Flexibility key to future of the NHS estate

IHEEM Annual Conference warns that current design approaches are not providing fit-for-purpose buildings

Speakers at last week's conference described the challenges facing the NHS estate moving forwards

Flexibility will be key to ensuring the NHS estate is fit for purpose moving forward, heard delegates at this year’s IHEEM Conference.

Speakers at the Institute of Healthcare Engineering & Estate Management’s annual event in Manchester last week said that new technology and emerging new clinical pathways would force a rethink of how the estate is utilised in the future.

To have a large, fixed, inflexible estate in a massively-fast-moving system creates a massive challenge. We need to move towards smaller systems

Jeremy Sneddon, director of project management consultancy, Provelio, questioned current building approaches, concerned they were not in line with the direction of travel. <.p>

He said: “There have been surveys recently showing doctors and GPs are working 3.5-4 days a week, and they are the gatekeepers to NHS services.

“Moving forward, this will have to change.

“We need more-flexible working practices. And, as estates are expensive fixed assets, if we can sweat that estate more, we will get more value out of the system.”

And he argued that many of the most-recent developments were out of keeping with the needs of the NHS.

He said: “Hospitals we are building are the wrong size.

“I’m not criticising PFI, but to have a large, fixed, inflexible estate in a massively-fast-moving system creates a massive challenge. We need to move towards smaller systems.

“The need for monolithic hospitals goes away. We still need new hospitals, but it’s more about how we use them.”

A more-pathway-led approach to design was a view supported by speaker, Simon Boundy of Stride Treglown.

He told the conference: “26 million square metres of NHS estate is not going to go away any time soon. But, if we are going to deliver the efficiencies needed, it’s going to be a key consideration and a key enabler.

“Capital investment is insufficient to fund transformation, so how we use the estate is going to be key moving forwards.”

And he warned that, while new models of care would mean less estate is needed, in other areas where pathways are changing, the demand on space could increase.

The devil is in the detail

This means flexibility will be key: “Our healthcare estate is there to support the delivery of healthcare services and should be driven by clinical need, but a lot of places are not sufficiently designed to dictate specific estate responses.

You can’t get better outcomes if you stick to business as usual with the estate

“The life of a building is 60 years, but clinical services evolve more dramatically.

“It’s a balance between what is needed and what can be achieved economically.

“For this, the key is understanding the potential of the estate. The devil is in the detail.”

He revealed that, when designers and masterplanners ask for information on NHS buildings, trusts can rarely provide this.

“We need new ways of understanding what we have,” he said.

“Will the buildings we have support the transformation challenge?”

Further throwing shade on the large PFI schemes that have dominated the market in recent years; he added: “We looked at buildings built 60 or 70 years ago and some are more flexible than those we are building now.

“The most-efficient way to build is not always the most flexible going forward.”

He advised looking at existing buildings to see whether they can be remodelled to meet modern standards, including minimum room sizes and privacy and dignity considerations such as the need for additional bathroom facilities.

Climate change, temperature control, rising expectations, and the advent of new technologies will also impact on whether buildings can be refurbished or new facilities will need to be built, he said.

“It’s about making NHS estates sustainable for the next 50-60 years,” he added.

“It’s not a one-size-fits-all solution.

“Many estates have become very confused. But the estate can be an enabler if we focus on the potential, rather than where we are now.

“We can’t predict the future, but we have some idea of the direction of travel.

“It’s about coming up with the scenarios that can be tested when development is required.”

A change of direction

And Jane Ho, associate principal healthcare design director at HKS Architects, said: “In the past we have been reactive in the way we design.

“By taking existing demand and, when required, looking into the future; there’s the ability to look much more predictively at what we are trying to design for.

Hospitals of the future should be built flexibly as, with technological drivers, we could be repurposing space every five years as things advance and change

“Refurbishment is high cost and disruptive, and bespoke buildings are difficult to adapt.

“In the NHS there is, on the whole, a lack of futureproofing and that is devaluing the built asset.

“You can’t get better outcomes if you stick to business as usual with the estate.

“What research is showing us is that technology and operational efficiencies can lead designers to create smaller hospitals.”

This technology will be absolutely key moving into the next era of estates development.

Sneddon said: “Genome is hopefully a game changer.

“Tailor-made personal healthcare needs a lot less equipment and recovery time and that will have a lot of influence on the estate in the future.

“We will see new treatments and departments with new facilities to deal with this.”

He added: “If you take any bit of equipment, they are all getting smaller, and that means estates will get smaller as well.

“Hospitals of the future should be built flexibly as, with technological drivers, we could be repurposing space every five years as things advance and change.”

Services such as laboratories, sterile services, laundries and the like are already routinely being outsourced in off-site estates.

And hospitals are already branching out, offering parts of their estate to other organisations, which increases utilisation and brings in an additional income. These include start-up technology and medical device firms, which are basing themselves in working hospitals; university research bodies; and clinical support services such as step-down care and patient hotels.

The conference also heard that new structural approaches to construction were also helping to improve flexibility, such as models where plant rooms and other vital building services are arranged around the edges of the building, leaving the centre able to be easily reconfigured as demands change.

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