Health and Social Care Planning Seminars

The recent pandemic caused by SARS-CoV-2 highlighted significant shortcomings in healthcare estates infrastructure across the NHS. A report commissioned by the Institute for Government 'How Fit were Public Service for Coronavirus' stated that 'The NHS could have entered this crisis with a more resilient health infrastructure if it had invested more in recent years' (Davies and Atkins, 2020).

In January 2021, the National Patient Safety Agency released data which states that patient safety incidents citing work and environmental factors in 2019/20 had doubled since 2011/12 (NHS England, 2020), amounting to over 115,000 incidents and accounting for 5.3% of all reported incidents - including deaths. All the while the estates backlog cost increases year on year to its highest ever point.

In addition, a review of research into the effects of backlog maintenance on patient outcomes has returned no studies in the last 20 years that link the level of backlog in healthcare to patient harm.

The presentation will discuss two key projects that will attempt to address the issue. The first is a summary of my PhD research into the effects of backlog maintenance on patient outcomes. The presentation will discuss:

- the review of 20 years of research in Patient Harm, and the role that infrastructure has
played,
- a review of over 9m NRLS patient safety incident reports,
- The future aims of the research over the coming three years.

The second project is an overview of a pilot study being developed at UHS NHS Foundation Trust. The aim of the study is to not only capture the cost to estates of infrastructure failures, but the clinical impact from a financial and patient disruption perspective. The pilot, taking place 2023/24 will aim to provide significant evidence of the direct effect infrastructure failure on the patient.

NHS Property Services and NHS Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group, working together with Kier recently delivered the new £10.9m Devizes Care Centre
As one of the county's first integrated care centres, it provides accommodation for primary care, community health, mental health and other associated services - all centred around the patient in a community setting, as well as:
• Minor procedures
• Outpatients
• Phlebotomy
• Physiotherapy
• Podiatry
• Audiology
• Diabetes
• Community dentistry
• Voluntary sector services

By providing an expanded range of primary care services to the local community, it will shift care closer to patients' homes with the ambition to deliver care efficiently through networks of practitioners working together and integrating services across the health, social care and voluntary sector spectrum.
Services are provided in an efficient building layout that has been designed for future flexibility, with a 'racetrack' typology that raises the quality of the patient journey, fostering intuitive way finding and improved patient experience, also giving local GPs additional clinical space needed for everyday care.
Focus on sustainability is not only one at community level but also through a reduced energy footprint, supported systems designed to provide ''net zero carbon' in operation, using heat pumps and solar panels to power and heat the building
"The new Devizes Health Centre will be a facility the whole community can be proud of and benefit from ... As the flagship location for health and care in Devizes, the centre will ensure patients have access to modern facilities and state-of-the-art services while also providing professionals with much-needed additional clinical space, which will allow teams to provide an even greater level of care. I very much look forward to the opening of the new Devizes Health Centre in 2022"
Dr Andrew Girdher, Clinical Chair

Panellists in this session are:

David Jones, Director of Estates, Facilities & Capital Development, University Hospital Southampton

Martyn Symonds,Senior Project Manager, Kier Construction

Alison Halmshaw, Associate Director, Archus

Andrew Strange, Estate Strategy Lead (South), NHS Property Services

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.

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.

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

1. Reduction of Hospital Acquired Infections (HAIs)
a. NHS Medical Director Stephen Powis: 'single rooms should be the 'default' as they boost privacy and infection control.'
b. 'minimum of 50% single rooms when investing in new or refurbished hospitals' to be considered
2. Prefabricated interior partitioning designed to refurbish existing facilities
a. flexible, adaptable and future-proof interiors are necessary for future operation of healthcare estates
b. Durable, seamless and anti-microbial materials ease operation and maintenance processes
c. Imbedding assets inside walls reduces clutter and promotes infection prevention, eliminating gaps from face-mounted solutions
3. Compliance
a. Prefabricated interiors must satisfy HTMs and HBNs
b. Refurbishments must adhere to building regulations on fire and health and safety
c. High levels of acoustic performance should be considered for patient privacy and well-being
4. Bed Blocking
a. MMC should be considered for construction efficiency. Bed spaces are inoperative during a project; quick, efficient construction reduces bed blocking
b. Once installed, ward-closures for maintenance and refurbishments should be minimal. Materials used must be flexible, easy to maintain, repair and reconfigure, improving overall life-span
5. Patient Privacy and Well-being
a. Single rooms must be built with high acoustic performance to promote privacy and confidentiality
b. Patients should be able to opt in and out of visibility of and by others in the bay
c. Well-being is improved through interaction and distraction eg:
i. Integrated monitors and televisions
ii. Writable surfaces
iii. Graphics and natural imagery
iv. Visibility of staff and other patients to reduce feelings of isolation
v. Biophilic design
6. Sustainability
a. Prefabricated, modular wall systems prevent materials going to landfill
b. Re-use and reconfiguration accommodates technological advancements over time
c. Low emitting solutions meet green building goals and certifications
d. Precise design and off-site manufacturing reduces off-cuts and waste on site

NOTE: This presentation will be delivered as a CPD for learning and not promote any specific products or systems

This project demonstrates the effective healthcare planning and delivery of some of the key recommendations of the Fuller Report. .

NHS Property Services partnered with Humber North Yorkshire ICB, Nimbuscare (GP Federation), Primary Care Networks, Acute and Mental Health Trusts to reuse underutilised healthcare space and to support the creation of a neighbourhood hub.

In total, 900sqm of under-utilised space of the former mental health residential facility was transformed on a modest budget, thanks to a highly collaborative approach

The ICB led the engagement with the local primary care community, resulting in the suggestion for a shared hub which gained support from all partners.

Nimbuscare took the lead role in developing the clinical services mix working with local healthcare providers.

NHSPS took the lead on redevelopment of the site, appointing design team and construction partners.

A community café was proposed and supported the inclusion of a social prescribing element completely aligns with aspirations of partners.

The ICB supported the proposals agreeing transfer of funding to support the facility costs.

The mental health service provider have retained a presence in the facility for community services and are engaging in hub delivery.

Benefits

We have estimated that the facilities will benefit many patients in the local area - potentially 22,000.

Patients will receive an enhanced range of services near to where they live.

Social prescribing and the community café is being used by a wide range of services and charities and allows local people to create support networks and potentially reduce loneliness and social isolation.

The range of services offered continues to expand and a second site development is now being considered.

Modern pleasant facilities for staff.

Capital costs significantly lower than alternatives.

Ian Strangward, Managing Director, Architectural Wallsz (International) ltd

Karina Dare, Regional Partnership Director, North East and Yorkshire - NHS Property Services