HOSPITAL PLANNING AND DESIGN
With the drive for increased productivity, NHS consultants are seeing a reduction in the number of ‘Supporting Professional Activities’ (SPAs) in their job plans. The BMA recommends that consultants have 2.5 ‘PAs’ (Programmed Activity; 1 PA is around 4 hours) per week, for all work that is not direct care delivery, which includes revalidation, appraisal, study, research, and supporting projects. Yet consultants are increasingly only allowed 1.5 PAs per week (six hours) for non-care delivery, which – according to the BMA – will only cover revalidation and appraisal-related activity,8
leaving no time in their working week for, say, supporting a new buildings project.
Consultant workforce shortage The BMA has also highlighted the issue of consultant workforce shortage. In a recent report, it states that ‘Prior to the COVID-19 pandemic the NHS workforce faced a perfect storm of consultants choosing to retire earlier, a significant proportion approaching retirement age, and a growing trend of younger doctors walking away from a career in the NHS’. Post-pandemic, pressures on the workforce are even more acute. For these reasons, clinical engagement will become
more challenging, so we only undertake this with hospital staff after we have obtained clinical input. The clinical engagement is tailored to the teams’ specific needs and outputs, deployed proportionately and flexibly depending on the scale and time pressures of any particular scheme. It will typically include the following: ‘Prep’ and post-workshop: Depending on the size of the scheme, and the availability of staff time, we hold a launch workshop, which gives everyone contextual information, sets expectations, and starts to bring together the individuals involved in the team. Before each session, we send a short reminder email which sets out the purpose of the session and what clinicians need to think about beforehand. After the session, we send a short write-up of ‘what we heard’, and how this information will be used. Align with ‘transformation team’: During the early stages of engagement we work with directors of Strategy/ Transformation Team or equivalent and ensure that we understand the wider vision for the hospital and workforce, potential implications for models of care, and what that
means for the use of the new development. Planning and timing: Recognising that clinical sessions are likely to be booked at least six weeks in advance and cannot be cancelled, we plan well ahead, and flex to enable everyone invited to participate. We work with the hospital team to identify a rota coordinator, or equivalent, who can support the planning. We ensure that diary time is blocked, and ask hospital administrators to ensure that there are no clashes with clinical sessions. We then send reminders prior to the session to workshop participants and the rota coordinator. Alternatively, we offer online and in-person sessions, and let the client team lead on this. Some clinicians prefer an online session, as it’s easier to fit in, but others welcome an in-person session, particularly when their work is done in-person. As part of our planning, we ensure that everyone is well briefed. This involves sharing information about location, logistics, and what questions to expect, well in advance. Additionally, as part of the pre-engagement briefing, we ensure that we iron out existing operational issues, so they don’t take over a workshop. We build on information we have obtained from our Experts Network to ensure that workshop and interview questions are informed and highly targeted. This also helps to counter a degree of (understandable) scepticism. Most clinicians will either have been involved in a previous building project, or will know a colleague who has, which hasn’t been realised. We are very mindful of this, and ensure that we do not ask questions of hospital staff that are not absolutely essential. For any specialty, we ask a question in three stages:
(1) What’s needed now?, (2) What is likely to be needed in the future?, and (3) Recap both sets of answers, and allow further thinking time for future requirements. The Nuffield Trust report referenced earlier states that ‘Planning for the new buildings often did not fully consider the emergence of new diseases or possible changes in disease management drugs, technology, or the labour market’. To address this, we feel it is imperative that specialists are actively guided and supported to think about future developments, as well as current needs. So, having a senior facilitator, who knows the sector well, is vital.
Neil Kukreja
Neil Kukreja is a Medical Director and consultant surgeon, specialising in robotic colorectal surgery. A European Proctor for Intuitive, he has trained consultant surgeons in over 30 hospitals in the UK and Europe. His clinical practice is at two Central London private hospitals, undertaking advanced laparoscopic and robotic colorectal surgery. He was formerly a Divisional Director of Surgery in a busy NHS hospital, and during his time there, it achieved compliance with national standards for the two-week wait cancer pathway, and maintained elective care during the COVID-19 pandemic. Awarded a study scholarship by his NHS Trust, he has been awarded the ‘Best Patient Care’ award at the Trust.
April 2025 Health Estate Journal 65
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