MASTERPLANNING
90 80 70 60 50 40 30 20 10 0
Source: RLB
around 5%, irrespective of modelling future clinical improvements. All projects need to answer the four fundamental issues (see Table 3) that marry to NHS England’s Five Year Forward View, and present a balanced scorecard for delivering commercial, sustainable, and aesthetic facilities and projects.
41
Driving commerciality and operating processes
Total 70% confidence Date Figure 2: Acute hospital emergency department modelling by annual activity. Transforming care
Transforming care needs to be looked at not only strategically – as within a local process – but more radically, if we are going to get a solvent and sustainable system, rather than ad-hoc responding to immediate needs. We have moved away from providing a brief development with clinical specifications and outlining patient pathways. The flow, separation, and interaction, within a healthcare establishment need to be clearly identified, and key adjacencies outlined. Above all, noting the link to the wider health community, input in the agreed provision of care should be clear. The NHS has been involved in several joint care initiatives, but too often these fall away into narrow organisational boundaries, and the policy becomes entrenched. We collectively need to demonstrate the future vision that will transform care by examining the process improvements and monetarising the impact or patient benefits. We need to ask the questions: What facilities will be available in the future?
What processes will there be? How short can we make the patient journey?
How much technology have we utilised?
What might be the changed relationship to other clinical departments?
How can we add value to our build or redesign?
How can we build in form following function, leaner solutions, more improved clinical outcomes, and an enhanced patient experience?
How can we use LEAN process outcomes like Carter Metrics and use a baseline of admissions avoidance, as alternative studies constantly show that 25+% of cases could be dealt with out of the hospital?
How can we standardise facilities to the same room, same concept, as we know that, currently, there is too much specialty-specific space apportioned?
Standardisation We know that not only can
standardisation reduce risk, but can also speed delivery of new services, and be more flexible for the future. We have seen plenty of clinics and hospitals where looking at practices carefully can save significant surface, often reducing it by
The key to success will be how we drive commerciality and operating processes within our healthcare estates. Taking ownership over our estates, and ensuring that we have the best systems in place and are working to the maximum efficiencies, have been the way forward for the best Trusts for the last three years or more. Activity needs to be benchmarked, as do workforces and equipment – with facility management evidence-based methodology. Planning frameworks are beginning to ease restrictions, but need fuller and quicker adoption across our healthcare estates. We are already presuming that offsite manufacturing that will use technology like BIM to improve delivery and outcome will take place by the end of 2019, but we also need to continue to measure economic sustainability indicators like BREEAM Excellence and SKA (a Royal Institute of Chartered Surveyors environmental assessment method, benchmark, and
Table 2. Comparisons of NHS key Estate metrics 2015-2017 derived from NHS Digital data (Source: RLB, with statistics from NHS Digital).
Item
Gross internal floor area (m2 )
Occupied floor area (m2
Not functionally suitable – occupied floor area – average/Trust, (%)
Total non-functionally suitable – occupied floor area (m2
)
Total non-functionally suitable – occupied floor area (%)
Total floor area – empty (m2 Total floor area – empty (%) Total high risk backlog
Average/Trust floor area – empty (%) )
Total significant risk backlog Sub-total backlog Total backlog
Estate pre-1945 (%) Estate pre-1945 (m2
)
Capital investment for improving existing buildings (£)
Capital investment for equipment (£) Public sector investment (£)
Investment to reduce backlog maintenance (£)
TOTAL ) 2015/16 2016/17 Variance
£ 26.8 m £ 26.9 m 0.4% £ 24.8 m £ 25.2 m 1.4%
8.13 9.87 21.3% £ 3.2 m £ 3.5 m 8.7%
13% 3%
14% 3%
2.3%
7.1% 0%
£ 0.7 m £ 0.6 m –13% 3%
–21.9%
£ 0.78 bn £ 0.95 bn 22.1% £ 1.57 bn £ 1.79 bn
11.5% 13.7% 14.3%
£ 2.34 bn £ 2.74 bn 16.9% £ 4.97 bn £ 5.58 bn 14%
£ 3.72 bn £ 3.68 bn £ 0.95 bn £ 0.95 bn
–2.3% –1.1%
0.1%
£ 0.38 bn £ 0.30 bn –22.1% £ 0.318 bn £ 0.20 bn –37.5%
£ 0.35 bn £ 0.32 bn £ 2.00 bn £ 1.77 bn
–8.1% –11.5%
August 2019 Health Estate Journal 37
Adult peak hour A&E cubicle demand
1 Apr 17 13 Apr 17 25 Apr 17 7 May 17 19 May 17 31 May 17 12 Jun 17 24 Jun 17 6 Jul 17 18 Jul 17 30 Jul 17 11 Aug 17 23 Aug 17 4 Sept 17 16 Sept 17 28 Sept 17 10 Oct 17 22 Oct 17 3 Nov 17 15 Nov 17 27 Nov 17 9 Dec 17 21 Dec 17 2 Jan 18 14 Jan 18 26 Jan 18 7 Feb 18 19 Feb 18 3 Mar 18 15 Mar 18 27 Mar 18
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
