Health on the High Street™ – a solution to reducing patient waiting lists

Building a way out of the backlog

 Long before the pandemic, high streets across the country have been in a gradual state of decline with many high street retailers closing stores and leaving behind empty premises, resulting in a reduction of footfall for neighbouring businesses. On the other side of cities and towns, and in typically less-central locations, hospitals are already full, with little or no means to physically expand, limiting the potential to react to ever-growing waiting lists.

Kelvin Moulding, Principal of Health Spaces, a healthcare construction company dedicated to NHS fast-track design and build, explains how their recent webinar explored this topic.

Working closely with NHS Trusts, responding to requests for help has quickly become a daily reality for the Health Spaces team. As a healthcare construction company we specialise in NHS fast-track design and turnkey build solutions – new builds and re-purposing – but it has become abundantly clear that we have a responsibility to do more: there is now a once-in-a-generation chance to embrace economic and technological changes and put healthcare right where it is most needed.

As Sir David Sloman and Sir James Mackey of NHS England wrote earlier this year– we will only be successful in delivering these commitments if we work together.

Putting more NHS healthcare assets into the heart of local communities presents an opportunity to increase efficiency, lower costs and improve staff wellbeing, while reducing clinical risk and freeing up valuable space on acute sites.

A first for the NHS

It was this drive to play our part in raising awareness of the benefits to Health on the High Street™ that led to the Health Spaces team visiting the outpatient assessment clinic situated in the Beales department store, Poole. Situated in the Dolphin Centre, the assessment clinic was one of the first of 40 community NHS diagnostic centres to open in England. The outpatient assessment clinic offers breast screening and diagnostics, as well as testing and assessments for orthopaedics, ophthalmology and dermatology.

Here the Health Spaces team met Ashleigh Boreham, Deputy Director Design and Transformation at Dorset Clinical Commissioning Group. Working with the University Hospitals Dorset NHS Foundation Trust, the Dorset CCG team set up the outpatient assessment centre using re-purposing methods.

Meeting Ashleigh and his team really opened our eyes to the urgency – the centre was the first of its kind and Ashleigh was keen to work with us to help share the story so that other NHS providers could benefit.

Already working closely with Jaime Bishop, co-founder of Fleet Architects and co-chair of Architects for Health, Health Spaces launched a webinar series to explore the setting up of Community Diagnostic Centres – from preparing and submitting a successful outline business case to procurement, design and build, finance, workstreams and recruitment, as well as exploring the wider considerations to health on the high street as a model.

With over 20 years of experience as healthcare architects, the Fleet team have been exploring the opportunities for bringing healthcare to the high street. Last year, Fleet Architects were shortlisted as a finalist in the Wolfson Economics Prize awards for their submission: A Well-Placed Hospital.

A Well-Placed Hospital was about bringing diagnostics to our high street,” explains Jaime.

“The Wolfson essay explored the idea of bringing a whole district hospital to the high street and its services back into the town centre, and the mutual benefits to patients, staff, place and the system.”

“We started to look at population density and where health services were being delivered, and we started thinking about diagnostics which are largely provided by hospitals, of which the majority are on the outskirts of town.

“We also know we have a large and increasing issue for existing sites on the edge of towns – the ERIC report (Estates Return Information Collection) suggested last year there was a £9 billion backlog of maintenance bill for these hospital sites. And most of these sites are very crowded, with not much space to decant. They are removed from public transport and are a long way from the amenities of town centres.”

“Quite often the hospital and health system is one of the largest employers in the area, so there are key benefits to bringing healthcare to the community.”

“Employing the Housing and Communities Agency (HCA) benchmarks, ‘the employment density of the optimal sites will increase up to four times when compared to the existing land uses in our case studies’. In other words, when you compare typical health use of land, the employment density increases up to four times compared to various mean uses within town centres – you are creating jobs within a town centre. This effect is amplified when you consider the employment multiplication factor resulting from well paid (greater than mean), highly skilled jobs, as found in the NHS.

“There are benefits to patients having access to diagnostics on their high street too – accessing screening in your lunchbreak, better working conditions for NHS staff, access to restaurants and cafes, better parking, benefits to the system – better access, waiting list improvement. We are re-purposing builds too.”

A one-stop-shop

Combining the Health on the High Street™ model with a real-life example at Poole, Ashleigh and Jaime hosted the first Health Spaces webinar in February.

A national first, Poole’s outpatient assessment centre was based upon the ideas used to create the Nightingale Hospitals and COVID-19 vaccination centres, which also used re-purposed buildings. The key lessons used in the Poole outpatient assessment centre were taken from these previous examples: robust governance structure, linkage to local community and the importance of high street locations.

“The concept was the delivery of a high flow clinical assessment facility in a safe, clinical operating environment,” Ashleigh explains.

“In order to enable the triage / risk stratification of the waiting lists in Dorset, to promote the wellbeing and health of our population and contribute to the recovery of elective waiting lists.”

The department store closed after the retail chain Beales fell into administration, but the Poole branch reopened in August 2020 under new ownership. The clinic, which is now run by up to 30 staff and 21 volunteers, started to see its first patients in November, with patient numbers now at approximately 130 patients a day.

Presenting the case study in the webinar, Ashleigh demonstrated that through increased space and flow, the space produced dedicated additional clinical capacity as well as the potential to operate the facility from 8am-8pm, 6/7 days per week. Capacity was released in hospital sites to support specialties to see long waiters and created the opportunity to pilot the adoption of enhanced links to wellbeing and lifestyle support and to the use of more conservative treatments. In addition, the centre was able to create the opportunity to inform the development of Dorset’s Community Diagnostic Centres and ‘Health Village’ brand.

Strategically located to support patients in the East and West, the set-up of the assessment centre went through detailed scoping, planning and delivery phases. The development of the clinical model by Rehearsal of Concept (ROC) drill marked the start of this process – testing the concept with patients, clinical, non-clinical and support teams. From there the journey moved into development and sign-off of the Outline Business Case and PID, and into detailed planning and delivery phases.

Highlighting the changes made to pathways and diagnostics, Ashleigh explains: “The reason why we chose specialities was because they were what we called ‘the early adopters’. We already had learns from other systems – for example, we shared and learned from Moorfields – so we knew the eye lane and the consultant on board knew how to work that, and was really enthused.

“That was how we brought people on – that ‘ROC (Rehearsal of Concept) drill’ identified the people who wanted to play early and that’s how we then brought those ones on first to get it going. It’s about great momentum.

“You want a one stop shop. You want one conversation; you don’t want your patient having five conversations. But certainly when you are dealing with inequality and deprivation, people cannot afford to go five times to these places, and if you’re working, and you’re working in an industry that doesn’t give you the leave that some other industries have, and you’re maybe self-employed, four times out of your time is four times you’re not earning money. It also means that four times you may not decide to turn up, so your DNA rates increase.”

“So reducing the amount of engagements is why we’ve linked diagnostics and outpatients and pulled it altogether into a pathway approach.  And all of our pathways are designed with a front end of diagnostics and then face to face as required, and then into action with the third sector.”

The delivery of the assessment centre was not without challenges, with Ashleigh listing the challenges being building and maintaining momentum at the start, staff resistance, scope creep, unexpected costs, and maximising the phase 2 utilisation alongside operational pressure.

Despite challenges, the success of the centre is clear. The diagnostic and assessment centre has also added value to the local community by providing opportunities for health volunteers, increased footfall to support regeneration of the high street, allowed easier access to health and wellbeing support and has built links with education. Travel time for diagnostics has been reduced with links to public transport.

In addition, the facility has been used to test new digital solutions to support UHD and Dorset ICS to improve interoperability and enhance digital systems to reduce costs, waste and delays and create capacity and resilience.

Improving patient experience

The heart of the design has always been to ensure effective interaction could be achieved to ensure for the best patient experience and to rapidly reduce patient waiting times. The model at Poole successfully achieves this – it allows for a patient to be engaged within the community, with the right help being easily signposted.

Ashleigh explains: “100 patients go through; of those 100 patients going through we are finding that 54 do not need a surgical intervention – they need another type of intervention.

“…That is 54 people that are not going to an acute that are then being treated elsewhere but also are then bringing other parts of the third sector and community together.

“Increasing access to health and wellbeing support through Public Health Organisations: LiveWell and Active Dorset has been a huge success for the project, as well as enabling the space to allow for signposting throughout patient journey and the physical presence of social prescribers and health coaches for targeted interventions.”

Utilising the same workforce

From a workforce point of view, the centre was able to utilise the same staff. In the Poole model it allowed for the removal of barriers and common frustrations that the workforce can often have in a traditional healthcare setting.

Ashleigh adds: “The idea is to use the same workforce – lift and shift – into a new space that they co-designed to work differently, that works better for them. We haven’t increased our workforce – well, we have very slightly with one or two extra technicians but that is all.

“The beauty of these models is about people operating at the top of their licence. The importance of Allied Healthcare Professionals being absolutely key to success because the consultant sees the patient when they need to see the patient, and the run-ups are done by the appropriate people. The only extra staff were the operational support team and here we’re talking about the operations manager and volunteer co-ordinators, who are really key and who work in the operations room that sustain the facility, a bit like how I’ve described going to a serviced office.

“You can take your team to a serviced office – it’s the same team but all the things that hamper you are put on for you – your illustrations, your digital. You are serviced better; you maximise your time there and then you leave.”

 

To find out more about Health Spaces or to watch the full webinar, visit our resources page. The University Hospitals Dorset NHS Foundation Trust opened the centre at Dorset Health Village as part of its ‘Think Big’ project to tackle backlogged outpatient appointments.

 

 

Kelvin Moulding – Principal of Health Spaces

Health Spaces is a healthcare construction company based in Peterborough. Health Spaces is dedicated to NHS design and build, including turnkey solutions for new build or re-purposing projects.

Health Spaces offer NHS Trusts a solution to provide fully fitted, fully compliant, multi-purpose clinical spaces in high street locations throughout the UK, either as a leased facility or as a design and build project. This is a fast-track and cost-effective way of upscaling capacity and is proving a popular way of tackling growing RTT waiting times in elective care and diagnostics.

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