ROUNDTABLE DISCUSSION – ‘DECANTING’
group to highlight risks attached to late engagement, and the benefits – in terms of time, money, and quality – of wider involvement at the earliest stage possible.”
n Prevention always better than cure AP: “The cost of getting it wrong far outweighs the cost of taking that little bit of extra time at the front end, because when it goes wrong the costs can be eye-watering. For example, there’s a project that has been publicised recently which was specified at more than £200 m, and they’re now £93 m over that budget because they got the ventilation specifications wrong, and they’re having to go back and fix it.” MJC: “In my experience, a mistake corrected on paper is so much better than one corrected on site.” Warren Percival (WP): “One area that’s often missed is electrical demand and energy. Are we talking to the client early enough about these decant temporary facilities that are probably not going to be temporary? Have we considered the additional electrical load, and thought early enough that perhaps if you’re trying to hit a Net Zero target, you’re going to have to speak to your DNO sufficiently early, knowing it could be up to two years before you can get additional power into the site to accommodate a higher electrical load?” MH: “I think we are all agreed that earlier involvement in the project would be beneficial not only to the project team, but also to provide a better solution for our clients. It’s clear from the conversation that during this early involvement, we can understand the client’s requirements better; both their short-term requirements for one type of use, and their long- term requirements for future uses. This can cover all the points we have just discussed.”
n The barriers to early engagement MK: “As I see it, there are too many barriers to that type of collaboration. What often occurs is that people are working in isolation. Clinical experts, the Procurement team, and the Estates team, should plan and work together to avoid building something that wasn’t really needed, or that is perceived as an afterthought. When that doesn’t happen, everything is urgent; we have insufficient space in a car park, and we thus need extra space right away. This lack of planning also compromises staff wellbeing, as no one has discussed what the staff needs are upfront. We then end up in a vicious cycle, as the people using the facilities, and the ones who paid for them, are not satisfied, because it’s not what they wanted or needed. We must have these discussions internally and externally right at the beginning.” MH: “Our solution to that is standardisation, using standard room
layouts that are multi-functional, and it doesn’t mean they have to be more expensive if they are designed with everyone’s involvement early on.” CA: “How can we use the existing systems to drive better engagement across the specialisms to enable Trusts / NHS to be informed of risk, compliance, and supporting business case, to deliver a long-term, adaptable, solution?”
n Early engagement’s benefits AP: “Often the issue is that the NHS is so constrained by budget. Organisations need a fit-for-purpose space, which may need to be used for a variety of specialisms over the life of the building. The space is then designed in good faith for the initial use, but later repurposed for something it wasn’t built for. It’s vital that we talk to the clinical teams about the purpose of the space, and the technical requirements it entails.” MK: “A major issue is the poor perception of what the temporary facilities may look like, and how they will function. There is a lack of understanding of how such facilities can function. There are many good examples of offsite manufacturing providing high-quality permanent and temporary solutions. While many of these spaces may be used for 1-5 years, there is an opportunity to repurpose the buildings and get a lot more value from them, if properly planned from the outset.” MJC: “You need to have a clear direction for the project, and know exactly what you’re trying to provide. Not being this clear from the outset can cause the design stages to fail. That’s why it’s so important to consult with the client and everyone involved in the project from the beginning. We need to understand their needs and issues, and then consider the potential situation 5-10 years down the line. However, it’s really difficult for a Trust to look this far forward and plan for requirements that are not yet known. “For example, in terms of meeting the
Net Zero carbon standard, you can’t achieve Net Zero carbon if you haven’t designed the building with this in mind from the outset. Furthermore, depending on how you categorise it as a facility, you can’t upgrade the spaces; you can only downgrade them technologically. So, if you really want to future-proof, the building should be designed and built as a top-
‘‘
“From an infection control standpoint, we are only ever brought in at Stage 2, and only find ourselves involved in the later stages of design,” Alyson Prince said.
end high-tech acute facility, but naturally there are costs involved. So, some of the big questions for NHS Trusts are: ‘What does the decant mean to you?’, and ‘Do you see it as a really viable part of your estate, or just a temporary fix?’ It might be a temporary fix in your head, costing not very much, but to us, it’s a project that we are delivering with reasonable care and duty and to meet compliance standards.”
Focusing on clinical needs WP: “Clearly there’s a need to focus on clinical needs, because the clinical functionality should inform the design process, but we should also not lose sight of the fact that not every decant facility directly provides a clinical setting. For example, it could be a back-office type of department that’s fundamentally important to the success of a clinical environment, so it’s important that the needs of those individuals are considered. I know of many instances in which, over the last 10 years or so, temporary or decant facilities have basically turned into permanent facilities for staff, and that has resulted in spaces being used for something they were never intended for. That’s not the kind of environment that staff – whether back office or clinicians – should be accepting as part of their day- to-day work, given the importance of their wellbeing.”
The NHS is so constrained by budget. Organisations need a fit-for-purpose space, which may need to be used for a variety of specialisms over the life of the building. The space is then designed in good faith for the initial use, but later repurposed for something it wasn’t built for
Alyson Prince March 2024 Health Estate Journal 81
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