Like Phoenix from the ashes

The arsonist who reduced Sandwell accident and emergency unit to a burned-out shell in July 2002 clearly did not do the hospital any favours. However, one bit of good fortune for Sandwell and West Birmingham NHS Trust was the fire came shortly after the start of the ProCure21 pilot programme that was being trialled in the Midlands and the North-west before being rolled out nationally.

The rapid resurrection of the department, in the form of a new emergency services centre, proves that not all hospital projects have to take an eternity to come to fruition. Within two weeks of the fire, Sandwell & West Birmingham NHS Trust had completed a series of interviews with potential PSCPs and appointed Interserve Health to lead the reconstruction programme. Nobody from the trust or Interserve can say for sure how many months were saved by the swift appointment compared with traditional routes. However, everyone is agreed it was significant, given that the ProCure21 central contract removed the need for the trusts to go through the time-consuming process of tendering for a partner.

Richard Kinnersley, the trust’s head of capital projects, says: “One of the benefits that ProCure21 can bring is the ability to secure a PSCP at short notice to deal with emergencies just like this.”

Interserve was appointed on a pre-start agreement, which is a bespoke contract devised by NHS Estates that dovetails into the NEC Engineering and Construction Contract. This contract is no longer applicable to ProCure21 schemes. With a pre-start agreement, the costs incurred by members of a supply chain are covered by a trust until, generally, the outline business case has been prepared. Then option C (target contract with activity schedule) of the ECC contract kicks in. Kinnersley says: “The pre-start agreement gave us [the trust] cost certainty while we identified the activities that needed to be carried out and their duration. At the time, we were trying to identify whether we needed to do more than just replace the old A&E department. It was an opportunity to see if we could enhance the facilities and level of services delivered.”

The pre-start agreement also allowed work to start on propping and making safe the building, which was in danger of partial collapse, before engineers went in to carry out a full structural survey.

One month after Interserve’s appointment, planning a replacement building started in earnest with a strategic review that included a control plan for the development. This was followed one month later, October 2002, by a value management workshop attended by members of the trust, clinicians, facilities managers and the principal players in the supply chain.

John Jones, Interserve’s Midlands operations manager, says one of the aims of the workshop was to develop a wish list of strategic needs for a replacement building. Jones explains: “Four options were explored. Replace the unit as it was before the arson attack; provide a new solution based on the same level of facilities and accommodation; enhance the facilities and services provided; or do nothing.”

Pretty quickly, the third option of enhancement was selected as the way forward and work began on preparing the outline business case (OBC) for the new emergency services centre.

To keep the momentum going while the OBC was being prepared, a further workshop was arranged – this time covering partnering. Kinnersley says: “The workshop wasn’t held to tell people what partnering is all about, but to get them to know one another and understand their needs and create a team. Also to show, we are here for the long haul.”

It took until July 2003 to finalise the OBC and gain approval from the strategic health authority to continue with preparing the full business case.

In the meantime, the pre-start agreement allowed the construction team to get on with demolition of the fire-gutted shell and carry out enabling works in advance of the main building programme.

Phil Malone, capital projects manager with the trust, says demolition wasn’t a straightforward task because the building was joined to another part of the hospital with a “live” corridor running between the two. Prior to the start of demolition, noise tests were conducted to establish the thresholds acceptable to the nearby hospital departments. In addition, concrete saws were used to cut through the floors around the perimeter of the damaged building to minimise the risk of noise and vibration being transmitted to the other departments, and a “sound wall” was erected in the corridor.

The heavily insulated sound wall helped deaden the noise of the demolition work as well as providing an effective barrier against dust. Malone adds: “Considering it is a 24/7 hospital, it was very successful operation and we had very few complaints.”

We tried to identify whether we needed to do more than just replace the old A&E. It was an opportunity to see if we could enhance the facilities

Richard Kinnersley

Another activity undertaken while the OBC was being finalised was running a risk workshop, which included a SWOT (strengths, weaknesses, opportunities, threats) analysis. “From this,” says Jones, “came a risk register that defined what are the risks, how they can be mitigated and who is responsible for managing and owning the risk.”

After acceptance of the OBC, it only took until December 2003 to prepare the full business case and a further three months to get to the GMP (guaranteed maximum price). Along the way, however, an affordability gap in funding was discovered and a series of value engineering exercises were staged to bring the project back to budget. Kinnersley says some compromises had to be reached, but not at the expense of the overall functionality of the centre. “With ProCure21, you have the ability to bridge any affordability gaps between the cost and the budget available.

You are able to establish a budget early on, so you can then achieve the functionality requirements and meet the time constraints within that financial envelope.”

The final green light for the project was acceptance of the GMP in March – a highly creditable period of little more than 18 months to gain approval for the scheme. Under a conventional construction method, this could take up to 27 months. Construction is due for completion next April, giving a total of just two years and nine months from the arson attack to Sandwell receiving a new emergency services centre.

Kinnersley says: “Within the NHS and the public sector generally, construction projects have received bad press for overrunning on time, not meeting their budgets, and not meeting the functionality that they set out to achieve. ProCure21 aims to undo all of this.”

He continues, ticking items off a mental list: “In terms of this scheme, has using ProCure21 helped the trust understand the PSCP’s business?

Then the answer is yes.

“Has it helped the PSCP understand the trust’s business? Definitely, yes.

“Has the scheme achieved cost certainty? That’s a resounding yes.

“Have we achieved the time constraints? The way things are going, the answer is yes.

“Will it meet the end-user’s criteria? Again, yes.”

“Finally, is the trust willing to pursue ProCure21 further? That’s also a yes, we are currently going through the selection process for a PSCP for a number of other suitable schemes.”