HEALTHCARE ESTATES 2021 KEYNOTES


The New Hospital Programme team is championing an ‘Alliancing’ approach to engagement with the supply chain on the 48 new hospitals to be built across England.


is more important than how we build it. Equally, where will we find the national talent to deliver this complex programme? Currently we are still very much at the start of a journey of engagement to solve some of the complexities; we are engaging with the market early and widely to bring together that thinking, and to enable it to happen.”


Not just about building hospitals She continued: “Let’s have a look at some of the detail. I’m going to start, perhaps oddly, by explaining what the New Hospital Programme is not – it’s not about building hospitals alone; it is part of a larger Government Major Projects Portfolio which covers some 200 projects and an investment of over £500 billion. NHP is very much a long-term strategic investment in the NHS’s future, and is also intended to be a catalyst for ‘levelling up’, driving productivity, improving local communities, and delivering skills, jobs, and growth. These are all critical parts of the NHP commercial approach, as we balance considerations not just around what we build, but how we build it. The Programme is also part of Project Speed, and thus has a major role to play in the Government’s focus on delivering better, faster, and greener.”


Emma-Jane Houghton explained that she would now set out ‘what this means in terms of both broader socio-economic objectives, and the overall NHP ambitions’. She said: “The scale and complexity of the programme is huge, and indeed the ambition to deliver 48 ‘intelligent’, digitally- enabled hospitals by 2030, that provide healthcare staff with world-class facilities to deliver cutting-edge care, will require an unprecedented volume and pace of hospital infrastructure construction.” Simultaneously, she noted, the Programme would need to be delivered alongside the NHS drive to be Net Zero by 2050, and to decarbonise the supply base – necessitating what she dubbed ‘a step change in how we design and deliver these hospitals.’ Emma-Jane Houghton said: “So, at the heart of our investment case is standardised design, so we can be


36 Health Estate Journal November 2021


Emma-Jane Houghton clearly set out the NHP team’s ambitions for one of the largest tranches of new hospital infrastructure to be built in England in many years.


consistent about how we think about designing these complex assets, and maximising the use of Modern Methods of Construction – from modular, right through to a ‘kit of parts’ approach that warrants a platform.” Also critical, she added, were ‘the trailblazing principles and the commitments’ of The Construction Playbook.


A multi-skilled Programme team Just as the NHP entailed a range of complexities, she explained, so the Programme team mirrored this by bringing together a range of skills and capabilities in ‘very much a blended team’. “So, for instance,” the speaker said, showing a slide of the NHP’s Senior Responsible Officer (or ‘SRO’), “Natalie Forrest has deep expertise within the sector, is a nurse, a former hospital CEO, and played a significant role in the Nightingale response. Other senior team members include our Digital lead, Sarah Thomas, and our Clinical director, Josie Rudman, while the wider team includes an amalgamation of senior personnel from NHSE/I, and representation from policy experts, and, for example, NHS Estates and Facilities teams.”


Some of the challenges


Moving to discuss some of the challenges the NHP team faces in bringing the commercial approach to market, Emma- Jane Houghton said: “We need a commercial strategy that delivers a complex transformation programme, that radically improves the way hospitals are specified, designed, procured, and built, and that drives use of standardised repeatable design – which is essential to unlock the benefits of MMC and get consistency cross the programme.” One notable challenge in designing and taking to market this commercial strategy was ‘current limitations around capacity and capability in the market’. The speaker elaborated: “Currently, even just at this early point, we’ve got huge constraints in segments like MEP and facades, and in latent manufacturing capacity; this will all need to be better mapped and understood if we’re to have the talents and size of


markets we need to deliver at this scale. The hospital risk profile also presents a barrier to participation – not just in the magnitude of these schemes and their design and delivery, but also in the complexity of some of those interfaces between, for example, structure and MEP. The sector has a history of risk dumping through the hierarchical supply chain – a problem in terms of broader participation from new entrants. More generally,” she continued, “there’s a lack of innovation and investment in the market which we need to address to drive confidence to create the markets we seek. Equally, a traditional approach, or delivering contractually in a way that we may have done previously won’t be fit for the challenges that we face for the NHP, and the scale of the delivery.”


An ‘Alliancing’ approach Emma-Jane Houghton explained that what the Programme team is seeking a commercial structure that will enable a shift to Design for Manufacture & Assembly (DFMA) ‘to unlock the Modern Methods of Construction needed to attract new funding and capital-intensive manufacture of the hospital components’. She elaborated: “We need to foster the innovation to bring the right people together to solve NHP challenges in a safe contractual environment that gives confidence to new entrants. We need to build intelligent and experienced teams, with clients and suppliers working together, and to make working with the NHS and building hospitals more attractive for new entrants, as well as requiring more capacity, more capital, more talent, and more ideas. So, our solution is what we call ‘alliancing’.” This approach ‘would work’, she said, because it was a long-term approach over the Programme’s duration, ‘aligns objectives to point everybody in the right direction’, and 'is compatible with a more equitable approach to risk and reward sharing’. Her next slide showed the five key elements of this so-called ‘Alliancing’ approach: n Long-term – ‘supports commitments, investment in people, technology, and learning’.


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