ESTATE DEVELOPMENT & STRATEGY 300 200
250 200 150 100 50 0
150 100 50 62 0 0 0 0 61 79 259 30 250
Following the assessment of the spatial needs and opportunities, this chart identifies pipeline projects by category.
able to support service delivery over the next 20+ years. We understand that the estate strategy should be
aspirational – creating an estate that will be flexible and suit the changing needs of the population for the next 20+ years. We should not be investing in ‘tail’ sites. However, we are currently working alongside a ‘tail’ site in Greenwich – a typical converted residential property. With a list size of over 5,000 patients, healthcare staff are operating out of three clinical rooms. I can give them an additional clinical room relatively easily for c. £60,000 fully fitted, which would significantly alleviate the pressure in the local community, but I know this will come under question. Investing in a ‘tail’ site is merely a plaster on a gaping wound, but will the £8 m+ funding needed for a new, integrated hub magically appear before the individual sites fall over? A typical study will take six to eight weeks to complete, and usually will incorporate the following outputs.
Building on experience This first piece of work in South East London was for a market-leader, and was completed towards the end of 2021, after which we started to prepare the Estates Strategy in the boroughs of Islington and Camden on behalf of North Central London (NCL) ICB. Subsequently, we undertook work in Ealing, on behalf of North West London ICB. We have recently kick-started the same piece of work on behalf of South West London ICB, which was due to conclude mid-May. Following the conclusion of the reports, as architects we are well placed to support individual practices, PCNs, and the ICB to take individual projects through, if funding becomes available. For example, we are working with one of the PCNs and NCL ICB to create an integrated hub to accommodate PCN services, Marie Curie, and NHS 111, as a joint venture between the council and external funders. You see such a wide range of issues and potential obstacles when you undertake this kind of work, but there are some common themes which have emerged: n Lack of funding for capital projects: this will not come as much of a surprise. It is widely understood that there is very little funding available for estates in the NHS, with little prospect of any becoming available in the short or even medium term. However, the reporting strategies get the PCNs and ICB ready to pounce should a glimmer of funding become available. The assessments carried out, and the options prepared, should allow them to be ‘business case ready’ to apply for funding, setting them in a good position.
n Vetting and approval / Governance: Navigating the NHS approvals process is tricky and time-consuming –
October 2024 Health Estate Journal 121
An external photo of each practice is taken to allow the ICB and PCNs to quickly identify the individual practices.
with little consistency between ICB processes.
n Cost increases due to delays in decision making: The time lag incurred by the approvals process leaves projects vulnerable to cost increases through inflation. Projects need to be fully tendered for a full business case; however the business case proposal is then subject to the lengthy approvals process, and a contractor is not able to hold its pricing for this length of time. This situation is made even more challenging by the turbulence of the British construction industry over recent years.
There is thus the imperative to optimise the available space and plan the interiors with greater efficiency – when speed and expertise are of the essence – and this is where we come into our own. If we look at the main challenges, these are:
1 First and foremost – communication. These projects are led ‘top down’, and getting the word through to practice level about our appointment, what we will need to see, discuss, and measure, is always a challenge, particularly as we are working in a fully operational healthcare environment.
2 Organisation of workflow and coordination. The sheer volume of documents can be quite staggering. We are currently working on 77 sites across the two boroughs
Left: A priority is to maximise the opportunities of shared and multiple uses in a health centre with flexible spaces.
Below: Supporting face- to-face training sessions and online meeting facilities.
Projects
Digitalise records
hybrid working LIG Voids reconfiguration
Extension New build
Pipeline project Internal Remote/
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