Refurbishment planning
Measuring best value from ‘refurb’ projects
Research at Aberdeen’s Robert Gordon University has identified the requirement for the development of a ‘Decision Support Model’ to ‘facilitate and measure the selection of main elements and sub-elements within refurbishment and maintenance projects’. One of the major drivers, explains Grant Wilson, a completing PhD researcher with the University’s Institute for Innovation, Design and Sustainability (IDEAS), was to provide a mechanism via which NHS estates managers, design teams, and contractors, could ‘evidence and demonstrate’ that best value-for-money had been pursued, ‘specific to the facility in question, and in the context of its unique business case requirements’.
for the NHS. During my PhD research at the Robert Gordon University, I have been studying the effects on the provision of healthcare services, and the challenges faced in terms of adequately maintaining the built estate. As most clinicians, asset and estates managers, and construction professionals with specialist knowledge of, and expertise in, the healthcare facilities field will acknowledge, the challenge for the NHS in the 21st century is almost ‘Canute-like’ in magnitude. Huge efficiency savings are demanded
T
by the Government, at a juncture in the NHS’s history when the provision of services is becoming increasingly stretched. The pressures on the NHS are multi-faceted, with the challenges compounded by an increasing occurrence of ‘modern’, ‘lifestyle-influenced’ diseases such as obesity and diabetes. Another well- recognised concern is the rapid growth in the ageing population, who are often subject to co-morbidities and associated complications in treatment.
The built estate Despite the complexity of the current changes across the healthcare sector, the clinical challenges seem fairly well understood, and, in terms of the political agenda, there has been a great deal of attention focused on the evolving models of care and service delivery.While the service issues discussed here on a wider front are clearly extremely important, this particular research project has focused on the seemingly under-researched area of challenges for the NHS built estate. The
Cossham Memorial Hospital in Kingswood, Bristol, re-opened earlier this year after an extensive £19 m refurbishment (HEJ – March 2013).
NHS is, of course, the largest public sector organisation in Europe, and the size of the associated healthcare built asset portfolio is correspondingly vast. The sheer size and spread of the estate brings its own challenges, not least in the wide range of facilities in use, their varying age, condition, and performance capabilities, in areas such as energy efficiency, material consumption, and service life of critical plant equipment, to name just a few. The majority of the NHS estate that will
be utilised throughout the remainder of the 21st century has already been built. This places the challenge of ensuring the delivery of care, and the ability of the NHS to adapt to changing demographics and constant medical and pharmaceutical developments, squarely at the feet of refurbishment and maintenance activities. Correspondingly, asset and estates
here is no doubt that the economic climate seen in the UK in recent years has presented enormous challenges
managers are on the front line in terms of ensuring a fit-for-purpose service delivery function – in terms both of facility functionality, and clinical service provision.
business case The nature of the capital investment process as regards major maintenance and refurbishment work on the existing estate brings the NHS, as the client, into contact, and a working partnership, with the Principal Supply Chain Partner (PSCP) through the route of a standard business case. It is well understood by all parties that one of the key requirements within a business case is to pursue and evidence the fact that value-for-money (VFM) has been achieved. Despite the differences in governance between the Scottish system, and those applicable in the rest of the UK, the capital investment guidance philosophies are broadly the same, and the model developed throughout the research project works perfectly well across the spectrum. A fundamental question that was asked throughout the research was: ‘How do the client/PSCP measure and agree value-for-money on a refurbishment or maintenance project, and how is this evidenced throughout the business case process?’
The challenges of the Primary and secondary
data collection A great deal of detailed secondary and primary data collection was undertaken at the ‘front end’ of themodel design process, although there were some key findings which signposted the development process. For example, it was found that, despite the wide range of experience and
Health Estate Journal September 2013
39
Courtesy of the North Bristol NHS Trust
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