Royal National Orthopaedic Hospital NHS Trust
New Theatre Business Case
For Approval
Summary
This business case establishes the rationale for the Trust to invest in:



A new modular Theatre facility
The refurbishment of Theatre 1 & 2
Explore the possibility of converting Theatre 3 to a new centralised Theatre
Storage Facility
Key Outcomes:
On completion of the preferred option the key outcomes will be :




Provision of additional theatre capacity
Elimination of critical backlog maintenance issues associated with Theatres
1&2
Facilitation a robust programme of theatre maintenance which will not be
interrupted by service demand pressures
Improved efficiency and financial control, through centralisation of supplies
and equipment within the theatre complex
The Trust Board is asked to approve the project and authorise the following funding:
Capital Costs:
1. Infrastructure and enabling work (including
IT infrastructure)
2. New modular Theatre
3. Theatres 1 & 2 refurbishment
4. Theatres 1 & 2 refurbishment
5. Theatre 3 conversion to a potential central
store and enhancement of changing
facilities, office space reconfiguration and
rest areas.
Total
Capital
Costs
£586,000
Funding
Year
2009/10
£938,000*
£510,000
£785,000
£483,000
2009/10
2009/10
2010/11
2010/11
£3,302,000
* The above represents the capital costs of purchasing a new modular theatre.
However, leasing is the currently the only option as there is insufficient scope within
the capital programme to cover such a significant outlay without compromising other
capital requirements such as medical equipment. A loan facility with the department
of Health is also being explored as this may provide a cheaper financing option than
leasing. Although it will not affect construction of the new theatre, a final decision on
the financing solution will be made before work on the new theatre begins.
Page 1 of 14
1.
INTRODUCTION
1.1
CONTEXT AND BACKGROUND TO THE BUSINESS CASE
1.1
In 2004 a Business Case for the installation of twin modular leased operating
theatres (Theatres 9 & 10) to allow the refurbishment of Theatres 1 & 2 was
approved. This Business Case did not result in the closure and refurbishment
of Theatres 1 & 2 due to activity increases which necessitated the need to
keep Theatre 1 operational and the requirement to use Theatre 2 as a
storage area.
1.2
This Business Case:

Highlights the need to provide a new modular Theatre Facility, undertake
refurbishment of Theatres 1 & 2 and to create a centralised Theatre
Storage Facility;

Seeks to secure funding to ensure surgical activity will be carried out in an
environmentally safe and regulatory compliant setting;

Will increase theatre capacity to support the 18 week referral to treatment
(RTT) pathway;

Clearly demonstrates that patients and staff will benefit from a safer
environment with reduced risk of infections and reduced clinical incidents;

Will deliver improved financial control over theatre procurement and
storage;

Will improve security arrangements and staff facilities within the Theatre
complex.
2.
SUMMARY OF CURRENT THEATRE SERVICES
2.1
The Trust currently has a Theatre complex consisting of 9 Theatres with only
8 operational (Theatres 1, 3 5, 6, 7, 8, 9 and 10). Theatre 2 is currently being
used for storage by sterile services.
2.2
There is operating capacity of up to 80 elective sessions Monday to Friday, 6
sessions on a Saturday and 15 overrun sessions a week.
2.3
The Trust is currently recruiting and appointing the following consultant posts,
all of whom will require increasing theatre time:





Spinal consultant
Spinal consultant
Shoulder consultant
Joint Reconstruction consultant
Paediatric consultant
- New post
- Replacement post
- Replacement post
- New post
- New post
The Trust also needs to provide two sessions for emergency lists and one
additional session for paediatric work.
Page 2 of 14
3.
CASE FOR CHANGE
3.1
ESTATE CONDITION OF THEATRES 1 & 2
3.1.1
Theatres 1 & 2 were built in 1962 and since that date only a minimal amount of
refurbishment work has been carried out. The Trust is now at the stage where the
refurbishment of Theatre 1 cannot be delayed as it is failing to deliver a safe and
reliable service and does not comply with the relevant standards such as:









HTM 07 ( Health Technical Memorandum)
HTM 04
HBN 26 ( Health Building Note)
UK and European legislation and guidance (Infection control)
The Hygiene Code
HTM 03
HTM 06
BS 5226 ( British Standard)
BS 6651
3.1.2
Theatre 2 has not been in use for a number of years and with the demand pressures
the Trust is facing, bringing this asset back up to standard to allow more operations to
be completed makes good business sense.
3.1.2
However, extensive work is required to bring them up to an acceptable standard as
shown in the Table 1:
Table 1:
Estatecode six facet performance – Theatres 1 & 2
A - Meets modern standards. B – Acceptable. C - Below standard.
D – Unacceptable.
Category A Category B Category C
Category D
Building
0%
5%
90%
5%
Condition
Electrical
0%
20%
40%
40%
Condition
Mechanical
0%
25%
37%
38%
Condition
3.1.3
The combination of all these factors creates a potential clinical risk to patients and
staff and ultimately a business risk. The additional capacity is also required to enable
an annual programme of theatres validation to ensure that ventilation systems are
tested for microbiological performance. The Trust has been unsuccessful over the
past five years in developing a robust annual validation programme due to waiting list
pressures.
3.1.4
The estate case for change can be summarised as follows:
 Inadequate environmental conditions
 Plant health risks and potential failures
 Potential risks to patient care and good clinical outcomes
 Potential risks to staff working in the environment
 Increased infection rates, due to the Theatres not being ultra clean ventilated as
recommended in HTM 2025 and HTM03
 Backlog maintenance liability and increasing costs in maintaining poorly
constructed facilities
 Prosecution due to failure to comply with statutory health and safety regulations
Page 3 of 14
3.2
FUTURE WORKLOAD AND CAPACITY REQUIREMENTS
3.2.1
An activity modelling and forecasting exercise was undertaken as part of the Outline
Business Case Addendum for Redevelopment which concluded that that the Trust
had seen an average year-on-year growth of 5% with an expectation is that activity
will continue to grow at a similar level.
3.2.2
This was just to keep on top of current 18 week referral to treatment pathway demand
and did not make a significant allowance for dealing with the growing backlog of
cases, introducing the full patient choice menu of services as well as keeping on top
of the general increase in specialist orthopaedic service referrals as a result of
changes in the market the Trust operates. Although this has not been properly
evidenced, part of the increase in demand is felt to be due the NHS’s success with
the 18 week target and the public not opting for private healthcare as in the past.
3.2.3
To further enhance the case for an additional theatre, at the end of September 2009
the volume of backlog was running at 207 patients waiting to be treated and 448
patients waiting for a decision to be treated. To get through this backlog will take a
minimum of 6 months of theatre time assuming an average of 5 cases can be dealt
with on a daily basis and the theatre has no down-time, which in reality is unlikely.
3.2.4
Keeping on top of this situation has only been possible with the use of the
independent sector, which the Trust has sourced extra capacity from Spire and the
HCA Group for joints, shoulder and spinal work. The possibility of working with
another Trust under a ‘hub’ and ‘spoke’ model of care is still an option, but due to
capital financing constraints, this is looking increasingly unlikely in the short-term to
deliver a solution.
3.2.5
Therefore going forward, and planning on the basis that referral rates will continue to
grow at the historical levels of growth, i.e. 5%, the Trust can expect an additional 530
cases per annum based on the current years plan. This along with bringing back the
250 cases the independent sector is planning to undertake on behalf of the Trust in
2009/10, ensures that there will be sufficient activity after the initial backlog is cleared
to sustain the viability of the additional theatre.
3.2.2
In summary, the service case for change can be summarised as follows:

The Trust currently has insufficient capacity to effectively deliver the admitted 18
week trajectory;

Capacity issues already exists with the 8 current theatres, leading to the Trust to
have a significant backlog of cases building even though the independent sector
is being used where possible;

The Trust is facing a growing problem with the reductions in consultant operating
time due to insufficient capacity. Consultants are increasingly having limited
access to theatre sessions which could compromise clinical outcomes and
increase overall waiting lists;

The recruitment of new consultants requires additional theatre capacity;

For various reasons the Trust has experienced an increase in the rates of
cancellations of booked patients which with the lack of overall capacity, has put
pressure on emergency lists as well as re-arranging the cancellations;
Page 4 of 14

Activity growth assumptions contained within the Integrated Business Plan and
the RNOH Outline Business Case for redevelopment form the basis of the
affordability assumptions, both in terms of being able to support the financing
costs of the scheme as well as delivering robust financial plans for the future.
3.3
PROCUREMENT AND STORAGE MANAGEMENT
3.3.1
The key challenges posed by the current procurement and storage arrangement
include:

Multiple procurement processes in operation making supply management to
theatres uncontrolled and inefficient. Stock is held in a number of locations
throughout the theatre complex and is susceptible to mis-management and
ultimately a cost concern;

Equipment and stock is stored in corridors which poses control of infection and
fire risks;

Product usage information severely limited hampering strategic decisions and
control of product selection;

A lack of management information relating to product usage, location and cost
resulting in the duplication of stock in various locations increasing the potential for
obsolescence.
3.3.2
This existing arrangement makes the theatre procurement, replenishing processes,
overall logistic flows, storage arrangements and stock levels requirements
functionally ineffective and a financial risk.
3.3.3
The proposal going forward is that all stocks are centrally located, supported by an
electronic information system and managed through an enhanced stock process.
Ideally, this will be in an area easily accessible within the theatre complex and the
use of theatre 3 is being explored as an option as this will shortly require significant
investment to keep it compliant under the relevant standards contained within section
3.
3.4
FINANCIAL CASE FOR CHANGE
3.4.1
The Trust’s current Business Plan was presented and agreed on the basis that a 5%
recurrent increase in baseline activity was required in order to meet the income
targets for 2009/10 and onwards. The assumptions going beyond 2009/10 were for
modest increases in the activity baseline, but the evidence suggest that this is
unlikely and the level of activity growth is likely to remain consistent with the 5%
average over the last 3 years. The business plan was supported by the Trust’s
workforce plans to recruit additional consultant surgeons and theatre staff to allow the
Trust to meet the operational performance targets and patient choice agenda more
effectively. Since the business plan was adopted by the Trust Board, the likelihood of
reductions in national funding as well as the prospect of delivering more activity for
the same amount of funding in the future has surfaced.
3.4.2
As set out in section 3 above, the additional activity requirements have only partially
been met through the Trust’s internal resources and a number of cases have been
sub-commissioned to the independent sector. This solution is not ideal for the Trust
as the contractual arrangements are such that only a small contribution to the Trust’s
costs is recovered. As a result, this is not considered a long term solution.
Page 5 of 14
3.4.3
Add to this the growing number of backlog cases arising from the new patients the
Trust can actually see on a weekly basis and the problem is clear from an operational
and clinical perspective. This should however not disguise the fact that an
opportunity also exists insofar as a guaranteed source of activity and profit is
available if the capacity constraints can be overcome. This will only benefit the Trust
by strengthening its financial position and ensuring that future financial plans will be
less reliant on delivering significant cost improvement savings and potentially
affecting the quality of services provided by the Trust.
3.4.4
In summary, the financial benefits supporting the additional theatre and storage
solutions are as follows:

5% increase in activity expected going forward, which translated represents
approximately an additional 1,000 operations or 800 discharges. Assuming the
case-mix will be delivered on the basis of the consultant appointments, then
income of approximately £9million could be expected from a full years activity
(see section 5 below);

Pressure to meet the 18-week target could be compounded by Commissioners
exercising their right to levy a financial penalty. This position would seriously
affect morale and defeat all the efforts made by clinical staff to deliver the 18week targets;

Using the decommissioned theatre as a store does not make good business
sense. The opportunity loss is significant and the Trust could be accused of not
sweating its assets sufficiently to deal with its capacity issues. The new theatre
will have sufficient space to decant the items from theatre 2 allowing this to be
refurbished as soon as possible;

Management of stock items has proved difficult to control over the years and
remains a major financial risk for the Trust. The project aims to deal with this by
having a dedicated stock facility, supported by a new electronic system and
redesigned processes to mitigate all the risks currently being experienced.
4.
OPTION APPRAISAL
4.1
Description of the options:
4.1.1
Option 1 - Do nothing
Do nothing is not a viable option as it combines lack of compliance, risks to the Trust
Performance on 18 weeks and length of stay. In addition, there is the possibility that
it will destabilise the Trust financially which could ultimately effect both the
achievement and continuation of Foundation Trust status.
4.2
Option 2 - Provision of a new storage facility and Theatre 1 & 2 refurbishment
The provision of a separate prefabricated storage unit adjacent to Theatres 1 & 2 with
plant installed on the roof ready for Theatre 1 & 2 refurbishment which will follow as a
second phase.
4.2.2
Timeline
The construction of a new central dedicated Theatre Storage Facility could
commence in October 2009 with an anticipated completion date of the end of
Page 6 of 14
February 2010. Refurbishment of Theatres 1 & 2 would commence in April 2010 and
the work will take approximately 3 months to complete thereafter.
4.2.3
Estimated capital costs:
Theatre store
Theatres 1 & 2 refurbishment
Infrastructure and enabling work
Total
4.2.4
£828,000
£1,295,000
£541,988
£2,664,988
SWOT Analysis
Strengths
Weaknesses
Enhanced physical layout which
will reduce stock holding and
enable better stock management
Robust alternative capacity solutions will
need to be put in place involving a
combination of theatre rescheduling and
using alternative external providers.
(none have been identified by the work
stream)
Equipment will meet all statutory
Health and Safety legislation,
regulations and directives
Improved access for patients with
the ability to meet 18 week
referral treatment target post
Theatre 1 & 2 refurbishment
Work on Theatres 1 & 2 could take
longer than 3 months
Activity decreases during refurbishment
phase resulting in Trust financial
downturn
Improve environmental quality for
patients and a service that does
not put patients at risk
Provision of an environment that
is safe for staff to work in and
complies with standards
Opportunities
Threats
Increased capacity through the Theatre 1 not being relinquished for
provision of ten extra sessions by refurbishment in order to maintain
having nine operating Theatres
activity through put.
4.3
Option 3 – A modular new theatre facility, Theatre 1 & 2 refurbishment and
conversion of Theatre 3 to a Centralised Store
A new modular theatre building with an integral store area to accommodate
instrumentation currently stored in Theatre 2 with plant space ready for Theatre 1 & 2
refurbishment. Theatre 1 & 2 refurbishment to follow on as a second phase and
finally Theatre 3 converted to create a central store area.
4.3.1
Timeline
Work on the installation of a modular theatre would commence in October 2009 and
completed by March 2010. Refurbishment of Theatres 1&2 commencing in April
2010 taking approximately 3 months to complete due to less enabling works carried
out this financial year in this option. Conversion of Theatre 3 would follow on from
this.
Page 7 of 14
4.3.2
Estimated capital costs
£586,000*
£938,000
£510,000
£785,000
£483,000
£3,302,000
Infrastructure and enabling work
New modular Theatre
Theatres 1 & 2 refurbishment
Theatres 1 & 2 refurbishment
Theatre 3 conversion to a central store
Total
4.4.3
SWOT Analysis
Strengths
Weaknesses
Enhanced physical layout which will Delays the creation of a
reduce stock holding and enable better centralised store by up to two
stock management
years
will
need
Trust
commitment that the third stage
Equipment will meet all statutory Health of this project will be given
and Safety legislation, regulations and priority for capital funding by the
directives
Trust in 2011/12.
Improved access for patients with the Key theatre and supplies
ability to meet 18 week referral stakeholders may not engage
treatment targets
particularly as the storage issues
are not immediately resolved
No activity pressure due to provision of
additional Theatre first with less
operational and business risk
Improve environmental quality for
patients and a service that does not put
patients at risk
Provision of an environment that is safe
for staff to work in and complies with
standards
Opportunities
Increased capacity through the provision
of ten Theatres from the third quarter of
2010/11 financial year
Threats
Theatres
may
not
be
relinquished as extra capacity
that is created may be required if
activity increases materialise
4.2
PREFERRED THEATRE OPTION
4.2.1
On the basis of the above, the Theatre Capacity Steering Group agreed at its meeting
held on 19th August 2009, that Option 3 i.e. the provision of a modular new Theatre
facility and the refurbishment of Theatres 1 & 2, was the favoured option.
4.2.2
Converting Theatre 3 to a centralised store was also considered the only solution at
this stage for the store. However, it was agreed that further investigation into
alternative solutions should continue to be explored as time was available to do this.
Page 8 of 14
4.3
TIMETABLE
4.3.1
The construction of a new modular theatre will commence in October 2009 and will
be completed by no later than March 2010. Although the expectation is that the new
theatre will be completed by January 2010, it is dependent on the complexity of the
infrastructure and enabling works, which will only become clearer once work
commences on the site in October.
4.3.2
The main refurbishment work to Theatres 1 & 2 will commence in April 2010 and be
completed by no later than July 2010 (see Appendix A for Capital Project Programme
and Theatre Project Plan).
4.3.3
Before April 2010, a final decision will be made on a location for the theatre store,
which may be Theatre 3. The plans at present Theatre 3 as the store solution, but
this may change.
4.3.4
The table below illustrates that the preferred option does not affect capacity during
the works and following completion the Trust will have 9 theatres thus increasing
theatre capacity by an additional ten sessions.
Description
No of
Theatres
Pre Construction of Modular Theatre
8
Post Construction of modular theatre
9
Closure of Theatres 1 & 2 for
8
Refurbishment
Post Refurbishment of Theatres 1 & 2
10
Conversion of Theatre 3 to a store and
9
enhancement of changing facilities, office
space reconfiguration and rest areas.
Timescale
Now to March 2010
March 2010 onwards
April 2010
July 2010
October 2010
4.4 WORKFORCE IMPLICATIONS AND COSTS
4.4.1
Table 3 illustrates the staffing requirements for Theatre 2. These are all new posts
that will need recruiting to.
Table 3:
Staffing requirements
Staff
numbers
(wte)
Staff
costs (£)
Consultant Surgeons (Spinal, JRU, Hip Paeds)
3.0
327,435
Consultant Anaesthetists (0.5wte per Surgical
appointment)
1.5
184,112
Junior Doctors (1 SHO & 1 SpR for each Surgical
appointment)
6.0
423,000
Therapists (1.5 for each Surgical appointment)
4.5
154,845
Theatre Radiographer (Imaging business case)
1.0
37,390
Orthotists
2.0
98,718
Nurses/ODPs - theatres
9.8
396,023
Page 9 of 14
Nurses/HCAs - wards
8.6
277,748
Nurses/HCAs - out-patients
3.0
72,522
Nurses - HDU outreach
3.0
141,431
Admin to support central booking/medical
records/medical secretaries/ward clerks
5.6
146,554
Total additional staff required & recurrent
cost
48.0 2,260,000
NB: The above staffing requirements have been brought together from the 2
consultant (Spinal & Paeds) and imaging business cases presented to the Trust
Board for approval. Final requirements to support the consultant posts will be
assessed once operating lists have been finalised. However, the numbers are not
expected to alter significantly with only minor skill mix changes.
4.4.2
Recruitment Strategy:
4.4.2.1 The Trust has had a successful recruitment campaign in the Philippines this year,
recruiting 25 qualified nurses. These will fill 14 vacancies in both the ‘recovery’ and
‘scrub’ area within theatres. However, given the turnover of staff in theatres, the Trust
still has 25 vacancies across all theatres even when the Filipino nurses start their
employment. Shortages are particularly acute in the Anaesthetic area and although
the Trust plans to initiate a further international recruitment campaign, because of the
requirement for an anaesthetic qualification, this group of staff are hard to find.
4.4.2.2 Therefore, in tandem with recruiting internationally we have appointed a clinical
educator who will support the development of a competency based approach to
training our nurses to the appropriate level of knowledge and skills to practice as an
anaesthetic nurse or Operating Department Practitioner (ODP). Nevertheless, once
the new theatre is in place we will still be reliant on employing agency staff and in
particular ODPs and with the current commission rates being paid this represents an
uplift of 7/8% on a normal NHS salary even when on costs are taken into
consideration..
4.5
EQUIPMENT REQUIREMENT
4.5.1
The new modular Theatre will require all new kit and equipment. The costs of these
are as follows:
4.5.2
Capital costs: A revised list of requirements has been produced and has been
calculated to cost approximately £240,000 plus VAT. This will be met through a
combination of the capital programme and I&E budgets, depending on the value of
the items.
4.5.3
Revenue costs: Annual revenue costs, i.e. capital charges (depreciation and
dividend), have been estimated at £32,000. An assessment of service and
maintenance charges is being undertaken, but it is not expected to exceed £20,000
per annum.
Page 10 of 14
5
FINANCIAL SUMMARY
5.3
The capital & revenue costs of the project are summarised in Table 4. The costs of
the project are current and have been obtained via a formal tender and or Official
Government of Commerce financial arrangements to ensure robustness.
Staff
WTE
2009/10
2010/11
2011/12
£k
£k
£k
2,150
200
100
0
2,450
6,260
600
500
100
7,260
7,760
700
600
100
9,060
950
2,260
2,260
600
1,800
2,400
400
1,100
1,500
100
200
200
NHS Patient Income
In-patient income
Out-patient income
Unbundled imaging income
Unbundled transport income
Total income
Pay Costs (as above in section
4.4)
48.0
Non-pay Costs
Prostheses
Other Medical Supplies & Services
(including utilities)
Theatre lease costs
Capital charges (all refurbishment
& enabling works)
Total non-pay
0
400
500
1,100
3,500
4,600
Sub-total - expenditure
2,050
5,760
6,860
400
1,500
2,200
Surplus
5.4
The financial summary above has allowed for ward configurations to create additional
inpatient bed capacity if the need arises. This will be assessed during the latter
stages of the refurbishment of Theatres 1 & 2 when a clearer indication of 2010/11
activity will be available.
Patient Income
Other Income
£k
82,110
7,730
Business
Case (full
year)
£k
9,060
0
Total Income
89,840
9,060
99,240
Pay
Non-Pay
-47,519
-36,248
-2,260
-4,100
-50,119
-40,348
Total Expenditure
-83,767
-6,360
-90,467
6,073
6.8%
2,700
8,773
8.8%
Income and Expenditure
Account (recurrent position)
EBITDA
EBITDA Margin
2009/10
Plans
Page 11 of 14
Impact on
Current
plans
£k
91,510
7,730
Depreciation
Interest & Finance Costs
PDC Dividends Paid
Retained Surplus
I&E Surplus Margin
-3,330
-14
-1,773
-400
0
-100
-3,730
-14
-1,873
956
2,200
3,156
1.06%
3.18%
Summary Balance Sheet
Total Non-Current Assets
62,709
1,723
64,432
Total Current Assets
Total Current Liabilities
11,503
-9,902
1,415
0
12,918
-9,902
1,601
1,415
3,016
-417
-478
-938
0
-1,355
-478
Total Assets Employed
63,415
2,200
65,615
Public dividend capital
Income and expenditure reserve
Revaluation reserve
Donated asset reserve
24,329
3,501
24,658
10,927
0
2,200
0
0
24,329
5,701
24,658
10,927
Total Funds Employed
63,415
2,200
65,615
Return on Assets (ROA)
4.33%
3.59%
7.84%
Net Current Assets
Creditors: >1 year
Provisions (liabilities & charges)
Liquidity Ratio
10.63
10.91
2009/10
Plans
Business
Case
Impact
Weighted Average Risk Rating
3
5
3
2
3
3
5
5
2
4
Overriding rules:
One financial criterion scored at '2'
OVERALL RATING
3
3
3
3
Financial Risk Rating
Financial Criteria:
Underlying Performance (EBITDA margin)
Achievement of Plan (EBITDA % achieved)
Financial Efficiency (Average of ROA + I&E
surplus margin)
Liquidity
6.
BENEFITS REALISATION
6.1
The following benefits have been identified in relation to the refurbishment of
Theatres 1 & 2:
Page 12 of 14





Equipment will meet all statutory Health and Safety legislation, regulations and
directives
Improved access for patients with the ability to meet 18 week referral treatment
target
Improve environmental quality for patients and service that does not put patients
at clinical risk
Provision of an environment that is safe for staff to work in and complies with
Health and Safety legislation, EC directives and building regulations
Increased capacity through the provision of ten extra sessions.
6.2
The new centralised storage facility will provide an enhanced physical layout which
will reduce stock holding due to the elimination of unnecessary duplicate stocking
locations. It will also improve stock management systems enabling application of ‘just
in time’ supplies methodology with greater control of non-stock/speciality product
deliveries and reducing the possibility of lost deliveries and misplaced stock.
6.3
It will also support enhanced management information - enabling the Trust to further
improve efficiency in procurement and supply through increased Trust awareness of
total acquisition cost for theatres.
7
RISKS
7.2
This Business Case demonstrates a very strong case for investment. The scenario
without change is one of crisis management and ultimately the risk to the continued
provision of services. The following high level risks have been identified if the Trust
does not approve the investment:
Patient care risks



Increased infection rates
Potential estate related serous untoward incidents
Electrical and/or mechanical breakdown
Environmental and plant risks



Inadequate ventilation systems with no ultra clean air handling
Air handling unit failure
Electrical failure
Risk associated to Trust Business




Prosecution due to failure to comply with basic standards
Prolonged cancellation of operations due to plant failure
Failure to achieve waiting list targets
Failure to achieve financial targets
8
PLANNING AND IMPLEMENTATION ARRANGEMENTS
8.2
A project Steering Committee has been convened who will be accountable to the
Trust Board for successful implementation; the project structure is illustrated in Figure
1.
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Figure1:
Theatre Capacity Project Structure
8.3
The Trust is planning to recruit a Service Development Project Manager on a fixed
term contract for 12 months to lead the project. The post holder will have
responsibility for ensuring there are robust and comprehensive plans covering all
aspects of theatre capacity service development project to ensure the Trust achieves
its service development aspirations and will act as the prime interface with the
Projects, Estates and Facilities Team for estates and facilities aspect of these
projects.
8.4
The project will be managed in accordance with PRINCE2TM methodology and the
project team will seek to manage all the various tasks which can be anticipated in a
project of this kind and with a commitment to undertake a post project evaluation.
9
RECOMMENDATION
9.2
The Trust Board is asked to support the capital investment required for the new
modular theatre, refurbishment of Theatre 1 & 2 and the conversion of Theatre 3 into
a store facility.
9.3
This option enables the Trust to maintain capacity throughout the project programme.
Furthermore at the end of the project the potential risk of infection from non compliant
theatres will be reduced, an additional theatre will be provided creating an extra ten
sessions per week which will contribute to improving patient flow and achievement of
the 18 week referral to treatment pathway. The project will also deliver a central store
facility which will deliver improved financial control over theatre procurement, stock
control and storage. Without the support of both capital and revenue funds to make
these improvements the Trust is at significant risk of underperformance, against key
targets.
Ahmet Koray, Director of Finance
Mark Masters, Director of Projects Estates and Facilities
Sheila Puckett, Director of Operations & Service Improvement
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