4.10.22 Seminars

The SEM TP is just getting started.  Formed in the Spring of 2022 it currently has 17 members with an ambition to grow to around 30 all working in smaller groups to drive forward its aims. Its membership is and will continue to be diverse and inter-disciplinary and has several initial aims which will be presented and discussed with attendees, for example:

* What is an estate strategy and when does it all start to fall apart?

* How many “flavours” of healthcare planning can you name and how do you find the right one?

* How should IHEEM members benefit from our work and how do we achieve that?

Within the Estates Department at the Royal Victoria Infirmary, a major trauma centre in the Northeast of England, the COVID-19 pandemic placed great pressure upon engineering services; exposing the need to maintain and improve the resilience and reliability of engineering services in the post-Covid era. This talk will present a case study, focusing on the Estate Department's initiative, the first in the UK, to improve medical air plant resilience and reliability using post-Covid innovation. At RVI, we conducted a risk-based backlog maintenance assessment on our medical and industrial air plant. The assessment revealed a need to replace the plant and identified key risks and areas of improvement when installing a new plant: reliability, critical spares availability, air quality and plant downtime. In line with Newcastle Hospitals' target of delivering a net zero NHS by 2030, we also looked for a plant that would address issues of energy inefficiency and carbon emission reduction. Following a tendering process, the RVI partnered with SHJ Medical Gas Specialists due to our shared vision on post-COVID resilience and innovation. The new system is built combining medical and industrial air plants as a whole to achieve maximum efficiency, where variable speed technology is employed to maintain a system base load with the option to call on selected fixed-speed compressors that adapt to different outputs and site demands. Further, the use of dewpoint temperature control, in the process of drying air, reduces energy wastage. The new plant uses a controllable global valve on the wet side of the system to give optimised control and resilience. In addition, an AI-based SHJ remote monitoring system will be implemented to collect data to further optimise the performance of the system, conduct predictive maintenance, and to estimate and quantity the net impact of the system. RVI's Sustainability Team is also collecting data from the system to quantify its impact. All the data will be collected and presented.

The unique circumstances surrounding the completion of the new Royal Hospital makes this scheme an exemplar project for lesson learned.
In 2018, when close to completion, the initial PFI contractor Carillion entered administration, leaving the NHS and Trust with a significant financial challenge and complex structural, building fabric and various other defect related issues.
Extensive works have followed to rectify major problems including extensive remediation to the structure and removal of significant sections of the building envelope and fabric.
The Royal Liverpool Hospital will reach Practical Completion and hospital commissioning will be completed by the week of IHEEM and as such will be the first major hospital completed under HIP cohort 1.
Paul, supported by the delivery team will highlight on the challenges encountered and how the building has finally become ready to accept patients and staff despite the turbulent delivery journey

Turner & Townsend will elaborate on the strategic approach to NHP as an introduction to Paul's presentation

Aerosols and droplets generated from expiratory events play a critical role in the transmission of infectious respiratory viruses. Fine aerosols play a crucial role in airborne transmission of respiratory diseases including COVID- 19. Out-patient hospital activity moved to virtual clinics during the pandemic, making effective communication difficult and leading to increased isolation and staff dissatisfaction. Mitigations for aerosol-borne disease spread are needed to make healthcare spaces safer for doctors and patients to safely meet face to face again.
Methods
We used computational flow dynamic (CFD) modelling to investigate the efficiency of portable air purifiers containing HEPA filters as a retrofit mitigation strategy to reduce airborne aerosols in hospital consulting rooms. We modelled a single doctor patient interaction in a room with a chilled beam air conditioning system at 3 air changes per hour, 220C and 50% humidity. We generated a detailed computational mesh including 800,000 elements. We performed 3D transient simulations, with steps of 0.01 s, for 180 s. Both continuous phase (air flow) and discrete phase (aerosols) were taken into account. The discrete phase of aerosols was tracked in a Lagrangian manner, with representative populations of around 200,000 particles being tracked.
Results
Aerosol particle number plateaued around 180 seconds. Clearance efficiency ranged from 25% to 62% depending on where the inlet/suction of the air purifier unit was placed. The best location for a single HEPA filter was on the desk between doctor and patient but highest efficiency was achieved using two devices, one on the desk and a second to the side of the room at the height where aerosols were generated.
Discussion
This work provides practical guidance on a mitigation that can be rapidly implemented in an expedient, cost-effective manner, and may lead to more science informed strategies to mitigate airborne transmission of respiratory infections in hospitals.

In October 2020, the NHS became the world's first health service to commit to reaching carbon net zero, in response to the growing threat to health posed by climate change. The "Delivering a Net Zero Health Service" report sets out a clear ambition and two evidence-based targets to achieve this.
The NHS Greener agenda sets out its ambitions for medicines and the respective supply chain - "By working with our suppliers to ensure that all of them meet or exceed our commitment on net zero emissions before the end of the decade.". This however requires detailed input and then follow up analysis.
MTS is working closely with the NHS NHP Team on equipment advisory for the re- use of equipment in the forthcoming build of over 40 hospitals. Key will be the evaluation of the multiple Medical and Non-Medical Equipment Suppliers and their attitude to Net Zero Carbon.

We working with Parent Company Sodexo and other leading companies to put a set of parameters in place which will constitute the evaluation of the Net Zero Carbon grading. This might include:

- Distance travelled from origin of manufacturing
- % of the item that can be re-cycled
- Specific energy outputs (other carbon rating)
- Commitment that no parts made with slave labour

The health sector is a significant contributor to global carbon emissions, accounting for between 4-5% of total emissions. A large part of this is the supply chain with around 70% of the sector's emissions coming from the production and transportation of medical equipment. UK health service emissions correspond to that global average, accounting for between 4-5% of the UK's total carbon emissions. A clear strategy to work with the leading UK and global suppliers to reduce these emissions will contribute significantly to the NHS Targets.

Surgical plume is a gaseous byproduct of burning organic material created from heat-producing surgical tools. The operating theatre workforce and patients may experience adverse effects from being exposed to surgical plume when plume evacuation devices and standards of practices are lacking.
Opportunities exist to increase awareness about the health consequences of surgical plume exposure to surgical teams and their patients. Engineers, hospital leadership, policy makers, and multidisciplinary surgical team members can influence practice through advocacy, education, and spreading awareness. To better understand the context of the problem, we will analyze the scientific evidence of the hazards and the health and safety risks of exposure to surgical plume and discuss the standards and best practices that guide protection against exposure to surgical plume.
Key to helping resolve issues over exposure will be covered by examining how the use of innovative ways of using technology to exploit data via remote sensors for measuring particulate which is one of the main component of surgical plume and using this to determine if the plume is not being adequately controlled in order to help the employer (Trust, manger) in protecting people's health.

Having something that alerts staff may just make a big difference to their exposure and their health.

• Your LEV isn't working
• Your surgeon isn't using the on tip extraction
• You are at risk

IOM have been working with clients to replace traditional methods of monitoring exposure which can be challenging in clinical environments and employing sensors where monitoring can be carried out remotely and over more meaningful time periods than can be captured in a site visit.
The interpretation being undertaken by AI allows fast accurate feedback on individual exposure.

Lastly, we will provide you with references and resources for further information on developing policy and surveying for compliance.

The construction process and project delivery ecosystem is evolving, as factors such as digtisation, whole life carbon cost and agile space emphasise the need for a step away from the conventional supply chain towards an structure that involves key value chain players throughout the whole project life cycle. From early engagement at the design phase, right through to the use, operation and maintenance of a building.

Our ability to retrieve data from our buildings, spaces and infrastructure is developing rapidly. With the right connected technology and software, we can understand and manage buildings in a different way than previously. For example, we have visibility into the condition of hospital assets and infrastructure, and we can apply condition-based maintenance to prevent the failure of critical assets. We can measure the energy used within a building or across an entire estate, and we can use the information we collect to improve the energy efficiency of buildings. We can collect data to understand how spaces are being used, to decide how we may repurpose space to optimise its use.

It is vital that action is taken because of the data we retrieve. We discuss the need for development and adaptation of facilities and operational staff in order benefit from the connected technologies. We conclude with the ideal 'digital hospital' scenario, where data streams and system information can be collated in one place, on a single pane of glass.

The NHS hope to be the first health service in the world to achieve zero carbon.

Building a net zero NHS, is allied to post Covid changes and so in all it is an exciting opportunity to change the future for the better.
The Central London Community Healthcare Trust (CLCH) is already on the front foot towards their decarbonisation journey and have developed a Green Plan and Board approved decarbonisation pathway which will be available to showcase in October (at the time of the conference). The presentation will discuss the Green Plan development journey including:

Why?
• Net zero carbon affects every aspect of our lives, so it is cross cutting and relevant.
• As a geographically widespread community trust across eleven London boroughs  and Hertfordshire, CLCH used 5900 tons of carbon in 2019, and needs to reach net zero  by 2040. The context is that the energy grid may be zero carbon by 2033-35. New energy standards for new build standards are soon to be released, so that the cost ‘gap’ between a net zero energy, and ‘standard’ construction is reduced.

How?
The CLCH Green Plan outcome is to reduce energy demand, leading to more environmentally sustainably and financially efficient buildings, and reducing the burden on the UK energy grid. At a time when bills are skyrocketing, the action plan is comprehensive and gets the Trust to net zero carbon across several years, including:
• Engaging with staff, installing efficient lighting and controls.
• Reducing fossil fuel consumption in buildings with heat decarbonisation plans.
• Removing unnecessary journeys for patients and staff, introducing electric chargers, bike racks, encouraging the fleet away from fossil fuel.
• Designing 'Green' spaces.
• Reviewing the commissioning of suppliers and reduction of carbon in medical gases.
• Identifying opportunities to link to local heat networks and battery storage.
• Working with our Integrated Care System partners to identify collaborative solutions across the sector.

Derbyshire is an outlier for the use of dormitory style accommodation with one of the highest levels in England. This has a negative impact on privacy and dignity and patient safety plus it also impacts on A&E and Acute Trust flow in Derbyshire.
Derbyshire Healthcare were issued a Formal CQC requirement under regulation 15(1)c to eradicate the use of dormitories by 2024.
Derbyshire also has no Psychiatric Intensive Care Unit capacity for male of female patients leading to all Derbyshire patients being placed out of area for this level of care. This leads to poor patient journeys and a lack of social, familial and environmental connections which are all known to aid recovery. The NHS 5 Year Forward View and Long Term Plan has a stated aim to end inappropriate out of area placements by March 2021.

The Programme being delivered by the DHcFT Programme Delivery Team includes 6 projects, 4 of which are related to dormitory eradication and 2 related to ending the inappropriate use of out of areas PICUs. The Programme include 3 new builds and 3 major refurbishments.

The Programme Delivery Team includes a Clinical Project Manager (a ward manager from an adult acute background) and a Project Officer who is also a service user with a physical disability. These key individuals attend all design meetings and are the key links to the Clinical and Service User reference groups respectively. The design meetings include a wide range of key individuals from across the Trust including E&F leads, Health and Safety, Fire, Security, Clinical, Medical and Infection Prevention specialists.
The co-design approach is being applied to all 6 projects with key decisions on form, function, look and feel being informed by the Clinical and Service Users Reference Groups.

The discussion on healthcare environments in the last 20 years shifts between what is known as evidence-based design and salutogenic environments. These concepts have even been used interchangeably and both come from the broader health sciences field. The former derives from evidence-based medicine concepts and the latter from the theory of salutogenesis from medical sociology, both outside the built environment (BE) discipline and therefore unable to capture the intricacies of space and place. So, once those have been introduced to the built environment the concept has changed from the original theories and they sometimes end up being buzzwords.
Thus, we propose therapeutic architecture as a paradigm that stems from both health and the BE. Under that paradigm, we argue that both tangible/physiological/objective and intangible/perceptual/subjective should be accounted for. For the tangible, we investigate physiological conditions because of illness or disease and how the BE needs to accommodate those, for instance through infection control and thermal comfort. For the intangible, which is not clearly defined in the literature so far, we need to consider aspects of social, hedonic, or aesthetic value. The therapeutic paradigm we offer caters not only to pathological and salutogenic but also to the inspirational, beautiful and artistic potential of the built environment. Those could be opportunities provided by the built environment.
To explore how this concept translates in practice and can be implemented in policy, we will test our theory on three landmark case studies, defining the discussion of the era they were introduced chosen deliberately for their differences: Maggie's centers, the Evelina hospital and Chinese Covid-19 hospital placed on a matrix that explores different tangible and intangible qualities that these places offer or don't offer.

Technology and the estate are both vital to delivering the NHS Long-Term Plan, and combining the two with an innovative piece of PropTech will help to answer the changing requirements and usage of NHS buildings. Health and wellbeing services are seeking more flexible access to spaces that are closer to communities, and often have to spend time and resources on finding and securing sessional space across a range of Primary Care Buildings.

In our presentation, NHS Property Services (NHSPS) would like to present our latest innovative solution to help solve this problem. NHS Open Space, developed by NHSPS, brings technology to the NHS estate by offering a digital platform and onsite support for the flexible booking of sessional space. The service supports health and wellbeing providers looking for alternative and flexible ways to deliver services in their community by using pay-as-you-go NHS spaces nationwide. These rooms can be booked by the hour, session, or day and cover both clinical and non-clinical spaces ranging from examination rooms, to offices, to group activity rooms. This programme is a significant step forward in the optimisation of the NHS estate, making much more efficient use of the estate and minimising vacant or underused space. It opens Primary Care buildings up to a wider range of health and wellbeing services, bringing care closer to the heart of local communities so we can reduce pressure on larger hospitals and make life easier for patients.

In this presentation we would like to explore NHS Open Space's journey, from identifying the role of property data and technology in supporting everchanging requirements for NHS space, to building a nationwide solution to help transform the NHS estate that we hope to further expand throughout 2022.

The BaNES Swindon and Wiltshire (BSW) ICS has a strong track record of effective estate strategy development and implementation, which has underpinned a programme of improvements to our hospital, community health and primary care facilities over the past few years. Further, publicly-funded, capital schemes are under development. We have been on a journey from individual organisations developing plans to meet their estates needs to a more collective approach. However, as has been the case for many ICSs, we recognised that we had some way to go before we had a fully integrated system-wide approach to strategic estates planning, and we changed our approach accordingly.

Delivering high-quality patient care requires an integrated approach to infrastructure, incorporating buildings, equipment, plant and digital technology into a single, coherent, environmentally sustainable strategy. New ways of working create the need to go beyond just thinking about facilities to considering buildings, equipment and digital technology as a combined asset.

Our transition from a silo approach to healthcare service delivery to integrated system-wide approaches, reflected in our new Health and Care Model, drives a need for new ways of thinking and for infrastructure to be seen as a collective asset rather than an organisation's own property.

All forms of healthcare infrastructure need to be planned (and funded) on a system basis, e.g., the concept of the 'smart hospital' needs to be extended to all healthcare facilities within our system.

Environmental sustainability targets and our Net Zero Carbon (NZC) commitments need a joined-up system-wide approach if they are to be achieved. NZC targets necessitate thinking differently about healthcare buildings and taking an infrastructure-based approach.

This presentation will describe the progress we have made (supported by Currie & Brown), the challenges we have faced and the opportunities we have identified through taking an integrated approach to infrastructure planning.

The presentation introduces the research conducted on how to enable more effective and timely knowledge sharing among NHS Hospital Estates and Facilities Management (HEFM) departments. These departments are critical in ensuring the safe delivery of care while facing not only the impacts of disasters such as COVID-19, climate change mitigation and adaptation initiatives but also organisational changes (e.g., new models of care) and structural issues (e.g., maintenance backlog). Effective flows of different types of knowledge (e.g., know-how or technological knowledge) among HEFM departments could significantly improve their ability to manage change and challenges effectively and efficiently.
As part of this research, multiple case studies in 6 hospitals across England are being conducted to investigate the flow of knowledge on medical oxygen infrastructure systems during the COVID-19 pandemic. The case studies track the flow of specific pieces of information through the various NHS system levels. In this way, the research identifies different types of knowledge, mechanisms, or channels for sharing these knowledge types and enablers/barriers that affect the knowledge sharing processes among HEFM departments.
The presentation will illustrate the key findings from the case studies to raise the understanding of knowledge sharing processes and simultaneously raise awareness for existing barriers to effective knowledge flows. Firstly, exemplary knowledge flows will be illustrated to highlight enablers and barriers to inter-organisational knowledge sharing during the COVID-19 pandemic. Further, using the persona method, knowledge needs and sharing behaviours of NHS HEFM staff on different levels are explained, elaborating on regional, organisational and structural variations. Lastly, the presentation will outline knowledge sharing structures and practices that were developed during the pandemic and ways to conserve these for non-pandemic operations in the future, enabling the efficiently manage the upcoming challenges related to the net-zero carbon targets.

Applying a carbon neutral programme approach to the whole estate to address the retrofit challenge; the benefits of cross-sector learning using relevant case studies from Hertfordshire County Council (HCC) and Hampshire.
With a lack of clarity surrounding the roadmap to net zero it is difficult for leaders in public bodies to understand where to begin, what to monitor and how to report progress and maximise the potential of funding. Irrespective of the sector or organisation, a programme approach that examines all estates related functions for the existing and planned new build estate, against the funding routes and Net Zero Carbon aspirations will ensure consistency and maximise outcomes, resulting in time and cost efficiencies.
HCC, in response to the Public Sector NZC target of 2030, and achieving government funding for decarbonisation, invested in the development of the Carbon Neutral Herts programme. In essence this initially recognised the school estate, both existing and planned and the funding pots available to the local authority. This looked beyond the capital workstream for the existing estate to also look at the new school build programme and FM function to create a NZC strategy for the entire property portfolio.
The impact of this approach has been particularly successful for the FM function with a Business as Usual (BAU)+ approach adopted that utilises a variety of funding streams bringing decarbonisation to the heart of delivery. This has been so successful that it has been mirrored across the organisation's wider estate, subsequently also being adopted by other local authorities.

Benefits include:

• Robust data capture and analysis providing a roadmap built on quality data, enhancing informed decision making and enabling progress tracked against targets
• A comprehensive database supporting funding bid, which provides a mechanism for speedy/effective responses to funding submission deadlines i.e., HCC achieved £24m of funding from 3 applications for decarbonisation works across 218 buildings, including window walling, solar panel works and ASHP installations.
• Continuous monitoring and evaluation of progress against performance indicators
• Trend analysis
• Identification of innovation and best practice
• Lessons learnt captured and used to strengthen future delivery
• Achievement of procurement efficiencies

Based on real life experiences of medical storage not being planned for adequately and when staff move in they are disappointed.
Key learning points:
- Modular storage design vs Conventional storage design, HTM63 vs HTM71
- The common pitfalls in storage design and how to avoid them
- Compliance and how to provide adequate and correct storage to meet current standards and requirements
- Standardisation and Future proofing

The presentation will include slides showing examples of the difference between HTM63 and HTM71:-

HTM71 provides dense storage and better accessibility

Real life case studies and examples

Infection prevention features and points, upgrading clinical rooms to modern, efficient and pleasant places to work in:-

SUMMARY:-
Often new medical facilities open without adequate thought going into the design of storage requirements. We see time and time again, flaws in the design of specialist clinical spaces, and both traditional and new design methods not picking up the requirements and best practice of today's clinicians working on the front line.

In October 2020, the NHS became the world's first health service to commit to reaching carbon net zero, in response to the growing threat to health posed by climate change. The "Delivering a Net Zero Health Service" report sets out a clear ambition and two evidence-based targets to achieve this.
The NHS Greener agenda sets out its ambitions for medicines and the respective supply chain - "By working with our suppliers to ensure that all of them meet or exceed our commitment on net zero emissions before the end of the decade.". This however requires detailed input and then follow up analysis.
MTS is working closely with the NHS NHP Team on equipment advisory for the re- use of equipment in the forthcoming build of over 40 hospitals. Key will be the evaluation of the multiple Medical and Non-Medical Equipment Suppliers and their attitude to Net Zero Carbon.

We working with Parent Company Sodexo and other leading companies to put a set of parameters in place which will constitute the evaluation of the Net Zero Carbon grading. This might include:

- Distance travelled from origin of manufacturing
- % of the item that can be re-cycled
- Specific energy outputs (other carbon rating)
- Commitment that no parts made with slave labour

The health sector is a significant contributor to global carbon emissions, accounting for between 4-5% of total emissions. A large part of this is the supply chain with around 70% of the sector's emissions coming from the production and transportation of medical equipment. UK health service emissions correspond to that global average, accounting for between 4-5% of the UK's total carbon emissions. A clear strategy to work with the leading UK and global suppliers to reduce these emissions will contribute significantly to the NHS Targets.

With the NHS facing financial challenges while being required to consistently improve patient safety and care, it needs to take action at all levels to maintain its estates and facilities to a standard required by law and expected by regulatory bodies and the general public.

The NHS estate is vast complex and varied, conditions range from world-class, state of-of-the-art facilities to old Victorian hospitals that are no longer fit for purpose. The backlog of maintenance costs are increasing year on year almost equalling the operating costs of nearly £10bn.

Much of the estate requires significant and costly refurbishment or reconfiguration to remain safe and suitable for modern patient care.

Phil Bishop, Healthcare Property Director at Capita will explore how the NHS can overcome these challenges focusing on the following key learning points in his presentation:

• The opportunities for NHS Trusts not captured within the New Hospital Programme.
• The untapped potential for increased occupation of NHS sites from both health services and other uses such as housing, which can be unlocked to build healthier communities.
• Strategic asset optimisation and identifying innovative opportunities to increase the value of the assets the NHS own and manage and reimagining sites to help the NHS get the most from its estate - clinically, financially and socially.
• Using asset portfolios linked to how to work collaboratively across the public sector to match needs with opportunities and unlock solutions through a social infrastructure bond .
• How to maximum value, generated from the sale and development of NHS land, delivering new healthcare environments for excellent patient care and generating income to reinvest in clinical care or into the wider estate.

In response to the climate crisis, the NHS has set a target to decarbonise its estate by 2040. A key part of the decarbonisation will be achieved through the transition away from fossil fuels to all-electric heating solutions utilising efficient electric heat pumps for the existing estate. The ongoing decarbonisation of the national grid over time will continue the reduce carbon emissions associated with electricity. Coupled with this, the systematic improvement in the efficiency of fabric and engineering systems will reduce the core energy demand. However, this is a complex and lengthy process with differing solutions for different buildings and sites.

An all female team present four perspectives of delivering a significant new healthcare project from concept to completion; Walsall Manor Emergency Department for Walsall Healthcare NHS Trust.

Delivered under the Procure 22 Framework, four speakers from different disciplines will describe the collaborative journey of the project and how the new ED will support Walsall Manor by improving patient experience, streamlining patient pathways and providing flexibility for the future, as well as covering lessons learned.

Debbie White
Senior Project Manager for Emergency Department and Acute Care New Build
Walsall Healthcare NHS Trust

Debbie will describe the background to the brief for a new ED, the requirements of the Trust, funding challenges and the aspirations for this new build to meet the growing demands on Walsall Manor Hospital.

Suzanne MacCormick
Director and Healthcare Planner
Spencer Harrison

Suzanne will demonstrate how a clinically-led approach, developed through workshops with multiple staff groups, ensured both a design wrapped around excellence in patient flow and a solution that improves the experience of patients and staff alike. She will illustrate how this clinically-driven design will help the Trust deliver operational efficiencies throughout its urgent and emergency care pathways.

Rebecca Phillips
Design Manager
Tilbury Douglas Construction

Becky will explain how the design and layout of the new Emergency Department has reflected the consultation process through the careful consideration of spatial design, key adjacencies and routes, design flexibility and a first-class healthcare environment. From a main contractor perspective she will discuss how Tilbury Douglas harnessed the Procure22 framework to overcome key challenges, including programme, budget and delivery on a fully operational hospital site.

Rachel Sutton
Mechanical Project Engineer
Tilbury Douglas Engineering

Rachel will divulge the innovations of the project and how the delivery team used technology and modern methods of construction to ensure high quality, value and reduce programme.

Elizabeth Slevin
Acute Care Transformational Lead Nurse
Walsall Healthcare NHS Trust

Liz will conclude with how the Trust are embarking on a programme of education to improve care and efficiency in the new building and beyond.