ESTATE DEVELOPMENT & STRATEGY
A wealth of information is gathered on each
individual practice, as well as identifying the current and future needs and opportunities.
of Rackstraw Ltd, and former Interim director of South East London Clinical Commissioning Group.
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of Wandsworth and Richmond, for which we will need to provide healthcare modelling and site assessments. This is one small element – so, overall, the utmost care is needed with the planning of workflow to ensure accuracy and timely delivery of our report.
Elisa Berry
Elisa Berry leads the Healthcare team at Howarth Litchfield, and has been working with clients to transform the estate across the country. With nearly 25 years’ experience as an architect, she is able to bring lessons of best practice from all sectors to improve the environment – offering flexibility and creativity. She provides support during the planning phase of healthcare estates, giving her an in-depth understanding of the wider picture in building accommodation requirements to support service delivery. In recent years, she has been involved in estates planning in both healthcare and higher education settings – ‘challenging established ways of working to improve utilisation and the sustainability of an estate’. Prior to becoming an
architect, Elisa worked as a maths teacher, which required clear communication – a skill she has fine-tuned in her architectural role to help guide clients through the design process and successful delivery of their projects.
3 Precedent – or should I say, the lack of it. This has always been challenging, because there was no ‘go to’ best practice example for this kind of work. Toolkits are emerging fortunately. We also now need to factor in additional ARRS roles, so we have had to work all the statistics and measurements through from scratch.
4 Complexity of service delivery: Appropriate estate and capacity are integral to the planning and delivery of transformational changes, but there can be competing requirements, even within one area.
To address these challenges, we need to: n Allow more time – because the communications from the ICB Project directors do not always trickle down quickly to the PCNs, let alone to the staff working within the practices. Ideally, you need to allow at least two weeks from instruction to sending out the advisory note about what is going to happen – not just once, but twice – to ensure optimal awareness about what is going on, why it is necessary, and who will be undertaking the work. Clinical directors could also be briefed at their weekly meetings to help this process.
n Closer collaboration – once the study begins, one of the key challenges is when we must tell estate management personnel the bad news: that there really is insufficient space. Often the premises we are monitoring are run down due to a lack of investment. Estate management teams do not want to hear this, as there is not enough money to easily find a solution, but realistically we are usually telling them what they already know – our study just crystallises it.
n Finding solutions, not raising problems: Working closely with the client team to put together a plan that addresses opportunities with costs and the issues that need to be considered. These may include digitisation, new IT infrastructure, sustainability, development of new hubs with short-, medium-, and long-term plans, and working at scale.
“ n What some of our clients say
The Howarth Litchfield team has brought diligence and creativity to the preparation of the estates plans, which
have given the ICB a sound basis for future planning of the estate – recognising the long-term ambitions and constraints, as well as targeting immediate interventions that can alleviate pressures. The team understands the pressures and the need for a flexible estate, and helpfully brings lessons of best practice from other sectors to help challenge current thinking and deliver solutions to improve the primary care environment.” Tony Rackstraw, Director
122 Health Estate Journal October 2024
Howarth Litchfield worked collaboratively and proactively with
the ICB team and fellow consultants to improve the estates planning across the ICB. The team understood that strategies were an important building block in the transformation of the estate, and was able to bring the architectural skills to assist in visualising how this might work from an individual site to a borough-level basis.” Kerry Bourne
BSc Hons MRICS, Director, Property Directors Ltd. “
Our surgery is a lovely place to work. Because of the size, and the way it has been designed, we never feel
hemmed in or claustrophobic, despite the lack of natural light. The patients also really like the premises; the most frequent term they use is ‘posh’! It isn’t the typical GP practice they are used to. They like the space and the freshness of the design, and are very impressed with the size of the facilities.” Helen Oakley, Business manager, Everest Health Partnership.
Freeing up potential space Our studies, which identify where there are deficits, also identify several strategies to address them. Accordingly, given that 15-25% is an agreed realistic target improvement (assuming 85% target utilisation), I believe the ability to free up this additional space would make a massive difference to most PCNs, and the opportunity to improve utilisation across any estate should be explored to meet future need and facilitate place-based integrated health and wellbeing service delivery. With a proven record of PCN Estates planning across
London, we are continuing to bring invaluable experience to efficient community healthcare provision in the London boroughs, which, arguably, have a greater call on NHS services than many other areas. Our role is to ensure that the PCNs are not just compliant, but genuinely fit for purpose. However, if we could set the rules, we would recommend wider collaboration between consultants and PCNs to make the process much more streamlined and ensure consistency of thinking. We would also advocate setting aside commercial and intellectual property considerations, which can be an issue when one or more healthcare consultants are working together on a project for fear of sharing best practice approaches with potential competitors. In fact, better communication generally, from the top down, is needed, with more time for pre-project planning at PCN level so that practices are better briefed before we arrive about how long we will be there, and what we will need from them to assist our work. Finally, of course, greater capital investment in community healthcare is essential. Where PCNs have appointed us, the studies we have produced are contributing to long-term planning to improve integration and the quality of healthcare facilities; with the introduction of ARRS, the demand for additional space within PCNs has never been greater. At a time when the availability of capital funding is likely to be minimal over the next few years, Howarth Litchfield’s work in the London boroughs should help to shape estates planning for the next 25 years, identifying the priorities that need addressing, and planning the necessary investment, so that the estate can support clinical delivery.
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