STATES OF JERSEY
Annual Business Plan 2012 (P.123/2011): amendment
Lodged au Greffe on xx August 2011
by the Minister for Treasury and Resources
STATES GREFFE
ANNUAL BUSINESS PLAN 2012 (P.123/2011): AMENDMENT
1 PAGE 2, PARAGRAPH (c) –
After the words “withdrawn from the consolidated fund” insert the words –
“except that the amount in Table C for Clinique Pinel Refurbishment in 2012 be increased from £1,100,000 to £2,868,000 with an increase in the amount to be withdrawn from the consolidated fund from £35,814,000 to £37,582,000”.
MINISTER FOR TREASURY AND RESOURCES
REPORT
The Minister for Treasury and Resources is proposing an amendment to the Council of Ministers’ Annual Business Plan to ensure that urgent capital works are carried out at Beech and Cedar Wards, Clinique Pinel. He does so at the request ofafter working with the Minister for Health and Social Services, with the agreement ofafter consultation with the Council of Ministers and following a visit to the site with the Minister for Health and Services, and the Treasurer of the States and the Chief Officer of Health and Social Services. It was apparent to the Minister from his visit that this work cannot be delayed and is absolutely essential in order to bring conditions for residents up to a minimum acceptable standard.
Whilst this proposal increases previously agreed total expenditure limits by £1.768 million, the Minister considers this work to be unavoidable and that it is unrealistic and inequitable to displace any other capital or revenue expenditure already proposed at this late stage. The work previously met the criteria for Fiscal Stimulus funding but was unable to be commenced in time. The forecast consolidated fund balance will not be adversely affected as the Minister is able to “return” £3.8 million to the fund which was previously earmarked for expenditure on pandemic flu, following past States approvals.
Background to Clinique Pinel
Clinique Pinel is situated in the St Saviour's Hospital site and provides assessment and treatment units for people over the age of 65 suffering from organic (the dementias) and functional (depression, psychosis, anxieties, etc.) mental illnesses. Currently it is divided into 3 units with 17 beds on Beech Ward, 16 beds on Cedar Ward and 10 beds on Lavender Ward. The building was originally constructed in the 1970’s and had some essential maintenance to keep it wind and water tight about 10 years ago. The design of the current environment is not conducive to 21st Century mental health care and there are limited bathing facilities with no showers and patients having to share small dormitory style bedrooms. Due to the nature of some of the presenting problems the patients experience when they come to Clinique Pinel, such as wandering, frustration, confusion and at times hostility towards other patients or staff, the current environment, rather than reducing such distress, has the opposite impact and makes it extremely difficult for the nursing team to provide evidenced based intervention dependant upon the needs of the individuals.
During 2009 an application was made for fiscal stimulus monies to upgrade both Clinique Pinel and Rosewood House (Rosewood House is a 52 bedded unit for long term care for people with organic mental health problems). Money was allocated but due to increased nature of building safety design extra money needed to be used for the refurbishment of Rosewood House. This included installing a fire sprinkler system, increased specification fire break doors and fire compartmentalisation within the roof space. This resulted in inadequate funding for the upgrade of Clinique Pinel, and, due to the inability of both projects to run simultaneously, and as there was no alternative space to decant the patients, the Clinique Pinel scheme fell outside of the clear time limits for fiscal stimulus funding.
During 2011, a Capital Bid of £1.1 million was made for essential safety works to be carried out in Clinique Pinel during 2012. The Council of Ministers agreed to include this in the draft 2012 Annual Business Plan. These safety works include:
- Improved fire safety by installing sprinklers, fire doors, and improved fire escape stairs at both ends of the building.
- Improved infection control by replacing ceilings and flooring throughout the building to comply with infection control standards.
- Increase the number of bathrooms and shower facilities as currently each of the wards only have one bathroom and no showers for their patient group.
Proposals for the release of additional funding
The additional request for £1.768 million will allow the internal environment to be upgraded to a nature and degree that is conducive to patient care and will reduce risks to the patients of slips, trips and falls as well as reducing risk to staff and patients due to confusion, violence and hostility. This proposal will not bring the unit to the standards specified within the NHS Estates document “HBN37 inpatient facilities for older people”, but will significantly improve the environment for the projected five to ten years that Clinique Pinel continues to provide inpatient services for this client group. It is proposed that all patients should have their own bedroom, and that 20% of these bedrooms should have ensuite facilities. There needs to be more, but smaller, living spaces for people with functional mental health problems and an area where people with organic mental health problems can be nursed safely during the day whilst full mental health assessments are carried out. It is also planned that each unit will have low stimulus areas which will incorporate bedroom and day time living space with bathroom facilities to allow those patients who pose significant risk to themselves or others to be nursed in a safe part of the ward thus reducing risk significantly.
It is recognised that longer term plans for the reprovision of inpatient services for patients with mental health problems are to be relocated onto the Overdale site at some stage in the future. Taking cognisance of the future development plans on the Overdale site this request for funding for Clinique Pinel upgrade is excluding any upgrade of the current plant (water, boiler and heating systems), lifts, extensions and significant external improvements.
Strategic Context
Within the States of Jersey Strategic Plan 2009 – 2014 this project links to priority No. 6, “Provide for the aging population” which states “we need to ensure that, as far as possible, older people can lead independent, healthy and productive lives for as long as possible, and then to provide high quality care when it becomes necessary”. The patients within Clinique Pinel are clinically assessed - the outcome of which is to identify appropriate treatment and a safe environment either by returning home with the appropriate community support or receiving ongoing care in the appropriate residential setting. With this in mind it is imperative that an environment is created that allows the clinical teams to “provide high quality care” for this vulnerable client group.
Summary of funding request
The total sum requested within this amendment is for £1.768 million, this is calculated by Currie & Brown, Quantity Surveyors, and the calculations below include the £1.1 million capital bid already included in the 2012 Business Plan for the health and safety improvements.
Project Scope: The upgrade and refurbishment of Clinique Pinel comprising the remodelling of the existing building to include for some ensuites and low stimulus suites, fire upgrade and redecorated throughout. | |
COST PROJECT DATE August 2011 | Cost at third quarter of 2011 £ |
Builders Work (Inclusive of Mechanical and Electrical) Asbestos Survey & Provision for Removal Remodelling of Existing Areas | 50,000 2,055,000 |
Construction Costs | 2,105,000 |
Fees @ 22% (Incl. Design Team, Project Manager, Programme Manager, Building Control, Hospital Engineers) Decant Fixture Fittings and Equipment External Improvements Medical Equipment | 463,000 100,000 140,000 60,000 Excluded |
Total Budget Cost | 2,868,000 |
Average £/m2 (excluding fixtures and fittings) | 1,298 |
Capital Bid for Health and Safety Improvements included in Business Plan for 2012 | 1,100,000 |
Additional Funding Requested | 1,768,000 |
Consequences of non approval
Should the States not approve this proposition, then the environment for people over the age of 65 years with significant mental health issues will continue to be not fit for purpose. This will result in increased risks to clients, staff, visitors and the organisation. Furthermore, the current environment does not lend itself to evidenced based modern treatment of mental health conditions and as such serious mental illnesses such as depression, psychosis and dementia will not respond to treatment as speedily and the environmental impact on the experience of patients and their families will continue to be negative.
Pandemic flu funding – return to the consolidated fund
Funding for a potential influenza pandemic has been approved on a number of occasions by the States.
A sum of £936,000 was earmarked from the then General Reserve by the Council of Ministers prior to the introduction of the Public Finances (Jersey) Law 2005, of which £665,985 was spent.
In P67/2008 the States allocated £1.23 m and in P174/2009 a further £5.547 m was allocated. P174/2009 determined that funds would be allocated to Departments retrospectively by the Minister for Treasury and Resources.
On 24th January 2011 the Minister for Treasury and Resources signed a Ministerial Decision MD-TR-2011-0007 for the return of a portion of the pandemic flu contingency funding (£1,162,015) to the consolidated fund.
The Health and Social Services Department has now confirmed that any immediate need for the remaining allocated funding has now passed. The remaining balance of expenditure approved for this purpose is £3.8 million. The Minister for Treasury and Resources is pleased to confirm that this sum is now no longer earmarked within the consolidated fund and so is effectively returned to the balance of that fund. The net effect of this and the proposed allocation to Clinique Pinel is reflected in “Financial and manpower implications” below.
Should a further pandemic threaten then the current provision for Central Reserves should be sufficient to address any funding requirements.
Financial and manpower implications
This proposal increases the amount in Table C for Clinique Pinel Refurbishment in 2012 from £1,100,000 to £2,868,000 with an increase in the amount to be withdrawn from the consolidated fund for capital expenditure in 2012 from £35,814,000 to £37,582,000. Following the return of £3.8 million now confirmed as not needed for pandemic flu preparations, the projected consolidated fund balance at the end of 2012 in figure 4.7 on page 25 will increase by £2 million to £7 million.
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