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Worcestershire Royal Hospital

Category: Hospitals

"....... But PPPs have brought about a more partnership approach and not an 'us and them' scenario. It has been quite refreshing but a big cultural change."

John Summers, Worcestershire Royal Hospital Project Director & David Snowdon, General Manager of Catalyst Healthcare (Worcester)

March, 2003

The hospital opened in March 2002, costing £95 million, and has nine operating theatres, a large Accident and Emergency Department and critical care unit, and specialist radiology and scanning suites.

The hospital replaces services previously provide by three separate sites. The environment is welcoming with good signage to help patients and visitors find their way round. Colours and graphics are used in the main corridors and departmental entrances as an aid to wayfinding. The landscape has been carefully integrated to blend with the existing environment, becoming more formal nearer the buildings. The spaces around the buildings are designed to fulfil appropriate functions, there is a therapy garden and a children's garden.

The PPP Forum interviewed John Summers, Worcestershire Royal Hospital project director, and David Snowdon, General Manager of Catalyst Healthcare (Worcester).

Amongst other reports, the recent CHI (Commission for Health Improvement) publication commended the trust for the safe transfer of patients to the new Worcestershire Royal Hospital in March 2002 with no reports of incidents or compromised patient safety. How was the move orchestrated?

"It was through partnership. The move on this scale was new to everybody. Bovis had built similar size projects in the U.S. and we embarked on a fact finding mission to look at best practice. Senior managers from the U.S. came to engage in workshops and through these activities we formed the basis of the Trust's plans. It involved a lot of hard work moving such a volume of patients in a short time. Practice in the U.K. has usually been to move patients over a period of several weeks but we achieved this in two weekends."

The new hospital replaces three ageing Worcester Royal Infirmary sites, some dating back to 18th Century. How have the staff responded?

"It has been a wrench for some people who have worked in the old facilities for some time. It has also meant a change in the way people work, which can be unnerving. For example, most of the staff from the Ronkswood site were used to working on one floor and they were worried about the use of lifts to move patients. However, staff were given the opportunity to tour the building before the transfer so fears about safety could be allayed.

Overall, they are delighted with the new facilities. The equipment has generally been new and we invested in a fair amount of training prior to the move so that they would be comfortable about working in the new building."

Doctors, nurses and other healthcare professionals have all had significant input into the design of the new hospital. Has this had a marked effect?

"I am convinced that it does have a positive effect as the greater involvement they have, the greater the acceptance of the new building. We got people involved early on. There is a time lag between staff contributing to plans and seeing them realised so when the building was completed, we took staff round on orientation visits. It's about being able to manage expectations.

The building has been designed around the user so you have key department such as A & E, X-ray and critical care and the operating theatres sited next to each other and means that valuable time is saved if a patient needs to be moved from one to another."

For any item of equipment, department user groups determine the output specifications to meet clinical needs. Has the concessionaire provided you with equipment of a good standard?

"Yes, we have the latest technology employed in the key areas. For example, in radiology the equipment is state of the art. The clinicians are satisfied they received a good calibre of products from the deal."

One of the main criticisms about PFI is that the concessionaire tries to cut costs with sub-standard equipment or services. What is your opinion?

"The risk lies with the PFI partners. They carry the maintenance costs and providing sub-standard equipment serves only to increase their own costs. There is no incentive in that respect. We have an asset that we are proud of."

The hospital has brought about a new level of privacy and dignity for patients, all of whom now have ensuite rooms, each with a maximum of 4 beds. How does this contrast with old facilities and has this had a marked effect on patients?

"Previously, we had nightingale wards with 20+ beds. Potentially, that could have led to mixed wards but you don't have that with these cubicles. There was also a restriction on the number of bathrooms we could accommodate but with the ensuite facilities, patients can use them unaided so that has to be an improvement.

Some patients have said that they enjoyed the camaraderie of a nightingale ward. However, we have in the new facility a day room for patients to mingle but have found that this has not been widely used. Part of the reason may be the patient bedside entertainment system that each room has."

How would you describe the relationship between you and the concessionaire?

"This is a new relationship and had to be created and built up from the commissioning of the project to the running of it now. We enjoy a good working relationship and talk regularly about any issues that arise. We share a general ethos about how a hospital should be run. There are regular forums to voice issues and we would always strive to resolve any problems without resorting to the contract. We all appreciate that running the service is the priority for both of us."

Have there been many problems?

"There have been problems, as you would expect with any project. However, we have been able to prioritise and resolve any issues to the extent that they have resulted in little or no impact to the patients and visitors."

Did you have any problems in the old hospital that have now been eliminated?

"Yes, there were problems that were associated with the age of the hospital. We were also split site working and now we are consolidated into one place."

Is there anything you would do differently and what advice would you give to anyone thinking about PPP?

"When we moved in, the focus was solely on patient safety. However, all the little issues you have when moving into a new building are compounded. People need to appreciate that moving in is just the beginning point and the plans for occupying are just as important. There is also an element of people running on adrenaline and excitement leading up to the opening but once moved into the building, when things don't go quite right, there can be anxiety. Therefore, the need for good occupying plans cannot be underestimated. At the end of the day, PFI is simply a funding stream and there will be problems. But PPPs have brought about a more partnership approach and not an 'us and them' scenario. It has been quite refreshing but a big cultural change.

Be very proactive in your press campaign leading up to the opening and post occupation. You must ensure the public are aware of your high class facility which is able to deliver to the needs of modern healthcare and one that the staff are proud of."