On the first day of last October’s Healthcare Estates 2023 conference, Natalie Forrest, the Senior Responsible Owner for the Programme, gave an update on progress with the New Hospital Programme. She also discussed the principles behind, and anticipated benefits of, Hospital 2.0 – a national approach to delivering new hospitals more quickly, at a lower cost, and with greater taxpayer value. Following her Manchester address, she was also among a number of high-level NHP speakers at an Autumn Market briefing held in London on 9 November, aimed principally at suppliers. HEJ editor, Jonathan Baillie, reports
Natalie Forrest’s early afternoon keynote speech on 10 October was immediately followed by an interesting address from clinical planner and global healthcare consultant, Suzanne MacCormick, in which she discussed some of the key sensory elements shown in studies to make for optimal staff and patient environments (see pages 31-36 for a report)
Presenting in the first ‘half’ of a two-part conference ‘slot’, Natalie Forrest was introduced to delegates by IHEEM Past-President, Paul Fenton. The Senior Responsible Owner for the NHP, who took up the role in January 2021, is a highly experienced former nurse, with a BA in Nursing from Sheffield Hallam University, and a Master of Science in Health Services Management. Before joining the NHP team she also served as Interim CEO and COO at West Hertfordshire Hospitals NHS Trust, Director for Service Transformation at Barnet & Chase Farm Hospitals NHS Trust, and Chief Executive Officer at Chase Farm Hospital.
A multitude of schemes
She began with a little background on the New Hospital Programme: “For those of you unfamiliar with it,” she explained, “we have a multitude of schemes – 40 in all – and a systematic way to deliver them by 2030 across England, including addressing the issues hospitals incorporating reinforced autoclaved aerated concrete (RAAC) are facing. We are set up as a centralised programme to deploy a systematic approach – including developing a common set of design principles – including Modern Methods of Construction.” Key to the Programme’s success, she said, was ‘the development and application of a common commercial and procurement strategy to achieve economies of scale and mitigate supply chain constraints’.
Hospital 2.0
The NHP speaker went on to explain, accordingly, that Hospital 2.0 – the second focus of her presentation – was the New Hospital Programme team’s ‘response to the things we know we could do across the NHS infrastructure in a completely different, or better, way’. “So,” she said, “it’s about learning from all the expertise in this conference centre and across healthcare and infrastructure. We know that, currently, it can take an incredibly long time to get a business case approved for a multi-million, and in some cases, billion pound, project.” In fact, she explained, on average it currently took around six years. While some schemes were approved faster, those which took six years or more to gain approval left communities desperately in need of a new healthcare facility with significant problems. She said: “So, we’re committed to changing this, and to reducing that timeframe quite significantly, i.e. by a number of years.” Hospital 2.0 was also ‘about standard design’. Natalie Forrest explained: “I believe many think it is just about standardisation. Standardisation is indeed one of the key requirements for us to be able to deliver these hospitals much quicker than we do currently. Our strategy is about changing the way we deliver healthcare infrastructure for the NHS, so we can build many more hospitals concurrently. Those of you familiar with the Programme will be wondering how we’re going to build so many in such a short timescale. The answer is that it will be through industrialisation and setting out new standards to take time out of the process, and to be able to manufacture the components and bring them to site and assemble these hospitals.”
Modern methods of construction
Achieving this would, she explained, mean using Modern Methods of Construction. While many working in healthcare were familiar with MMC via their experience of modularisation, this was – Natalie Forrest stressed – ‘just one tiny component of what we’re capable of in this sector’. She said: “We need to bring all these things and the associated learnings together to assemble a much better kit of parts that will allow the sector and the industry to come together and develop these components to enable us to build all of these hospitals concurrently.” Equally critical to Hospital 2.0’s success was the work the NHP team is doing with the NHS ‘to transform the way we will deliver (future) healthcare in these facilities’. The speaker said: “Continue doing what we do now – even if we do it better – and it will not be enough for us to be able to meet the needs of the people of this country, and the NHS requirements for modern medicine.”
Need ‘to change the way we do things’
Natalie Forrest said that the new hospitals created across England via the New Hospital Programme would be open at the end of this decade, and for them to meet the country’s needs, the sector would need to ‘change the way we do things’. The NHP team is thus working with the Royal Colleges and clinicians, both across England and internationally, to identify the greatest opportunities to change the way healthcare is delivered.
At the heart of the NHP team’s approach is ‘agreeing the right size of hospital’. Natalie Forrest said this required understanding changes in the models of care, and care delivery location – whether closer to home, or via other facilities such as elective care or diagnostic centres, as well as being able to standardise the way demand and capacity modelling are undertaken. She said: “This is a universal process when thinking about a new hospital, but has so far been undertaken in many different ways using different assumptions. So, across the NHS, we want to be able to standardise this, and, by doing so, achieve it much more quickly, reducing the length of the business case planning process.”
Hospital 2.0 would, she said, be the vehicle for all of these goals – the business case process, the standardisation of the design, the clinical pathways, and ‘how we commission and open the buildings, and ensure they are safe for staff and patients’. Natalie Forrest said one of the NHP team’s guiding principles was that it will use the NHS ‘to tell us what it really needs for the future’. “It’s not for us to tell the service how to function,” she explained, “but rather to facilitate all the building blocks the NHS needs to improve clinical outcomes, and to have the right space, adjacencies, and digital solutions, to maximise staff’s potential at work every day. It’s also,” she added, “about reducing unwarranted variation, because we know this improves quality, and reduces stress on staff, and that patients quite like going and seeing similar environments on a continuous basis.”
She stressed that this didn’t mean that all hospitals would look the same, but rather that from the NHP team’s perspective, the components would be put together in a similar way – an objective requiring engaging all users. This was one of the key reasons she and her colleagues were at the conference – ‘to ensure that we’re visible, talking to the right people, and listening to all the things everyone wants to tell us about how we can do things better’. Hospital 2.0 was also, the NHP SRO said, ‘about utilising the evidence already available to properly learn about what goes well, and doesn’t go well’, in healthcare infrastructure programmes, and continuing the learning, ‘so that we’re learning from ourselves, not just repeating mistakes, and getting better through that improvement cycle’.
The wellbeing of those served
She added: “It’s also about the wellbeing of the people we are here to serve, enhancing patient safety, contributing to Net Zero, ensuring that we’re mindful of both the patient and staff experience and wellbeing, can add to the environment we’re working in, and are playing our part in the social value of having a hospital in our community.”
She added: “Hospital 2.0 is all about transforming all of the processes from end to end, so we’re picking up all the components throughout the process of building a hospital. It’s about working with our schemes right from the start, understanding their needs, and translating that into something we can deliver swiftly.”
While healthcare estates staff will generally properly consider the maintenance of healthcare buildings post-completion, Natalie Forrest conceded that the NHS hadn’t had had the opportunity to do this as well as it would like to. The NHP team was therefore putting considerable emphasis on ensuring that the new hospital buildings were ‘smart’, and can be maintained throughout their lifecycle, ‘in a very structured way’. Elaborating, she said: “This revolves strongly around the clinical standards, so begins with our clinical teams setting out the brief, working with the Royal Colleges and clinicians across the NHS to understand what the best looks like, and identifying how we create that environment so we can replicate it across all the schemes.”
It was then about identifying how this came together in a kit of parts that could be procured, manufactured, and brought to site as quickly as possible, and about looking at the economies of scale of building so many hospitals simultaneously. “So,” Natalie Forrest said, “that’s using every opportunity we can through Modern Methods of Construction, and looking at how we integrate the logistics of this, and prepare for having many large hospitals being constructed simultaneously. We need to think about putting together a ‘Reference Design’, so we can showcase to all the organisations we’re working with the art of the possible.”
An iterative approach
The NHP speaker emphasised that Hospital 2.0, once fully deployed, would be ‘an iterative process taking in emerging technology’. The NHP team believes, however, that the initiative could see new hospitals created 30% faster than via ‘traditional methods’. Natalie Forrest showed a slide ‘mapping out’ what the NHP team sees happening around the design, business case, and approvals process, construction and commissioning, and where team members believe the key savings are achievable. She said that while some elements were aspects that those involved in hospital design and construction would have known about for years, there were some ‘really positive ways’ these things could be done concurrently, or ‘in swifter order’.
A ‘real enabler’ for the steps required to set these organisations up for the future was ‘to really enhance the opportunities technology brings’. She explained: “We see that in the three components of fabric, footprint, and flow.” From a fabric perspective, this was about ensuring the sector was putting together ‘smart’ buildings, with the capability to support Net Zero carbon, and control energy consumption, potentially ‘involving technology we have yet to see and don’t understand, so that these buildings are set for the future’. The speaker added: “It’s about the footprint of the technology, and making sure it connects across the hospital facilities to allow a better patient experience, and enhance the care staff are giving. We all know that ‘workforce’ is both our biggest challenge, and our greatest gift in the NHS, and we need to provide staff with the enhanced capabilities that digital solutions will provide.”
Latest clinical standards being worked on
Given the acknowledgment that technology, information flow, and data around patient care, will improve outcomes, it was, she said, the NHP team and the sector’s responsibility to ensure that these new buildings had all of that capability. Here, Natalie Forrest said she would outline some of the key clinical standards the team has been working on, and which it believes will have the biggest impact. She said: “One is 100% single rooms; there are some obvious advantages. Emerging from a global pandemic, we saw the impact – from an infection control perspective – of not being able to separate patients, and we have a duty to address this. We know we want to be able to promote the privacy and dignity of all our patients. This is the ideal way to do that, and to enhance their ability to engage with their families, without disturbing others, on a 24-hour basis. We also want to be able to ensure that ‘available’ beds are truly available, and to ensure better flow through our capacity in the hospitals.” The NHP team was also ‘doing a huge amount of work on adjacencies’.
Looking at current hospital layouts, Natalie Forrest explained that the NHP team could see ‘a massive impact’ from not having services in the right place and co-located. This was an issue that clinicians pointed out ‘very easily’, emphasising the impact not only on the hours they spend moving patients around, but also on patient safety
Nearing the end of her presentation, the speaker noted that among the NHP schemes were a number of schemes where hospital buildings would be ‘stripped back the to the bare bones’ and refurbished. She said: “It’s easy to get excited about a new building, but if we want to be sustainable, and offer out all of the learning across the NHS, it’s important that we set some standards for refurbishment as well. Hospital 2.0 thus includes those.” Pointing to a slide, Natalie Forrest said: “You can see that Hospital 2.0 isn’t just about design; it’s also about our vision for equipping these buildings, and in particular, understanding the Workforce Strategy. If we set out 100% single rooms and different adjacencies to what people are used to, we need to think very carefully about the impact on the workforce. Equally, if we set out new digital technologies, it’s important that we’ve taken the staff into account. We don’t want to add to the cognitive load on NHS staff in the NHS; we want to enhance things. Finally,” she said, “we are very keen to hear from the industries represented here today about how we can do this better, what we should be standardising, and how we bring things together.”
With this, Natalie Forrest thanked the audience for listening, and handed back to Paul Fenton to introduce Suzanne MacCormick, who explained to the audience that she would be speaking about ‘Building for excellent outcomes’. (See separate report, pages 31-36.)
Getting suppliers fully ‘on board’
One of the fundamentals for success in the programme to build the 40 new hospitals across England will be engaging suppliers fully, and on 9 November the New Hospital Programme team held an ‘Autumn Market Briefing Update’ designed to do just that in London. Here many of the senior personnel within the team – including Natalie Forrest, Chief Programme Officer, Morag Stuart, and Programme Director, Saurabh Bhandari, spoke. The audience was a mix of representatives from contractors, manufacturers, and clinical service providers, keen both to hear about progress to date, and the key delivery models for the 40 hospitals the Department of Health & Social Care says remain on track to be completed by 2030, and the commercial opportunities across the associated supply chain. There was also the opportunity to hear from speakers about some of the different methods and ways the NHP team believes hospital care may be delivered in future – particularly given the increasing ‘digitalisation’ of many aspects of healthcare.
NHP team members emphasised early in the day that one of the fundamentals in ensuring the Programme met its goals was getting contractors, suppliers, and the wider supply chain involved in ‘the biggest hospital project in a generation’. The team says the Programme is taking a ‘transformative approach’ to designing and building hospitals for the future, harnessing, in particular, Modern Methods of Construction, standardised design for manufacture and assembly, and use of ‘the latest technology’.
Part of the Government Major Projects Portfolio (GMPP), it will see outdated infrastructure replaced by facilities for both staff and patients ‘that are on the cutting edge of modern technology, innovation, and sustainability’. The NHP team says the new healthcare facilities will be delivered via ‘a collaborative partnering approach’, the aim being ‘to build an enduring capability to continue to deliver new generation hospital facilities way beyond the first phase’.
Four key elements
Natalie Forrest was the first speaker, and having welcomed attendees, set the context for the rest of the day. She said the New Hospital Programme would ‘transform the way healthcare is delivered across England’ based on four key elements:
Delivery: Delivering hospitals faster and for less cost. The Programme aims to address some of the most pressing challenges for the NHS estate – ‘ensuring that our health infrastructure can adapt to changing clinical need, deliver significantly improved value for money and a sustainable legacy, and create enhanced social value and local community benefits’.
Quality: Ensuring that all new hospitals integrate ‘innovative national new standards for healthcare infrastructure, and enable high-quality modern healthcare’. This, the DHSC and NHP team say, ‘will support transformational change for each hospital, patient, and staff member’.
Sustainability: ‘Building the foundations for an enduring national capability for enhanced healthcare infrastructure delivery’. This will enable continuous learning, ‘working in an agile way to respond to innovation and advances in medicine over time’.
Collaboration: Supporting the codesign and co-creation of schemes in collaboration with local and regional health systems. The New Hospital Programme will ‘build trust and constructively challenge’.
Natalie Forrest was clear that the extent of the success of the Programme would be ‘measured’ by NHS staff and patients. She said: “Our job is to ensure that on top of a building programme, we enable transformation in clinical care.” This would require the sector to be ‘curious, brave, and challenge everything we know’, while the NHP team’s focus would be to maintain patient services and keep hospitals open while new buildings are being built. The team would also be putting a high priority on looking at how healthcare services are best delivered both here and internationally, learning from others, and ‘adopting and adapting for success’. She told those gathered: “Our goal is to be world-leading, and to do that, we need your help.”
Driving a step-change
In a subsequent presentation, Saurabh Bhandari, NHP Programme Director, explained why the NHP team has developed a ‘H 2.0’ system, describing it as ‘an integrated system that drives a step-change in the delivery of healthcare infrastructure’. He said: “NHP needs to deliver hospitals cheaper and faster, yet currently every scheme is a standalone project with a new solution to the same fundamental challenges developed each time, with no learning between projects”. To address this, the Programme will aim for standardised business cases, efficiency, and consistent design, to address current cost and schedule challenges, and identify opportunities for innovation and continuous improvement.
Hospital 2.0 was – he explained – ‘an integrated systems approach providing curated design and development solutions to efficiently deliver transformational, sustainable healthcare environments for patients and staff’. The Programme would:
Provide a blueprint for fast-track project development.
Drive operational excellence ‘by empowering employees to maximise use of the facilities’.
Optimise interpretation of clinical standards, enabling future models of care.
Provide ‘robust, adaptable designs based on balanced input matching capacity to demand’.
‘Ensure repeatable solutions, delivering procurement at scale’.
Drive cost reduction, with standardisation / modularisation at the heart of design.
Mitigate delivery risks by simplifying processes and pooling contingency.
Deliver curated and codified knowledge resources to Trusts, ‘formed from a rich network of SMEs’.
Draw on best practices ‘to drive smooth operational readiness and transition to new facilities’.
‘Enable continuous value management through check and challenge’.