Special Report: Buildings

Published: 30/01/2003, Volume II3, No. 5840 Page 31 33

Moving an inpatients department to a new hospital in just a week is no mean feat.

Lyn Whitfield reports from Swindon

'Remember, remember, the third of December, ' said the posters across Swindon. It is not a day NHS managers are likely to forget.

At 7am, the accident and emergency department of Princess Margaret Hospital, high above the M4 towards the west of town, closed. At 7.01am, the A&E department of Great Western Hospital, a greenfield private finance initiative project a couple of miles to the east, opened.

Day two of a hugely ambitious plan to move inpatient services from one hospital to another in the space of a week was underway.

'I do not think we have actually sworn at each other, ' says Les Meaton, Swindon and Marlborough trust commissioning co-ordinator, a couple of days later. 'I think we might have glared a bit.'

'It has been very stressful, ' agrees Veronica Cavanagh, project manager for United Medical Enterprises, which helped commission the building. 'Tuesday was a very difficult day. But it has been OK, I think. We have worked very well as a team.'

PMH was described as a distinguished building when it opened in 1959. But it was also a maintenance-hungry building that had much money spent on it. The low point came in 1997, when the Health and Safety Executive won a landmark prosecution against the trust for breaching regulations in four areas.

In 1995, it hosted a£45m PFI project, one of the first in the country. However, by the time the Health and Safety Executive prosecuted, the repair bill for the existing buildings had reached£40m.

Plans were developed for a rebuild on the existing site, but later abandoned because of access problems. Financial close for a new hospital at Commonhead was finally reached in 1999.

GWH cost£98m to build, but other elements of the 27year deal with The Hospital Company, a consortium headed by Carillion, take the total value of the contract to£148m. The building was handed over, bang on time, on 5 November.

'I have always received a building and then commissioned it, ' says Mr Meaton. This time, planning started much earlier.

It was also carried out in a unique way; through a partnership between Carillion, the trust and United Medical, which has been involved in 10 UK PFI relocations.

'Usually, only trust employees are involved [in a commissioning process] and they are not likely to have moved a whole hospital before, ' says Mr Meaton.

'Having somebody in with experience of doing that has been very useful.'

A commissioning team was established and members given responsibility for key aspects of the process - such as licences, transport, IT, training and decommissioning the old buildings. Individual departments had team leaders and deputy team leaders for their own plans.

'We went to all the departments asking them about their aims and assumptions, what equipment was absolutely critical to them, who they were dependent on and who was dependent on them, ' says Mr Meaton. 'We asked them how staff would be deployed during the move, what training they would need and how their move would be resourced. It gave them plenty to think about.'

The trust also asked departments to produce risk management plans, which were circulated to other departments for comment.

A plan was then produced to move the whole hospital. By the time of the move, this was a six-inch thick binder with charts showing exactly what should be happening when.

Meanwhile a training, induction and familiarisation programme was run for staff.

More than 3,000 visited a special training room, where everything from new equipment to samples of the new curtains were on show.

The trust ran information about the new hospital on its intranet and in newsletters, arranged open days for GPs and community staff and launched a media blitz, including the Remember, Remember campaign.

The trust wanted to fully occupy the new building before Christmas. A rapid move would keep expensive dual running to a minimum, while keeping a full range of services operating for as long as possible.

Support services such as radiology and pathology moved first, with some dual running across the two sites.

Intensive care followed on 2 December, when four patients were transferred in 'blue light' ambulances with police escorts.

A&E opened on 3 December, as inpatients were transferred to the new site by ambulance. By 5 December, the trust was ahead of schedule, with Pickfords gamely moving furniture as fast as Wiltshire Ambulance Service could move people, while using the same lifts.

Ms Cavanagh says the key was moving intensive care first. 'Once intensive care and A&E had gone, the rest of the hospital wanted to move, ' she says. 'It just followed on behind.'

The trust and United Medical made innovative use of microchips supplied by Rochester-based Operation Back Up during the move.

These allowed patients to be 'scanned' out of PMH and into GWH. Ambulance movements were updated on computerised maps every 10 seconds, using global positioning systems.

The commissioning control room could tell staff exactly when patients would arrive.

But Ms Cavanagh says the technology came into its own as the special care baby unit was transferred; parents could be told exactly where their children were. The unit moved on 4 December, in 'blue light' ambulances accompanied by police motorcycle outriders. Most took nine minutes - the fastest, six.

The commissioning project - which won the publicprivate partnership award in this year's HSJHealth Management Awards - will be fully evaluated. Four days into the transfer, however, Mr Meaton feels the unique approach has paid off.

His initial 'lessons to be learned' include 'getting equipment in earlier' and 'talking to departments more about where they were'.

Though some departments diligently implemented their plans, others did not.

The main committee also became 'distracted' by other issues. The trust has been forced to put money into Thamesdown Transport for new bus links, for example.

There were also wrinkles to iron out in the new building.

And as late as October, the trust decided to convert office accommodation into an additional 36-bed ward.

These distractions highlight two big questions about GWH's future: is it in the right place - it is away from Swindon's centre and main growth areas - and does it have enough beds?

As soon as the new hospital opened, it faced a chronic bed crisis and was temporarily forced to cancel surgery as a result of what chief executive Sonia Mills termed 'an exceptional peak in demand'.

GWH has slightly fewer beds than PMH - 590 in total. It will be supported by a 60-bed intermediate care centre run by Swindon primary care trust and a 70-bed elective treatment centre, not due to open until 2004.

However, Swindon will grow from 153,000 people to 208,000 by 2008. And the trust has faced intractable bed-blocking problems that could get worse.

Despite these issues, staff are enjoying the new environment. 'Everybody knows that when you move house, it is stressful, ' says Mr Meaton. 'Well, we have moved something like 70 or 80 houses.'

Ms Cavanagh concurs: 'Everyone knows there will be a few things that take time to get right. We have moved a whole hospital in four weeks.

It is the fastest ever move for a PFI. It has just been phenomenal.'