January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
The reduction in A&E att income has been based on data from WMAS
The reduction in NEL income has been calculated using 80% achievement of the Best Practice Tariff
The reduction in excess bed day income has been calculated using an average trimpoint of 51 days
This catchment loss modelling and underlying assumptions will need to be further tested and
modified prior to identifying a preferred option and using the ambulance flow modelling work
when this is available. For example, the ‘income change’ indicated is a gross change and has
not been adjusted for cost changes or mitigating transitional funding arrangements.
8.2 Capacity
In terms of implications for capacity the following assumptions have been used in order to
identify the ‘worst case scenario’ in terms of potential capacity required: These include:
No catchment loss and so continuing with current activity levels.
Continue with current length of stay i.e. an average of 29 days for patients who have
had a stroke.
In addition diagnostic capacity was considered and specifically the need for the
Hyper-Acute stroke service to be located on a site with 2 CT scanners in order to
ensure continuity of service if a CT scanner is unavailable. This is considered
essential as a CT scan is one of the key diagnostic tools that has to be provided at a
very early stage in the patient pathway in order to identify if thrombolysis is
appropriate and allow this to be delivered within the required timescale to maximise
the patient outcome.
A high level design brief based on the short listed options and the above capacity
requirements was provided by clinical and operational leads for consideration of potential
capital refurbishment requirements and an initial scoping study.
The capacity required in summary is:
o The site with the Hyper-Acute Stroke Unit requires 2 CT scanners.
o The functional content of all options includes 33 acute beds on one site (which is
comprises 17 acute short stay beds; 7 acute neuro beds; 8 monitored beds and 1
Transient Ischaemic Attack (TIA) assessment bed/trolley) and 50 Rehabilitation beds.
This is considered ‘a worst case scenario’ in terms of beds numbers and would need
to be refined for the next stage of work including a clearer view on targeted lower
length of stay and probable catchment loss.
The Capital Projects Team used the high level design brief to identify the potential capital
investment required under each option. The initial outcome of this high level work suggests:
a capital investment of up to £2.5 million may be required for the options with acute
services consolidated at City Hospital. This is based on identifying the space required
for the number of beds identified and assumes some form of refurbishment to this
space is needed e.g. to meet enhanced bed head requirements for the monitored
beds and also to improve the ward environment e.g. additional en suite bathrooms.
City Hospital currently has 2 CT scanners and so an additional scanner would not be
required.
a capital investment of up to £5 million may be required for the options with acute
services consolidated at Sandwell Hospital. This is based on identifying the space
required for the number of beds identified and assumes some form of refurbishment
to this space is needed e.g. to meet enhanced bed head requirements for the
monitored beds and also to improve the ward environment e.g. additional en suite
bathrooms. In addition Sandwell Hospital currently only has 1 CT scanner and so an
additional scanner would be required.
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