Summarising the Need for Change Stobhill Hospital The following table summarises the need for change. What is the cause of the need for change? What effect is it having, or likely to have, on the organisation? Why action now: Dislocated service – both clinically and physically Existing service arrangements leave the service dislocated and vulnerable to risk and also challenge effective management of and medical rota provision Service sustainability will be at risk if this proposal isn’t implemented now Ineffective service arrangements Inefficient service performance Continuation of the existing service performance is unsustainable Service arrangements not person centred Service is not meeting user requirements e.g. no access to single rooms with en-suite resulting in little privacy or ‘own space’ which is not conducive to providing a therapeutic environment and recovery. The facilities are in a busy noisy congested public area without proper outdoor space or greenery to promote well-being. A service that isn’t meeting user requirements is unsustainable, even in the short term Accommodation with high levels of backlog maintenance and poor functionality Increased safety risk from outstanding maintenance and inefficient service performance. Building condition, performance and associated risks will continue to deteriorate if action isn’t taken now Impact on staffing and additionally on out of hours Increased safety risk due to desirability and location of accommodation impact on recruitment Service sustainability and retaining existing staff when other opportunities on site present will be at risk if this proposal isn’t implemented now
Investment Priority: Person Centred It will provide a therapeutic environment supporting privacy and dignity for the patient, enhances focused care peace and calm (restful night’s sleep, own space not in a dormitory with other patients disturbing them, peace to read a book and watch TV) Direct access to own toilet and shower. Access to outdoor green space which offers peace and relaxation. Patient satisfaction surveys No. of serious clinical incidents Mental welfare Commission Reports feedback Safe Enhanced observation. Staff surveys. No. of incidents By having own and peace and calm means that less inter patient friction and aggression, less intimidating. Improved working environment for staff through reduced number of violent incidents Reduced number of violent incidents as measured by Glasgow CHP Health and Safety report. Effective Quality of Care Enhanced recovery due to therapeutic environment. Co-locations with other services will enhance management of co morbidities Access to other mental health services and access to diagnostic services Health of Population Promotes recovery and independence. Feedback report from Advocacy Service Enhance therapeutic environment supports suicide reduction Reduced incidence of suicide Value & Sustainability Through economies of and direct access to greater resources. Less travel to patient appointments as on site, ECT on site, intensive care unit on site, staff training local. Reduction in travel expenditure Birdston Care Home services - responding to NHS Scotland’s strategic
Initial Assessment of options – Birdston Care Home Strategic of Option: Proposed Solution ii New Build Proposed Solution v Refurbished vacant ward Service provision: Service arrangements: Service provider and workforce arrangements: Supporting assets: Partial Public & service user expectations: Partial Indicative costs Acute Adult mental Health services – cost of each shortlisted option Costs in £millions Do Nothing i: As existing arrangements Proposed Solution ii Proposed Solution v Capital cost (or equivalent 0 £5.3m £4.1m of life capital costs £11.954m £12.390m £5.551m Whole of life operating costs £6.993m £6.009m £6.009m Estimated Net Present Value of Costs £7.913m £10.151m £4.851m Complex Elderly mental Health services – cost of each shortlisted option in £millions Do Nothing i: As existing arrangements Proposed Solution ii Proposed Solution v Capital cost (or equivalent value) 0 £5.3m £4.1m Whole of life capital costs £65.391m £12.364m £5.551m of life operating costs 0 £5.896m £6.009m Estimated Net Present Value of Costs £39.886m £10.051m £4.851m
32 Improved comfort ambiance and atmosphere of the wards for some users/carers and visitors Non-financial Service user and care survey whereby by majority of surveyed who experienced the same service at pervious ward voice a measurable improvement in the new ward Pre move timescales TBC Post move timescales TBC 33 Improved catchment access. HBCC wards Non-financial Percentage reduction in 1 service users home to ward distance 2 main carer/visitor home to ward distance 12 months pre move based on catchment address on administration Survey TBC 12 Months post move based on catchment address on admission. Survey TBC APPENDIX D – RISK REGISTER Stobhill MH New-Build DBFM Ref Category Summary Description of Risk Stage of hub West Process Likelihood Impact -Time Cost (£) Risk Mitigation Owner Last Cause of Risk Risk Description Effect of Risk
BIM Design Coordination of design information to BIM level 2 - protocols and plans to be established of BIM level 1, 2 and post FC 3 1 1 3 Agree BIM EIRs with NHS and prepare BIM Execution Plan in response with design team and contractor hWS/NHS Roads Statutory approvals required Risk of car parking numbers required under local planning in turns out to be in excess of current cost model consumptions. Change in assumed hWS scope of work 1 and Stage 2 4 5 5 20 Undertake traffic impact assessment. Continue on-going engagement with facilities management. Ground Ground obstructions identified Ground obstructions identified Change in assumed hWS scope of work Stage 1 and Stage 2 5 3 3 15 SI surveys to be progressed at Stage 1 MSPS Ground Gas Venting Gas venting may be required for ground gases given historical industrial use of site Change in assumed hWS scope of work Stage 1 and Stage 2 3 1 2 6 SI surveys to be progressed at Stage 1 MSPS
Decant Failure to identify alternative location for occupants of existing accommodation due for demolition. Programme delay Stage 1 and Stage 2 2 5 5 10 Early decant plan initiated by NHS GG&C NHS Delay Asbestos Failure to undertaken Asbestos survey works / removal in advance of demolition programme Programme delay Stage 1 and Stage 2 5 5 5 25 Early engagement with NHS GG&C Asbestos team NHS Delay Demolition Existing wards not demolished in-line with hWS programme requirements. Programme delay 1 and Stage 2 5 5 5 25 NHS Engagement with NHS GG&C Demolitions Programme Manager and Contractor NHS
Scope Service alterations / enabling Scope of service alterations associated with Demolitions programme not clearly understood Change in programme Stage 1 and Stage 2 4 5 5 20 NHS Engagement with NHS GG&C Demolitions Programme Manager and Contractor NHS Significant works required in relation to Asbestos lined service tunnels Complex works design impact Stage 1 and Stage 2 3 3 5 15 investigation and design proposals to be developed to avoid access / disturbance NHS Approvals I.A not signed off / NPR not issued. Project does not proceed Project does not proceed Stage 1 1 5 5 5 None. NHS Bundling for bundled projects fail to align Stobhill project value requires it to be bundled with another project. Unable to achieve FC 1 and Stage 2 3 4 4 12 Ensure no programme slippage and alignment at key stages NHS Planning Failure to obtain Planning approval Failure to obtain timely Planning approval Failure to achieve FC Stage 1 and Stage 2 2 5 5 10 Early engagement with Planning Dept. NHS
Design Failure to obtain design Project unable to proceed on programme design impact Stage 1 and Stage 2 3 3 5 15 Design to be developed in conjunction with Stakeholders NHS Client doesn't have the capacity or capability to deliver the project Project unable to proceed on programme design impact Stage 1 and Stage 2 3 3 5 15 Develop appropriate governance arrangements for the project including resource planning and individual skills review NHS Scope Project Objectives not clearly defined Scope of service alterations associated with programme not clearly understood Change in programme Stage 1 and Stage 2 4 5 5 20 Set out clear objectives for the project as part of the Initial Agreement, linking them to clearly defined & measurable benefits and outcomes NHS The anticipated benefits from the project are not achieved following project completion Benefits of change are not delivered Change in Scope and 1 and Stage 2 3 3 5 15 Set out a realistically achievable benefits realisation plan as part of the Initial Agreement. Further engagement with stakeholders during process NHS
Scope Different stakeholders have different expectations of the outcome of the project Benefits of change are not delivered design impact Stage 1 and Stage 2 1 5 5 5 On-going engagement with all stakeholders to consensus on the strategic brief for the project at IA stage and project brief at OBC stage NHS Scope Poor stakeholder Poor stakeholder involvement will result in a lack of support for project design impact 1 and Stage 2 1 5 5 5 On-going development and implementation of project communication plan which includes engaging with all appropriate stakeholders at appropriate stages of the project NHS
Delay Adverse publicity occurs due to an operational issue Sensitivity to existing service issues insufficient Change in programme 1 and Stage 3 1 5 5 5 Review on-going operational arrangements associated with the project and ensure that any specific risks are encapsulated into the project risk register NHS Service demand Demand for the service does not match the levels planned, projected or presumed Change in programme Stage 1 and Stage 4 1 5 5 5 Carry out sensitivity testing of assumptions behind service demand projections to understand and manage any underlying risks NHS
Scope Design The available accommodation is unable to support the proposed service model Change to design and or scope of work may be necessary Stage 1 and Stage 5 1 5 5 5 New service arrangements tested at the early design planning stages of project and further testing throughout the development of the project NHS
5 Self-Assessment Process Decision Authority of Decision Additional Skills or other perspectives How the above criteria will be considered at this stage and/or valued in the decision Information needed to allow evaluation. Selection of early design concept from options developed Decision by Health Board with advice from Project Board Comment to be sought from NDAP Stakeholder assessment of options AEDET or other methodology to evaluate the likelihood of the options delivering a development that meets the criteria above Sketch proposals developed to RIBA C coloured to distinguish the main use types (bedrooms, day space, circulation treatment, staff facilities, usable external space).Rough Model Approval of Design prior to Planning submission Decision by Health Board with advice from Project Board Report & support to be sought from NDAP Stakeholder assessment of options using AEDET or other methodology to evaluate the likelihood of the proposals delivering a development that meets the criteria above Approval of Detailed Design proposals to construction Decision by Health Board with advice from Project Board Report & support to be sought from NDAP Stakeholder assessment of options using AEDET or other methodology to evaluate the likelihood of the proposals delivering a development that meets the criteria above Post Occupancy Evaluations Consideration by Health Board – lesson fed to SGHSCD Stakeholder assessment of options using AEDET or other methodology to evaluate completed development delivering the above criteria and business goals they set