Key Issues in NHS Estates – Moving Forward

05.02.2019

By Stephanie Brada, Strategic Health Planner

On 24th January I was one of 100+ delegates that attended a seminar entitled Key Issues for NHS Estates: funding, planning and policy. When we left at 1pm what did we feel the key issues were for us, as participants?

From my perspective, I gleaned a number of common themes: a shared frustration at the pace of change within a system that can be slow and complex; the tendency for process to block the view and make us forget the people we are actually trying to help; and, on a more positive note, the commitment to working with partners to provide joined up public estate and services, feeding into overall local regeneration.

The government has promised that more money is going into the NHS to support progress on NHS transformation, making services more responsive to people’s needs, embracing the opportunities opened up by new technology and moving aspects of care from hospitals into local facilities.  So expectations have been raised, and people need to see things happening.

One of the main estates initiatives is provision of integrated care hubs for populations of 30-50,000 people, focussed around primary care and including services transferred from acute hospitals, as well as social care. At the seminar we listened to a powerful plea from the floor for an understanding of healthcare in its widest sense. The new policy of social prescribing is an exciting part of this new approach, which we have already seen in action at facilities like Bromley by Bow, where there are a range of activities focussing on social well being in addition to traditional medical care.

The development of this model of care will be one of the first responses to more integrated care that the public will see. It may mean co-locating services from the NHS, local authorities and the third sector in the same building to enhance team working. And the logical follow on is that facilities will be shared so that the building is used as intensively as possible, creating a buzz and maximising efficiency.

Thinking creatively, these new hubs may form part of a residential development, locate in a former Marks and Spencer on the High Street, move into existing or extended public sector estate, or be new build.

Most speakers at the seminar acknowledged that there are obstacles to the delivery of new facilities. At Willmott Dixon, building on our experience in the education sector, we have worked to drive time out of the design and construction process with our pre-designed healthcare hub, called cura.

We looked at the hubs delivered to date, each individually designed, and saw that, despite looking very different externally, inside the contents were very similar. Designing each of these buildings from scratch meant re-designing the same rooms, over and over again, wasting time and money.

Reflecting on that, we created a pre-designed facility with a central communication core on to which you can add modules providing accommodation for clinical and other services. The customer can choose from a menu of departmental modules that meet their brief. The structure of the building and service runs means that the room configuration can easily be modified during the life of the building, changing as services evolve. The rooms are standard sizes, offering the most ergonomic solutions so that a wide range of providers can use them – this will ensure that each room can achieve maximum occupancy – one of the major objectives of the hubs.

“Personalisation” to respond to the local community comes through choices about external and interior design. The building can be freestanding or could have upper levels of housing for example.

Pre-design has the advantage of providing a fixed programme and cost at a very early stage. cura incorporates design learning from previous projects, published post project evaluations and best practice to give people confidence that they are getting the best quality without wasting time on reinventing the wheel – time that could be better spent delivering care.

There are many challenges for Estates but we believe that initiatives such as cura can accelerate the pace of change in delivering NHS transformation.

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