South West London - Kingston Council
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South West London
Kingston Health & Care Estates Strategy
Our ambitions and aspirations
Our ambition mirrors that of the London Estates Board, that is
for all people in South West London, regardless of their
background or where they live, to have access to a world
class health services in world class facilities.
1 |
Disclaimer
The options set out in this document are for discussion purposes. The involved NHS
bodies understand, and will comply with, their statutory obligations when seeking to
make decisions over estate strategies which impact on the provision of care to patients
and the public. The options set out do not represent a mandate from NHS
Improvement/NHS England or commitment to any particular course of action on the part
of the organisations involved.
In respect of any request for disclosure under the Freedom of Information Act 2000
(“FoIA”): This is a confidential document for discussion purposes and any application for
disclosure under the FoIA should be considered in accordance with disclosure
obligations under the Act, including against potential exemptions such as those
contained in s.22 (‘Information intended for future publication’), s.36 (‘Prejudice to
effective conduct of public affairs’) and s.43 (‘Commercial Interests’). Prior to any
disclosure under the FoIA, the party which has received the request is invited to discuss
the potential impact of releasing such information with NHS Improvement/NHS England,
and any other relevant parties.
2 |
Document version control
Version Owner /
Issue Ref. Status / Summary of changes
Date Author
1.2 2/01/2020 KH FT additions – Charles Haniford KH FT
2.1 15/01/2020 CCG primary care information incorporated NF
2.2 09/02/2021 Initial comments received from Estates Group - updated by Radha Pankhania RP
2.3 26/02/2021 Additional feed back from Estates Group - updated by Radha Pankhania RP
2.4 12/03/2021 Final comments received from Estates Group – updated by Radha Pankhania RP
2.5 19/02/2021 KHFT & RBK additions received – updated by Radha Pankhania RP
2.6 26/04/2021 Updates from stakeholders received – updated by Liz Ayres, Malcom Souch LA/MS
2.7 28/04/2021 Updates from RBK RP
3 |
Contents
1. Context
1. National, London, SW London and Kingston
2. Prevention, Clinical and Service Strategies
3. Estates Baseline Summary
4. The Capital Challenge - Funding Sources
2. Our Progress so far
1. Governance
2. Completed capital projects summary
3. What people have told us about our health & care estate
3. Our focus and actions
1. Capital pipeline, link to service strategy
2. Delivery plan
3. Resourcing plan
4. Vacant and under-utilised space
5. Disposal of surplus land and buildings
6. Delivery of estates efficiencies
4. Measures of success
Appendix 1: Terms of reference for estates governance
Appendix 2: Primary Care Networks and mapping
4 |
1. Context 5 |
1. Strategic Context
This section covers the national and local context for how health and
care will be delivered in Kingston.
Our Vision
The ambition is to have modern fit for purpose acute and mental health
hospitals, community and primary care premises that meet the needs of
the clinical strategies of South West London. We want to greatly
enhance the experience for people in Kingston within these settings so
that they are seen, treated and cared for in modern facilities, with the
latest equipment and digital infrastructure.
Health and care landscape in Kingston
• Primary Care: 21 GP Practices, and 5 Primary Care Networks
• Acute Care: Kingston Hospital NHS Foundation Trust - a district
general hospital, providing a full range of treatment and diagnostic
services.
• Community Services: Your Healthcare CIC providing services such
as; District Nursing, Health Visiting, School Nursing, Rehabilitation,
Rapid Response Service, Continence Service, Respiratory Service,
Tissue Viability & Leg Ulcer Service, Integrated Care Team,
Neurodevelopmental Services, Physiotherapy, Podiatry and Speech
& Language Provision.
• Mental Health: Tolworth Hospital – a major inpatient unit of South
West London and St George's Mental Health NHS Trust.
6 |
1.1 National, London, SW London and Kingston Integration and Innovation: White Paper (2021) The proposals in this paper aim to build on the collaborations seen through COVID and shape a system that’s better able to serve people in a fast-changing world. A key aspect of this is establishment of Integrated care systems (ICSs) on a statutory footing through both an ‘NHS ICS board’. The partnership aims to bring together the NHS, local government and wider partners to address the health, social care and public health needs of their system. The vision includes building of infrastructure for the future, which will require each system to take stock of their current positions jointly. Integrating Care (2020) Building on the experience of the earliest ICSs, from April 2021 the expectation is for all parts of health and care systems to work together. A key aspect will be for the NHS as a major estate owner, to play a full part in social and economic development and environmental sustainability. It will require coordination between different NHS providers, also aligned with local authorities’ management of their estates and wider assets. Energy White Paper: Powering Our Net Zero Future (Dec 2020) The system recognises the UK Government’s commitment to take action on climate change with a target to cut carbon emissions by 100% by 2050 (also referred to as Net Zero). As an NHS organisation, and as a spender of public funds, the system has an obligation to work in a way that has a positive effect on the communities we serve. Sustainability means spending public money well, smart and efficient use of natural resources, and building healthy, resilient communities. Diagnostics: Recovery and Renewal (October 2020) To deliver the increase in diagnostic activity required now and over the coming years, and to provide safe, patient-centred pathways for diagnostics, new service models are needed. The report outlines key actions including: the separation of acute and elective diagnostics; and community diagnostic hubs to be established away from acute hospitals. These new services will require major investment in facilities, equipment and workforce, alongside replacement of obsolete equipment 7 |
1.1 National, London, SW London and Kingston NHS Long Term Plan (2019) The Long Term Plan prioritises primary care at scale: primary care networks bringing together GPs and community services; early detection and prevention of major health problems; backing the workforce; making better use of digital technology and reducing duplication, coordinating between organisations and systems to increase efficiency. This requires investment in estate, IT and equipment in order to deliver future services in modern, fit for purpose buildings. London Estates Plan (2019) The London Health Board recently approved the London Estates Strategy. This is the first London-wide health and care estates strategy in the 70-year history of the NHS. It identifies that to provide a sustainable, fit for purpose estate, we will stop working in organisational silos, take a long term and holistic view of acute, mental health, community and primary care estates. Clicks and Mortar (2019) Developments in technology are affecting the NHS estate in different ways. In future, these changes could lead to an estate that is better for patients and staff, smarter and more integrated. This report sets out how technology and agile working is likely to result in a different NHS estate, rather than a smaller one, with space being used or configured in different ways. Lord Carter Review (2016) and the Naylor Review (2017) The Carter Report highlighted the opportunities to improve operational productivity in acute hospitals, including: reducing estate and facilities running costs, reducing the percentage of nonclinical space as a proportion to overall space and reducing unoccupied and underused space. The Naylor Report provided further insight into NHS assets and one of its key recommendations was that land vacated by NHS should be prioritised for the development of residential homes for NHS staff, where there is a need. 8 |
1.1 National, London, SW London and Kingston South West London Tackling backlog maintenance and improving the infrastructure within acute and mental health hospitals and community and primary care facilities in South West London is a key priority across the STP/ICS to ensure that we have fit for purpose health and care facilities to meet the needs of our population. The demand for capital currently outstrips the available funding and South West London providers have already deferred expenditure totalling £100m into 2020/21 resulting in provider capital plans that are largely dealing with urgent and significant estate related service risks. Kingston Health and Plan In line with the London and South West London plans, Kingston’s priorities include addressing the condition of our estate and how community hubs need to shape in order to take health and care closer to the population. In refreshing the estate, we have the opportunity to deliver broader, integrated health and wellbeing services in line with our Local Health and Care Plans. This includes developing plans for co- locating out of hospital health services with local authority and voluntary sector services and requires collaboration within boroughs on developing Asset Management Strategies. Impact of Digitisation Using digital technology will change the way we interact with the space and estate in the borough, for example the progression towards SWL ambition for agile working, will see colleagues across the system being able to work more flexibly. Digitisation will reduce the requirement for medical records storage space and provide the opportunity to offer more clinical accommodation within existing estate. Equally the use of more web based communication, replacing face to face consultations, will increase the efficiency within practices and reduce some of the impact of new community space requirements. All developments will need to be rigorously tested against space required with new ways of providing care. 9 |
1.1 National, London, SW London and Kingston
Impact of Digitisation, continued.
This will present opportunities for primary and community care, including:
• Repurposing space used by records for hot desking, telephone triage etc
• Release of space for multidisciplinary working
• Reviewing opportunities to ensure population health focussed place-based care
COVID-19: Estates Implications
COVID-19 has impacted every corner of the NHS. The borough’s strategy will continue to be reviewed, in
conjunction with the post-COVID plans for South West London Integrated Care System. The COVID-19
pandemic has resulted in a significant reduction in the volumes of elective procedures performed during
2020. In addition all hospitals are operating with less surgical and patient capacity to ensure a safe
environment. When the peak of the pandemic passes and patients feel safe to present to the NHS for
treatment there will be a significant increase in demand but hospitals are likely to need to continue to
operate at reduced capacity. Future considerations for estate include:
• Ensuring that there can be multiple ways to separate flows and access across the site, so that the
estate does not falter at a single entry.
• Consideration of the layout / access for key elements to enable clear and dedicated access, e.g. for
non-infected / tested people away from those as yet undetermined (Blue Zone / Green Zone).
• Reviewing the make up of each service so that they can be more easily separated off to allow them to
continue uninterrupted by others
• Clear separation between those services which may demand more resource / are more complex to
manage, and the other more day-to-day services
• Creating a leaner estate by embracing relevant operational methods and digital tools
• Supporting a more digital / virtual service (which also aligns with a more digital workforce)
• Creating a future-proof facility by building in resilience
10 |1.2. Prevention, Clinical & Service Strategies
1.2.1 Kingston Health and Care Plan
Based on the conversations we have had with local people over the past two years, the Kingston story
and the case for change, we have agreed three priority areas for action.
• Improve the mental wellbeing and resilience of our children and young people
• Support children and young people with special educational needs, disabilities and
complex health and care needs to flourish and to be independent in their local
communities
Start well • Focus on reducing obesity to improve the health of our children and young people
• Support people to stay healthy and manage their long term health conditions
• Promote mental wellbeing and support those who experience poor mental health to
avoid mental health crisis
• Reduce health inequalities for those with poor health
Live well
• Maximise people’s independence and resilience to enable them to live well at
home where that is their choice
• Reduce loneliness and isolation for everyone particularly older people and their
carers
Age well • Enable people to live their last years of life well and end well
11 |1.2. Prevention, Clinical & Service Strategies
1.2.2 New Models of Care and Estates
Across Kingston, new out of hospital models of care are being designed and delivered to support the
Health and Care Plans for both boroughs. These are underpinned by 10 workstreams that facilitate the
delivery of Live Well, and Age Well in addition to prevention and early intervention.
At present these models are at different stages of the transformation approach from ambition to design
and delivery in the proof of concept form. They will change the way we interact with people and space
going forward, with examples including:
The model aims to bring multi-agency working at the Delivery of this model will entail teams
Anticipatory forefront within primary care. The model requires coming together virtually or physically to
Care Model professionals from across the system to work collaboratively do multi disciplinary planning and deliver
to support people with complexity and rising risks. coordinated care.
Identification and management of people with long term
This will include group
conditions remains a high priority exacerbated further due to
consultations and coaching and
Long Term consequences from pandemic. The model of care requires
integrated working between
Conditions working with communities to identify people at risk, use effective
multiple professionals to support
digital tools for self management, and establish new ways of
patients who are complex.
working.
This programme includes delivery of joint Learning and development for staff within care homes
Care Homes
clinical and professional teams to support and application of digital tools such as remote monitoring
and end of life
people in care homes. are some of the key aspects for this programme.
PCN estate will be crucial for integrated teams working around a network footprint. Spaces to meet will
be required for multidisciplinary working, and getting communities together to demedicalise care.
12 |1.2. Prevention, Clinical & Service Strategies 1.2.3 Partners Plans and Priorities Acute sector • Improving Patient Flow through the inpatient setting – developing acute assessment space and dementia friendly environments to reduce length of stay. • Protecting elective surgical capacity – creating more outpatient and day case facilities to treat patients away from the bed base. • Expanding access to diagnostic tests – to ensure adequate capacity for growing demand • Improved patient pathways to speed up diagnosis and treatment – developing one stop clinic and see and treat facilities within the outpatient clinic setting • Community site services to protect from acute site pressures and improve access – provide more clinics, test and treatments away from the acute hospital site • Harnessing the benefits of technology to share resource and improve access to clinical opinion – utilise virtual clinics, electronic records and shared reporting facilities through investment in IT systems and suitable environments for this desk based activity. • Agile working initiatives have reduced the space requirements for non clinical services and allowed clinical staff more flexibility in their service delivery in a variety of locations. Mental health • Improvement in local accessibility – high street locations for immediate access to services STP priority of developing integrated sub-locality teams which also impacts on community estate. • New London Estates Board and STP Estates Group prioritising and identifying estates activity for South West London. Working with the South London Partnership (SLP) to identify efficiencies across the SWLSTG, SLAM and Oxleas. • SWLSTG Estate Modernisation Programme – Brand new "state of the art" facilities enabling modern methods of treatment. Full visibility on wards and lowers SUIs. 13 |
1.2. Prevention, Clinical & Service Strategies
1.2.3 Partners Plans and Priorities
Mental health (continued)
• SWLSTG People Readiness and Culture Change Programme– Doing more with less space. Desk
ratios for community and corporate staff under this programme will be rationalised. Hub and Spoke
Model – Ensuring we have the correct accommodation model in each borough. Progressive transfer of
services to community locations – looking at providing services closer to main high streets.
• Deliver increasing complicated and quality improvements – eliminate same sex wards, provide en-
suite accommodation, ensure lines of sight and easy to navigate wards.
Primary Care, PCNs and Out of Hospital
• The council and health providers have a wide range of estate across the borough from which they
provide and deliver services. As part of the Kingston Health and Care Plan, the priorities are to:
• Maximise the use of our estate (voids, utilisation, and efficiency)
• Co-locate services where appropriate
• Explore access to estate by community groups to support community connections
• Continue programme management and development of current and pipeline primary care
improvement schemes already underway.
• Work with PCN Clinical Directors to ensure primary care estate is fit for evolving PCNs in Kingston.
• Work with borough partners to ensure adequate healthcare provision is in place to meet future growth
increase in population and changing demands.
• Prioritise future investment opportunities from CIL/S106 and respond to climate and environmental
controls set by local and London plans.
14 |1.2. Prevention, Clinical & Service Strategies
Source: HUDU | February 2021
1.2.4 Population Projections [2020-2030] 2018-based Housing-Led GLA Round Population Projections
Note: The GLA's housing-led projections incorporated assumptions about future development are based on the results of a 2017 London Strategic Housing
Land Availability Assessment (SHLAA). This will be updated to align with the Council’s emerging local SHLAA data, particularly with regard to the timing of
housing supply.
Projected Population Change The largest population increases will be Projected Population Changes
among 15-44 year olds, while the highest by Local Area
Kingston upon Thames projected mid-2020 relative growth (38%) is projected for 75-84.
population was 176,300. 18% were children (0- The greatest relative increase is
14 years old), 68% young adults and working projected to happen within
age people (15-64 years old), and 14% of Grove (35.1%), Norbiton
population were aged 65 and over. (24.3%), Tolworth and Hook
Rise (24%) wards.
Table 1. Projected Population Growth 2020-2030.
Figure 1. Projected Population (2020)
Kingston's population is expected to grow over
the next decade by 20,400 (11.5%).
Figure 2. Projected Relative Population Change Map 1. Projected Population Change
15 | 2020-2030. 2020-2030.1.2. Prevention, Clinical & Service Strategies
1.2.4 Population Based Floor Requirements [2020-2030] Source: HUDU | September 2020
In September 2020, using the NHS HUDU Model, population projections were Total floorspace needs
Floorspace requirements (sqm)
within Kingston
used to establish future requirements for floorspace within Kingston across the
Floorspace requirements (sqm)
borough (assuming no capacity at present to address space). The key message
is that over the next 10 years:
• Primary Care – will continue to be the pivotal enabler for care closer to home, Primary Care
and with OOH services only increasing, and population growth expected at Primary Care
Acute
20,400 – consideration needs to be given to how PCNs will shape to meet this
Kingston
need. Acute Health
Mental
Kingston
• Acute – there is no empty space at KHFT, and therefore OOH movement, and Mental Health
efficient use of existing estate is required, albeit with conditional maintenance Intermediate Care
backlog addressed. Intermediate Care
Primary Care/ PCN Acute Mental Health Intermediate Care
16 |1.3. Estates Baseline Summary
1.3.1 Summary of Estate in the Borough
Hawks Road NHSPS
This section covers owned clinic closed and
• Planned housing sites across the borough has been sold for
Hawks Road redevelopment of
• Pipeline developments residential
excluding
development
existing NHSPS owned clinic
new health
to provide residential plus new Acre Road Clinic
• Primary care/ PCN estate health premises
provision.
H Kingston Hospital FT
• Schedule of other sites Cambridge Road Estate
• Borough estate strategic priorities RBK led regeneration Hawks Road Clinic
programme – approx.
• A summary of the estate in Kingston Cambridge
4000 Road
population Estate
growth. Rose
RBK ledhealth
Additional regeneration
care Lodge
programme - approx. 4000
The following page shows the planned large scale facilities will be planned
population growth
as part of the Estate
residential sites coming forward across the Borough Redevelopment to meet
as set out in the emerging local plan. emerging need due to
additional 1300 homes
planned in the scheme.
Hollyfield House
A further call for sites is anticipated during 2021 which (office)
South West London & St
is likely to identify new land for housing. This will George’s MHT Estates The Manor Drive Health
Modernisation Plan - H Clinic
Tolworth Hospital
require a review of the NHS Estates Strategy to align Tolworth Hospital rebuild (MHT)
with emerging demand for healthcare facilities across 21 main sites, 4 branch sites
the Borough.
Gosbury Hill Clinic
The redevelopment proposal for Cambridge Road
Estate (CRE) is for c2200 homes of which c1300 are
new homes resulting in a forecast population increase Merritt Medical Centre/
Amy Woodgate Day Centre
of c4000 in Norbiton ward.
The planning application has been submitted to RBK
at time of writing (June 2021) and is due for
determination later in the year. It is anticipated that
additional health care provision will be required to Health developments
support the existing and new community coming Major housing developments
17 |
together at CRE.1.3. Estates Baseline Summary 1.3.2 Planned Housing Sites Across the Borough The first plan here shows the large housing sites coming forward as part of the emerging Local Plan. A further call for sites is taking place during 2021 and it is anticipated that further sites will come forward. The recently adopted London Plan (March 2021) forecasts c9600 homes being delivered across the Borough during the 10 year plan period. The emerging Local Plan assumes new development will come forward in existing centres with good public transport accessibility levels (PTALs) including Kingston, Norbiton, New Malden and Tolworth (where current PTALs are in the upper 3-6 range). At this early stage in the emerging Local Plan it is anticipated that a significant number of new homes will come forward in the North of the Borough in and around Kingston town centre and Norbiton. Further engagement is required between NHS and RBK to ensure adequate health care provision is planned and funded to support this residential growth. 18 |
1.3. Estates Baseline Summary 1.3.3 Pipeline Developments Cambridge Road Estate Renewal Scheme Kingston Council and housing developer Countryside Properties are working in partnership to deliver regeneration proposals at Cambridge Road Estate (CRE). The proposed plans will deliver high-quality new homes, gardens, play areas, streets, community facilities, new jobs and local training opportunities. The Hawks Road Clinic, owned by NHS Property Services is located on the perimeter of the CRE. The Council had hoped to acquire this site. However, NHSPS has recently sold the site for residential use, subject to planning consent. The phase 1 proposals for CRE include a community facility - consultations with a wide range of stakeholders, including the NHS, are planned to commence in the summer of 2021 and will consider how the multi-functional spaces can be used to support the needs of the local population. Further work is required to ensure adequate healthcare provision is integral to the scheme, including options for a new primary care health facility in a more central location within the redeveloped Cambridge Road Estate. A detailed assessment is needed to examine the capacity of existing healthcare infrastructure to support the c4000 population uplift. A working group will be established. The cost of providing new and/ or improved healthcare facilities to support the existing and new community at CRE is yet to be determined and will be funded by a range of sources. The timing and Source: Master Plan Design Guidelines, November 2020 (Caveat: the implementation of the social infrastructure provision will be subject to scheme remains subject to planning approval at time of writing: March 2021) the development programme of CRE following determination of the planning application. 19 |
1.3. Estates Baseline Summary 1.3.3 Pipeline Developments Tolworth - Planned Major Developments A number of major developments are It is important to note that phasing of development and the planned in Tolworth including: timing of the delivery of new homes remains uncertain. Consented refurbishment of Tolworth Tower for residential c250 units Further joint working with RBK and NHS Estates is required Consented outline application for 950 to plan effectively for new health facilities to support new homes at the land to the south of residential communities coming on line in this area. Tolworth roundabout includes a GP surgery in Phase 2 In addition there is a current planning application pending for two new residential towers adjacent to the existing Tolworth Tower which would deliver c500 units if consent is granted A master plan for Tolworth Station is also being undertaken with Network Rail and other landowners which may bring forward additional new homes. 20 | Source: Planning Application for 950 homes south of Tolworth Roundabout
1.3. Estates Baseline Summary 1.3.3 Pipeline Developments Tolworth Hospital - Redevelopment Opportunity Through consultation with patients, service users, carers and staff, South West London and St Georges Mental Health Trust, in partnership with RBK decided to proceed with developing the two largest sites, Springfield University Hospital, and Tolworth Hospital, in two phases. Tolworth will form phase two of the development and will be subject to a separate approvals process. The majority of the funds for building the two new hospitals are being raised through selling land no longer required for our services. The facilities at Tolworth Hospital simply do not meet today's need. Existing buildings are mainly old, unsuitable and expensive to run which means there is less to spend on frontline services and jobs. Through the programme there is an intention to invest in better mental health services to create modern mental health inpatient services at Tolworth Hospital. Tolworth Hospital will become a modern centre of excellence delivering expert mental health care. Benefits include: • Potential to deliver an integrated local health and social care mental health service • Updating the current, outdated buildings • Improving ward layouts, creating a good environment for patients and staff • Effective use of NHS resources in the long term future • Providing care and accommodation of the very best standard • Reducing running cost so more can be spent on frontline services and jobs Based on current timelines, construction is expected to begin by 2022/2023. 21 |
1.3. Estates Baseline Summary
1.3.4 Primary Care/ PCN Estate
GP Practice by Primary Care Network
Current Estate
Extend
Primary Care Network Practice Premises Access Hub
Fairhill branch - 14 Fairfield South, Kingston KT1 2UJ
Fairhill Medical
Kingston Hill branch - 81 Kingston Hill, KT2 7PX
Practice Surgery Kingston HC
Kingston PCN University branch - Penrhyn Road, Kingston, KT1 2EE
Kingston Health Centre 10 Skerne Road, Kingston, KT2 5AD7 X
St Alban’s Medical Centre 212 Richmond Road, Kingston KT2 5HF
Canbury Medical Centre 1 Elm Road, Kingston KT2 6HR
Kingston branch - Clifton Road, Kingston KT2 6PG
Canbury, Churchhill Churchill Medical Centre Evesham branch - 1 Evesham Terrace, St Andrew's Road, Surbiton
Orchard Berrylands KT6 4DS
PCN
Orchard Practice Gosbury Hill Health Centre, Orchard Gardens, Chessington KT9 1AG
Surbiton HC
Berrylands Surgery Surbiton Health Centre, Surbiton KT6 6EZ
Brunswick Surgery
Surbiton Health
Central Surgery Surbiton Health Centre, Ewell Road, Surbiton KT6 6EZ X
Centre PCN
Langley Medical Practice
Roselawn 149 Malden Road, New Malden KT3 6AA
Manor Drive Health Centre 3 The Manor Drive, Worcester Park KT4 7LG
Holmewood Corner Surgery 134 Malden Road, New Malden KT3 6DR
New Malden PCN
West Barnes Surgery 229 West Barnes Lane, New Malden KT3 6JD
The Village Surgery 157 High Street, New Malden KT3 4BH
The Groves Medical Centre 171 Clarence Avenue, New Malden KT3 3TX
Sunray Surgery 97 Warren Drive South, Tolworth KT5 9QD
Claremont Medical Centre 2a Glenbuck Road, Surbiton KT6 6BS Merritt MC
Chessington & Red Lion Road Surgery 1a Red Lion Road, Tolworth KT6 7QG (branch of
Surbiton Network Mediventure Surgery)
Chessington Park Surgery X
Merritt Medical Centre, Merritt Gardens, Chessington KT9 2GY
Hook Surgery
Primary Care is delivered by 21 Practices from 20 locations.
Source: SHAPE ATLAS 2021
Extended Access Hubs are provided in 3 locations within the
borough.
22 |1.3. Estates Baseline Summary
1.3.4 Primary Care/ PCN Estate
PCN Map
Kingston Primary Care
Networks
Canbury, Churchill, Orchard &
Berrylands
Chessington & Surbiton
Kingston PCN
New Malden & Worcester Park
Surbiton Health Centre
23 |1.3. Estates Baseline Summary
1.3.4 Primary Care/ PCN Estate
6 Facet Summary (2016)
Facet 1 Facet 2 Facet 3 Space Facet 4 Quality Facet 5 Facet 5
Condition Functional Utilisation Grade Statutory Statutory Future Growth
Grade Suitability Grade Compliance Compliance & Expansion
Primary Care Network Practice Premises Grade Cost Grade TOTAL COST (all facets)
Fairhill branch - 14 Fairfield South, Kingston KT1 2UJ B C Fully Used B D 4,200 C 9,800
Fairhill Medical
Kingston Hill branch - 81 Kingston Hill, KT2 7PX B C Fully Used B D 4,200 B 30,300
Practice Surgery
Kingston PCN University branch - Penrhyn Road, Kingston, KT1 2EE B B Fully Used B D 4,200 D 6,300
Kingston Health Centre 10 Skerne Road, Kingston, KT2 5AD7 A A Fully Used A C 1,000 D 13,600
St Alban’s Medical Centre 212 Richmond Road, Kingston KT2 5HF B B Fully Used B D 7,200 C 11,500
Canbury Medical Centre 1 Elm Road, Kingston KT2 6HR B B Fully Used B D 5,200 A 21,700
Kingston branch - Clifton Road, Kingston KT2 6PG B B Fully Used B D 5,000 B 11,800
Canbury, Churchhill Churchill Medical Centre Evesham branch - 1 Evesham Terrace, St Andrew's Road, Surbiton
Orchard Berrylands KT6 4DS B C Under Used B D 5,000 C 8,600
PCN
Orchard Practice Gosbury Hill Health Centre, Orchard Gardens, Chessington KT9 1AG
C B Fully Used B C 1,000 C 41,400
Berrylands Surgery Surbiton Health Centre, Surbiton KT6 6EZ A B Fully Used B C 2,000 A 7,000
Brunswick Surgery A B Fully Used B C 2,000 A 7,000
Surbiton Health
Central Surgery Surbiton Health Centre, Ewell Road, Surbiton KT6 6EZ A B Fully Used B C 2,000 A 7,000
Centre PCN
Langley Medical Practice A B Fully Used B C 2,000 A 7,000
Roselawn 149 Malden Road, New Malden KT3 6AA B B Fully Used B D 7,900 C 17,300
Manor Drive Health Centre 3 The Manor Drive, Worcester Park KT4 7LG C C Under Used B D 6,600 A 143,600
Holmewood Corner Surgery 134 Malden Road, New Malden KT3 6DR B B Fully Used B C 3,000 B 28,450
New Malden PCN
West Barnes Surgery 229 West Barnes Lane, New Malden KT3 6JD B B Fully Used B D 7,000 B 13,300
The Village Surgery 157 High Street, New Malden KT3 4BH B B Fully Used B D 8,700 D 13,850
The Groves Medical Centre 171 Clarence Avenue, New Malden KT3 3TX B B Fully Used B C 2,000 A 30,000
Sunray Surgery 97 Warren Drive South, Tolworth KT5 9QD B B Under Used B D 2,450 B 8,050
Claremont Medical Centre 2a Glenbuck Road, Surbiton KT6 6BS B B Fully Used B D 7,200 C 17,100
Chessington & Red Lion Road Surgery 1a Red Lion Road, Tolworth KT6 7QG (branch of
Surbiton Network Mediventure Surgery) B B Fully Used B D 6,600 C 19,700
Chessington Park Surgery A B Fully Used B C 1,000 A 11,000
Merritt Medical Centre, Merritt Gardens, Chessington KT9 2GY
Hook Surgery A B Fully Used B C 1,000 A 11,000
98,450 496,350
KEY:
Physical Condition: Functional Suitability Space Utilisation Quality Statutory Compliance Developability/Future Growth
A - Good. Performing as intended. A - Very satisfactory, no change needed. E - Empty A - A facility of excellent quality. A - Complies with all relevant standards and relevant guidance. A - Excellent Scope for Expansion
B - Satisfactory. Performing as intended, minor deterioration. B - Satisfactory, minor change needed. U - Underused B - A facility requiring general maintenance investment only. B - Action required to comply with relevant guidance and statutory requirements. B - Reasonable Scope for Expansion
C - Poor. Exhibiting defects and/or not operating as intended. C - Not satisfactory, major change needed. F - Fully Used C - A less than acceptable facility requiring major capital investment or replacement. C - Building with known contravention of one or more standards. C - Limited Scope for Expansion
D - Bad. Life expired and/or serious risk of imminent failure. D - Unacceptable in its present condition. O - Overcrowded D - A very poor facility requiring major capital investment or replacement. D - Building areas which are dangerously below 'B'. D - Very Limited Scope for Expansion
*Please note that this list from 2016 for practices inspected, and does not reflect updated configurations
24 |1.3. Estates Baseline Summary
1.3.4 Primary Care/ PCN Estate
6 Facet Summary (2016), Continued.
1) In 2016, the backlog cost (2016) was £89,100; and 2017-21 was expected to be £308,800.
• Gosbury Hill HC, where the Orchard Practice is located was assessed as condition C and
accounted for £36k of the backlog;
• Manor Drive HC was also assessed as condition C accounted for £42k of the backlog
and £94.8k of the spend between 2017 & 2021.
2) The functional suitability was assessed as not satisfactory for four premises: The Fairhill
and Kingston Hill branches of Fairhill Medical Practice; the Eversham branch of Churchill
MC; and Manor Drive HC.
3) The space utilisation were assessed as fully utilised in all but 3 premises, however a post
COVID assessment is required for a current picture.
4) The quality grade was assessed as either A or B for all premises.
5) The statutory compliance was assessed as either C or D for all premises.
6) Each primary care network contains premises that have future growth expansion.
Future out of hospital service delivery is dependent on future proofed primary care estate,
where care can be delivered closer to home. As well as mitigating current essential
backlog maintenance, given the predicted population growth and requirement of space,
further considerations must be given to PCN estate that is modern and fit for purpose.
25 |1.3. Estates Baseline Summary 1.3.5 Schedule of Other Sites Community Services – Your Healthcare CIC YH as a community service provider has rationalised the estate it occupies and now mainly operating from one owned building i.e. Hollyfield House. The estates strategy for YH is mainly driven by CCG / ICS strategy for delivering services as required by the commissioner (e.g. use of Surbiton Health Centre & Teddington Memorial Hospital. The existing estate YH currently occupy /utilise includes Hollyfield House in Surbiton, and under a lease arrangement YH occupy: • Surbiton Health Centre (1st floor); • Sheridan House in Twickenham; • Teddington Memorial Hospital (25 inpatients beds – Cedars Ward) • Manor Drive Clinic • Worcester Park (2 rooms on a sessional basis). YH will continue to explore opportunities to work in partnership and maximise the usage of estate within their portfolio, which they currently occupy / utilise. The strategic priority is to consider future utilisation of Estate following the changing work patterns as a result of COVID-19 to ensure YH achieve a portfolio of Estate that can change and flex with the changing requirements of the organisation & offers Value for Money with a changing market of demand. 26 |
1.3. Estates Baseline Summary
1.3.5 Schedule of Other Sites
Includes multi-occupied sites with GP representation.
Ownership/ NIA Cost
Property Description Cost (£)
expiry date (sqm) /sqm
Surbiton Health Centre Modern purpose built health building LIFT 30+ yrs 1,920 1,625,342 £846.50
Part converted house, part single story NHSPS
Gosbury Hill Clinic health building - poor quality Freehold 288 *49,000 *£170
Purpose built 1980s health centre. Part NHSPS
Manor Drive Clinic vacant. Freehold 532 *91,000 *£171
A table of the occupiers and a summary description of each property is included at Appendix B
*Costing under review – indicative figure.
27 |1.3. Estates Baseline Summary
1.3.5 Schedule of Other Sites
NHS Property Services Buildings – Strategic Direction
Site (owner) Current position Strategic intentions Timing and financial
implications
1 Gosbury Hill Converted House with large In need of redevelopment to No timetable established
(NHSPS) single story extension. address condition issues. A yet, to be considered
Contains three GP practices and study needs to be done to within the next bids.
a WiC. establish whether Capital investment would
redevelopment or relocation be required with ongoing
would best suit population Revenue consequences.
needs.
2 Manor Drive Two story purpose built health Long term hold for GP on Void costs previously
(NHSPS) centre. GP occupies ground ground floor. borne by KCCG (£45k
floor. First floor vacant (YHC has First floor to be redeveloped by pa)
vacated) and has been handed NHS PS to facilitate delivery of
back to NHS PS. health and care services.
3 Hawks Road The property was declared Potential recycling of
(NHSPS) surplus, fully handed back to part sale proceeds back
NHSPS during FY20/21 and is to SWL estates priorities.
now in the process of sale, likely
to complete shortly after
vaccination use ceases.
Note: Strategy and need for revenue funding is a priority for Gosbury Hill. NHS PS will consider
redevelopment options and support through strategy, planning and developments teams.
28 |1.3. Estates Baseline Summary 1.3.5 Schedule of Other Sites Kingston Hospital Foundation Trust (KHFT) Kingston Hospital, part of Kingston Hospital NHS Foundation Trust, is situated just outside of Kingston- Upon-Thames to the North West of the town centre. The buildings on this site vary dramatically in terms of age and type of construction, ranging in age from 1860 for the Regent Wing to 2008 for The Sir William Rous Unit. Some of the buildings are connected via a link corridor. 6 Facet Summary (2017) In 2017 a 6 Facet Summary was undertaken for KHFT, which highlighted: • The total backlog maintenance cost is £45.6m, expected to increase to £57.1m by 2022 excl. on costs. • 34% of the estate is in poor (23%) or bad (11%) condition, requiring attention. • The 11% in bad condition, represents 79% of the backlog maintenance cost, at £36m. Attention is required to address essential backlog based on risk, however ERIC data (2018/19) shows good use of floor space based on GIA, and less than 10% of not functionality suitable space used for patient care. Efficient use of the estate will be required, to meet projected floor space requirements. 29 |
1.3. Estates Baseline Summary
1.3.6 Vacant Space, Underutilised Space, and Disposals
Vacant Space
Manor Drive HC - NHS PS freehold, total 761.60 sqm
• Majority of first floor is vacant 23.56% (approx. 180 sqm) after YHC released the space in 2014/15
• Ground floor occupied by GP practice
• CCG previously covered the cost of the vacant space.
Hawks Road Clinic - NHS PS freehold, total 636.26 sqm
• YHC vacated
• Subject to redevelopment as part of Cambridge Road Estate Redevelopment
• In process of being disposed of.
As per 20/21 Annual Charging Schedules (ACS) received
Occupation Annual Rent Annual Service Annual Facilities
Total Annual Costs
ssioner Property Charges proportion Charges Charges Management
£
% £ £ £
CCG Manor Drive Health Centre Vacant Space 23.56% 30,393.00 11,515.24 4,004.72 45,912.96
CCG Hawks Road Clinic Vacant Space 49.54% 65,612.79 12,525.38 11,411.39 89,549.56
Under-utilised space :
Surbiton Health Centre – Community Health Partnership Unallocated space is 7.83%
• CCG covers the cost of unallocated space, annual forecast £127,234 for 2020/21
30 |1.3. Estates Baseline Summary 1.3.6 Vacant Space, Underutilised Space, and Disposals NHS Property Services has introduced a number of initiatives that aim to reduce the liabilities of void or under used space, such as: 1. Open Space: an online portal that allows customers to hire both clinical and non-clinical space as and when they need it, on an hourly or daily basis, which in turn reduces CCG cost liabilities. This platform will be available to other Health and Public Sector bodies in the near future. 2. Vacant Space Handback Scheme: allow CCGs to release space or properties if they are no longer needed. This removes the burden of costs such as rent, business rates and service charges from customers, this approach also gives others the opportunity to occupy the space. NHSPS then reallocate any space released through re-letting, disposal or development. 3. Social Prescribing (again, tackling voids but also as a Primary Care/ long term plan solution): Social prescribing is a way that GPs, nurses and other primary care professionals can refer patients to local, non-clinical services to address the root cause of health concerns and improve a patient’s overall wellbeing. The growth of social prescribing is an important factor in reducing demands on primary care networks, but is often restricted by a lack of suitable indoor and outdoor space for community groups and charities to deliver their services. The NHSPS social prescribing programme aims to increase the availability of space for these community and voluntary groups. We will be working with our customers to open more dedicated social prescribing spaces, supporting as many voluntary groups and local communities as possible. As an estates and facilities provider to the NHS, with a national portfolio, are in a good position to support the growth of social prescribing by meeting local needs for dedicated social prescribing spaces, thereby adding value to the health system and fulfilling our purpose to enable excellent patient care. 31 |
1.3. Estates Baseline Summary
1.3.7 Estates Strategic Priorities
Estate Name/ location Objective/ Challenge to be resolved Desired outcome
Area
1) Tolworth Hospital Disposal of surplus land at Springfield Hospital to provide funding for the New state of the art mental health
Tolworth Hospital development inpatient facilities to provide care to
patients in South West London
2) Tolworth Plan RBK with other partners are consulting on an area plan to develop the
RBK Led - Tolworth area.
Redevelop
ment and 3) Hawks Road Finalise disposal. Recycling of part capital to SWL
disposals priorities.
4) Chamberlain Way Finalise disposal to RBK Reduction in NHS PS portfolio.
5) Gosbury Hill HC Resolving the physical condition C assessment. Building includes a GP Relocation of practice to alternative
practice and health centre, where 1/3 building including part of the GP site.
practice is closed due to the condition.
6) Manor Drive HC Resolving the physical condition C assessment, functional suitability C Consider options for refurbishment
assessment and the existing void space on 1st Floor and possible hand back of void
space.
7) Fairhill Practice: Kingston Hill & Address the functional suitability C assessment.
Primary Fairfield South premises
Care Estate
8) Churchill Practice - Evesham Address the functional suitability C assessment.
Terrace premises
9) Grove / Norbiton & Tolworth Consider expansion options with Primary Care networks to address
wards population growth population growth
10) All Practices Ensure statutory compliance assessments are resolved.
11) Kingston Health Centre Latest list size indicates growth of 11 000 patients since 2013. Expansion of current premises or
relocation to larger site.
RBK/YHC 12) To be determined Review options for intermediate care beds, currently provided by YHC at Consolidate provision of Kingston
Teddington Hospital. with Richmond borough to enable
flexibility and possible economies of
scale.
YHC 13) Consider future utilisation of Ensure YH achieve a portfolio of Estate that can change and flex with the Offers Value for Money with a
Estate following the changing changing requirements of the organisation changing market of demand.
work patterns as a result of
COVID-19
32 |1.3. Estates Baseline Summary
1.3.7 Estates Strategic Priorities - IDP
Project Name Description of project/proposal Categorisation Indicative Project lead and Potential Estimated Funding
timescale partners funding Cost gap for
sources S106/CIL
New primary care New health facility in a more central Essential Short-Term SWCCG; RBK; NHS; TBC TBC
health facility as location within Cambridge Road Estate as Infrastructure NHSPS S106/CIL
part of the part of the first phase of the estate
regeneration of the redevelopment.
Cambridge Road
estate
Gosbury Hill Health Options to establish whether Essential Medium-Term SWCCG; NHSPS; NHS TBC TBC
Centre redevelopment or relocation would best suit Infrastructure RBK
population needs and provide additional
primary care services
New healthcare Options for new or improved primary Critical Short-Medium SWCCG; RBK NHS; TBC TBC
premises in healthcare facilities in the Tolworth area, Infrastructure Term S106/CIL
Tolworth which could include a new community hub
to expand healthcare capacity and provide
additional services.
Redevelopment of Redevelopment of Tolworth Hospital to Essential Short-Term St Georges Mental NHS £88m n/a
Tolworth Hospital deliver the Estate Modernisation Infrastructure Health Trust
Programme and increase capacity and to
meet changing and growing population
needs.
Primary Care Expansion and improvement of the estate Critical Short-Medium- SWCCG NHS; TBC TBC
Networks - estate to accommodate the additional Primary Infrastructure Long-Term S106/CIL
investment Care Network workforce and services and
address the impacts of population growth
and change. The short-term focus is to
address immediate PCN estate issues.
33 |1.3. Estates Baseline Summary 1.3.8. Estates Strategic Priorities - KHFT Acute Sector: Kingston Hospital Short Term 2021/22 Address residual issues with backlog maintenance focussing on fire code works Decant all buildings impacted by the land sale on Coombe Lane to Advance Living Continue to decant Roehampton Wing moving AOD and CSSD and bed stores out Expand our eye unit in phase 1 of a 3 phase plan Complete our wave 4 patient flow schemes with developments in ED and surgery Plan and decant ready for ITU expansion Start the development of an expanded ITU facility Install 3rd CT scanner Complete the installation of new modular build to accommodate Gynaecology, ENT and Audiology to facilitate the decant for Roehampton Wing Complete decant of Roehampton Wing Complete demolition of Roehampton Wing Medium Term 2022/23 Address residual issues with backlog maintenance focussing on electrical and chiller renewal Further develop car parking facilities on the land freed up through demolition of the Command Centre Develop and expanded ITU facility Move to phase 2 of the eye unit expansion which include paediatric oncology Plan for the energy centre renewal Longer Term 2023/24 Address residual issues with backlog maintenance Energy Centre development Outpatient refurbishment including Pharmacy modernisation 34 |
1.3. Estates Baseline Summary
1.3.8 Summary of the Estate in Kingston
Service Drivers: Sector No. Size (sqm)
• Population Growth: +20,400 Acute (Kingston Hospital FT) 1 71,400
• Community and PCN Based Models of Care Mental Health (Tolworth Hospital SWLStG NHS MHT) 1 15,140
• Below Condition B Primary Care Estate Community provider 0 0
CHP (Surbiton Health Centre) 1 3,887
NHSPS 4 2,820
Primary care 17 4,278
Office 0
Total 24 97,525
We require estate, with digital considerations, within the
locality and PCN footprints that support our new models of
care and integrated working. We want health and care from
different organisations and teams to be able to come
together and provide services within communities, meeting
the needs of the local population.
In order to achieve this we require quality in local estate and
to develop flexible spaces that have better utilisation,
rationalisation and productivity across the system. This could
include co-location of staff, development of local community
hubs and a response that sees traditional acute care being
delivered more so in the community.
This means that estate must be optimised across the system
to absorb the scale of impact, especially on primary care
sites and subsequent demand on community assets.
Consideration should be given to sports halls, libraries and
other community spaces which have the ability to flex based
on need, and provide non-judgmental spaces for people to
35 | meet.1.4. The Capital Challenge – Funding Sources The South West London Integrated Care System (ICS) as a system has serious concerns regarding the condition of much of our NHS estate, equipment and ICT infrastructure. The current availability of capital funding combined with the lack of flexibility around alternative sources of investment is exacerbating this problem. The system will work with NHSE/I, Her Majesty’s Treasury (HMT) our six local authorities and the GLA to identify other pragmatic, commercial and deliverable solutions to this major problem. Over the past 10 years, NHS providers in South West London, in common with the rest of England, have only been able to invest up to 5% of their turnover on capital investment when the norm for health systems is 10%.Therefore, tackling backlog maintenance and improving the infrastructure within acute and mental health hospitals and community and primary care facilities in South West London is a key priority across the STP/ICS to ensure that we have fit for purpose health and care facilities to meet the needs of our population. The demand for capital outstrips the available funding and South West London providers have already deferred expenditure totalling £100m into 2020/21 resulting in provider capital plans that are largely dealing with urgent and significant estate related service risks. 36 |
2. Our Progress So
Far
This section covers covers progress so
far including arrangements around
governance, completed capital projects
and also what people have told us about
our Health and Care Estate.
37 |2. Our Progress So Far
2.1. Governance Kingston Borough Estates Group is a quarterly meeting of
representative of the commissioners, Your Healthcare, SWL St
Georges & RB Kingston. Delivery of the Estates Strategy will be
overseen by KBEG and regular reporting to the SWL Estates and
Investment Group. The agreed governance arrangement supports
engagement and decision making in respect of prioritising the
required capital and investment pipeline and preparing bids from
across the borough. Having the correct leadership and effective
engagement in place means that delivery of projects, management
of vacant space, utilisation and disposals will enable the delivery of
Kingston’s local health & care plans.
38 | Terms of reference attached at Appendix 12. Our Progress So Far
2.2 Completed Capital Projects
Basic Scheme Information Financials Outcome
Lead Comments
Title of Scheme Scheme Description Total Capital Invested (£)
Organisation (inc funding source)
Expanding clinical space for patient
KHFT Emergency Department Expansion 5.5m Trust
assessment and administration
Development of minor injury and
KHFT Urgent Treatment Centre 2m Trust
illness treatment
New unit built to replace existing and
KHFT Endoscopy Department 3.7m Trust
increase capacity
Refurbishment of existing department
Expansion and refurbishment of to improve patient flow and
KHFT 3.5m Trust
radiology experience while also increasing
capacity
New unit built to replace existing and
KHFT MRI scanning and Orthopaedic Unit 5m Trust
increase capacity
Refurbishment to ensure all wards
KHFT Ward refurbishment areas are dementia friendly to reduce 1.7m Trust
LOS and improve outcomes
Backlog Maintenance and Safety
KHFT Fire Code Works 15m Trust
works
Refurbishment of unused nursing
Vera Brown House Administration
KHFT home to provide central 3.4m Trust
Block
administration facility
Mental Health Inpatient Ward
SWLSTG Old Lilacs Ward Refurb 3.5m Trust
refurbishment
Mental Health Inpatient Ward
SWLSTG New Lilacs Refurbishment 3.75m Trust
refurbishment
39 |2. Our Progress So Far
2.3. What people have told us about our Estate at the SWL Borough Health
and Care Plan Event
• “A lot of NHS buildings are in
poor repair.
• Some hospitals and some
wards are very old and need to
be upgraded to bring them up to
modern standards.
• A poor environment can affect
people’s mood and general
wellbeing.
• We should be working with
councils to look for opportunities
to solve some of our estate’s
challenges.
• Services need to be more flexible and offer different levels of support to people in their own homes.
• The idea of having more locally provided care is supported, but there are concerns that the local
NHS does not have the capacity and resources to manage the change towards a more local care
model.”
40 |Decision making focused on
cost effective service delivery
The boroughs in South West
3. Our focus and London are moving forward with
projects within a decision-making
actions framework that prioritises the
greatest need and best use of the
assets available. This directs
investment into key properties and
maximises their use, and enables
the release of surplus for sale.
41 |3. Our Focus and Actions
3.1. RBK Development Programme (March 2021)
Estimated Dates
Estimated Estimated
for receipt of Estimated start
Name of Project Project Lead Type of Development Total Scheme handover
Planning date on site
Costs date
Permission
Q4-23/Q1-24
£110m Q1-22
GhRP - Guildhall Matt Collyer Residential/Commercial Q3-22 (first Phase)
GhRP - Leisure Centre & Q4-23/Q1-24
£85m Q1-22
Cattle Market Matt Collyer Leisure/Residential Q3-22 (first Phase)
Cocks Crescent Ian Beckett Residential/Leisure/Commercial £176m 31-Jan-23 01-May-23 31-Jan-27
Liz Martin &
March-22 August-22 December-23
Murray House Andy Quek Residential £16m
Cambridge Road Estate Elaine Taylor Residential £500m 31-Mar-21 June/July 2021 2033
Small Sites Phase 1 Robin Oliver Residential £40m Granted 31-Mar-21 31-Dec-23
Small Sites Phase 2
(GN and ASC) Robin Oliver Residential £40m 31-Mar-22 31-Oct-22 31-Oct-24
Small Sites Phase 3
(GN and ASC) Robin Oliver Residential £60m 31-Mar-23 31-Oct-23 31-Oct-26
Source: Property Team, RBK
Given the scale and ambition of RBK’s own development programme it is important that a
comprehensive and joined up approach to the planning and delivery of new health facilities is integral to
the master planning of these schemes. Each scheme is at a different stage of development and as such
future provision will need to be considered on a case by case basis with the exception of Kingston Town
Centre where the Guildhall, Leisure Centre and Cattle Market sites should be planned in unison. Further
engagement is also required on the provision of new health facilities to support the delivery of major new
developments across the Borough through the mechanism of Section 106 financial contributions paid by
developers at the time of planning consent.
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