HEALTHCARE INFRASTRUCTURE
NHS Foundation Trust, which has some outstanding estate, such as Cramlington Hospital, but equally some that is in very poor condition. Indeed, the slide makes clear we have a growing national problem. Siva Anandaciva said that when considering the overall condition of the UK healthcare estate, most tended to focus predominantly on hospitals. He elaborated: “I think there’s a good reason for this; you will have seen reports, for example, about RAAC (Reinforced Autoclaved Concrete) planks, and about some hospitals and school buildings in England that incorporate them being at risk of the ceilings falling in due to the type of concrete used, and its degradation over time.” He continued: “Walk into these places, and you can see the temporary metal pillars literally holding up the ceiling – so the focus on the condition of large hospitals is understandable. Consider mental health services, however, and you’ll see the high proportion of inpatients still in dormitory-style accommodation. With GP premises, it’s again a story of variation; there are some that are simply not fit for purpose. We also know that much of our care and nursing home stock is ageing and unfit for purpose. Overall, we’ve got a worrying picture for the healthcare estate overall.”
Why do an ageing estate, buildings, and equipment matter? Having alluded to the billions of pounds needed to eradicate backlog, and the 85% of care home stock that is ‘ageing’, Siva Andanciva asked: ‘Why does it matter?’ “For me,” he said, “the first reason is that ageing buildings and equipment mean lower productivity at a time when the NHS is striving to maximise value for money.” The service was also having to pay for bespoke-manufactured replacement parts for equipment that was ‘so old’ that the manufacturer no longer supported it. Equally, he noted, ‘old’ medical scanners were less productive than their modern counterparts. He said: “This all impacts on patient care. Imagine turning up to an appointment you’ve been waiting for, anxiously, to be told it must be re-booked because the scanner isn’t working, or, having had your scan, the clinician telling you the resolution isn’t sufficiently clear, and sending you elsewhere for another.”
Staff experience
One ‘less reported’ effect of ageing and ‘unfit’ buildings and equipment, Siva Andanciva noted, was the impact on staff experience and efficiency. He said: “Some mental health providers will, for example, need to rota extra staff for observation, in facilities where you can’t remove ligature points.” Speaking anecdotally, he said that on recently asked a friend, who is on a hospital Board, about his weekend, he had explained that, as the director on call,
32 Health Estate Journal January 2022
Former NHS Trust CEO, Sir Robert Naylor’s thought-provoking review, NHS property and estates; why the estate matters for patients, published in March 2017, identified some of the underlying issues for the healthcare estate being in such a parlous state.
he had been in charge of the ‘water handover’. Siva Andanciva initially thought this meant him having responsibility for patients’ fluid management. The friend explained, however, that the ‘water handover’ actually involved ensuring that every agency nurse unfamiliar with the site was told that because the hospital’s gutters ‘don’t work’, they would need to start unplugging equipment when the damp reached a certain point on the wall. The King’s Fund speaker said: “These are the levels of workarounds that affect the NHS.” He added: “Sir Robert Naylor – a former University College London Hospitals NHS Foundation Trust CEO who made capital and estate strategy a core part of his job – published a thought-provoking review in March 2017, entitled NHS property and estates; why the estate matters for patients. This identified some of the underlying issues for the estate being in such a parlous state, and questioned whether there was sufficient headroom and capability in the NHS to tackle both the operational and strategic agenda.”
A seminal NHS estate review Sir Robert’s review had, he said, presented ‘a really diverse view on where accountability best sits’, and was written at a time when, broadly-speaking, the NHS had individual provider organisations and national bodies involved in estate planning. Now,” Siva Andanciva remarked, “we have Integrated Care Systems, which will also play a role in the accountability structures.” Among the current-day obstacles to efficient, forward-looking estate planning in his view were ‘red tape in the approvals process’, and late notice on capital funding availability. He said: “This is a perennial issue, but doesn’t require a massive transformational effort, or masses of new funding; it can in fact be tackled quite quickly.” Sir Robert Naylor had also highlighted the competing demands of urgently addressing ageing estate ‘assets’, while simultaneously developing the future estate.
Not ‘all doom and gloom’ As he neared the end of his presentation, Siva Andanciva stressed that not all was ‘doom and gloom’. Showing a graph which indicated that capital budgets for healthcare had been rising in recent years, he said: “This is the Department of Health’s capital investment budget for about a 20-year period – a real roller- coaster. The period following the great financial crisis saw money purposely transferred from capital investment budgets into day-to-day spending. We’re now in a growth phase, with ambitious plans for 48 new hospitals in England. Looking at funding, however, and there may still not be enough to cover both backwards and forwards investment. It will broadly take until the end of the Spending Review for capital infrastructure spending to get back close to the OECD average for industrial nations.” The second key ‘positive’ was ‘work already underway’. He said: “So, tomorrow (24 November 2021), we’ll see announced the winner of the Wolfson Economics Prize 2021 (see also pages 5 and 13), which this year sought radical new hospital designs.”
Further reasons for optimism He continued: “My third reason for optimism is shown in the slide top left – the grass-roofed Alder Hey Children’s Hospital in Liverpool (which opened in October 2015). I am focusing on Alder Hey,” he explained, “because the planners there had intended to build a very different hospital until they talked to the children, and asked them: ‘Alongside the staff, you will be the main users of this building; what do you want to see?’ Together with requests for privacy and dignity, the children requested green space, and ‘something that didn’t feel like a traditional hospital’ – which they duly got.” Siva Andanciva added: “Obviously, there’s a need for a coherent national estates strategy framework, but we also need to keep a sense of local agency – precisely what the Board at Alder Hey did.”
Moving up the agenda
His closing slides would ‘pick up some other issues to bring forward into the discussion’. He said: “The first is that I’ve been covering healthcare infrastructure for a long time, and at times it’s felt like shouting in the dark. However, the whole area has definitely risen up the agenda recently – both funding-wise and strategically – in a way I haven’t seen for years. The second is that I’ve probably spoken from a very parochial NHS view; whether in 10-15 years’ time we have 40- 48 new hospitals will depend as much on supply chains, construction costs, and labour workforce shortages, all elements outside the NHS’s control. The third is that the way we build hospitals is changing.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68
