This paper draws on my doctoral research titled Infrastructure is More than Material, which considers the impact of infrastructure on society and is concerned with human interaction with infrastructure. The research reflects critically on many years working as an engineer delivering projects in ports and transport, water and sanitation, education and health in post-apartheid South Africa.
My argument is influenced by the growing body of interdisciplinary work in the fields of infrastructure and science studies in the humanities and considers the question of post-apartheid infrastructures’ legacies. As Zannah Matson argues in her review of the edited monograph The Promise of Infrastructure, infrastructure (and its promise) structures our relationship to the future and allows us to think ‘alongside the unfinished and interrupted forms that infrastructures often take’.
My paper explores aspects of the unfinished using notions of human-centred design in public infrastructure and the importance of involving the ‘users’ and ‘beneficiaries’ in infrastructure development and delivery. Infrastructure has a profound impact on society, socially and economically, and has been promised as an effective driver of economic growth. Yet depending how it is delivered, the infrastructure capital spent can produce significant human and social assets, in addition to the physical facilities.
Increasingly in South Africa we are seeing facilities fall into disrepair. We see infrastructure that is not used as intended, that doesn’t provide the socio-economic benefits that were intended. For example, a power system that only provides intermittent electricity to businesses severely limits the economy. We see vandalism to socioeconomic infrastructure and in the past schools damaged in protest action.
How do factors such as governance and funding models, design considerations, project implementation methodologies, operational and maintenance policies affect the promise of infrastructural change and facility longevity?

Lithium-Ion Battery Fires - the Dos and Don’ts!  This session will delve into the challenges associated with these types of fires and you will gain valuable insights into why they happen and how to prevent.

With the ever-changing landscape of the healthcare environment, facilities professionals play a pivotal role in sustaining a high-quality service. Their responsibilities encompass a range of tasks that contribute to the smooth operation of the healthcare facilities and the overall well-being of staff and patients.

LED lighting is evolving, and the brightness of lighting elements has increased over time. Many NHS organisations opt for a like for like replacement of their aging Fluorescent lighting. That means if a room had 6 fittings of fluorescent lights they now have 6 fittings of LED lights. The lux level is usually 3 or 4 times what is required for building standards and as a result there is wasted energy (and sunglasses for the staff). In a survey of 10 NHS locations with LED lighting without a lighting design all sites were on average 300% over the recommended LUX level for their environments.

Understanding lighting risk assessments, the lighting process and  importance of emergency lighting

Multivista assist both new builds and the built environment using AI to ascertain a buildings fire strategy within days. We will look at the challenges within both new builds and existing buildings of managing the fire compartments, are they intact or have tradespeople or maintenance teams jeopardised the strategy? Also looking at the Building Safety Act and how this affects your strategy in both short and long term.
We will also provide an insight into how AI can speed up processes to reduce time on site and costs.

Hospice Care provision and getting the the balance between the finances, workforce and net carbon zero agenda right can prove challenging. Especially considering the additional pressure of being a charity (Overgate is only partially funded by the NHS). The Hospice is an anchor institution in the local area, as a charity we depend on our supporters to raise the £3m a year to keep our services running, As such we have an obligation to ensure we are committed to the social value agenda.

The Hospice estate is varied, consisting of the Hospice building, offices, 16 charity shops, a distribution centre and a new capital build for an extended in patient unit, which means the scope is vast. This means it can be difficult to know where to start, we are very lucky as one of our supporters is a leading green solutions provider and has undertaken a digital clipboard exercise to understand our current position and the scope we have for improvement. From this we have taken the quick-wins and now are working through those actions where the investment saves the Hospice money.

The experience of waiting is a significant yet often overlooked aspect of healthcare delivery. Patients frequently spend considerable amounts of time in waiting areas, with average waiting times for NHS services extending significantly and durations in waiting rooms ranging from one to six hours. The design of the waiting spaces plays a crucial role in shaping patients' overall healthcare experience, impacting their perceptions of care, emotional well-being, and subsequent interactions with healthcare professionals, which can subsequently affect treatment processes. The role of art as a positive distraction in waiting areas has been acknowledged, yet the impact of the holistic interplay between art and other elements of the physical environment remains underexplored.

Aims: This study aims to bridge the existing research gap by adopting a holistic approach to waiting area design in healthcare facilities. It seeks to evaluate how various aesthetic elements of design contribute to improving patient comfort and the overall experience.

Methods: A mixed-methods research design is employed, beginning with a systematic literature review to gather insights into previously studied aesthetic elements of waiting area designs. Subsequently, a quantitative study is conducted using patient questionnaires to assess preferences regarding different design elements, including art, nature, window views, etc. Participants will be asked to compare and select their most preferred designs from a range of waiting area configurations. Additionally, interviews will be conducted with patients in two waiting areas featuring various design approaches.

Results: Preliminary findings indicate a strong preference among patients for waiting areas that incorporate both art and elements of nature, as well as providing design configurations for privacy and safety. These preferences underscore the importance of a holistic design approach that considers both aesthetic appeal and functional practicality.

Conclusions: The study concludes that the design of healthcare waiting areas should not be overlooked, as it plays a vital role in patient care. A well-designed waiting area can mitigate the stress and anxiety associated with waiting, improve patient-doctor communication, and influence treatment outcomes. The research highlights the need for healthcare facilities to adopt a holistic design strategy that integrates both aesthetic and physical design elements to create environments that support patient well-being.

Implications: This research will have potential implications for healthcare administrators, architects, and designers, offering a framework for the development of waiting areas that cater to patient needs and preferences. This study advocates for a shift in perspective, recognising the waiting area as a crucial component of the healthcare environment that warrants careful consideration and strategic design.

Whilst it seems everyone is gearing up for and thinking about PFI, PPP or LIFT hand back, what if you are still in the early or mid concession stages, with years left to run on the operational contract?

This presentation will focus on how to get the best out of your PPP /PFI arrangements over its remaining life, whilst not prejudicing any handback considerations.

So much may have changed since your buildings were handed over – the services you deliver, how you deliver them, the needs of those you deliver too, your workforce and their preferred ways of working… the list could go on.

You are probably therefore considering how to ensure the estate continues to meet your needs , whilst perhaps feeling wary of re-opening those debates and discussion you remember from when the deal was originally made. Or perhaps you weren’t around at the time and don’t know what to expect.

If so this is the presentation for you! The key themes that will be talked through include:

• The different forms of PFI/ PPP and why it matters
• What constitutes a variation, how to deal with them and why you should face the fear and do it anyway
• What good contract management looks and the contractual pifalls to avoid
• How to build and maintain good relationships with your private sector partner

The session will include lessons learned from our experience in establishing, delivering and managing PPP vehicles and concessions over a 20 year period, as well as client and end user voices from our lived experience as a consultancy working with those who deliver services from these buildings.

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.

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.