Cwm Taf Morgannwg UHB Chief Operating Officer, Gethin Hughes, explains how patient services will continue during an extensive refurbishment

Cwm Taf Morgannwg University Health Board has reacted quickly and effectively to the need for the urgent replacement of sections of the roof at the Princess of Wales Hospital. Vanguard is helping by combining mobile and modular facilities to provide endoscopy treatment and scope processing, four operating theatres, and two wards.
Gethin met Vanguard CEO, Chris-Blackwell-Frost on the day that the endoscopy facilities were 'handed over' to the Health Board, with the first patients being treated four days later. You can watch their conversation here, and a transcript is below.

Take a tour of the Vanguard Endoscopy Complex that has been installed at The Royal Glamorgan Hospital:

A transcript of the conversation between Gethin and Chris:

Chris:

It's really nice to meet you, Gethin. We've emailed quite a bit and had various sort of correspondence through the different teams as well. Obviously, the reason we're here is because we've got a lot of work going on on-site with the Vanguard units going in. It'd be really helpful, actually, just to start with a bit of background as to the challenges that you're facing and what you're hoping to achieve.

Gethin:

So, as a health board, we had a challenge with a critical incident involving the integrity of the roof at the Princess of Wales Hospital in Bridgend. That required us in a really short period of time to have to decant the first floor of the main hospital at Princess of Wales. That involved having to relocate the main theatre suite, intensive care, 200 beds, the endoscopy unit. And thankfully, just before that incident, we'd already decanted maternity and neonatal. So part of that move was then having to use the day surgery unit and the eye unit as alternatives for our emergency surgery provision and our intensive care provision, which resulted in the loss of 10 operating theatres from the health board's capacity. It also meant that we lost two of our six endoscopy rooms. So, for both of those areas, it was in the region of about a third of our physical capacity was lost. And so part of this work is around replacing, whilst the roof replacement programme is completed, the lost capacity to allow us to address our waiting times and get those poor patients treated who've had their care delayed because of that ongoing incident.

Chris:

Yeah, and stating the obvious, a third of your operating capacity and a third of your endo capacity as well, actually, the impact that will have on your waiting list and patients will be quite significant.

Gethin:

Hugely so. Our teams have been fantastically flexible. We've got teams working in evenings at weekends using our existing estate. But that only reduces the demand by a small proportion. So our waiting times have gone out. We are not going to land our waiting time position where we were planning to do it. I'm really sorry for those patients who've had to wait for that longer time. So we've prioritised the urgent clinical cases to make sure that those patients on suspected cancer pathways have been the priority through endoscopy so that we can continue to make sure that those patients at greatest risk are being managed as effectively as we can.

Chris:

I suspect speed became one of the big determining factors, actually, because that waiting list is just going to keep getting longer the longer that you were without that third of that capacity.

Gethin:

Very much so. So we wanted to mobilise as much additional capacity as we could, clearly constrained by the physical space. Because of the volume of work that's going on on the Princess of Wales site, we weren't in a position to put the additional capacity there. And of course, on our other acute site at Prince Charles in Merthyr, we're also undertaking a massive redevelopment of that facility. So, the only site where there was spare capacity to bring the mobile theatre services on site is here at the Royal Glamorgan. And it's been fun, a real game to try and work out the most effective shape of those to get the four theatres in.

Chris:

It's quite a snug space, isn't it?

Gethin:

It is an exceptionally snug space. And we've had to work really flexibly with yourselves to get that, and also with our partners in shared services around all the building regulations, recognising it's in a courtyard space.

Chris:

So, speed would have been one of the considerations. Was there anything else within the health board perspective that was what these are the priorities or these are the areas that we just need to cover?

Gethin:

I think the key bit for us was around flexibility. So speed, absolutely, we wanted them up and running as quickly as possible. But secondly, it was around the flexibility of that environment so that we could put the greatest range of procedures through there. It's allowing us to focus the majority of our day surgery activity through those theatres that frees up other theatre capacity to do major joint surgery and major bowel surgery in the main suite in the Royal Glamorgan. But it absolutely is about standing up capacity in as short a time as possible.

Chris:

And almost moving those pieces around, I suspect as well from a different specialty perspective. So, in terms of solutions that you would have looked at, because ultimately this is one of them, was there any, because you already described the challenges you've got?

Gethin:

Yeah, so our flexibility was limited. We had no additional space, no additional facility that we could bring online for theatres within the health board. We looked at partner organisations, many of those are fully committed as well in terms of their theatre programme and the independent sector, again, very little spare capacity there. So the only solution to us was bringing on-site mobile theatre capacity and endoscopy capacity.

Chris:

So what would you say your impression of working with Vanguard has been over the last few weeks and months?

Gethin:

Really positive. The team have been really engaging from the first site visit and the team dropped a lot, I know, to come to us really, really quickly. That responsiveness has been really important. We've touched on the complexity of the site we're trying to fit it into and that's been a challenge and the team from Vanguard have been really helpful working with our own estate services to make sure that we can do that. The responsiveness, whenever we've identified a challenge, everyone's been focused on how do we make the solution work and how do we get there with the consistent primary aim for all of us has been to get these facilities mobilised as quickly as possible. And that's been really evident from the approach that everyone's taken from day one of getting the process up and running.

Chris:

And I think from a Vanguard perspective, just the size and the scale and the speed and the complexity, it has been a full team effort. I mean, I personally feel I've sort of lived and breathed every moment of it as well, actually. So it's great to be here today and just seeing it coming together, actually. It really does feel like there's been a huge team effort actually between the hospital team and the health board team and the Vanguard team just to make sure you've got the right solution for you.

Gethin:

Yeah, it's been great.

Chris:

They're in position now. How would you say the installation has gone? Because there's a huge amount of building work going on, on the site, as well.

Gethin:

The biggest challenge on any hospital site, of course, is parking. And we have lost some parking capacity because of where we've had to situate them. But actually, in terms of the installation, it's gone really smoothly. We have had temporary facilities in that space previously, but never to the degree that we've got now. And it's gone remarkably smoothly with very little hiccups. So that's been great.

Chris:

Especially with Christmas in the middle of it and winter and everything else.

Gethin:

Absolutely.

Chris:

The reason we're here, actually, is we've got the first units being handed over today, the endoscopy units. So great to get those on board. And it was great to be able to work with you to phase those in. Feels like they're going to have a really positive impact on patients, actually, just being able to have that additional capacity back.

Gethin:

Hugely so. We've been running with two out of six fewer rooms, which has impacted on our waiting times, and will allow us to ensure that all our patients within the next month or so will be being treated within a maximum of eight weeks from referral. That's a huge achievement and so important for our local population that we can offer that. We're running these rooms for the next year and we will get the POW rooms back online, probably May, June time. So that means that we will have a bigger step up in our capacity and we'll be able to bring down even further the waiting times for all our patients. So it's a huge, huge importance.

Chris:

Yeah, which is really significant, actually. Make the most of the additional capacity while you've got it, I guess.

Gethin:

Absolutely.

Chris:

Have you been inside the units yet?

Gethin:

Not yet. I wasn't around the day they went in, so I'm looking forward to Monday, to going and having a good route around it.

Chris:

Well, it's an impressive site, actually, in the scale of it, like you say, just in terms of the configuration and how tight the site is. So, yeah, first impressions on the outside look very impressive.

Gethin:

It looks really smart and is really adding to the infrastructure of the organisation.

Chris:

What's the sense of the teams here as well, actually? Because it's one of those things where they can see it coming together and look down on it as well, actually. So any feedback from the broader team, either around the speed that it's come together or anyone being on the facilities as well and any initial feedback from them?

Gethin:

Feedback from the teams that have been going in and out, really positive, really looking forward to being in there and really liking the environment and the layout. So that's been positive. Again, in terms of the speed at which we've been able to mobilise it, people have been shocked that we're in a position where we've been able to turn from that decision to them being on site and now being operational, you know, in such a short space of time. So lots of excitement, lots of people getting very excited about having lots of operating lists back. And, you know, and again, it's about maintaining that service for our local population.

Chris:

Yeah. And I think that's probably the final question is just around the patient side of things as well, actually. So what would you say to any patients that are due to receive treatment within the Vanguard units.

Gethin:

Well, that it's great that you're having your treatment. The facilities are state of the art. The facilities are as good as the facilities that are in the main body of the hospital. And we look forward to treating you. You know, it is so important. Our waiting times in Wales are significantly longer than in England. And it's really important that we provide our patients with the timeliness of access that other patients within the UK are receiving. And this is such an important part of being able to do that.

Chris:

Well, I just want to say thank you for trusting us with this project. We've loved working on it with you. Your team have been amazingly responsive. And yeah, in order for us to work at the pace we've been able to, it's just because your guys have been excellent and they've worked very well with us as well. So, yeah, we genuinely appreciate the opportunity. So, thank you for that.

Gethin:

Well, and thank you and again to your teams because it's been, you know, nobody underestimates the scale of the ask and people have been really supportive and flexible in delivering it.