Capital Priorities 2008-2018 · SHSCT Capital Priorities 2008-2018 v0.8 Page 5 of 33 Approved by...

SHSCT Capital Priorities 2008-2018 v0.8

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Approved by Board of Directors 25th February 2010

Capital Priorities

2008-2018

Corporate Planning Division

Directorate of Performance & Reform

February 2010

Version 0.8


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TABLE OF CONTENTS

1. INTRODUCTION AND BACKGROUND ..........................................................3

2. STRATEGIC DEVELOPMENT OF ACUTE SERVICES.....................................4

3. MAINTAINING EXISTING SERVICES...........................................................9

4. PRIMARY AND COMMUNITY CARE INFRASTRUCTURE..........................11

5. COMPREHENSIVE SPENDING REVIEW .....................................................12

6. SHSCT CAPITAL PRIORITIES .....................................................................13


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1. INTRODUCTION AND BACKGROUND

1.1. Introduction

In June 2008 the Southern Health & Social Care Trust (SHSCT) submitted a report to the Department of Health Social Services and Public Safety (DHSSPS) on its capital priorities for the next 10 years. The Trust was subsequently asked to undertake further work in relation to that submission to specifically:

� Review the phased development plans for the Acute Hospital priorities.

� To specify the areas of risk/maintaining existing services (MES) which require investment of circa £0.5m which needed to be addressed to ensure safety.

� List CSR related investment critical to the delivery of efficiency savings targets in Years 1-3 (2008/09 – 2010/11).

A paper ‘Capital Priorities (2008-2018) Summary’ was subsequently submitted to the DHSSPS in July 2008.

Since this submission the Trust has been utilising its General Capital, MES Capital and specific capital for larger projects to undertake work to reduce risks and to progress toward the implementation of its strategic estates/service priorities.

The Trust remains committed to the broader strategic vision for the service and estate strategy that was set out in the response to Developing Better Services and in the Primary and Community Care Infrastructure programme. However the Trust recognises that the capital available within the ISNI period is not sufficient to meet the Trust’s original programme for investment. The Trust has therefore reviewed its priorities recognising that only smaller amounts of capital will be available. The focus of the reprioritisation is to ensure that all expenditure, especially on interim schemes, is targeted at the longer term aspirations for the estate.

This paper sets out the investment undertaken by the Trust to date against the priorities identified in 2008. It further sets out the revised priorities taking into account this investment and emerging pressures. The areas identified for investment in the ‘Capital Priorities (2008-2018) Summary’ were as follows:

� Acute Hospital Priorities – Strategic Development of Acute Services, see Section 2;

� Maintaining Existing Services – Infrastructure Projects, see Section 3;

� Primary and Community Care Infrastructure (PCCI), see Section 4; and

� Comprehensive Spending Review – capital investment critical to the delivery of efficiency savings targets, see Section 5.

Priorities for each of these key areas are identified in the following sections. Section 6 provides an overall assessment of the relative priorities of the Trust across all of the above categories.


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2. STRATEGIC DEVELOPMENT OF ACUTE SERVICES

2.1. Introduction

The SHSCT Capital Priorities paper developed during 2008 outlined the following priority investment over the period 2008-18 for Acute Services:

� CAH Phase 0 - Infrastructure works (£3.5m)

� CAH Phase 1A - Main Theatre Suite, Intensive Care/High Dependency Unit, Day Surgery, Intra/Postnatal Facilities, Neonatal Unit, Central Sterile Services Department (£101m)

� DHH Phase 1A – Main Theatres, Day Procedure Unit, Maternity Services, Special Care Baby Unit, CSSD, Paediatrics, Remedial works to external facade (£54m)

� CAH Phase 1B – A&E, Minor Injuries, GP Out of Hours, Radiology Department, Ambulatory Care Centre, Medical Admissions Unit (£90m)

� DHH Phase 1B – Ambulatory Care/Outpatients, Radiology Department, Remedial works to external façade, Relocation of Non-Clinical Services (£27m)

� CAH Phase 1C – Women & Children’ Centre (£66m)

� CAH Phase 1D – Surgical Beds, Cardiac Invasive Facility, Medical Admission Unit (£101m)

� CAH Phase 1E – Refurbishment of Existing Accommodation (£38m)

� STH – Paediatrics, Outpatients Department, Minor Injuries Unit, Radiology, Physiotherapy, Day Surgery, Wards, Day Hospital, Remedial works to external façade (£58m)

CAH – Craigavon Area Hospital

DHH – Daisy Hill Hospital

STH – South Tyrone Hospital


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2.2. Updated 2008-2018 Acute Priorities

Table 1 below indicates the updated position as at February 2010 against the original 2008 priorities, reflecting work undertaken since then and any new priorities that have emerged.

Table 1 – Updated 2008-2018 Acute Capital Priorities

PHASING 2008 INTERIM ACTION 2008-10

PRIORITY 2010-2015

PRIORITY 2015-2018

PRIORITY POST 2018

CAH Phase 0 – Infrastructure (£3.5m)

• Electrical Infrastructure

• Mechanical Infrastructure

• Water Infrastructure

Electrical distribution board ward block

Electrical distribution board med

wards

Electrical distribution board

maternity

Oxygen ring main replaced

Infrastructure works (also reflected in MES

costs)

Energy Centre £800,000

Electrical Infrastructure

£2,480,000

Medical Gas Infrastructure £420,000

Hot Water Plant £250,000

Boiler Plant £500,000

Upgrade Lifts £170,000

Other Priority MES Schemes

- -

CAH Phase 1A (£101m)

• Main Theatre Suite £33.7m

• ICU/HDU £13.2m

• Day Surgery/Endoscope Decontamination

£17.9m • Intra/Post natal £29m

• Neonatal £5.4m

• CSSD £2.3m

Development of T5, T&O (PKL), T&O Phase 2.

Extension of ICU x 1bed.

Interim decontamination facilities

Extension of Delivery Suite.

Refurbishment of Neonatal Unit.

Theatres 1-4 including purchase of PKL £14m,

estimate

Endoscopy Suite £3.7m

Orthopaedic Ward Fallow

Floor £500,000

Endoscope Decontamination £3.9m

CSSD

ICU/HDU

Intra/Post Natal

Neonatal


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DHH Phase 1A (£54m)

• New Build Day Procedures Unit £16.2m

• Relocation of Non-Clinical Services £2.4m

• New Build CSSD £4.3m

• Refurbishment Theatres, Maternity,

Paediatrics, Special Care Baby Unit, £31.3m

Electrical Infrastructure (ongoing)

Boiler Plant/Heating

Infrastructure/Chimney (ongoing)

Replacement of air handling units

Refurbishment of Delivery Suite and Special Care Baby Unit

Extension of Renal Unit

Infrastructure works (also reflected in MES

costs)

Electrical Infrastructure

£480,000

Boiler Plant/Heating

Infrastructure/Chimney £1,350,000

DHH Lifts £450,000

Interim improvements to

A&E/outpatients £750k

Redevelopment of

hospital £49.8m:

Phases 1-5

1. Dedicated

Paediatric Unit, 30 bed decant

ward £7.8m *

2. Twin Endoscopy

Facility, 30 bed unit £7.8m

3. Main Theatres inc DPU £7.9m

4. Two 30 bed wards £5.2m

5. Two 30 bed

wards £5.2m

Replace CT Scanner £560,000

Endoscope Decontamination £1.4m

Redevelopment of hospital £49.8m:

Phase 6 - Refurbish A&E, Outpatients, Radiology,

Administrative areas and extension £15.9m

CSSD

-

*The surgical element of this proposal will be subject to formal consultation therefore may change.


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CAH Phase 1B (£90m)

• A&E, Minor Injuries, GP Out Of Hours

£33m

• Radiology £16.4m • Ambulatory Care Centre (Outpatients,

Diagnostics, Day Assessment Treatment

Unit) £31.7m • Medical Admissions Unit £9.3m

Extension of A/E and introduction of Paediatric A/E.

PACS Implementation.

New GP out of hours.

Minor extension to Radiology.

Creation of medical admissions

unit.

Assessment area Old Psychiatric

Unit

Replacement of Screening Room 1 –

£444,000

Radiology equipment -

£2.8m

A&E, Minor Injuries Unit, GP Out of Hours,

Radiology

Ambulatory Care Centre

Medical Admissions Unit

DHH Phase 1B (£27m)

• Ambulatory Care Outpatients £2.2m

• Radiology Department £3.1m

• Additional clinical space £4.8m

• Remedial works to external façade £17.2m

Strategic Outline Case has been submitted – see

DHH Phase 1A

Strategic Outline Case has been submitted

(Phase 6 Refurbish A&E, Outpatients, Radiology,

Administrative Areas and extension)

Additional Clinical Space

Remedial works to

external façade

CAH Phase 1C (£66m)

• Ante Natal and Gynaecology Outpatients

£10.5m

• Gynaecology ward £10.4m

• Paediatric Ward £45.5m

Transfer of paediatric ward to Old Psychiatric

Unit £750,000

Ante Natal and Gynaecology Outpatients

Gynaecology Wards

CAH Phase 1D (£101m)

• Surgical beds £100m

• Cardiac invasive facility £1m

Cardiac Catheterisation Laboratory

Extension to Cardiac Catheterisation

Laboratory £1m

Surgical Beds Surgical Beds

CAH Phase 1E (£38m)

• Refurbishment of Existing Accommodation £38m

- - Refurbishment of Existing

Accommodation


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STH (£58m)

• Paediatrics £3m

• Outpatients £4.1m

• Minor Injuries Unit £2.1m

• Radiology £2.7m

• Physiotherapy (Wards) £1.5m

• Day Surgery £13.7m

• Wards £22.5m • Day Hospital £2.5m

• Support Accommodation - Dining etc.

£3.2m

• Remedial Works to External Façade £3.2m

Phase 1 & 2 Loane House complete to facilitate the 45

elderly care beds.

Remedial Works to External Façade

£750,000

Endoscope

Decontamination £870,000

- Remaining elements of £58m redevelopment


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3. MAINTAINING EXISTING SERVICES

3.1. Introduction

In 2008 the immediate priorities for capital investment in the Trust’s acute hospital network to alleviate the key infrastructure risks were identified. These were then categorised as those requiring an investment of less than £500,000 and those requiring more than £500,000.

The following tables summarise the investment made against these infrastructure priorities to sustain existing services and to contribute to the longer term development of the estate.

There has been investment of approximately £4.6 million in 17 projects each with a value of less than £500,000. While this has reduced some of the infrastructure risks they have not been fully alleviated.

Significant risk remains particularly around the electrical infrastructure at Craigavon Area and Daisy Hill Hospitals. These are critical to all future developments on both sites and therefore remain a very high priority for the Trust.

3.2. MES Schemes Funded to Date

Table 2 sets out the MES schemes that have been funded during 2008/09 and 2009/10.

Table 2 - MES Schemes Funded to date

MES Schemes Completed 2008/09 Allocations to

Date £CAH - Cleaning Ventilation Systems 300,000

DHH - Theatre ventilation (interim scheme) 490,000

DHH - Firecode Compliance 200,000

Cloughreagh House - Rewiring 365,000

Crozier House - Rewiring 125,000

DHH - Generator Plant 230,000

DHH - Maternity Refurbishment 500,000

Armagh & Dungannon - Firecode Compliance 178,000

MES Schemes Current 2009/10 Allocations to

Date £DHH - Electrical Infrastructure 720,000

DHH - Boiler Plant / Heating Infrastructure Upgrade 215,000

DHH - Chimney 25,000


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3.3. MES Priority Schemes

Table 3 sets out the MES Priority Schemes that require funding, these schemes have been assigned a priority risk rating, with 5 being the highest priority.

Table 3 - MES Priority Schemes

Risk

Priority

MES Schemes to be Completed Funding

Required £5 CAH - Energy Centre 800,000

5 STH - Holding works to Building Fabric 750,000

5 Lurgan Hospital - New Lift 500,000

5 DHH - Boiler/Heating Infrastructure - Phased Replacement of Boilers 500,000

5 DHH - Boiler/Heating Infrastructure - Replace critical engineering plant associated with

boiler

500,000

5 Trustwide - Firecode works 500,000

5 Trustwide - Infection Control 1,308,968

5 CAH - Interim Electrical Upgrade 480,000

5 DHH - Electrical Infrastructure 480,000

5 DHH - Upgrade Lifts 450,000

5 CAH - Upgrade Medical Gas Outlets 420,000

5 CAH - Replace roof in Day Surgery/Theatre/Main ward block/Maternity Labour Suite 420,000

5 CAH - Removal of Fire Loading from basement & provision of waste storage area 320,000

5 Lurgan Hospital - Phase 1 (Ward 5 plus Stroke Unit) 300,000

5 DHH - Replacement of Chimney 250,000

5 DHH - Remedial works to Building Fabric Main Hospital 200,000

5 DHH - External Fire Escape to address Non-Compliance in Doctor's Accommodation and

Nurses Home

150,000

5 CAH - Replace Laundry roof covering 120,000

4 CAH – Replacement Laundry equipment 1,000,000

4 CAH – Phased Replacement of Boilers - 2 Boilers 500,000

4 DHH - Theatres - Maintaining Existing Mechanical and Electrical Services 500,000

4 DHH - Phased Replacement of Defective CI Water Mains 400,000

4 John Mitchell Place - Repairs to external fabric 400,000

4 CAH – Hot Water Plant 250,000

4 DHH - Phased replacement Chilling plant 250,000

4 DHH - Phased Replacement Nurse Call System 250,000

4 CAH - Upgrade Lifts 170,000

4 DHH - Replace Roof in Nurses Home 150,000

4 CAH - Cold Room 110,000

4 DHH - Install Gas to replace Electrical Heating to reduce Electrical Load and provide

resilience in kitchen

100,000

4 Lurgan Hospital - Replace Roof in Wards 9 & 10 and Day Hospital 75,000

3 DHH - Phased Replacement Air Handling Plant 500,000

3 CAH - Tube Transfer of Soiled Linen 460,000

3 CAH - Install Clean Steam Generators – CSSD 320,000

3 CAH - Replacement of Existing Defective CI Water Mains 300,000

3 DHH - Localised Steam Generation - CSSD (Main Steam Boilers being replaced) 100,000

3 DHH - Relocate 800 KVA Generator to DHH 50,000

2 CAH - Phased replacement of Sterilisers 250,000

1 Lurgan Hospital - Modular Kitchen 490,000

1 Trustwide - Phased Replacement of Roof Lights 250,000

A description of each of these schemes is provided as Appendix 1.

There is no prioritisation within Risk Priority 5s, 4s etc.


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4. PRIMARY AND COMMUNITY CARE INFRASTRUCTURE

4.1. Introduction

The funding which was initially proposed for the PCCI programme is no longer available. This will necessitate the Trust refurbishing and repairing primary care facilities as opposed to replacing those which have been shown to be no longer fit for purpose.

The Trust’s priorities remain unchanged and are reflected in Table 4 below.

Table 4 - Priority PCCI Schemes

Priority Description Estimated

Capital Cost £

1 Banbridge CTCC & Day Care 14,905,461

2 Oakridge Learning Disability Day Care Centre 7,210,000

3 Crossmaglen SEC * 3,421,130

4 Keady Level 1 H&CC 9,258,514

5 Newry CTCC 30,600,000

6 Warrenpoint Level 1 H&CC 3,000,000

7 Dungannon CTCC 16,800,000

8 Learning Disability Respite Unit Gilford 1,250,000

9 Community Dementia Unit Armagh 5,000,000

10 Millview Physical Disability Day Centre 8,340,000

11 Rathfriland H&CC 5,400,000

12 Newtownhamilton H&CC 3,900,000

13 Crossmaglen H&CC 5,800,000

14 Armagh CTCC 8,700,000

15 Lurgan CTCC 20,000,000

16 Richhill H&CC 4,200,000

17 Coalisland H&CC 2,900,000

18 Brownlow CTCC 16,000,000

19 Dromore H&CC 7,500,000

20 Markethill H&CC 500,000

21 Ballygawley H&CC 3,000,000

22 Armagh Assessment & Treatment Centre, Learning Disability TBC

* Business Case approved no site available

The Trust expects to receive capital funding to progress new build projects for Banbridge CTCC & Day Care Project and Oakridge Learning Disability Day Care Centre. The capital costs indicated for all of the other projects noted in Table 4 above reflect new build costs, however the Trust recognises that if new build funding is not available then refurbishment options will need to be considered (potentially funded from Trust General Capital and phased over a number of years).


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5. COMPREHENSIVE SPENDING REVIEW

5.1. Introduction

There were two critical developments for delivery of CSR efficiency savings identified in the original 2008 paper. The first was for the centralisation of Mental Health inpatient beds on the Craigavon Area Hospital site and a business case for this has been submitted to the DHSSPS.

The second proposal was for the rationalisation of non-acute hospital care of the elderly. Significant progress has been made in this regard through refurbishment of areas in South Tyrone Hospital. Full implementation will require however further expenditure at Lurgan Hospital.

Both these developments therefore remain a high priority for the Trust. A further efficiency plan has been developed by the Trust related to maximising use of Trust estate. In response to a Ministerial request, the initial focus for this plan has been on the Armagh area.

The three critical developments for delivery of CSR efficiency savings are:

� Bluestone Extension - centralisation of mental health acute hospital care (£4.8m), see description Appendix 2;

� Relocation of Trust Services to Armagh site – the Trust seeks to rationalise estate and maximise efficiency by moving services to the St Luke’s / Longstone Hospital sites in Armagh. These moves will incur capital expenditure on refurbishment and upgrades;

� Lurgan Hospital - Rationalisation of non-acute hospital care of the elderly (included within £3.4m requirement for Lurgan Hospital Refurbishment which seeks to refurbish ward accommodation within Lurgan Hospital to primarily address issues concerning infection control and compliance with statutory requirements – see Appendix 2 for full description).


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6. SHSCT CAPITAL PRIORITIES

6.1. Introduction

Table 5 below is a summary of the priorities across the four key areas, with indicative phasing of capital investment over years 2009/10 to 2017/18. Where there is a relationship between an MES requirement and a larger development these have been combined.

Table 5 – SHSCT Capital Priorities 2008-18 Priority Scheme Total Capital

Cost

£

2009/10

£

2010/11

£

2011/12

£

2012/13

£

2013/14

£

2014/15

£

2015/16

£

2016/17

£

2017/18

£

1 Infrastructure Works

- CAH Energy Centre 800,000 - 800,000 - - - - - - -

- CAH Electrical Distribution (Note 1) 2,480,000 - 480,000 2,000,000 - - - - - -

- DHH Electrical Infrastructure 480,000 - 480,000 - - - - - - -

- DHH Boiler Plant / Heating Infrastructure / Chimney 1,350,000 - 1,250,000 100,000 - - - - - -

- CAH Medical Gas Infrastructure 420,000 - 420,000 - - - - - - -

- CAH Hot Water Plant 250,000 - - 250,000 - - - - - -

- CAH Boiler Plant 500,000 - - 500,000 - - - - - -

- CAH/DHH Lifts 620,000 - 450,000 170,000 - - - - - -

- Trustwide Infection Control 1,308,968 500,000 808,968 - - - - - -

- Other MES Schemes 6,840,000 1,060,000 3,060,000 1,730,000 250,000 740,000 - - -

2 CAH - Replacement Operating Theatres 1-4 13,800,000 5,000,000 8,800,000 - - - - - -

3 DHH - Replacement of CT Scanner 560,000 - 560,000 - - - - - - -

4 Bluestone Extension - Mental Health Resettlement 4,816,715 - 1,778,109 2,853,451 185,155 - - - - -

5 Relocation of Trust services to Armagh site 500,000 500,000 - - - - - - -

6 DHH - Interim improvements to A&E and Outpatients 750,000 750,000 - - - - - - -

7 Endoscope Decontamination

- Craigavon & Banbridge locality (Note 2) 3,900,000 - 1,800,000 2,100,000 - - - - - -

- Newry & Mourne locality 1,300,000 - 1,300,000 - - - - - - -

- Armagh & Dungannon locality 870,000 - 870,000 - - - - - - -

8 CAH - Endoscopy Suite (Note 2) 3,700,000 - 2,000,000 1,700,000 - - - - - -

9 DHH - Site Redevelopment (Phase 1) 7,774,862 - 7,774,862 - - - - - -

10 Banbridge CTCC & Day Care 14,905,461 500,000 4,385,132 8,105,606 1,736,516 178,207 - - - -

11 Lurgan Hospital - Refurbishment 3,408,851 - 1,000,000 2,408,851 - - - - - -

12 DHH - Site Redevelopment (Other Phases) 46,323,941 - - 7,750,060 7,899,992 5,218,633 5,218,633 15,936,623 4,300,000 -

13 CAH - Replacement of Fluoroscopy Screening Room 1 444,000 - 444,000 - - - - - - -

14 CAH - Orthopaedic Ward Fallow Floor 500,000 500,000 - - - - - - -

15 CAH - New Paediatric Ward 750,000 - 750,000 - - - - - - -

16 Oakridge Learning Disability Day Care Centre 7,210,000 - - 500,000 4,026,000 2,684,000 -

17 Trustwide - Fire Code 3,400,000 670,000 645,000 720,000 647,000 718,000 - - -

18 STH - Remedial Works to External Façade 750,000 - 400,000 350,000 - - - - - -

19 CAH - Extension of Cardiac Catheterisation Laboratory 1,000,000 - - 1,000,000 - - - - - -

20 Interim Centralisation of Dental & Podiatry Decontamination -

Portadown CTCC

300,000 300,000 - - - - - - - -

21 Acute Radiology Equipment - Mammography & STH Screening

Room

1,300,000 - 650,000 650,000 - - - - - -

22 Acute Radiology Equipment - Ultrasound Rooms and additional

MRI Scanner

1,540,000 - 770,000 770,000 - - - - - -

23 Trustwide ICT 2,500,000 1,000,000 1,500,000

24 Trustwide Transport Strategy 5,464,000 - 683,000 683,000 683,000 683,000 683,000 683,000 683,000 683,000

25 Centralisation of Dental & Podiatry Decontamination 3,064,207 - 3,064,207 - - - - - - -

26 CAH Phase 1 174,800,000 - - - - - 2,300,000 57,500,000 57,500,000 57,500,000

27 Crossmaglen Social Education Centre 3,420,130 - - 500,000 1,752,078 1,168,052 - - -

28 Keady Level 1 CTCC 9,258,514 - - - - 3,500,000 5,758,514 - - -

Annual Total 333,359,649 800,000 42,089,310 46,704,936 17,480,663 14,912,918 16,586,199 74,119,623 62,483,000 58,183,000

Note 1 CAH Electrical Distribution will be required in advance of any

new schemes being progressed on CAH site.

Note 2 Now proposed to combine these schemes.


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Appendix 1

Description of Priority MES Schemes


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Priority MES Schemes

Risk Level

Description of Works £ EST DURATION OF WORK

PERIOD

5 CAH – Energy Centre The Energy Distribution Centre at CAH is currently at full capacity. This distribution system provides high pressure hot water throughout the site to generate heat for general heating systems, domestic hot water and heating for all ventilation systems. A new modular Energy Centre will be required on the site to meet the heating demands for all future developments.

800,000 9 MONTHS

5 STH - Remedial works to Building Fabric

Building fabric in need of major repair, there is a need to take action to mitigate the possibility of falling debris and loose concrete.

750,000 6 MONTHS

5 Lurgan Hospital - New Lift

Existing lift requires to be replaced - spares no longer available and no resilience.

500,000 6 MONTHS

5 DHH - Boiler/Heating Infrastructure - Phased Replacement of Boilers

Boilers are 40 years old and are due for immediate replacement. Critical spare parts are not available.

500,000 6 MONTHS SUMMER ONLY

5 DHH - Boiler/Heating Infrastructure - Replace critical engineering plant associated with boiler

Plant is 30 years old and could fail at any time causing loss of critical service to patients.


5 Trustwide - Firecode Priority works determined by Firecode Compliance Plan. 500,000 6 MONTHS


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works

5 Trustwide - Infection Control

Works determined by infection control requirements. 1,308,968 8 MONTHS

5 CAH - Interim Electrical Upgrade

Upgrade 11 KV underground cable. The existing cable is 35 year old paper insulated construction and is subjected to ever increasing electrical load. 11KV switchboard showing signs of stress on 11,00 volt insulators. Risk of electrical failure of switchgear to the acute site.

480,000 6 MONTHS

5 DHH - Electrical Infrastructure

Replace the existing NIE supply which is unable to meet site demand and could fail at any time causing significant service disruption. Requires new mains supply for NIE, new HV & LV switchgear, new distribution supplies to hospital block.

480,000 ASAP 3 MONTHS

5 DHH - Upgrade Lifts Lifts are 30 years old and critical spares are no longer available. Failure would significantly impact on service delivery.

450,000 3 MONTHS

5 CAH - Upgrade Medical Gas Outlets

The gas outlets in the wards are MK1 units and are 35 years old. Outlets and ports are no longer available. The Trust has been using salvaged outlets from other Trusts. Works will require decant.

420,000 12 MONTHS

5 CAH - Replace roof in Day Surgery/Theatre/Main ward block/Maternity Labour Suite

Roof now 35 years old. Collapse of roof would result in loss of day surgery / theatre.


5 CAH - Removal of Fire Loading from basement & provision of waste

This area is very congested and is located below the main patient wards. Work is urgently needed to reduce fire loading.

320,000 6 MONTHS


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storage area

5 Lurgan Hospital - Phase 1 (Ward 5 plus Stroke Unit)

This scheme seeks to refurbish ward accommodation in Lurgan Hospital primarily to address issues concerning infection control and compliance with statutory standards.

300,000 6 MONTHS

5 DHH - Replacement of Chimney

Recent structural survey recommends immediate replacement. Severe deterioration to structural concrete.


5 DHH - Holding works to Building Fabric Main Hospital

Concrete and roofing structure require works. Spalling concrete reports available. Need to provide protection to public from falling debris and loose concrete

200,000 6 MONTHS

5 DHH - External Fire Escape to address Non-Compliance in Doctor's Accommodation and Nurses Home

This is required to accommodate junior doctors and medical students from Queens University and achieve Firecode Compliance.

150,000 3 MONTHS

5 CAH - Replace Laundry roof covering

Roof now 35 years old and leaking. Laundry critical to theatre and wards.


4 CAH – Replacement Laundry equipment

Phased Replacement of Tunnel Washer, Calendar Ironing Machine and Tumble Driers. The tunnel washer provides half of the laundry production for the Southern Trust, Belfast City and Musgrave Park Hospitals. The plant is 15 years old and is showing signs of stress and structural failure due to age. The calender ironing machine provides one third of all laundry production and is 38 years old. Parts and components are no longer available.

1,000,000 3 MONTHS


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4 CAH – Phased Replacement of Boilers - 2 Boilers

The boiler plant provides steam and HPHW for the acute site. One boiler is now not adequate to carry load due to increased demand due to new builds. Second boiler is 30 years old and beyond economic life. This boiler provides steam supply to critical services i.e. sterile services, kitchens and laundry production.

500,000 6 MONTHS

4 DHH - Theatres - Maintaining Existing Mechanical and Electrical Services

Medical gas systems and theatre electrics are all inadequate in meeting present requirements. This could lead to restriction in delivering surgical care. Major upgrade required.

500,000 6 MONTHS

4 DHH - Phased Replacement of Defective CI Water Mains

Mains located at defective retaining wall (Camlough Road). Ground movement likely which could cause loss of mains incoming water supply.

400,000 3 MONTHS

4 John Mitchell Place - Repairs to external fabric

Building fabric in need of major repairs, windows, roof etc. To ensure continued use of patient clinics.

400,000 6 MONTHS

4 CAH – Hot Water Plant The hot water angeleries and heating calorifiers are 35 years old and have been failing in service due to fatigue and stress failures. All of the plant needs to be replaced with high efficiency plate heat exchangers. Risks include loss of hot water, heating failure to clinical spaces and risk of legionella.


4 DHH - Phased replacement Chilling plant

Plant presently uses R22 gas which must be replaced by 2010. If gas is not available plant could fail resulting in significant service disruption.

250,000 3 MONTHS

4 DHH - Phased Replacement Nurse Call System

Systems are 30 years old and are unable to deliver appropriate services for patients.

250,000 3 MONTHS

4 CAH - Upgrade Lifts Continued phased replacement of lifts. Lifts are 35 years 170,000 2 MONTHS


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old. Upgrade two passenger lifts - Main Ward Block.

4 DHH - Replace Roof in Nurses Home

Roof of Nurses Home is in poor condition - loose copings. main ward asphalt roof severely cracked. Low level flat roof now at end of life. Requires phased replacement (A&E, Outpatients department etc.)


4 CAH - Cold Room The cold room holds frozen and chilled food for production kitchen. The rooms are 15 years old and are non-compliant and failure of plant will cause severe disruption to food production to patients.

110,000 2 MONTHS

4 DHH - Install Gas to replace Electrical Heating to reduce Electrical Load and provide resilience in kitchen

This is to enable the steam boilers to be replaced and to provide further resilience in the kitchen and to provide savings in the energy bill with a reduced electrical load.

100,000 3 MONTHS

4 Lurgan Hospital - Replace Roof in Wards 9 & 10 and Day Hospital

The roof is a warm roof 30 years old. It is a felt based flat roof. Insulation requires to be replaced and upgraded (community paediatrics day hospital)


3 DHH - Phased Replacement Air Handling Plant

Air handling plant is 30 years old and is not designed to deliver a clean safe air supply to patient areas and should be replaced as soon as possible.

500,000 6 MONTHS

3 CAH - Tube Transfer of Soiled Linen

Tube transfer of soiled linen from ward to laundry to reduce fire loading. Storage of laundry/linen in basement of hospital is major fire risk. This system will supply and remove laundry directly from the wards without the need of storage.

460,000 6 MONTHS

3 CAH - Install Clean Steam Generators – CSSD

Steam quality to steriliser equipment is required to meet the quality set out in HTM2030. Existing steam supply cannot

320,000 1 MONTH


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meet the required standard.

3 CAH - Replacement of Existing Defective CI Water Mains

Mains 30 years old. Cast iron - cracking and shearing due to ground movement. Area being intensely developed, and as a consequence - loss of water supply to hospital.

300,000 4 MONTHS

3 DHH - Localised Steam Generation - CSSD (Main Steam Boilers being replaced)

This is to take the load off steam boilers which must be replaced. It will also deliver a clean steam supply for CSSD plant which will be required for increased theatre delivery.

100,000 6 MONTHS

3 DHH - Relocate 800 KVA Generator to DHH

Relocate 800 KVA Generator to DHH to provide resilience to Stand-by Generator. Generator for CAH (foc) Renal/Theatre Back-up. Relocation of spare generator from Craigavon Area Hospital to provide backup to single site generator. Failure on load would result in service collapse.

50,000 6 MONTHS

2 CAH - Phased replacement of Sterilisers

The existing sterlisers are now several years old and are critical for Trust wide decontamination services. It is essential that this plant is replaced on a phased approach to secure continuity of service.

250,000 3 MONTHS

1 Lurgan Hospital - Modular Kitchen

Kitchen beyond repair. Second hand building in place since 1981 requires replacement (may need to consider cook chill process etc.)

490,000 3 MONTHS

1 Trustwide - Phased Replacement of Roof Lights

Roof lights have gone opaque and are distorted in shape, causing leaking.



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Appendix 2

Description of Priority Schemes


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Project information and risks This Appendix describes each of the priority items identified in Section 6. Infrastructure Works Much of the original infrastructure on the Craigavon Area Hospital (CAH) and Daisy Hill Hospital (DHH) sites is still in use and is now in urgent need of investment to prevent serious impact on patient services. The following are the most critical areas where urgent upgrade work is required. The schemes are listed in priority order.

CAH, Energy Centre The Energy Distribution Centre at CAH is currently at full capacity. This distribution system provides high pressure hot water throughout the site to generate heat for general heating systems, domestic hot water and heating for all ventilation systems. A new modular Energy Centre will be required on the site to meet the heating demands for all future developments. CAH, Energy Distribution Investment is required to increase the electrical distribution on the CAH site, which is insufficient to provide electrical supply for new developments. CAH, Electrical Infrastructure The existing electrical infrastructure at CAH is approximately 40 years old although parts of the infrastructure has been upgraded over the last 2 years the following items are still a risk and require to be upgraded: � LV distribution medical wards � LV distribution main kitchen � HV transformer and RMU serving the maternity block These boards are original (38 years old).

Due to an ever increasing electrical loading to support expanding services, these boards are running at full capacity. Some cables have been replaced to meet increased loads. It is no longer possible to provide additional electrical services from these boards.


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DHH, Electrical Infrastructure The electrical supply to DHH from NIE is rated at a capacity of 1MW / 400v. The present electrical demand of the site is around 1.2MW which means that the hospital is drawing an electrical load that is bigger than that of the NIE supply transformer. Additional load has been added on continually over the past 25 years there is a need to review the load bearing capacity of the complete internal distribution infrastructure. Whilst the standby generator has been upgraded in recent years a further generator will be required as a result of increased demand to ensure full cover is available in the event of mains failure. Failure of the electricity supply would cause severe disruption to the service.

DHH, Boiler Plant / Heating Infrastructure / Chimney The site mechanical & electrical services in DHH are now around 40 years old and are in urgent need of replacement. All heat & domestic hot water on the DHH site is provided from a central boiler house. The boiler house contains 3 steam boilers each with a rated capacity of 10,000 lbs/hour. The boilers were commissioned in 1970 and are fuelled with 3500 sec oil. The boilers are now approximately 15 years beyond their expected service life. The oil burners are redundant, with no spares available. The boilers are connected to peripheral buildings (7 num) via a steam main operating at around 8 bar. The steam main is inaccessible and is in a poor condition. To repair even a minor steam leak can cost up to £10k. Steam mains run underneath car parks and are covered over with interlocking reinforced concrete slabs. The insulation on the steam pipe work is in poor condition and it cannot be maintained. As a consequence there are major standing losses which cannot be controlled. All of the peripheral buildings have steam processing plant, Calorifiers for Heating & DHW. Most of this equipment is over 30 years old and is in urgent need of replacement. The main Boiler flue is in very poor condition. Structural Engineers have advised that the chimney is unsafe and should be demolished with a maximum time frame of 12 months. If the present rate of deterioration continues the date for demolition may be brought forward.

CAH, Medical Gas Infrastructure The medical gas distribution system at CAH is 35 years old and is in urgent need of upgrade work. There are MK1 outlets throughout the Ward Block, Maternity, Outpatients, A&E, Theatres, ICU and Radiology. Parts are no longer available and parts are sourced from other hospitals in an attempt to maintain a service. It is becoming increasingly difficult to keep this life critical medical gas system operational. Replacement GEM 10 outlets will have to be fitted as the MK1s as outlets fail. The GEM10 outlets will not be compatible with the MK1 outlets and will require separate/ dedicated oxygen flow meters and vacuum units to be supplied.


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CAH, Hot Water Plant Urgent upgrade is required to the heating and domestic hot water services to the maternity unit, main ward blocks and intensive care, theatres and recovery at CAH. The heating plant is 38 years old (controls and valves have been replaced). This plant has failed on several occasions and two non storage DHW calorifiers have been taken out of service because they failed statutory inspections. Failure of this plant has caused, and will continue to cause, disruption to patient services. CAH, Boiler Plant One steam boiler at CAH is now beyond its useful life. It is 38 years old and whilst it is currently operational, given its age, it needs to be replaced urgently. This boiler provides the steam supply for the CAH Laundry, CSSD, and Main kitchens. Should the 38 year old boiler fail in service or fail statutory inspection then the hospital will not be able to maintain a full steam service. This will present a serious risk to the delivery of the Trust laundry service, CSSD services and Craigavon catering services. The laundry provides a service to all of the Southern Trust as well as the Belfast City Hospital and Musgrave Park Hospital. The Catering Service provides all patient and staff meals for the CAH site.

CAH / DHH, Upgrade to Lifts The lifts at CAH and DHH are at the end of their useful life. Lifts on both sites are old cable style lifts and were installed when the hospitals opened. They are not DDA compliant. The lifts at CAH have been in service for 38 years, and the DHH lifts for approximately 32 years. They have not been upgraded in their life time nor can they be, as the technology is out of date and parts are not available. The lifts break down on a daily basis and are extremely unreliable. Trustwide Infection Control Issues Much of the Trust’s estate is in excess of 30 years old, and does not comply with current Health Building Notes (HBNs), Health Technical Memoranda (HTMs) and other guidance. The state of the fabric of the building is poor in many key areas such as sluices, patient toilet and shower areas and ward kitchens resulting in surfaces which are difficult to clean properly. There are inadequate clinical hand washing facilities with most wash hand basins having the old style hand operated taps. As a result the risk


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of patients contracting Healthcare Associated Infection (HAI) is significantly increased. CAH, Replacement of Operating Theatres 1-4 The four main operating theatres at CAH present one of the highest risks to patient safety in terms of infection control issues and also because of the likelihood of catastrophic failure due to mechanical and electrical services issues. If no action is taken then the risk will increase until it is deemed to be too high to operate safely. This would have a serious impact on the delivery of services to patients.

The Trust’s current proposal is to provide temporary theatre accommodation until implementation of the new Clinical Core/Phase 1A of the CAH Site Development Plan, to minimise nugatory expenditure and work towards a more strategic solution to a range of risk issues on this site.

This option proposes the purchase of 2 theatres and associated accommodation which are currently leased for Trauma and Orthopaedics. Some upgrade works will be required to the ventilation and fire alarm systems. In addition two new theatres and associated accommodation would be built in the area currently occupied by the existing theatres.

DHH – Replacement of CT Scanner The Trust proposes the replacement of the CT Scanner in the Radiology Department at DHH.

At present the CT Scanner in DHH is a GE High Speed Plus single-slice system produced by the medical company GE Medical. It was installed during 2000. The existing scanner in DHH is the only single-slice scanner in use in Northern Ireland. Due to the speed at which CT scanning technology has developed, the existing machine is technically outdated in terms of functionality and capability compared to technology now deemed as standard. This is mainly due to ‘tube cooling’ issues which result in poor quality images. The single slice scanner takes slices 7mm apart which has significant implications for clinicians.

Bluestone Extension – Mental Health Resettlement This scheme proposes to extend accommodation at Bluestone by providing an additional 20 bed unit which will enable the transfer of psychiatric intensive care and addiction beds from St Luke’s Hospital, Armagh and facilitate the centralisation of acute mental health inpatient care to one site within the Trust.


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The proposed capital investment will enable the Trust to deliver on its new service model and assessed need for the future provision of mental health inpatient care.

The additional capital works will:

� Provide the physical environment that will enhance the well being of patients, staff and visitors. � Aid Bed Management. � Improve clinical effectiveness and ensure the safe delivery of effective and high quality care. � Facilitate a single cohesive staff culture. � Promote integrated working.

This proposal supports the Trust CSR proposal for the rationalisation of acute mental health beds.

Relocation of Trust Services to Armagh site An efficiency plan has been developed by the Trust related to maximising use of Trust estate. In response to a Ministerial request, the initial focus for this plan has been on the Armagh area. The Trust seeks to rationalise estate and maximise efficiency by moving services to the St Luke’s / Longstone Hospital sites in Armagh. These moves will incur refurbishment and upgrade expenditure.

DHH – Interim improvements to A&E and Outpatient departments Long term development of A&E and Outpatients is included as Phase 6 (estimated as 2015/16) of the overall site development plan for DHH. However the Trust will need to undertake interim works to support service modernisation and maximise service capacity e.g. through developing facilities to enable increased outpatient-with-procedure services hence avoiding the need for patients to be admitted to hospital.

Endoscope Decontamination Following concerns in relation to arrangements for the cleaning and decontamination of flexible endoscopes in Northern Ireland hospitals in 2004 the DHSSPS commissioned an independent external review of the systems and processes used in NI to achieve the cleaning and high-level disinfection of flexible endoscopes. The output of the external review was The Report of an Independent Review of Endoscope Decontamination in Northern Ireland (December 2004), the ‘Hine Review’.


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Trust facilities for the cleaning, decontamination and storage of endoscopes do not comply with standards recommended in the ‘Hine Review’, increasing the risk of infection transmission.

All Endoscopy Units will be required to be accredited with the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) by 2009/10. The JAG accreditation process relies heavily, although not exclusively, on a unit’s performance against quality standards set as part of the Global Rating Scheme (GRS) which is a tool to enable units to assess how well they provide a patient centred service.

It is proposed to provide a central decontamination facility on each of the hospital sites which fully complies with the Hine Review recommendations.

Craigavon & Banbridge locality - Centralised Decontamination Facility at CAH adjacent to Day Surgery Unit (new build) - will service the Day Surgery Unit, Main Theatres, X-Ray and ICU.

Newry & Mourne locality - Centralised Decontamination Facility at DHH adjoining the Day Procedure Unit (new build) - will service the whole hospital.

Armagh & Dungannon locality - Centralised Decontamination Facility at STH in refurbished accommodation - will service the Day Surgery Unit and Outpatients Department.

CAH, Endoscopy Unit The Trust has a need to expand endoscopy capacity at CAH – to increase its endoscopy sessions in line with Joint Advisory Group (JAG) recommendations and to support the delivery of a local Bowel Cancer Screening Service to the population of the SHSCT. DHH – Site Redevelopment The Trust has a need to redevelop the Daisy Hill Hospital (DHH) site. The Trust is committed to developing the DHH site in order to maximise it as part of the Trust’s network of hospital services (in particular to maximise DHH’s role in supporting CAH). The Trust is currently undertaking an extensive review of the existing services on the DHH site and from this will develop and implement new models of care/service models. The Trust considers that redevelopment of the site is necessary to allow the new models of care/service models to be fully implemented. There are major weaknesses with the existing accommodation at DHH, the weaknesses are not simply cosmetic or giving rise to minor inconvenience to patients and staff. Much of the accommodation is unpleasant and cramped with inadequate environmental control and falling short of safety and statutory standards.


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The preferred option proposes the reconfiguration and refurbishment of the existing ward/theatre block, A&E, Outpatients, and Radiology to meet the needs of the new service models. The Trust recognises that it will be necessary to maintain clinical services during the redevelopment of the site and therefore has set out a number of phases that will ensure stability of services during the programme of works. It is estimated that the work could be carried out over a one to five year period dependent on the ability to take forward more than one phase in any given year.

The phases would be as follows:

� Phase 1 – Conversion of Floor 6 to accommodate a paediatric centre of excellence including a paediatric theatre, ward accommodation and paediatric ambulatory care. This would create a floor dedicated to paediatrics and support the Trusts strategic direction of centralising paediatric surgery on the DHH site. It is intended that Trust Board will make a decision on the associated consultation on service changes for planned surgical paediatric care early 2010. A decant facility will also be constructed in Phase 1. This will allow the different bed accommodation refurbishment elements of the phasing to proceed while clinical services continue. The decant will then be utilised as part of Phase 6 and provide the space for the extended A&E and Outpatients.

� Phase 2 – This involves the creation of 2 endoscopy suites on the third floor which would be used initially as main theatres to facilitate Phase 3 which is the refurbishment of main theatres, day surgery, recovery high dependency and the refurbishment of a 30 bedded area.

� Phase 3 - Refurbishment of main theatres, day surgery, recovery and high dependency on Floor 1. � Phase 4 - Refurbishment of Floor 5 ward accommodation for 60 beds. � Phase 5 - Refurbishment of Floor 4 ward accommodation for 60 beds. � Phase 6 – Refurbishment of the podium level to include A&E, Outpatients, Radiology and administrative areas. The additional space

required will be provided in the decant facility constructed during Phase 1.

Banbridge CTCC & Day Care Project The Banbridge CTCC and Day Care project will provide for a new build solution in Banbridge that will accommodate physical disability day care, learning disability day care and community treatment and care services.

The key drivers for this scheme include the need to complete previously agreed plans for a community health village for the local population of Banbridge. This scheme will be developed on the former Banbridge Hospital site which already provides GP services, Banbridge Polyclinic, Fold and Oaklee Housing Schemes.

Current facilities at Copperfields SEC (physical disability day care), Ballydown SEC (learning disability day care) and Banbridge HSSC (Scarva Street) are below statutory standards and consequently require action to ensure alternative accommodation that is fit for purpose which can be provided to facilitate improved integration of services, better working arrangements and improved quality services for the local population.


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Lurgan Hospital Refurbishment This scheme seeks to refurbish ward accommodation within Lurgan Hospital to primarily address issues concerning infection control and compliance with statutory requirements. The refurbishment works will facilitate the following requirements:

� Address the issues raised in the RQIA Inspection Report and in particular the spacing of beds. � Support the Trusts CSR proposal for the rationalisation of non acute beds for older people. � Assist in provision of high quality and effective service delivery for patients through refurbishment of ward accommodation. � Provide for replacement of the existing lift which will be necessary to enable services to continue within the hospital. � Contribute towards containment and a reduction in infection rates and specifically in regards to cases of C Difficile. � Improve the patient pathway and experience. � Complement strategies in regards to:

o Preventing unnecessary hospital attendance. o Facilitate timely discharge from hospital.

CAH – Replacement of Fluoroscopy Screening Room 1 The Trust proposes the replacement of the Fluroscopy Room (Screening Room 1) in the Radiology Department at CAH.

The existing facility at CAH was installed during June 1994. Following a series of breakdowns (including complete failure) a new room was requested during 2005. The room was not replaced in its entirety, however during 2005 a new camera, new image intensifier, a new high speed x-ray tube and a new TV system were installed. The Trust continues to have a high level of breakdowns of equipment which has created difficulty in meeting performance targets.

CAH, Orthopaedic Ward Fallow Floor The new Trauma & Orthopaedic Unit is almost completed and it will become operational on 4th May 2010. The Unit includes a 15 bed orthopaedic ward. There is a fallow area adjacent to the ward which, when fitted out, will provide another 6 single rooms increasing the bed complement to 21 orthopaedic beds. The additional beds will enable the Trust to increase the number of orthopaedic patients it is able to treat. Two Consultant Orthopaedic surgeons from the SHSCT have operated in Musgrave Park Hospital each week, largely due to the limited bed capacity at CAH. The additional 6 beds will support this activity being undertaken at the SHSCT. In addition they will facilitate the


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treatment of some patients from the Newry and Mourne area. (The local service does not currently enable the treatment of any orthopaedic patients from Newry and Mourne).

CAH, New Paediatric Ward Current Paediatric inpatient accommodation at CAH is in need of capital works in order to address the deficiencies in the standard of the accommodation and to facilitate the implementation of the new SHSCT Paediatric non elective service model.

The Trust proposes to refurbish accommodation in the former Psychiatric Unit which will provide the physical space and functional layout that is required to accommodate the reconfigured model of care.

Oakridge Learning Disability Day Care Centre This project is seeking to replace existing day care accommodation which is no longer fit for purpose and is in need of urgent replacement. This scheme aims to provide a new build 60 place learning disability day care centre on the Drumglass site in Dungannon.

The new centre would achieve the following:

� Overcome shortfalls in the existing accommodation. � Provide an accommodation solution which would meet the requirements of service users by providing suitable space and functional layouts

for the delivery of care. � Meet all statutory and building standards.

Trustwide Firecode Requirements Structural Fire Precaution - The structural fire barriers are essential in health care facilities to prevent the spread of smoke and flames. Some existing fire barriers are either in very poor condition or are non existent. In the event of a fire, smoke and flames can spread throughout the facility and will not be contained, resulting in mass evacuation of a large area of a building which could include high risk clinical areas. The absence of adequate fire barriers significantly increases the risk of serious harm and loss of life.

Fire alarm - There is an immediate need to upgrade existing fire alarm systems. These systems are essential to provide early indication of a potential fire. If a fire is not detected at an early stage then there is the very real possibility that the fire will be allowed to take hold and will get out of control. This, together with the poor or non existent fire barriers, could have the potential for a high loss of life.


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The current estimated cost of achieving Fire Code compliance is as follows:

� CAH - £1,250,000. � Dr/Nurses acc. DHH - £505,000. � Lurgan - £300,000. � Ivybrook House £77,000. � Warrenpoint Health Centre and library £57,000. � Rathfriland Health Centre and library £57,000. � Crossmaglen Health Centre £48,000. � Bessbrook Clinic £46,000. STH – Remedial Works to External Façade Building fabric in need of major repair, there is a need to take action to mitigate the possibility of falling debris and loose concrete. Significant structural repairs including window replacement required. CAH – Extension of Cardiac Catheterisation Laboratory Extension of Cardiac Catheterisation Laboratory required to allow the Trust to manage additional demand for service. Interim Centralisation of Dental & Podiatry Decontamination – Portadown CTCC In advance of long term arrangements being established for the decontamination of dental and podiatry instruments the Trust seeks funding to ensure that instrumentation used by Dental and Podiatry services at the new Portadown CTCC are decontaminated in line with DHSSPS guidance. Acute Radiology Equipment The Trust urgently requires funding for Radiology equipment including Mammography (estimated as £1m for SHSCT - to be funded regionally via SOC submitted Sept 09), Ultrasound rooms, MRI scanner and Digital Screening Room for STH. Existing equipment is old/well beyond recommended replacement dates and has increased failures/down time which impacts on care for patients.


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Trustwide ICT

The Trust has a need to improve ICT infrastructure following many problems with downtime of key information systems and emails. The works proposed cover servers, switches, Comms, bandwidth etc. The reason for the Trust’s technological problems relates to under investment in ICT infrastructure in three of the legacy Trust. Some servers and switches are over 10 years old and problems are arising including incompatability, resilience and capability. Investment is also required to support known ICT developments and service-led ICT investments.

Trustwide Transport Strategy The Trust has identified funding required to bring the Trust fleet into line with the recommended vehicle replacement term of 7 years. Centralisation of Dental & Podiatry Decontamination Proposal to centralise the decontamination of dental and podiatry instrumentation rather that continuing with ‘local’ clinic based decontamination in line with DHSSPS guidance. CAH Phase 1 Elements of CAH Phase 1 plans as identified in Table 1. Crossmaglen Social Education Centre This scheme seeks to provide a new build 40 place day centre in Crossmaglen for adults with a learning disability.

Services are currently provided from leased accommodation in Crossmaglen. This accommodation falls short of standards required for service delivery thus the need for an urgent solution for the provision of alternative accommodation.

The Trust proposes to purchase land and to build a 40 place day care centre in Crossmaglen which will provide appropriate accommodation to meet the needs of service users.


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Keady Level 1 CTCC This project seeks to provide for the development of a Level 1 HCC for the re-provision and expansion of a range of primary health care services.

The scheme is primarily driven by the need to replace the existing Health Centre premises which is entirely unsuitable and unsustainable for future use. The current Health Centre is being leased on an annual basis by the GPs and is attached to the home of a retired GP.

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