Crisis, Care And Collaboration

Andrew Panniker, Managing Director Royal Free London Property Services

During 2020, BDP worked closely with the NHS as it battled admirably throughout the Covid-19 pandemic. As we salute all those key workers, we talk to Andrew Panniker, managing director of Royal Free London Property Services and ask him how he thinks the pandemic will affect the future of healthcare properties and the NHS.

Hi Andrew, thanks for speaking with us. 2020 was a very testing year for all at the NHS. What has last year taught you and how do you think we can prepare healthcare estates for the future?

The Covid-19 pandemic sparked an enormous collaborative effort between built environment experts and healthcare professionals to design and adapt facilities to help care for, and cure so many people. Creating hospitals that accommodate the new operational realities of a postCovid-19 world has brought about a new era for healthcare design. In many respects, traditional tramline thinking and rule books must be thrown out of the window so we can respond to demands for new flexible and adaptable healthcare facilities that demonstrate real value, improve quality and reduce the cost of health services.

I think part of that means preparing well for the next pandemic which, we are advised, is unfortunately inevitable. We need to provide the environment and equipment to ensure that our doctors and nurses can deliver the care needed even better than they did in the last year. We also need to look out for staff wellbeing. Could we improve the patient experience and achieve better outcomes? Could we ease the pressure, make the staffing experience smoother and invest more in existing hospital infrastructure to make the NHS more resilient?

It’s fantastic that there is a new Healthcare Infrastructure Plan underway to upgrade 40+ hospitals and the design, adaptability and system transformation needs careful thought. Lots of people are talking about modern methods of construction and the ability to standardise and deliver quickly, but they also need to be flexible to respond to ever-changing clinical demands. I know BDP is doing a lot of work in this field and is in a prime position to set the standards and establish the direction for more adaptable healthcare facilities. When we think about how hospitals could be built in the future, we can build in standard design and repeatability. The framing of a building like this would allow ‘pick and mix’ clinical pod use that could be changed out, as and when clinical priorities or intensity of use changes.

Going forward we need the time to think and plan; we have to look at and test everything from clinical environments, supply chains, PPE, cleaning services, general supplies and even food provision. It’s no small task.

How do you think businesses in the built environment can work more effectively with the NHS to support it in the future?

Collaboration really was the industry buzzword in 2020 and I have worked closely with the supply chain, numerous organisations, businesses and even the military to help me to respond to the crisis. During the pandemic, it was the collaboration between individuals who had never worked together, and their ability to move at speed and adapt, that impressed me. They worked to a relentless drumbeat, translating multiple voices and opinions into new ideas.

Building a new hospital or reconfiguring an existing one is incredibly complex, which means we need to be even more conscious of making both the big and small decisions at the right time. It is essential that a collaborative approach and streamlined decision making are at the forefront of all new hospital projects. All those engaged in healthcare estate management, design and construction must find a way to embrace the real collaboration that incentivises everyone to share knowledge and innovations across multiple NHS projects. We have the opportunity to deliver the most cutting-edge healthcare facilities of the future.

By sharing design, production and build information with the whole supply chain, we can ensure hospitals are delivered on time, with the precise facilities that are required to support both patients and staff and then adapt them when the patient needs change.

Historically, build contracts are formed around conflict, risk management and negotiation. This needs to change and contract from choice needs really careful consideration. We cannot afford to work in silos or see everything as a competition. We have a duty to see public money spent wisely and make a step change in clinical productivity. Our behaviours need to change; our obstacles need to be better defined and collectively navigated without losing sight of the ambition.

When we were in the thick of the pandemic, it was wonderful to see everyone looking out for each other’s wellbeing - both on site and in the wider communities. I think that network of care will be the legacy of our work in 2020 and something we want to replicate on all future NHS projects.

How do you think healthcare facilities will change? How could the UK’s infrastructure of care be optimised for the future?

The staff of the NHS are the pride of the nation. We must invest in people and facilities, but we should start with public health initiatives to reduce the burden on our healthcare systems. We’ve got to address the challenges – obesity, diabetes, mental health and other chronic illnesses, focusing on research and working with the relevant organisations to understand these emerging and existing issues. We need to look, in depth, at how to sustain improvement in the health of the nation at the same time we look at the buildings.

During the pandemic the staffing response was fantastic. Everyone in the system coped with relentless flows of sick patients and unprecedented deaths in some ageing buildings and infrastructure. At the Royal Free London, whilst the infrastructure was good, we had to continually adapt and reinforce all the electrics, gases and the general systems to meet the massive change in intensity of use and clinical need. We now have breathing space to not only look at the NHS’s infrastructure, but wider public health in more granular detail, extending our reach across cities to make more facilities available for specialist and emergency care situations.

The NHS is still used as an exemplar for healthcare facilities across the world. How do we ensure facilities continue to be world-class?

From an estates perspective, transformation relies on inspiring people and reshaping perceptions of the NHS as an employer. If we want to attract the best talent we need to excite potential recruits. The need to design spaces for NHS staff so they feel looked after and valued has always been important but it’s now rising up the agenda further. From career development to environments conducive to relaxation, we need to create places where staff feel truly valued as this will really help the NHS move forward.

Concurrently, the NHS must build real partnerships with commercial and professional service providers. I know that BDP has experience in designing a whole range of different buildings and environments and transfers best practice from other sectors to help produce better hospitals, thus transforming the way patients receive care. We must be confident in harvesting best practice from other industries, to adapt traditional designs and standards. Royal Free London Property Services has recently employed a number of people from the aviation industry and manufacturing engineering facilities. Their knowledge and experience of designing, processing and managing high volumes of people or products through buildings or manufacturing process quickly converts really well to healthcare, and it has

NHS Nightingale Hospital, London

challenged the way we think and improved our routine service response and design solutions. Similarly, we look at how the education sector has cracked the use of standardised design for manufacture and assembly. They can deliver schools quickly and with certainty of timing and cost - and this system is very appealing.

To do this we need to engage in collaborative partnership arrangements with the design, manufacture and build supply chain to allow us to build smarter, quicker, more efficiently and in a way that really is adaptable to change. Investing in staff is also key to improving resilience, safety and quality of care. We have to rebalance the number of people coming into healthcare as data indicates there are more people leaving through the back door than coming through the front door.

Our experience in 2020 has taught us that we need to deliver innovative change - at speed - not only for the new hospital programme but also within the existing estates. As we emerge from the Covid-19 crisis, the reputation of the NHS remains strong, but investment, innovation and trust is what will guarantee the future of this amazing institution and make sure that it is always there in the right form, whenever it is needed.

[Left] Watford General Hospital – new healthy living community.

[Right] Watford General Hospital – concept ideagram