Webinar event – questions and answers

A webinar event was held on the 18th August 2020, to provide an update on the project and to talk through the master plan documents. A range of experts answered questions from members of the public and explained the next steps.

This is the full list of questions received (pre-submitted, received on the night and sent in post-event) along with the answers from the event.

You can find out more about the event on the webinar page.

1. How will you make sure that services which are moved to new buildings have enough space both for their current needs and room to accommodate growth in patient and staff numbers and that this is not trimmed away for ‘efficiency’ or cost savings?

The first point is that the hospital has employed expert health care architects to evaluate the space requirements, which is an ongoing process and is particularly relevant given the current Covid-19 crisis. This is, therefore continually under review. The second point refers to efficiency of cost saving not being trimmed away, we have been designing the masterplan buildings to relate to the requirements to date. Those requirements do keep changing. We are also working on data from population and demographics.

In addition, we have a lot of work to do with individual clinical teams to work out the exact requirements for each of the departments that have been described today. We will be doing this with a mind’s eye on the future demands. Also learning from other hospitals – in the last year we have been to 2 or 3 other hospitals who have completed new building schemes and tried to learn from them – and will continue to do this.

2. Where on the masterplan is space allocated for the functions currently based where the care village and rehabilitation unit are proposed?

We are at the early stages of planning, so as we have allocated large areas for different uses. The details of the elements are added to those uses that are being worked out in floor space requirement terms first before we allocate where they go and what the adjacencies are, which is ongoing work.

To stress that each individual element needs to happen to free up space, which will allow us to work out what will be moved. For example, when somebody talks about the services, admin services and services on SDH South, we will not be able to move or accommodate those until such time like we have done on some other development. There will be a real phased element to this. As we do them it will enable us to move other services. Again, working with the clinical teams and the departments will be key to work out the next phase.

3. Is there scope for a walk in Immunisation Centre for Adults.  

We will investigate this with local primary care providers which is where the majority of immunisation is provided.

4. Are you considering an increase in capacity with regards to new builds in the city?

Yes, absolutely we are, we have already had discussions with Wiltshire council regarding that and have also borne in mind the return of the armed forces which will have an impact on the hospital’s team.

5. What wellbeing facilities /services are envisaged?

A lot of scientific research has gone into creating healthy spaces. This does not just mean parks and gardens, but also plants and the relationship people have with plants. The health and wellbeing theme at the core of this development is the reason why there are a lot of green spaces allocated here. The hospital has a lot of experience itself; Horatio’s garden is a really good example. If we can build upon the success of that but not just one garden, but a range of gardens with different activities that relate to different wellness therapies. It is a cohesive and important part of the plan.

In addition, that will be an area we will be engaging with local people about and trying to get other people’s ideas.

6. What will be included in the first phase and where will the departments go that are affected by the removal of buildings and while the new buildings are being built?

We are currently looking at two elements of the building, one being the day surgery unit and the other being the maternity unit. Our biggest estate risk is day surgery and then it is the maternity block. This new facility will include cancer services and some other outpatient services. It is a phased process, so we will try and do day surgery in a way that it will not displace any other services, although it might. We will have to have a plan for any services which are displaced.

7. Could you explain how this would facilitate opportunities for links between research, education and innovation, including the benefits it would offer?

The education elements are coming forward in the discussions we are having with Wiltshire College and a local university. Due to Covid-19, change is occurring quite rapidly. A lot of people will be considering some retraining, or some other aspect of education and the colleges are very mindful that those changes are so rapid. It is quite clear that as the world evolves and changes there are new opportunities for different kinds of work from that envisaged even a few years ago.

8. How will the education facilities be used to develop staff/students and be inclusive for the wider population?

We have had a number of discussions over the last couple of years, particularly with Wiltshire college, and there is a relationship between them and Oxford Brookes and Bournemouth University, where they underwrite the degree courses. We are trying to produce a campus design that is inclusive for all levels of education, whether that be for apprenticeships, diplomas, or degrees. We hope that the people of South Wiltshire will be educated in Salisbury and find future work in Salisbury, this scheme provides that opportunity. All the educational requirements that are coming forward already from Wiltshire college and other associations will be adopted onto the campus site.

9. Do your educational plans include research links with Porton and Southampton in particular, as well as Bath on the physics and bioengineering side?

We have had several discussions with Wiltshire Council and their economic development team. It has been clear from those discussions that the success of Porton science park could be emulated in a different way at Salisbury. One of the reasons for that, is that there are several restrictions on security for certain companies to operate at Porton. This would not be the case for companies where the requirements for security are not as tight. Therefore, the location for some of those businesses and skills could be accommodated here at the Salisbury site. Importantly, this is to do with generating employment locally, we need to supply the skills companies need. For example, life sciences, which is a key element of this plan ensuring that people are equipped to be employed here. There are about 380 different jobs in a hospital environment, not just medical jobs but a wide range of other skills are needed to run the institution.

10. What training facilities will be provided for resuscitation training, both for day-to day training and to upscale for larger national courses?

This is a very detailed question, and we will need to take it offline with the department involved, I spoke earlier about working with all the clinical teams about future requirements and can do that with the resuscitation team

11. When will the new Education Centre be likely to be built?

We are right at the being of the planning process. Firstly, we are seeking to align this development and get it included in the local plan review as a principle. The second stage would be an outline application, and then that will be followed by a detailed application for individual buildings. We are quite a long way off I am afraid, looking at a period of 2022/2023 when that planning process may come to a fruition. Then there will be the time taken to build, so not for a few years.

12. Will the project mean that more apprenticeships can be delivered on site?

Certainly, we hope so and is one of the intentions in meshing this in with the hospital’s requirements.

13. Do you anticipate any mental health and dementia development in the education plan?

I would think almost certainly, but we have not got to that point yet. It is not just education; we are having some conversations with commissioners and Avon and Wiltshire partnership whether there could be an element of mental health into this scheme. It is probably too early to say, with the land we have got available it could be possible to accommodate a mental health provision, if it works, again for the service and for the patients. We think there is a good connection between the requirements for patients’ mental and physical health needs. Particularly for dementia patient services which is one area we are particularly keen to look at. Yes, to the education and potentially service provision as well.

14. How are we going to develop the clinical services we offer in day surgery to meet the technological advancements in surgery and the changes in our longer living population.

This is a real priority for us. We have described that the day surgery building is quite an old building and it is a real constraint on the ability of our clinical team to practice in the way that they would want to. Currently, we do not do as many types of procedures on the day care unit as we probably should and a lot of that Is down to the environment and the lack of flexibility of the environment.  For example, we would like to do a lot more orthopaedic work as a day case and particularly more basic procedures that require specialist ventilation flow that we do not have in our day surgery theatres.

15. How might research fit in? 

We are looking at a focus on service provision, life sciences and education. As it stands, the Trust already offers more research opportunities in excess of what could be expected for a hospital of its size, and the proposed development will enhance this.

16. How is children’s care being considered in the HEAT project?

Children services are currently in the main/new hospital. It is one of the services in the newest part and has recently been refurbished in 2012. The environment is particularly good and still benefits a huge amount from the contributions made from the Stars appeal. Some parts of the children’s areas will benefit, including the day surgery unit, which does not have dedicated facilities for children which we would like them to have. There is pressure on the current paediatric department in terms of emergency care (will try and do something but might not be from this scheme). The last area that will be improved by this scheme is the neonatal intensive care unit, together with the maternal development, which would be improved and expanded. We want to improve the environment and especially the links between the maternity, post natal and near natal care as, at the moment they are quite disjointed.

17. I would like to hear the plans for relocation of OML and Department of Clinical Science and Engineering. 

This is a very detailed question, and we will need to take it offline with the department involved. I spoke earlier about working with all the clinical teams about future requirements and will do that with this team.

18. Plans for cancer services.

One of the areas we are intent on providing improved facilities for are our outpatient cancer services. The building at the front of the hospital will include outpatient cancer services such as haematology, oncology and the regular treatments that patients have for chemotherapy.

19. Will the orthopaedic fracture clinic be situated in this restructure. 

We expect orthopaedic clinic to be moved before the campus project gets underway.  There will be further details on this soon.

20. Salisbury Hospital needs to expand, to replace its aging Day Surgery Unit, to build in more capacity (especially since Covid, but even before).  How can the HEAT project promote and support such infrastructure investment? 

As described elsewhere, this is a fundamental reason for the overall scheme and the replacement of the day surgery unit is our highest priority.  The new facility will have greater capacity to undertake more procedures on a day-case basis.

21. The wards had to be reorganised to accommodate Covid-19 patients and the presence of these patients on site prevented treatment of others for a while.  What changes or flexible arrangements are necessary to allow ongoing urgent treatments to exist with coronavirus, flu or other significantly infectious patients being on site?

In terms of our emergency prevision, where the expanded, standalone day surgery unit will help separating our elective care away from our emergency care. We will try and prepare ourselves for any future spikes/waves – the Trust is already planning on doing work on our intensive care unit, such as additional beds so it doesn’t impact on our theatres (which it did during march/April/May) – this will hopefully be up and running by November.

In terms of the ward environment, we will be able to manage that relatively effectively because we have a ward area down on level 2 of the hospital which has which has a good proportion of side rooms and 4 bedded bays which has enable us to manage patients with Covid-19 (or suspected Covid-19) relatively effectively. In addition, in terms of A&E we have got some central funding to help with improving and expanding the number of spaces we have for waiting areas, and our ability to segregate patients whilst waiting to be seen in A&E.

22. What advice/requests has the team had from neighbouring trusts that Salisbury serves eg spinal, rehab, max facial, burns, plastic /reconstructive surgery, cyto genetic?

Nothing specific. What I would say is the rehabilitation area will be an important aspect on how we manage patients who have been treated in the major trauma centre that runs out of Southampton. We know with our engagement with them, they are very keen to see patients repatriated back to the acute hospital and back to our therapy services as quickly as possible. I think Southampton will be very supportive.  In terms of spinal and genetics we have got separate schemes that will see developments there.

23. On the plans there appears to be no radiology facility which would replace what is currently there, including the about to be positioned MRI scanner. Are the plans to accommodate an OP radiology service area, to keep it separate from IP? How will hospice patients get to radiology (currently this is a journey taken under cover)?

In terms of the x-ray services, the x-ray service in the central hospital will be provided as part of the maternity building. It will absolutely be kept separate from the inpatient services, so that will be maintained. In terms of the hospital, about patients getting to radiology is back to the issue about the central corridor, which almost certainly will not be there in the future. We may need to change the model of care for patients cared for in the hospice and if we don’t change the model of care, it will be about the access – we may need to transfer via ambulance which is not ideal. There is further work to be done on this and we are discussing with the hospice.

24. Is there a net loss of beds in the proposed scheme and how do you justify this?

There are not any bed reductions in the scheme. You are not allowed to put forward a capital scheme that involves a reduction in beds. We will be working with system colleagues to make sure we have the right balance of beds of various types on the hospital site, which support the future needs we have described elsewhere.

25. & 26. Transport

  • How will ensure transport to the site is green and sustainable? Will bike lanes, secure bike parking and changing facilities be included?
  • Cycling links to and from the hospital need to be improved. Cyclists need segregated routes – what are planning as part of the project?

Salisbury has already begun to do this already, and I have mentioned the people friendly streets and the reallocation of road space for cycling. I have also mentioned that the hospital already operates electric cars and we intend to build upon that by having bus services and taxis services which is common elsewhere. There is an app that people can use to dial up a bus or taxis to come and meet you at a certain time. Bus services are allocated accordingly, we have been talking to bus companies about limited stop services to and from the hospital. People are not using the bus at the moment due to it stopping too often, we could run a direct bus to the hospital that only stops at certain points. These are options to be introduced gradually; they need to be trailed and demonstrate that they are successful.

27. How many floors would the decked car parking be and would the lighting impact on the local area at night? Will it be seen from A338?

I think we are considering five decks to the car park, but we cannot be absolutely be sure of that. The key element is that we must be below the level of the existing main hospital building and that means we will be about a storey below that level. A zone of theoretical visibility study has been undertaken, we are aiming and succeeding in making sure the new heights of the building that are being proposed fall within the visual shadow cast of the existing buildings. We have undertaken some lighting studies and it is evident that you can see the existing car park in winter, from the A338 and A36 and other areas around Salisbury. By removing the existing car park and putting 2 story buildings in the valley instead, we have removed that impact. The car park itself will have modern reduced glare lighting, which will be shielded so it will not extend outside the frame of the building.

  • 28. You also mention possibly opening up an entrance by the Britford park and ride. Would this be for vehicles and how would this affect the bridle way currently on the current dirt track? It is used not only by people gaining entrance to the hospital but by horse riders and dog walkers along with the impact of wildlife in the fields
  • 29. Are there plans to link the park and ride? The master plan notes a future potential access. This access is a byway and a well-used walking route and on private land

We have looked at this as there is a clear geographical link between park and ride and the hospital site in terms of its location. The Park and Ride is a little underused, so we may consider using part of it in our master plan. Currently, it is complicated because there are a lot of different landownerships. There are further complications in that there is a lease arrangement with Wiltshire Council and the landowner. There is a possible link, for example we would consider using an electric vehicle or shuttlebus, if we ever had to do something like this, it could also be a cycleway or something similar and still function as a bridle way and footpath. I think we need to be careful, quite rightly about the bridleway and other connections with the public footpath. The true answer is that we are considering it, but we fully appreciate it is not straightforward.

30. With the site subject to winter access issues (i.e. snow), would a cable car system be from the town centre be an idea and might be a tourist attraction?

It might be but given the fact, but I think a cable car will be quite expensive. We will not object to it, but I believe it will be an unlikely attraction.

31. A growing hospital is going to impact the villages, notably Nunton and Odstock, even more than they currently are by traffic movements to the hospital. The roads linking the hospital to the south of the county are inferior to the northern connections, how are you proposing to deal with this?

There are alternative modes of transport that are being considered that will not increase the use of car traffic beyond the current level. Even with this development the target for us, and this is what we are working towards, is not to increase current levels of traffic.

32. Can you assure us that the plans and works will be implemented with due concern for the natural environment and biodiversity of this landscape, and will preserve and enhance the special features of this site?

I hope I have explained this earlier but just to recap the plan for this site is to reintroduce biodiversity back into the landscape and we are trying our hardest to ensure that it is accessed and managed appropriately. This is key to the project; this is not just based on the fact we want to a make it greener, but it is based on a lot of research on health and wellbeing and its relationship with landscape quality.

33. Tell me more about the projects low carbon plans and how it hopes to help tackle climate change in Salisbury.

Firstly, we want to manage the traffic on site, secondly we are keen to introduce a number of modal movement shifts by which I mean car sharing and electric cars, cycling etc. The hospital already runs an electric / car sharing car group – that can increase. Again, Covid-19 and the momentum behind Wiltshire Council’s funding to discourage the use of motor transport will mean there will be less. Overall and importantly we will use alternative technology for renewable energy in all new buildings and as best we can in the refurbished ones.

34. Is the additional land taken in the illustrative master plan the extent of the proposed land take or are you going to expand further into our beautiful countryside. If so, how good is this for the environment?

The land shown east of the existing car park is the full extent of the additional land required for the proposal. The field is bounded on the eastern side by a substantial hedge line which we believe is the limit of development, having regard for any potential impact on the surrounding landscape character and views. There is no intention of developing beyond this.

As we have mentioned, only 3% of the existing hospital land is green, useable, and publicly accessible. We consider this to be unacceptably low when designing a new hospital master plan, especially since gardens and green space evidentially contribute to wellbeing. We intend to increase this substantially in the design for the new campus layout, creating a new biodiverse landscape with specially designed gardens set within a framework of native trees, woodland clumps, and grassland.

35. Do the plans involve any joint venture or outsourcing of services run by Salisbury NHS Foundation Trust?

There is a joint venture in terms of our work with Salutem partners who are helping us with the development that has got us to the stage that we are. In terms of outsourcing of clinical or ancillary services there is no plans for that at the current time, and I don’t expect that there will be.

36. Given the ageing population and demographic of hospital service users how will the project ensure it serves the needs of older people.

Certainly, the rehabilitation is an important element as it includes a number of patient groups in relation to some of our specialist services and the trauma support that we provide to local and beyond patients, such as Southampton and Dorset. It is also for our core elderly population, which is growing, and we need to make sure that we are providing services that meet the needs of older people. Not just for coming into hospital in the first place, by helping to facilitate support within the community, helping support through our front door / a&e department/medical assessment unit, but also as patients leave acute environment, providing an intensive rehabilitation therapy unit. We will continue what we have done during our current wards, making sure facilities are as appropriate as possible for the elderly, especially our program of dementia friendly ward environments.

37. Is there any provision for care for the elderly, either in the form of a Care Home, Rehabilitation facility, or Day Care Centre in the plans please?

As described above, rehabilitation services for older people will be an important element of the scheme.  At the moment there are no plans for the other services mentioned, but that could be considered in the future and we will discuss with local commissioners.

38. How might the plans affect the Salisbury Hospice?

One of the challenges with the hospice is that it is reliant on the corridor that goes down from the south of the hospital site down to the hospice. I think what that would mean is that we will have to change some of the nature of the patients that go there. We are in close contact with the hospice that are aware of all our plans, have had 3 or 4 meetings with them over the last 18 months. This will be an issue that we will work with them as the plans get more advanced – it will be a challenge that we will have to address.

39. What potential partnerships and collaborators are being considered? What is the criteria for their consideration?

At the moment, the only collaborations that we have had are with Salutem who we have worked with since the outset, and with the education providers, who were slightly self-selecting and delightful to work with in terms, particularly Wiltshire College. We have also had other discussions with different aspects such as care village and patient’s hotel, those haven’t gone anywhere at the moment and put those out to formal tender with appropriate criteria at the appropriate time.

40. How much is it going to cost and how will it be paid for?

At the current time we have only costed the hospital elements of the scheme.  At the current time the value of the work is in the range of £165-175m.  We will be looking to secure funding from the government for this scheme.

41. Will there be any opportunities to tender for any works?

Yes, we will be putting out formal tenders with the appropriate criteria at the appropriate time.

42. Does the plan have involvement with local organisations such as Wiltshire Creative, on the education / arts side and also have a place for the future of Horatio’s Garden and the hospice and its garden?

We have covered the hospice in where its future location may lie. In the case of Horatio’s Garden that will be included in the plan we come up with. Local Wiltshire Creative will have the opportunity to comment and involve themselves.

43. How do you anticipate accessibility for the diverse population you will be serving?

This will be something that we address as part of the engagement as we develop plans. As we approach each element of the scheme, we will make sure that we undertake full engagement with local people. We will do our best to appropriately address and seek information of the needs and wishes of people who are using our services. This is an ongoing process.

Additional questions (received after the event)

44. What are the plans for the Department of Clinical Science and Engineering and Odstock Medical Limited?

Please see the answer to question 17.

45. It would be helpful if Primary Care planning for Salisbury/South Wiltshire could provide a brief to sit alongside the Heat project and provide some context in relation to services, access, education and sourcing manpower. I have lived in Salisbury for just over 10 years and find the lack of visibility about Primary Care a constant.

We are working with primary care and local commissioners about the provision of primary care in south Wiltshire.  There are plans underway to develop an estates strategy for south Wiltshire which will answer some of the facilities related questions and how this ties in to the campus scheme.  The newly formed Wiltshire Locality takes the lead on the development of local primary care.

46. In other parts of UK, I am aware for example, that accessing services online has included enabling patients and/or carers to be given structured assistance to access appointments from primary or social or residential care settings. This is maximising access from vulnerable people – not always identified as such- and from people without technical equipment or expertise. It also appears to enable various services to improve their productivity. 

We are increasing the provision of virtual clinics – the opportunity for patients to have consultations via telephone or online.  We only expect this provision to increase for hospital based services; we are unable to comment for other sectors.

47. As education was one of the main points of focus for this project, I would like to see some mention of the library which supports education, and some provision for a new modern library as part of this project.

This is a detailed point as the quantum and type of educational facility has not yet been defined, but the point is noted.

48. Can you share the details of analysis that has (or will be undertaken if not yet done) of the traffic volumes on the Odstock Road given that changes will result in an increase in the numbers of people who will be going to and from the hospital? It seems unlikely that patients would in general be arriving by anything other than cars.

We have already mentioned that we wish to introduce a series of transport initiatives, such as a supplementary bus service or limited stop service, support for increased car sharing especially for staff, a simple phone app for calling taxis or the bus as used elsewhere in the country and so on. These will need to be trialled, some are already partly in use. Our aim is not to increase car usage beyond its current level.

49. As there will be replacement car parking facilities, will the number of spaces for staff and/or visitors be increasing or decreasing?

In line with our sustainability plans, we are not intending to increase car parking numbers for visitors or staff.

50. I am interested if this proposed development is going to extend outside of the current hospital footprint please.

The proposal will need to use some land to the east of the existing hospital. It has been an important part of the new master plan that through careful design and placement, the impact of the form and massing of new buildings on the landscape and visual characteristics of the surrounding area will remain substantially similar to that of the existing hospital.

The current hospital site has an exceptionally small area devoted to useable green space being only 3% of the total site area which is similar to a city centre location. Significantly, the proposals also seek to introduce public access to green spaces which will be designed to have greater biodiversity with the creation of a new indigenous woodland landscape framing designed gardens and spaces.