Cast your minds back to September 2019.
Boris Johnson and his government had been in tenure for around three months, global growth was forecast at 3%, the lowest level since 2008-9 but still an upwards trajectory, and the pandemic and Covid-19 were little known entities outside of virologist circles. For those of us working in the healthcare sector, September 2019 was a pivotable date as it was then that the Prime Minister announced the New Hospital Programme (NHP) with a pledge to build 40 new hospitals by 2030.
We all know what happened next – Trusts, working with consultants like RLB, presented outline and full business cases, strategic masterplans were drawn up and five Cohorts were created to allocate Trusts with a slice of the NHP funding. Hospital Trusts that RLB works with like University Hospitals of Leicester, University Hospitals Sussex NHS Trust, Midland Metropolitan, Greater Manchester Major Trauma and Royal Liverpool Hospital began the work that had been planned and designed and had agreed funding from the programme. Let’s head back into the present – over three and a half years on from September 2019 and so much has changed. Although Covid-19 still lurks, the pandemic seems over, yet now macro uncertainty is our only certainty with global events bringing new concerns and challenges to us all including the cost-of-living crisis, the on-going Ukraine/Russia war and the resulting hike in energy prices. Our world has changed beyond recognition and for many, our outlook and view of it has changed too.
So where does this leave us from a healthcare estates point of view? For those working on New Hospital Programmes, we wait with bated breath for the outcome of funding decisions, which seems to be pushed back again and again. Meanwhile the parameters have changed with macro and micro requirements revising the strategic masterplans and consequently the budget needed to meet these new outcomes. From a sustainability point of view, all Trusts are now mandated to meet the NHS Net Zero commitment for the NHS carbon footprint. So those emissions they control directly, to reach net zero by 2040 and to reach an 80% reduction by 2028-2032 and those they can influence to reach net zero by 2045 and reach an 80% reduction by 2036-2039.
Economically, all Trusts are now dealing, as we all are, with a massive rise in cost-of-living expense, much of the initial budgets have now increased by as much as 100% and conversations around Minimal Viable Product (MVPs) the norm. Of course, many of these goalposts are needed for all estates to build for the future, to be sustainable both economically and environmentally in the long-term, but were unexpected, unplanned and unpredictable. What this means in reality is it is really only inflight projects that have really seen progress, those in Cohort 1 and 2, and in some cases hospitals that have been identified as high risk with RAAC remedial works needing to take place. Instead of Cohort 3 and Cohort 4 projects being progressed to final design stage with timeframes for being onsite, priorities have been elsewhere.
At RLB much of the time consists of undertaking the role of strategic counsel – whether this is from a cost management point of view, from a programme or project management or strategic masterplanning. We look to provide advice based on probability, from past outcomes and research and from the wealth of experience our team has between them. If there is anything the last few years has shown us is that sometimes there are curveballs and experience cannot always predict the future. And that’s when measured thought, understanding risk in individual context and being adaptable and agile comes into play. So perhaps this means continuing with Cohorts 1 and 2 presently, to ensure healthcare estates are in the best place possible for it or when Cohorts 3 and 4 can be reactivated. Or it could be to use the Government’s Value Toolkit, that the RLB team supported in its conception, to really pinpoint the priorities for each build and the impact and long-term value on other elements that each priority plays in that dynamic.
At present, none of us know the outcome of the additional funding requested for the New Hospital Programmes from The Treasury and the Chancellor of the Exchequer. What we do know is that we need to think differently to the way we design and plan with agility and adaptability at the heart of it. From designs that allow different clinical outcomes – to be able to separate areas quickly and efficiently – to creating solutions that have long-term productivity and sustainability, such as building community health hubs to reduce travel, costs and time for patients through to new ways of working such as digitalisation of our services, our diagnostic tools and our healthcare solutions.
 World Economic Outlook, October 2019, Global Manufacturing Downturn, Rising Trade Barriers