A £40 million plan to rebuild and expand Hereford County Hospital passed its first test this morning (Thurs).

Wye Valley NHS Trust board offered support in principle to the five-phase strategy addressing the limited options of the hospital’s present lay-out.

As revealed by the Hereford Times today (Thurs), much of the work timetabled to 2018 represents major internal reconfiguration of the hospital which is accepted as having been built too small to cope with demand.

This morning, the trust board was told the strategy represented the most significant investment in the hospital since the PFI deal that saw it built.

The NHS has already recognised the trust's present capital programme as amongst the smallest ever submitted.

 Financial constraints mean the trust has not been able to invest adequately in its layout for some time, despite obvious needs.

With its costs covered by a capital investment loan, the new strategy sees the end of the hospital’s hutted wards after 75 years to be replaced with new wards and a clinical block.

Multi-storey car parking and better staff accommodation are also explored.

A capital investment loan (CIL) is the strategy's preferred funding option.

The hospital already faces a number of urgent issues which need to be addressed through investment, including an £11 million backlog of maintenance and underlying shortfalls in the capacity for critical services.

As put to the board, the rebuild and expansion case focuses on:

* Replacing the old hutted wards.

* Extending the hospital’s capacity for inpatients.

* Bringing together services for day surgery and outpatient treatment onto a

single site.

It also includes the creation of an already planned midwifery-led unit, and the possible creation of a multistorey car park, new urgent care centre and internal changes to create a larger emergency department.

Trust chief executive Richard Beeken told the board that its support today was the first step of a process that brought together projects that might be possible in future - all of which remain subject to funding bids.

The board was warned that a £40 million plus loan cannot be taken for granted given  the trust’s existing underlying deficit and a cash position currently dependent on £12.7 million of financial support from the NHS.

With board support secured, the strategy moves to the trust's finance and performance committee next month for preliminary work on a business case.

An estimated capital cost for all five phases of the work is between £40-50 million.

The hospital’s estate issues date back to 1998 when the then Hereford Hospitals NHS Trust signed a business case for the development of the County Hospital under a PFI deal which became operational in 2002 and expires in 2029.

That business case only dealt with part of the site.

The plan that went to the trust board today demonstrates the need for significant investment in the rest of the site.

Amongst the drivers of the new business case is the recent Care Quality Commission report that put the trust into special measures with particular concerns identified over the provision of A&E, medical care services and managing patient numbers.

A key test for the strategy is the extent to which identified  works could be carried out through the current PFI contract with Mercia Healthcare Limited.

As outlined, the schedule for the work will be:

PHASE 1

Urgent works in the first year including:

* 16 new inpatient beds on an existing car park near mortuary/pathology.

* A multi-deck inpatient car park with a site identified above the existing Gwyndra

Downs car park.

* Decommissioning the “Arkwright” outpatient facility – a hired modular building – to cut cost pressures.

* A midwifery unit – already approved to be funded from charity.

* Internal revamp to improve patient flow.

*  A new base for medical records.

* Options to improve storage capacity across the hospital.

PHASE 2

* A new theatre complex, urgent care centre near A&E and clinical decisions unit.

* A new day/night helipad above the urgent care centre.

* Re-location of the “Spires” restaurant to the main entrance area, freeing space for a pharmacy, equipment decontamination and other activity needing to be near inpatient services.

* A multi-storey staff/patient car park.

* A combined heat and power unit to cut energy costs.

* An administration unit – probably in the present underused Lionel Green building – housing offices from other parts of the site.

PHASE 3

* Creating a wards and clinical block to house current wards well past their useful life as well as a permanent solution to the lack of inpatient capacity.

PHASE 4

* New endoscopy accommodation and the reorganisation of the daycase unit.

PHASE 5

* A number of future development zones identified for different types of development, with an emphasis on staff accommodation and including the possibility of a joint project with the proposed university. There are also cases for more CT and MRI scanning facilities and a combined children’s centre.