The Hospital Modernisation Programme was unanimously approved by the States and the first phase is already underway. Keep referring back to this page for updates.
Health and Social Care (HSC) has set out through the Partnership of Purpose (PoP) to tackle some of the deep seated challenges within the Bailiwick's health and care systems including those relating to the physical infrastructure of the Princess Elizabeth Hospital (PEH).
The main projects and their primary objectives are designed to resolve the most pressing clinical needs and bottlenecks faced by the hospital daily and that have potentially unacceptable risks and consequences, affecting both staff and service user experience as well as safety.
The phases in planning and designing our hospital
Clinical Services Plan
- In this phase, health care planners assess what the health care needs of the community will be in the future and how these are best delivered. Our advisors took into account forecasts of the changing needs of the population, technological innovations and adopting practices for elsewhere around the world and in particular small islands. Our architects assess what types of building solutions may be applied to meet the future health care needs. We have projected 30 years into the future using current health data and data projections of future needs, such as population growth and a changing age profile.
Clinical Design Brief
- The Clinical Design Brief uses the predicted activity levels for each clinical service from the health care planning and applies the next level of detail to the project. This can be seen as the first definition of the new department and wards as it describes the full range of services to be provided, how they will operate and the functional and design requirements. Clinical User Groups have been established for each area (Maternity, Paediatrics, Critical Care, Operating Theatres and Emergency Care) as it is important to fully engage with clinicians and other staff, including nurses and hospital managers, during this stage. We also fully involved staff from supporting services, particular in respect of engineering services, to provide input into the infrastructure and services such as catering and linen.
Development Control Plan
- The first step in the design phase is the production of a development control plan. This considers the whole hospital and establishes areas of development that knit the site together to enable it to function for the healthcare needs of the future. The design is 'high level' and shows the relationships between the clinical functions, services, buildings and other facilities both horizontally and vertically. Throughout this phase the programme team has continued to consult extensively with user groups and key stakeholders. Consultation during this phase is vital in ensuring the design is heading in the right direction providing a means for adjustments to be made to ensure quality and value outcomes are delivered that meet stakeholders needs.
Business Case Development
- The development of a robust business case is States of Guernsey requirement for all large scale capital projects to ensure the projects drive value for money outcomes for the community. The Programme team will develop a preliminary business case in the first instance and once key elements of the final business case are endorsed by the various stakeholders, the final business case will be submitted for consideration.
Departmental and Developed Design
- This is the next step once the development control plan has been agreed and finalised. This stage is 'department focused' and includes plans for how rooms and services will relate to each other within a defined service, such as a critical care unit. Designers take into account the 'flow' of patients and staff through the hospital. They also incorporate the next level of detail including logistics around delivery of consumables, collection and disposal of waste, and interconnection with services such as electricity, water and telecommunications. The departmental design considers the building and services to the next level of detail, providing clinicians, staff and other stakeholders with a greater level of understanding of what the new departments will look like and how it will work. In parallel with the departmental design the overall design is developed in readiness for a planning application. This will require proposals that clearly demonstrate the exterior scale and materiality of the developments.
Detailed Design
- After the departmental and developed design has been completed and signed off by key stakeholders, including senior clinicians at the hospital, the project moves into the detailed design phase. As an example of the level of detail taken into account in this phase, a data sheet will be made up for each and every room in the hospital, including specifications for the layout of the furniture, fittings and equipment. Packages of detailed information are also produced to enable a construction partner to price and construct the works.
Procurement
- Procurement processes are designed to engage with the most capable range of local contractors to facilitate certainty of delivery. Tenders are evaluated on all their merits, taking into account the proven skills and capabilities of construction firms to ensure the right infrastructure is safely constructed, to meet the needs of the local community, within project timeframes and budget. As part of the procurement process, we are particularly interested in ensuring we support the local economy recovery phase for Guernsey post Covid-19.
Construction
- This phase often involves enabling works, early works as well as the main building works. Enabling works are often required to upgrade electricity, water or other utility networks to support the new scale of the infrastructure. Early works often involve demolishing, clearing and preparing a site for the start of main works.
Completion and Commissioning
- Throughout the construction process the project managers are responsible for the management of the overall project and making sure the buildings are being built to specifications and standards which are fit for purpose. After main works construction has been completed, and before patients are admitted, there is a commissioning and testing period, to ensure the facilities are ready to start delivering the highest quality of care. Commissioning is the process of assuring that all components are installed, tested, operated and maintained to the requirements.
Post occupancy evaluation
- This will ensure that any learning and improvement opportunities, and examples of best practice, are taken into account in planning, designing and implementing subsequent projects.
Progress made to date - June 2020
On 9 September 2019 following a detailed appointment process, Carnall Farrar was appointed as the Strategic Partner to deliver the first phase of the Programme. Carnall Farrar are co-ordinating an experienced consortium of professionals in hospital developments, including architects and health care planners, to complete the work needed to design the new departments.
Developing the preferred design
- An extensive process was undertaken to develop the preferred design option for the layout of the areas of the hospital undergoing modernisation. This design meets today's requirements but also provides flexibility to increase capacity when demand increases. The work completed included demand analysis and capacity modelling to calculate the capacity required for each department over the next 30 years.
- High level designs were developed which translated the demand analysis, the operating principles, and room size into a site design solution, with flexibility and adaptability to address future changes.
Engagement
- Workshops with clinicians and staff from HSC and MSG, (from Emergency Department, Critical Care Unit, Maternity, Paediatrics, Theatres) helped develop the options for the clinical models and the configuration of the hospital. Nominated staff and clinicians from the departments reviewed the designs and discussed the layouts, the pros and cons and the timeline for delivery for each of the departments before scoring each option individually against qualitative criteria.
Design Evaluation
- The designs were evaluated against a list of requirements, including clinical safety and ability to meet capacity predictions, to arrive at a short list of options which all deliver the following:
- Best practice clinical model for each of the department, for example LDRP (labour, delivery, recovery, postpartum) model for Maternity; and Clinical Decision Unit in Emergency Department
- Sufficient capacity based on demand and capacity modelling
- Achieve critical adjacencies of Maternity next to Theatre, and CCU next to Theatre PACU.
- The outcome of the design evaluation resulted in some consistent themes:
- All clinical groups gave highest scores to design options with Maternity and Paediatrics in the north and CCU and PACU in the south of the site. Overall the two designs that were front runners both had the above arrangements. Both designs scored highly and were relatively close in the qualitative evaluation.
Further Feedback
- Further feedback was then received from the clinicians, which included;
- A new build including Paediatrics, Private ward, Maternity, Theatres, Surgical Admissions and Discharge unit within 3-storey building is favoured.
- Critical care, and PACU located to the south, with a new build extension was favoured and seen to be more flexible and the adjacency to ED was of great clinical benefit.
- Fracture clinic should be nearer ED than currently proposed.
- Improvements to ED are positive and are a priority.
Hybrid Design Option
- It was agreed to develop a 'hybrid design option' which could deliver the benefits of both front runners to include in the quantitative evaluation process. The combined evaluation resulted in the hybrid option being chosen as the best value for money. This design has been developed with the support of clinicians and the staff working in the wards. The benefits of this design are that it:
- Delivers what the clinical teams believe to be the best solution for Maternity/NICU with vertical link to Paediatrics
- Provides a new Breast Unit and allows the current Breast Unit to stay open eliminating any break in service
- Provides Private ward accommodating private outpatient facilities on Level 3 with a separate entrance and lift
- Improves patient flow with Fracture clinic near to ED
- Provides a new main entrance which meets way finding guidance, a better patient experience and a more efficient flow around the hospital
- Delivers new solutions for ED and Theatres and a combination of refurbishment and new extensions for CCU
- Provides a flexible 3 storey solution, minimises disruption to the site and delivers within a relatively short timeframe (7 years in total)
This page will be updated regularly. Please refer to our Frequently Asked Questions page for more information or if you would like to contact us to ask a question about the PEH Modernisation Programme, please email: Hospital.ModernisationProgramme@gov.gg.
