Stores. The required work is described in more detail in the Economic Case. In essence the preferred option will:- • Bring all neurosurgery and neurology inpatient and day

treatment services together in one location, in close proximity to theatre and critical care facilities


Consultant Neurosurgeons from Morriston Hospital • Provide teaching facilities in close proximity to the dedicated

neurosurgery theatres, with IT links between the seminar room and theatres

In summary, the Business Cases prepared to support the required capital investment for the development of safe and sustainable neurosurgery services are as follows:- • BJC 1 - additional 2 theatres in Tower Block 3 (approved in

June 2010)

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• BJC 2 – additional 2 wards in Tower Block 3 (approved in June

2010) • BJC 3 – reconfiguration of inpatient facilities, provision of

additional critical care beds, teaching facilities and office accommodation (the subject of this BJC)

The revenue consequences of the consolidation of neurosurgical services at Cardiff and Vale UHB have been recognised by the newly established Welsh Health Specialised Services Committee. These costs were agreed for the year to date, i.e. 2009/10 between the Abertawe Bro Morgannwg University Health Board, Cardiff and Vale UHB and the former Health Commission Wales. An exercise has recently been completed within the UHB to identify the future service model to implement the Axford recommendations along with the consequent activity and resource implications to support a sustainable service. This paper is attached as Appendix 3 and forms the basis of discussions with WHSSC. The proposal to develop the project as 3 non-compliant BJCs has been agreed with the Head of Capital and Estates Division at WAG, in response to the urgency given by the Minister for Health to the development of safe and sustainable neurosurgery services at UHW.

3. THE ECONOMIC CASE 3.1 INTRODUCTION

In October 2009, the Minister for Health and Social Services wrote to Assembly Members confirming that the recommendations of the Mid and South Wales and the North Wales Neurosciences Implementation Planning Groups had been referred to the Chairs of the relevant Health Boards for Implementation. The Minister has indicated her expectation that the recommendations will be implemented as a matter of urgency.

While a safe interim emergency neurosurgery service transfer to UHW was implemented in July 2009, it is imperative that this

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arrangement is formalised, and a sustainable solution implemented as soon as possible, to ensure the continued safe provision of neurosurgery at UHW. In agreement with colleagues at the Capital and Estates Division at WAG, this BJC, and in particular the Economic Case, does not fully comply with the 5 Case Model. The Steers and Axford Reviews attached as Appendices 1 and 2, considered in detail the most appropriate configuration of neuroscience services within Mid and South Wales, including the location of the single neurosurgical unit and came to the conclusion that this should be at UHW. It is felt that the Steers and Axford Reviews should be considered as a proxy for the analysis of options that would normally be undertaken as part of the business case process. Membership of the Implementation Board chaired by Dr. Alan Axford and the Workstreams, included a wide range of clinicians, representatives from NHS Trusts, Health Commission Wales, the National Public Health Service, Federation of Community Health Councils in Wales and also organisations representing service users including the Wales Neurological Alliance and the Chair of the Stroke Service Improvement Programme. In order to develop the neurosurgical unit at UHW, it was acknowledged that there was an urgent need to increase both inpatient and theatre capacity at UHW as set out in the needs assessment section of BJCs 1 and 2. A suitable location for creating additional inpatient and theatre facilities was identified in close proximity to existing theatre, critical care unit and inpatient facilities. As this was the only option available for creating suitable additional facilities, it was considered neither useful nor possible to undertake an option appraisal as part of the economic analysis, as would normally be done as part of the business case process. BJCs 1 and 2 set out the case for constructing accommodation within Tower Block 3 at UHW to provide additional inpatient and theatre facilities, which will facilitate the development of the neurosurgery unit at UHW. These BJCs were approved by WAG in June 2010. At the time of their submission, the full implications of the transfer of neurosurgery services from Morriston, and its impact on the existing service at UHW, was still being worked through. The intention was that once this had been established, BJC 3 would set out the case for reconfiguring both the existing facilities, and also the new accommodation where necessary, to meet the

FOR DECISION


identified requirements for the provision of a safe and sustainable neurosurgery service at UHW. As part of this process, and within the context of the development of the UHB’s Bed Capacity Plan, the current use and allocation of the ward areas and theatres has been reviewed with a view to ensuring the optimum utilisation of the facilities, both existing and new. The outcome of this review has identified the capital works required to reconfigure inpatient facilities to create an enhanced neurosurgery unit which will deliver the activity implications relating to the transfer of services from Swansea, the achievement of RTT targets and the implementation of Axford, as set out in the earlier section on needs assessment. The capital solution is described in the following section. The revenue consequences of the consolidation of neurosurgical services at Cardiff and Vale UHB have been recognised by the newly established Welsh Health Specialised Services Committee. These costs were agreed for the year to date, i.e. 2009/10 between the Abertawe Bro Morgannwg Local Health Board, Cardiff and Vale UHB and the former Health Commission Wales. An exercise has been undertaken within the UHB to identify the future service model to implement the Axford recommendations along with the consequent activity and resource implications to support a sustainable service. This paper is attached as Appendix 3 and forms the basis of discussions with WHSSC. In agreement with the Head of Capital and Estates Division at WAG, this BJC will focus on the final proposed capital solution to facilitate the development of the neurosurgery unit within Cardiff.

3.2 PREFERRED OPTION In essence the preferred option will:- • Bring all neurosurgery and neurology inpatient and day

treatment services together in one location, in close proximity to theatre and critical care facilities


Consultant Neurosurgeons from Morriston Hospital

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• Provide teaching facilities in close proximity to the dedicated neurosurgery theatres, with IT links between the seminar room and theatres

In order to achieve this, the preferred option is made up of a number of intricately related and dependent elements which will enable the current inpatient accommodation, to be reconfigured in a way that will efficiently utilise the facilities available to support the development of a cohesive and integrated neurosurgery unit within the neuroscience service at UHW. The proposals will also enable the creation of additional critical care beds to support the neurosurgery unit, neurosurgery teaching facilities and office accommodation to support the Consultants transferred from Morriston Hospital. As indicated previously, the proposals in this BJC reflect the outcome of the internal service review and will support the development of the neurosurgery unit at UHW. The internal service review confirmed that in terms of functionality, it is crucial that:- • All neurosurgery inpatient facilities are located on the 4th floor, in

close proximity to main theatres and the critical care unit, which are both on the 3rd floor

• High care neurosurgery beds to be located as close as possible to the new neurosurgery theatres

• Neurosurgery and neurology inpatient and day treatment facilities to be co-located

• Teaching facilities are provided in close proximity to the dedicated neurosurgery theatre, with IT links between the seminar room and theatres

• Consultant neurosurgeons and support staff have office accommodation in close proximity to the neurosurgery inpatient facilities

The current situation is that neurosurgery has beds, including high care beds, on wards B4 north and south and neurology has beds on ward C4 north. As part of the interim transfer arrangements there are also neurosurgery beds located on ward C7, three floors above the main neuroscience inpatient facilities. Renal and thoracic beds are located in ward C4 south. The current configuration means that neurosurgery beds are scattered across UHW, creating problems for service delivery as described in

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Section 2.5.1 Service Issues/Problems with the Status Quo. The current and proposed configurations are shown below:- Current Ward Configuration of Neurosurgery and Neurology Services

North Neurosurgery

South Neurosurgery (including high

care beds)

NorthNeurology +

Neurosurgery beds

SouthThoracic, Renal + Neurosurgery

beds

Tower Block 3 New 4th Floor

Ward – allocated for neurosurgery

4th Floor Main Corridor

Ward B4 Ward C4

Ward C7 Neurosurgery beds located on a medical

ward

Tower Block 3 New 2nd Floor

Ward

Also:

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Proposed 4th Floor Ward Configuration and Associated Moves/Developments

In order to achieve the proposed co-location of all neurology and neurosurgery beds to support the service model, on the 4th floors of the main UHW building and Tower Block 3, and also accommodate additional ICU beds on the 3rd Floor, it will be necessary to relocate a number of inpatient facilities, office accommodation and stores within the UHW site. The capital works are described below:-

3.2.1 CO-LOCATION OF NEUROSURGERY AND NEUROLOGY ON 4TH FLOOR The proposals are shown below:- • the new ward area on the 4th floor of Tower Block 3 will be

configured to provide 14 high care neurosurgery beds. Costs contained within the approved BJC 2

• Renal beds currently accommodated on ward C4 south will transfer to new ward accommodation on floor 5 of Tower Block 3, provided as part of a separately approved scheme

• Thoracic beds currently on ward C4 south will transfer to ward C5, which will require some minor electrical works to accommodate them. The costs are contained within this BJC

• Reconfiguration of wards B4/C4 to support the developed neurosurgery service and enable neurosurgery inpatient

North Neurology

South Neurology

NorthNeurosurgery

SouthNeurosurgery

Tower Block 3 4th Floor Ward Neurosurgery

High Care Beds

4th Floor Main Corridor

Ward B4 Ward C4

Renal beds > TB3 5th Floor

Tower Block 32nd Floor Ward – Decant Facility to

facilitate neurosurgery

scheme, 5 Year Framework and

Bed Capacity Plan

Ward A3 Link, Main Building

Additional ICU beds, adjacent to main ICU department

Also:

Thoracic beds > Ward C5

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facilities to be co-located. The costs are contained within this BJC.

• Transfer of neurosurgery beds currently on ward C7 to newly configured B4/C4

This is summarised below:-

Proposed Use of Ward/Area

Ward/Area

Current Use Transfer current service to …

Capital works required High Care Neurosurgery beds

4th Floor ward, TB3

Newly constructed to provide 14 high care neurosurgery beds (BJC 2)

-

No additional work to be done

Decant facility to facilitate the neurosurgery scheme, the implementation of the 5 Year Framework and Bed Capacity Plan

2nd Floor ward TB3

Newly constructed to provide 22 beds as part of a decant ward (BJC 2)

-

No additional work to be done Neurosurgery beds Renal beds New ward on

5th floor TB3 Reconfiguration of accommodation Neurosurgery beds Thoracic

beds Ward C5

Reconfiguration of accommodation To remain neuroscience beds

Ward C4 south

Neurosurgery beds

To remain on C4

Reconfiguration of accommodation Renal beds New ward

on 5th Floor TB3

Newly constructed

-

Construction of new renal ward provided as part of a separate approved BJC Thoracic beds Ward C5 Medical beds C7 Minor works, mainly

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electrical Neurology/neurosurgery beds

Ward B4 south and north

Neurosurgery beds

Ward C4

Reconfiguration of accommodation Vacated beds to accommodate medical beds from ward C5

Ward C7 Medical and neurosurgery beds

Neurosurgery beds to ward C4

None

The original proposals in BJC 2 were to develop additional inpatient facilities on floors 2 and 4 of Tower Block 3. Having completed the internal review of beds and considered the activity and resource implications of the new service model, the preferred plan is to keep all neurosurgery inpatient services together on the 4th floor. The ward on floor 2 of Tower Block 3 will now be utilised as a decant ward to facilitate the neurosurgery scheme described in this BJC along with the implementation of the UHB’s 5 Year Strategic Framework and Bed Capacity Plan. It is proposed that the following services be accommodated in the new Tower Block 3 building:-

Floor Service 5th Floor Renal ward 4th Floor Neurosurgery – 18 Bed High Care Ward 3rd Floor 2 x dedicated neurosurgery theatres

Neurosurgery teaching facilities and consultant offices

2nd Floor Decant Ward 1st Floor Paediatrics Upper Ground Floor

Renal Outpatient Department

Ground Floor PET Service Lower Ground Floor

Cyclotron

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3.2.2 CREATION OF ADDITIONAL CRITICAL CARE BEDS The proposal to create an additional 4 x level 3 critical care beds will require the utilisation of part of the inpatient ward on the A3 link, which is located adjacent to the Critical Care Unit on Floor 3 of the main building, and currently used for medical inpatients. This will involve the reconfiguration of spaces in an area of this ward to accommodate the additional space and service requirements for critical care beds. A reorganisation of beds within the critical care unit will be required to maintain a safe level of supervision for the different categories of beds and it is proposed that the area in the A3 link be used to accommodate level 2 beds. In the long term it is proposed that when the paediatric critical care beds are transferred into new accommodation within the final phase of the Children’s Hospital for Wales in 2014, the critical care beds on the A3 Link Ward will be transferred back into the main critical care unit. The displacement of medical beds currently on the A3 Link will involve an intricate and dependent series of moves, the majority of which will require some level of capital works. The medical beds currently on the A3 link will be required to transfer to A1 link, which currently houses the Surgical Assessment Unit (SAU). It is proposed that the Surgical Assessment Unit will transfer from A1 link into the Emergency Unit. A number of smaller enabling projects will also be required to relocate offices and storage areas to create space in the EU for the SAU to be constructed. It is planned that the offices will relocate to the adjoining SAC4 building, with the transfer of the storage areas into space currently available beneath the Helipad. In summary, the moves involved are as follows:-

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Proposed Use of Ward/Area

Ward/Area Current Use Transfer current service to … Capital Works

Involved Critical Care beds

Ward A3 Link Medical beds Ward A1 Link

Reconfiguration of bed spaces to accommodate level 2 critical care beds Medical beds from A3 Link

Ward A1 Link Surgical Assessment Unit

Office accommodation in Emergency Unit

None

Surgical Assessment Unit from A1 Link

Offices/storage, EU

Offices/storage

SAC4/helipad stores

Creation of clinical area to accommodate SAU EU Offices SAC4 Offices/Storag

e Elsewhere on UHW site/ Helipad Stores Creation/

reconfiguration of office accommodation EU Storage Helipad Stores Storage No move

required Minor refurbishment works and extension

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3.2.3 CREATION OF OFFICE ACCOMMODATION AND TEACHING FACILITIES The neurosurgery capacity and revenue modelling exercise identified the need for an additional 4 consultants, to deliver the additional activity transferred from ABM and also the increased neurosurgical RTT requirements. It has not been possible to provide suitable office space close to inpatient services and this has caused significant problems for the consultants and the administrative service. The proposal is to fit out the shell accommodation adjacent to the new theatres in TB3 to provide office accommodation for the additional consultants and supporting secretarial staff. The shell accommodation will also provide the opportunity to fit out a seminar room with IT links to the dedicated neurosurgery theatres.

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