HEALTHCARE ESTATES 2021 KEYNOTES
fact, listening to you talking, myself and others and colleagues at IHEEM have linked up with UHBM and the Bartlett and are taking our own look at healthcare planning for the future. One of the things we’re starting to challenge,” the IHEEM CEO added, “is that currently, the model is always around how much capital we are spending. What are your thoughts around this? I know capital is important, but should we actually be looking more at the revenue consequences of what we spend, and the outcomes in terms of the clinical benefits this brings to patients, and the whole lifecycle – including the staff and the resources to deliver those services for the next 25 years, as against just the capital bills? In one respect the capital bill might be £400 million, but actually what’s been approved could be up to £25 bn of taxpayers’ money over the next 25-30 years in that system. What are your thoughts as to the opportunities to transition to a different way of how we analyse the value for money evaluation?”
A ‘very pertinent’ question
Describing this question as ‘a very pertinent challenge’, David Flory replied: “I do think there’s a much broader range of factors to consider in making an investment than the ROI we’ve always talked about previously . I was listening also to Emma-Jane Houghton; (see pages 35-38), talking about the New Hospital Programme, and the importance through it of the economic impact in the areas in which these hospitals are being built – the skills, the jobs, the economic growth. Today, I think that’s a vitally important part of the whole package of considerations for the value of an investment. To come to your point, if we were looking at some of the facilities that we operate from now, they are all at least a generation old in their planning and design, and many are multiple generations’ old in these respects. We’re finding workarounds and new ways to use facilities that were designed for something completely different in a completely different age. “When we invest in infrastructure now, of course, when we look at the economic prospects going forward, we’re looking for at least one generation’s return, probably two more, into the build. So I think those broader considerations are absolutely vital, and you’re right that one of the biggest challenges in our system here currently is workforce availability. We headed into the winter in care homes with local government colleagues. In lots of our services, people are leaving to earn a bit more money – in the hospitality sector, for example. So, we need to solve some of these problems in the immediate short term, and make ourselves more attractive for recruitment and retention, but we also need to think about completely different models of care for the future going forward.
42 Health Estate Journal November 2021
Conference delegates listen to a ‘live’ streamed session at Manchester Central at this year’s Healthcare Estates event.
The patient and staff experience “We need,” David Flory continued, “not only to think about patient outcomes from the system, but also the experience of people. How easy is the facility to access? How comfortable do I feel there? Is my privacy protected and my dignity respected? I think that where we get this right, we can do it with a very different staff model, that feels more sustainable for the future – both in our clinical staff, typically nursing staff, and support staff. I do, though, think it’s a much broader system consideration of the benefits overall – of which this capital investment is one small part, and I believe the ICSs are an exciting opportunity for us to get that right, and think across a much broader range of benefits.”
Continuing the dialogue, Pete Sellars then said: “Sir Simon Stevens, of course, set the Net Zero challenge for the NHS, which for me brings together the first opportunity for our clinical activities to actually be integrated to the estates, the facilities, the buildings, and the supply chain. You mentioned Qatar, where maybe the clinicians were leading this agenda, but what the pandemic showed here in England was that the best response we got was when our clinical teams, our Estates teams, and a range of others, got together. We’re trying to explore and understand whether the Net Zero carbon agenda is the common denominator that brings everybody together to have a responsibility to get to that point, which means that we must work much more closely together to achieve it. Again, it’s a huge question I’m asking you.” David Flory replied: “It certainly could be, Peter. I think that again it is a common purpose for all parts of, and professions in, our system and beyond – in terms of our engagement with the public that we serve – to get us all looking in the same direction.
Put down the agenda
‘I am embarrassed to say this, but at the ICS we receive papers about our carbon- neutral strategies and the actions we must take, and we have capable and energised leadership in these areas. However, when you sit down to do it you think: ‘Right, we’ve got to talk about discharges from hospital next week, the ambulances that are queuing on the ramps, the long waiters for their operations, and the finances – because if we don’t improve this number by this much next month we will be in real trouble. The longer-term issues with ultimately far greater impact on us and the lives of the people we serve in this country get put down the agenda a bit, and we all have to be a bit better than that. It’s a challenge currently though to create the space to do these things properly.”
Talking to engineers
Pete Sellars responded: “You’re right, David, and now you’re talking to an engineering profession where sustainability has been part and parcel of everything we’ve done for many years – is that the glue we all need? Actually, could you put a carbon credit to every activity and care pathway in the system, and use that as a common currency to drive everybody to think about the future?” David Flory replied: “I think it is a great suggestion, Peter.”
Pete Sellars then asked: “Going back to my old days when I used to work for you, actually – and one of the problems we saw then was the Section 106 agreements, but particularly around the planning agenda, where it was broadly considered that the NHS really played second fiddle on this agenda to local authorities, and potentially lost out on millions of pounds in funding from the Section 106 agenda to support health. I’m just going close with a
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