Efficiency in the NHS doesn’t have to mean cost cutting

At the start of October, the NHS launched the third generation of its design and construction services framework, ProCure 22, as the primary procurement vehicle for delivering healthcare capital projects across England (Scotland and Wales have their own broadly similar arrangements). As with all current public procurement, delivering greater efficiencies is at the front of the agenda, as each NHS Trust tries to squeeze every penny out of limited capital funding.

Earlier iterations of the framework were broadly considered as successful attempts to increase collaboration through the supply chain, with contractors engaged right at the start of the design process to lead a one-stop integrated team under a well-balanced NEC contract. ProCure 22 continues this theme, whilst also injecting some new blood alongside established players. 

Procuring NHS Trusts are strongly encouraged to use the framework, but the decision of whether and when to implement it present several challenges for a client and their project managers.

The first challenge is one of appropriateness and applicability. In general terms, frameworks can offer significant benefits to a project manager trying to navigate a route through increasingly complex and protracted public procurement rules. Many frameworks are available, the majority multi-disciplinary designer led, although ProCure 22 is in a minority as being contractor led. 

This reduces the number of individual procurement actions on a project, and brings in a comprehensive supply chain and wealth of associated experience early on.  It is ideal for projects that have navigated the initial business case stages, and will allow an expedient start on site. This should be weighed up against an arguable reduction in commercial position and slightly higher pre-construction costs.

Perhaps the greatest opportunity for improving efficiency lies not in the design process and the use of standard components, but in the effectiveness of the people delivering them

The second challenge is around timing, and deciding your scheme is ready to come to market.  Any good project manager will know that the opportunity to influence a better outcome is in the very earliest brief development stages. As with any building designed from the inside out, defining the clinical need and operational requirement necessitates a deep understanding of how the staff and patients will interact with the building around them.  Taking time for a project to go through basic feasibility before being let loose upon the market will give it the robust foundation it needs to prove viability. 

Additionally, although designs must respond to a unique requirement in a unique context, the solutions themselves don’t always have to be unique. The effective use of standardised systems and components has been something of a two-edge sword for years in healthcare, pitting the need to drive cost efficiency of schemes against accusations of ‘cookie-cutter’ bland design.  

As a counter to this, the NHS generally embraces technical consistency, although occasionally a little dogmatically.  One of the interesting and evolving features in ProCure 22 is promoting the sharing of knowledge across the whole framework and the investment in the development of repeatable design solutions for commonly faced challenges – design of a four-bed bay, for example. The time savings are obvious and familiarity with standard solutions provides benefit to contractors and operators alike.

The final challenge is somewhat ideological in a public procurement context. Perhaps the greatest opportunity for improving efficiency lies not in the design process and the use of standard components, but in the effectiveness of the people delivering them. The obvious challenge is that by their very nature, teams are brought together for a specific project, work hard to deliver the best outcome they can, and are then dispersed into the wind.  Not sharing knowledge and lessons learned through the course of technically challenging projects, thereby allowing teams to mature and build effectiveness from project to project, is perhaps the single greatest lost opportunity in public procurement. 

Ultimately though, no framework or procurement decision is ever perfect, and is merely a best fit response to the circumstances of a project. However, as funding levels are continually squeezed, everyone knows the pressure is on to pull increasingly large rabbits out of the proverbial hat. But with some careful thought at the early stages, a proper evaluation of viability and procurement choices and allowing your team to share knowledge, you have at least three strategies for delivering a better outcome.

Mark Halstead is director of programme & project management at Essentia, the consultancy arm of Guy’s and St Thomas’s NHS Foundation Trust