Developing an estate strategy
We spoke to NHS teams about the long-term benefits of estate strategy – from NHS masterplanning to the gaining the stakeholder engagement necessary for creating a Development Control Plan (DCP). In the January issue of FORTIS magazine, we talked to two NHS Trusts about how they were tackling their long-term estate strategy, healthcare masterplanning, the key questions that should form part of NHS masterplanning and long-term strategic work, how to create a DCP and guidance on gaining the stakeholder buy-in to create a successful plan for growth of the future estate.
What do you need to know about DCPs?
Every issue we ask leading thinkers working in health estates, planning or strategy to answer a core question around healthcare. This issue we asked what are the benefits of Development Control Plans (DCPs) and how do you create one?
Neil McElduff is Director of Estates and Facilities Management at Medway NHS Foundation Trust
A typical NHS hospital gets built and then added to over the years. Nobody considers if the layouts are correct or if the site could be used better, so they’re not optimised to create the best patient journey and experience. Creating a DCP is a collaborative, multi-year process to develop a vision that will guide investment in physical spaces. This strategy should provide a modern, flexible, functional and effective estate to support the Trust to deliver its key priorities and improve services to the public.
For me, the key questions that form the basis of a DCP are:
- Where is the Trust now and where does it want to be in the future?
- What does the road to the future look like?
- What are the possibilities, risks and challenges?
- What are the best options?
- What level of investment is necessary?
- What is the timing?
The process of creating a DCP can be split into five stages.
Step one is engaging with stakeholders to define requirements. Ask what the pain points are, the causes of them and collaborate to set goals. It’s hard to get stakeholders from a wide range of areas together and to get them on board with the process. We’re conducting one-to-one interviews to make it personal to build relationships and trust. Having clarity on expectations is a big thing and getting people to understand what we’re trying to achieve – the technical resources, the financial modelling, taking it through assurance, alignment of incentives, governance, effective collaboration and change management processes.
Step two is identifying the vision of the Trust, which is the foundation of the DCP. Crafting a mission statement outlining core values and goals is useful. Look at the demographics and the service programme. Physical facilities must be capable and flexible to support the service programme – what standards and technology are required? There should be a link between building, services and site, which is the basis for assessment, budgeting and all future phases of the process.
Set out what you hope to achieve and have key performance indicators to help demonstrate the return on investments and what the benefits will be. Apply the Pareto principle [which states that, for many outcomes, roughly 80% of consequences come from 20% of causes] and ask which things are going to have the maximum impact on the patient.
Step three is assessment to understand the current conditions of the facilities and capital assets. Look at functionality, capacity, building code compliance, accessibility, environment, structure, safety and security, mechanics and plumbing, landscaping, maintainability, telecommunications, sustainability and any cultural, historical or heritage concerns.
Step four is project definition. Concepts need to be sketched and project plans developed to weigh up costs and benefits and explore options. Capital needs to be developed, scoped, prioritised and sequenced into integrated short-, medium- and long-term capital projects to optimise future needs. Seek support and advice to address any gaps in skills or knowledge.
The viability of long-term capital plans is dependent on confirmation by stakeholders.
Finally, step five is validation from stakeholders and those external to the process. The viability of long-term capital plans is dependent on confirmation by stakeholders. Your final DCP should outline the journey from now to where you want to be in future, including the principles of the Trust and an acknowledgement of stakeholders and participants. The plan will give context about the community and identify constraints and opportunities, with a summary of assessments of the existing asset portfolio and an analysis of renovations, additions, replacements or adaptive re-use, alongside conceptual plans and diagrams.
Creating a DCP must be an efficient and transparent process and we need a whole-life focus on qualitative and quantitative evaluation.
Learn from what’s going on, apply best practice and get the appropriate resources. DCPs need strong leadership, good governance, a defined strategy, principles for moving forward and stakeholder engagement. Creating a DCP must be an efficient and transparent process and we need a whole-life focus on qualitative and quantitative evaluation.
Jamie Deas is Director of Strategy and Integration at University Hospitals Coventry and Warwickshire NHS Trust
The focus of my work is integrating pathways of care and services with other parts of the community and society. Our Trust’s strategy is called ‘More than a hospital’, recognising that patients don’t live in the hospital, they live in their communities, and we need to be more engaged in prevention rather than a care and repair model.
Your Trust’s overarching strategy will give a description of the future and a structure on which to model your DCP. Strategic documents can be high-level, blue-sky thinking, but you need something tangible that
gives you the ability to deliver.
A DCP gives you a clear direction of travel, but it needs to be flexible so you can chunk it up and be ready to respond when opportunities arise. We have a capital allowance, but most of our estate is a public finance initiative [PFI], so our ability to raise capital is quite limited; we’re often reliant on placing bids and responding to funding packages. If you haven’t got a shovel-ready plan in place, you’re starting from scratch and there can be tight timelines on funding applications.
It’s a 10-15-year plan, so trying to get it all funded at once is unrealistic.
The DCP is a full plan, but split into a suite of shovel-ready business cases, so you’re agile to respond to those opportunities. It’s a 10-15-year plan, so trying to get it all funded at once is unrealistic.
When formulating a DCP, ask: why are you doing it? Often, you have a site that’s not fit for purpose or it doesn’t provide the capacity and capability you need. The starting point of a clear vision is a golden thread through to the reason you’re doing it in the first place. What’s the problem you’re trying to solve? How does this particular site solve it? Is that the answer or are there other ways to do it? You must be able to describe why this is going to be better than what you’ve got now, so some visuals are helpful.
It’s also important to engage stakeholders. We’ve been developing theatres and wards with the staff who are going to use them. It’s important that you take the views of the community that surrounds the hospital into
account too. Winning over hearts and minds is essential and investing time in it upfront is key.
In our strategy, for example, we started off with an engagement process with our vision and three purposes within it. By the end of the process, the vision had changed and we’ve got five purposes now. For us, part of this is the ‘catchball process’ [an inclusive way to share information and ideas, encouraging those who have ideas out of their area of expertise to share them], and we ensure feedback is highly visible in whatever we come up with next. Patients and staff need to be confident using the facility, so their views are essential.
Find a design partner that is cognisant of what’s important to you, rather than what’s important to them.
To bring a DCP to life, you need a clear brief and a good relationship with whoever you’re working with, including trust so you can constructively challenge each other. Find a design partner that is cognisant of what’s important to you, rather than what’s important to them.
It’s also essential that there’s an understanding of what the cost of this vision is in broad terms. The end document is dual-purpose. It’s a design for what it’s going to look like, but it’s also a business case to help secure funding to deliver it.
© Dialogue Content Marketing Ltd 2024.
This article was taken from the January 2024 edition of FORTIS magazine.
FORTIS magazine is a Health Spaces Limited publication. Opinions expressed in FORTIS magazine are not necessarily those of Health Spaces Limited or Dialogue Content Marketing Ltd. Material contained in this publication may not be reproduced, in whole or in part, without prior permission of the publishers. No responsibility can be taken on behalf of advertisements printed in the magazine.
FORTIS magazine
This article was written for the January 2024 edition of FORTIS magazine; a forum for the NHS to share ideas, innovations and case studies. To read the publication in full and access digital copies, visit FORTIS magazine. FORTIS magazine is free for NHS change-makers and leaders and is available as a print or digital copy. FORTIS magazine is managed and owned by Health Spaces Ltd.
Want to know more?
Read about best practice in NHS masterplanning and long-term estate strategy in further issues of FORTIS magazine.
