1.7 CHI commented favourably on the design of the new hospital in October 2002.3 It considered the design helps to facilitate clinical pathways for the treatment of patients and had flexibility to accommodate additional facilities. The local Primary Care Trust (PCT) commented that no major design issues had been raised by GPs or patients. The new hospital was considered to have good ward layout, quality of lighting and direction finding.
1.8 Despite CHI's positive design evaluation, clinical staff raised some concerns with us. They were concerned in the early days that the Accident and Emergency (A&E) Unit had problems of crowding and unacceptable waiting times. The Trust has addressed these problems and since March 2004 is one of the top performing Trusts in England.
1.9 Clinical staff also felt that it had been difficult to envisage what design plans would mean in practice. They suggested that it would be helpful for clinicians if scale models of designs were produced to diminish the risk that the actual design is different to expectations. Detailed drawings of proposed facilities were made available to clinical staff during the consultation process. It is now standard practice to use computer aided design (CAD) to help clinicians visualise what a hospital will be like to work in.
1.10 As noted in our earlier report on this deal the bed capacity in the new hospital of 400 in-patient beds (a reduction from the 475 beds which the Trust had previously in use) had been proposed by the then Regional Health Authority and was broadly consistent with NHS policy guidelines for new hospitals at the time.
1.11 After the new hospital opened, the Trust suffered some adverse press comment on the performance of the A & E Unit and also from a perception by some users of the hospital that the bed numbers were insufficient. The Medical Director informed us that after the move to the new hospital there were clinical concerns that an increase in emergency admissions had caused some deferrals of elective surgery admissions because beds were taken by the emergency admissions. This was dealt with by increased productivity, changes in clinical practice and reductions in delayed transfers to care. New additions to the A&E department, to address recent changes in GP out of hours services, were completed in August 2004 and are now fully operational. These additions were built as a conventionally funded variation to the project.
1.12 There was also a reduction in confidence by local GPs in the ability of the new hospital to cope with the demand from patients. Some GPs then increasingly referred patients to London hospitals. Intermediate care, those facilities and services which patients can be referred to by GPs rather than going to a hospital, struggled to cope with the effects of the reduction in bed numbers as other local facilities had not been sufficiently built up to cope with the reduction in beds. The local PCT commented to us that, with hindsight, intermediate care facilities should have been built up 18 to 24 months prior to the opening of the new hospital. Confidence in the new hospital has returned, evidenced by a decrease in the levels of activity being referred to London. The bed numbers at the hospital have been increased to around 420.
1.13 A view that was consistently expressed to us was that developing and implementing the PFI deal had taken up a lot of management time reducing focus on the other day-to-day responsibilities and ongoing strategic direction of the Trust. The Department recognises this and advises Trusts to identify adequate project management resources and also acknowledges that there is a difficult balance to be struck by Chief Executives managing a PFI deal as well as day to day operations of the Trust.
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3 CHI Clinical Governance Review, October ‘02.