County Durham and Darlington NHS Foundation Trust was a finalist in the 2019 HEFMA Awards for its substantial STEM project at Darlington Memorial Hospital. HEFMA finds out more.
In August 2015 the Board of County Durham and Darlington NHS Foundation Trust (CDDFT), approved the full business case for the Surgical Theatre and Enhanced Mortuary project (STEM) at Darlington Memorial Hospital. The approved cost was circa £32million, with a three-year build period.
The existing theatres and mortuary were in an extremely sub optimal condition, with the backlog maintenance over £5.5m. The accommodation and services were high on the Trust's Estates and Corporate Risk Register. Demand for theatres exceeded the existing capacity, mortuary body storage and post mortem facilities were inadequate and the deceased journey from the hospital to the mortuary was undignified.
The STEM new build and refurbishment project aimed to resolve the physical problems and estate deficiencies, and provide new, improved facilities. It involved demolishing existing, redundant buildings and constructing a new building to connect and extend the existing operating facilities with six new state-of-the-art operating theatres. Complete refurbishment and remodelling of the existing operating theatres and day surgery ward areas would include a new admissions lounge, a range of consulting rooms, block room and an extended recovery facility.
On the lower level of the new build, a larger modern mortuary facility was constructed, together with a bereavement suite and multi faith Chapel.
The scheme was developed following the NHS ProCure 21+ Framework. The Trust's NHS Estates Project Manager Robert Young managed the contract, design and construction process with assistance from Paul Saunders in relation to the M&E services. Project Implementation Manager, Sharon Farlow (Matron) managed the clinical requirements with assistance from Paul Buckley.
The Trust's team provided a detailed Clients Requirements Brief, and worked closely with the P21+ team, including architects, mechanical & electrical engineers, structural engineers and cost consultants in order to procure a suitable design and cost that fulfilled the Trust's goals and objectives. This took over a year to complete prior to the project obtaining Board approval to progress and for work to commence on site.
Key challenges
The Trust required that the patient throughput of the existing operating theatres was not to be compromised. Maintaining full clinical activity was particularly difficult during the refurbishment phase, as the construction work was always in close proximity to clinical services. Meticulous infection control management was maintained throughout with no increased incidences of infection, and there was minimal reduced clinical activity as a result of the effective management procedures adopted.
Each stage of the project was carefully planned, working closely with the clinical teams and contractor to establish the phasing of works and to agree the details of decanting arrangements. A booklet, encapsulating the detailed elements of each phase of the construction works, was produced to assist clinical teams in planning workflow and to ensure that the whole team had a clear understanding of the works, availability of accommodation, and could plan activity accordingly.
Extensive enabling demolition created the potential for vibration, noise and dust (again a major infection control risk) to affect the hospital, including major asbestos removal.
Underground tunnels located beneath the buildings being demolished housed vital services to the main hospital, which if damaged would have had catastrophic consequences.
Highly complex mechanical and electrical facilities were installed that required integrating in a new infrastructure whilst maintaining existing M&E services, including new plant rooms and supplies.
During the refurbishment, careful construction phasing was required as floor space for construction needed to be created within the existing accommodation; de-canting was not possible due to the requirement of clinical adjacencies at all times.
The extent of asbestos and existing services within the existing buildings were totally unknown until the various construction footprints could be made available to the contractors.
Approaches adopted
Strict project reporting and governance was adopted to develop and implement the project:
• A project board was established and specific work streams were put in place to manage the significant number of tasks to be completed including clinical and design/construction matters, phasing and planning
• Risk, business continuity and issue management
• Financial management
• Business case/progress reporting to Trust Board/regular briefings
• Inclusive and transparent leadership
• Robust staff engagement
• Stakeholder’s engagement and communications
• Adherence to the P21+ Framework management requirements
Performance measurement
Practical completion of the full scheme was achieved in December 2018, however the new build theatres and mortuary were handed over in July 2017. A detailed benefits realisation plan has been devised to measure the success of the project and this will link to the improvement and efficiency programme.
Consultant General Surgeon and the Trust’s Clinical Director for Surgery, Andrew Mitchell described the work as: “of huge importance”. The new investment allows more operations to be carried out with greater flexibility for emergency work. The admissions unit, now adjacent to the theatre suite, has smoothed the patient flow and the upgraded mortuary has greatly improved facilities for the bereaved.
The modern facilities are also proving to be an incentive to recruitment, attracting more high calibre staff to work at the hospital, easing pressure and improving quality.
This new development has transformed and future-proofed Darlington's capability and capacity for surgical procedures, at the same time as improving the environment for patients and staff.
The P21+ framework has enabled a highly experienced team to share their specialist knowledge and overcome challenges to successfully deliver a service and product with which the Trust is delighted.
Innovation
The contractor utilised BIM to develop a 3D model which provided essential information to M&E and Structural Engineers, assisting in clash detection throughout and proving particularly valuable for the design.
Best practice principals from the P21+ Repeatable Rooms initiative were used in designs.
All theatres are spacious and ergonomically designed, some with natural light creating a more pleasant working environment for surgical teams. Technology has had a huge impact with widescreen touchscreen surgeon’s panels for lighting and ventilation, as well as better imaging. Ultra Clean Ventilation canopies (UCV) in four of the new theatres feature modern skirt-less design and the largest size presently available. Two fully integrated laparoscopic theatres also utilise the latest technology.
The mortuary has pass through fridges, high spec mortuary adjustable tables, a ritual wash facility, dedicated waiting and viewing rooms and concealed body routes. A bereavement facility is co-located.
Sharing of best practice
Procure 21+ has “Highly Commended" the project, stating it particularly liked the bright, supportive feel of the development and singled out the improvement to the mortuary environment as a beacon to other Trusts. Details of the project will be on the P21+ website for other Trusts and designers to view.
CDDFT is one of the largest integrated care providers in England, serving a population of around 600,000 people, with over 1 million patient contacts per year.
