11 October 2023 AM Seminars

Infrastructure planning is fundamental in the move towards building strong and effective Integrated Care Systems. It acts as a key enabler to delivering high-quality patient care, improving system-wide access to health and social care, and addressing health equalities. It is also key to delivering a more sustainable NHS.

To quote the Fuller Stocktake Report: "Estates are so much more than buildings. We must move to a model that makes estates a catalyst for integration rather than a barrier to it."
From well-designed and used facilities in the right location, to the installation of technology and equipment, effective infrastructure planning can support local systems in adopting new ways of working, enabling effective change to service delivery and providing greater access to the population is serves.

With the pressing requirement for ICSs to have an Estates and Digital Strategy, including Green/Carbon Reduction Plans, in place this year (2023), we'd like to share practical insights and a simple 5 step approach that we have developed through successfully delivering over 50 NHS estates strategies and infrastructure planning projects.

Andrew will introduce the session, and Malcolm will speak on the HBN update.

The new MMC toolkit is aligned to the Government MMC framework and has taken this to the next level. The MMC toolkit works alongside the social value charter and with the NHS Net Zero Carbon Building Standard tool aiding Trusts in their thinking and approach. Aides discussion and thinking between Stakeholders and Contractors in the consideration of the opportunities, benefits and desired outcomes in development work across all typologies of buildings. It incorporates a very useful executive summary capturing the proposal complete with 'RAG - STOP/Re-Think/GO'.

The Construction Playbook includes a separate section on MMC in which it states:
It is important to stress that MMC is not an end in itself and contracting authorities should consider whether, how and to what extent the use of MMC can drive wider value and achieve the project or programme outcomes. The goal is improving outcomes, such as increasing productivity and efficiency in infrastructure projects, and creating wider social value by using platform approaches and MMC where appropriate. MMC may not always provide the best result. Still keeping the overall MMC principle requirement just aligning it with wider governmental advice about choosing the right MMC solutions, balancing it with other drivers and ensuring that all forms of MMC (not just offsite) are considered.

The assessment toolkit has been developed to support clients, design teams, Contractors and Supply chains in responding to the NHSE MMC business case requirements, setting outcome objectives, quantifiable targets and evidence of compliance by enabling them to be embed through the decision making, design procurement, construction & operational phase.

MMC toolkit drives value through a consistent approach in MMC collating data from business case submissions and with regular review by the P23 working group to be agile in updates, responding to informed data & industry changes. The metrics supported and reviewed by a number of cross government programmes.

The toolkit is being adopted in P23, NHP and Wider Government bodies.

Feedback following recent introduction of the toolkit:

NHP consultant - Kevin Masters - KPMG Technical Director - Major Projects Advisory:
'I think the model is absolutely right - I like to think of it as a process/product sandwich. We tend to focus on the filling and forget the bread!
Great work - really stimulates a great discussion, one that is desperately needed'

'I just wanted to let you know what an exceptional piece of work I think this is'.

Scott Tacchi, Head of MMC , Sir Robert McAlpine Ltd:
'My previous role was running the DfE's £3bn off site framework, we required PMV calcs to pass business case, this is much more comprehensive than I asked for, much much better'.

'Most don't understand PMV, 99% are reporting it incorrectly, this will hopefully set a benchmark across public (and private) sectors'.

Health & Social Planning is at the forefront of the public's mind, brought about by the crisis over December and into the winter months as we continually saw more and more ambulances parked outside the front of A & E.

The problem is generally understood, in that we need to unblock circa 15% of beds blocked by, primarily, older people, thereby allowing the improved flow of patients through the hospital

As the government announces plans to deliver 5,000 new beds as part of wider £ 1 Billion investment strategy, we want to offer an alternative reaction to potentially the health system doing as they have always done within the context of what they already know

Our presentation builds on the conversation from the IHEEM 2020 conference presentation 'Homes in the Park' in which we shared our thoughts on how understanding the funding of housing and flexible design can unlock a multiple of opportunities in the NHS.

In essence, funding from Homes England can be used to unlock old hospital estate, reduce backlog maintenance, whilst adding value to the patient experience as we build adjacent or on a hospital site. Fundamental to the plan is the patient wellbeing and the need to address the concerns of clinicians who might resist discharge due to poor quality accommodation in the wrong location.

Critically we discuss the supply of funding in partnership with private investor partners, who then partner with housing associations to underwrite their new build projects, thereby addressing the limitations associated with CDEL

In refreshing our ideas, we are confident, that if adopted, we can and will influence the delivery of the Integrated Health & Social Care System's future strategic planning requirements.

This presentation summarises the results of a three-year study at the University of Cambridge in collaboration with the Cambridge University Hospitals NHS Foundation Trust. Hospital EFM departments play a critical role in ensuring the safe delivery of care. However, these departments are suffering from numerous challenges, such as limited financial resources, recruitment problems, a widening skills gap, the need for climate change mitigation and adaptation interventions, and an ever-increasing maintenance backlog. Effective flows of knowledge among EFM departments can enhance their capability to manage change and challenges effectively and efficiently. However, evidence from academic literature, governmental reports, and practitioner interviews highlights the absence of effective knowledge sharing among NHS Estates and Facilities Management (EFM) departments.

Our research aimed to examine the crucial elements affecting knowledge sharing among NHS EFM departments and comprised two studies: (i) a multiple comparative case study of seven NHS Trusts across England and (ii) a three-stage Delphi study involving EFM participants from various hospital types (acute, mental health, and community) and at different organisational levels.

The audience will gain insights into the distinct characteristics of EFM staff at different organisational levels, including their varying career backgrounds, essential knowledge requirements, and common challenges in the role. Additionally, we will highlight the critical collaboration enablers that should be taken into account when designing knowledge sharing channels across different hospital types and regions. Overall, the results highlight the need for customising knowledge sharing channels for different organisational levels and Trust types.

These findings provide NHS policymakers with an understanding of the fundamental principles of knowledge sharing for designing of cross-organisational and regional collaboration initiatives. Furthermore, the insights can support EFM practitioners in implementing and maintaining collaborative partnerships with other NHS Trusts.

The NHS currently faces complex challenges in its ability to deliver current and long-term service demand. These challenges come in several forms from vacancies, growing waiting lists, aging buildings, and infrastructure at its capacity limits.
Estate infrastructure poses a serious concern to many NHS trusts, with backlogs for building repair mounting, proposed new infrastructure to drive down waiting lists, as well as the ability to maintain or replace infrastructure severely hampered due to a legacy of under-investment.
In this environment, the governance and investment decisions for NHS Trusts need to be strategically targeted to align clinical & system priorities, estate risk & safety standards, as well as estate infrastructure capacity and alignment to long-term Net Zero targets.
Governance of capital investment is critical in providing clear organisational structure, effective decision‐making, and control processes ensuring viable and affordable investments. These processes face competing investment priorities; however, these processes can be problematic, with risk to infrastructure not prioritised against new or expanded services. Estates' risk may not be acknowledged or considered within developments, or risks may be reduced for political purposes, with subsequent impacts on the viability and affordability of the capital investments. These sorts of failures of governance extended into planning for Net Zero targets, where investment in new green technologies may fail to acknowledge the required infrastructure to support them.
Governance has a significant influence on investment decisions, NHS Trusts need a coordinated governance structure to reduce risks, ensuring viability and affordability, particularly in large complex investments.
NHS trusts need to ensure they are appropriately prioritising estate investment, ensuring risks are understood across the organisation's governance, the investments required to support service expansion & delivery are factored into the business cases as well as ensuring PFI providers are meeting their requirements in terms of estate investment.

The Heartlands Treatment Centre (HTC), the first large-scale capital investment at the hospital since 2008, boosts the Trust's capacity to meet healthcare requirements of local people. Offering a 'one-stop-shop' for patients, the state-of-the-art centre brings a range of services under one roof, including diagnostics, day case procedures, endoscopy, audiology, outpatients, therapies, and imaging services, seeing up to 1,500 patients per day.

Following planning permission from Birmingham City Council, the £97m investment in the new centre was announced by the Department for Health and Social Care in August 2019 as part of the Sustainability & Transformation Plan for the local area. The building phase of the £97million Heartlands Treatment Centre (HTC) was completed successfully, on time and on budget on 24th November 2022 and opened to patients on Monday 9th January 2023.

Kier Construction were appointed to work in partnership with the Trust to build the new centre, starting the main construction works in early 2020 and delivering during the COVID-19 pandemic, a key challenge was delivering whilst ensuring that the hospital's core business continued to be delivered in a safe and pleasant environment, maintaining the blue light services and working in and around a vulnerable patient group.

The HTC is new addition to the East Birmingham skyline; an impressive modern and spacious environment which houses world-class facilities to meet the needs of patients with dementia-friendly and accessible design features.

In Summer 2023, we will undertake a 6 month post occupancy evaluation to share the outputs at the IHEEM to demonstrate if the HTC is addressing the increased & conflicting challenges of capability, capacity, and efficiency for UHB and the wider healthcare economy.

The presentation is about an update on the work carried out by the Decontamination Technical Platform and AE(D) Registration Board.

Many technical topics have arisen in recent times and the two groups are working on various subjects, some that will require long term planning and trials. Others could be short term guidance papers for IHEEM members, but especially the registered AE(D)s.

This work includes a paper on the best tips of decontamination of dental phaco hand pieces which should be available very soon. We are also working with QUIQSolutions on digitizing our AE(D) endoscopy audit tool, and the development of new pre-audit systems that will enable better informed audits and assist the users in collecting the correct evidence. We are also investigating the specialist Pharma world, again on testing and competence levels to assist people working in that industry.

We are also looking at AP(D) and CP(D) competence levels and personal logbooks for inspection to ensure correctly educated and trained people work on the hospital equipment.

There will be a section on the continued AE(D) Framework in partnership with EWP and speak about our latest position.

2022 saw the publication of NHS England's first ever Estates & Facilities Management (EFM) Workforce Action Plan. The importance of developing a diverse, resilient workforce, building the next generation of EFM staff was highlighted but how prepared are NHS departments to deliver against this ambitious plan and to meet their strategic objectives?

Following an 'inadequate' rating of some services by the CQC in 2020, Sheffield Health & Social Care NHS Foundation Trust (SHSC) launched a new Strategic Plan which included a programme to review and develop the estate and facilities team. It was critical for the Estates & Facilities (E&F) Directorate to ensure staff had the right capabilities and support in place for the new plan to have a chance of success; however, it was unclear if some the challenges they faced were due to issues with competency or a lack of capacity in staff.

The E&F leadership worked closely with organisation development specialist Hatching Ideas to engage staff, producing a detailed capability review of the department which informed the Trust leadership of actions and additional support required. The report was subsequently endorsed by NHS England as an example of how Trusts should be looking to grow, develop and retain their workforces.

Capability Reviews are likely to form a key starting point of any department's response to the NHSE EFM Workforce Action Plan - understanding the starting point for change, whether staff feel engaged and equipped for the change ahead and if the leadership has the capability to deliver the strategic objectives of the Trust.

This talk will be co-presented by Pat Keeling, Director of Strategy at SHSC, and Rebecca Bridger, CEO of Hatching Ideas, and will cover their experiences of an engagement programme that resonated with staff and helped to safeguard the Trust's ability to deliver exceptional EFM services.

Innovative and sustainable approaches for the healthcare estate are required to efficiently provide additional capacity within hospitals.

Paul Stansfield, Principal Project Manager from University Hospital Southampton NHS Foundation Trust (UHS), will outline the business case and progress for their innovative strategic expansion plan working with Prime and the multi-disciplinary design team, ONE Creative environments (ONE).
Situated on a constrained site, Southampton General Hospital is UHS's largest estate. It is well-established as a world-leading research, training and academic centre as well as proving specialist patient care. Their expansion strategy includes a second nearby site, Adanac Health & Innovation Campus, and has enabled: the development of a leading health and innovation campus, a training space for healthcare professionals, a park and ride facility to ease congestion at the hospital and the relocation of supporting services (Aseptic Pharmacy and Sterile Services Department) to free up space with the main hospital site.

Harindar Dhaliwal, Managing Director, Step Places

Raymond Mcfee, Associate Director, WT Partnership

Mark Page, ICS Associate Director for Estates and Net Zero, Norfolk and Waveney ICB

Panellists in this session are:

Nick Armstrong, Estates Lead, Cheshire & Merseyside ICS

Samantha McCumiskey, Managing Director, gbpartnerships consult

Adam Ewing, Senior Project Manager, Kier Construction

Mike Taylor, Head of Estates, University Hospitals Birmingham NHS Foundation Trust

Colin Hamilton, Sector Director, Health, ISG

Andrew Rolf, Technical Advisory Lead, Mott MacDonald

Helen Sturdy, Head of P23 Procurement Framework & Construction Lead-, NHSE

Paul Stansfield, Principal Project Manager, University Hospital Southampton NHS Foundation Trust (UHS)

Abz Randera, Director and Architect, ONE Creative environments (ONE)

Panellists in this session are:

Carl-Magnus con Behr, Doctoral Research, University of Cambridge

Pat Keeling, Director of Strategy, Sheffield Health and Social Care NHS Foundation Trust

Rebecca Bridger, CEO, Hatching Ideas

Panellists in this session are:

Andrew Poplett, Chair, IHEEM Ventilation Technical Platform

Graham Stanton, Chair, IHEEM Decontamination Technical Platform & BoR(AE)(D)