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Healthcare Planning and Clinical Strategy
Barts and The London New Hospitals PFI
The £1.1 billion redevelopment of Bart’s and The London New Hospitals is the largest private finance initiative hospital scheme to be undertaken in the United Kingdom and involves the reconfiguration and reprovision of clinical accommodation across two major inner London acute hospital sites. The infrastructure works are part of a wider reorganisation of clinical services within central and east London and see the creation of a centre of excellence for cardiac and cancer services at Bart’s Hospital, and the redevelopment of emergency and elective facilities at The London Hospital.
Clinical facilities at Bart’s Hospital include cardiac catheterisation suites for cardiac angiography, operating theatres for cardiac and cancer surgery, and dedicated radiotherapy and chemotherapy accommodation. These are supported by out-patient, in-patient and diagnostic facilities, as well as a wide range of non-clinical support services. The ultimate scheme strikes a balance between shared highly technical facilities and speciality-specific clinical accommodation as a means of ensuring the best clinical environment for patients at all stages of their contact with the hospital. The building design provides a dramatic central atrium around which departments are configured, thereby aiding orientation. The project also separates out facilities management traffic as far as possible into dedicated zones which minimise disruption to the clinical functioning of the hospital
At The Royal London Hospital, the project provides a major new accident & emergency department and trauma unit, supported by operating theatres, critical care facilities and specialised diagnostic and in-patient facilities. The hospital has to cater for a wide range of patients, from those arriving by emergency air ambulance, to those attending for day surgery, to those walking in for an out-patient. Great care has been taken to ensure that different streams of patients are appropriately zoned in order to provide the safest, most efficient and most appropriate environments for all. The scheme also sees the creation of a dedicated women’s and children’s hospital, a replacement of the dental institute and a major new renal department. All of these have presented specific challenges given the differing needs of the respective patient groups.
HCP have provided healthcare planning services to the successful bidding consortium Skanska-Innisfree, including advising on the development control plans for the two sites, as well as the detailed planning of clinical departments. We have been instrumental in working with the contractor and the design team to ensure that the aspirations and requirements of the Trust’s clinical users have been addressed as far as possible in the development of the design. This has included advising on the phasing of the construction of the facilities to ensure that the two sites continue to offer the highest standards of care in the interim period. The two schemes are currently under construction, with facilities being handed over the course of the next six years.
Hull Cardiothoracics & Elective Surgical Unit
Following the publication of the NHS Plan and the subsequent National Service Framework for Coronary Heart Disease, the prevention and treatment of cardiac disease has been a high priority demanding an integrated approach to the diagnosis, management and treatment of a wide range of cardiological conditions, ranging across primary and secondary care, and demanding a multi-disciplinary approach across medical, surgical and allied health professionals.
In Hull and East Yorkshire, the ability of the local health economy to address the challenge posed by coronary heart disease has been the lack of physical capacity in the acute sector. The increasing emphasis on the non-surgical, minimally invasive, treatment of cardiac conditions has witnessed a sea-change in the type and quantity of facilities required. This has demanded significant investment in new clinical facilities to provide the capacity to meet growing workload. Furthermore, the rising expectations of patients has brought with it the need to provide a higher standard of accommodation than the existing facilities were able to offer – most notably in connection with the proportion of single bedroom accommodation for in-patients. Finally, the increasing sophistication of medical technology required to support advanced diagnostic methodologies and surgical and minimally-invasive interventions has dictated the need for more highly specified and serviced facilities.
As well as addressing these issues, the commitment to undertake major capital investment in clinical facilities by the Hull & East Yorkshire NHS Trust also offered the opportunity to address other fundamental issues relating to the organisation of the hospital site as a whole. Most importantly, the scheme enabled the Trust to bring clarity to the site, offering a means of resolving patient and visitor access from the west and also allowing the Trust to integrate other surgical and critical care facilities into the project. In this way the project offered a means of creating the critical mass necessary for improving operational efficiency and patient safety.
HCP worked with the Trust as healthcare planners for the project which was developed as a Procure 21 scheme via the Kier supply chain. HCP undertook a thorough review and critique of the existing business case scheme and worked with the Trust’s users to develop operational policies and a brief for the new facilities. These were subsequently used by the design team to develop their proposals which were refined through an iterative process of review and amendment. HCP supported the project through to 1:50 design and the building is now under construction with a scheduled operational date in 2008.
HCP’s experience of cardiac facilities encompasses not only the new centre at Hull, but also the major new cardiac department at Bart’s Hospital London and facilities at Derby City General Hospital. At Bart’s Hospital the project includes a wide range of in-patient, out-patient, surgical, minimally-invasive and testing facilities. The HCP team includes staff with cardiac nursing skills as well as professionals with specialised design experience.
