Maintenance and new build on NHS estates
While UK industry is demonstrating unprecedented innovation in hospital and healthcare sites building and maintenance, the sector still faces huge challenges.
Central to this paradigm is the need to integrate new technology with improvements or maintenance to hospital estates as well as facing up to sceptics within the NHS who are sometimes in denial about the need for change, arguing that the money needs to be spent on bricks and mortar, and probably also pen and paper.
NHS Providers sounds a warning
NHS Providers, which represents NHS trusts, reported in July that” filling the gaps after almost a decade of austerity will account for much if not most of the new money promised by the prime minister.” Specifically, dealing with maintenance on NHS estates and preventing any further backlog would cost “at least £1.2 billion a year for three years.”
So given that estimate why do estates issues matter to the NHS in the first place? Getting the future health care estate right is of similar strategic importance to trusts as getting the workforce right and poses some significant but different challenges.
An effective hospital estate system sees the efficient use of its combined estate and other infrastructure, such as IT, as a significant enabler to partnership working, and importantly the creative use of estate resources can release funds to be reinvested in patient care.
Most importantly, getting the estate right makes a difference to patients. As well as improving the experience of care, we know that being cared for in a good environment can improve health outcomes. Several trusts have ambitious plans to transform services, reconfigure hospitals, and develop primary care.
Portakabin offers modular solutions
They often involve modular buildings built off-site an exponent of which is Portakabin, which recently worked at Papworth Hospital. “We were very impressed by the Portakabin tender-return programme and the level of customer service we received throughout. This was a huge project, the first of its kind, and Portakabin were the only company who could commit to such a rapid turnaround, comments Pepe Marinelli, Architect, Frank Shaw Associates
Portakabin can make this promise because its modular solutions are manufactured off-site in a controlled factory environment. Before they leave the Portakabin production centre, the buildings are fully fitted with all electrics, plumbing, heating, doors, windows and internal finishes.
A major driver in the greater efficiency drive here has been NHS Improvement under the leadership of its chief executive Baroness Dido Harding who has brought to her role extensive experience in the private sector.
Let us not underestimate the scale of the challenge. The ownership of the NHS estate is scattered across 250 trusts and foundation trusts, NHS Property Services and Community Health Partnerships. In addition, the NHS leases estate from local authorities, private companies and PFI providers, and hundreds of individual GP practices own their own premises.
Unlike workforce development, no organisation has strategic responsibility for NHS estate development across a system, and few individual organisations have board or executive level strategic estate leads able to engage effectively across a system or with other partners. All this is destined to change with NHS Improvement encouraging greater engagement with the public about the best way to configure estates services. With the NHS and social care in the community increasingly integrated there are nevertheless barriers to progress.
Public opposition to change affecting NHS buildings which people identify as places of safety and security can be significant, and until recently the NHS has not historically been very successful at working with local communities to see such change as a gain rather than a loss.