MASTERPLANNING


standard for non-domestic fit-outs) ratings. Healthcare simulation software will help inform decisions, improve systems of care, and maximise resources. We also need to look at commercial assets being fully utilised in both public and private sector settings.


Resource sharing


As is the case in many other public sector fields, more joined-up accessibility and sharing of resources from larger to smaller NHS Trusts need to become the norm. However, we need to realise that bigger doesn’t always mean better, as the King’s Fund has shown through its research – showing that after around 100 NHS mergers, and in a study of 12 in detail, deficits have often increased from relatively small numbers in 2010 to more than 60% post-merger in one case.5


The


King’s Fund concluded that there seemed little improvement (‘a paucity of evidence’) around overall long-term efficiency or economies of scale. We believe that in following the Treasury and NHSI good practice guidance, the NHS should look at a range of healthcare settings to consider an ideal mix of shared assets, dispose of those assets that are not efficient, and reinvest via public sector joint venture investment.


Driving evidence-based design into environment ‘low tech’ There are also micro rather than macro wins through evidence-based design that can improve efficiency in our healthcare settings. Studies show that dynamic lighting reduces scanning times and changes the mood of patients and staff for the better – for example, in the USA at the Phoenix Children’s Hospital in Arizona. Experiences of music playing in operating theatres in the US resulted in surgeons working faster, and with better accuracy, and also lowered blood pressure for patients. The Maastricht University Medical Centre study showed that the trial of HealWell system – where patients are subjected to better natural light linking to their biological clock and biorhythms – increased sleep and allowed them to heal better and quicker.


Driving commerciality via technology Technology will also have a revolutionary effect on our healthcare estates as its impact widens daily. Usage of smartphone technology in healthcare will continue to grow, with a forecast of 2.5 bn users in 20196


‘‘ What will this


technology mean for those of us working in healthcare design and build, and how can it help us drive commerciality in our estates?


the range and efficiency of healthcare, while reducing the associated costs; indeed the global market for medical wearable devices is projected to reach $12.1 bn by 2021.8


Driving commerciality in our estates What will this technology mean for those of us working in healthcare design and build, and how can it help us drive commerciality in our estates? It will allow teams to work more effectively and efficiently with integrated reporting and management data dashboards that can be shared digitally and accurately, and control of the environment and integrated building management systems. Equipment will be asset tagged, and renewal will be automatic, with machine- to-machine technology, resulting in less human hours taken up by ‘admin’, and the ability to gather data as part of a locality health system.


The question around why the NHS needs its own branded IT will be asked. Instead of the problem that is the NHS IT masterplan, why can we not accept a ‘95% good’ IT system from around the world which could deliver with just rudimentary changes to make it NHS- compliant, rather than wholescale bespoke specifications? Anyone who has seen patient tele-tracking in European or US systems knows how far behind we are.


Only five UK Trusts, including the


Wolverhampton NHS Trust, have seen remarkable results, such as an 11% reduction in length of stay, or a 35% improvement in non-cancelled surgical operations on the day. The NHSI website notes this as ‘new technologies’, although many of us saw this technology in place outside the UK a decade ago, but were unable to persuade our clients to engage due to fear of IT failure or capital constraints. We know that transformation from IT is now finally getting the push within NHSI that has been needed for the past five years or more.


Turmoil in construction In an ongoing era of major financial turmoil in the construction industry, and large-scale losses, the need for the NHS to have long-term sustainable partners will be more important than ever. This means more due diligence, and NHS procurement teams getting ahead of the curve by employing more commercially- minded and experienced staff. It also means project bank accounts to safeguard SMEs from the excesses of large companies, and an ‘outcome- based, transparent, and more efficient industry’, as outlined by RLB’s Global Board director and member of the Construction Leadership Council, Ann Bentley, in the report, Procuring for Value.9


Encouraging social value Not all benefits are monetarised. We all work for better public benefit in its widest form. Clearly many of the joint local collaborations may impact on cash, but equally can benefit the community in wider forms. This includes education – encouraging people to look after their treatment, and therefore become less dependent on the NHS. However, there are some great examples of how NHS Trusts can save money through more of a social/healthcare integrated approach. Social value is far more than a Government requirement of the Social Value Act 2012. It is a byword for


Table 3. Four fundamentals aligned with the Five Year Forward View. Issue


Outcome Improving the environment.


Projects must be sustainable, improve the patient, staff, and visitor total experience, and reduce the build impact.


Cost efficiency reducing annual Commercial and public sector cases increasingly operating cost.


– searching on everything from pregnancy information to common cold remedies. In 2017, consumers downloaded 178.1 bn apps to their phones, and in 2022 this figure is predicted to grow to 258.2 bn healthcare download apps.7


Research into


mobile health technologies has shown an array or real and potential benefits to both patients and practitioners by increasing


38 Health Estate Journal August 2019


need higher return on investment – be radical with all project areas and lifecycle costs.


Reduce backlog maintenance. Schemes must impact on decreasing high and significant backlog.


Function.


Invest strategic design time early – IT-enabled, making the most difference to users and standardising components.


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