EFM POLICY AND STRATEGY IN WALES


and where, for example, the single points of failure risk are. Have we got to the point where they listen enough? That’s an ongoing journey, but Boards are certainly looking to us more to help them understand the risks.” I next asked if he feels there is greater


recognition of the need for capital funding. He said: “People have always been shouting. I’m not sure anyone’s ever said we have enough, but I try to accept it the way it comes. We have to provide a viable health model, and if it’s set at a level of investment the public wants, we must accept that this is the money available, and do it well. We must also ensure people understand the implications. We’re being asked to do more – both in activity, and breadth of service.” Stuart Douglas pointed out there are


examples of pharmacists being asked to do more. He said: “We have great opportunities to use pharmacists and their advice, and perhaps we can run clinics remotely from some of the spaces pharmacies have. We can think more imaginatively about how we provide services; it’s not always about new money. We have to grasp the nettle of changing service needs.” I wondered how telehealth adoption


is progressing in Wales. Stuart Douglas said: “There is some, but I think people are worried about confidentiality and the risks of someone being remote from you, but it’s definitely going to have to happen. I anticipate some of the forward-looking GP practices will begin operating remote clinics, lining up those they know have iPads etc. Perhaps that’s the Well Rich, but at least if they can clear that volume, others will get greater access to face to face consultations. I think there’s a long way to go – with a degree of acceptance or cultural change required from both patients and clinicians.”


A protracted planning process When I had interviewed Stuart Douglas’s counterpart in England, Director and Head of Profession, NHS Estates, at NHS England, Simon Corben, a few months ago (HEJ – January 2024), we discussed how protracted the existing planning process can be for healthcare facilities. I asked Stuart Douglas for his standpoint. He said: “The voices on how long it can take for healthcare schemes to secure approval are as loud in Wales as in England. How many Strategic Outline Case proposals are a similar shape when they reach final stage proposals? The amounts of money people talk about at SOC stage are often some way from the costs at FBC. Organisations need to reflect on why, and when we create a Strategic Outline case, we must consider whether it embraces the full scope of what we are we going to accept? The answer is often ‘no’. We should insist that when an SOC is put together – yes


A scheme approaching Full Business Case approval at the Ysbyty Glan Clwyd site in north Wales will see the redevelopment of adult and older adult mental health facilities for circa £100 m.


it’s short and high-level, but actually the 80/20 rule applies: if you set up the Strategic Outline Case in the right way, you should be able to get a reasonable handle on scope and the broad cost envelope. Establish a good working arrangement with those required to have scrutiny, and share information openly and fully, and you could potentially reach these transition stages with not a lot to say – because you’ve been given the information as you go.


“There’s thus something we at Shared


Services and Welsh Government can do on the scrutiny side to help – get involved and take a proactive view when things aren’t looking quite right. We are already taking more of a developmental role and asking to get involved more quickly. Welsh Government has recently issued guidance informing Health Boards that if they move outside a particular cost margin as they’re developing proposals, they must go straight back to Welsh Government for advice – and that’s only right.” I next asked Stuart Douglas what he thinks have been some of the biggest impacts for healthcare engineers and estates and facilities personnel of the COVID-19 pandemic on both clinical and engineering practices. He said: “It’s certainly made people more conscious of air quality and ventilation, and it’s good to have that wider support for making sure our facilities achieve the right standards.” The PFI model has undoubtedly


benefited communities who might not otherwise have had hospitals built, but has also faced criticism. Aware that Velindre University NHS Trust’s proposed new Cancer Centre in Cardiff is being part funded by private finance, I asked Stuart Douglas about this. He said: “It’s in fact being funded by the Mutual Investment Model – a form of private finance, modified along the lines of the non-profit- distributing model pioneered in Scotland to reduce the high finance costs which had emerged in previous models. Plans for use of such models for future schemes will clearly need to take account of the risks we have experienced (building costs,


interest rates etc), and their potential impacts on affordability.” I next asked about he and his team’s


biggest challenges since we emerged from the pandemic. He said: “I think helping Health Boards plan estate rationalisation, say, through the use of OccupEye, a tool we found and distributed. I think that’s been helpful. There’s been quite a call on Specialist Estates Services; we’ve been asked to work more closely with Health Boards – because they have had limited resources, and there’s been more of an ask. As a shared service, that’s what we are here for.” What about his biggest personal


achievements in recent years? He said: “It’s early days yet; I only celebrate my first year in the job at the end of February. Things that have pleased me include having access to Welsh Government advisors directly, and that they call me and my colleagues for advice. We’ve established a similar rapport with the Health Boards – a huge privilege that you can never ignore.”


Biggest opportunities As our discussion ended, I asked Stuart Douglas what he felt might be the biggest changes to the way the healthcare estate is run over the next 5-10 years. He said: “Artificial Intelligence should probably be top of the list. Our NWSSP Corporate colleagues are looking at the opportunities with AI, and so are we in the Specialist Estates Services Division – in diagnostics and radiotherapy equipment particularly. AI will have a huge impact across the board, including in engineering and plant.” He added: “I also think – looking ahead – that regional and multi-agency planning still needs to be something we push people more towards. There is a momentum to make us work more closely with social services and education. We know our Welsh government and Education counterparts, and need to build on this, since sooner or later there is no doubt that resources will have to be coordinated and shared – by way of estates staff, knowledge, software, technology, and learning.”


March 2024 Health Estate Journal 27


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