MASTERPLANNING
Case Study – Brighton General Community Health Hub The challenge
The aim was to build a multi-purpose primary & secondary health hub on the Brighton General Hospital site in East Sussex. The project had been proposed, yet stalled due to an affordability gap of £ 44 million, highlighted by the previous consultancy design team.
The solution
RLB, linking with the One Public Estate, looked at ways to improve the commercial site planning. Still achieving a balance of health and social care facilities, the new plan would reduce the onsite area to 10,863 m2
, while optimising capital
receipts from the sale of surplus land, new revenue streams, accurate forecasting of whole-life costs, lower operating costs, and facilities management efficiencies.
design. They will have integrated design and commerciality built in from the beginning, and be revenue optimised, and it is likely that they will be funded through a mixed funding method – via NHS capital, public sector partnerships, England’s Estates and Technology Transformation Fund (ETTS), Healthcare Management Trusts (HMT), and the Independent Trust Financing Facility (ITFF) – although most are unsure as to where private sector capital plans will go after the Chancellor’s Autumn statement. Yet without private sector capital, the circa direct NHS capital investments of £1-2 bn per year will make less impact than the politicians, our health communities, and the local NHS staff, want.
Learning for design teams and the public sector
How do we change the way we work in healthcare estates management to recognise this future, and what steps can we take to ensure that our buildings are as commercially viable as possible? We need to agree a single measurable set of objectives that can be constantly used to assess, analyse, and be a measure against, our builds. There should be a clear brief for the design and consortium for our buildings, and estates managers need to think like a developer. We must ensure that we benchmark all our assets. The best commercial deal should be bargained for by land agents that we have employed to add value to the solution. We need to avoid ‘slips’ in our project management schemes, and aim for quicker decisions and lower project costs,
40 Health Estate Journal August 2019
Positive outcomes
Working with Brighton & Hove City Council and other stakeholders, the Rider Levett Bucknall team looked to provide patient care, residential and affordable housing, commercial
and we need to use the power of a consortium team to deliver an integrated service that plays on the strengths of a collective, rather than acting as individual entities.
Moving forward: a conclusion So, where does this leave us today as we head towards 2020? With the demand for healthcare continuing to increase, after navigating the clinical care model, we need to drive developer thinking in our healthcare estates. We need to aim to try to self-fund projects by optimising area, and reducing facilities management and estates management. We should aim for more dynamic, integrated working, with regular project objectives reviewed. We must say ‘No’ to wasteful practice, and avoid ‘death by analysis’, by being more decision- orientated. Technology – such as virtual and augmented reality, future BIM developments, and Revit design – needs to be embraced, and there needs to be an acceptance of alternative financial ventures, such as sovereign wealth funds and use of local authority investment in pension plans to help finance our healthcare estates.
Meanwhile, we see evidence that even existing capital demands are growing over that originally envisaged. No one disputes best value-for-money from public capital, but if it isn’t there, it needs an alternative. Private sector capital is now cheaper than it has been for decades, to the point that there are deals possible below Treasury rates – just at a time when the private sector is being pushed from the table by politics.
opportunities, and jobs, on the site, while delivering a complete local sustainability agenda, re-thinking not just the building itself, but the entire future site.
In conclusion, to change the state of our healthcare estate, we need to change the way we think, learn the lessons of procuring for value, standardise the brief, build offsite, and act more decisively to ensure that we can build and maintain a healthcare infrastructure that takes us forward into 2030 and beyond.
References 1 Office for National Statistics. Healthcare expenditure, UK Health Accounts: 2017, 25 April 2019.
2 The World Bank. Current health expenditure (% of GDP). World Health Organization Global Health Expenditure database, 2019 [
www.tinyurl.com/ y77s8f8z].
3 Office for National Statistics. UK Health Accounts: 2016 [
www.tinyurl.com/ y6m6q4e3].
4 What Future for Health Spending? OECD Economics Department Policy Notes, No. 19 June 2013 [
www.oecd.org/economy/ health-spending.pdf].
5 The King’s Fund. Foundation trust and NHS trust mergers: 2010 to 2015. 24 September 2015.
6 Statista. Number of smartphone users worldwide from 2014 to 2020 (in billions) [
www.tinyurl.com/hy2skfk].
7 Statista. Number of mobile app downloads worldwide in 2017, 2018 and 2022 (in billions) [
www.tinyurl.com/y9g9nmog].
8 Medical Sensors Design Conference 2018: Wearable Health: the Next Generation of Monitoring. June 26, 2018 [
www.tinyurl.com/y6ajybjf].
9 Construction Leadership Council. Procuring for Value. July 2018 [
www.tinyurl.com/y2gkpq2m].
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©IBI Group
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