January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
These costs are high level estimates made by applying actual refurbishment costs by m2
from a recent refurbishment of similar areas. The capital investments proposed to support the
reconfiguration need to be considered in conjunction with the Trust’s strategy to centralise
acute inpatient services at the Midland Metropolitan Hospital (MMH). Therefore, the
estimated capital costs allow for appropriate refurbishment of areas of current estate to
support service delivery for the time between now and planned move to the MMH. Issues
such as BREEAM and backlog maintenance are being addressed through the agreed
strategy.
This analysis suggests there is a greater capital cost for the options with the acute stroke
services based at Sandwell Hospital in the order of an additional £2.5 m. This is due to the
need for an additional CT scanner at Sandwell Hospital. It should be noted that one of the CT
scanners based at City Hospital is due to be replaced in the next 12-18 months and the view
has been expressed that this could be located at Sandwell rather than City Hospital. The cost
of replacing the CT scanner at City would be in the order of £2.2m (based on the outturn cost
for the last replacement) and so if this is taken into account the difference between Sandwell
and City options reduces to £0.3m.
The initial study also suggests that it is not possible to meet the identified bed numbers for
the options with acute stroke services based at Sandwell Hospital -for option 3b and 6b there
would be a short fall of 1 rehabilitation and 9 acute beds. However, the bed numbers as
previously explained assume the current length of stay which would reduce under a new
service model to an average of circa 21 days and therefore 13 less beds would be required.
Emerging evidence from similar reconfigurations would support this reduction in length of stay
and in some cases even greater reductions are being seen.
The next stage of more detailed work would be an assessment of the reduction in length of
stay, including how this will be achieved and linking to the Trust’s Transformation
Programme, which will then generate a more robust estimate of required bed numbers. In
addition more detailed surveys of the current condition of estate being considered as part of
the reconfiguration need to take place in order to identify the actual refurbishment required to
meet the design brief. It is likely that together these will reduce the refurbishment costs. Also
the timescale for any refurbishment work will be reviewed as part of the next stage of
planning and consideration will be given to phasing of the work to ensure it first with the
Trust’s overall capital programme.
It should be noted that if a capital investment of £3million or more is required it will be
necessary to submit a case to the SHA for approval of this investment.
In summary the work to date suggests all options require a capital investment although the
level identified is likely to be reduced as a result of work to reduce length of stay and
therefore bed numbers and the more detailed surveys into the actual condition of the current
estate. Also the variation between the options is due to the need for a 2 nd CT scanner at
Sandwell Hospital. Given this could be installed on the basis of one due to be replaced at City
Hospital (this would leave 1 CT scanner at City and 2 at Sandwell) the difference between the
options can be argued to be £300 000 which is due to additional refurbishment work that
would be required to convert an existing area within the Imaging Department at Sandwell to
accommodate the 2 nd CT scanner. Therefore given the high level nature of the work to date
and the potential difference between options of only £300 000k it is questionable whether
there is sufficient evidence to exclude any of the short listed options at this stage on the
grounds of the capital investment required.
8.3 Revenue Costs
The initial high level analysis of the medical staffing implications associated with the proposed
reconfiguration suggests there will be no additional medical staff revenue costs associated
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