Healthcare Property, Issue 1, January-February 2024

JANUARY-FEBRUARY 2024

01/2024

A new approach to mental health design for children and young people A positive outlook for healthcare construction Political parties prioritise health and social care ahead of election Health sector continues its carbon net zero journey

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W E L C O M E

A new era for the healthcare estate Welcome to the first edition of Healthcare Property magazine.

To be published bi-monthly, this new title will be bringing you all the latest news from the healthcare property sector, including financial and market analysis and trends.

We will also be exploring best practice in the design and construction of the next generation of health and care facilities, as well as looking at estates and facilities management pracitices.

In this first edition, we cover the health sector’s continued journey to becoming carbon net zero and speak to leading industry experts about how the buildings of the future will be financed and operated.

There’s insight from leading names including Harry Hyman, founder and chief executive of Primary Health Properties and publisher of Healthcare Property Magazine’s owner, Nexus Media Group; Fiona Halstead and Alison Cann, clinical compliance specialists at Barts Health NHS Trust; Nick Gray, chief operating officer for the UK and Europe at Currie & Brown; Adam Lenton, Colliers’ director and head of healthcare valuation and advisory; and Benjamin Davis, chief executive of Octopus Investments, among others.

And the launch comes at a pertinent time for the sector as it follows the Chancellor’s recent Autumn

Statement and the political party conferences, where the main contenders laid out their plans for the future of health and social care in the run-up to the next General Election.

It also comes on the back of the Cabinet reshuffle, which saw Victoria Atkins appointed the new Secretary of State for Health and Social Care.

While admitting there was still ‘a lot of work to do’ to bed in the new Integrated Care Systems and boost staffing numbers, as well as overcome the COVID-19 backlog; she claimed there were clear recovery plans in place and financial certainty.

But, with the tough winter season in full swing, and capital and revenue funding being pinched, it remains to be seen just how quickly and efficiently the NHS can emerge from its current crisis.

Moving into 2024, Healthcare Property will be at the forefront of these endeavours, bringing you all the latest from the marketplace.

And we want to hear from you!

If you can help, or have projects and news you want to share with us, please email joanne.makosinski@nexusgroup.co.uk Jo Makosinski Editor Healthcare Property

About Jo: Jo is the editor of Healthcare Property, having joined Nexus Media in November.

She has been specialising in design and construction best practice within the health and care sector for the past 14 years, working on the Building Better Healthcare

Awards and editing both Building Better Healthcare and Healthcare Design & Management magazines.

She has a special interest in the design of mental health and dementia care settings and in modern methods of construction and energy efficiency.

HEALTHCARE-PROPERTY.COM

JANUARY-FEBRUARY 2024 | 3

Contents

6-9 News

Chief executive officer Alex Dampier Chief operating officer Sarah Hyman Chief marketing officer Julia Payne Editor Joanne Makosinski joanne.makosinski@nexusgroup.co.uk Reporter and subeditor Charles Wheeldon Business development director Mike Griffin Advertising & event sales director Caroline Bowern Business development executive Kirsty Parks Sales manager Luke Crist Publisher Harry Hyman

We round up the latest big stories, including new building projects, the ongoing RAAC crisis, and the rollout of community diagnostic clinics across England

10-13 Policy

Political parties put health and care firmly on their agendas, the Chancellor reveals his Autumn Statement, and the NHS looks to cut waiting lists by offering patients the opportunity to travel for treatment

14-17 Finance and Property Deals

We look at the latest market transactions and explore the benefit of B Corps within the financial sector. There is also insight into the state of the healthcare property investment market and details of a new pay deal for health workers

Investor Publishing Ltd, 5th Floor, Greener House, 66-68 Haymarket, London, SW1Y 4RF Tel: 020 7104 2000 Website: www.healthcare-property.com Healthcare Property is published six times a year

by Investor Publishing Ltd. ISSN 3029-0627 © Investor Publishing Limited 2024 The views expressed in Healthcare Property are not necessarily those of the editor or publishers.

@HCprop linkedin.com/company/healthcare-property/

18 18-19 Market Analysis Interview

Harry Hyman, founder and chief executive of Primary Health Properties and publisher of Healthcare Property Magazine’s owner, Nexus Media Group, explores the delays to new healthcare projects being caused by intransigence on rental levels from the NHS

21-23 Market Analysis

Skills and labour shortages continue to impact healthcare construction activity, plus a new report from market analyst, Glenigan, predicts a rise in the number of healthcare projects over the next two years

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24-29 Building Design

Exploring the latest trends impacting the design of health and care buildings. Features include the latest guidance for mental health settings, lessons learned from the design of new psychiatric facilities at Alder Hey Children’s Hospital, and how we can harness the benefits of regenerative design for greater resiliency

30-32 Estates and Facilities Management

The role of smart technology in healthcare estates management and why chlorine is not the best cleaning solution for tackling superbugs

34-45 Environmental

The health sector continues its netzero carbon journey, with news of the latest projects and information on funding streams and the challenges and opportunities faced by the NHS and private providers

47 Interview

Fiona Halstead and Alison Cann of Barts Health NHS Trust reveal why clinical input is critical to successful building projects

50 People

Staffing and people news

JANUARY-FEBRUARY 2024 | 5

News

Backlog-busting CDC plan delivered ahead of schedule Government plans to open 160 NHS community diagnostic centres (CDCs) will be realised a year ahead of schedule, helping to address the crippling postCOVID patient backlog.

Backed by £2.3bn in capital funding, the centres are based in a variety of community settings including shopping centres, university campuses, and football stadiums, and offer patients a wide range of diagnostic tests closer to home, reducing the need for hospital visits.

The programme constitutes the largest central cash investment in MRI and CT scanning capacity in the history of the NHS and, combined, the centres have already delivered five million tests, checks, and scans.

So far, 127 hubs have opened — including 40 brought forward earlier than planned.

And, earlier this month, the Government announced three of the final locations in London, Sussex, and Yorkshire.

In a speech to the Independent Healthcare Providers Network last month, former Health and Social Care Secretary, Steve Barclay, announced the remaining centres would open by March, a year ahead of the original March 2025 target.

He said: “Patients deserve the highestquality care, and community diagnostic centres have been instrumental in speeding up the diagnosis of illnesses like cancer and heart disease to ensure patients are treated more quickly.

“I am delighted we will open 160 CDCs a year early, allowing greater access to hightech scans and diagnostics in communities across England.

“This has been made possible by using all capacity available to us and drawing on the independent sector — helping us to cut waiting lists, one of the Government’s top five priorities.”

The newly-announced hubs will be: • Queen Mary’s Sidcup CDC — Based in south-east London, the facility will offer CT, MRI, and ultrasound checks, along with blood tests, providing at least 58,000 additional checks • Halifax CDC — Based at Broad Street Plaza shopping centre, the CDC will offer ultrasound checks, blood tests, and heart scans — delivering at least 90,000 tests once fully operational • Chichester University CDC, Bognor Regis — This facility will offer CT and 6 | JANUARY-FEBRUARY 2024

Barking CDC

Southlands CDC. Crowther Associate Architects

Dorset Health Village. University Hospitals Dorset NHS Foundation Trust

MRI scans along with ultrasound checks and blood tests, delivering at least 18,000 additional tests once fully operational In total, 13 of the CDCs are led by the independent sector, with eight of these already operational.

There are a further 22 CDCs located on the NHS estate where the independent sector is providing diagnostic services.

They function like NHS-run CDCs, but by making use of the available capacity in the independent sector patients can access additional diagnostic capacity free at the point of need.

Alongside this, as the Prime Minister originally announced in May, hundreds

of thousands of NHS patients who have been waiting longer than 40 weeks for treatment will be offered the opportunity to travel to a different hospital as part of ambitious measures set out in the Elective Recovery Plan.

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News

REOPENS Work continues to rid HOSPITAL FOLLOWING FLOOD the NHS estate of RAAC The Government has reiterated its pledge to rid the NHS estate of high-risk reinforced autoclaved aerated concrete (RAAC) by 2035.

In an updated statement issued last month, a Department of Health and Social Care (DHSC) spokesperson said significant additional funding of £698m was being spent to put in place necessary remediation and failsafe measures.

RAAC is a highly-aerated, lightweight, concrete-based material, with different material properties to conventional concrete and was frequently used in public sector building construction in the UK from the mid-1950s to the mid-1990s, typically in precast panels in walls, roofs, and sometimes floors.

However, it is known to be more vulnerable to corrosion than reinforced concrete, with problems including high deflection, corrosion, and spalling, and, where there is a low-end bearing, the possibility of sudden collapse due to cracking.

And this corrosion can occur without visual indication that the panel is in poor condition.

The DHSC spokesman said: “The NHS has established a national programme to manage hospital buildings with confirmed reinforced autoclaved aerated concrete (RAAC), backed with significant additional funding from 2021-2025.

“We remain committed to eradicating RAAC from the NHS estate entirely by 2035 and our approach is in line with guidance from the Institution of Structural Engineers.”

Inspections have been carried out, with

a total of 42 NHS sites confirmed to have RAAC plank construction, according to the latest list published on gov.uk.

Through the national remediation programme, RAAC has already been completely eradicated in three of these sites.

In most identified cases, RAAC has been found in limited parts of a building.

However, seven of these hospitals need a full replacement and will be rebuilt by 2030 through the Government’s £3.7bn New Hospital Programme (NHP). These are Airedale, Queen Elizabeth King’s Lynn, Hinchingbrooke, Mid Cheshire Leighton, Frimley Park, West Suffolk, and James Paget hospitals.

For the other facilities, the Institution of Structural Engineers has published guidance on remediation and management strategies.

The approach will differ depending on the assessment of risk, but includes secondary supports or beams for the highest risk to inspection regimes for lower risk areas.

Doncaster and Bassetlaw Teaching Hospitals (DBTH) was the first acute NHS provider in the country to successfully eradicate RAAC from its sites.

Following extensive surveys, it was found that the RAAC panels installed at Bassetlaw Hospital were in very good condition. However, they still had to be replaced as part of the national initiative.

As such, the trust received funding of £15.944m to replace the affected roofs by early to mid-2023.

The significant replacement works, undertaken in partnership with contractor, Integrated Health Projects (IHP), required theatres to be relocated into three temporary modular units which were placed in the existing car park outside the site’s clinical therapies department, with a link corridor into the main building.

And, throughout the project, theatre services on the Worksop site remained fully operational.

Dr Kirsty Edmondson Jones, director of innovation and infrastructure at the trust, said: “The removal of RAAC from Bassetlaw Hospital is a testament to our unwavering dedication to ensuring the safety and wellbeing of our patients, staff, and visitors.

“This achievement underscores our commitment to providing the highest quality of care in buildings which are fit for purpose.”

A three-year, £110m RAAC removal programme is also underway at The Queen Elizabeth Hospital King’s Lynn in Norfolk.

Led by Exi Group, the programme consists of enabling works and the relocation of existing users from proposed works areas; failsafe works to the underside of roof planks; wall protection works to vertical load-bearing RAAC planks; roof protection works; and statutory compliance works.

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Repair work has been completed following a severe flood in the basement of the women and children’s unit at Blackpool Victoria Hospital. The flood, on 6 November, which caused a power and network outage throughout the building, led to the declaration of a ‘level 2 major incident’ by Blackpool Teaching Hospitals NHS Foundation Trust, with patients being evacuated. As a result, some elective surgery procedures and outpatient appointments were rescheduled. But, in an update, the trust’s deputy chief executive, Steve Christian, said the critical incident had been formally ‘stood down’.

BUILDING WORK COMPLETES ON MENTAL HEALTH UNITS

Work has been completed on the construction of specialist new mental health facilities at Alder Hey Children’s Hospital in Liverpool. The Catkin Centre and Sunflower House project for Alder Hey NHS Foundation Trust was designed

by Cullinan Studio and delivered by 10architect. Procured through a RIBA competition, the development brings services for children and young adults together in two connected buildings.

And the design approach embraces a therapeutic principle, with places for refuge and outlook gathered around courtyard gardens, with strong connections to natural materials.

SEVEN-DAY ENDOSCOPY UNIT REDUCES WAITING TIMES A new purpose-built endoscopy unit has

opened its doors to patients at the Royal Gwent Hospital. The facility includes four operating theatres, a range of treatment rooms, a spacious recovery area, and a dedicated space for relatives. The enhanced unit will now offer endoscopy services seven days a week and will significantly improve quality, safety, and patient experience by doubling capacity, helping to reduce waiting times and length of stay for inpatients. The unit was designed by architects, BDP, and built by contractor, Lancer Scott.

JANUARY-FEBRUARY 2024 | 7

News

TOPPING-OUT CEREMONY MARKS MILESTONE

A traditional topping-out ceremony has been held at the site of the new emergency department at the Great Western Hospital in Swindon.

Hospital trust chief executive, Kevin McNamara, joined staff, supporters, and representatives from main contractor, Integrated Health Projects, on the roof of the £31m extension to mark the completion of the main structure. Once completed, the 1,492sq m extension will include a new children’s emergency unit, same-day emergency care and joint initial assessment unit, and will improve links between all sections of the department and the new urgent treatment centre.

GREEN LIGHT FOR FLAGSHIP PATHOLOGY UNIT

Cornwall Hospitals NHS Trust has been granted full planning permission for a new pathology building at the Royal Cornwall Hospital site in Truro. The development is the largest and mostcomplex of all the ‘enabling’ schemes that will facilitate the construction of the new Women and Children’s Hospital for Cornwall and the Isles of Scilly. Located next to the current microbiology building and opposite the Trelawny Wing Main Entrance, construction work is due to begin next summer, enabling the reprovision of pathology services and supporting improvements in both the patient and staff experience.

MENTAL HEALTH HOSPITALS TO OPEN NEXT YEAR

Two new emergency adult mental health services are set to open in the West Midlands next year. Cygnet Hospital Oldbury and Cygnet Hospital Wolverhampton, to be operated by Cygnet Group, are two purpose-built units currently under construction. They will offer psychiatric intensive care and acute mental health services for adults, with female services located at Oldbury and male services at Wolverhampton.

Facilities will include gardens, ensuite bedrooms, therapy rooms, multifaith rooms, a gym, treatment rooms, communal lounges, dining rooms, quiet lounges, and meeting rooms.

8 | JANUARY-FEBRUARY 2024

Offsite construction methods speed up project delivery Portakabin has delivered its first modular mental health facility in the North East.

The permanent building, commissioned by Tees, Esk and Wear Valleys NHS Foundation Trust, will house consultation and treatment rooms for community mental health and crisis teams ifrom across Stockton-on-Tees and is the first of its kind in the region.

Using Modern Methods of Construction (MMC), 25 modules were precision engineered and constructed at the Portakabin manufacturing facility in York and transported to the site in Durham Road in Stockton-on-Tees to create Brook House.

The unit brings some of the trust’s community adult mental health services onto one site, helping them work more closely together and providing a modern and improved environment for staff and patients.

It will also be home to the trust’s north intensive home treatment team (IHT).

James Pearson, divisional managing director for Portakabin, said: “It is incredibly important to us to be able to keep disruption to an absolute minimum for busy healthcare providers and part of this is being able to achieve up to 70% of the final fit-out in our factory before it reaches our customer.

“That means far fewer workers and materials travelling to and from a construction site and a much-faster handover of buildings.”

Portakabin worked within fixed cost parameters to generate as much usable office and consultation space as possible for the clinical teams and had to work to a challenging programme to meet the trust’s deadlines.

Patients and staff now benefit from clinical space, consultation rooms, a welcoming reception area, openplan and cellular offices, a kitchenette, and amenities.

Externally, the building ties in with the rest of the existing estate and is complete with a small section of feature external finishing.

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News

Reconfiguration project marks record capital investment

Construction work has begun at Mount Gould Local Care Centre (LCC) in Plymouth to reconfigure the space to house the Plym Neuro Rehabilitation Service.

At present the service is delivered from the neighbouring NHS Property Services-owned facility located on the Mount Gould Hospital estate, a few minutes away from the Mount Gould LCC. Its current home at the Plym Neuro Rehab Unit is a 15-bed inpatient facility for adults with acquired brain injuries, spinal cord injuries, and other neurological conditions and it has been operating from the site for 18 years.

Mount Gould LCC opened in 2006 and currently delivers a range of healthcare services, providing both inpatient rehabilitation and outpatient services.

This £6.9m project will reconfigure existing space to allow for the relocation of the Plym Neuro Service into a new, modern, and fit-for-purpose healthcare facility.

The new building will also be able to deliver additional appointments, benefiting local and regional patients.

The reconfiguration works will be Community Health Partnerships’ (CHP) biggest capital-funded variation to date HEALTHCARE-PROPERTY.COM

and, once complete, the relocation of the Plym Neuro Service will complement existing services currently delivered from the site, allowing for a ‘one stop shop’.

Through collaborative working with both NHS and private partners, including CHP, ReSound Health, gbpartnerships, NHS Property Services (NHS PS), LiveWell, University Hospitals Plymouth NHS Trust and NHS England, the project will be undertaken through several reconfiguration stages, including: • Reconfiguration and refurbishment of the current NHS PS-owned Beauchamp Centre to internally relocate some services and to accommodate services displaced from Mount Gould LCC. The refurbishment contracts totalling £2.95m were completed in the spring of 2023 and were capital funded by NHSPS • Relocation of podiatry and orthotics services from Mount Gould LCC to the Beauchamp Centre to free up the relevant space for the Plym Neuro service and to allow works to the LCC to commence • The £6.9m major reconfiguration of Mount Gould LCC to accommodate the relocated Plym Neuro service, due for completion in the spring of 2025 Simon Waters, regional director for the South at CHP, said: “CHP is committed to ensuring our NHS estate continues to make a valuable contribution to the delivery of modern health services in local communities and our buildings are positioned as core assets to support this delivery.

“Once complete, the new Plym Neuro Service will be a prime exemplar of this.”

The project is set to complete in early 2025 and scheduled to open to patients in April 2025.

EMERGENCY DEPARTMENT OVERHAUL NEARS COMPLETION

The latest phase of a multi-millionpound refurbishment of the emergency department at the Queen Elizabeth The Queen Mother Hospital in Margate is complete. Phase 3a involved rebuilding the existing resuscitation unit to provide five bays. Other upgrades include a new commercial kitchen, storage spaces, accessible toilets, and clean and dirty utility areas. A new ambulance road has also been completed to provide direct access for emergency vehicles to the new emergency department entrance.

This phase is the latest improvement to the department, which has also seen major redevelopment of the majors and paediatric areas. The next and final phase will see two additional cubicles, a relatives’ room, and point-of-care-testing facilities created. Final completion is due early next year. The project has been delivered by contractor, WW Martin, and HMY Architects.

FIRST PATIENTS TREATED IN NEW RADIOTHERAPY UNIT

A new radiotherapy department has opened to patients at Leicester Royal Infirmary. Contractor, G F Tomlinson, completed work on the extension earlier in the summer, with the new, larger building housing the latest equipment, alongside comfortable waiting areas and pleasant office spaces for staff.

Commissioned by University Hospitals of Leicester NHS Trust, the works involved a significant extension to the existing department, housing a radiotherapy bunker, control room and plant room, and an ancillary accommodation block, both of which connect to the existing Osborne Building via link corridors. As part of the project’s green credentials, 32 solar panels were installed on the roof to provide power to the facility, alongside air source heat pumps for efficient heating and cooling through the building.

JANUARY-FEBRUARY 2024 | 9

Policy

The next General Election must be called by 28 January 2025

Lib Dem leader, Ed Davey, addresses the 2023 party conference. Credit Dinendra Haria

Health is high on the political agenda With a General Election looming over the next year, the health and care sector will be key to the success of all parties’ campaigns

T

he King’s Speech on 7 November included measures such as tackling smoking by raising the age of sale for tobacco products as well as reiterating the Government’s intention to implement the NHS Long-Term Workforce Plan.

King Charles also said the Government would deliver plans to cut waiting lists and outlined a proposal to implement minimum service levels to prevent strikes from undermining patient safety.

However, beyond this, there was little mention of health and social care services, with the speech instead focusing on growing the economy, strengthening society, and reducing crime.

In particular, critics have cited the failure to mention the long-awaited Mental Health Act reforms and a proposed ban on conversion therapy.

But all this is set to change as the main political parties look ahead to the next General Election, which must be held before 28 January 2025, but is more than likely to be called towards the latter half of next year.

10 | JANUARY-FEBRUARY 2024

WINNING VOTES Traditionally, the NHS is one of the key areas of focus for election manifestos, with all political parties promising to improve services and address inequalities and failures

with the hope of winning over voters.

And, having recently held their annual party conferences, all the main political parties spoke of their plans for health and social care.

In his speech, the current Prime Minister, Rishi Sunak, announced his commitment to ban the sale of cigarettes to anyone born on or after 1 January 2009, essentially creating a phased ban on smoking.

This move would be a landmark moment for health, with YouGov polling revealing support from 63% of the public and widespread approval from public health chiefs.

Chancellor, Jeremy Hunt, also announced a review into why so many public sector staff, including doctors and nurses, spend a significant chunk of their time dealing with admin tasks.

And the then Health and Social Care Secretary, Steve Barclay, set out plans to move resource away from ‘the back office’ to the frontline.

Another theme from the Conservative conference was gender and trans rights, with plans to reverse guidance allowing trans people to be placed on hospital wards according to the gender they identify as.

The Conservatives have committed to banning the sale of cigarettes to anyone born on or after 1 January 2009. Martin Büdenbender from Pixabay

HEALTHCARE-PROPERTY.COM

Policy

Daisy Cooper, the Lib Dem spokesperson for health and social care, sets out the party’s plans for health and social care. Credit Dinendra Haria

INTEGRATING HEALTH AND SOCIAL CARE For the Lib Dems, the Mental Health Act reforms are a key commitment, as well as a £5bn-a-year free social care plan.

The policy would increase access to statefunded care at a time when people’s need is higher than ever.

And it would allow social care services to better integrate with the NHS. The Lib Dem conference also agreed to a raft of measures to boost public health, including restricting junk food advertising, increasing funding for council public health teams, and making it easier for people to have their blood pressure checked.

REFORM TO SURVIVE For Labour, the buzzword was ‘reform’, with the Shadow Secretary of State for Health and Social Care, Wes Streeting, using the phrases ‘modernise or die’ and ‘reform to survive’.

The party outlined plans to rebalance

the focus of the NHS away from hospitals towards primary and community services, with greater emphasis on preventing illness.

The party also announced plans for more and better CT and MRI scanners, increased out-of-hours working to deal with the elective care waiting list, and policies to improve and overhaul NHS dentistry.

A GREEN FUTURE And the Green Party has outlined a 10-point plan aimed at delivering a ‘fairer and greener’ country.

This includes increasing public health spending by £1.4bn, increasing NHS spending by £8bn to ensure staff get an inflation-matching pay award, and increasing access to NHS dentistry by raising the level of spend by 50%.

Commenting on the manifestos, Andrew McCracken of health think tank, The King’s Fund, said: “With a general election expected in 2024, the political party conferences were an opportunity for the

Both Labour and the Green Party have announced plans to overhaul NHS dentistry services. Image by Michal Jarmoluk from Pixabay

HEALTHCARE-PROPERTY.COM

…the NHS consistently ranks in the top three public concerns, so it was no surprise that each of the parties had health high on their agenda parties to make their pitch to voters.

“According to polling by Ipsos, the NHS consistently ranks in the top three public concerns, so it was no surprise that each of the main parties had health high on their agenda.”

FIRING THE STARTING GUN But he added: “As well as listening to the various policy announcements, it is interesting to note what wasn’t said at the party conferences.

“Neither Labour or Conservatives had much to say about the desperately-needed and long-overdue reform of adult social care services.

“Labour, like the Liberal Democrats, committed to increasing the pay of care workers, but neither Labour nor the Conservatives set out any detail on wider reform of social care.

“For all the future-focused policies heard at the conferences, it’s clear there are some immediate and pressing health and care challenges that will be on voters’ minds.

“The starting gun has been fired, the election campaign is under way, and health will remain high on the agenda.” n

The starting gun has been fired, the election campaign is under way, and health will remain high on the agenda.

JANUARY-FEBRUARY 2024 | 11

Policy

Patients offered the choice to travel for treatment Hundreds of thousands of NHS patients who have been waiting the longest for treatment will be offered the opportunity to travel to a different hospital.

Under government plans, announced last month, any patient who has been waiting longer than 40 weeks and does not have an appointment within the next eight weeks will be contacted by their hospital via letter, text, or email.

As part of the ambitious NHS Elective Recovery Plan, offers will be sent to up to 400,000 eligible patients who will then be able to submit their details, including how far they are willing to travel — 50 miles, 100 miles, or nationally.

NHS teams can then identify whether any alternative hospitals have capacity to see them sooner.

In some instances, the patient’s request will be uploaded to the NHS’s innovative hospital matching platform — the Digital Mutual Aid System — to see if NHS or independent sector providers elsewhere in the country can take on their care.

Amanda Pritchard, NHS chief executive, said: “Despite pressure and the huge disruption caused by strikes, NHS staff have made great progress in reducing the longest waits for patients — and this is just another example of how we are introducing new approaches to reduce how long patients

Under the new proposals, patients who have been waiting for over 40 weeks will be able to seek treatment at another hospital. Image, Sasin Tipchai from Pixabay

wait, while improving the choice and control they have over their own care.

“Giving this extra option to these patients also demonstrates the clear benefits of a single national health service, with staff able to share capacity right across the country.”

It is estimated that approximately 400,000 patients — 5% of the overall waiting list — will meet the criteria.

If no alternative hospital is found within eight weeks of starting the process, the patient will remain with their current provider and keep their position on the

waiting list.

Some patients will not be eligible if their clinical condition is too complex, making it inappropriate to travel.

Responding to the announcement, Louise Ansari of patient watchdog, Healthwatch England, said: “Long waits are having a devastating impact on both the physical and mental health of people.

“People have also told us that they would welcome the opportunity to travel to receive care more quickly, as long as any additional costs incurred would be covered.”

Lib Dems demand introduction of bill to speed up delivery of New Hospital Programme Lib Dem leader, Ed Davey, is calling for the introduction of a ‘Hospital Construction and Repairs Bill’, which would force the Government to deliver on its 2019 manifesto pledge to build 40 new hospitals by 2030 by creating a legally-binding target date.

It comes as, according to a Lib Dem Freedom of Information (FOI) request, NHS trusts up and down the country have either yet to receive the promised funding, or have received less than 10% of the projected costs to build the new hospitals.

Trusts which have yet to receive capital include Hampshire Hospitals NHS Foundation Trust and the Royal Berkshire NHS Foundation Trust.

And Nottingham University Hospitals NHS Trust, Dorset County Hospital NHS Foundation Trust, James Paget University Hospitals NHS Foundation Trust, The Royal Cornwall Hospital Trust, West Suffolk NHS Foundation Trust, University Hospitals Sussex NHS Foundation Trust, and Milton Keynes Hospital NHS Trust are

12 | JANUARY-FEBRUARY 2024

among those organisation that have received less than a tenth of their outstanding project costs, according to the FOI data.

The findings follow figures which show the backlog maintenance bill across NHS hospitals now stands at over £10bn.

And they come after an earlier Lib Dem report found that just a quarter of the 40 new hospitals have received planning permission.

Davey said: “NHS trusts have been left without any funding whatsoever as the walls fall around them.

“This is a national scandal.

“Ministers must introduce a Hospital Construction and Repairs Bill to finally make good on their new hospitals promise and ensure patients and staff are safe.

“We are left with hospital wards being drenched in sewage, becoming roasting infernos in heat waves, and more often than not, becoming overcrowded and in unacceptable condition. This isn’t good enough.”

HEALTHCARE-PROPERTY.COM

Policy

A ‘rocky road’ for health and care services as Chancellor’s budget falls short The road ahead for the health and care sector looks ‘decidedly rocky’, according to industry leaders after the Chancellor’s recent Autumn Statement offered little in the way of additional funding or a longterm vision for recovery of services.

In his budget announcement last month, Jeremy Hunt announced that between 2023/24 and 2024/25, under current plans, NHS England’s budget will only crawl up from £161.1bn to £162.5bn in cash terms — i.e before factoring in inflation.

And day-to-day spending is now planned to be some £3.4bn lower in 2024/25 compared to the Spring Budget 2023, according to experts at health think tank, The King’s Fund.

IT’S GOOD TO TALK Improvements to health and care announced during his speech broadly fell into two categories — more support to tackle mental and physical illness to help people back into work, and investment to boost healthcare innovation.

There were new funding commitments to expand Talking Therapies — an NHS England programme to support people with mild and moderate mental health conditions — plans to expand employment support services within community mental health teams to help people gain and retain paid employment; and proposals to embed employment support within mental health and musculoskeletal services in England.

There was also a commitment to publish a health and disability White Paper.

But, alongside this increased support, there was also the hotly-debated threat to remove free prescriptions for those the government describe as ‘people who should be looking for work but aren’t’.

INNOVATION BOOST On boosting innovation in healthcare, the Chancellor announced a new West Yorkshire investment zone with a focus on life sciences; and £5m seed funding for a new Fleming Centre to help tackle antimicrobial resistance.

And Hunt reiterated the desire to improve the UK’s ability to support commercial clinical research trials and provided HEALTHCARE-PROPERTY.COM

The Prime Minister chairs a cabinet meeting before the Chancellor’s Autumn Statement. Photo credit: Simon Walker/No 10 Downing Street.

slightly more than £50m for the Our Future Health genotyping programme, as well as announcing a freeze on alcohol duty; a rise on duty rates on tobacco products; and a rise in the National Living Wage from 2024.

But what does all this mean?

Siva Anandaciva, chief analyst in The King’s Fund’s policy team, said: “Overall, the budget documents had relatively little new to say on health and care spending and are instead replete with references to the Autumn Statement 2022, when there were more-significant funding announcements for health and social care.

UNDER PRESSURE “From what I can see, the path ahead for health spending looks decidedly rocky.

“Overall health spending growth is starting to stall in real terms and higher economywide inflation has further eroded substantial amounts from the cash boosts awarded to health and care services in last year’s Autumn Statement — essentially, the cash announced in 2022 will not go as far.”

He added: “Public sector pay awards have a clear impact on NHS England’s spending pressures and until those are set for 2024/25 it is hard to anticipate just how large NHS England’s budget should be.

“But few would believe it is possible for the NHS to stick to its putative 2024/25 budget without significant cuts to the scope and quality of services for patients.

“And, even if the 2024/25 spending plans are untenably low, until there is something else on the table they will have to form the basis of NHS operational and financial planning for the coming year.

“So, even if these budgets are topped-up in the fullness of time, in the interim NHS leaders can expect the usual unproductive industry of submitting, revising, and resubmitting plans to begin.”

POOR DECISIONS And he warned that, with local authorities going bust and directors of adult social services saying they cannot meet their statutory duties, there are fears they may not be able to balance the books.

He said: “No one knows what the future course of industrial action may look like, or what its financial implications will be.

“But, by not investing more in health and care services now, the Government is taking a substantial bet that it may rue when organisations lay their accounts next year and reveal potentially large and embarrassing overspends.”

Instead, he argued, the Government needs a more-long-term approach, saying: “It is starting to feel like incoherency and a lack of strategy represent ‘path dependency’ for health and care funding announcements — where decisions for the future are constrained by the poor decisions of today and the past.”

JANUARY-FEBRUARY 2024 | 13

Finance and Property Deals

Funding supports pay deal for non-NHS health workers Eligible healthcare staff at non-NHS organisations such as charities, local authorities, or social enterprises will benefit from government funding to cover the cost of their one-off payments as part of the NHS pay award, worth at least £1,655 each.

It comes after the NHS pay deal, agreed between the Government and unions in May, saw over one million staff including nurses, paramedics, and 999 call handlers receive a 5% pay rise for 2023 to 2024, backdated to April, alongside two one-off payments worth between £1,655-£3,789 for full-time staff.

The Government has now agreed to provide additional funding for organisations with contracts to deliver NHS services, who employ their staff on dynamically-linked Agenda for Change contracts.

While these staff are contractually eligible for the payments, the independent organisations employing them are responsible for making them.

The Department of Health and Social Care has, however, responded to concerns around providing the payments in the current economic circumstances and will make funding available to help deliver them.

Health Minister, Will Quince, said: “This will ensure hardworking healthcare staff and the organisations they work for are not financially disadvantaged as a result of the NHS pay deal, and means they will receive their backlog bonus for their efforts during the pandemic.

“Organisations will be able to apply for the funding and will need to show they have been negatively financially impacted by the pay deal, and that their staff are employed on dynamically-linked Agenda for Change contracts.

“Many organisations have already delivered the one-off payments to staff, but can apply to be reimbursed to ensure there is no impact on vital frontline services.”

The scheme, which will be funded from existing departmental budgets, will open in the coming weeks, and is expected to be completed by the end of the 2023-2024 financial year.

As a result of the pay award, a newlyqualified nurse has seen their salary go up by more than £2,750 over the two years from 2021-2022 and 2023-2024, alongside over £1,890 in one-off payments this year.

Non-NHS organisations commissioned by 14 | JANUARY-FEBRUARY 2024

Healthcare staff not directly employed by NHS trusts will also receive a one-off payment. Image by Fernando Shiminaicela from Pixabay

the NHS have, where eligible, already been funded for the consolidated 5% uplift under the terms of existing contracts.

Responding to the announcement, Miriam Deakin, director of policy and strategy at NHS Providers, a membership organisation which represents NHS organisations, said: “Leaders across the NHS will welcome wholeheartedly the news that eligible healthcare staff providing vital health and care services through social enterprises, charities, and community interest companies will receive the one-off payment as part of this year’s pay award.

“These staff make a vital contribution to delivering frontline patient care and at a time when cost of living pressures continue to bite, it is positive that this discrepancy is finally being addressed.

“It is essential now that the process for applying for this funding is as straightforward as possible and that where organisations have delivered the one-off payments to staff already the reimbursement process is equally streamlined to minimise the impact on vital frontline services.”

Matthew Taylor, chief executive of the NHS Confederation, which represents providers from across England, Wales, and Northern Ireland, added: “This is a very-welcome intervention from the Government, and one that recognises some of our members’

concerns that excluding non-statutory providers from eligibility for central funding of the recent pay rise would threaten the ability of many to continue delivering vital health and care services.

“This extra funding will help provide some welcome certainty over the next year.”

But he warned that it was only a ‘one-off short-term financial boost’ and called for a longer-term solution.

“While grateful, our members will question what they are meant to do in subsequent years”, he said.

“Longer-term thinking and funding will be required to ensure that healthcare providers can continue to attract and retain the staff needed to meet the increasing demand for services.

“The fact that this one-off funding comes from the existing Department of Health and Social Care budget suggests that this may come at a cost elsewhere in the health service, and health leaders are clear that robbing Peter to pay Paul does the service no favours in the long run.

“While we are pleased that our calls have been heard, and grateful that a short-term solution has been found for non-statutory providers, we are clear that the problem is only partially tackled and will need funding for future years to be found outside of existing budgets.”

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Finance and Property Deals

CARE HOME BUYOUT PROTECTS JOBS More than 250 jobs have been safeguarded at three North East care homes following a multi-million-pound deal by Malhotra Group Plc. The Newcastle property, care, and leisure company says it plans to plough significant investment into the trio of homes — which were formerly part of Four Seasons Healthcare — based in Howdon, Morpeth, and Blyth.

The value of the deal has not been disclosed and the newly-acquired homes have now been renamed, forming part of Malhotra’s Lifestyle Care brand.

The company, which owns 15 homes across the North East through its Prestwick Care brand, said the deal saved 257 jobs, but crucially secures 217 critical care beds across the region, offering both residential and nursing care, while protecting community resources.

Care home sale completed Christie & Co has completed the freehold sale of Burlington Nursing Home in Bognor Regis, West Sussex.

Burlington Nursing Home is registered for 40 service users in 36 rooms, of which 21 have ensuite facilities.

The home comprises two attached properties which have been extended and upgraded over the years, as well as a large garden with secure outdoor space.

The business has been owned by Carey Jamison since 2007 and was recently brought to market to allow her to pursue other business interests.

Following a confidential sales process with Charles Phillips at Christie & Co, it has now been purchased by Prime Care Ltd — an established nursing agency that places professionals in nursing and care jobs in and around the Sussex, Surrey, and Staffordshire regions.

The company also owns two care homes in the region, with this acquisition taking it to three.

Jamison said: “When I bought the business through Charles, this was my first care home and venture into the sector.

“It was a steep learning curve and, although there have been challenges along HEALTHCARE-PROPERTY.COM

the way, I have enjoyed the time I have had at Burlington and have taken the decision to sell as I want to pursue other interests and feel now is a good time to be handing over the business to a new owner.”

Rojimon Varughese, director at Prime Care Ltd, added: “Having been involved in the domiciliary care sector since 2014, and also owning two care homes in the south, I was keen to expand, and Burlington Nursing Home appealed greatly to me.

“The home has a good reputation in the area and a dedicated team of staff, who I am looking forward to getting to know and work with.”

And Charles Phillips, director of healthcare at Christie & Co, said: “Having sold the business to Carey back in 2007, it was a pleasure to be asked by her to act as the agent when she decided to sell.

“The home attracted a good deal of interest from first-time buyers, existing operators, and investors due to the number of registrations and performance.

“This is a good business in the popular coastal town of Bognor Regis and is the third care home completion we have had in the town in the last five weeks.”

Burlington Nursing Home was sold for an undisclosed price.

PROPERTY FUNDS SUPPORT HEALTH INFRASTRUCTURE

Blackfinch Group has introduced two new infrastructure and property funds — the IFSL Blackfinch NextGen Infrastructure and IFSL Blackfinch NextGen Property Securities funds.

Both will have a minimum of 75% of holdings within developed markets and will look for companies under the umbrella of digitalisation, energy transition, and sustainable urbanisation, including energy storage and renewable energy generation, healthcare infrastructure, and sustainable waste disposal.

PRIVATE FUNDING OFFERS LIFELINE

Private developer, Citybranch, has offered to forward fund the construction of a long-awaited new health and wellbeing hub in Knutsford, Cheshire.

If approved, the £15m facility would be let to the NHS on a 30-year lease, with the agreement enabling the NHS to acquire the freehold interest for £1 at the end of the term.

The offer comes after 15 years of lobbying to improve facilities for doctors currently working out of four outdated surgeries.

A decision is expected to be made early in the new year.

JANUARY-FEBRUARY 2024 | 15

Finance and Property Deals

Benefiting from trust and transparency Exploring the role of benefit corporations within the property investment market

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osses at a leading healthcare property investor are calling for an increase in the creation of benefit corporations — or B Corps — within the financial services industry.

Octopus Investments is the largest manager of Venture Capital Trusts and investments, helping to build care homes, retirement communities, and other healthcare facilities across the country.

And, in 2021, the company became a B Corp — a certification measuring an organisation’s overall social and environmental performance.

Benjamin Davis, chief executive of Octopus Investments, said: “B Corp certification requires a company to meet the highest standards of social and environmental consideration, transparency, and accountability, to balance profit and the impact they have.

“The movement should feel especially relevant for financial services, where trust and transparency are integral.

“Whether you’re a financial adviser guiding a client through an economic downturn, an institutional investor committing capital to a fund, or an investor investing through a platform, the whole industry relies on trust.

“Yet trust and transparency have not always been associated with our industry.

In fact, I often see financial services ranked among the least-trusted industries by consumers globally.

“This is something we should strive to change and is why we should be encouraging frameworks like B Corp to drive better, more-transparent business.”

He added: “I have been at Octopus for 12 years and I can say with confidence that becoming a B Corp in 2021 was one of the best decisions we have made in our 23-year history.

“We have always known that people want to buy from, and work for, companies that out-behave and do the right thing, even when no one is watching, so becoming a B Corp was another important step for us in building a trustworthy business that makes decisions by considering all of its stakeholders.”

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The qualification and certification process took the company two years and has changed the way it operates.

Davis explains: “In every decision we look at how we can serve our shareholders, employees, customers, the environment, and the broader community.

“It’s a powerful framework that’s legally cemented into our business as we changed our Articles of Association to ensure we must consider the interests of all our stakeholders when making decisions.

“And we use that framework to help us continue to do the right thing when we set objectives, run the day-to-day business, and report on progress.”

Examples of the impact of the certification include: • Shareholders — the company produces a comprehensive, publicly-available annual report, despite there being no obligation to do so as a privately-owned company • Employees — Diversity and inclusion targets build a more inclusive workforce and place renewed focus on training and education • Customers — The company continues to provide a best-in-class service, with financial advisers voting it five stars for service nine years in a row at the

Financial Adviser Service Awards • Environment — A net zero carbon emissions target has been set to track emissions every year • Community — Volunteering is actively encouraged among employees and more than £1.5m has been donated through the foundation, Octopus Giving Davis said: “Financial services is an industry that influences society, both in terms of customers and in deciding where money is directed and how effectively it is used.

“The industry has an enormous impact on people’s lives and the planet, and consequently we have a duty to people and the planet.

“B Corp is an ideal framework to develop trust and we are looking forward to growing the ground swell of support for better business.” n HEALTHCARE-PROPERTY.COM

Finance and Property Deals

Shoots of light for healthcare property investment This article explores the current state of the healthcare property market and why as it matures as a sector it is becoming more attractive to investors

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he healthcare property investment market, like other commercial property markets, has seen a downturn over the past 12 months, driven principally by inflationary pressures and subsequent interest rate rises since the mini budget in September 2022.

However, according to experts at commercial real estate and investment specialist, Colliers, there is a growing appetite from global capital funds to explore the sector moving forwards.

In particular, the care home market is attracting interest, according to Colliers’ Healthcare Market Snapshot for the third quarter of 2023.

Speaking to Healthcare Property, Richard Harris, director and head of healthcare capital markets at Colliers, said: “For the past 12-18 months, there have been capital restrictions due Richard Harris to wider market activity and this slowed everything down.

“But we are now in a position where we are seeing shoots of light in terms of new investors from the UK and overseas — including Adam Lenton the US, Europe and the Far East — who are seeing value in the market.”

On the attraction of investors to the

Transaction volumes are notably down on previous years, with openly available stock limited, but there is growing appetite from global capital to explore the healthcare sector

social care sector in particular, Adam Lenton, Colliers’ director and head of healthcare valuation and advisory, added: “With an aging population, and the subsequent acute illnesses that come with this, there is increasing demand for care-based property advice and investment across private and NHS providers.

A LIGHT TOUCH “There are as many care homes closing as there are opening, so there is a strong case within real estate to develop high-quality, purpose-built facilities.

“We have also seen significant capital interest in the senior living/retirement sectors, which are designed with a ‘light touch’ care element on site.”

The NHS waiting list crisis is also

Colliers’ latest Healthcare Market Snapshot reveals shoots of light as new investors move in from overseas

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attracting attention, with Harris reporting an emerging market among property investors for high-acuity facilities including neuro and rehabilitation services.

“Over the past decade, the pool of investor interest in care homes has grown significantly, with specialist funds such as Octopus, Target, and Impact being joined by mainstream institutional investors”, he said.

“There is still a degree of nervousness around ‘reputational risk’ which is less prevalent than in core sectors such as offices, but as the market continues to mature, and lease structures become aligned to that risk , investors generally are more relaxed.”

TICKING BOXES He adds: “Healthcare has really matured as a sector and is noticeably on the agenda of the majority of funds now.

“It provides a long-term, secure income for investors and ‘ticks the ESG box’, which is a real attraction.”

“With yields moving out over the last 12 months, we are seeing engagement from new investors who see this as a window of opportunity to acquire good-quality assets while the specialist healthcare REITs have capital restrictions.

“Despite the recent fall in capital values, there is still an imbalance between supply and demand of good-quality real estate and, as such, we predict yields will recover at a faster pace than some of the other real estate sectors.” n JANUARY-FEBRUARY 2024 | 17

Finance and Property Deals

Healthcare premises investment stalls Harry Hyman, founder and chief executive of Primary Health Properties and publisher of Healthcare Property Magazine’s owner, Nexus Media Group, explores the delays to new healthcare projects being caused by intransigence on rental levels from the NHS

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rimary Health Properties PLC (PHP) is a FTSE 250-listed real estate investment trust (REIT).

Established for nearly 30 years, PHP is a long-term specialist investor in healthcare premises, with £2.8bn invested across 514 sets of premises in the UK and Ireland.

Approximately 70% of this portfolio is let to GP practices delivering services in primary care for the NHS and its Irish equivalent, with 20% let to NHS organisations delivering similar services.

Currently, 90% of the portfolio is in the UK and some six million people obtain healthcare services from PHP’s buildings Newly-formed Integrated Care Systems (ICSs) have a fundamental requirement to change models of care.

And, for every right clinical reason, appropriate services are being moved from secondary care to primary care.

That requirement is bolstered alongside the introduction of more than 29,000 direct patient care staff working in general practice — who are not GPs or nurses — since March 2019.

In many cases these dynamics, alongside an ageing, unfit, and inadequate primary care estate, result in a need for new primary care premises in order to realise commissioning intentions.

New primary care estate has to be paid for by capital and this is available from state and also from the private sector.

State capital is fundamentally restricted and subject to myriad competing priorities, including the New Hospital Programme and rectification of Reinforced Autoclaved Aerated Concrete (RAAC).

It is a matter of record that allocations of state capital to primary care are extremely low and the delivery of new primary care premises through state capital is minimal.

Private capital for new primary care premises is available through Third Party Development (3PD), a market that has been established for some 30 years.

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… in the last 12 months the delivery of new premises through 3PD has largely ground to a halt, with no immediate prospect of a resumption.

Under 3PD, the private developer draws on its own capital to deliver appropriate premises which are then let to either GP practices or members of the NHS ‘family’ under an institutionally-investable commercial lease, usually for a fixed period of 25 years.

The rent payable for the premises represents the developer’s annualised cost of delivering the building.

And this rent is agreed with the ICS,

which is advised by the District Valuer (DV) and revenue funded, either through premises reimbursement — where GP practices hold the lease — or direct by the NHS if an NHS body takes the lease.

Over the years 3PD has delivered a large number of purpose-built, modern, and flexible premises, with over 12 million patients — around 18% of the UK — now served through buildings owned by its main providers.

HEALTHCARE-PROPERTY.COM

Finance and Property Deals

However, in the last 12 months the delivery of new premises through 3PD has largely ground to a halt, with no immediate prospect of a resumption.

The reason delivery has failed is that the typical level of rent which is offered by the NHS is approximately 30% lower than it needs to be in order to allow schemes to be commercially viable.

As a result, private capital from 3PDs will not be made available for scheme delivery, instead pursuing acceptable returns in other sectors and territories.

Alongside the shortage of state capital, there is a very bleak prospect for delivery of new primary care premises, which are so essential for service change.

The situation for 3PD rents becomes even more frustrating on closer examination.

The cost of constructing new premises (materials and labour) has increased by approximately 60% over the last three years.

And, over the last 18 months, the Bank of England base rate has risen from 0.75% p.a. to 5.25% p.a as the market has returned to the norm of higher base rate not last seen since the 2007-08 Global Financial Crisis (GFC).

The rise in interest rates means the yield or rent multiplier on all commercial property, including primary care, also increases, which means the same amount of rent pays for less capital cost for the building. There is, therefore, significant rising cost and less ability to pay for it with a given level of rent.

ICSs use the DV to advise them on the level of rent for a new development and they do not value the rent on the cost of delivering the premises, but instead adopt historic rental ‘comparables’.

The DV’s methodology typically generates a rent which is about 30% less than the cost of delivering the premises in today’s climate of higher build and labour HEALTHCARE-PROPERTY.COM

costs and the cost of capital reverting to pre-GFC levels.

In some limited cases ICSs have chosen to increase the DV’s level of rent to enable developments to proceed. However, significantly more ICSs have chosen to follow the DV’s advice, meaning that developments are no longer viable and will not be delivered.

The rental tone in the sector as controlled by the DV has ensured, over the years, that rents have fallen in real terms and performed considerably worse than other alternative sectors like care homes and student housing.

And this has resulted in limited capital investment from 3PD in the UK as more-equitable returns can be achieved in other sectors. For example, we have seen specialist investors like Primary Health Properties invest over £200m into Irish primary care developments since 2016.

While primary care, and therefore the setting of rents for new primary care developments, is fully delegated from NHS England to ICSs, it is our understanding that NHS England continues to take an active role and advises ICSs that the level of rents for new developments must not exceed the DV’s valuation.

Adopting that advice means new schemes cannot come to fruition, thereby frustrating ICS commissioning objectives.

Research commissioned by PHP has shown that primary care rents can rise

Alongside the shortage of state capital, there is a very bleak prospect for delivery of new primary care premises, which are so essential for service change. ahead of inflation and remain relatively more affordable than other health sectors including local authority-funded elderly care homes, and considerably more affordable than the mainstream commercial sectors.

From a 3PD perspective there is fundamental demand for new premises from service commissioners.

In its recent Mission Statement for the NHS, the Labour Party is clear that primary care will play a very-significant role in modernising the NHS. Although in the minority, we are starting to see a handful of ICSs increase rents beyond DV assessment, in order to provide a suitable funding envelope.

PHP and other investors alike want to continue to invest in the sector, but require acceptance from commissioners and their advisers that the rental tone needs to be higher to enable modernisation of the primary care estate to meet current and future commissioning requirements. n

PHP and other investors alike want to continue to invest in the sector, but require acceptance from commissioners and their advisers that the rental tone needs to be higher to enable modernisation of the primary care estate to meet commissioning requirements.

JANUARY-FEBRUARY 2024 | 19

Market Analysis

A positive outlook for healthcare construction The latest Glenigan construction industry forecast predicts a rise in the number of healthcare projects over the next two years

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The report provides a forecast based on analysis of Glenigan’s database of current and planned construction projects across all sectors

he healthcare construction sector is expected to pick up over the next two years as delayed projects start on site and the upcoming General Election puts the NHS at the forefront of the political landscape.

According to Glenigan’s newly-released Construction Industry Forecast 20242025, health projects starts dropped by an estimated 15% in 2023 as NHS resources and management time were prioritised on addressing long waiting lists and resolving industrial unrest.

Nevertheless, the outlook for the health sector remains positive with NHS investment likely to be a high political priority and a 3.8% per year real-term growth rate in NHS capital funding set to support a rise in starts from 2024.

LOOKING AHEAD The report forecasts the value of underlying project starts for health developments with a construction value of less than £100m will reach £3.5bn in 2024 — an 11% increase on this year — and £3.55bn in 2025 — a further 2% rise.

The report states: “The Government has committed to a progressive long-term increase in NHS capital investment.

“The Spending Review in October 2021 allocated £32.2bn of capital funding to the Department of Health over the three years to 2024/25, including plans to upgrade over 70 hospitals by the end of the decade.

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“In 2019, the Government also announced plans for 40 ‘new’ hospitals by 2030. This was relaunched in May of this year as Hospital 2.0, an enlarged programme of 45 hospital projects, including five additional hospitals with a RAAC problem.

“However, progress to date has been slow, with a National Audit Office investigation finding that only 32 projects are likely to be completed by the end of the decade.

“To date, only seven projects have started on site, while 31 do not yet have full funding to start core building works, suggesting that they are unlikely to start during the forecast period.”

TOP PRIORITY However, the report adds: “Although project starts have fallen recently, the outlook for the health sector remains positive.

“NHS investment will be a top political priority in the run-up to next year’s General Election, and a 3.8% annual realterm growth rate in NHS capital funding is expected to support an increase in starts from 2024

This graph shows the value of underlying project starts in the health sector compared to other markets

The healthcare construction market is expected to grow over the next two years

The South East and East of England have seen the most activity

as the current frontline service delivery crisis eases.

“The increase in approvals this year is forecast to feed through as an 11% rise in project starts in 2024.

“Post-election, sector growth is forecast to moderate to 2% in 2025 as the new administration reviews spending programmes and priorities.” n JANUARY-FEBRUARY 2024 | 21

Market Analysis

Skills and labour shortages continue to impact healthcare construction T he UK construction industry is a crucial driver of economic growth and development.

However, it faces a series of challenges, with one of the most-pressing issues being the ongoing skills and labour shortage.

According to Currie & Brown’s UK Construction Market Outlook report — which tracks construction activity from the start of 2023 to date — 225,000 extra construction workers will be needed by 2027 to meet predicted demand.

Nick Gray, chief operating officer for the UK and Europe at Currie & Brown, said: “The national infrastructure pipeline is crucial to both the economic health of the UK, and improving the entire population’s quality of living through increased access to key services.

“Therefore, the predicted skills shortage revealed in this report should be seen as a wake-up call for the construction industry.

“Avoiding a cliff edge that threatens the delivery of key projects such as the New Hospital Programme will demand a collaborative effort on training from players across the industry.

“It will also need robust project management and continuous, close control of cost and risk.”

A key issue is an ageing workforce, with 35% of construction workers over the age of 50.

An exodus of EU workers post Brexit and during the COVID-19 pandemic has further exacerbated the problem.

One of the most-concerning trends, however, is the sharp rise in skills shortages, with plumbers, bricklayers, carpenters, and electricians among the trades experiencing the most-significant issues.

And one of the root causes of this is the decline in the number of completed construction apprenticeships, which since 2017/18 has fallen by around 11% annually.

Tim Balcon, chief executive of the Construction Industry Training Board, (CITB), said: “From building the homes the country needs, to constructing energy and transport infrastructure and retrofitting the built environment to help drive down HEALTHCARE-PROPERTY.COM

energy bills and meet net zero targets, the need to recruit and retain talent in the sector has arguably never been greater.

“To bolster industry’s resilience, CITB will strive to attract and train a diverse range of recruits for industry, equipping them with modern skills for rewarding construction careers and I look forward to working with and supporting industry and stakeholders in the challenging times that lay ahead.”

As well as creating new apprenticeships within the market, Currie & Brown’s report advises project teams to engage early with their contractors to ringfence skilled labour and expand their pool of supply partners.

It also suggests that part of the solution to

the problem could be delivered through the use of advanced technologies, such as AI, which will provide benefits through design, cost, and risk management, safety, and offsite construction innovations. n

Avoiding a cliff edge that threatens the delivery of key projects such as the New Hospital Programme will demand a collaborative effort on training from players across the industry.

JANUARY-FEBRUARY 2024 | 23

Building Design

New guidance sets the tone for the future of mental health settings NHS England has updated its design guidance for the development of medium and low-secure mental health facilities for both adults and children and young people.

Health Building Note 03-01 Supplement 1: Medium and low secure mental health facilities for adults; and Health Building Note 03-02 Supplement 1: Medium and low secure mental health facilities for children and young people were published last month and highlight best-practice approaches to the creation of more-therapeutic environments for psychiatric patients in acute facilities.

Informed by the Design in Mental Health Network, the Care Quality Commission, architects and contractors, and estates specialists, key recommendations include: • Providing ground-floor living

Photo: Kleiton Santos from Pixabay

accommodation where possible • Briefing and design should respond to the national service specifications around leastrestrictive environments • A careful balance between maintaining a therapeutic and psychologically-supportive environment within a safe and secure

facility, while protecting the safety and wellbeing of all building users • Designing services, not just buildings, informed by ‘experts by experience’ • Accessible accommodation and facilities which promote equality, choice, and inclusivity • Greater emphasis on supporting meaningful activity through a variety of spaces which are flexible and adaptable Hannah Chamberlain, chief executive of the Design in Mental Health Network, said: “Much work has been going on behind the scenes and we are delighted to be able to share these updates.

“We look forward to continuing our engagement with NHS England and articulating the standards of excellence that we all as a design community aspire to.”

Reducing ligature risk on psychiatric wards A new guidance document has been published aimed at reducing harm from ligatures in mental health wards and environments for people with learning disabilities.

Developed by members of the Mental Health and Learning Disability Nurse Directors Forum, experts by experience, and the Care Quality Commission (CQC); the guidance is aimed at staff who have responsibility for caring for patients, as well as those who assess and manage risk in the inpatient environment, and those responsible for buying, installing, and maintaining fixtures and fittings.

The built environment is one of five key factors that the guidance says should be considered when working to reduce harm from ligatures — the others being therapeutic engagement, staffing and skills, technology, and procurement.

The detailed section on the built environment focuses on minimising harm associated with the use of ligatures, including ligature material and ligature anchor points.

SAFETY FIRST And the guidance gives examples of safety interventions, with a critical difference from previous advice being that low-lying ligature points should not be deemed low risk and should be removed wherever possible.

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The guidance also covers ward layout and design, and the importance of striking a delicate balance where staff are able to observe patients, support a home-like environment, provide private spaces to promote patient dignity, and create a therapeutic environment.

It states: “Ward design and how well staff are able to observe patients are contributory factors for a proportion of suicides.

“An ideal ward design provides maximum opportunity to observe patients.

“Locations with a good line of sight reduce the need for restrictive intrusions and support a non-institutional ‘home-like’ environment.

“Private spaces are also important for providing patients with a greater sense of control, identity, and dignity and can help improve people’s wellbeing and positive behaviour and play a significant role in their recovery journey.”

It adds: “Research has shown that almost all deaths by suicide happen in places where patients have privacy in bedrooms and bathrooms — with a minority of 8% happening in shared or communal areas.

“Safe and effective mental health care relies on a careful balance between safety, privacy, and dignity, ensuring individual patient needs are met in line with the Equality Act 2010 and patients’ human rights.

“As a result, services need to make sure that they have appropriate systems and controls in place to keep people safe while balancing the need for privacy.”

To coincide with the guidance, the Mental Health and Learning Disability Nurse Directors Forum has developed a ligature point assessment template designed to support staff in identifying and recording ligature risk points, controls, and actions required to mitigate risks associated with the built environment.

Commenting on the document, Hannah Cadogan, a lecturer in nursing at Roehampton University and representative for lived experience at the Royal College of Nursing, said: “As a nurse myself, I know how easy it is to concentrate on the measurable aspects of a risk or difficulty.

“You can easily create a tick-box form to say you have door handles that cannot be used as ligature point; in this you feel as a healthcare worker you can demonstrate you have reduced the risk, which feels like a job well done.

“However, as a person who has suffered from severe mental illness and used mental health services, I have learnt from my own lived experience that the interventions that are not so easily measurable, like therapeutic engagement, more often than not were the factors that reduced my risk of using a ligature.”

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Preview

The cream of the caring crop The Healthcare Design Awards, previously run by Pinders for 25 years, will next year be organised by long-term event partner, Caring Times.

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o be held at the Royal Lancaster Hotel on 27 March, the awards recognise innovation and excellence in the design of care facilities.

Whether it’s a new-build, extension, or regeneration project, the judges will be looking for entries which not only demonstrate good design, but have made a real impact on people’s lives.

They will include care homes for the elderly; homes for adults and younger people with learning difficulties, sensory or physical impairment, mental disorders, acquired brain injuries, or substance misuse; extra-care, assisted living, and retirement housing; care

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villages; and clinics and secure units.

This year there are six categories: • Best Architectural Design (sponsored by Virgin Money) • Best Interior Design • Best Exterior Design • Best Specialist/Dementia Care Design • Best Independent Living Design • Best Acute/Primary Care Design The entry deadline has now passed and the judges will soon be meeting to consider all entries, with three finalists to be chosen in each category.

Judges will then visit the finalists to view the projects in person and decide on a winner for each category.

Each finalist will receive: • A trophy recognising their achievement to display within the project • £500 payable to a charity/good cause of their choosing • Two free tickets to the Healthcare Design Awards in London, where finalist projects will be showcased prior to winners being announced • PR in Caring Times magazine • An awards finalist logo for use in marketing material For more information on attending the event, visit healthcaredesignawards.co.uk or call 020 7104 2000 JANUARY-FEBRUARY 2024 | 25

Building Design

Five lessons from Alder Hey In this report we explore the approach to the design of two new mental health buildings at Alder Hey Children’s Hospital in Liverpool and how they will set a precedent for future delivery of more-therapeutic clinical settings “But why should it be this way?

“Imagine if typical clinical buildings were uplifting, positive, homely environments, flooded with natural light and connected to gardens and greenery.

“And imagine if, instead of dreading entering a hospital, patients felt they were visiting a calm, comforting place of healing.”

To inform future design, he has collated five ‘lessons learned’ from the projects, which he hopes will create a new generation of psychiatric facilities.

The Catkin Centre and Sunflower House have been designed as two connected buildings surrounded by open space and views to parkland

P

atients are set to move into two new purpose-built mental health units at Alder Hey Children’s Hospital in Liverpool.

The Catkin Centre and Sunflower House provide much-improved mental health care for children and young adults, bringing together a range of specialist psychiatric services previously scattered across the hospital site and through the city.

Arranged in two connected buildings covering 3,000sq m, the facilities were designed by Cullinan Studio and represent an alternative approach to the traditional hospital typology by creating a series of cloistered routes around two courtyard buildings where clusters of consulting rooms, bedrooms, and day spaces are gathered around a central outdoor garden room.

NATURAL MATERIALS The buildings themselves are raised over the car park, drop-off, and pedestrian access area and are set against a backdrop of stone gabions and garden terraces.

External walls are clad in red-brown weathering steel panels to contrast with the green planting and bay windows.

And, inside, the interior is lined with timber, adding warmth and bringing a feeling of nature into the internal spaces, while bedrooms and clinical consulting rooms have projecting bay windows offering ‘child-sized’ refuge spaces looking towards a new park.

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The Catkin Centre will provide a new home for outpatient services including ASD, ADHD, development paediatrics, CAMHS, eating disorders, and crisis care; and Sunflower House provides a ‘homefrom-home’ for young people with complex and enduring mental health conditions, comprising a 12-bed inpatient mental health unit for children aged 5-13.

It is one of only six inpatient units for this age group in the country.

LESSONS LEARNED Architect, Roddy Langmuir of Cullinan Studio, said: “Designed for patients’ mental wellbeing, the Alder Hey Children’s Hospital in Liverpool pioneers a new approach to clinical buildings.

“As the architects behind the hospital’s new Catkin Centre and Sunflower House buildings, we believe these buildings can provide a blueprint for the NHS and all healthcare providers.”

He added: “The links between environment, mental health, and physical health are now well established. For example, a significant body of evidence shows that a connection to nature can improve patient outcomes and recovery times.

“Yet, traditional hospital buildings are designed with virtually no reference to the mental wellbeing of their patients.

“Too often they are functional, forbidding, and detached from the natural world.

1. Hospital masterplanning: Enable a joined-up healthcare approach by creating a ‘health campus’ The Alder Hey project brings together a range of facilities that were previously scattered across the hospital site and the city of Liverpool in two connected buildings.

The new buildings come together with the main hospital, The Institute, the bereavement centre, and a re-imagined Springfield Park (also designed by Cullinan Studio with Turkington Martin) to form a ‘health campus’, offering a new joined-up approach to the treatment of physical and mental health for children and young adults and giving patients what one clinician described as ‘a Ritz experience’.

The buildings and the spaces between them have been designed to accentuate opportunities for planting, walks through landscape, and views to create a holistic approach to ‘health in nature’.

This kind of innovative approach has great benefits, but also challenges as clinical and patient privacy needs must be balanced with maintaining a welcoming and open environment.

With imaginative solutions, architects can meet these challenges and enable hospitals to deliver healthcare that joins up physical and mental wellbeing.

2. Design legible layouts that feel safe, warm, welcoming, and noninstitutional Traditional hospital buildings tend to be mazes without centres; confusing labyrinths of corridors and identical, boxy rooms that leave patients disorientated and alienated.

Alder Hey takes a completely different approach.

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Building Design

Masterplanning of the site has created a ‘health campus’. Drawing, Turkington Martin

Cloistered routes surround two courtyard buildings, where clusters of consulting rooms, bedrooms, and day spaces are gathered around a central outdoor garden room offering activities and views.

It is a legible layout as users can easily orientate themselves within the building, promoting feelings of security, and reducing stress.

Gone are the long, intimidating, windowless corridors of typical clinical buildings.

With plenty of seating, daylight, and views outside, the circulation at Alder Hey is designed as a place to be, not just to pass through.

And extra-wide ‘bulges’ in the generous corridors prevent the circulation areas from being potential places of conflict — a common cause of patient stress in traditional mental health units with their typically narrow routes.

3. Connect patients to the natural world The eddies in the corridors serve another purpose; they connect patients to the buildings’ central outdoor garden rooms, so that even when indoors they feel close to flowers, plants, and daylight.

Alder Hey is the first children’s hospital in Europe to be integrated within a new publicly-accessible park, and the mental health buildings are surrounded by green space, trees, and flowers.

Bedrooms and consulting rooms have projecting bay windows that offer ‘child-sized’ refuge spaces that shield direct overview from outside and look instead towards the new park.

So all parts of the buildings — and all spaces to wait, be alone, or be sociable — give views of nature.

Numerous empirical studies have shown that connection to nature reduces stress and heart rates and improves feelings of wellbeing.

While a parkland may not be a practical possibility for all hospitals, architects and designers can find imaginative ways to bring patients closer to nature, even in the most-unpromising locations.

4. Make hospital buildings multi-sensory instruments for healing Connecting with nature promotes healing because it provides a form of effortless stimulation appreciated via all the senses.

The simple act of sitting in contemplation in a courtyard garden presents you with an array of subtly changing colours, textures, lights, sounds, and scents.

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Simple, clear layouts and corridor ‘bulges’ help with orientation, reducing stress

A timber ‘cone’ brings daylight into the building

The buildings represent a new way of designing hospitals

It is important to integrate mental health facilities into the community

Central outdoor garden rooms bring people close to nature, even when they are indoors, thanks to the planters being right up to the glazing

As well as creating gardens and outdoor rooms, architects can bring nature into buildings by using natural materials.

Internally, the Alder Hey buildings are made of timber, a material not normally associated with hospitals, but here revealed and expressed throughout.

The wood creates a warm, tactile effect that can be appreciated with multiple senses: sight, smell, and touch.

The building itself can then become an instrument for healing.

5. Integrate hospitals into the community Hospitals are public buildings, but even when they are in residential and urban areas, it is rare for them to feel like cherished parts of the community. They are usually alien ‘other’ places: forbidding institutions, generally ignored and, when needed, approached with trepidation.

Alder Hey’s location within a new park points the way to new ways of thinking about hospital buildings.

Why shouldn’t they be pleasant places to visit, positively integrated into communities, even loved?

Visitors to The Catkin Centre and Sunflower House do not have to sit in the ‘limbo’ of boring, formal waiting rooms between appointments; they can wander in adjoining courtyards, sit at desks to carry on their work or school homework, and carry on their lives in a visually-interesting space.

The British have a deep regard for the NHS and visiting its hospitals shouldn’t be a matter of dread, but thought of warmly as an opportunity to find tranquillity and restoration in a place of healing. n JANUARY-FEBRUARY 2024 | 27

Building Design

Closing the circle: Regenerative design for health and wellbeing Building resilient healthcare across the UK and Europe is a growing priority and the market is facing many challenges that are straining such a vital resource. Here, Andrew Tempany, technical director, and associate director, Lynne Houlbrooke, from Stephenson Halliday, an RSK Group company, lay out how we close the circle and harness the benefits of regenerative design for greater resiliency

I

n today’s world, we face challenges that exert pressure on indispensable healthcare systems: an escalating climate crisis, the legacy of a global pandemic, and economic uncertainty are stretching the services and infrastructure of national health and social care across Europe.

With extreme high temperatures being felt across the continent this summer, the pressure caused by environmental conditions is only increasing and, when combined with economic stresses, it is making for difficulties in care provision.

However, regenerative design approaches offer the opportunity to contribute towards the alleviation of the present challenges facing our vital healthcare systems.

RESTORING AND REPLENISHING The principle of regenerative design places ideas of restoring and replenishing the surrounding natural environment through our built infrastructure at its centre,

…regenerative design approaches offer the opportunity to contribute towards the alleviation of the present challenges facing our vital healthcare systems.

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The village of Staunton in Gloucestershire is cultivating ‘edible landscapes’ that embody therapeutic horticulture principles

creating net positives through a circular approach.

This means integrating buildings and infrastructure into existing networks and spaces so they are of benefit to, and accessible by, the community.

And, in the healthcare context, this is particularly valuable.

A recent study by The Wildlife Trusts in the UK found that ‘green prescribing’ — that is, referring patients to nature-based programmes — could result in an annual cost saving of £635.5m when supporting 1.2 million people, in addition to the mental and physical health benefits of accessing nature to the individual.

Stanley House is a specialist facility in neurological complex care in Herefordshire where the landscape has been design to incorporate healing courtyards

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Building Design

Creating health and social care environments that give access to green space and nature offers healthier spaces for patients and clinicians by supporting both mental and physical wellbeing.

And the reach is much wider: staff and patients become their guardians, maintaining the environment and further supporting patient rehabilitation.

BRINGING THE OUTSIDE IN Nurturing this link between the indoors and the outdoors, bringing nature to patients, is exemplified at Stanley House, a specialist facility in neurological complex care in Herefordshire.

Here, the landscape has been designed to incorporate ‘healing courtyards’ that are directly linked to the individual rooms of the building, connecting the outdoors and indoors.

Local orchards have been reinstated for their cultural and sensory associations, and plants have been installed at different levels to create a unique sensory environment that brings residents back in touch with nature.

The cultural aspect of ecosystems services in contributing to our wellbeing is important, as it relates to a sense of place, connection and identity, as well as creating a rich design focus for spaces in which to decompress.

The village of Staunton in Gloucestershire is another successful example of developing greater access to nature through cultivating ‘edible landscapes’ that embody therapeutic horticulture principles.

LIVING OFF THE LAND The village’s community garden, designed to reflect the historic Chartist architecture of the village and to embody the aspirations of the Chartists to live a life on the land, offers a shared central space to be enjoyed by everyone.

The garden is an extension of the village that encourages healthy living through increased access to fresh fruit and vegetables grown by residents and social spaces that can be enjoyed by all.

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Staunton’s gardens take a preventative approach to healthcare, supporting health and wellbeing in day-to-day life.

Bringing these spaces to the heart of communities has innumerable benefits.

The regeneration of Green Gates Community Park in Frodsham, Cheshire, emphasises the power of accessible green space, as well as co-design with its users.

Here, the community directly informed the development and rebuilding of its local playground, which ensured it met its needs.

CLOSING THE CIRCLE Now open to the public, the park was co-designed to provide learning and play space for children at the same time as being an open space for all local residents, incorporating accessible paths for the elderly and wheelchair users as part of a lifetime neighbourhood design concept, another core tenet of healthy and sustainable communities.

Closing the circle and bringing health and social care considerations back into these wider contexts offers multiple benefits by curating reflective landscapes that are more than ‘just’ restorative.

By embracing regenerative principles, developers can design healthy environments for all and, most importantly, integrate these into the heart of communities, where they are valued most.

Circular and regenerative design approaches ensure the design is right for its context by looking closely at the interconnections that already exist in the community and incorporating wider benefits.

Such an approach draws the United Nations Sustainable Development Goals (SDG) and the six capitals of design into projects, creating lifetime neighbourhoods that meet our needs and grow with us into the future, as well as contributing solutions to contemporary environmental and societal challenges.

The challenges faced by this industry are broad but, by recognising the benefits of many smaller scale interventions, we can achieve strategic benefit.

SMALL-SCALE INTERVENTIONS The important thing here is to have a compelling vision and to recognise how the design for a site can contribute to a wider environmental vision or strategy as part of a network of practical, regenerative, naturebased interventions.

This is how we can harness the power of small-scale interventions to add value so they are greater than the sum of their parts.

To achieve this vision, good design is key.

The simplicity of design — elegant solutions that realise multiple benefits and that work for people — is equally vital.

Whether this is through considering access and flow, creating a design to capture the imagination and delight the senses, or working for a range of different interests and behaviours, we must take an approach that considers the management, sustainable maintenance, and governance of the space from the start.

Such a regenerative, collaborative approach ensures the delivery of resilient healthcare services for the future in line with the wider benefits of sustainable development goals.

This is the bigger picture of modern healthcare.

Designing healthcare settings to sit within natural and community spaces affords us the opportunity to create real, far-reaching resilience. n ABOUT THE AUTHORS Andrew Tempany is technical director of landscape design at Stephenson Halliday, an RSK Group company specialising in landscape architecture and environmental planning.

Lynne Houlbrooke is associate director of landscape design at Stephenson Halliday.

JANUARY-FEBRUARY 2024 | 29

Estates and Facilities Management

Ultra-Violet light can disinfect larger areas, such as operating theatres or consultation rooms, within minutes

Robots provide a consistency of service, enabling Some cleaning robots are equipped with UV-C the upkeep of cleaning standards and compliance, technology to disinfect areas as they clean them while providing valuable real-time data

Smart choices: Facilities management technology for hospitals Adam Mitton, managing director of healthcare at Mitie, looks at three ways hospitals are embracing smart technology to enhance services and deliver efficiencies

A

gainst the backdrop of a notoriously-busy healthcare system, managing healthcare estates and facilities to an optimal standard has never been more crucial.

Clean, safe, and well-maintained spaces are a key part of enhancing staff and patient experiences, and with the ongoing focus on easing waiting list backlogs, increasing the speed at which care facilities can be turned around is more important than ever before.

And developments in facilities management (FM) technology can help, such as these three smart solutions.

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SENSORS AND REMOTE MONITORING The most-efficient way of enhancing the day-to-day running of any building is to have a complete understanding of both the facilities and the people using them — and hospitals are no different.

Sensors can be used to gain a full view of the facilities and areas that can be optimised, by monitoring movements and collecting data in real time.

This provides FMs with the knowledge needed to continually evolve their service and identify longer-term trends.

They also help with the practical, everyday operations of healthcare estates, by providing actionable insights, which allow FMs to deliver demand-led services.

For example, real-time data measuring footfall provides crucial insight on which areas are busiest, and where cleaning or security services may be most needed.

Similarly, automatic alerts may prompt the replenishment of hand towel and sanitiser dispensers when these are running low, removing the need to manually check each one — especially in non-acute areas of the building, such as administration or HEALTHCARE-PROPERTY.COM

Estates and Facilities Management

outpatient units.

Engineers, too, can benefit from remote monitoring, as this may point towards the early signs of a problem with an asset or system — such as critical ventilation– so this can be pro-actively addressed before an impact occurs affecting patients and clinicians.

UV-C LIGHTS With thousands of people visiting every day, it is critical that healthcare estates and facilities are maintained to a safe hygiene standard, as efficiently as possible.

To address this, there are innovative solutions to speed up some of the more manual, time-consuming tasks.

One solution is Ultra-Violet (UV-C) light, which can disinfect larger areas, such as operating theatres or consultation rooms, within minutes, saving crucial time as well as achieving exceptional results.

In fact, researchers from Boston University found UV-C reduced 99.9999% of the COVID-19 virus within 25 seconds.

Using such technology, critical areas can be sanitised and prepared for the next patient in record time, helping to ease waiting list backlogs and relieve pressure in an environment where every second counts.

Sensors can be used to increase efficiency by monitoring movements and collecting data in real time

ROBOTS As technology continues to improve exponentially, tools like cleaning robots are become increasingly commonplace.

Because robots provide a consistency of service, their use allows for the upkeep of cleaning standards and compliance, while also providing valuable real-time data.

These can eliminate tasks that take up significant amounts of cleaners’ time, as they allow colleagues to focus on duties that require direct human intervention, such as disinfecting difficult-to-reach areas, or

sterilising equipment.

But one thing we have noticed with cleaning robots is that connecting technologies together helps to compound the benefits of smart tech.

For example, some cleaning robots are also equipped with UV-C technology to thoroughly disinfect areas as they clean them.

Sensor technology, UV-C cleaning, and robots are just three smart innovations which can be introduced in hospitals to deliver more-efficient FM services.

And, not only are they easy to implement, without disrupting the delivery of essential healthcare services, but, importantly, they play a crucial role in improving the experience of both patients and staff. n

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JANUARY-FEBRUARY 2024 | 31

Estates and Facilities Management

Chlorine disinfectant has no impact on common superbug, research finds New research from the University of Plymouth has concluded that treating spores of Clostridioides difficile (C. diff) on hospital surfaces with chlorine disinfectant is no more effective than using water with no additives.

The study found that spores of C. diff on surfaces remain completely unaffected despite being treated with high concentrations of bleach.

The research has been written-up in the journal Microbiology, in which the study’s authors say susceptible people working and being treated in clinical settings might be unknowingly placed at risk of contracting the suberbug.

As a result, and with incidence of biocide overuse only serving to fuel rises in antimicrobial resistance (AMR) worldwide, they have called for urgent research to find alternative strategies to disinfect C. diff spores in order to break the chain of transmission in clinical environments.

Dr Tina Joshi, associate professor in molecular microbiology in the Peninsula Dental School, carried out the study with Humaira Ahmed, a fourth year medicine student from the same school.

She said: “With incidence of antimicrobial resistance on the rise, the threat posed by superbugs to human health is increasing.

“But far from demonstrating that our clinical environments are clean and safe for staff and patients, this study highlights the ability of C. diff spores to tolerate disinfection at in-use and recommended active chlorine concentrations.

“It shows we need disinfectants and guidelines that are fit for purpose and work in line with bacterial evolution, and the research should have significant impact on current disinfection protocols in the medical field globally.”

C. diff is a microbe that causes diarrhoea, colitis, and other bowel complications and is known to infect millions of people around the world every year.

Previously, Dr Joshi and colleagues

have demonstrated the ability of C. diff spores to survive exposure to recommended concentrations of sodium dichloroisocyanurate in liquid form and within personal protective fabrics such as surgical gowns.

The new study examined the spore response of three different strains of C. diff to three clinical in-use concentrations of sodium hypochlorite.

The spores were then spiked onto surgical scrubs and patient gowns and examined using scanning electron microscopes to establish whether there were any morphological changes to the outer spore coat.

Dr Joshi, who is on the Microbiology Society Council and co-chairs its Impact & Influence Committee, said: “Understanding how these spores and disinfectants interact is integral to practical management of C. diff infection and reducing the burden of infection in healthcare settings.

“However, there are still unanswered questions regarding the extent of biocide tolerance within C. diff and whether it is affected by antibiotic co-tolerance.

“With AMR increasing globally, the need to find those answers — both for C. diff and other superbugs — has never been more pressing.”

AI tool supports EFM professionals NHS estates and facilities management (EFM) staff at all levels are being invited to contribute to an innovative research project being led by Carl-Magnus von Behr and Carl Partow from the University of Cambridge.

The initiative is centred on developing innex.ai, an artificial intelligence (AI)/ large language model (LLM) tool to boost productivity for NHS EFM teams.

The tool is being developed based on three years of research on knowledge sharing among NHS trusts and in partnership with AI specialists at the University of Cambridge.

A knowledge-sharing platform, it has an LLM-powered chatbot interface for NHS engineers, leveraging large language 32 | JANUARY-FEBRUARY 2024

and fact verification models to enable conversations with a custom-built vector database of relevant information across different categories (regulatory, guidance, standards, peer knowledge, etc) to provide

accurate answers and insights, bridging the current skills gap and empowering informed decision-making in healthcare infrastructure management.

Moreover, it will facilitate connecting to domain experts and peers for best-practice knowledge sharing as well as assisting in policy drafting and grant applications.

A recent pilot workshop at the Health Estates and Facilities Management Association’s (HEFMA) Trent Branch annual conference has already demonstrated promising results, indicating significant productivity improvements.

And it is now being demonstrated more widely through online training and taster sessions.

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Environmental

Advancing green healthcare amid climate challenges Jessica Brown, senior sustainability consultant at Lexica, explores the NHS’s journey to becoming carbon net zero and outlines where the challenges lie to meet the Government’s 2040 target

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ach week seems to highlight the critical importance of sustainable healthcare solutions, to ready the service for undeniable changes in our climate.

And, having recognised the emerging threat and defining its net-zero target timeline, the NHS is now in a pivotal phase for turning ambition into action.

Sobering reminders of climate change and continued pressures on our health services have reinforced the significance of delivering against net-zero targets.

The NHS has set itself two targets for delivering net-zero carbon healthcare and aims to be the world’s-first net-zero national health service.

While these targets may appear ambitious, the NHS has made significant progress in its advancement for green innovation this year.

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MAKING PROGRESS At the beginning of the year, NHS England announced the decommissioning of desflurane by early 2024.

Desflurane is a volatile anaesthetic used for surgery, but it has a global warming potential 2,500 times greater than carbon dioxide.

The commitment and progress made in 2023 builds upon the continued hard work of anaesthetists who had already successfully reduced desflurane from 20% of all anaesthetic gases to just 3% over the last five years.

And, from April 2023, all new contracts above £5m per year require suppliers to publish a Carbon Reduction Plan for their UK Scope 1 and 2 emissions and a subset of Scope 3 emissions as a minimum (aligning with PPN 06/21).

This is the latest driving force embedding net-zero commitments within procurement.

Sobering reminders of climate change and continued pressures on our health services have reinforced the significance of delivering against net-zero targets HEALTHCARE-PROPERTY.COM

Environmental Moreover, a wealth of guidance and toolkits has been published to educate, guide, and embed net zero within the NHS. These include the Carbon Literacy toolkit, which provides resources to engage staff in national net-zero policy and encourage low-carbon actions; the Net Zero Building Standard, which provides technical guidance to support the development of sustainable, resilient, and energy-efficient buildings; and the newly-published NHS Net Zero Travel and Transport Strategy, the latest roadmap to support NHS bodies to achieve a zeroemissions fleet by 2040.

FUNDING FOR HEAT DECARBONISATION With NHS buildings contributing 15% of the total NHS carbon footprint, reducing emissions from hot water and space heating systems, which account for 80% of NHS greenhouse gas emissions, and improving the energy efficiency of the ageing estate will be essential.

Stringent limits on capital budgets, however, mean integrated care boards (ICBs) and trusts must source external backing through funding rounds such as the Public Sector Decarbonisation Scheme and the Green Heat Network Fund.

Feedback on the award process has highlighted concerns over allocations being made on a first-come-first-served basis.

As the policy landscape evolves, and with a general election likely in 2024, increasing green funding opportunities for the NHS will be crucial to deliver heat decarbonisation and reach its net-zero goal.

INCREASING CLIMATE RESILIENCE As global temperatures rise and extreme weather events become increasingly common, the need for climate-resilient health systems has never been more important.

Risk management and adaptation will, therefore, play a vital role in protecting the NHS from climate-related hazards.

The World Health Organisation (WHO) has recently published the Operational Framework for building climate-resilient and low carbon health systems.

This, along with the publication of the third National Adaptation Plan, reinforces the magnitude of embedding climate adaptation and resilience in existing and new building infrastructure globally.

Of climate change hazards, heat stress presents a key risk, with the summer heat waves of 2022-23 highlighting the vulnerabilities present within ageing building infrastructure, with a third of the HEALTHCARE-PROPERTY.COM

estate having been built before 1965 and designed to keep heat in when the climate was cooler.

As a result, employees, patients, and visitors are regularly experiencing heat stress and the NHS faces many obstacles in attempting to reduce its impact.

The population continues to require self help about how to keep cool and hydrated, placing more demand on the service, and there is an economic disconnect between government, developers, and retrofitters, with different agendas and motivations.

Addressing these challenges, and safeguarding healthcare systems from climate risks, will become a much-morepressing matter for the NHS in 2024.

PRIORITISING AND EMBEDDING SOCIAL VALUE Alongside emissions reduction efforts, social value continues to be a high priority on the sustainability agenda for the NHS. Driven by the public procurement note (PPN 06/20), social value delivery within the NHS’s supply chain provides a mechanism to align targets, obtain Scope 3 footprints, and deliver additional value to the communities served by national healthcare.

INVESTMENT IN SOCIAL PRESCRIBING Another key initiative is social prescribing, which presents significant opportunity for public health benefits through engagement

with ICBs and their systems.

This alternative treatment method aims to reduce demand on healthcare facilities and strengthen community support.

Non-pharmaceutical medical interventions, such as green social prescribing, also work to address the importance of being outdoors for people’s mental and physical health.

Social prescribing is important to reduce pressure on the existing NHS services, but also increasing focus on preventative care, such as treating pre-diabetics through lifestyle changes.

Continued investment into robust community care and support will be key for NHS sustainability in adopting joined-up, efficient, and low-carbon care models for the future.

INCREASING INNOVATION And continued investment into technologies and processes will be a point of focus within the healthcare sector moving forward.

In 2023, the National Institute for Health and Care Research partnered with UK Research and Innovation to launch the £30m programme ‘Realising the health cobenefits of the transition to net zero’.

Award of the successful researchers in 2024, and further funding, is expected to identify the carbon impact and material waste associated with emerging health and social care delivery models and pathways.

To maintain momentum and progress against trusts’ Green Plans, 2024 is expected to be a year of shared learning and innovation, keystone commitments, and data-driven action.

As technology advances, so must the speed of access to capture the carbon benefits that arise.

Similarly, suitable funding and commercial solutions must be brought back to the NHS to allow full benefits to be unlocked.

The efforts of NHS staff across the country have proven the potential and scalability of several solutions. And now is the time to commit and reap the associated wider societal, environmental, and economic benefits. n

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Environmental

Priming pumps and plant rooms for a net-zero NHS There are clear and ambitious targets in place to get the NHS to net zero, but identifying a route for such a complex system is going to be particularly challenging. And key to this is navigating plant rooms and pumps, which are safety critical to healthcare settings. This is why it is imperative they are specified and maintained correctly, as Jason Hartigan, specification sales manager at Wilo UK explains

H

ealthcare settings must run like clockwork to ensure patient safety is prioritised at all times.

At the beating heart of hospital services, hidden away from patients, most staff, and members of the general public, are plant rooms.

Within these rooms, the vital organs of hospitals are stored, transporting water and other mission-critical supplies around the building and across the estate.

And this is where you will find circulating and booster pumps, distributing hot and cold water to the main arteries of a hospital.

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These plant rooms and pumps cannot fail. If they do, disaster can strike, leading to disrupted operations, surgical wards shutting down, and the creation of unsafe environments for both patients and staff.

At a time where the NHS is under immense stress with a growing backlog of patients in need of medical care, this is simply not an option.

THE BEATING HEART Alongside the safety aspect, it is essential that these plant rooms operate efficiently.

The NHS contributes roughly 4-5% of

the UK’s total carbon emissions, with the NHS in England alone responsible for 40% of the public sector’s emissions, so bringing these figures down is a must to get to the NHS’s goal of becoming net zero by 2045.

This is why the beating heart of healthcare settings, plant rooms, and pumps also require a level of ‘medical’ attention.

A CHALLENGE FOR MANAGERS As plant rooms and pumps essentially keep healthcare properties up and running, they require regular, specialist monitoring for HEALTHCARE-PROPERTY.COM

Environmental accurate and efficient operational levels.

Industry professionals will be aware that individual pumps have various levels of ‘health’ which deteriorates over time.

And while the responsibility of monitoring the health of pumps in a plant room generally falls to estates and facilities managers, they are often overloaded with other tasks, which means that individual pumps can be overlooked.

Due to estate managers moving between healthcare settings, too, one of the biggest challenges is that managers are unaware of the equipment that resides within a plant room and may not have an up-to-date asset list. This, in turn, means managers do not know when equipment was installed, who it was installed by, and when it needs to be serviced or replaced.

Since estate managers tend to spread their expertise across a wide subject field, it is also the case that many do not have enough specialist knowledge on individual pumps in particular.

This is why it is key that specialists from the pump industry are brought on board to establish clear maintenance schedules within healthcare settings.

PUMPS IN DIFFICULT PLACES Alongside challenges of not having the historical background of a plant room and the equipment within, these areas are notoriously difficult to navigate, let alone going in to assess the condition of individual assets.

Often, plant rooms are located in difficult places to access with numerous complications around them.

For instance, a plant room may be located on top of a hospital, with poor access. And pumps that need replacing in these areas, particularly bigger, heavier pumps, will require careful planning and consideration, from demounting the existing pump, removing it off site, and then craning any new pumps in.

THE IMPORTANCE OF PROFESSIONALS Given these challenges, seeking expert advice and consulting with pump manufacturers is crucial for asset and plant managers to ensure plant rooms stay in tiptop condition.

Reputable suppliers can offer expertise which consolidate and enhance existing assets.

From here, an asset list can be drawn up, and thereafter an effective maintenance schedule can be deployed.

A straightforward-yet-effective planned preventative maintenance (PPM) schedule is the traffic light system, which ranks HEALTHCARE-PROPERTY.COM

equipment from red to green.

Quite simply, equipment ranked red needs urgent attention, amber may require attention soon, and green means pumps are in good health.

Adopted by Wilo when aiding estate managers draw up their asset lists and assess their pumps, these schedules assist with organising ongoing maintenance routines and staying on top of documentation, while mitigating any sudden and unforeseen downtime.

Remote monitoring, preventative maintenance, and service agreements can also be offered, taking the pain completely away from estate managers.

Importantly, when finding reputable suppliers to work with, it is vital that they understand plant rooms are, in lots of ways, delicate areas.

And any third-party staff should undergo the correct training and be certified to enter these areas, so they do not cause any additional problems.

Industry specialists should also undergo CSCS training and hold all the right qualifications.

SMART PUMPS After determining what is in plant rooms, and how to stay on top of maintaining the pumps inside of them, by working together estate managers and pump manufacturers can start to make inroads into helping the NHS get to net zero.

One of the biggest leaps forward in recent years is the advent of ‘smart’ technology, which has lessened the sole responsibility on individuals and introduced helpful solutions.

Modern smart pumps not only move water around a building, but also provide immediate energy savings through intelligent, automated operation, which can be used to define an ongoing energy usage strategy.

To illustrate this, pumps such as the Wilo-Stratos MAXO, can ‘learn’ the operational characteristics of a heating or

cooling system.

And, used in conjunction, circulating pumps can be configured to adapt in realtime to demands and work holistically with other building services.

These smart functions not only provide detailed data to estate managers, but they also keep healthcare settings running by identifying any issues before they become at risk of operating inefficiently, or worse, breaking down.

Performance data, alerts, warnings, and notifications can ensure systems are always maintained and operating to their highest efficiency.

The latest in smart pump technology also provides data on heat flow, cooling flow, and volume flow.

The combination of this data with other smart systems provides insight into usage patterns, resulting in better-regulated indoor climate control that keeps power and water usage to a minimum while also reducing costs.

By working with manufacturers, not only can they help specify the right pumps for the application, but they can also help forecast energy and cost savings.

To give an example, Wilo, when drawing up asset lists, can provide an energy audit at the same time. This will show both cost and carbon savings that helps determine the ROI, as well as how many years it will take to pay back the investment.

SAFER, MORE-EFFICIENT HEALTHCARE FACILITIES Plant rooms and pumps are safety critical to many settings, but particularly to healthcare environments.

This is why the role of maintenance should be taken seriously and given proper and thorough attention by both managers and external specialists.

Through the holistic use of ‘smart’ pumps, important data can be collected and analysed to save money, water, energy usage, and ultimately move the NHS much faster to its net zero ambitions. n JANUARY-FEBRUARY 2024 | 37

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Photo credit: Jon Hunt from Pixabay

New framework supports green transport plans N HS Shared Business Services (NHS SBS) has launched a new ‘Sustainable Transport and Infrastructure’ framework agreement designed to support the NHS in lowering its carbon output and achieving its 2040 carbon net zero ambition.

According to NHS England, emissions from travel and transport account for 14% of the total carbon footprint of the NHS. This includes 4% for business travel and fleet transport, 5% for patient travel, 4% for staff commutes, and 1% for visitor travel.

Transitioning fleets to zero-emission vehicles; encouraging employees towards active forms of travel like cycling, walking, and car sharing; and looking to low-carbon logistics and transportation of goods using pedal power, are some of the interventions the NHS is putting in place to meet its sustainable transport objectives.

In its ‘Net Zero Travel and Transport Strategy’ the NHS has said that by 2033 staff travel emissions will be reduced by 50% through shifts to more-sustainable forms of travel and the electrification of

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personal vehicles.

And, from 2030, all new ambulances will be zero emission vehicles, while, from 2040, all owned, leased, and commissioned vehicles will be zero emissions.

However, to get there, NHS trusts will need to have the necessary supporting infrastructure in place.

Bicycles, for instance, will need cycle parking facilities, built with materials that are climate friendly.

In addition, electric vehicles and e-bikes will require power-charging infrastructure and the means to tap into renewable energy, like solar, to store and generate the power to fuel them.

These are services the NHS can access via NHS SBS’s new framework agreement, which includes the design and construction of car parks incorporating solar panels to generate and store electricity; sustainable transport consultancy services; bike hire and repair; low-carbon logistics; and electric vehicle charging solutions Anjub Ali, senior construction specialist at NHS SBS, said: “We have worked

with NHS sustainability, estates, and procurement colleagues in designing this framework and have aligned it to fulfil the common themes which have emerged from NHS trusts’ Green Travel Plans so it includes a range of suppliers providing transport and infrastructure-related services to support the NHS on its journey.”

The framework offers core services in nine lots: • Sustainable transport consultancy • Cycle parking and infrastructure • Micro-mobility • Low carbon deliveries • Electric vehicle charging solutions • Design, build and finance of sustainable car parks • Design, build, finance and operation of sustainable car parks • Car park management • Car park equipment and maintenance The framework agreement offers a compliant route to market to all NHS and public sector organisations across the UK and will run from 20 November 2023 to 19 November 2027. n HEALTHCARE-PROPERTY.COM

Environmental

Funding the future Securing funding for decarbonisation projects within the health sector has proved a stumbling block to achieving the Government’s net-zero ambitions. Here, we look at the avenues available and how they are helping to transform estates and drive efficiencies

F

rom 1 April 2021 the England Salix Energy Efficiency Loan Scheme (SEEF) was replaced by the Public Sector Decarbonisation Scheme (PSDS).

The PSDS was developed to reduce the level of emissions from public sector buildings, while also supporting the economic recovery from the COVID-19 outbreak.

And, since it was first launched, two successful phases have been completed, with phase three having recently closed and worth up to £1.425bn. Overall, the scheme aims to reduce emissions by 75% by 2037, contributing to a 22% reduction of all UK emissions.

The funding and deliverance of the scheme is completed via Salix Finance, a non-departmental Department for Business, Energy & Industrial Strategy (BEIS) body that is solely owned by the Government.

And it offers 100% interest-free capital for the public sector, enabling health trusts to install modern and renewable energy technologies to replace outdated and traditional methods that only negatively impact the environment.

VALUE FOR MONEY This includes upgrading existing heating systems using low-carbon technologies such as air source, water source, or ground source heat pumps.

Ian Rodger, director of programmes at Salix, said: “The scheme is empowering organisations across England to make significant reductions in their carbon footprint from heating public buildings.

“The huge enthusiasm for the scheme shows how much public sector bodies care about their carbon emissions and Salix is proud to be able to support them with finance and technical support to achieve their ambitions.”

Working with Vital Energi, Nottingham University Hospitals NHS Trust received £25m from the first phase of the PSDS scheme

TIME IS RUNNING OUT But a major stumbling block for NHS trusts has been the short window for bids to be received and funding to be spent.

For example, the latest phase closed after just three days after a previous applications portal suffered technical issues.

Applications are now being assessed and funding will be awarded based on the order in which they were submitted — in effect a first-come-first-served approach — with offer letters being sent out in March and trusts then having just a short amount of time to spend the money and deliver the improvements — 31 March 2026 for phase 3c.

The process demands six mandatory submissions: • Application form • Cost evidence, including quotes and CapEx • Energy-savings calculations • End-of-life heating system evidence • A project programme • A detailed risk register There is also the option of uploading up to three further documents, including feasibility studies, schematics, and building energy figures.

And this means trusts must be forward thinking and ‘bid ready’ as each phase is announced.

Vital Energi helped The Christie Hospital to successfully bid for PSDS funding, with works including new solar panels and battery storage

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Environmental

An air source heat pump is helping to reduce carbon emissions at York Teaching Hospital as part of an EPC with Vital Energi

MAKING A CASE Mark Seberry, director of innovation delivery at engineering design, energy, and sustainability consultancy, Hydrock, advises: “In simple terms, teams’ bids for funding must be able to provide detailed baseline evidence data and a coherent plan which supports a compelling case for investment.

“However, the challenge for NHS trusts is that net-zero targets are often set by third parties who may have limited awareness of what is required to achieve them in practice.

“Perhaps this is why the 2021-2022 ERIC data showed that more than 60% of NHS trusts did not currently have a written and approved Heat Decarbonisation Plan for their sites, which sets out how they will remove the use of fossil fuels as a heating source and ensure a net-zero carbon heating system by 2040.

“In addition, the key information which informs how an estate is currently performing is often spread across a disparate number of teams and varies in quality, often in non-digitalised formats.

“In preparation for funding, trusts must acknowledge these challenges and allow sufficient time, steps, and resources to fully gather, digitise, and synthesise the relevant information to support their bid.”

And he advocates a five-pronged approach to being ‘fund ready’: • Consider the range of data needed • Understand and map existing sources and formats of data • Identify time, resources, and steps needed to gather and analyse data • Capture and integrate behavioural insights alongside traditional estates and sustainability metrics • Collaborate to align PSDS funding opportunities with both sustainability and estates goals Vital Energi has also worked with a number of NHS organisations to successfully secure funding under the scheme.

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This is an opportunity to make a significant investment into the energy infrastructure on your site, putting you well on the path to net-zero carbon OVERSUBSCRIBED Its managing director, Ashley Malin, said: “The timescales for submission are very short, and the level of interest leads to a large number of applications and an oversubscription for the funding available.

“Our advice would be to develop your project and complete as much detailed work as you can in advance of making an application.

“This is an opportunity to make a significant investment into the energy infrastructure on your site, putting you well on the path to net-zero carbon.”

And he advises using specialist consultants to support bid development, adding: “The Government is looking for a balance between overall carbon reduction and the amount of grant funding required.

So, if you’ve got a scheme which will save you a few tonnes of carbon, but it costs £50m, then the tonnes of carbon saved per pound invested won’t be substantial and that particular project won’t be as desirable to fund.

“We have a proven track record of helping new and existing clients gain PSDS funding.

“Of the £1bn fund, we helped secure £100m in phase one for public sector organisations, which has increased during subsequent phases, and we have the inhouse capability to complete feasibility studies, surveys, and data analysis required to develop a qualifying scheme.”

HOTTING UP Among the NHS organisations to benefit from this collaborative approach is Nottingham University Hospitals NHS Trust, which received £25m from the first phase of the scheme.

The project involved completely removing the existing coal-fired boiler house and replacing it with a higherefficiency, lower-carbon system.

In addition, Vital Energi has installed

over 300kWe of solar across the hospital estate to generate zero-carbon electricity, along with air source heat pumps to generate low-carbon heat.

The savings to the trust are in excess of £2.5m a year and there will be a carbon reduction of 14,000 tonnes a year.

If trusts choose not to use the PSDS, or their bids have been unsuccessful, there are a few other avenues they can try.

The Green Heat Network Fund (GHNF) is a three-year, £288m capital grant fund which launched in March 2022 to support the commercialisation and construction of new low and zero carbon heat networks and the retrofitting and expansion of existing heat networks.

It aims to develop and grow the heat network market and address some of the challenges of decarbonising the UK’s heat sector.

Funding rounds take place on a quarterly basis and it will run until November 2024.

PRIVATE FUNDING There is also help available from the private sector, with many manufacturers and energy companies offering Energy Performance Contracts (EPCs), which are a low-risk method of financing and delivering improvements and renewable projects for the NHS and private health sector.

These contacts deliver the infrastructure needed to drive energy efficiency and overall estate improvements without organisations needing to find the upfront capital.

Typical EPCs have a contract length of between 10-15 years and incorporate debt and equipment financing.

And what makes them particularly attractive to the health sector is that they guarantee specific levels of energy savings for the length of the contract.

An example of this approach can be found at St George’s University Hospitals NHS Foundation Trust, the largest acute healthcare provider in south west London.

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Environmental

Mark Seberry of Hydrock advocates a five-pronged approach to being ‘fund ready’

Under the contract the tust is guaranteed to save more than £1m a year as well as saving 6,000 tonnes of carbon annually — the equivalent of the emissions from 3,000 cars.

The savings allow the trust to invest more in patient care and teaching medical staff, as well as helping to meet regulatory compliance.

And Veolia is also operating a 20-year EPC at The Rotherham NHS Foundation Trust.

Most recently, the agreement has seen the commissioning of a new Battery Energy Storage System (BESS), which will contribute to targeted EPC savings of over £1m a year, provide an energy income, increase resilience of the energy supply, and enable the trust to cut carbon emissions by 49,620 tonnes.

Centrica Business Solutions has a 15-year EPC with St George’s University Hospitals NHS Foundation Trust, which includes the installation of two new combined heat and power units

The location had been served by a 40-year-old energy centre which had become inefficient and incapable of meeting new environmental targets.

In response, the trust partnered with Centrica Business Solutions to create a new energy strategy for the hospital as part of a 15-year EPC.

GUARANTEED SAVINGS The contract includes the installation of two Combined Heat and Power (CHP) units and four boilers, which form a new energy centre.

Centrica Business Solutions also introduced a number of improvement schemes across the site, including lighting, a building management system, chiller replacement, and split unit air conditioning optimisation.

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RESEARCH But research is also set to play a key role moving forward.

In September, the National Institute for Health and Care Research (NIHR) announced a partnership with UK Research and Innovation (UKRI) to launch a new £30m funding programme which will support the UK in its transition to net zero.

The funding call will provide up to £6m over five years to a number of UK research institutions.

Each research hub will address at least one challenge of the net zero agenda and the hope is to generate research to understand the human health implications of current policies and identify new health-focused interventions.

Commenting on the launch, Dr Sophia Lentzos, head of sustainability at NIHR, said: “I am delighted to announce this joint funding opportunity.

“In addressing the urgent need to reduce carbon emissions and combat climate change, it is paramount that we understand how to best protect and promote the physical and mental health of the UK population as we transition to a net zero world.

This funding call will allow us to better understand the impact of new interventions across sectors on health and will be vital to ensuring a healthy population in the future.

“It also acknowledges the impact of healthcare on the environment and the urgent need to understand the changing nature of care.” n JANUARY-FEBRUARY 2024 | 41

Environmental

GP premises go green A number of GP practice and community hospital buildings across Forth Valley are set for a green boost as part of wider plans to improve energy efficiency, reduce carbon emissions, and support the delivery of the health board’s net-zero targets.

Almost £2m of funding from the Green Public Sector Estate De-Carbonisation Scheme (GPSEDS) will be used to improve the energy efficiency of 13 primary care premises across Forth Valley.

This includes Airth Health Centre, Camelon Health Centre, Falkirk Community Hospital (Westfield Medical Practice and Woodlands Resource Centre), Slamannan Health Centre, Bannockburn Health Centre, Dunblane Health Centre, Orchard House Health Centre, Stirling Health and Care Village, St Ninians Health Centre, Clackmannan Health Centre, and Tullibody Health Centre.

The work will include the installation of morethermally-efficient glazing, solar roof panels, insulation, LED lighting, and electric boilers.

Building Management Systems will also be upgraded at a number of sites to improve the control of heating and cooling systems using digital technology that will allow remote access from multiple devices.

Financial savings from these improvements are expecting to be around £59,000 a year, underpinned by an additional £30,000-a-year income from electricity generated by the new onsite solar panels.

Lifetime carbon savings are anticipated as 1,595 tonnes of carbon dioxide.

This supports efforts to reduce maintenance and energy costs and contribute to the delivery of targets set

The Woodlands Resource Centre is one of a number of primary care facilities which will be upgraded to improve environmental efficiency

out in NHS Scotland’s Climate Emergency & Sustainability Strategy.

Derek Jarvie, NHS Forth Valley’s head of climate change and sustainability, said: “Increasing the energy efficiency of local healthcare facilities across Forth Valley is a key priority as this will not only cut energy bills and generate income, but will also help reduce carbon emissions.

“This work is just one of a wide range of initiatives underway to reduce waste, use more-environmentally-friendly products and deliver greener, moresustainable services in our efforts to achieve net zero emissions by 2040.”

The works will also see improvements to green space around Stenhousemuir Health Centre funded by the contractor.

This will support the health and wellbeing of staff onsite and people in the local community, as well as encouraging greater biodiversity.

Other initiatives include work in theatres to discontinue the use of certain anaesthetic gases which contribute to global warming, reducing packaging waste, and increasing the use of reusable equipment.

And work is underway to reduce food waste from patient meals, switch to an electric vehicle fleet, and reduce the use of single-use products.

Plymouth trust cements its commitment to a carbon-free future University Hospitals Plymouth NHS Trust (UHP) has updated its Plan For A Greener Future with the aim of reducing its carbon footprint by 80% by 2032.

The plan contains more-targeted aims and objectives to ensure it aligns with the National Greener NHS and sets out the process to meet the NHS Long-Term Plan and documents.

Some of these aims include reducing carbon, waste, and water; improving air quality and biodiversity; and reducing the use of avoidable single-use plastics.

The plan will guide and develop future services in line with national and local policies and will ensure sustainability is embedded in all services.

The objectives are to: • Reduce the trust’s NHS carbon footprint by 80% by 2032, and achieve net zero by 2040 • Reduce the trust’s NHS carbon footprint plus (including in its wider supply chain) by 80% by

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2039, and achieve net zero by 2045 • Achieve 10% net biodiversity gain by 2030 across the estate • Adopt the Clean Air Hospital Framework to achieve an ‘Excellent’ score of 70% by 2028 • Reduce the risk rating of the climate change risk assessment by 20% by 2025 • Adopt a sustainable model of care for each clinical pathway by 2030 The plan will be reviewed regularly and will align with emerging policy, guidance, and other resources within the Greener NHS Programme.

The trust’s Green Plan programme manager, Kirsty Wavish, said: “Since the publication of the Green Plan in 2020, we have taken steps to embed sustainability into trust culture and operations.

“Our initial focus has been on engaging our staff and seeking views as to how we can become a moresustainable organisation.

“A governance structure has been set up with a dedicated sustainability sub-committee and specific working groups whose purpose has been to drive the aims and objectives set out in the plan.”

She added: “Acting responsibly and reducing the impact we have on our environment is an important consideration for the trust, from the way we care for our patients to ensuring we have a strong, financial and sustainable system in place.

“As a large acute healthcare organisation, we are committed to actively delivering our contribution to reduce carbon emissions and embed sustainability into everything we do.

“Climate change is globally recognised as the greatest environmental and economic threat faced by the national governments and individuals and it is also an opportunity for us to make those sustainable improvements, ensuring we use resources responsibly.”

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Green competition helps to drive efficiencies across hospital services Sustainability leads at Hampshire Hospitals NHS Foundation Trust are helping to save thousands of pounds as well as reducing carbon emissions as part of an innovative competition.

In June of this year, the trust announced a Green Team Competition in partnership with the Centre for Sustainable Healthcare (CSH).

Through the initiative, six teams were selected to engage in an award-winning programme in sustainability in quality improvement (SusQI) which transforms expert knowledge into action on the frontline.

Each team received mentoring from CSH facilitators to drive healthcare transformation by developing, implementing, and measuring the impact of projects through the lens of the sustainable value equation.

And, collectively, the competition has brought anticipated savings to the trust of £443,119 and 252,112 kgCO2e each year — the carbon footprint equivalent of driving 744,572 miles in an average car, or 917 return trips between Basingstoke and Edinburgh.

The teams presented their projects, including the anticipated savings and opportunities to scale and spread the innovations, at a showcase and awards ceremony on 28 November.

The six projects are: • Reducing medicine waste (pharmacy team) — The aim is to reduce waste by moving patients’ medication with them and returning unused medication so it can be reused. Across a month trial period, the team observed an increase return in medication to the cost of £6,942, equivalent to 2,360.28 kgCO2e. And savings from waste disposal (incineration) were approximately £27 and 32 kgCO2e. In addition, the project has increased awareness among ward teams of how pharmacy works and has enhanced working relationships • Outpatient parenteral antimicrobial therapy (OPAT) service (OPAT team) — OPAT is a safe and validated model of care that allows patients to receive antimicrobial therapy on an outpatient basis instead of needing to stay in hospital. At its current capacity, the service is demonstrating annual savings of £115,641 and 5,139 kgCO2e • Reducing CO2 waste through implementing remanufactured harmonic scalpels in laparoscopic surgery and replacing disposable surgical gowns with reusable surgical gowns (theatres team) — Projected across a year an anticipated £50,163 and 395 kgCO2e will be saved (based on purchasing a 67:33 ratio of remanufactured/new scalpel). Using reusable surgical gowns is projected to save £23,310 and 52,524 kgCO2e per year • HHFT Glove Use Awareness Campaign, (infection prevention and control team) — Leadership HEALTHCARE-PROPERTY.COM

engagement sessions, poster campaigns, and educational videos have been used and a trial across two wards recorded a 7% reduction in unnecessary glove use. Projected across a year, the project will achieve savings of £992 and 804 kgCO2e • Reducing low value activity in the emergency department (emergency team) — The aim was to reduce the number of unnecessary coagulation samples. The team observed a reduction in 1,884 coagulation samples in two months — a 24% reduction. This reduction equates to a saving of £7,266 and 1,095.67 kgCO2e per year. It also saved approximately 955 hours (40 days) of lab processing time per year • Reducing food waste (catering team) — The team engaged clinical staff to provide information on their perceptions for why food may be wasted .

Through implementing several changes the team has projected annual savings of £157,135 and 143,716 kgCO2e per year. There will also be an additional saving for reduced food waste Alex Whitfield, trust chief executive, said: “The Green Team Competition is a brilliant initiative which captured the energy and enthusiasm of our frontline teams from across the trust.

“The projects saved carbon, saved money, and improved patient care.

“They really showcased some of the outstanding innovation in our teams and the judging was incredibly difficult as every project was a winner!”

The catering team eventually took the top prize.

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Interview

Alison and Fiona frequently speak at industry conferences and events to explain the importance of clinical involvement from the earliest stages of a building project

The importance of clinical involvement in healthcare building projects Jo Makosinski speaks to Fiona Halstead and Alison Cann about why involving clinical staff in building projects is crucial to designing healthcare buildings which work for all

“P

eople do not appreciate how well thought out modern healthcare buildings should be, and with the ones that are great, how hard it was to get there.”

This stark observation comes from Alison Cann, clinical compliance specialist at Barts Health NHS Trust, who, along with colleague, Fiona Halstead, is leading a charge to imbed clinical advisors in all healthcare development project teams.

“The problem is there’s a lot of clinical people who do not understand buildings and a lot of architects who do not understand the intricacies of healthcare delivery”, Halstead adds.

“They have a huge vision, quite rightly, but to get that into a building is very difficult.

“Creating a healthcare building which truly works is about flows and processes, and you have to look at that.

“It is all very well giving an architect a brief for a new ward, or a new room on a ward, and they do that very well. But it might not flow well and support patients and staff, and that’s where we come in.”

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A BRAVE MOVE Barts’ clinical compliance team was born 23 years ago when Jilly Bowen, the deputy director of EFM (capital), made the ‘brave’ decision to bypass external consultants and put together an in-house team made up of senior clinical staff whose job it would be to ensure the needs of patients and staff were acknowledged, and acted upon, when building projects were developed.

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Interview

Fiona Halstead and Alison Cann are clinical compliance specialists at Barts Health NHS Trust

Halstead and Cann are both RNs and were drafted in from operational management and clinical nurse management roles to lead this team.

And the results have set a new benchmark for the design, construction, and operation of healthcare developments, both at Barts and across other healthcare operators in the UK and further afield.

“There’s a lot of things we can do by going by the book, but we can’t understand a lot of it without using each project as an individual entity, and that’s where we can act as the lynchpin”, said Cann.

“Clinicians have great ideas, and so do architects, and we help to marry them up.”

Halstead adds: “We are the link between

We are the link between the clinical users and the architects, who are at two ends of the spectrum. One doesn’t always understand drawings, and the other doesn’t understand clinical flow, and we understand both the clinical users and the architects, who are at two ends of the spectrum. One doesn’t always understand drawings, and the other doesn’t understand clinical flow, and we understand both.”

EARLY INTERVENTION To maximise the positive impact of this role, they advise trusts to create clinical advisory panels, and get them involved in all building projects at the very-earliest opportunity.

Halstead explains: “In the very-early stages we should be involved — just as the project is being morphed and when they have an idea of what they want because they might be looking at the wrong space or a space that

One of the projects Alison and Fiona were involved with was the creation of new theatres at Newham Hospital in east London

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does not link with other correct services.”

An example of this is the creation of standalone surgical units, an increasinglycommon development within the health sector as it struggles to cope with an increase in patients and a post-COVID backlog of procedures.

Cann said: “If it’s a standalone building like a surgical unit the only way to get a patient to ICU is to call 999 and send an ambulance.

“It is such a ridiculous waste of resources and as a nurse I cannot say that it is in the patient’s best interest.

“In this case, I would want a link corridor running between both buildings written into the plans at the earliest stage.

“While it might also seem simple on paper to get patients in for surgery, when you start to factor in all the support spaces, for example staff changing rooms, nursing stations, and clean and dirty utilities, these can be overlooked and then the department does not work in the best way for staff or patients.

DEVELOPING SKILLS “As a team we think about this all the time and there are certain things we have developed unusual skills in which are helping to inform more-efficient healthcare facilities.”

Another key attribute for those on the team, and another role they play, is forward thinking to ensure that all developments meet the needs of patients and clinical staff both when they open and in the future.

“What happens a lot is they choose the wrong building, without thinking about how different a service might look in a few years”, said Cann.

“Part of our job is to look at future demographics.

“When we were building an A&E unit in London the (then) consultants wanted to have it all curtains with no solid walls so in the event of a major incident they could use it like a field hospital.

“We thought it was a horrible way to JANUARY-FEBRUARY 2024 | 47

Interview

Using their clinical and management knowledge, Fiona and Alison ensure buildings work for both staff and patients

… there are certain things we have developed unusual skills in which are helping to inform more-efficient healthcare facilities look after people, not to mention the lack of confidentiality, privacy and dignity, and noise.

“We insisted on hard walls, while some had curtains in the front, and we got support from our infection prevention and control team.

“And that was a good move when COVID hit.

“Looking to the future, we are likely to have another pandemic and it is also our job to look at things like that.

THE LITTLE THINGS “We also are very keen on single rooms and we get the same comments that they are not good for nursing, but if you design them well, there is no difference.

“These are great for confidentiality, 48 | JANUARY-FEBRUARY 2024

privacy and dignity, and for managing patients with infectious diseases or those who need to mobilise after surgery.

“It’s the little things like that which people do not think about it until they have thought about it!”

Halstead adds: “Flexibility is critical and part of our role is in the background to look at new projects and developments in technology, what other people have done, and to read healthcare magazines so we know what the future looks like.

“As a manager I understand the needs, not just from nursing, but all staff and patient flows etc.

“And we have to be negotiators as you work with some difficult personalities who do not want to be told what to do, and might not see the reasons why we are doing it.

MEETING NEEDS “Having management on board, as well as clinical staff, is advisable too because they see things from a different perspective and a good manager who can manage their staff can be a real asset as there is a lot of delicate weaving to be done.”

In conclusion, Cann said: “People do not realise how complex an environment a clinical space is.

“If you have done your homework, and have considered the needs of staff, patients, and managers, you can create lovely environments which improve patient outcomes and are places staff want to work in.

“I think if we don’t design our healthcare buildings with clinical input we will not meet people’s needs.” n HEALTHCARE-PROPERTY.COM

People

COMPANY Plugging the skills gap LIFT ANNOUNCES Integrated Health Projects (IHP), the joint venture between construction giants, VINCI Building and Sir Robert McAlpine, has teamed up with Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester City Council, and the Skills Construction Centre to open a new Community Skills Centre.

The centre, which officially opened on 12 September, is situated on the construction site of GMMH’s new £105m adult mental health inpatient unit, North View, on the North Manchester General Hospital (NMGH) estate.

The hands-on service will support local residents aged 16-24 who are not in employment, education, or training to gain new skills and experience for employment, helping to close the future construction skills gap.

And it will provide local people furthest away from the labour market the opportunity to gain a Level 1 Award in a construction trade of their choice, alongside basic digital, maths, and English skills, a CV, Construction Skills Certification Scheme (CSCS) Card, and will involve a minimum of 70 hours practical work experience on the North View site.

Each trade cohort delivered through the centre will support 15 trainees and a second cohort which will focus on training for basic DIY skills and digital skills is also planned.

Danielle Doherty, VINCI Building’s social value manager, said: “Teaming up with the

NEW CHAIR

Skills Construction Centre allows us to provide a very-different training environment from mainstream education providers, which is so important as many people have struggled or have previously been excluded from school and would not thrive in a traditional college setting.

“We understand the barriers some young people face getting into employment and believe everyone should be provided with the opportunity to showcase their best qualities away from the traditional interview.

“Providing training and a minimum of 70 hours work experience allows candidates to gain confidence and showcase their work ethic away from an otherwise-stressful setting.”

Work on North View started in August 2022, with the new unit anticipated to open in the coming months.

Once completed, the upgrade will house a purpose-built Psychiatric Intensive Care Unit (PICU), eight adult acute wards, and a treatment suite.

Refugee scheme bolsters workforce Refugees are helping to bolster the NHS workforce in the capital.

Set up by West London NHS Trust 18 months ago and now overseen by the North West London Integrated Care Board (NWL ICB), the Refugee Employment Programme is offering new career opportunities for refugees living in local communities.

The initiative was the brainchild of West London NHS Trust chief executive, Carolyn Regan, after the organisation received a number of enquiries from refugees seeking employment with the NHS. The differentiating factor of the programme is that it does not focus solely on refugee doctors or nurses. It also recruits clinical HEALTHCARE-PROPERTY.COM

and non-clinical staff, including estates and facilities workers.

And there are eight NHS trusts across the ICS area delivering the programme, giving jobseekers more options.

At a recruitment fair earlier this year, 100 refugees from countries such as Ukraine, Afghanistan, and Syria accessed support and advice and took part in face-to-face interviews, with 25% of the candidates offered work placements.

A spokesman for the programme said: “It is mutually beneficial as we are developing talented people and broadening the diversity of our workforce.

“We would like to encourage trusts within all ICBs to take on some of the refugee volunteers, especially those living locally, and will continue to work together with other London ICBs to recruit suitable refugee candidates nearer to where they live.”

Simon Murphy has been appointed as the new chairman of the Coventry LIFT Company, Arden Estate Partnerships, a long-term public-private collaboration between Community Health Partnerships, Equitix, and gbpartnerships.

An experienced and well-regarded senior leader within the health sector, holding positions as chairman of Sandwell Estates Partnership LIFT Company and deputy chairman of the Worcestershire Acute Hospitals NHS Trust, Murphy takes over from outgoing chairman, George Marsh, who has led Arden Estate Partnerships since its formation in 2003.

Over the past 20 years the LIFT company has delivered five new, highquality integrated health and wellbeing hubs, representing a capital investment of over £34m.

NHSPS EMPLOYS DATA AND INTELLIGENCE LEAD

NHS Property Services has announced the appointment of Richard Fitzsimmons as its new head of data and intelligence.

Appointed in 2019 as operations business intelligence lead at the government-owned property organisation, he will shape NHSPS’ data and intelligence strategy and promote the use of assured and quality analytics for data-driven decision making.

SALES DIRECTOR JOINS BENDER Healthcare electrical safety equipment supplier, Bender, has appointed Carl Fletcher as its new UK sales director.

He will be responsible for the management and development of the sales function covering the main business areas of healthcare, eMobility, service solutions, and industry.

A supplier of electrical safety monitoring products, engineered solutions, and services, Bender UK employs over 100 staff across three office locations in the UK and Ireland.

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People

CONSTRUCTION GIANT RESTRUCTURES OPERATIONS

Bouygues’ UK chief executive, Rob Bradley, is retiring from the company as the firm restructures its UK operations.

He will be succeeded

by Fabienne Viala, who will also continue her roles as chair and UK country director for Bouygues Construction.

As a result, Bouygues UK will now be organised into three business units, including two regional businesses covering London and the South East and the South West and Wales. They will be led by Philippa Prongué and John Boughton respectively.

The additional business unit, Complex Projects, will be led by Gerald Farque, and will primarily concentrate on healthcare, science, and research projects nationwide.

PLANNING CONSULTANCY BRINGS IN ASSOCIATE DIRECTOR Healthcare strategy and planning consultancy, Lexica, has appointed Yogesh Luhar as associate director to the property consultancy team.

Based in Manchester and with over 30 years of experience in estates and asset management growth strategies across the NHS and wider public sector, he will oversee Lexica’s full range of property consultancy services across various clients in the North West, including strategic estate reviews, asset management, and full business case development.

He will also focus on acquiring new client relationships and leading business development strategies for the region.

Mental health units create jobs

More than 200 jobs will be created as part of a £150m investment in the construction and renovation of six mental health units in Derbyshire.

This project is part of the Making Room for Dignity initiative led by Derbyshire Healthcare NHS Foundation Trust, which encompasses the development of three new units and the refurbishment of three existing psychiatric facilities.

It has already added 27 full-time positions, and an additional 209 jobs are expected

to be generated in the upcoming financial year, spanning April 2024 to April 2025. Two mental health units, each with 54 beds, will be located at Chesterfield Royal Hospital and Kingsway Hospital in Derby and are expected to be finished next autumn, opening to patients in November.

Additionally, a psychiatric intensive care unit designed to accommodate 14 male patients at the Kingsway site will be completed by November 2024 and is set to open its doors by March 2025.

CHP boosts the board Community Health Partnerships (CHP) has appointed two new non-executive directors to the board.

The Department of Health and Social Care-owned company provides services to commissioners and local partners across England with the aim of delivering savings, increasing service integration, and driving optimal use of the primary and community health estate.

Pete Cornforth and Eric Guillaume have now joined the board for three years.

Cornforth brings over 35 years experience in the investment and asset management sector, having previously held non-executive roles at Surrey and Borders Partnership NHS Trust and One Housing Group, while currently undertaking roles at Pete Cornforth John Whitgift Foundation, Transport

for London, The Ormiston Trust, and East London NHS Foundation Trust.

Guillaume has over 20 years experience developing customer-led strategies and Eric Guillaume has delivered major programmes of digital business transformation at board level, previously working for Grosvenor Group, ITV, and AOL as well as the UK Parliament, HMRC, and the BBC.

NEW ROLE FOR LEADING CONTRACTOR Galliford Try has appointed Andrew Spencer to the newlycreated role of supply chain and procurement director.

Spencer joins the business from Skanska, and has more than 25 years’ experience in construction. He will become the functional head of supply chain and procurement professionals across the business.

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As part of his new role, Spencer will be tasked with developing the business’s strategic approach to supply chain management, supporting the development of a strong and aligned supply chain to enhance delivery performance and support the business’s future growth plans.

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