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NHS 5YFV Vanguards-Sarah Denton presentation
- 1. Hire Division 9th December 2015
- 2. Who, what and why? Who? β’ Sarah Denton : Business Development Manager for Health What? β’ Portakabin and the link to delivering flexible healthcare services Why? β’ Services required replicated across UK
- 4. Other momentous events of 1967
Editor's Notes
- Good morning Iβm delighted to be here this morning to talk to you about something Iβm passionate about, sharing solutions where there are reoccurring requirements to hopefully uncover areas for best practise.
- Before I tell you about some of the projects we have been involved with I wanted to tell you a little about me, what we are talking to you about and why.
- Portakabin has been trading for over 54 years and is owned by the Shepherd Group, a family owned business whose head office and manufacturing plant is located in York. As a business we a split into 5 companies in the UK, Portakabin Limited, incorporates both sales and hire divisions and supply modular buildings for both interim and permanent facilities on site, Yorkon, supplying professionally designed buildings for prestigious contracts across the UK and Foremans who deal with the sale of second hand building. Finally Portaloo and Konstructa supporting welfare and the construction sector respectively. Today Iβm going to take a closer look at the Portakabin Hire model of the business, mainly because itβs a great template to look at supporting NHS services to provide a vital route to supporting quick revenue generation effectively whilst still complying with the relevant HBN/HTM requirements. Firstly some background on Portakabin and our work within the healthcare sector.
- As a group we have been supplying buildings to the healthcare sector since 1967 this year gave Portakabin the first chance to demonstrate the flexibility within their building uses. Let me tell you a little about the projectβs background as itβs had an impact on the type of buildings we deliver today; Queen Elizabeth Hospital in Gateshead required portable accommodation for their breast screening clinic, this was a must for the project because of the possibility that the clinic may have to relocate in the future. The temporary clinic was created by linking 5 buildings together, each equipped with easy-to-clean hygienic internal linings, air-conditioning and central heating. The temporary complex was operational within 13 weeks.
- This linked complex provided at Queen Elizabeth Hospital was a major step forward in making it possible to create complex buildings with larger floor areas and was a springboard for Portakabin to grow its knowledge within the healthcare sector. As you will see this knowledge has allowed us to develop ward and theatre units, whole GP Practices for both interim and permanent solutions and included helping NHS Property Services respond to emergency situations across their estate. Letβs fast forward to the present day and highlight some of the healthcare projects that Portakabin have directly supported, all of which are funded by the hire model of the business. The NHS is now facing its most challenging period since its creation in 1948 and the focus has been over Governments reforms across England, however there are now more pressing factors that are now at a critical point, rising demand and costs.
- We are all familiar with some of the obstacles the NHS are facing during this unprecedented time period, a continual rising life expectancy is one. Since the NHS was created life-spans have increased by a dozen years for both men and women and this trend is predicted to continue. Whilst this is great news for the majority of us, me included, it comes with its own challenges. The growing number of elderly people mean more patients with multiple conditions, some of which present significant difficulties in providing care and support, like dementia. However, the problem is further compounded by the lack of care beds outside acute care. A reduction in the amount of care homes and subsequently beds has led to a growing number of patients receiving care in acute units where they would be much better placed locally and outside of acute care. The outcome of these factors has led to delayed transfer of care. There is evidence to support this growing need, DTOC stood at 147,738 for September this year, representing a 6.8% increase year on year and a 28% increase since September 2010. January 2015 saw the highest DTOC ever at over 150,000, these figures reflect the requirements we are seeing across the NHS for discharge units and outside acute care for care beds.
- Both of these issues within the acute and care sectors are areas where modular builds can provide timely support in comparison to traditional brick and block builds. Even though requirements can be delivered within shorter time frames when compared with traditional builds the life cycle of the building and the quality within the build are more than comparable. Whatβs even more important is that due to the shorter build times the unit can start generating revenue at a much faster pace and deliver care in modern safer surroundings. A recent report from the British Property Federation reported that modern facilities are safer for patients, with 30% lower fall rates and 10% lower overall patient harm in new hospitals with similar reductions in care homes. Another report, Quality Buildings, Quality Care, found that newly built Acute Trusts are more likely to have lower mortality rates, in fact 16% of Trusts in the UK that have new-build units incur βsignificantly below averageβ deaths when compared to older Trust buildings. The issues however are not isolated to the back end of hospital services but also extends to front end service like A&E, this becomes particularly apparent when the winter period hits and demand reaches its peak. Both A&E and discharge units are reoccurring requirements we are asked to support and the question asked by many within the NHS is often βhow can hospitals increase capacity quickly without impacting on existing services?β This question usually comes at a time when services are under the most pressure and winter demand has already impacted on services.
- How do we increase capacity without compromising on quality or existing services? The Princess Alexandra Hospital NHS Trust recently sourced a 20 bed short stay assessment unit which was directly attached to their A&E unit, a major requirement for the Trust was speed of delivery, after a bed survey the Trust needed to ensure they achieved a targeted amount of beds for their local area, because of the efficiencies of modular construction the unit was delivered in just 10 weeks. How was this achieved? A vast majority of the work was carried out on our yard prior to the delivery on site, this means that buildings can be delivered with a good proportion of fit out already existing and reduce the amount of workforce on site during the installation but more importantly allows us to deliver with much less disruption to patient care within existing units that may surround these working area.
- Buildings that comply with the relevant HBN and HTM guidelines can be hired and delivered fully fitted with nurse call systems, bedhead trunking, specialist furniture and other services essential to the unit either as a stand-alone unit or integrated into the main hospital services to maintain patient flow.
- The versatility of modular buildings means that they can be craned into enclosed courtyards, sited on steel platforms, on roofs of existing buildings or installed on sites where site-based construction and access would be extremely difficult or disruptive to patient care. So with all the benefits of quicker installation and rapid revenue gain for the Trust how are projects funded? Previously A&E additional funding streams have allowed Trusts to support their facilities across the winter period and beyond, however we know that 2015/16 presents an unprecedented year as far as funding is concerned and the winter allocation that has been seen across the previous 2 years has since been allocated into general Clinical Commissioning Group allocations. The second method of funding has been revenue based with minimal capital outlay. This allows additional services to be supported within short periods of time and allows the revenue within the Trust to be increased by the additional capacity provided, all within a short space of time because of the efficiencies of modular construction.
- Letβs talk a little more about the financing of a project and base it on a typical unit we are often asked to supply, a 20 bed assessment unit for a year. At the outset there is no capital cost, initial visits to the Trust and subsequent site visits with the project teams are all free of charge, as are the outline drawings. The scope of the plan is developed with the key stakeholders to develop a unit or units that mirror the immediate and future possible requirements. The only real capital outlay is once the project is completed with the cost of the delivery and installation of the project, plus any principal contractor costs. All of which in terms of the project as a whole is minimal, for a 20 bed assessment unit for a year it would be less than 1/3rd of the total contract value for that year. The cost of the unit and its fittings are paid for in monthly payments, these are set out at the time of our full quotation and itβs at this stage that costs are confirmed and will not change; no inflationary increase a flat rate of spend. This means the Trust is aware of the capital outlay and the monthly costs in advance of the project starting to look at the return on investment achieved by these additional facilities. All the best modular suppliers set out guarantees to the end user, our pricing and service levels for example are outlined by our unique customer charter, so you can be assured of the service at the outset, guarantees are in place for every project we deliver across all 60 of our hire and service centre networks, ensuring each project is delivered within budget and importantly on schedule.
- Whilst increasing services is a direct approach to resolving a capacity issue there are other ways of supporting facilities and additional space. We often relocate administrative or storage facilities outside clinical space allowing this space to be used for clinical requirements. This can help with patient flows and provide a cost-effective solution by using existing services such as air-handling and medical gases for rooms converted from administrative to clinical needs. Itβs about working with the trust to respond to their needs and with the most appropriate and cost effective solution, depending on whether we are dealing with a crisis situation, anticipating and preparing for a patient surge or simply strategically planning for the trusts future. In every case Portakabin will work with Trusts to provide a plan that takes into account factors affecting the short or longer term plans of the trust, much of which is done on a no cost basis. When we engage with Trusts on a more strategic approach we have more time to look in detail at the services that require longer term support, these are often services that provide a better return on investment, like elective and diagnostic services.
- The completion of the University of North Midland Trust is an example of where we worked with a trust to look at a longer term strategic approach to delivering additional services. To facilitate the transfer of orthopaedic services to the Trust Portakabin had an urgent requirement for a highly complex, 4,200sqm interim ward and theatre building. The purpose-designed scheme would occupy a constrained site immediately adjacent to the main hospital and Keele Universityβs Medical School, where it will be in use for the next five years. A modular solution was developed to fast track construction and to deliver a high quality, fully fitted building in less than four months. The structure itself was installed in only 18 days to minimise disruption to patient care. Facilities include:
- 56 in-patient beds as single ensuite rooms and four-bed bays β’ Two large, state-of-the-art clean air theatres for all orthopaedic procedures β’ Staff changing room β’ Clean and dirty utilities β’ Reception
- Theatre recovery room β’ Offices β’ Kitchenette β’ 33-person βcrash teamβ lift
- β’ Integral plant room The building is constructed and fitted out to permanent standards, in compliance with current Building Regulations and has a design life of at least 60 years. The Project Challenges This was a highly challenging project in terms of scale, logistics, difficult access for vehicles and the extremely close proximity of existing wards which had to remain operational throughout
- To minimise disruption, Portakabin maximised work off site wherever possible. The modular solution allowed the building structure to be installed complete with wall finishes, internal partitioning, mechanical and electrical services, and flooring already in place to further reduce the programme time During the cranage phase, Portakabin managed and maintained access for 200 students to the adjacent Keele University Medical School and also co-ordinated operations with West Midlands Air Ambulance for inbound emergency patients
- The building installation involved detailed logistical planning and a 350-tonne crane on a highly restricted site close to a busy road. Although there were many challenges to be considered and put in place whilst on site the project remained in scope and on time due to rigorous planning and contingency planning. These examples show some of the capabilities that can be supported and they include turnkey packages that start from building and planning right the way through to showing end users how the installed facilities operate prior to the building handover ready for the trust to deep clean. The advantages of using this model of the business to support requirements within the NHS is first and foremost speed of delivery and its ability to quickly start generating revenue for the Trust. How can you procure? Our main route to procurement with Trusts has been through Crown Commercial Services, Portakabin is an accredited supplier. This means that Portakabin products and services have been independently pre-approved for quality and value for money β significantly reducing procurement time for public sector organisations. This procurement route also allows us to keep pace with our delivery timeframes.
- To give you an idea of how quickly we can react we have won the sole supply agreement to Zurich over the past 12 years. This has allowed us to build up expertise on quick project turnarounds and deliver these across our 60 nationwide hire centres with confidence. This also highlights an area within the NHS that we can support by providing Business Continuity Plans for primary and secondary healthcare providers. A recent example of where we worked together with NHS Property Services was the Carmel Medical Practice in Darlington, the Practice was hit by fire on August 30th causing considerable damage to its roof. Although the practice is not an NHS Property owned site Darlington CCG and NHS England asked NHS Property Services to provide urgent assistance to support alternative premises for the practice whilst their building was being repaired. How did NHS Property Service supply the additional facilities? After securing a space off site NHS Property Services then engaged with Portakabin to provide the temporary accommodation, this would give the practice the total number of clinical rooms required and ensure they could remain fully functioning and provide all the necessary services quickly and efficiently. We can help to create business continuity plans for exact scenarios like this, we can work with directly with Practices and / or NHS Property Services to outline decant sites, asses for service connections and provide a skeleton plan to the practice or trust and one to Zurich. This speeds up the process of requirements should the worst case scenario happen, meaning we can get services operational quicker than ever before. So to recap we have outlined the needs for immediate and strategic requirements by trusts and practices, we have however come across trusts that are also incorporating a more progressive approach to the underlying issues they are faced with, here are a few examples.
- The Central Manchester University Hospitals NHS Foundation Trust has put in place the means to deliver intravenous drugs to treat people at home, to free up hospital beds. Across 16 months nurses treated around 300 patients and claim it saved an incredible 2,800 bed days. At Newcastleβs Royal Victoria Infirmary a team of medical staff and social workers are coordinating community care to make sure there are no delays in discharging older patients from hospital. They are aware that delayed discharges often feed back into A&Es causing delays for patients waiting to be admitted. Finally to address the issue of people arriving for treatment at A&E when they could have been seen by their GP, family doctors have been working alongside emergency specialist at North Manchester General to filter less urgent cases. The hospital estimates that at least 15% of their patients could have been treated elsewhere, perhaps by a pharmacist or a GP. From these examples we can see differing approaches to care emerging, how can we help new models of care?
- We are aware that Vanguard models of care are new and are based very much on localised requirements. They will require an element of flexibility due to their early development stages either in terms of building requirements or even a location decision. Modular buildings provide requirements efficiently and the opportunity to easily extend services with little or no disruption to existing services. This means that new models of care can be trialled not only from a location point of view but also in terms of the services that are delivered through the unit. Modular construction allows providers to look at manipulating services and locations to prove best fit and placement prior to making final decisions on where and which services are offered locally. It also means that there is little capital outlay to trial these services as they are supported by the revenue they generate. To conclude, with the face of the NHS changing and going through its most radical challenges since 1948 the models of care delivered through primary and secondary providers needs to remain flexible, allowing for service changes and extreme peak demands being met. Modular builds provide a flexible approach to either immediate or strategic needs. In some cases buildings can be removed from site once peak demands have reduced so the need can be satisfied and the removal during the times where thereβs less demands means you donβt end up paying for additional space when itβs no longer required, allowing you to increase and reduce services to mirror revenue and peak demand times.
- Thank you for your time this morning, please feel free to pop and see either myself or my colleague Mike at any time today to chat either about specific projects or informally about requirements.