The UK government plans to spend £Bn’s over the next decade on an unprecedented public sector capital projects and infrastructure programme. At its core is the design and delivery of a world class new-build major hospital programme.
The HIP programme sets out the UK government’s ambitious roadmap for 21st century standards of care within the NHS. It calls for a transformation in approach, technology and new models of care, supported by a world class health sector infrastructure. What are the opportunities and how should NHS Boards engage and organise themselves to take full advantage for the communities they serve?
An Evolving Vision
In September 2019, the United Kingdom’s Department for Health and Social Security published its Health Infrastructure Plan (HIP), a rolling 5-year programme of investment addressing the building of new hospitals and the modernisation of primary care estate. In October 2020, the Prime Minister and Health Secretary announced the 40 hospitals that will be built by 2030 as part of a package now worth £3.7bn and invited eight further schemes to bid for future funding. In all, the Government has committed to funding and building a total of 48 hospitals over the decade.
Trusts that have won inclusion in the Health Infrastructure Plan will rapidly have to acquire additional capabilities, competencies, and agility in order to successfully navigate through the mandated business case process[1] and demonstrate that their scheme:
- Is service-led, centred on patient needs and based on a clear vision across the health and social care system;
- Involved local people and staff in its development from the outset;
- Meets the needs and objectives in both the Trust’s own and locally agreed health services strategy;
- Is affordable and deliverable.
Setting Up For Success – HIP Imperatives
Ankura is a leading international Capital Projects Advisory consultancy that is at the forefront of the ‘NHS HIP-1 journey’ assisting Princess Alexandra Hospital NHS Trust, Harlow, in designing, establishing and procuring its organisational PMO, governance structure, programme controls and systems, as well as providing staffing to support its HIP1 journey. Our experience gives us unique insight and experience (the do’s and don’ts) ideally placing us to guide, support and advise other NHS Trust Boards looking to advance their own schemes.
Accordingly, Ankura can help Trusts to plan, procure and deliver their HIP projects, saving time, and reducing risk, waste and fruitless work. To achieve this together we will address the following ‘HIP critical success factors.’
Our 7# HIP Critical Success Factors
- Defining the project brief – improving healthcare outcomes
The new facilities must be designed to match expected Demand and Capacity requirements taking into account demographic and non-demographic change, operational assumptions (such as utilization, operating weeks, days & hours and Length of Stay) and expected activity changes. A Model of Care must be defined and approved through engagement with internal and external stakeholders including with the wider system. Comparison with the `as is’ situation will enable a Schedule of Accommodation to be developed, and scheme objectives and expected benefits to be defined.
- Using the capital project as a transformation catalyst for the Trust
New hospital facilities require new ways of working to operate them. The capital project will need to be supported by a transformational or organization development program so the Trust, its workforce and the wider system are ready to use the new facilities as they are completed. To do this, Trust’s need to think more holistically than merely the provision of a new building to how the building’s design should act as a catalyst for new methods of care, technology and clinical excellence transformation. To achieve this Trust’s need to develop and establish specialist teams often from outside their core capability to define and drive.
- Establishing robust, fully costed business cases
Preparing approvable Project or Program Business Cases using the 5-case model requires very high levels of specialist expertise to correctly articulate how the scheme will:
- Provides strategic fit and is supported by a compelling case for change (Strategic Case).
- Will maximize public value to society through the selection of the optimal combination of components and related activities (Economic Case).
- Is commercially viable and attractive to the supply side (Commercial Case).
- Is affordable and is fundable over time (Financial Case).
- Can be delivered successfully by the Trust and its partners (Management Case).
- Establishing the right Estates strategy
In addition to the 5 ‘normal’ cases listed above, Trust’s considering HIP funding will also need to consider and set out:
- How Estates and Facilities Management requirements will be achieved.
- Provide detail on efficiency, backlog maintenance reduction and information on how the condition of the estate will be maintained in the long term.
- Set out what (if any) associated disposals there are with the project and demonstrate that they are generating as much capital receipt as possible to help with the construction of the new build.
- Set out how Sustainability Considerations / Other Government Policies regarding construction are built into the design process and will be achieved through the build.
- Developing organizational capability to plan, deliver and control major projects
Most Trusts have well developed governance structures and processes, operated by lean workforces that are optimized to deliver the current model of care. Taking on major capital and transformation programs in addition necessarily requires that these are robustly reviewed, adapted and augmented, which may be achieved through a combination of recruitment and strategic consultancy procurement. The challenge is to achieve adapted and enhanced structures and processes that enable current facilities to be operated efficiently while the new ones are developed. Developing the right fit for purpose organization to deliver major capital projects is one of the Trust’s most challenging and risky tasks. After years of under investment in major new healthcare infrastructure Trust’s will need to seek planning and delivery partner relationships.
- Embedding data and technology at the heart of the capital project journey
The generational opportunity HIP presents mean Trusts’ need to vision how the new hospital, its staff and patients will interact perform and change over many decades of use. It is therefore vital that Trusts future-proof as much as they can through the early and wholescale adoption of technology to define:
- Its digital and technological vision/ambition for the new facilities;
- How technology will support new ways of working;
- Any foundation technologies that will be required (e.g. 5G);
- Technologies that will need to be installed with the new building (e.g. Automated Guided Vehicles);
- Any supporting technologies (e.g. digital control center)
- How the hospital will communicate, securely store and process data in relation to GDPR, patient records, GP practices, 3rd Party vendors as well as the latest in medical technology and equipment.
Putting a technology strategy at heart of HIP is critical and should lead and inform what resultant healthcare infrastructure is to be build.
- Effective Stakeholder engagement – inside and outside
Trusts will already be aware of the vastly complex stakeholder landscape they operate in, but the HIP journey will bring this into sharper focus than ever before. Every key product/deliverable will require an assurance process to be mapped for it. There will be inevitable tensions between the clinicians’ requirements and the budget. Local authorities, and every component in the local healthcare eco-system will expect to be consulted on the scheme; they will encourage, and they will warn. It is therefore paramount that the Trust effectively builds, onboards and maintains the optimum stakeholder engagement support capability
In Summary
The UK’s Health Infrastructure Plan now offers NHS Trusts a much needed and welcome opportunity to significantly invest in their physical healthcare infrastructure after decades of under investment.
Despite the £3.7bn funding set, aside only those Trusts who can demonstrate compelling clinical, business and health benefit cases will success, leaving others inevitably excluded.
Understanding the HIP landscape from the outset and by addressing the critical success factor set out above, Trusts can secure their place in this transformational program.
Talk to the Ankura team now and together we can unlock your HIP potential.
[1] As set out in the HM Treasury “Green Book” (revised in November 2018) and in NHSI’s guidance ‘Capital regime, investment and property business case approval guidance for NHS Trusts and Foundation Trusts’ (November 2016)
© Copyright 2021. The views expressed herein are those of the author(s) and not necessarily the views of Ankura Consulting Group, LLC., its management, its subsidiaries, its affiliates, or its other professionals. Ankura is not a law firm and cannot provide legal advice.
