Renovating the NHS from the ground up

According to a recent report from the King’s Fund looking at how NHS estates might be used more effectively, “The NHS has many under-utilised properties, and a significant amount of its estate is in poor condition or not fit for its current purpose.” This poses unique challenges for hospital and estate managers, who are required to fulfil a range of obligations including improving building quality, keeping buildings safe, warm and clean, and ensuring that the estate portfolio is used effectively, all while trying to keep down costs.
    
The report by Nigel Edwards, called NHS Buildings: Obstacle or Opportunity? argues that NHS buildings are not being used to their full potential, and that front line services could suffer as a result. In light of this, we take a look at refurbishment projects, some recently completed and others still under way, that show how investment in the NHS estates portfolio can deliver greater comfort to patient and improved clinical outcomes.
    
Report
The King’s Fund report issued in July 2013 outlines some of the key issues in this area, for example the problem of facilities that are out of date: “The rapid pace of change in medicine means that it is very difficult to future-proof large-scale investments and, once built, there are very few mechanisms for these assets to be changed. Many hospitals are still planned in ways that perpetuate practices that may be inefficient or out of date.”

Edwards writes that the NHS has also been criticised for lacking a clear management vision when it comes to its estate, resulting in space being wasted and certain facilities underused. The King’s Fund report says: “A significant amount of the NHS estate houses back-office functions and services that could be provided in much lower cost buildings. High-cost buildings and equipment are, in general, substantially underused.”

Combining services
Edwards’ report calls for NHS managers to be more ambitious in using health buildings to integrate disparate care models: “The objective of any change needs to be to support and encourage new or improved models of delivery that bring healthcare, social care, housing, private sector provision of long-term care and other related services together in a more integrated way and create more value for the wider community.”
    
The report points to the improved Townlands Community Hospital in Henley-on-Thames as an example of a successful project. This involved the original site being split into three sections. The first section, the site of the original hospital, was sold freehold, with listed buildings refurbished. The second was sold on a long lease to Order of St John to build an Alzheimer’s care home. Proceeds from these two sales helped to fund the building and maintenance of a new community hospital.

Barnsley Hospital
Barnsley Hospital reopened in January of this year following a £1.7 million refurbishment project that included the demolition and reconfiguration of the 500-bed South Yorkshire hospital’s Emergency Observation and Resuscitation wards. A competitive tender process sought to identify a health service refurbishment team who could demonstrate expertise in working in live clinical environments.

The successful team, Styles&Wood, worked alongside the Barnsley Hospital NHS Foundation Trust’s estates department to plan an appropriate schedule for works to take place while other wards were open and operational. This included implementing a specialist infection control system to ensure work areas were fully segregated, preventing the spread of dust and debris across the site.

Chesterfield Royal Hospital
Last summer saw the completion of a £1.2 million refurbishment project at Chesterfield Royal Hospital in Derbyshire, also carried out by Styles&Wood. The 21-week project involved the complete strip-out and remodelling of the hospital’s Women’s Health Unit and Trinity Ward, to bring its gynaecology services together in a modern high quality facility.

Linda Gustard, head of midwifery and senior matron for gynaecology at Chesterfield Royal Hospital, said: “We’re absolutely delighted with the way the two wards look and, in particular, how it will improve the privacy and dignity of the WHU patients by bringing all gynaecology outpatient clinics into one place. The WHU has three clinic rooms where we’ll see patients who previously came to outpatient suite one, we also have a completely separate area and waiting room for the women coming to our early pregnancy assessment unit along with other separate areas for outpatient procedures and day case surgery and completely private areas for changing.
    
“Our gynaecology patients will notice a big difference as will anybody returning to Trinity Ward. We’ve incorporated the same styles, furnishings and relaxing artwork that you will have seen in our birth centre. It will allow for a much smoother transition from the birth centre to the maternity ward, and additional features there include a milk preparation room and parent’s rest room. The feedback we’ve had from our patients has been overwhelmingly positive.”
    
Energy
Carbon reduction is an increasingly important goal in hospital refurbishment, as the financial benefits of carbon efficiency become better understood. A recently completed project overseen by GVA Grimsley in Haslemere Hospital, Surrey saw the 1920s building refitted with a new roof and windows, resulting in significantly improved insulation.
    
The roof was made using foam board and TLX Gold, a combined multi-foil insulation and breather membrane. The insulation material was chosen for clinical reasons as well as efficiency – it was found to be the most breathable of the multi-foil products on offer, eliminating the risk of condensation, which can contribute to infection outbreaks.
    
Gordon Day, estates project manager at NHS Surrey, said that the new design “will prolong the life of the building and help NHS Surrey to deliver on its carbon reduction targets.
    
“The design has taken into account the age of the building and has been sympathetic in the materials used. For example, the new fire escapes have enabled us to utilise the second floor, which had been unoccupied for several years, and the new insulation will reduce our running costs.”

In the pipeline
The refurbishment case studies presented here show what can be done to provide safer, more modernised services, even in hospitals originally built over a century ago. Similar schemes have been announced recently – for example, NHS Property Services has said it is carrying out feasibility studies for the repurposing of the derelict Marie Foster nursing home in north London.  
    
The Royal Sussex Hospital in Brighton, which has some of the oldest buildings currently being used by the NHS, is also to receive a major redevelopment. £420 million is to be spent demolishing several buildings on the site and replacing them with modern facilities.

Further information
Read the King’s Fund report in full at tinyurl.com/mtgtr7x