In the light of widespread cuts to funding, the capital budget means only the most-pressing developments will take place, with other planned projects shelved until a review of changing patient pathways has been carried out.
We have had to look at our capital investment programme in a completely different way, while making sure we are prioritising the things that are going to be of immediate benefit to our patients
Nick Thomas, the trust's director of strategic planning and information, explained: "We are in a changing world. Financially it is tougher and the NHS is changing to provide more services out in the community and closer to patients' homes. We know we are going to see more specialist care and primary care and self care are going to be bigger and our tertiary work will more than likely increase. It is expected that sites for secondary care will in turn become smaller. What this might mean for us as a secondary care provider at Derriford Hospital is seeing more secondary care delivered in different community settings and the actual Derriford building being used differently. Taking all of this into account, we have had to look at our capital investment programme in a completely different way, while making sure we are prioritising the things that are going to be of immediate benefit to our patients. At the trust board meeting in March, the board agreed the capital investment programme for 2011/12. This will see £12m invested in a number of capital projects."
Those that have been given the go-ahead for the current year include:
- Upgrade of theatres: One of the biggest projects will be the refurbishment of theatres, including upgrading the air handling at a cost of several million pounds. This is essential as the theatres have changed very little since the hospital was built
- Relocation of services from the Royal Eye Infirmary: The trust is looking at the relocation of eye services from the current location at Mutley Plain to Derriford. The move aims to improve on the services by providing a more modern setting. The current proposal is to relocate eye services to level 3 of Derriford Hospital and it is anticipated work will start later this year, although this is subject to plans being approved
- New haemodialysis unit: To improve the patient experience and enable the work for the relocation of eye services to start, the trust needs to move out the haemodialysis unit. As part of last year's capital programme, the unit is being moved off site to a purpose-built building at Estover, which is going to provide state-of-the-art facilities for patients in a community setting
- Investing in cancer treatments: As part of an ongoing commitment to improving the quality of care offered to patients and developing services for cancer and neurosurgery, the plan was to replace three LINAC radiotherapy machines at Derriford Hospital. One has already been procured and the second is priority for the coming months. However, plans for the third, and an additional Cyberknife non-invasive robotic machine, have been shelved for at least a year while the trust considers changing patient pathways and research into the best approach to cancer care
- The reprovision of isolation facilities: Feasibility work is underway to explore the potential to improve facilities for those patients needing stem cell treatment.
- Medical equipment replacement: £1m will be spent on the replacement of vital medical equipment, for instance blood pressure machines and ultrasound
- Remedial building works: This includes pressing engineering and electrical work
- Improvements to IT systems: This will include the introduction of barcoded wristbands and blood tracking technologies
A number of development are also still under review, including improvements to the main entrance, which is on hold until after a review of urgent care pathways; and work to re-organise the children's hospital. Thomas said: "The main entrance is the facilitator to the urgent care pathway. However, what we first need to determine is the space requirements for urgent care. At the moment, we are undertaking work to look at how the urgent care pathway works, between the emergency department, clinical decisions unit, medical assessment unit, and the surgical assessment unit. This will enable us to see how they work as they are now, if they could be re-organised within the current space, or whether they would need to move into the space currently occupied by the main entrance on level 6. This is one of the crucial factors in determining the need for a new main entrance. If it is deemed that the urgent care needs to move within this space, then a new main entrance would be required. However, this won't happen within this financial year."
We are in a changing world. Financially it is tougher and the NHS is changing to provide more services out in the community and closer to patients' homes
On the issues of the children's hospital improvements, he added: "As with the work required for the urgent care pathway, more work needs to be undertaken to look at children's services to see how they work as they are now, if they could be re0organised or whether they would need to move into a purpose-built space. By the autumn, we will have our five-year plan and will be able to provide more detail on the provision of future developments."