MASTERPLANNING
the workforce dimensions, while striving to get to two decimal places in quasi- scientific understanding of capital.
Moving in the right direction Wave Four monies will go towards moving the NHS estate and transformation agenda in the right direction, both asset-wise and in terms of modernisation, yet will still result in an overall NHS estate not being anywhere near fit for modern healthcare purposes. (see Table 2).
So, what does this lack of real expenditure look like in terms of estate management?
Extensive duplicated services Presently we have extensive duplicated services and high fixed costs in our healthcare estates. We assemble on site, and are ‘build focused’, rather than commercially focused. We plan projects as components – architecture, FM, financing, and commercial – yet many of the schemes we see may well not be sustainable, and certainly not profitable.
Integrating stakeholder views and balancing aspirations With less capital, we need to drive commerciality forward, while aiming for aesthetic, functional, and sustainable buildings. We need to think about how we change the way we work, and how we can move forward towards a more sustainable future. Design and construction do not go wrong at the end of the project; they go wrong at the beginning. Estate management processes need to become more astute, and to build the key stakeholders into the project at the beginning of every build, redesign, or redevelopment. Using the key objectives of the project there need to be at least three sets of engagement with users – early brief, design test, and a review – to ensure that each stakeholder is not only consulted, but has ‘bought into’ the design and concept, and that their understanding and knowledge of the project is taken into account. The recent rush of ultra-quick projects has meant high-risk outcomes for Trust
organisations, invariably leading to delays that increase cost, and often unnecessary work on all sides.
A ‘cross-section’ of stakeholders It is important to ensure that during the engagement process, user groups have a cross-section of ‘stakeholders’, and that the same named persons are consulted regularly. A diverse and well-informed stakeholder group will have differing views, but is usually best placed to discuss and address difficult decisions. There is a danger that difficult decisions can be sidelined, but it is essential that these are talked about and addressed at the
36 Health Estate Journal August 2019
Table 1. An example of a schedule of accommodation for an emergency department (Source: RLB).
EMERGENCY DEPARTMENT: OBSERVATION BEDS Room
Area m2
Entrance Reception
Waiting area
WC male/female WC disabled Leaflet rack
Clinical space (48) Staff base – 3 person Resus trolley bay
Single room (universal room) Single room (standard) En suite facility
Social seating space Shower room
Isolation suite (2) Isolation Lobby
Isolation Suite Patient Room en suite En suite facility
Clinical support space (50) Clean utility
Drug prep associated with CU Pneumatic tube station Dirty utility MDT office
Sister’s office
Equipment store Pantry/kitchen
Mobile hoist/equip bay
Ward shared accommodation Staff facilities and non-clinical support Staff rest and beverage bay WC staff female WC staff male Quiet work area
Quiet room/interview
Matron/Clinical Nurse Specialists Seminar room
Facility Management Disposal hold Housekeeping Linen bay IT hub
consultation phase; otherwise they remain problematic further into the scheme. As the Construction Industry Council (CIC) notes, cost increases escalate proportionally as a project progresses, so why do we try and skim on the project inception phase that brings not only better public value, but is so critical to every project?
We should also be aware that public sector priorities don’t always align,
12.0 9.0 2.5 5.0 1.0
12.0 1.0
22.5 16.0 4.5
16.0 9.0
6.0 21.5 4.5
16.0 5.0 1.0
9.0
15.0 9.0
16.0 14.0 4.0
No. of rooms Total area m2 1.0
2.0 2.0 2.0 2.0
2.0 2.0 4.0
44.0 48.0 2.0 2.0
2.0 2.0 2.0
2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0
12.0 18.0 5.0
10.0 2.0
24.0 2.0
90.0
704.0 216.0 32.0 18.0
12.0
43.0 9.0
32.0 10.0 2.0
18.0
30.0 18.0 32.0 28.0 8.0
15.0 2.5 2.5
12.0 9.0
14.0 24.0
15.0 7.0 4.0 6.0
2.0 2.0 2.0 2.0 2.0 2.0 2.0
2.0 2.0 2.0 2.0
30.0 5.0 5.0
24.0 18.0 28.0 48.0
30.0 14.0 8.0
12.0
especially between educational, housing, and social care need and priority. One Public Estate (OPE), social care, and revenue savings, often conflict, rather than complement, and the key priorities need to be agreed by all stakeholders at the starting point. Working with OPE can deliver integrated planning, and enhance not only the services to local people, but also make a contribution to a ‘joined-up’ local response and funding.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69
