Multi-million-pound investments, surgical innovation, artificial intelligence, and estate rationalisation were just some of the key issues discussed during Place North West’s Healthcare Property Update, sponsored by Curtins, Graham Construction, IBI Group, and Wardell Armstrong.
More than 130 delegates attended the event at the Museum of Science & Industry to hear from a panel of expert speakers, who discussed how the changing face of healthcare will impact property and construction across the North West and beyond.
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Speakers included Jason Dawson, director of capital, estates and facilities at The Christie NHS Foundation Trust; Tracy Paine, deputy chief executive of Belong Villages; Neil Grice, estates lead for the Greater Manchester Health & Social Care Partnership; John Knape, frameworks director at IBI Group; Keith Hayes, healthcare director at Graham; and Jayne Traverse, regional manager for One Public Estate.
Grice of the Greater Manchester Health & Social Care Partnership kicked off proceedings with an overview of the partnership’s role in the region, and outlined how it is working to bring forward investment in both large and small healthcare schemes across Greater Manchester.
- The partnership has a combined health and social care budget of £6bn, which is among the largest of its scale in the country.
- A local asset review, which works out which new facilities are needed, what can be divested, and how local authorities can best use these assets, has already been completed in both Bury and Stockport, with plans in place to roll this out across the borough. The process has already started in Trafford.
- This process also includes identifying land owned by healthcare bodies that can be released for housing.
- However, Grice warned that the capital receipts from land disposals “would only just cover annual running costs” and said that the partnership had be “more clever” about how the money is used, compared with London-based healthcare bodies, given land values in the North West are much lower.
- He added there was “no chance” of funding everything on the capital pipeline within the region, but the partnership was putting together a longlist of bids to bring forward for the next round of national funding in the summer.
- Grice warned: “Even if we get half of it, which we won’t, we have a huge amount [of funding] that won’t be met”.
- Alongside the local asset review, the partnership is working on a Greater Manchester mental health estate strategy, due to be delivered by consultant Currie & Brown by September this year. This will look to help inform a 10-15 year estates strategy for mental health needs and a parallel strategy for mental health services across the borough.
- He also highlighted the Gorton Hub project in North Manchester, which is funded with £20m supported by prudential borrowing. Due to start in March next year, it will include an integrated community health hub and social care services.
- Grice said to “expect more projects like this” across the region, particularly those backed by borrowing.
Grice’s presentation was followed by an overview by John Knape of IBI, who outlined how surgical innovation had shaped the design and usage of hospital estates, and how technological advances would continue to change how hospitals are used in the future.
- Knape outlined how improvements in the operating and surgical environment had impacted design and construction in the past, and pointed to a series of trends to show how the rise of technology in surgery will transform how hospitals are designed and built in the future.
- Current operating theatres face a series of challenges; often they are too small, leading to crowded and inefficient working environments, while patient turnaround is variable, and few are used to their maximum capacity.
- New technology is often introduced in a haphazard manner into “what is already a highly-complex environment”, he said, while some surgical equipment “is not significantly different from what was used a hundred years ago”.
- The adoption of technology will radically change processes and development of operating theatres with a number of examples already coming forward.
- Operating theatres have already been designed and built featuring self-sterilising walls, retractable equipment, in-wall waste receptacles, back-lit walls, and heated beds, all of which improve the efficiency and operation of healthcare estates.
- Artificial intelligence has a major part to play in this advancement; surgical simulation, robotics, augmented reality and 3D modelling will all help to overcome the physical limitations of surgeons, said Knape.
- Technologies already addressing this include 3D modelling of body parts using bio-texture models which use materials that replicate soft tissue and bone, allowing surgical procedures to be improved.
- He said those working with hospital estates should expect less conventional theatres; hybrid theatres; and those specifically designed for robotics.
- However, he warned that capital constraints remained and issue: “I’m not sure that under the current model we can afford to build multi-use and interdisciplinary theatres”, he concluded.
Future demand for services
Knape and Grice then joined Jayne Traverse, Tracy Paine, Keith Hayes, and Jason Dawson on a panel discussion chaired by Place North West editor Jessica Middleton-Pugh to discusses the future opportunities and challenges faced by the healthcare sector and their impact on property and construction.
- Dawson began by outlining The Christie’s upcoming investment in its estate, part of “real change” over the last 10 years to the organisation’s approach to the built environment.
- As the Proton Beam Therapy Centre at The Christie’s Didsbury site nears completion, ahead of welcoming its first patients later in the year, Dawson said the organisation was already looking at investments worth more than £170m, including a £150m research and patient care hub at The Patterson Building, damaged by a fire last year.
- Other investments also include a £26m cancer centre at The Christie’s site in Macclesfield.
- Traverse outlined One Public Estate’s approach to estate rationalisation, and praised Greater Manchester’s “advanced approach” towards it health and social care agenda.
- She outlined how Greater Manchester was mapping the future demand for healthcare services, and how opportunities for estate rationalisation were identified: “We have to ask if we have the right properties, and if we don’t, we can dispose of those assets or acquire assets to bring services together”.
- She added this approach would help to release more sites from healthcare estates into housing, but also added that public land “should not be taken in isolation” and should be considered alongside private landholdings and other stakeholders to maximise how healthcare estates are used.
Making a business case
- Asked about funding challenges for healthcare projects, Graham Construction’s Hayes said that getting business cases signed off, rather than funding, was the biggest issue faced by contractors working in the sector.
- “A lot of skills within trusts to deliver projects first time have been lost because of austerity, and those that have their own capital can get projects off the ground much quicker,” he said.
- Grice agreed that there was a lack of training and skills to get businesses cases through the approvals process, and pointed towards masterplanning of estates to help push projects forward. This process has also flagged up where estates can include built-in provision for training and development at hospital sites, alongside key worker accommodation.
- Paine said the largest challenge for Belong, which provides “village-style” accommodation for assisted living and care, was the planning process.
- The developer has had a site in Chester city centre for four to five years but this project is still “waiting to get going” due to planning restrictions, she said.
- She added Belong had two more villages due to start on site this year, with two more going to planning, and said the developer would continue to offer an alternative to larger-scale extra-care facilities: “Some extra-care facilities won’t be the answer for everyone and we need to think about places for the most frail and vulnerable, or they will end up in hospital”.
- On the role of technology, Knape said patients are starting to “expect more” from hospital environments: “What was acceptable in the past, for example multi-bed bays, are no longer seen as such, and hospitals will have to adapt to meet this expectation”.
- Asked about primary care hubs, like the Gorton scheme mentioned by Grice, Hayes said the model had become increasingly prominent in the South East and South West, and that more of these were likely to come forward in the North West.
- These could include different designs: “We’re beginning to see some different things where a number of GP practices, pharmacy, and inpatient bays are all in one development to take out “bed blocking” patients out of hospitals,” he said.
- Grice said there were further plans to look at GP practices coming together under one roof in Greater Manchester, but said “there will always be a market” for third-party development as “the capital just isn’t there”.
- Adding to the discussion on private partnerships, Dawson said there had been “a great deal of scepticism” around the NHS working with the private sector, but argued: “Sharing experience with the sector is important and I’d encourage organisations to be fearless in taking advantage of that”.
- However, he also called on the construction industry to do more to support healthcare estates and their adoption of new technology, arguing that construction should play a role in “shaping the healthcare sector”.
The panel concluded with each member asked on where the opportunities lie for the healthcare sector, and the panellists agreed that cross-sector and regional collaboration would be key for healthcare to maximise efficiency and seize the opportunities presented by new technologies.
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