Over the last few years, the Diversity and Inclusion Working Group has been looking at different aspects of this subject.  This year we have been looking at the "Inclusion Ceiling" - what that means to ensure that we have a diverse and inclusive workforce at the highest levels of our industry.  The session will explore different aspects from what we have heard.

Explore the principles of designing for dementia, and how we can specify products that ensure an inclusive environment that improves safety, wellbeing, comfort, and memory.

NHS England’s Technical Standards and Guidance programme is responsible for a rolling programme of Standards and Guidance for the NHS estate. They have issued ten documents in the year to July 2024 with more targeted for release ahead of Healthcare Estates 2024. 

The session will provide the chance to hear priorities for new documents, lessons learned and plans for enhancing the programme.  

There will also be an interactive workshop for attendees to input their valuable feedback directly into the programme. The session will feature the national leads for the programme: Fiona Daly, Michael Rope and Abigail Pride and partners Archus.

The NHS uses ventilation to keep patients, staff and visitors safe in what are known as “critical” areas of the healthcare estate. In the aftermath of Covid-19 the number of areas deemed “critical” has expanded. This means that the burden on the NHS to maintain the plant that supplies the air flows and ensures the correct pressure cascade has increased. It also has meant that the amount of energy used in critical ventilation has increased.

Areas that previous to Covid-19 were not deemed to require measured rates of ventilation have now come under the guidance of the HTM03-01. General wards and waiting areas in hospitals are also being considered as areas where increased ventilation is being provided with a minimum of 6 air changes an hour becoming the accepted norm, which is significantly greater than the CIBSE occupancy guidance levels. Where air handling units are not supplying enough air the room ventilation rate can be supplemented by opening windows and/or the provision of air scrubbers.

This presentation will discuss how technology, for example links to Building Management Systems and phone Apps can allow Engineers in Estates to be more pro-active in their management of critical Air Handling Units.

There will also be discussion of new fan technology and the most up-to-date AHUs which are built to be self-managing and send alerts to the BMS and also mobile Apps when there is a fault.

The presentation will take the format of a note from the outgoing to the incoming government (whichever party and adapted to suit wherever we are in the election cycle), highlighting the major estates and facilities issues the NHS need to be consider during the next parliament.
The presentation will be structured around the following themes:
- What does the NHS of the future look like? Dealing with increasing clinical demand, an ageing workforce, substantial waiting lists and a disconnect between health and social care alongside how to make best use of emerging technological solutions.
- Providing estate which meets clinical requirements despite financial constraints. Considering the worsening national backlog maintenance position, the difficulty of quickly replacing aged estate and system-wide capital prioritisation
- Doing more with less (from a revenue perspective) - Ensuring the retained estate is working hard to provide tangible healthcare outcomes and suit modern ways of working.
- Focus on primary care and preventative healthcare - Ensuring that hospital care is not the default
- PFI and LIFT expiry - Considering the issues in relation to lease renewal, NHS purchase of assets and PFI handback and making sure this doesn't detract from the day job of delivering healthcare
- Ageing NHS estates workforce - Succession planning and ensuring that we have a long-term sustainable workforce
- Partnership working as part of collaborative systems with wider public sector partners and the role that the private sector could play
- sustainability - what might need to be done to achieve the NHS net zero aspirations
- Data - Ensuring that estates related information is consistent and high quality to facilitate evidence based decision making
The content will bring together opinions from across the healthcare estate market, clinicians, commissioners and patients to present a holistic view of the estates environment.

The healthcare sector needs to adapt quickly to this fast-changing world where facilities must do more with less. On the one hand, this means focusing on building performance. In this regard it’s mostly about reducing energy and maintenance costs, but also increasing the utilization of available floorspace. On the other hand, staff must become more efficient. When it comes to technical and facility staff, the focus is on reducing the time needed for repairs and creating synergies when managing multiple buildings.

The need for smart hospitals that can do more with fewer resources is evident. More and more healthcare facilities are addressing these challenges with a culture of data-driven decision-making. Digitalization is broadly accepted as the enabler to tackle the challenges and stay competitive. For 75% of companies, digitalization is viewed as a key driver of change processes in buildings. But uncertainty and lagging experience are behind many requests for advice and simplified implementation.
What are the hurdles?

Cybersecurity concerns

Lack of collaboration between OT & IT

Complex, heterogeneous environments

Old & unconnected infrastructure

Many different facilities spread over a campus, region, or country

Multiple stakeholders with differing needs

Out of date tender processes

Unfamiliarity with new technology & best practices from around the world

What needs to change to make hospitals smarter? To answer this question, it is important to understand the two main components of what makes a hospital smart from a building-infrastructure perspective:

1. One common data environment (CDE) through the integration of systems and bringing data from these systems together in a data lake

2. Ecosystem of applications tailored to different stakeholders to maximize data value

In this session we look to cover the current challenges whilst shedding light on today’s solutions.

The Care is Care Australasian industry collaborative study brought together a wide range of organisations who deliver health care, advocate for health care users and advise on the planning and delivery of health care facilities.

The Care is Care study group set out to learn from virtual care leaders from North America to Europe and the UK to see how these leaders and innovators are scaling virtual and digital healthcare service delivery to address the health 'burning platform' of meeting growing demand with a workforce supply challenge.

After a global tour of 24 virtual health programs across 6 countries, one of the most powerful lessons learned was the approach these leaders applied to integrating digital technology at the front line of care delivery in any setting and supporting the exploration of future innovations through an adaptive innovation framework and facility planning.

This session will outline these key lessons learned and how others might apply an adaptive innovation framework to support testing and prototyping of new ideas to improve clinical outcomes and the experiences of care for patients and staff, and support human-centred design. The presenter will also outline how these valuable insights are now being applied to client projects to deliver health projects with impact.

Summary of Presentation by IHEEM Registered AE Ventilation – David Livingstone – Chartered Engineer and Fellow of IHEEM

Presentation Title: Critical Air Handling Units – Commissioning new and refurbished units – the role of the AE Ventilation and independent validators to ensure compliance

Healthcare providers are constantly replacing Air Handling Units or carrying out major refurbishments.

It is vital to the continued compliant operation of the air supply systems to ensure safety of patients, staff and visitors that the commissioning is planned and involves the Authorising Engineer Ventilation. It is also part of the standard that is followed for AHU commissioning – HTM03-01 Part A – that commissioning is witnessed by people independent of the contractors and tests are carried out by “Validation experts” – normally the same contractors who carry out annual verifications.

David will discuss commissioning using his experience of witnessing this is in a number of settings including:

1. Refurbishment of operating theatres in Royal Hallamshire – tower block building which underwent major refurbishment of a number of Theatres
2. New build of Aseptic suites at NHS Blood Transfusion HQ – Filton, Bristol
3. Refurbishment of theatres at Kings College Hospital
4. Refurbishment of theatres at Sheffield Northern General Hospital
5. Nightingale hospital at Excel Centre – London. Commissioning the field hospital built to absorb Covid-19 spillover from London hospitals

David has developed a commissioning matrix which he will explain and make available to attendees of this talk. He has used this system in a number of commissioning scenarios to great effect and the matrix has been highly praised by a number of his clients.

NHS Net Zero Carbon Building Standard (NZCBS) has been introduced, ensuring a consistent level of ambition when it comes to the environmental performance of the NHS estate. But what potential benefits are there to adopting principles which exceed the standards?

Our findings sit within the context of the Cavell Centre programme, which proposes a blueprint for the transformation of primary and community care facilities in England. These proposed centres pioneer an approach to standardised yet adaptable planning, with a specific approach to MMC, net zero carbon, and environments for wellbeing. Following this, Medical Architecture were commissioned alongside Architype to design one of six pilot schemes, and the only one designed to Passivhaus standards.

The building will offer ultra-low, net-zero aligned operational energy performance whilst delivering a very healthy and comfortable internal environment. Integrated structural and services strategies, judicious use of biobased materials and a standardised, MMC-ready façade has enabled embodied carbon to be dramatically reduced below the NZCBS limits.

The amount of active mechanical plant has been radically reduced through a strategy of ‘concrete core activation’, ensuring the internal mass of the building is held at close to ambient temperature all year-round.

To maximise the building’s flexibility and repeatability, the design team developed a site-agnostic scheme that would enable Passivhaus certification regardless of which way the building was orientated – something that has not been achieved before.

Exceeding the NZCBS, the design ensures Passivhaus accreditation for no additional cost, whilst guaranteeing significant operational savings over the life of the building.

Historically, setting ambitious targets for sustainability has been seen as an additional cost to be budgeted for, leading to delivery of the minimum requirements. This project provides the first evidence of the significant long-term cost benefits to be achieved by adopting an ambitious approach to sustainable design from the earliest stages.

There has been a long running ambition to make the health system less hospital-focused and more focused on primary and community care. This looks to a proactive, preventative approach to health, as opposed to a reactive, treatment-based approach, with care delivered closer to people’s homes. The King’s Fund believes this requires an integrated, holistic response, rather than a ‘body part’ or single condition response, with more focus on people and outcomes, than processes and outputs.

This has been embraced at the pioneering Jean Bishop Integrated Care Centre (JBICC). Hull had around 25,000 residents living with frailty, and 3,200 with severe frailty. As a result, the health system was overwhelmed with non-elective hospital admissions. In response, Humber and North Yorkshire ICS developed an anticipatory care model that created an out-of-hospital service to help people to stay at home.

The JBICC was designed to deliver this, bringing together a range of specialist services to provide a holistic approach. Unlike regular community health facilities, where patients receive treatment for a single health issue, at the JBICC patients receive a full physical and mental health check, as well as social support. They may spend an entire day there, but they leave treated and with a care plan. The facilities and non-institutional character of the design reflect this.

A Wolfson Palliative Care Research Centre study showed:

• Those living in their own home saw a 15-20% reduction in emergency department (ED) attends and a 10-25% reduction in emergency admissions for the twelve months after their assessment.

• The frail cohort who had over five ED attends in the twelve months preceding their assessment, saw over 50% reduction in ED attends and admissions.

This presentation will explore how long-term investment in the right community-focused facilities can reduce demand for acute services, creating NHS savings, and improving individual wellbeing.

Safety is at the heart of the work of the national Estates and Facilities team. NHS England’s new assurance function aims to ensure we are meeting our statutory and regulatory obligations. Led by Vajid Mahmood, the function focuses on estates data and EPRR processes, and aims to increase our technical expertise to support the system over time. In parallel, Head of Hard FM, Simon Picking, is developing a Safety Management System (SMS) for the Estate. This session will discuss how the NHS SMS builds on industry best practice to put risk management at its heart, including the identification of safety issues, risk assessments and risk mitigation; supported by a strong assurance function that monitors compliance and performance.

This presentation introduces the concept of an all-electric hospital, high-lighting the pivotal role of electrification and digitisation in revolutionising healthcare infrastructure with an emphasis on the challenges and opportunities associated with replacing traditional energy sources with electric alternatives.
Electrification and digitisation play a crucial role in achieving these objectives by reducing emissions, optimising energy usage, and promoting environmentally friendly practices. However, there are challenges to overcome, such as initial capital investment, regulatory compliance, and the reliability of newer technologies. Implementing an all-electric hospital requires careful planning, including conducting energy audits, researching suitable electric alternatives, analysing the grid energy mix, and redefining asset management strategies.

The transition to all-electric hospitals can significantly impact power demand, requiring the redesign of electrical infrastructure, the installation of EV chargers and solar PV generation, and the replacement of backup diesel generators with greener alternatives such as hydrogen fuel cells.

While there are challenges to address, the feasibility of designing all-electric hospitals is achievable with the coordination of multiple stakeholders and a commitment to sustainable practices.

As NHS organisation attempt to address these challenges it has become increasing difficult to align the traditional project models and governance as new approaches emerge.
NHS policy now states a requirement that Modern Methods of Construction (MMC) will be utilised as default on all construction projects. The promise of MMC has gained popularity with its apparent ability to provide rapid, cost-effective, sustainable buildings. However, there is emerging evidence suggesting that MMC may not be delivering all the promised benefits to the NHS.
Herein the challenge emerges to apply existing methods of governance to emerging technologies and systems that may not align with the NHS’ established approach, especially with construction related projects in a complex and non-linear environment.
As NHS projects become more complex, wider engagement of specialist and stakeholders is required. However, stakeholders have a range of power, legitimacy, and urgency, leading to a conflict due of differing interests and goals. This can result in inappropriate influencing subsequent decisions. One of the challenges for governance is therefore how to navigate the stakeholder salience in relation to healthcare projects and MMC.
The complexity now inherent in the healthcare system reflect and intractable disorderliness of the contemporary world. Combined with the complex, interlocking and varying salience of stakeholder generates a non-linear environment. This presents risks for governance, as systems become more complex recognising failures becomes increasingly difficult because failures are the result of a combination of several factors and viewpoints.
Governance of capital investment is critical in providing clear structure, effective decision‐making and control processes ensuring viable and affordable investments. As NHS organisation attempt to address its growing challenges with MMC projects, the governance needs careful consideration and alignment to deliver benefits from MMC.
While MMC is seen as crucial for delivering healthcare projects due to perceived cost-effectiveness, speed, and flexibility, there are concerns that expected cost and program benefits might not be fully realised, potentially leading to delays in delivery and increased costs which may negate the MMC benefits over more traditional methods of construction.
While the pressure on the NHS may promote haste, appropriate time for preparations is required in order to deliver the benefit of a MMC project.

Since its adoption in October 2023, the NHS NZC Building Standard aims to drastically reduce the operational and embodied carbon emissions impact of it's estate. In this presentation, we reveal project examples of how the Standard has impacted estates teams, designers and contractors.

Healthcare estates face an impending perfect storm with regard to ventilation. On the one side a Greener NHS looks towards a rapidly approaching roadmap with regards sustainability. On the other ERIC data is showing a £11.6Bn maintenance backlog and indications centrally there is unlikely to be an increase in budget allocations. Natural ventilation using outside air is the preferred method under HTM 03.01. Today, in many city areas, this natural air can be heavily polluted with PM2.5 and VOC’s. These pollutants can increase mental health symptoms, such as aggression and violence, whilst also directly affecting patient outcomes, particularly in relation to cardiac and respiratory areas.

HTM 03.01 is carefully thought out innovation and good practice. This talk is aimed at exploring innovative approaches enabled within HTM 03.01, with a view to helping mitigate risk without significant capital spend or energy overheads.

During 2023 the royal college of midwifes sent out a letter to all registered midwifery staff informing them of their employers duties to ensure that they are not exposed to Nitrous oxide levels above the safe limit. In short, we needed to look at how we upgrade our 1980's building infrastructure to ensure thee safety of our staff. The timeline for this started way back in 2017 when we took the decision to install the purair 750 made by MEC ltd. These were installed by a sub-contractor and maintained by the in house team. Rightly or wrongly the system was left in this way until 2023 when the letter from RCM landed and many trusts withdrew Entonox as a form of pain relief until systems were put into place. Our trust set up a incident management team that worked to ensure mitigations were in place to protect staff whilst in estates, we started to formulate a design to ensure that we did not put staff at risk. Within 7 days we had installed low level extract fans in each delivery room that had to be manually turned on when entonox was being used. This design has since progressed and now each extract fan is individually controlled by a nitrous oxide sensor situated at low level within the room. This activates the fan and brings in air from the corridor at high level down across the patient and out at low level. This has also increased the air change rates within all delivery rooms and achieved cross flow ventilation within the room, further protecting staff. The system also allows us to log via the BMS the nitrous oxide levels for all rooms and also alert midwifery team of any rooms where the levels become too high for use in that room to continue. Liaison with clinical teams has also enabled the delivery unit to switch to re-breather masks that when connected to the purair 750 collect much more of the exhaled gas.

Dorset County Hospital (DCH)NHS Foundation Trust has opened its newly refurbished Outpatient Assessment Centre at South Walks House in Dorchester. This clinically led model of care provides health on the high street for outpatient appointments and diagnostics testing resulting in:

• Reduced waiting times
• Patients receiving the right care and treatment more quickly
• Clinicians across different specialties can work together to find the best treatment options for patients
• People are signposted to the services they need on the day, so they can see the healthcare professionals they need at the same appointment
• Patients can access a wealth of health and wellbeing information and advice on-site to support their treatment
• Alleviates pressures on the main DCH clinical site

DCH (along with University Hospitals Dorset NHS Foundation Trust and Dorset HealthCare University NHS Foundation Trust) is a healthcare partner of the Dorset Integrated Care System (ICS) working with two local councils, other NHS services and the community and voluntary sector to address local health, wellbeing, quality, and financial challenges across the county.

In November 2021 a pop-up Outpatient Assessment Centre was created operating out of the ground floor of the former council offices in South Walks House which had been unoccupied since the start of the COVID pandemic due to the consolidation of the council’s office requirements. This consolidation provided the NHS with a unique opportunity to re-purpose the space as it was in a prime location, close to both the high street and the hospital with excellent transport links and facilities, was convenient for patients and staff, and ensured a positive experience by avoiding the need to visit an acute hospital setting unless necessary. This temporary measure to tackle NHS waiting lists was created as part of a partnership between NHS Dorset, Dorset HealthCare, Active Dorset and LiveWell Dorset.

The Trust received more than £14million from the NHS England Elective Recovery and Community Diagnostics Programme to transform two floors of South Walks House into permanent clinical space after signing a 20-year lease with Dorset Council. This funding has been used to expand and enhance the centre. There are now two floors of dedicated clinical space that will allow the Trust to run more outpatient clinics and offer diagnostics appointments (such as x-rays and scans), as well as day case local anaesthetic procedures and general health and wellbeing services.

Join Lancashire and South Cumbria NHS Foundation Trust as they explore the challenges, opportunities and learning from the re-imagining and master planning of a 100+ acre NHS site.

When you can potentially do anything on a site, how do you decide what to do? How do you find clarity and focus, whilst meeting organisational and system partner objectives? How do you ensure that an exercise in the art of the possible does not morph into a demonstration of the art of the impossible?

Over the last 12 months Lancashire and South Cumbria NHS Foundation Trust have been working on the development of visionary, yet deliverable plans for the future of one of their sites. Whalley is a place where the Trust are blurring lines and breaking barriers. It’s a place where innovation meets people, place and planet to shape the future of health. It’s a story we would love to share.

This presentation will explore the critical role of lighting in healthcare settings, reviewing new evidence of the impact of smart lighting solutions on healthcare outcomes, staff engagement and energy use in acute and residential healthcare settings.  We will look at the science behind the hype and real-world examples of smart lighting installations in the UK and around the world that are harnessing the power of AI and new sensor and lighting technologies to improve sleep, mood, and medication use while meeting environmental and financial targets.

A new mixed-use, vibrant and diverse neighbourhood with a strong sense of place and community is being realised in north Manchester.

This presentation will focus on the transformation of North Manchester General Hospital (NMGH) which is one of the hospitals being built through the New Hospital Programme with a completion date of 2030 and is being led by Manchester University NHS Foundation Trust with Manchester City Council and the Greater Manchester Integrated Care Partnership. The Trust also works in partnership with Bruntwood through a Strategic Property Partnership.

About the development:
Currently home to a district general hospital, an intermediate care facility and a mental health hospital, the 27-hectare NMGH site presents an enormous opportunity to enable generational change in the local community by creating a modern and integrated health and social care environment, a new residential neighbourhood that encourages social inclusion and healthy ageing, alongside green space and science innovation.

Context and aims:
Residents of north Manchester experience some of the highest rates of deprivation and the poorest health outcomes in England. Many have significant ill health, which is a major factor in reducing economic activity and suppressing household incomes.

A radical new approach is proposed which will provide a focal point for the community, with integrated health and social care facilities, high-quality new homes, access to better education and training for local people alongside more inviting public open spaces.

The strategic aims of the project will be detailed in the presentation, from transforming health outcomes and investing in skills and employment, to local economic factors and contributing to a new zero carbon city.

Healthy neighbourhood:
The 5-hectare parcel of land to the south west of the site has been allocated primarily for residential use for a wide range of ages and needs, celebrating all the benefits of an intergenerational, age-friendly community. The integrated concept includes family housing, later living, extra care, step-down/intermediate care/respite, dementia care, key worker and supported housing.

The presentation:
Leading the presentation will be Michelle Humphreys, Manchester University NHS Foundation Trust alongside Emma Tanti, Pozzoni Architecture. The session will focus on the strategic aims behind the development, why a radical and wide-ranging approach was required, the integrated healthy neighbourhood concept and, to conclude, an update on current progress on this ‘once in a generation’ transformational project.

Technology enabled care:

Evidence data

Improve response rates

Efficiency savings

Reduction in the number of falls

The Patient Safety Operation Room of the Future at the New karolinska University Hospital

The First part - A New Patient Safety System in the OR of Future at Karolinska Ortopedic Department

Objective
The purpose of this system is to enable
- real time digitalized monitoring of air quality in the OR
- digitalizing manual critical routines and
- to develop an investigative tool assessing known risk factors for prosthetic joint infections (PJI).

Methods
The system includes one OR Ipad-checklist one real time Bio Aerosol Monitoring System, door opening logging devices, air climate indicators and a TV-screen on the wall in the OR showing air quality and alarms in real time. Parallel measurements between a traditional air sampler (Sartorius MD8, Sartorius AG, Germany) and the real time monitoring system (BAMS) were made in 15 live elective arthroplasty surgeries.

Results
Digital feedback in the OR and in the corridor had an immediate positive effect on the outcome of the routines. Real time values of Fluorescence Bio Particles (FBP) during elective arthroplasty surgery showed a high correlation with parallel traditional aerobic (CFU/m3) measurements. The R-value between mean values of FBP/50dm3 ≥3µm and CFU/m3 sampled during 15 operations was 0.85.

Discussion and Conclusion
Real time data feedback is important to create awareness and optimize patent safety.
This system has the potential to minimize complications, engage staff, give feedback, and create a learning culture for the entire staff. By serving as a real-time checklist, it has the potential to prevent complications in complex situations. It can also serve as a means for cognitive support.

Real time values of FBP during arthroplasty surgery can be used as a surrogate measure of air bacterial load. Together with the routines logged and visualized, the OR staff are made aware of and can improve routines and logistics. The results of this feasibility study indicate that this quality system has the potential to lower PJI and strengthen the OR staff´s knowledge over time.

The second part - New Nordic Guideline in OR Design
The New Karolinska and the Nordic Ortopedic Surgeon Teams and have changed their approach of how to Design new Operation rooms. Presentation of a new Guideline on Hospital Ventilation. This design guide provides guidance and solid basis for design as well as for verification of the technical performance of ventilation systems. It also gives guidance for the users to assess the realization of the critical indoor parameters
as well as life-cycle quality assurance of the systems performance. The guideline outlines basic requirements for proper design of ventilation systems for hospital applications. The guideline expresses what is perceived to be best practice in the field

15.30 Steeve Rees, President IFHE

15.50 Celebrity presentation from:  Perry McCarthy

16.20 Closing Address:  Alison Ryan, IHEEM President