Healthy criticism

The NHS is the UK’s largest construction client, and will continue to be so for years to come. But it doesn’t present a single face to the industry. Different NHS Trusts work in very diverse ways when it comes to procurement of new buildings and refurbishment work.

Peter Woolliscroft, head of construction for NHS Estates, believes that in some cases, Trusts have demonstrated that the NHS can be a very good client: “The NHS client is becoming a very sophisticated client to the construction industry in general. Because the industry itself is becoming more sophisticated in its innovation and bringing to the client base a far better and more cost-effective way of doing what it does than it used to do. A lot of this has been driven out of Latham and Egan and initiatives such as this, some of it is due to natural evolution to be honest.”

However, even Woolliscroft would agree that this is the NHS at its best. “The NHS client rarely has the opportunity to rise to those levels of sophistication because they have got an operational job in running hospitals and managing the interface between the new work and the existing maintenance work.” This though, is where building services can move to the fore. With client attention focused on whole life running costs, building services is well placed to offer expert advice.

“Around 25% to 30% of hospitals’ revenue budget goes on maintaining the asset base,” explains Woolliscroft. “And of that probably 60% is put into building services of one sort or another. It may be higher in other cases. It seems to me that future hospitals will need to have very high quality life cycle regime to make sure they are getting value for money.”

For Woolliscroft, value for money isn’t simply achieved through specification of efficient products. Nor does it mean that each area of the building is efficient in its own right, but that the whole achieves synergy. “I’m not saying anything that others haven’t said. Why I am saying it is that we are now beginning to recognise this within the Health Service. We need the building services side of the construction industry to get off its backside and respond to that. Stop doing things traditionally; stop engaging with government clients using traditional piping or wiring methods just because somewhere along the line there is a standard that somebody pulled out of a bottom drawer which mentioned these techniques.”

Woolliscroft is passionate about engaging with new methods of construction. He understands though, that the NHS Trusts aren’t all eager to try these things out. “Challenge the traditional methods. Bring innovation to the table for the client. Challenge the client to justify the old ways of doing things. Raise the bar with the client all the time. The client will require educating; will require a high level of sophisticated security.”

New methods include modularisation, standardisation in design and greater use of IT to aid team collaboration. “I am looking for the building services industry to take that leap of faith into modularisation, into standardisation of their plant and equipment into making an industry into a profession. Consultants know that most hospitals are similar. It’s very rare to have a unique set of circumstances in a hospital environment, it doesn’t work that way. So why do they redesign things over and over again? Why do architects design toilets over and over again?”

It is vital in this vision of hospital design that all parts of the construction team have their say, including the suppliers, whom Woolliscroft views as vital to the process.

“We have to recognise that the real innovation comes from the specialist suppliers not the designers. The designers are becoming more conceptual, leaving the precise detail to those that make the products to fit the bill. If it were possible (which it isn’t, but may be one day) to standardise the range of products required in hospital buildings, manufacturers would have confidence to produce them. These products would absolutely meet the needs of the service rather than being the compromise that we often have now. That would be a real step forward.”

The partnering approach is central to Woolliscroft’s vision of how healthcare procurement should be. ProCure 21 is in place for five years, and in spite of recent rumours about the future of NHS Estates, the programme will run its course.

“We are looking for lean construction and modularised solutions which require plant and equipment to be assembled off-site defect free, fully guaranteed. We want this delivered to site with quick fix connections onto the minimum amount of infrastructure to make it up. Couple with that some easy and rapid withdrawal of that plant as and when replacement is required or increased capacity. This would involve the planners, architects and the building services consultants.” Use of IT is seen as a major part of achieving better co-operation (see box below for more on Woolliscroft’s vision)

So what are the hurdles to achieving this ideal of hospital procurement? Many of those working on these projects would say that the NHS as a client is as focused on first costs as any other, and just as likely to avoid the partnering approach.

Wooliscroft says: “The reason we can’t achieve this is because of the government’s philosophy of passing decision making to the lowest level. I don’t have a problem with that, but we need to address this. What needs to happen is that the building services industry comes to the client with an approach, rather than expecting the client to initiate this. The NHS can’t do it because we are all individual hospitals with individual needs at different times. But they aren’t unique no matter that they think they are!”

Convincing clients to take the partnering route offered by ProCure 21, as well as adopting methods such as prefabrication, requires education and a way to cut down the risks to all concerned.

Woolliscroft points to services such as Compassure which can offer insurance for the whole project. The ProCure 21 process also offers ways to identify and hence reduce the risks inherent in any construction project.

“We have spent the last 12 months developing a risk analysis tool. It takes the collaborative team formed by the client through the early stages of the project so all project risks can be seen by all parties. They collaborate in providing solutions to those risks. This is standard stuff, but often it doesn’t get done.

“Currently we have about 150 risks in our databank. These can be offered to the new client – and they can add to them if they want. It’s all web-based and the team works through the list to identify show stopper risks and sort out who can deal with them. Profiles are drawn on a spider diagram to show where tolerances lie in terms of which risks are greatest.”

But the other block to making a success of new methods is cultural. This problem lies with the client and the industry. But the client must not be allowed to resort to ‘old ways’ of thinking. Woolliscroft would also like to see an accreditation scheme for engineers working in the healthcare sector, which would give the client more confidence in taking advice.

From Peter Woolliscroft’s point of view, it’s down to the construction industry to take the lead in finding new ways of bringing more efficiency to the construction process.

“We have reached 80% success using traditional procurement. Now we are biting into the 20% improvement area. That’s when the screw starts to bite. I am determined that the supply chain will operate as it should do. If it doesn’t, it is stifling innovation.

“Lean thinking on every aspect of what we do is the key. If there was a great big chunk we could take out, someone would have seen it by now. Small cost savings may not add up to a hill of beans, but if you have a lot of hills, that adds up to a mountain.”