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 and nobody thinks about 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, when implemented, should provide a modern, flexible, functional and effective estate to support the Trust to deliver its key priorities over the coming years 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 future?
- What does the road to the future look like?
- What possibilities do we have and what challenges/risks do we face?
- 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 and the causes of those and collaborate to set goals. It’s hard to get stakeholders from across such a wide range of areas together and to get them on board with the process. The way we’re approaching it is to have one-to-one interviews and 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 activity, the financial modelling, taking it through assurance, alignment of incentives, proper governance, effective collaboration and effective 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, the outlook for the community and the service programme. Physical facilities must be capable and flexible enough 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, which will help demonstrate the return on investments and what the benefits will be. We can come up with a list of things to do and 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, use, 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 and alternative scenarios. Capital needs to be developed, scoped, prioritised and sequenced into integrated short-, medium- and long-term capital projects to optimise future needs. This is where you should seek support and advice to address any gaps in skills or knowledge.
“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 the assessments of the existing asset portfolio and an analysis of renovations, additions, replacements or adaptive re-use, alongside conceptual plans and diagrams.
“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 strong stakeholder engagement. Creating a DCP needs to be an efficient and transparent process and we need a whole-life focus on qualitative and quantitative evaluation.”
Neil started working in mental and community healthcare in 1993. His first Director of Estates role was in London in 2002 before he was headhunted to work as Director of Property and Asset Management at the Department of Health’s property company, Community Health Partnerships. Following a period of consultancy work, he is now Director of Estates and Facilities at Medway NHS Foundation Trust.
Jamie Deas is Director of Strategy and Integration at University Hospitals Coventry and Warwickshire NHS Trust
“The focus of my work is around the integration agenda – 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 much more engaged in prevention and the proactive side rather than a care and repair model.
“Your Trust’s overarching strategy will give a description of what the future looks like and a structure on which to model your DCP. Sometimes a strategic document is high-level, blue-sky thinking, but you need something tangible that gives you the ability to actually deliver.
“There are several benefits of having a DCP. It gives you a clear direction of travel, as mentioned, but it needs to be flexible enough so you can chunk it up and, when opportunities arise, be ready to respond. 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 and 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. The DCP is almost like 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 to try to get it all funded at once is unrealistic.
“When formulating a DCP, the first question to ask is: 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 and how does this particular site help you solve it? Are you sure that is the answer to the problem or are there other ways to do it? You need to 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. Some of the work we’ve been doing developing theatres and wards has been effective because they have been designed in conjunction with the staff who are going to use them, so we’ve been meeting weekly with those clinicians to talk about the practicalities and how it will be when they work there. 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. It’s about getting people engaged with what you plan to do. In our strategy, for example, we started off with an engagement process where we had our vision and three purposes within it. By the end of the process, the vision had changed and we’ve got five purposes now. It’s important that people see your vision and that you’re not just paying lip service to it; they’ve actually shaped it because ultimately they’re the ones who are going to be using the site.
“We have a management methodology called ‘UHCW Improvement’ and part of that is the ‘catchball process’ [an inclusive way to share information and ideas among teams or members at all levels, this process is intended to encourage those who have ideas out of their area of specialisation to share them], so we come up with ideas developed in conjunction with stakeholders and invite everyone to pull them apart, tell us what they think and ensure feedback is highly visible in whatever we come up with next. You need to get the views and voices of end users of the facility – patients and staff – so people are confident about using the facilities.
“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. I’ve found, with some organisations, you give the brief but get a sense that you’re being shoehorned into what suits them in terms of the design. Find a design partner that is cognisant of what’s important to you, rather than what’s important to the company. It’s also essential that there’s an understanding of what the cost of this vision is in broad terms, so we all – Trusts, stakeholders and any companies you work with – understand what we’re aiming at.
“The end document is dual-purpose because it’s a design for what it’s going to look like, but it also needs to be a business case that enables you to get the money to deliver it.”
Jamie has worked in the NHS since 1997, originally as a clinician operating in the field of addictions. From there, he moved into management roles, including service improvements and redesigns, got qualified in project management and programme management, and then moved into more strategic roles.
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This article was taken from the January 2024 edition of FORTIS magazine.
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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.
